VIP and endothelin receptor antagonist: An effective combination against experimental pulmonary arterial hypertension

Background

Pulmonary Arterial Hypertension (PAH) remains a therapeutic challenge, and the search continues for more effective drugs and drug combinations. We recently reported that deletion of the vasoactive intestinal peptide (VIP) gene caused the spontaneous expression of a PH phenotype that was fully corrected by VIP. The objectives of this investigation were to answer the questions: 1) Can VIP protect against PH in other experimental models? and 2) Does combining VIP with an endothelin (ET) receptor antagonist bosentan enhance its efficacy?

Methods

Within 3 weeks of a single injection of monocrotaline (MCT, s.c.) in Sprague Dawley rats, PAH developed, manifested by pulmonary vascular remodeling, lung inflammation, RV hypertrophy, and death within the next 2 weeks. MCT-injected animals were either untreated, treated with bosentan (p.o.) alone, with VIP (i.p.) alone, or with both together. We selected this particular combination upon finding that VIP down-regulates endothelin receptor expression which is further suppressed by bosentan. Therapeutic outcomes were compared as to hemodynamics, pulmonary vascular pathology, and survival.

Results

Treatment with VIP, every other day for 3 weeks, begun on the same day as MCT, almost totally prevented PAH pathology, and eliminated mortality for 45 days. Begun 3 weeks after MCT, however, VIP only partially reversed PAH pathology, though more effectively than bosentan. Combined therapy with both drugs fully reversed the pathology, while preventing mortality for at least 45 days.

Conclusions

1) VIP completely prevented and significantly reversed MCT-induced PAH; 2) VIP was more effective than bosentan, probably because it targets a wider range of pro-remodeling pathways; and 3) combination therapy with VIP plus bosentan was more effective than either drug alone, probably because both drugs synergistically suppressed ET-ET receptor pathway.     

不同数目骨髓间充质干细胞移植对大鼠肺损伤的抑制作用

目的研究不同数目的骨髓间充质干细胞（mesenchymal stem cells,MSCs）静脉移植对野百合碱（monocrotaline,MCT）诱导大鼠肺损伤的抑制作用。方法全骨髓贴壁法培养Wistar大鼠MSCs,取第3～5代细胞进行移植。健康雄性Wistar大鼠20只由颈外静脉移植MSCs,按移植细胞个数分为5×105组、1×106组、5×106组和对照（生理盐水）组（n=5）,测定移植前、移植后5 min,30 min及24 h的RVSP。另40只随机分组（n=10）：①MCT/MSCs 5×105组;②MCT/MSCs 1×106组;③MCT组;④对照组,腹腔注射60 mg/kgM CT（对照组注射等量生理盐水）,同时分别移植MSCs 5×105个、1×106个或等量PBS液体。4周后检测大鼠右心室收缩压（right ventricularsystolic pressure,RVSP）、RV/（LV＋S）重量比值;肺组织苏木素-伊红染色、地衣红染色和平滑肌Actin免疫组织化学染色。统计数据采用SPSS 11.0软件,对各组数据进行单因素方差分析检验。结果少于1×106个MSCs颈外静脉移植是安全的。MSCs颈外静脉移植4周后,MCT/MSCs 1×106组RVSP（35.6±8.4）mmHg与MCT组（47.2±10.5）mmHg相比明显下降（P〈0.05）,心室比0.3572±0.0923明显低于MCT组0.4454±0.0935（P〈0.05）,而MCT/MSCs 5×105组RVSP为（42.5±11.3）mmHg,心室比0.4003±0.0725,与MCT组相比无明显下降（两者P〉0.05）;病理染色可见肺组织肺小动脉中,MCT/MSCs 1×106组中膜厚度分布为（19.2±3.8）%,较MCT组（26.4±4.9）%明显变薄（P〈0.05）;而MCT/MSCs 5×105组（23.3±3.6）%较MCT组相比无显著差异（P〉0.05）。结论 MSCs颈外静脉移植对MCT诱导的肺损伤具有抑制作用,1×106个细胞较5×105个细胞移植抑制作用显著。     

Discriminating pulmonary hypertension caused by monocrotaline toxicity from chronic hypoxia by near-infrared spectroscopy and multivariate methods of analysis

