Increase In Albumin Clearance Research Articles

Dual activation of p38MAPK and SFK pathways is required to induce endothelial permeability

We previously showed that activation of endogenous Src family kinases (SFK) by expression of a dominant negative form of Csk (DN‐Csk) is not sufficient to induce changes in endothelial monolayer permeability, but allows low doses of TNF to increase endothelial permeability. This increase induced by joint SFK activation and TNF treatment is attenuated by addition of p38 inhibitors. Thus, we hypothesized that p38MAPK activation may induce an increase in permeability of ECs already primed by activation of SFKs. To test this, we constructed a lentiviral vector to express a flag tagged constitutively active form of MKK6 under the control of a tetracycline‐regulated promoter (iMKK6E). Addition of doxycyclin (dox) to infected cells induced a dose‐dependent increase in MKK6E expression resulting in the phosphorylation and nuclear translocation of p38 as well as HSP27 phosphorylation. This treatment did not induce any change in permeability. In contrast, MKK6E expression resulted in a large drop in TEER and an increase in albumin clearance in cells with SFK activation. This was accompanied by the formation of large gaps in the monolayer but no change in actin fibers. Our results support a model in which dual activation of SFKs and p38 are required for the induction of endothelial permeability. This model could explain the tight spatio‐temporal response to inflammatory mediators during an inflammatory response.

Phosphodiesterase 4 inhibition attenuates plasma volume loss and transvascular exchange in volume expanded mice

Phosphodiesterase 4 inhibition attenuates plasma volume loss and transvascular exchange in volume expanded mice

Lipopolysaccharide activation of pericyte’s Toll-like receptor-4 regulates co-culture permeability

Background Pericytes (PCs) have a synergistic relationship with endothelial cells (MVEC) in regulating capillary permeability. PCs express Toll-like receptor-4 (TLR-4). We hypothesize one mechanism of MVEC/PC co-culture permeability is regulated through lipopolysaccharide (LPS) activation of pericyte TLR-4. Methods Rat PCs were harvested and cultured. PCs were transfected with siRNA targeted to TLR-4. Western blotting was used to confirm gene silencing of TLR-4. A previously described co-culture permeability assay was performed after LPS treatment. Results Western blot confirmed successful silencing of TLR-4 in PCs, which was sustained for 7 days. A dose- and time-dependent effect of LPS on albumin clearance was seen in MVEC/PC co-cultures. Co-cultures with TLR-4 silenced in PCs eliminated the LPS dose-dependent increase in albumin clearance. Conclusions TLR-4 regulates pericyte mediated capillary leak seen with LPS exposure. Our TLR-4 silencing model can be used to further investigate TLR-4’s role in pericyte mediated capillary leak.

TNF-α and IL-1β Increase Pericyte/Endothelial Cell Co-Culture Permeability

Pericytes (PC) have a unique synergistic relationship with microvascular endothelial cells (MVEC) in the regulation of capillary permeability. This study investigates the effect of TNF-alpha, IL-1beta, and IL-6 on the microvasculature by measuring changes in PC contractility, and also, albumin permeability across MVEC/PC co-cultures. Semi-permeable inserts were plated first with rat lung MVEC and then PCs (on the fourth day) at a ratio of 10:1 MVEC/PC. On day 5, 50 ng/ml of TNF-alpha, IL-1beta, and IL-6 were added with or without a secretory phospholipase A(2)-IIA (sPLA(2)-IIA) inhibitor for 24 h. After treatments, albumin clearances were quantified. For measuring contractility, PCs were cultured on collagen matrices and exposed for 24 h to TNF-alpha, IL-1beta, and IL-6 at 1 ng/ml, 10 ng/ml, and 50 ng/ml with/without inhibitors for sPLA(2)-IIA, phospholipase A(2) (PLA(2)), and cyclooxygenase-II (COX-II). After treatments, the surface area of the collagen disks was digitally quantified. TNF-alpha and IL-1beta significantly increased albumin clearance in MVEC/PC co-cultures (P < 0.05) and induced dose-dependent relaxation of PCs (P < 0.05). PC relaxation was completely attenuated with the sPLA(2)-IIA and pLA(2) inhibitors; the COX-II inhibitor provided partial blockade. IL-6 had no effect on PC contractility or permeability. TNF-alpha and IL-1beta directly increased microvascular permeability in co-cultures. They also induced relaxation of PCs through a sPLA(2)-IIA dependent mechanism. Interestingly, IL-6 had no effect, although its presence in high levels has been demonstrated in inflamed lungs. These findings may help elucidate the significance of PC in regulating the capillary response to various pro-inflammatory cytokines.

Proinflammatory cytokines increase permeability of rat microvascular endothelial cell: Pericyte cocultures in vitro

Pericytes (PC) have a unique synergistic relationship with microvascular endothelial cells (MVEC) in the regulation of capillary permeability. This relationship may be important in the increased permeability noted in septic and posttraumatic states. This study investigates the effect of TNF-α, IL-1β, and IL-6 on the permeability of albumin across MVEC:PC coculture barriers. Methods. Semipermeable inserts were coated with gelatin and plated with rat lung MVEC at a concentration of 3 × 10 5 cells/ml. On the fourth day, PCs were added at concentrations to approximate a ratio of 10:1 MVEC:PC. On day 5, 100 ng of TNF-α, IL-1β, and IL-6 were added separately. Following a 24-h incubation period, the clearance of albumin across the coculture barriers was measured. Results. TNF-α and IL-1β significantly increased albumin clearance in comparison to control cocultures ( P < 0.05). IL-6 had no effect on permeability compared to control. Conclusion. TNF-α and IL-1β had a direct effect on MVEC:PC cocultures leading to increased microvascular permeability. Interestingly, IL-6 had no effect, although its presence in high levels has been demonstrated in inflamed lungs. These findings may help elucidate the significance of pericytes in regulating the capillary response to various proinflammatory cytokines.

Peroxynitrite causes endothelial cell monolayer barrier dysfunction.

Nitric oxide (.NO) attenuates hydrogen peroxide (H(2)O(2))-mediated barrier dysfunction in cultured porcine pulmonary artery endothelial cells (PAEC) (Gupta MP, Ober MD, Patterson C, Al-Hassani M, Natarajan V, and Hart, CM. Am J Physiol Lung Cell Mol Physiol 280: L116-L126, 2001). However,.NO rapidly combines with superoxide (O) to form the powerful oxidant peroxynitrite (ONOO(-)), which we hypothesized would cause PAEC monolayer barrier dysfunction. To test this hypothesis, we treated PAEC with ONOO(-) (500 microM) or 3-morpholinosydnonimine hydrochloride (SIN-1; 1-500 microM). SIN-1-mediated ONOO(-) formation was confirmed by monitoring the oxidation of dihydrorhodamine 123 to rhodamine. Both ONOO(-) and SIN-1 increased albumin clearance (P < 0.05) in the absence of cytotoxicity and altered the architecture of the cytoskeletal proteins actin and beta-catenin as detected by immunofluorescent confocal imaging. ONOO(-)-induced barrier dysfunction was partially reversible and was attenuated by cysteine. Both ONOO(-) and SIN-1 nitrated tyrosine residues, including those on beta-catenin and actin, and oxidized proteins in PAEC. The introduction of actin treated with ONOO(-) into PAEC monolayers via liposomes also resulted in barrier dysfunction. These results indicate that ONOO(-) directly alters endothelial cytoskeletal proteins, leading to barrier dysfunction.

Nitric oxide-related experiments on peritoneal solute transport in the rabbit.

It is unclear whether nitric oxide (NO) is important in regulating peritoneal transport during non-infected peritoneal dialysis. In 13 rabbits, 250 mg/l L-arginine, a substrate for NO synthesis, was added to a 3.86% glucose dialysis solution. N:(G)-monomethyl-L-arginine (L-NMMA) 25 mg/1, an inhibitor of NO synthase, was added to the dialysate in 10 rabbits. Standard peritoneal permeability analyses in rabbits were used to analyse the effects of these interventions on solute transport during 1-h dwells. The addition of 4.5 mg/l nitroprusside to the dialysate in five rabbits was used for validation of this model. Nitroprusside caused an 86% (48-233%) increase in albumin clearance, which is similar to the nitroprusside-induced increase found in humans (70%). Contrary to human studies, no effect was found on the mass transfer area coefficient (MTAC) of urea and creatinine, or on glucose absorption. L-Arginine did not affect either the MTAC of urea and creatinine, or the absorption of glucose. Peritoneal albumin clearance increased 18% (-24 to 609%). This resembles the NO-mediated effects of nitroprusside. Addition of L-NMMA caused no change in the solute transport rate. The rabbit dialysis model can be used for analysing the effects of interventions on peritoneal permeability characteristics, although the rabbit peritoneal membrane is probably less sensitive to NO compared with that of humans. L-Arginine-induced effects are similar to those of nitroprusside, which suggests that these effects possibly are mediated by NO. As L-NMMA did not affect peritoneal transport, it is unlikely that NO is involved in the regulation of peritoneal permeability in rabbits.

Hypoxia–Reoxygenation Potentiates Zymosan Activated Plasma-Induced Endothelial Injury

The pathophysiology of ischemia–reperfusion injury and the role played by the interaction of plasma proteins, including complement, with reperfused endothelium remains incompletely understood. Venular endothelial changes due to hypoxia followed by reoxygenation (H-R) are vital because venules are the primary site of fluid accumulation and polymorphonuclear leukocyte deposition due to inflammation. This investigation focused on whether H-R potentiates the response to permeability inducing agents found in activated plasma. Activated complement was studied by using zymosan activated plasma (ZAP). Permeability changes were assessed by quantitating rate of clearance of albumin across the monolayers. H-R alone did not change permeability relative to the normoxic condition. ZAP at 2% in normoxic cells increased albumin clearance from 2 ± 0.2 to 9 ± 1.0 μL/h, which increased significantly to 13.5 ± 2.0 μL/h when given to hypoxia–reoxygenation challenged monolayers. The permeability response to ZAP was dose related and not present with heat inactivated ZAP. ZAP at 2% altered the structure of the cytoskeleton of the human umbilical vein endothelial cells (HUVEC). However, addition of monoclonal anti-complement antibodies or addition of soluble complement receptor-1 did not attenuate ZAP-induced HUVEC permeability. Addition of zymosan-activated serum did not alter the permeability and addition of heparin inhibited the ZAP-induced changes in permeability, suggesting that these changes were mediated via thrombin and not complement. The increase in monolayer permeability due to ZAP was prevented by increasing intracellular adenosine-3′,5′-cyclic monophosphate. These findings suggest that HUVEC monolayers challenged with H-R are more susceptible to increases in permeability induced by activated plasma components.

Effects of supplementation with vitamin C or E on albuminuria, glomerular TGF-beta, and glomerular size in diabetes.

Oxidant stress and a reduction in antioxidant status, including reduced plasma and tissue ascorbic acid content, occur in diabetic patients and experimental models of diabetes. In this study, the effects of treatment of streptozotocin diabetic rats for 2 mo with vitamin C (10 g/kg body wt/d) or dietary vitamin E (200 mg/kg body wt/d) in the drinking water on urinary albumin excretion, glomerular transforming growth factor (TGF)-beta content, and glomerular size were examined. Treatment of diabetic rats with vitamin C or E had no effect on blood glucose levels compared with that in untreated diabetics (453 +/- 28 g/dl +/- SEM). Body weight, BP, and creatinine clearance rates were not significantly different among the study groups. Kidney weight was significantly higher in all of the diabetic groups compared with age-matched control rats. Treatment with vitamin C, but not vitamin E, significantly reduced kidney weight compared with that in untreated diabetic rats. Immunohistochemical staining for TGF-beta was 2.5-fold higher in glomeruli of cortical sections from untreated diabetic rats versus control rats. Treatment with vitamin C or E prevented the increase in glomerular TGF-beta immunoreactivity. Glomerular volume was also significantly increased (twofold) in kidneys of untreated diabetic rats compared with control rats, as assessed by light microscopy. Treatment with vitamin C prevented and treatment with vitamin E reduced the increase in glomerular volume. Treatment with vitamin C also prevented the sevenfold increase in albumin clearance otherwise seen in untreated diabetic rats. By contrast, treatment with vitamin E had no effect on albumin clearance despite reductions in glomerular size and TGF-beta. Renal cortical vitamin E and plasma, but not renal cortical vitamin C, were reduced in diabetic rats versus control rats. Supplementation of diabetic rats with vitamin C markedly increased plasma and renal cortical vitamin C content to values greater than those in control rats. Supplementation with vitamin E increased renal cortical vitamin E content by 50% compared with values in control rats and also increased plasma and renal cortical vitamin C. These results support the potential utility of antioxidant treatment for the prevention of renal injury in diabetes.

Mechanisms of ionomycin-induced endothelial cell barrier dysfunction.

Myosin light chain (MLC) phosphorylation catalyzed by the Ca(2+)- calmodulin-dependent MLC kinase (MLCK) is critical to thrombin-mediated endothelial cell gap formation and barrier dysfunction. We have tested the hypothesis that the Ca2+ ionophore ionomycin stimulates MLCK-dependent endothelial cell contraction and permeability. Ionomycin significantly increased albumin clearance and decreased electrical resistance across confluent bovine pulmonary microvascular and macrovascular endothelial cell monolayers in a concentration-dependent manner that was temporally similar to that produced by thrombin. In contrast, however, ionomycin produced a significant Ca(2+)-dependent reduction in the levels of phosphorylated MLC with evidence of serine/threonine phosphatase activation. Potential MLCK-independent mechanisms of endothelial cell permeability were examined with little evidence to support a role for stimulated nitric oxide synthase or phospholipase A2 activities. Importantly, ionomycin produced 1) reductions in the activities of the barrier protective adenylate cyclase and the adenosine 3',5'-cyclic monophosphate-dependent protein kinase A, 2) dramatic dose- and time-dependent inhibition of endothelial cell tyrosine kinase activities, and 3) marked decreases in the phosphotyrosine content of the p125 focal adhesion kinase. These data indicate that ionomycin produces endothelial cell barrier dysfunction by mechanisms that are independent of MLCK activation and may involve reductions in endothelial cell tethering forces via inhibition of protein kinase A and tyrosine kinase activities, especially the p125 focal adhesion kinase.

Role of H1 receptors and P-selectin in histamine-induced leukocyte rolling and adhesion in postcapillary venules.

The objective of this study was to define the nature, magnitude, and mechanisms of histamine-induced leukocyte-endothelial cell interactions in postcapillary venules of the rat mesentery using intravital microscopic techniques. Superfusion of the mesentery with histamine (10(-7)-10(-5) M) resulted in a dose-related increase in the number of rolling leukocytes, a reduction in rolling velocity, and an increased clearance of FITC-labeled rat albumin from blood to superfusate. The histamine-induced recruitment of rolling leukocytes and increased albumin clearance were prevented by histamine H1 (hydroxyzine, diphenhydramine) but not H2 (cimetidine) receptor antagonists. Because histamine induces expression of the adhesion molecule P-selectin in cultured endothelial cells, a monoclonal antibody directed against rat P-selectin and soluble sialyl-LewisX oligosaccharide (the carbohydrate ligand to P-selectin) were also tested as inhibitors. Both were effective in preventing the histamine-induced recruitment of rolling leukocytes, but neither agent attenuated the increased albumin clearance. These observations suggest that (a) histamine recruits rolling leukocytes and increases albumin leakage in postcapillary venules via H1 receptor activation, (b) histamine-induced recruitment of rolling leukocytes is mediated in part by P-selectin expressed on the endothelial cell surface, and (c) the histamine-induced vascular albumin leakage is unrelated to leukocyte-endothelial cell adhesion. Our results are consistent with the view that histamine may act as a mediator of acute inflammatory reactions.

Tissue extravasation of albumin from intraabdominal trauma in rats

Intraabdominal surgery tends to lower circulating plasma volume by mechanisms unrelated to bleeding and evaporation. In chloralose-anesthetized rats, the tissue clearance of radiolabelled albumin was determined by a double isotope method. Animals were subjected to a standardized abdominal trauma, eliciting minimal bleeding and evaporation, and others served as controls. The trauma significantly increased tissue albumin extravasation in abdominal skin, abdominal wall, pancreas, small intestine, colon, mesentery and diaphragm. Considering the mass of the respective tissues, a substantial portion of the albumin extravasation took place in the abdominal wall. No increased albumin clearance was found in extra-abdominal tissues. It is suggested that abdominal surgery decreases plasma volume by extravasation in the operation field.

Pentoxifylline Lessens the Endotoxin-induced Increase in Albumin Clearance Across Pulmonary Artery Endothelial Monolayers With and Without Neutrophils

Pentoxifylline, a methylxanthine with phosphodiesterase inhibitor activity, attenuates endotoxin-induced pulmonary vascular protein leak and decreases lung neutrophil accumulation in vivo. In vitro, pentoxifylline decreases neutrophil activation as measured by superoxide release and phagocytosis of latex beads. To test the hypothesis that the beneficial effect of pentoxifylline may be via a direct effect on the endothelial cells as well as via prevention of neutrophil activation, we incubated bovine pulmonary artery endothelial cell monolayers with endotoxin and pentoxifylline in the presence or absence of human neutrophils. Albumin clearance across the monolayers was used as an index of endothelial permeability. Endotoxin (1.0 micrograms/ml) increased albumin clearance in a dose- and time-dependent fashion (207.5 +/- 25%, P less than 0.05). Co-incubation with neutrophils enhanced this effect. Pentoxifylline significantly attenuated the endotoxin-induced increase in albumin clearance both with and without neutrophils, and lessened endotoxin-induced cell lysis (chromium release) and morphologic changes. Because increased endothelial cyclic adenosine monophosphate (cAMP) levels may decrease protein permeability and pentoxifylline increases cAMP in neutrophils, we measured cAMP levels in endothelial cells. Incubation with pentoxifylline failed to raise cAMP levels in endothelial cells, in contrast to incubation with aminophylline. In conclusion, pentoxifylline attenuates endotoxin-induced increase in albumin clearance across endothelial monolayers both in the presence and absence of neutrophils. These results suggest that part of the protective effect of pentoxifylline may be mediated via effects on endothelium. Furthermore, this pentoxifylline-mediated endothelial barrier effect appears to be independent of an effect on cAMP.

Isoproterenol reduces thrombin-induced pulmonary endothelial permeability in vitro

The ability of the beta-adrenergic agonist, isoproterenol, to attenuate the thrombin-induced increase in endothelial permeability was examined by measuring 125I-labeled albumin clearance across endothelial cell monolayers. Bovine pulmonary artery endothelial cells (CCL-209) were grown to confluence on gelatinized, polycarbonate micropore filters and mounted on modified Boyden chambers with Dulbecco's modified Eagle's medium (DMEM) and 0.5% bovine serum albumin. alpha-Thrombin at 0.2 nM to 2 microM produced a dose-related increase (P less than 0.01) in 125I-labeled albumin clearance from the DMEM control value. Light and electron microscopy revealed that the thrombin-induced increase in permeability correlated with changes in cell shape and rearrangement of filamentous actin. