(Hypertension. 1999;33:207-211.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
From The Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC.
Correspondence to E. Ann Tallant, The Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1032. E-mail atallant{at}wfubmc.edu
| Abstract |
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Key Words: angiotensin angiotensin II muscle, smooth vascular injury vascular proliferation hyperplasia
| Introduction |
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Although Ang II is a potent vasoconstrictor, recent results suggest that Ang-(17) regulates arterial pressure by counteracting the pressor effects of Ang II. Ang-(17) reduced the blood pressure of spontaneously hypertensive rats11 and renovascular hypertensive dogs,12 while central neutralization of Ang-(17) with a selective antibody increased the blood pressure of rats.13 The heptapeptide relaxed canine coronary artery rings through the release of nitric oxide, bradykinin, or both.14 Ang-(17) released vasorelaxant prostacyclin from cultured vascular cells,7 8 9 while indomethacin abolished the vasodilator effects of Ang-(17) in pithed rats15 and piglet pial arterioles.16 Recent studies by Iyer et al17 18 in spontaneously hypertensive rats chronically treated with both an ACE inhibitor and an AT1 receptor antagonist showed a rapid pressor response to administration of a monoclonal antibody to Ang-(17), a neprilysin inhibitor, or the nonselective angiotensin peptide antagonist [sarcosine1-threonine8]angiotensin II ([Sar1-Thr8]Ang II). Because these agents effectively reduced circulating Ang-(17) or inhibited its activity, the endogenous depressor action of Ang-(17) was unmasked. Taken together, these results suggest that Ang-(17) opposes the pressor effects of Ang II.
Ang-(17) also opposes the mitogenic response to Ang II in cultured vascular smooth muscle cells (VSMC). We showed that Ang-(17) inhibited the serum-, Ang II, or platelet-derived growth factorstimulated growth of cultured VSMC,19 in contrast to the growth-stimulatory effects of Ang II.20 21 Ang-(17) caused a dose-dependent inhibition of [3H]thymidine incorporation into serum-stimulated VSMC as well as a decrease in cell number. Therefore, we examined the effect of exogenous Ang-(17) on neointimal formation and medial remodeling in balloon-injured carotid arteries to determine whether Ang-(17) also attenuated stimulated vascular growth in vivo.
| Methods |
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Experimental Protocol
Rats were randomly divided into 2 groups of 6 to 8 rats each.
Each rat was anesthetized with an intramuscular injection of
ketamine hydrochloride (40 mg/kg; Ketaset, Fort Dodge
Laboratories, Inc), xylazine (4 mg/kg; Rompun, Miles), and
acepromazine maleate (0.5 mg/kg; PromAce, Fort Dodge Laboratories,
Inc). An osmotic minipump (model 2ML2, Alzet osmotic pump, Alza)
implanted subcutaneously delivered via catheter either 24 µg/kg per
hour of Ang-(17) (Bachem) in saline or saline alone (5 µL/h) into
the jugular vein. A second subcutaneous minipump delivered the
nonradioactive thymidine analogue 5-bromo-2'-deoxyuridine (BrdU) (0.8
mg/kg per day in saline, 5 µL/h; Boehringer Mannheim).
In anesthetized animals implanted with osmotic pumps for drug administration, the left common carotid artery wall was injured with an embolectomy balloon catheter (2F Fogarty, Baxter Healthcare) to induce neointimal formation, as described by Clowes et al.22 The left and right carotid bifurcations and external carotid branches were exposed by an incision through the skin of the ventral neck. After ligation of the external carotid artery, the embolectomy catheter was introduced into the left common carotid artery and passed to the aorta. Endothelial denudation and artery wall injury were achieved by simultaneously withdrawing and twisting the catheter through the common carotid while the catheter balloon was inflated with 0.1 mL 0.9% NaCl. This process was repeated 3 times before removal of the catheter and ligation of the external carotid artery. The right carotid bifurcation was similarly exposed as a sham-operated control, and the right external carotid artery was ligated before wound closure.
After 12 days of peptide infusion, the rats were anesthetized with the combination of ketamine, xylazine, and acepromazine. Blood pressure and heart rate were measured on a multichannel polygraph (model 2000, Gould) by insertion of an 18-gauge angiocatheter (Baxter Healthcare) into the abdominal aorta and attachment of the catheter to a strain gauge transducer (Spectramed TXXAD-R, Spectramed). Blood (7 mL) was withdrawn for angiotensin peptide measurement, as described below. A 5% solution of Evans blue dye (0.3 mL) was administered via the catheter to identify denuded and injured artery, followed by a bolus injection of pentobarbital sodium (25 mg/kg). The arteries were perfusion-fixed in situ through the catheter at a pressure of 110 mm Hg with 4% phosphate-buffered formalin after flushing with warm, heparinized (2 U/mL) PBS. Four 5.0-mm consecutive samples from the blue-stained region of the left carotid artery and a corresponding region of the right carotid artery were removed, placed overnight in 4% PBS, and embedded in paraffin.
Paraffin-embedded sections (4 µm thick) were mounted on glass slides and stained with hematoxylin and eosin. Cross-sectional areas (3 to 4 per vessel) were measured by morphometry, using a computerized imaging system (MCID, Imaging Research, Inc) calibrated for distance (millimeters) and area (square millimeters) before each analysis. The media was defined as the area circumscribed by the internal and external elastic laminae. The neointima was defined as the area delimited by the internal elastic lamina and the lumenartery wall interface.
Replication of VSMC was determined with the use of an indirect peroxidase-labeled antibody technique to detect the BrdU that was incorporated into cell nuclei during the S phase of DNA synthesis. Artery sections were deparaffinized, and endogenous peroxidase activity was blocked with H2O2 (0.3% in methanol). Sections were digested with 0.1 mg/mL pepsin in 0.1N HCl for 60 minutes. The DNA was denatured and stabilized by immersion in 1.5N HCl for 30 minutes at 37°C followed by rinsing in 0.1 mol/L Na-tetraborate, pH 8.5. After they were rinsed in PBS, sections were incubated with a monoclonal mouse antibody to BrdU (1:10; Boehringer-Mannheim) overnight at 4°C, followed by a biotinylated horse anti-mouse IgG (1:400; Vector Laboratories) for 3 hours at 4°C and an avidin:biotin peroxidase complex (1:50, Standard Vectastain Elite ABC kit, Vector) for 30 minutes at 22°C. The peroxidase reaction was visualized with 0.1% 3,3'-diaminobenzidine tetrachloride. Cell nuclei were counterstained with hematoxylin. The numbers of hematoxylin-stained and BrdU-positive nuclei from 3 to 4 cross-sections per artery per animal were counted within 0.005-mm2 areas of the neointima and media at x400 magnification by a single investigator blinded to the animal treatment. The BrdU labeling index was calculated as the number of peroxidase-positive nuclei/total number of nucleix100.
Angiotensin Peptide Assays
Blood was collected into chilled tubes containing 25
mmol/L EDTA and a cocktail of peptidase inhibitors
(0.44 mmol/L o-phenanthroline, 0.12 mmol/L
pepstatin A, and 1 mmol/L 4-chloromercuribenzoic acid). Blood
samples were stored on ice before processing. Blood cells were
collected by centrifugation at 4°C, and the plasma
was stored at 20°C. Immunoreactive plasma levels of Ang II and
Ang-(17) were measured by radioimmunoassay, as previously
described.3 4 The minimum detectable levels for the
Ang II and Ang-(17) assays were 4.0 and 2.2 fmol per tube,
respectively.
Statistical Analysis
All data are presented as mean±SEM. Statistical
differences were evaluated by 1-way ANOVA followed by Dunnett's post
hoc test with a criterion set for statistical significance of
P<0.05. Student's t test was used when
comparisons were made between 2 groups only. Nonparametric
analysis with the use of the Mann-Whitney test was performed
when the SDs of the 2 groups were significantly different when assessed
by parametric analysis.
| Results |
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Effect of Intravenous Infusion of Ang-(17) on
Neointimal Formation
Balloon-catheter injury of carotid arteries caused the
formation of a neointima in both saline- and
Ang-(17)treated rats. Contralateral uninjured carotid arteries had
no discernible intima. Intravenous infusion of Ang-(17)
significantly reduced the cross-sectional area of the
neointima, as shown in Figures 2
and 3
.
Ang-(17) caused a 37% reduction in the cross-sectional area of the
neointima, from 0.100±0.009 mm2
in saline-infused rats (n=8) to 0.063±0.011
mm2 in Ang-(17)infused rats (n=6;
P<0.05). In contrast, Ang-(17) infusion had no effect on
the medial area of injured or uninjured carotid arteries compared with
saline-infused rats. Correspondingly, the neointima/media
ratio was reduced in Ang-(17)infused rats compared with
saline-infused rats (from 0.62±0.03 in saline-infused rats to
0.42±0.07 in Ang-(17)infused animals).
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Effect of Intravenous Infusion of Ang-(17) on DNA
Synthesis in the Neointima and Media
The rate of DNA synthesis was measured by the incorporation
of BrdU into newly synthesized DNA in the neointima and the
media of injured arteries and the media of uninjured carotid arteries.
The rate of DNA synthesis was defined as the cumulative BrdU labeling
index, calculated by the percentage of nuclei within the
neointima or media incorporating BrdU during the 12-day
infusion period. BrdU was incorporated into a significant number of
cell nuclei in both the neointima (92.5±0.4%) and the
media (48.1±2.4%) of the injured carotid arteries of saline-infused
rats. Ang-(17) infusion significantly (P<0.05) reduced
the rate of DNA synthesis in both the neointima and the
media of the injured arteries, as shown in Figure 4
. DNA synthesis was rare or absent in
the media of the uninjured carotid arteries of saline- or
Ang-(17)infused rats (data not shown).
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| Discussion |
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Ang-(17) inhibited the serum-, platelet-derived growth factor, and Ang IIstimulated increase in [3H]thymidine incorporation in cultured VSMC.19 Infusion of Ang II into Sprague-Dawley rats stimulates vascular smooth muscle growth in conjunction with increased blood pressure.20 Vascular growth in response to coinfusion of Ang II and hydralazine demonstrated that the Ang IImediated increase in proliferation was independent of its pressor effect.21 This is in agreement with a reduction in neointimal formation after vascular injury by treatment with either ACE inhibitors or AT1 receptor antagonists.23 24 25 ACE inhibitors increase circulating kinins while decreasing or having no effect on plasma Ang II, suggesting that bradykinin participates in the antiproliferative effects of ACE inhibition. Farhy et al26 showed that a B2 antagonist attenuated the ACE inhibitorreduced neointimal formation through blockade of kinin-stimulated migration of medial cells.27 However, circulating levels of Ang-(17) increase 25- to 50-fold during ACE inhibition,3 4 5 secondary to increased Ang I conversion to Ang-(17) and inhibition of Ang-(17) breakdown by ACE.28 Since Ang-(17) inhibits vascular proliferation in vitro and in vivo, the heptapeptide may participate in the antiproliferative effects of ACE inhibition.
Ang-(17) reduced the cross-sectional area of the neointima and decreased the rate of DNA synthesis. In contrast, the heptapeptide decreased the rate of DNA synthesis in the media of the injured artery but did not reduce the medial cross-sectional area. The response to vascular injury in the rat carotid artery follows a pattern of medial smooth muscle proliferation, migration of smooth muscle cells across the internal elastic lamina to form the neointima, and neointimal smooth muscle proliferation.22 29 Inhibition of VSMC migration by Ang-(17) could account for the decreased rate of medial DNA synthesis without a significant decrease in medial area. Alternatively, Ang-(17) may attenuate medial VSMC apoptosis to oppose the decreased rate of medial DNA synthesis. deBlois et al30 showed that treatment of spontaneously hypertensive rats with ACE inhibitors altered vascular cell apoptosis in addition to inhibiting vascular growth.