A new method has been developed for the determination of tissue pathology caused by chronic hypoxia and monocrotaline toxicity. The method is based on the use of near-infrared (NIR) spectrophotometry to measure spectra of lung tissue from normal chronic hypoxia (CH) and monocrotaline (MCT) models of pulmonary hypertension (PH), followed by analysis using multivariate methods, that is, principal component analysis (PCA) and partial least squares (PLS). Synergistic use of NIR with the PCA/PLS method makes it possible, for the first time, not only to divide different lung tissue samples into their respective groups (normal, CH, and MCT) but also to gain insight into mechanisms of PH caused by CH and MCT toxicity. Specifically, MCT metabolites and other hypertensive conditions are known to produce subtle and minor chemical changes in the compositions of tissue (e.g., proteins, carbohydrates, lipids). Although these changes were detected by the NIR technique, they were too small to be discerned through visual inspection of the spectra. However, they can be accurately classified and properly assigned by the PCA/PLS method. The fact that different tissue types can be accurately divided into their corresponding groups by the NIR and PCA/PLS methods suggests that chemical alterations and mechanisms of pulmonary vascular remodeling and PH induced by MCT are different from those induced by CH.     

Comparison of lung proteome profiles in two rodent models of pulmonary arterial hypertension

We studied the lung proteome changes in two widely used models of pulmonary arterial hypertension (PAH): monocrotaline (MCT) injection and chronic hypoxia (CH); untreated rats were used as controls (n = 6/group). After 28 days, invasive right ventricular systolic pressure (RVSP) was measured. Lungs were immunostained for alpha-smooth muscle actin (alphaSMA). 2-DE (n = 4/group) followed by nano-LC-MS/MS was applied for protein identification. Western blotting was used additionally if possible. RVSP was significantly increased in MCT- and CH-rats (MCT 62.5 +/- 4.4 mmHg, CH 62.2 +/- 4.1 mmHg, control 25.0 +/- 1.7 mmHg, p<0.001). This was associated with an increase of alphaSMA positive vessels. In both groups, there was a significantly increased expression of proteins associated with the contractile apparatus (diphosphoHsp27 (p<0.001), Septin2 (p<0.001), F-actin capping protein (p<0.01), and tropomyosin beta (p<0.02)). In CH, proteins of the nitric oxide (Hsc70; p = 0.002), carbon monoxide (biliverdin reductase; p = 0.005), and vascular endothelial growth factor (VEGF) pathway (annexin 3; p<0.001) were significantly increased. In MCT, proteins involved in serotonin synthesis (14-3-3; p = 0.02), the enhanced unfolded protein response (ERp57; p = 0.02), and intracellular chloride channels (CLIC 1; p = 0.002) were significantly elevated. Therefore, MCT- and CH-induced vasoconstriction and remodeling seemed to be mediated via different signaling pathways. These differences should be considered in future studies using either PAH model.     

不同剂量野百合碱诱导大鼠肺动脉高压模型的实验研究

目的:肺动脉高压患者的预后非常差并且目前对肺动脉高压的治疗缺乏有效的方法.因此,对肺动脉高压的研究十分迫切,而建立稳定、操作简便、稳定的肺动脉高压模型是研究肺动脉高压的基础.本实验的目的就是采用不同剂量野百合碱(monocrotaline,MCT)诱导建立SD大鼠肺动脉高压模型,探讨肺动脉高压模型的制作方法及其稳定性.方法:清洁级SD雄性大鼠75只,随机分为C组、M1、M2、M3和M4组,每组各15只.其中M1～M4组大鼠分别一次性腹腔注射MCT 30、40、50和60 mg/kg,诱导制作肺动脉高压动物模型;C组为对照组,给予相同剂量溶剂腹腔注射.腹腔注射4周后比较各组大鼠的生存率、检测平均肺动脉压力(mPAP),肺动脉收缩压(PASP),右心肥大指数(RVHI),并取肺组织行苏木素-伊红染色,观察肺的病理改变,采用肺小动脉形态计量学指标综合判断肺动脉高压模型的稳定性.结果:C组无死亡,M1～M4组大鼠的生存率分别为87％,87％,67％,40％.M1～M4各组SD大鼠平均肺动脉压、肺动脉收缩压、右心肥大指数依次增大(P＜0.05),肺小动脉形态计量学指标检测显示肺血管中膜厚度百分比依次增大(P＜0.05),而M3与M4组各测量结果无明显差异.结论:腹腔注射50 mg/kg、60 mg/kg剂量野百合碱均可引起大鼠肺动脉压力升高和肺血管重构,均可诱导稳定的肺动脉高压模型,而50 mg/kg剂量有更高的生存率.所以50mg/kg剂量野百合碱腹腔注射是成功诱导大鼠肺动脉高压模型的合适剂量.     

肺动脉高压动物模型的相关研究进展

肺动脉高压动物模型旨在模拟人类疾病特征,是研究者探索该疾病相关病理生理学机制及其治疗措施的重要工具。经典的肺动脉高压动物模型包括药物型、低氧型、手术型等,进来也出现一些新的模型,但这些动物模型都存在着不同的缺陷,不能很好地全面模拟人体肺动脉高压的特征。本文归纳总结了经典的造模方法和近年来出现的新方法,并且分析了各种模型的优势及其局限性,力求为今后实验动物模型的建立提供合适的方向,使其能更好地符合人类疾病特征。     

Pyrrolizidine alkaloid profiles in Crotalaria species from Brazil: Chemotaxonomic significance

Gas chromatography–mass spectrometry analysis of seeds from 28 species of Crotalaria from Brazil (sections Calycinae, Crotalaria, Chrysocalycinae and Hedriocarpae) showed that pyrrolizidine alkaloids (PAs) are important as chemotaxonomic markers at the infrageneric level. The sections Calycinae and Crotalaria were characterized by 11-membered macrocyclic monocrotaline-type PAs. In the section Chrysocalycinae, a single species in the subsection Incanae, C. incana, showed integerrimine, a 12-membered macrocyclic senecionine-type, as main PA. The group close to the subsection Stipulosae (C. micans and C. maypurensis) showed distinctive PA patterns: C. micans presented mainly the 12-membered macrocyclic integerrimine, and C. maypurensis the unusual 7-hydroxy-1-methylene-8-pyrrolizidine. In the group close to the subsection Glaucae, the PAs with otonecine as the necine base were the main alkaloids, except in C. rufipila which showed an assamicadine-like PA (monocrotaline-type). The section Hedriocarpae showed main 12-membered macrocyclic senecionine-type PAs.     

Involvement of cytochrome P450 3A in the metabolism and covalent binding of 14C-monocrotaline in rat liver microsomes

The metabolism and covalent binding of ¹⁴C-monocrotaline in Sprague–Dawley (SD) rat liver microsomes was investigated using the inducers dexamethasone, clotrimazole, pregnenolone-16α-carbonitrile, and phenobarbital. Monocrotaline is a pyrrolizidine alkaloid (PA) that causes a syndrome in rats that is a model for human primary pulmonary hypertension. It has been documented that bioactivation of PAs (dehydrogenation to reactive pyrroles) in the liver by cytochromes P450 is required for their toxicity. Covalent binding of these reactive pyrroles to tissue macromolecules has been hypothesized to correspond to PA toxicosis. We correlated metabolism and total microsomal covalent binding of ¹⁴C-monocrotaline with cytochrome P450 3A using the aforementioned inducers, troleandomycin (a cytochrome P450 3A inhibitor), erythromycin N-demethylase assay of cytochrome P450 3A activity, and Western blots employing anti-rat cytochrome P450 3A antibodies. In addition, autoradiography of membranes electroblotted from SDS-PAGE demonstrated the formation of radiolabeled adducts with specific protein(s). The most intensely radiolabeled protein bands have an apparent molecular weight of ∼52 kDa, which was similar to the molecular weight detected by anti-rat cytochrome P450 3A antibodies in the Western blots. No radiolabeled proteins were detected in microsomes pretreated with troleandomycin. © 1998 John Wiley & Sons, Inc. J Biochem Toxicol 12: 157–166, 1998     

脂肪干细胞移植对野百合碱诱发的肺动脉高压大鼠肺动脉压的量效和时效作用

目的探索脂肪干细胞（ADSC）移植治疗野百合碱（MCT）诱导的肺动脉高压（PAH）大鼠的适宜细胞数和干预时间。 方法（1）MCT的建模时效和量效：雄性SD大鼠48只分为正常对照组,20 mg/kg、30 mg/kg、40 mg/kg MCT组分别予腹腔注射生理盐水、MCT 20 mg/kg、30 mg/kg、40 mg/kg,4和8周后,右心室插管法检测平均肺动脉压（mPAP）,称重法计算右心室肥厚指数（RVHI）。（2）ADSC的治疗量效作用：雄性SD大鼠分别予腹腔注射MCT（30只）和生理盐水（30只）,1周后通过颈静脉注射分别移植0.5×10⁶、1.0×10⁶、3.0×10⁶、5.0×10⁶ADSC,其他组予等量生理盐水。移植3周后检测mPAP和RVHI。（3）ADSC的治疗时效作用：雄性SD大鼠30只,分别注射40 mg/kg MCT（24只）和生理盐水（6只）。MCT腹腔注射1 d,1、2周后分别移植1.0×10⁶个ADSC。MCT注射4周后检测mPAP和RVHI。多组间比较采用单因素或双因素方差分析,两两比较采用LSD检验。 结果（1）腹腔注射4周后,30 mg/ kg或40 mg/kg MCT组mPAP和RVHI均升高[mPAP值（24.89±3.31）mmHg,（27.19±2.11）mmHg比（15.80±0.42）mmHg,差异有统计学意义（P均< 0.05）;RVHI值0.42±0.06,0.47±0.04比0.25±0.02,差异有统计学意义（P均< 0.05）]。8周后,20 mg/kg或30 mg/ kg MCT组mPAP和RVHI均恢复正常,而40 mg/kg MCT组大鼠全部死亡。（2）40 mg/ kg MCT诱导的PAH大鼠mPAP和RVHI均升高。移植1.0×10⁶个ADSC可降低PAH大鼠的mPAP[（17.24±0.66）mmHg比（27.19±1.73）mmHg,P < 0.05]。移植0.5×10⁶、3.0×10⁶、5.0× 10⁶个ADSC不能降低PAH大鼠的mPAP和RVHI。（3）MCT腹腔注射1周和2周后,移植1.0×10⁶个ADSC可降低PAH大鼠的mPAP。 结论40 mg/kg MCT造模4周可建立稳定的PAH大鼠模型;造模1或2周后移植1.0×10⁶个ADSC能有效降低PAH大鼠的mPAP。     

Chronic hypoxia- and monocrotaline-induced elevation of hypoxia-inducible factor-1α levels and pulmonary hypertension

A close relationship exists between hypoxia-inducible factor (HIF)-1 and pulmonary hypertension. The present study was carried out to explore if there are temporal alterations in HIF-1 levels during prolonged hypoxia and after monocrotaline (MCT) treatment. First, young Wistar rats were divided into 5 groups: control, hypoxia-1, hypoxia-2, hypoxia-3 and hypoxia-4. Hypoxic rats were placed in a closed hypobaric chamber (380 mm Hg) for a 1-week (hypoxia-1), 2-week (hypoxia-2), 3-week (hypoxia-3) or 5-week (hypoxia-4) period. Second, other young Wistar rats were divided into 4 groups: control, MCT-1, MCT-2 and MCT-3. MCT-treated rats were injected subcutaneously once with MCT (60 mg/kg) for a 1-week (MCT-1), 2-week (MCT-2) or 3-week (MCT-3) period. Subsequently, pulmonary arterial pressure (Ppa) and the weight ratio of the right ventricle to the left ventricle plus the septum [RV/(LV + S)] were measured, and lungs were obtained for the determination of HIF-1 via Western blot analysis. Both hypoxia and MCT induced temporal increases in the Ppa, the ratio RV/(LV + S) and HIF-1 levels. A close relationship between the Ppa and HIF-1 level was found in both hypoxia- and MCT-treated animals. In addition, the PaO₂ level significantly decreased in rats 1–3 weeks after MCT treatment. These results, along with previous data in the literature, suggest that both chronic hypoxia- and MCT-induced lung hypoxia activate an increase in the production of HIF-1, and result in vascular remodeling and pulmonary hypertension.