慢性低氧性肺动脉高压大鼠肾上腺髓质素前体N端20肽的变化

目的：探讨慢性低氧性肺动脉高压和肺血管结构重建时肾上腺髓质素前体N端20肽（PAMP）的变化。方法:将18只雄性Wistar大鼠随机分为对照组和低氧组，每组各9只。常压低氧2周后，以右心导管法测定肺动脉平均压（mPAP），检测右心室与左心室加室间隔比值 ［RV/(LV+S)］，观测肺血管显微和超微结构的变化。并且以放免法测定血浆中PAMP含量，以免疫组化法检测肺组织中PAMP表达，以原位杂交检测肺组织中肾上腺髓质素（ADM） mRNA的表达。结果: 低氧组大鼠mPAP及RV/（LV+S）均明显高于对照组（均P<0.01）。光镜下，肺小血管肌化程度明显增强，肺中、小型肌型动脉相对中膜厚度明显增加。电镜下，肺腺泡内动脉内皮细胞增生、肿胀，内弹力层粗细不均，平滑肌细胞肥厚、向合成表型转化。并且低氧组大鼠血浆PAMP含量明显高于对照组（P<0.01），肺动脉PAMP表达和ADM mRNA表达均明显增强。结论：低氧后肺动脉PAMP表达和血浆PAMP含量的上调可能参与了慢性低氧性肺动脉高压和肺血管结构重建的形成。     

Clinical perspective of hypoxia-mediated pulmonary hypertension

Pulmonary hypertension is a condition associated with a variety of pulmonary disorders whose common denominator is alveolar hypoxia. Such disorders include chronic obstructive pulmonary disease, pulmonary fibrosis, sleep-disordered breathing, and exposure to high altitude. Acute hypoxia is characterized by vasoconstriction of small pulmonary arteries, a phenomenon called hypoxic pulmonary vasoconstriction. With prolonged hypoxia, thickening of the smooth vascular layer of the small pulmonary arteries occurs, a phenomenon described as pulmonary vascular remodeling. Although the core mechanisms of both vasoconstriction and remodeling are thought to reside in the smooth muscle cell layer, the endothelium modulates these two processes. The purpose of this review is briefly to (a) discuss the mechanisms of hypoxic pulmonary hypertension as it pertains to certain disease states, and (b) examine the pathways that have potential therapeutic applications for this condition.     

低氧致鼠腺泡内肺动脉PDGF—B链蛋白表达的变化

目的：探讨血小板源性生长因子（ＰＤＧＦ）在低氧肺动脉高压血管构形重建发生中的作用。方法：应用免疫组化技术结合计算机图像分析，检测了低氧大鼠腺泡内肺动脉（ＩＡＰＡ）ＰＤＧＦ－Ｂ链蛋白表达水平。结果：常氧时，ＩＡＰＡ仅有ＰＤＧＦ－Ｂ链蛋白弱表达；低氧１天时，ＩＡＰＡ便有较强的ＰＤＧＦ－Ｂ链蛋白表达，定位于ＩＡＰＡ的内皮和中膜，低氧３天至１４天仅分布于中膜；低氧１、３、５、７、１４天各时间点ＰＤＧＦ－Ｂ链蛋白表达分别为常氧组的１．５３、１．５９、１．５６、１．６２和１．４２倍，差异有显著性（Ｐ＜０．０１）。结论：ＰＤＧＦ－Ｂ链蛋白可能参与了低氧肺动脉高压血管构形重建的发病过程     

低氧大鼠肾上腺髓质素对其前体N端20肽和肺血管结构重构的影响

目的探讨肾上腺髓质素(ADM)对低氧性肺动脉高压大鼠肺血管结构重构和肾上腺髓质素前体N端20肽(PAMP)的影响。方法24只雄性Wistar大鼠随机分为对照组、低氧组、低氧 ADM组,每组各8只。低氧 ADM组大鼠,通过微量渗透泵皮下持续给予ADM(300 ng/h)。用放免法测定血浆中PAMP含量,用免疫组化法检测肺组织中PAMP表达。结果低氧2周后,大鼠肺动脉平均压、右心室与左心室加室间隔的比值、肺动脉相对中膜厚度和面积较对照组均明显增高(P<0.01),超微结构也发生了明显改变。并且低氧组大鼠血浆PAMP含量明显升高,肺动脉PAMP表达明显增强。而ADM可显著缓解上述变化。结论ADM分子内调控参与了ADM对于低氧性肺动脉高压的干预机制。     

白藜芦醇苷对低氧大鼠肺血管构型重建的影响

目的:观察白藜芦醇苷对慢性常压低氧性肺动脉高压(HPH)大鼠肺血管构型重建的影响并探讨可能的机理。方法:29只健康SD大鼠随机分为正常对照组、单纯低氧组和低氧加白藜芦醇苷(PD)组。各组内按照肺小血管外径分为I组(30μm-100μm)和II组(101μm-200μm)。右心导管法检测大鼠肺动脉压力(mPAP)、微量滴定法检测血浆和肺匀浆中磷脂酶A₂(PLA₂)活性、光镜下观察肺小血管中膜厚度(MT%)和中膜面积(MA%)的变化。结果:低氧3周后大鼠mPAP、血浆及肺匀浆中PLA₂活性、肺小血管MA%、I组MT%显著高于对照组,II组MT%无显著性改变。低氧加PD预处理后上述改变明显轻于单纯低氧组。结论:PD可有效防治慢性常压低氧性大鼠肺动脉压力的升高,其机理与抑制大鼠肺血管构型重建有关。     

Acute and chronic hypoxia as well as 7-day recovery from chronic hypoxia affects the distribution of pulmonary mast cells and their MMP-13 expression in rats

Chronic hypoxia results in pulmonary hypertension due to vasoconstriction and structural remodelling of peripheral lung blood vessels. We hypothesize that vascular remodelling is initiated in the walls of prealveolar pulmonary arteries by collagenolytic metalloproteinases (MMP) released from activated mast cells. Distribution of mast cells and their expression of interstitial collagenase, MMP-13, in lung conduit, small muscular, and prealveolar arteries was determined quantitatively in rats exposed for 4 and 20 days to hypoxia as well as after 7-day recovery from 20-day hypoxia (10% O2). Mast cells were identified using Toluidine Blue staining, and MMP-13 expression was detected using monoclonal antibody. After 4, but not after 20 days of hypoxia, a significant increase in the number of mast cells and their MMP-13 expression was found within walls of prealveolar arteries. In rats exposed for 20 days, MMP-13 positive mast cells accumulated within the walls of conduit arteries and subpleurally. In recovered rats, MMP-13 positive mast cells gathered at the prealveolar arterial level as well as in the walls of small muscular arteries; these mast cells stayed also in the conduit part of the pulmonary vasculature. These data support the hypothesis that perivascular pulmonary mast cells contribute to the vascular remodelling in hypoxic pulmonary hypertension in rats by releasing interstitial collagenase.     

Localization and distribution of endothelin receptor subtypes in pulmonary vasculature of normal and hypoxia-exposed rats

To clarify the roles of two different endothelin (ET) receptors in the pulmonary vasculature, the localization and distribution of endothelin-A (ETA) and ETB receptors were investigated in rat lung under normal and hypoxic conditions by an immunohistochemical method. We also carried out in situ hybridization for ETB receptor. In normal rats, ETA receptor is localized in the media of the pulmonary artery and vein with predominant distribution in such proximal segments as elastic arteries and large muscular arteries. ETB receptor is expressed in the intima and media of pulmonary vessels. The distribution of ETB receptor in the media predominates in the distal segments of the pulmonary artery, whereas its distribution in the intima is greater in the proximal segments. Immunoreactivity for ETA receptor increases in the media of the distal segments of the pulmonary artery after exposure to hypobaric hypoxia. Semiquantitative evaluation showed immunoreactivity for ETA receptor in the pulmonary arteries accompanying the terminal bronchioles, respiratory bronchioles, and alveolar ducts to be increased by 2.5-, 5-, and 20-fold after 14 d exposure to hypoxia, respectively. The messenger RNA and immunoreactivity for ETB receptor increased significantly in the intima of the distal segments of pulmonary artery after 7 and 14 d exposure to hypoxia. These results suggest that the vasoconstrictive effects of ET-1 are exerted mainly through ETA receptor in the proximal segments of the pulmonary artery and vein, whereas its effects in the distal segments are mediated by ETA and ETB receptors in normal rats. ETA receptors that increase in resistance arteries after exposure to hypoxia appear to play an important role in the vascular remodeling associated with hypoxic pulmonary hypertension. Because ETB receptors in the endothelium mediate ET-1-induced vasodilatory effects, the increase in endothelial ETB receptors may counteract the development of hypoxic pulmonary hypertension.     

缺氧大鼠肺内动脉壁FN及LN的改变

目的　利用大鼠常压缺氧模型 ,采用形态计量学方法 ,系统观察缺氧大鼠肺动脉壁FN及LN的改变 ,进一步探讨缺氧性肺血管组织重建的机制。　方法　利用常压缺氧舱建立大鼠缺氧模型 ,取肺分别进行免疫组织化学染色和电镜观察。　结果　缺氧后肺动脉壁上FN及LN均增加 ,这一变化在缺氧 7d时最明显 ,且FN增加的程度及含量远远高于LN。电镜观察显示 ,肺动脉中膜平滑肌细胞有由收缩表型转化为合成表型的倾向。　结论　肺动脉壁上FN及LN增加 ,不仅可以增加血管紧张性及血管壁厚度 ,同时也为诱导中膜平滑肌细胞表型转换及增生提供了条件     

Iptakalim, a novel ATP-sensitive potassium channel opener, inhibits pulmonary arterial smooth muscle cell proliferation by downregulation of PKC-α

Iptakalim is a new ATP-sensitive potassium (K ATP ) channel opener, and it inhibits the proliferation of pulmonary arterial smooth muscle cells (PASMCs) and pulmonary vascular remodeling. However, the underlying mechanism remains unclear. In the present study, we found that iptakalim significantly decreased pulmonary artery pressure, inhibited pulmonary ariery remodeling and PKC-α overexpression in chronic hypoxia in a rat pulmonary hypertension model. Iptakalim reduced hypoxia-induced expression of PKC-α, and abolished the effect of hypoxia on PASMC proliferation significantly in a dose-dependent manner in vitro. Moreover, these effects were abolished by glibenclamide, a selective K ATP channel antagonist. These results indicate that iptakalim inhibits PASMC proliferation and pulmonary vascular remodeling induced by hypoxia through downregulating the expression of PKC-α. Iptakalim can serve as a novel promising treatment for hypoxic pulmonary hypertension.     

缺氧性肺动脉高压大鼠右心室重构

摘要目的：研究缺氧性肺动脉高压大鼠右心室重构情况。方法：常压间断缺氧法复制缺氧性肺动脉高压大鼠模型，采用右心导管法测定平均肺动脉压力，通过测量右心室流入及流出道长度、左心室壁和右心室壁厚度、右心室和左心室 室间隔重量对其右心室重构情况进行定性研究。结果：缺氧14d后大鼠平均肺动脉压力显著升高，右心室流出道长度及右心室肥大指数显著增加，缺氧21d后右心室游离壁重量显著增加；右心室流人道长度及左、右心室壁厚度与对照组无统计学差异。结论：缺氧性肺动脉高压大鼠右心室早期表现为离心性肥大。     

The dynamic placenta: I. Hypothetical model of a placental mechanism matching local fetal blood flow to local intervillus oxygen delivery

The placenta can be severely infarcted and yet return well oxygenated blood in spite of the potential shunt paths produced. Optimisation of oxygen transport by some form of local flow matching has been suggested, either via a direct action of hypoxia on subchorial vessels, or indirectly by syncytiotrophoblastic metabolic products. Using casts of cotyledonal vessels and software modelling, a mechanism of hypoxic fetoplacental vasoconstriction could be demonstrated. A simple previously described passive placental model was extended to include hypoxic sensitive arteries and dependence of syncytio-trophoblastic metabolism on intervillus (maternal) blood oxygen content. Such a mechanism of placental flow matching could maintain fetal pO2 by reducing flow through inadequately oxygenated cotyledons, therefore optimising pO2 at the expense of flow. A further modification stabilising fetal water transfer was required to avoid changes in intervillus oxygen delivery producing changes in fetal water content via placental capillary pressure alterations. Intervillus/villus flow matching is likely in the human placenta and this study suggests probable biologically plausible mechanisms for such a phenomenon.     

Ca2+ and ion channels in hypoxia-mediated pulmonary hypertension

Alveolar hypoxia, a consequence of many lung diseases, can have adverse effects on the pulmonary vasculature. The changes that occur in the pulmonary circulation with exposure to chronic hypoxia include reductions in the diameter of the pulmonary arteries due to structural remodeling of the vasculature. Although the structural and functional changes that occur in the development of pulmonary hypertension have been well investigated, less is known about the cellular and molecular mechanisms of this process. This review will discuss the role of several potassium and calcium channels in hypoxic pulmonary vasoconstriction, both in elevating calcium influx into pulmonary artery smooth muscle cells (PASMCs). In addition to other signal transduction pathways, Ca²⁺ signaling in PASMCs plays an important role in the development and progression of pulmonary hypertension due to its central roles in vasoconstriction and vascular remodeling. This review will focus on the effect of chronic hypoxia on ion channels and the potential pathogenic role of Ca²⁺ signaling and regulation in the progression of pulmonary hypertension.     

Hypoxia activates jun-N-terminal kinase, extracellular signal-regulated protein kinase, and p38 kinase in pulmonary arteries

Chronic alveolar hypoxia is the major cause of pulmonary hypertension. The cellular mechanisms involved in hypoxia- induced pulmonary arterial remodeling are still poorly understood. Mitogen-activated protein kinase (MAPK) is a key enzyme in the signaling pathway leading to cellular growth and proliferation. The purpose of this investigation was to determine the roles that MAPKs, specifically Jun-N-terminal kinase (JNK), extracellular signal-regulated protein kinase (ERK), and p38 kinase, play in the hypoxia-induced pulmonary arterial remodeling. Rats were exposed to normobaric hypoxia (10% O(2)) for 1, 3, 7, or 14 d. Hypoxia caused significant remodeling in the pulmonary artery characterized by thickening of pulmonary arterial wall and increases in tissue mass and total RNA. JNK, ERK, and p38 kinase tyrosine phosphorylations and their activities were significantly increased by hypoxia. JNK activation peaked at Day 1 and ERK/p38 kinase activation peaked after 7 d of hypoxia. The results from immunohistochemistry show that hypoxia increased phospho-MAPK staining in both large and small intrapulmonary arteries. Hypoxia also upregulated vascular endothelial growth factor messenger RNA (mRNA) and platelet-derived growth factor receptor mRNA levels in pulmonary artery with a time course correlated to the activation of ERK and p38 kinase. The gene expressions of c-jun, c-fos, and egr-1, known as downstream effectors of MAPK, were also investigated. Hypoxia upregulated egr-1 mRNA but downregulated c-jun and c-fos mRNAs. These data suggest that hypoxia-induced activation of JNK is an early response to hypoxic stress and that activation of ERK and p38 kinase appears to be associated with hypoxia-induced pulmonary arterial remodeling.     

Gax在肺动脉高压大鼠肺动脉中的表达变化

目的:使用低氧及野百合碱(monocrotaline,MCT)诱导的两种肺动脉高压(pulmonary arterialhypertension,PAH)大鼠模型,观察生长终止特异性同源盒(growth arrest-specific homeobox,Gax)在肺动脉的表达变化。方法:Sprague Dawley大鼠随机分为四组:低氧模型组(n=16)、低氧对照组(n=16)、MCT模型组(n=16)及MCT对照组(n=16)。采用插管法测定大鼠的右心室压力及肺动脉压力。右心室质量除以左心室和室间隔质量,计算右心肥厚指数。采用定量RT-PCR法测定肺动脉主干及肺组织Gax mRNA表达;采用Western免疫印迹法测定肺动脉主干Gax蛋白表达;免疫组织化学染色观测Gax在肺内的分布及表达变化。结果:低氧模型组及MCT模型组大鼠的右心压力、肺动脉压力及右心肥厚指数均显著高于相应对照组(P<0.01),两种模型大鼠的肺动脉血管均出现明显重构。与对照组比较,Gax mRNA在两种模型组大鼠的肺组织表达降低(P<0.05),而在肺动脉主干表达升高(P<0.05)。Gax蛋白在肺内主要表达在微小动脉。与对照组比较,两种模型组大鼠的肺动脉主干和肺微小动脉Gax蛋白表达均升高(P<0.05),而肺组织Gax蛋白表达下降(P<0.05)。结论:Gax主要表达在肺微小动脉,在PAH发生时表达上调。     

缺氧诱导大鼠肺动脉PDGF和c－myc基因表达增强

为了研究生长因子和原癌基因在缺氧所致肺血管结构重建中的作用，我们选用Ｗｉｓｔａｒ大鼠，置于低压仓内模拟海拔５０００米高度持续缺氧７天和１４天。与平原对照组相比，缺氧７天时肺动脉血小板源生长因子Ａ链（ＰＤＧＦ－Ａ）基因表达水平略有升高，而后有下降趋势；缺氧１４天时ＰＤＧＦ－Ｂ链３．５ｋｂｍＲＮＡ表达显著升高。点杂交结果显示：ｃ－ｍｙｃ原癌基因正常时表达水平很低。Ｎｏｒｔｈｅｒｎｂｌｏｔ可见缺氧７天时有２．２ｋｂｍＲＮＡ转录，缺氧１４天时其含量进一步增加为正常的６倍。结果表明，缺氧过程中，ＰＤＧＦ－Ａ链和Ｂ链是顺序表达的，其表达水平与缺氧性肺血管结构重组过程有一定相关。ＰＤＧＦ的促增殖作用是通过ｃ－ｍｙｃ基因产物实现的。     

Hypoxic induction of cox-2 regulates proliferation of human pulmonary artery smooth muscle cells

Chronic hypoxia-induced pulmonary hypertension results partly from proliferation of smooth muscle cells in small peripheral pulmonary arteries. Therefore, we examined the effect of hypoxia on growth of pulmonary artery smooth muscle cells (PASMCs) from human distal pulmonary arteries. Initial studies identified that serum-induced proliferation of explant-derived PASMCs was inhibited under hypoxic conditions (3-4 kPa in medium). However, selection of hypoxia-stimulated cells was achieved by culturing cells at low density under conditions of prolonged hypoxia (1-2 wk). In hypoxia-inhibited and -stimulated cells, Western blotting revealed hypoxic induction of cyclooxygenase (COX)-2, which was dependent on the activation of p38(MAPK), but not COX-1, inducible nitric oxide synthase (iNOS), or hemoxygenase-1 (HO-1). Hypoxic induction of COX-2 was also observed in the media of pulmonary arteries in lung organ culture. Hypoxia induced a 4- to 5-fold increase (P < 0.001) in prostaglandin (PG)E(2), PGD(2), PGF(2alpha), and 6-keto-PGF(1alpha) release from PASMCs. Hypoxic inhibition of proliferation was attenuated by incubation with indomethacin (10 micro M), or the COX-2 antagonist, NS398 (10 micro M), but not by the COX-1 antagonist, valeryl salicylate (0.5 mM). In conclusion, we have isolated cells from human peripheral pulmonary arteries that are either inhibited or stimulated by culture under hypoxic conditions. In both cell types hypoxia modulates cell proliferation by induction of COX-2 and production of antiproliferative prostaglandins. Induction of COX-2 may contribute to the inhibition of hypoxia-induced pulmonary vascular remodeling.     

肺血管顺应性的变化和结构重组在肺动脉高压形成中的作用

本实验观察了慢性低压缺氧不同时间对大鼠肺血管顺应性和结构的影响,结果表明缺氧4天肺血管顺应性下降,伴有肺泡区非肌性小血管肌化增加;缺氧15天顺应性继续下降,肌化小血管数进一步增加,同时平滑肌中层增厚;缺氧40天顺应性、肌化小血管数和平滑肌厚度不再继续改变。提示缺氧性肺动脉高压的发展和维持与肺血管顺应性及结构的重组有关。     

The pathophysiological basis of chronic hypoxic pulmonary hypertension in the mouse: vasoconstrictor and structural mechanisms contribute equally

Chronic hypoxic pulmonary hypertension is characterized by a sustained increase in pulmonary arterial pressure due to abnormally elevated pulmonary vascular resistance. This increased vascular resistance was previously thought to be due largely to changes in the structure of the pulmonary vasculature, i.e. lumen narrowing due to wall hypertrophy and loss of vessels. Recently, this model has been challenged by the demonstration that hypoxic pulmonary hypertension in the rat is caused almost completely by sustained vasoconstriction. The contribution of this vasocontriction to hypoxic pulmonary hypertension has not been examined directly in other species. We exposed groups of mice to hypoxia (10% O(2)) or normoxia for 3 weeks, following which the lungs were removed post mortem, and vascular resistance was measured in an isolated, ventilated, perfused preparation. Mean pulmonary vascular resistance was significantly increased in hypoxic compared with control normoxic lungs. The rho kinase inhibitor Y27635 (10(-4)m) (Tocris Bioscience, Bristol, United Kingdom.) significantly reduced the mean (± SEM) hypoxia induced increase by 45.4 (10.8)%, implying that structural vascular changes acounted for the remainder of the hypoxic increase. Stereological quantification showed a significant reduction in the mean lumen diameter of the fully relaxed vessels in hypoxic lungs compared with normoxic control lungs; there was no intra-acinar vessel loss. Thus, in contrast to the rat, hypoxic pulmonary hypertension in the mouse is due to two mechanisms contributing equally: sustained vasoconstriction and structural lumen narrowing of intra-acinar vessels. These important species diferences must be considered when using genetically mutated mice to investigate the mechanisms underlying pulmonary hypertension.     

西拉普利对低氧大鼠肺动脉和心肌细胞增殖的抑制作用

目的：探索cilazapril 对低氧大鼠肺血管和心肌细胞增殖的抑制机理。 方法： 采用生化、放射免疫、免疫组织化学、细胞凋亡标记和血流动力学技术研究低氧肺血管及心肌细胞增殖和结构重建。 结果： （1）低氧大鼠mPAP显著增高，伴有肺动脉血管管腔狭窄、管壁增厚，心肌肥大，R/L+S增高。（2）B组、C组大鼠肺动脉和右心肌细胞增殖指数（PI）均分别明显高于A组，而C组明显低于B组。ET-1免疫组化染色阳性细胞主要分布在肺动脉血管壁和心肌细胞上，染色程度由强到弱依次为B组>C组>A组。（3）B组大鼠ET-1水平和ACE活性明显高于A组，而C组显著低于B组。（4）直线相关分析显示ET-1、ACE分别与R/(L+S)、mPAP、肺动脉PI、心肌PI呈正相关；多元回归分析显示ET-1和ACE可能是影响PI的主要因素。 结论： 低氧大鼠存在细胞过度增殖状态，继发肺血管、右心结构重建是低氧性肺动脉高压发病机理之一。Cilazapril通过抑制ACE和ET-1的促增殖作用，阻止肺血管及心肌重建，对低氧性肺动脉高压的防治有一定作用。