The angiotensin receptor coupled to the inhibition of VSMC growth in vivo was not investigated in the present study. However, in cultured VSMC, we showed that inhibition of serum-stimulated [3H]thymidine incorporation by Ang-(17) was prevented by the sarcosine analogues of Ang II[Sar1-Thr8]Ang II or [sarcosine1-isoleucine8]angiotensin II ([Sar1-Ile8]Ang II)but not by AT1 or AT2 receptor antagonists.19 We identified a novel non-AT1, non-AT2 Ang-(17) receptor in bovine aortic endothelial cells31 and canine coronary arteries,1 suggesting that Ang-(17) activates a unique angiotensin peptide receptor. The Ang-(17)mediated relaxation of preconstricted canine coronary arteries was prevented by sarcosine analogues of Ang II but not by AT1 or AT2 receptor antagonists.14 In addition, Iyer et al17 18 recently showed that the antihypertensive effect of combined ACE inhibition and AT1 receptor antagonism was attenuated by an antibody to Ang-(17), an inhibitor of Ang-(17) formation or [Sar1-Thr8]Ang II but not by an AT2 receptor antagonist. Collectively, these results suggest that Ang-(17) activates a novel Ang-(17) receptor to regulate blood pressure and inhibit VSMC proliferation.
Although we did not investigate the mechanisms by which Ang-(17) inhibits vascular proliferation, we previously showed that Ang-(17) released prostacyclin from cultured VSMC.7 8 9 Blockade of prostaglandin production by indomethacin attenuates the inhibition of VSMC thymidine incorporation by Ang-(17) (E.A. Tallant, unpublished data, 1998). Prostacyclin inhibited the growth of cultured VSMC.32 In addition, overexpression of prostacyclin synthase in rat VSMC increased prostacyclin production and decreased DNA synthesis in response to serum stimulation, providing further proof that prostacyclin inhibits VSMC growth.33 Treatment with a stable prostacyclin analogue also reduced neointimal growth in vivo after vascular injury to the rabbit aorta.34 Although other mechanisms may participate in the Ang-(17)mediated inhibition of vascular growth (such as production of the growth inhibitor nitric oxide), our results suggest that Ang-(17) may inhibit vascular growth by the production of prostacyclin.
VSMC growth is regulated by hemodynamic, blood-borne, and tissue-derived signals to maintain normal blood flow and vessel patency.22 29 Proliferative and antiproliferative factors tend to balance VSMC growth. Artery wall thickness is maintained in normal adult arteries by permitting only a slow rate of smooth muscle cell proliferation to adjust compliance. Abnormal vascular growth is an important etiologic factor in the pathology of many vascular disorders, including hypertension. The results of the present study demonstrate that infusion of exogenous Ang-(17) results in a reduction in neointimal formation, suggesting that Ang-(17) may inhibit VSMC growth in vivo. Since plasma Ang-(17) is elevated after treatment with ACE inhibitors, our results suggest that Ang-(17) may contribute to the antiproliferative effects of ACE inhibition.
| Acknowledgments |
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Received September 17, 1998; first decision October 14, 1998; accepted October 30, 1998.
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R. A. S. Santos, A. J. Ferreira, A. P. Nadu, A. N. G. Braga, A. P. de Almeida, M. J. Campagnole-Santos, O. Baltatu, R. Iliescu, T. L. Reudelhuber, and M. Bader Expression of an angiotensin-(1-7)-producing fusion protein produces cardioprotective effects in rats Physiol Genomics, May 19, 2004; 17(3): 292 - 299. [Abstract] [Full Text] [PDF] |
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Y. Ishiyama, P. E. Gallagher, D. B. Averill, E. A. Tallant, K. B. Brosnihan, and C. M. Ferrario Upregulation of Angiotensin-Converting Enzyme 2 After Myocardial Infarction by Blockade of Angiotensin II Receptors Hypertension, May 1, 2004; 43(5): 970 - 976. [Abstract] [Full Text] [PDF] |
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A. Schafer, D. Fraccarollo, P. Tas, I. Schmidt, G. Ertl, and J. Bauersachs Endothelial dysfunction in congestive heart failure: ACE inhibition vs. angiotensin II antagonism Eur J Heart Fail, March 1, 2004; 6(2): 151 - 159. [Abstract] [Full Text] [PDF] |
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E. A. Tallant and M. A. Clark Molecular Mechanisms of Inhibition of Vascular Growth by Angiotensin-(1-7) Hypertension, October 1, 2003; 42(4): 574 - 579. [Abstract] [Full Text] [PDF] |
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G. Wiemer, L. W. Dobrucki, F. R. Louka, T. Malinski, and H. Heitsch AVE 0991, a Nonpeptide Mimic of the Effects of Angiotensin-(1-7) on the Endothelium Hypertension, December 1, 2002; 40(6): 847 - 852. [Abstract] [Full Text] [PDF] |
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C. M. Ferrario Does Angiotensin-(1-7) Contribute to Cardiac Adaptation and Preservation of Endothelial Function in Heart Failure? Circulation, April 2, 2002; 105(13): 1523 - 1525. [Full Text] [PDF] |
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T. Mustafa, Joo Hyung Lee, Siew Yeen Chai, A. L Albiston, S. G McDowall, and F. A. Mendelsohn Bioactive angiotensin peptides: focus on angiotensin IV Journal of Renin-Angiotensin-Aldosterone System, December 1, 2001; 2(4): 205 - 210. [PDF] |
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M. A. Clark, D. I. Diz, and E. A. Tallant Angiotensin-(1-7) Downregulates the Angiotensin II Type 1 Receptor in Vascular Smooth Muscle Cells Hypertension, April 1, 2001; 37(4): 1141 - 1146. [Abstract] [Full Text] [PDF] |
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H. Heitsch, S. Brovkovych, T. Malinski, and G. Wiemer Angiotensin-(1-7)-Stimulated Nitric Oxide and Superoxide Release From Endothelial Cells Hypertension, January 1, 2001; 37(1): 72 - 76. [Abstract] [Full Text] [PDF] |
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A. J. Allred, D. I. Diz, C. M. Ferrario, and M. C. Chappell Pathways for angiotensin-(1---7) metabolism in pulmonary and renal tissues Am J Physiol Renal Physiol, November 1, 2000; 279(5): F841 - F850. [Abstract] [Full Text] [PDF] |
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J. L. Hansen, G. Servant, T. J. Baranski, T. Fujita, T. Iiri, and S. P. Sheikh Functional Reconstitution of the Angiotensin II Type 2 Receptor and Gi Activation Circ. Res., October 27, 2000; 87(9): 753 - 759. [Abstract] [Full Text] [PDF] |
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W. B. Strawn, M. C. Chappell, R. H. Dean, S. Kivlighn, and C. M. Ferrario Inhibition of Early Atherogenesis by Losartan in Monkeys With Diet-Induced Hypercholesterolemia Circulation, April 4, 2000; 101(13): 1586 - 1593. [Abstract] [Full Text] [PDF] |
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S. P. Kessler, T. M. Rowe, J. B. Gomos, P. M. Kessler, and G. C. Sen Physiological Non-equivalence of the Two Isoforms of Angiotensin-converting Enzyme J. Biol. Chem., August 18, 2000; 275(34): 26259 - 26264. [Abstract] [Full Text] [PDF] |
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A. E. Loot, A. J.M. Roks, R. H. Henning, R. A. Tio, A. J.H. Suurmeijer, F. Boomsma, and W. H. van Gilst Angiotensin-(1-7) Attenuates the Development of Heart Failure After Myocardial Infarction in Rats Circulation, April 2, 2002; 105(13): 1548 - 1550. [Abstract] [Full Text] [PDF] |
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