(Hypertension. 1996;27:740-745.)
© 1996 American Heart Association, Inc.
Articles |
From the Department of Physiology, University of New Mexico School of Medicine, Albuquerque (N.L.K.); and the Department of Physiology, University of Michigan, Ann Arbor (R.C.W.).
Correspondence to Dr Nancy L. Kanagy, Department of Physiology, 237 Basic Medical Sciences Bldg, University of New Mexico School of Medicine, Albuquerque, NM 87131-5321.
| Abstract |
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q, the G protein
-subunit that
activates phospholipase C. Thoracic aortae from DOCA-salt
hypertensive rats (systolic blood pressure 183±7 mm Hg) and
normotensive controls (systolic blood pressure 115±2 mm Hg)
were homogenized and G protein content determined. Western
analysis revealed that G
i content was decreased
in DOCA compared with control rats (1364±196 versus 2343±188
densitometry units, P
.05) with no differences observed for
G
q or G
s. In addition, contractile
responses in denuded femoral artery strips revealed a significant
decrease in EC50 values in DOCA arteries to all of the
agonists examined: aluminum fluoride (DOCA=1.42, control=2.34
mmol/L), mastoparan (DOCA=0.51, control=35 µmol/L),
phenylephrine (DOCA=0.08, control=0.53 µmol/L), and
serotonin (DOCA=0.014, control=0.04 µmol/L,
EC20 values). Finally, arteries from DOCA rats contracted
with aluminum fluoride had increased sensitivity to G protein
antagonists but not to a phospholipase C
inhibitor. The enhanced contractile responsiveness in the
DOCA arteries may be mediated in part through decreased
G
i levels. However, it is not caused by increased
concentrations of G
q in the cell membrane or by
increased phospholipase C sensitivity, and the increased constrictor
response to G protein stimulators of phospholipase C appears to depend
primarily on increased G protein sensitivity.
Key Words: aluminum fluoride mineralocorticoids G proteins
| Introduction |
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-subunits that
activate the ß-isoform of PLC
(PLCß)3 ; the G
i family that
inhibits adenylyl cyclase,4 inhibits calcium
channels,5 and activates potassium
channels6 ; and the G
s family that
activates adenylyl cyclase7 and
inhibits calcium channels.8 An increased responsiveness or
quantity of G
q should lead to increased vasoconstriction
dependent on increased PLC activation after receptor stimulation.
Similarly, decreased activity or expression of G
s should
lead to a decreased vasodilator response by decreasing the
production of cAMP. The effect of decreased expression of
G
i, however, is more difficult to predict.
G
i activation has been associated with activation of
PLC9 and vasoconstriction in some vascular beds,
suggesting that inhibition of G
i-modulated pathways
would lead to decreased vasoconstriction. Similarly, decreased
G
i inhibition of adenylyl cyclase should lead to
increased cAMP production and decreased vascular tone. However,
G
i also has been linked to inhibition of calcium
channels5 and activation of potassium
channels,6 suggesting that decreased expression of
G
i also could lead to depolarization and elevated
calcium influx contributing to increased vasoconstriction.
Previous studies examining G protein content in tissues from DOCA rats
found that G
i was increased in myocardial
tissues.10 11 These studies also found decreased
myocardial cAMP production, indicating that depressed
adenylyl cyclase activity in failing hearts might be
dependent on elevated levels of G
i protein. Studies in
vascular tissue from hypertensive rats have produced mixed reports.
Several models of hypertension have been shown to have increased
G
i expression,12 decreased
G
i expression and elevated G
q
expression,13 or unchanged levels of G protein subunit
expression.14 Since there are conflicting reports in the
literature regarding the relation between G
-subunit expression
and vascular contractility and no studies have examined
vascular expression in this model of hypertension, the current
investigation was conducted to determine whether altered expression of
G
proteins could contribute to increased vascular reactivity in
DOCA-salt hypertension. We hypothesized that the elevated
contractility in this model of hypertension is due to
increased expression of G
q.
| Methods |
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Animals
Adult male Sprague-Dawley rats (200 to 300 g; Harlan
Animal Farms, Indianapolis, Ind) were used in this study. Rats were
anesthetized with ether and uninephrectomized. Half of the rats
received a subcutaneous silicone implant impregnated with DOCA (200
mg/kg). After surgery, DOCA rats were given 1% NaCl and 0.2% KCl in
their drinking water. Control rats received no implant and drank tap
water. Experiments were performed after 4 to 5 weeks of DOCA treatment.
Systolic blood pressure was measured weekly in conscious rats
using the tail-cuff method (pneumatic transducer). All animal
protocols were approved by either the University of Michigan or the
University of New Mexico committees for animal use. All protocols
conformed to National Institutes of Health and university guidelines
for the ethical treatment of animals.
Preparation of Tissues
On the day of the experiment, animals
were anesthetized
with sodium pentobarbital (60 mg/kg) and exsanguinated. Thoracic aorta
and femoral arteries were removed and placed in
physiological saline solution containing (mmol/L)
NaCl 130, KCl 4.7, KH2PO4 1.18,
MgSO4 · 7H2O 1.17, NaHCO3 14.9,
dextrose 5.5, CaNa2 EDTA 0.026, and CaCl2 1.6.
Femoral arteries were cleaned, cut into helical strips (1 mmx15 mm),
and mounted in tissue baths filled with
physiological saline solution maintained at 37°C
and aerated with 95% O2/5% CO2 to
achieve a pH of 7.2. All strips used were denuded of
endothelium by gently rubbing the lumen of the strips
with a cotton-tipped applicator. The removal of the
endothelium was confirmed by failure of contracted
strips (10-7 mol/L PE) to relax to acetylcholine
(10-6 mol/L). Strips were stretched with a passive tension
(700 mg) determined previously15 to allow maximal
contraction in response to norepinephrine
(5.9x10-6 mol/L) and were equilibrated 2 hours before
experiments were performed. Strips from a DOCA rat and a sham rat were
paired in each bath and force-recorded with FT03 Grass
Instruments transducers. Two strips from a single rat were used in
antagonist studies, and no strip was used for more than two
concentration-response curves. The number of animals used for each
protocol is indicated by n values.
Experimental Protocols
Sensitivity to Contractile
Agents
After equilibration, cumulative concentration-response
curves were generated for two G protein stimulators:
AlF4-, which binds to the GDP of the
GTPase in the
-subunit of G proteins to cause
activation16 and mastoparan, a peptide that mimics a
ligand-bound receptor to directly stimulate G protein
activity.17 Cumulative concentration-response curves
were also generated for PE, an
1-adrenergic agonist, and
serotonin. The concentration required to produce half
maximal tension development (EC50 value) was used to
evaluate the sensitivity to contractile agents, while maximal tension
development was used to evaluate the ability of the strip to develop
tension and the efficacy of the contractile agent.
Sensitivity to Inhibitors
A second set of
experiments evaluated the functional sensitivity
of the G proteins causing AlF4- contraction by
determining the sensitivity to G protein inhibitors in
strips contracted with AlF4-. Cumulative
concentration-response curves to inhibitors were
obtained in strips contracted with AlF4- (6
mmol/L). Contractions are expressed as percentage of initial force. A
third series of experiments evaluated the contribution of PLC
stimulation to AlF4- contractions. PLC
sensitivity was evaluated by constructing cumulative
inhibitory concentration-response curves with the PLC
inhibitor NCDC in strips contracted with
AlF4- (6 mmol/L). NCDC has been demonstrated
to inhibit PLC, and to a limited extent phospholipase
A2, in a concentration-dependent manner in
intact cells.18 19 Elevated sensitivity at the level
of
the effector (PLC and/or phospholipase A2) to G protein
stimulation would be expected to cause increased sensitivity to the
inhibitor, NCDC.
Western Analysis of G Proteins
Assessment of vascular smooth muscle G protein
-subunit
content was evaluated using a modification of the
immunoblotting method described by Clark et
al.14 Thoracic aortae were cleaned of connective and
adventitial tissue, disrupted in a Dounce homogenizer
containing ice-cold Tris-HCl buffer with EDTA (0.3 mg/mL) and
phenylmethylsulfonyl fluoride (35 µg/mL), and the
homogenate was spun at 800g for 10 minutes to
remove cellular debris. The supernatant was drawn off and spun at
50 000g for 1 hour to isolate membranes. Membranes were
resuspended in 500 µL buffer, an aliquot of each preparation was
analyzed for protein concentration, and the remainder was
stored at -70°C until used. Membranes were dissolved in sample
buffer (1 µg/µL), boiled for 3 minutes, and separated on 12%
polyacrylamide gels. In addition to paired DOCA and sham
samples (25 µg/lane), each gel contained molecular-weight
standards and purified G protein standards. Separated proteins were
transferred to membranes and probed with monoclonal antibodies specific
for the different G protein
-subunits; AS/7 recognizes both
i1 and
i2 isoforms, QL is specific for
q, while RM/1
recognizes Gs
. Gels were stained with Coomassie blue to evaluate
sample loading, and enhanced chemoluminescence development was used to
visualize proteins. The relative quantity of protein was estimated
using densitometry and molecular-weight markers and purified G
proteins were used to verify antibody specificity.
After immunoblotting
for G protein
-subunits,
some blots were stripped and reprobed with an antibody to ß-actin
(Sigma). These blots were used to evaluate smooth muscle content in
each group.
Data Analysis and Statistics
Data are reported as the
mean±SEM. For calculation of
EC50 values (concentration that caused 50% maximal
response), a logit-log transformation was performed and the
transformed data were curve-fitted by using an unweighted
least-squares linear regression. Since not all agents caused
maximal responses, threshold values were calculated using a one-way
ANOVA with the least significant difference post-hoc test. The
lowest value to cause a significant difference from control is
designated the threshold. Unpaired Student's t tests were
used to compare systolic blood pressures, absolute force
measurements, and EC50 values of the transformed data
between animal groups. When multiple t tests were used for
comparisons between groups, the Bonferroni adjustment for multiple
testing was employed. A value of P<.05 was considered
statistically significant.
| Results |
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Sensitivity to Contractile Agents
Femoral arteries from DOCA
rats had a significant increase in
sensitivity to both AlF4- and mastoparan,
apparent as decreased EC50 values and leftward shifts in
the concentration-response curves (Table 2
and Fig
1
). In addition, the time to half-maximal tension
development for an EC80 concentration of
AlF4- was significantly less in DOCA tissues,
while total tension developed was greater in artery segments from
control rats (Fig 2
). DOCA tissues were also more
sensitive to PE and serotonin, especially at low
concentrations (Fig 3
). These results indicate that the
contractile response to G protein stimulation in arteries from
DOCA-hypertensive rats is upregulated through a pathway at least
partially independent of receptor stimulation. Similar shifts in
AlF4- and PE concentration-response curves
were seen in three experiments conducted in aortic ring segments (data
not shown). These experiments indicated that the functional response to
these agents is qualitatively similar between the two vascular
preparations.
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Sensitivity to Inhibitors
AlF4-
contractions were reversed by both
sodium suramin and benzalkonium chloride (Fig 4
).
Tissues from DOCA rats were more sensitive to both G protein
antagonists evidenced by the lower threshold for relaxation
(Fig 4
). In contrast, both groups of tissues exhibited
equivalent
sensitivities to the PLC inhibitor, NCDC (Fig 5
). This
indicates that the increased sensitivity to G
protein stimulation is not dependent on increased responsiveness of
PLC. Rather, the upregulation in the G protein pathway appears to
depend on increased sensitivity of the G proteins themselves.
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Western Analysis of G Proteins
Western analysis of vascular
tissue revealed a significant
decrease in the expression of Gi
-subunits but no changes in Gs
or Gq expression (Fig 6
). A single band was observed in
blots probed for G
i, indicating that only a
single isoform was present. Since the antibody recognizes both i1
and i2 isoforms but only i2 is present in vascular
tissue,20 it appears that the change was in
i-2
expression. When blots were analyzed for ß-actin, there
was no difference in the amount of total protein loaded per well so
that the decreased expression appears to be independent of changes in
vascular smooth muscle mass (Table 3
).
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| Discussion |
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-subunits during DOCA-salt hypertension.
There were two primary findings. First, an increased sensitivity to
contractile agents acting through G proteinregulated pathways was
observed. However, the increased sensitivity was not accompanied by
increased expression of G
q as predicted, and it appears
that the elevated response is not caused by an increased number of
G
q proteins in the membrane. Second, there was a
significant decrease in the content of Gi
-subunits, and this
may have contributed to the elevated contractility as
discussed in the beginning of this article. Vascular contractility to receptor-mediated agonists in the DOCA-salt model of hypertension is consistently found to be increased.15 22 This model of hypertension is induced by giving high doses of the mineralocorticoid deoxycorticosterone in combination with elevated salt intake. Within 1 week, blood pressure is elevated and remains elevated for the duration of high salt intake.23 Initially, the hypertension appears to depend on sodium and water retention at the kidney, but the sustained phase of the hypertension is maintained by increased vascular resistance accompanied by elevated sympathetic outflow24 and increased vasoconstrictor responses to endogenous stimuli.22 The current study investigated the mechanisms responsible for the elevated vasoconstrictor responses to receptor-mediated agonists in the established phase of hypertension.
It has previously been shown that during this phase of DOCA hypertension, vascular smooth muscle does not exhibit increased receptor number but does have an increased calcium signal in response to receptor stimulation.15 25 26 Therefore, changes in contractile sensitivity appear to be mediated by altered signal transduction at a point distal to receptor stimulation. In addition, contractile proteins in vascular tissue from DOCA rats do not have increased sensitivity to calcium,26 further indicating that the changes in vascular responsiveness are dependent on altered signal transduction. However, it has been difficult to directly relate altered expression or function of signal transduction components to the increased vascular reactivity.
Previous reports in other models of hypertension have examined the
vascular smooth muscle expression level of the different G protein
-subunits that regulate contraction in smooth muscle cells:
i,
q, and
s.
In genetic models of hypertension, myocardial content of
G
i has been reported to be increased.12
However, in vascular tissue from spontaneously hypertensive rats,
levels of G
i and G
q appear to be
unchanged,14 while in at least two experimental models of
hypertension, G
i has been shown to be decreased and
G
q to be increased.13 The expression of
G
-subunits in vascular tissue from DOCA rats has not been
reported previously, although at least two groups have reported an
increase in G
i expression in myocardial
tissue.10 11 Therefore, it was hypothesized that
arteries
from DOCA rats would have increased expression of
G
q, the G protein subtype commonly associated
with PLC activation, as well as an increase in
G
i, the subtype associated with inhibition of
adenylyl cyclase and calcium channels and stimulation of potassium
channels. It was expected that the altered G protein expression would
be accompanied by increased sensitivity to G protein
inhibitors but not to PLC inactivation and by increased
sensitivity to contractile agents that activate G proteins (ie,
AlF4-). However, Western analysis
found a significant decrease in the amount of immunoreactive
G
i and no apparent change in the expression of
G
q or G
s. This was accompanied by a
dramatic increase in the vasoconstrictor response to G protein
stimulation with AlF4- and mastoparan. Because
sodium fluoride inhibits phosphatase activity at millimolar
concentrations,27 the contractions induced by the
combination of Al+3 and sodium fluoride in this
study may be partially dependent on phosphatase inhibition. However,
the highest concentration of AlF4- used, 12
mmol, causes only 50% inhibition of phosphatase activity in an
isolated system,28 and it is unlikely that phosphatase
inhibition could account for the entire contraction produced in the
vascular strips. In addition, the phosphatase inhibition induced by
AlF4- may be a downstream event of the
activation of a G protein29 that also contributes to the
contractile response of G proteincoupled receptors in vascular
smooth muscle. This pathway is an important area for future studies in
vascular contractility.
The reason for the differences between the observed results and
the hypothesis is not immediately clear, but it is apparent that an
increase in G
q is not responsible for the elevated
contractile response to G protein stimulators. Rather, a decrease in Gi
-subunits may contribute to the elevated vascular reactivity as
described below.
A previous investigation also reported decreased G
i-2
expression in aortic tissue from experimentally hypertensive
rats,13 although myocardial tissue from DOCA rats appears
to have elevated G
i expression accompanied by decreased
adenylyl cyclase production.10 11 The differences
are most likely due to the different tissues examined. Importantly, the
differences observed between models of hypertension indicate that blood
pressure alone does not regulate aortic expression of G protein
-subunits. The antibody used in the current study recognizes
transducin, G
i-1, and G
i-2, but only
G
i-2 is appreciably expressed in vascular smooth
muscle.20 Therefore, our data indicate that
G
i-2, the subtype linked to adenylyl cyclase
inhibition,4 K+ channel
activation,6 and Ca2+ channel
inhibition,30 is decreased in DOCA-salt vasculature, a
change that would decrease rather than increase vascular reactivity.
Therefore, decreased G
i mediation of K+
channel activation and Ca2+ channel inhibition is more
likely to contribute to the contractility changes
observed. However, the small changes in Gi expression would not be
expected to fully account for the augmented vascular response to G
protein stimulation.
In summary, the current study found increased sensitivity of vascular tissues to G protein activation that was not accompanied by changes in Gq protein content. Therefore, the characteristic increase in PLC activation in DOCA hypertension30 might depend instead on changes in the activation sensitivity of the G proteins. It appears that G protein function is regulated separately from expression levels and that regulation of G protein function can alter vascular reactivity.
| Selected Abbreviations and Acronyms |
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| Acknowledgments |
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| References |
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|
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2. Birnbaumer L, Birnbaumer M. Signal transduction by G proteins: 1994 edition. J Recept Sig Trans Res. 1995;15:213-252. [Medline] [Order article via Infotrieve]
3. Taylor SJ, Chae HZ, Rhee SG, Exton JH. Activation of the beta-1 isozyme of phospholipase C by alpha-subunit of Gq class of G proteins. Nature. 1991;350:516-518. [Medline] [Order article via Infotrieve]
4. Dickerson CD, Weiss ER. The coupling of pertussis toxin-sensitive G proteins to phospholipase A2 and adenylyl cyclase in CHO cells expressing bovine rhodopsin. Exp Cell Res. 1995;216:46-50.[Medline] [Order article via Infotrieve]
5. Dolphin AC. Voltage-dependent calcium channels and their modulation by neurotransmitters and G proteins. Exp Physiol. 1995;80:1-36. [Medline] [Order article via Infotrieve]
6.
Nelson MT, Quayle JM.
Physiological roles and properties of
potassium channels in arterial smooth muscle.
Am J Physiol. 1995;268:C799-C822.
7. Onali P, Olianas MC. Bimodal regulation of cyclic AMP by muscarinic receptors: involvement of multiple G proteins and different forms of adenylyl cyclase. Life Sci. 1995;56:973-980. [Medline] [Order article via Infotrieve]
8.
Matsumoto H, Baron CB, Coburn RF. Smooth
muscle stretch-activated phospholipase C activity.
Am J Physiol. 1995;268:C458-C465.
9.
Raymond JR. Multiple mechanisms of receptor-G
protein signaling specificity. Am J Physiol. 1995;269:F141-F158. Editorial.
10. Anand-Srivastava MB, de Champlain J, Thibault C. DOCA-salt hypertensive rat hearts exhibit altered expression of G proteins. Am J Hypertens. 1993;6:72-75. [Medline] [Order article via Infotrieve]
11.
Böhm M, Gierschik P, Knorr A, Larisch K, Weismann
K, Erdmann E. Desensitization of adenylate cyclase
and increase in Gi
in cardiac hypertrophy
due to acquired hypertension.
Hypertension. 1992;20:103-112.
12. Anand-Srivastava MB. Enhanced expression of inhibitory guanine nucleotide regulatory protein in spontaneously hypertensive rats: relationship to adenylate cyclase inhibition. Biochem J. 1992;288:79-85.
13.
Li P, Zou AP, al-Kayed NJ, Rusch NJ, Harder DR.
Guanine nucleotide-binding proteins in aortic
smooth muscle from hypertensive rats.
Hypertension. 1994;23:914-918.
14. Clark CJ, Milligan G, Connell JM. Guanine nucleotide regulatory protein alterations in young Milan hypertensive strain rats. Biochim Biophys Acta. 1994;1225:149-157. [Medline] [Order article via Infotrieve]
15.
Mecca TE, Webb RC. Vascular responses to
serotonin in steroid hypertensive rats.
Hypertension. 1984;6:887-892.
16. Bigay J, Deterre P, Pfister C, Chabre M. Fluoroaluminates activate transducin-GDP by mimicking the gamma-phosphate of GTP in its binding site. FEBS Lett. 1985;191:181-185. [Medline] [Order article via Infotrieve]
17.
Higashijima T, Burnier J, Ross EM. Regulation of
Gi and Go by mastoparan, related amphiphilic peptides, and hydrophobic
amines. J Biol Chem. 1990;265:14176-14186.
18.
Walenga R, Vanderhoek JY, Feinstein MB. Serine
esterase inhibitors block stimulus-induced mobilization
of arachidonic acid and
phosphatidylinositide-specific phospholipase C activity in
platelets. J Biol Chem. 1980;255:6024-6027.
19. Mahadevappa VG, Sicilia F. Mobilization of arachidonic acid in thrombin-stimulated human platelets. Biochem Cell Biol. 1990;68:520-527. [Medline] [Order article via Infotrieve]
20. Davies MG, Ramkumar V, Gettys TW, Hagen P-O. The expression and function of G-proteins in experimental intimal hyperplasia. J Clin Invest. 1994;94:1680-1689.
21. Nürnberg B, Gudermann T, Schultz G. Receptors and G proteins as primary components of transmembrane signal transduction, part 2. G proteins: structure and function. J Mol Med. 1995;73:123-132. [Medline] [Order article via Infotrieve]
22.
Holloway ET, Bohr DF. Reactivity of vascular
smooth muscle in hypertensive rats. Circ
Res. 1973;33:678-685.
23. Stanton HC. Experimental hypertension. In: Schwartz A, ed. Methods in Pharmacology. New York, NY: Plenum Press; 1971:125-150.
24.
Bruner CA, Mangiapane ML, Fink GD, Webb RC. Area
postrema ablation and vascular reactivity in
deoxycorticosterone-salt-treated rats.
Hypertension. 1988;11:668-673.
25.
Suzuki S, Takata Y, Kubota S, Ozaki S, Kato H.
Characterization of the alpha-1 adrenoceptors in the mesenteric
vasculature from deoxycorticosterone-salt hypertensive rats:
studies on vasoconstriction, radioligand binding and
postreceptor events. J Pharmacol Exp Ther. 1994;268:576-583.
26.
Storm DS, Webb RC.
-Adrenergic receptors and
45Ca2+ efflux in arteries from
deoxycorticosterone acetate hypertensive rats.
Hypertension. 1992;19:734-738.
27.
Shacter-Noiman E, Chock PB. Properties of a
Mr=38,000 phosphoprotein phosphatase: modulation by
divalent cations, ATP, and fluoride. J
Biol Chem. 1983;258:4214-4219.
28. Shetty KT, Guru V, Guru SC. Phosphatase activity against neurofilament proteins from bovine spinal cord: effect of aluminum and neuropsychoactive drugs. Neurosci Lett. 1992;137:83-86. [Medline] [Order article via Infotrieve]
29.
Inoue M, Imanaga I. Phosphatase is responsible
for run down, and probably G protein-mediated inhibition of
inwardly rectifying K+ currents in guinea pig chromaffin
cells. J Gen Physiol. 1995;105:249-266.
30. Uehara Y, Numabe A, Ishimitsu T, Ishii M, Yagi S. Role of cardiovascular phospholipase A2 and C in the development of DOCA-salt hypertensive rats. Adv Exp Med Biol. 1989;247(A):231-236.
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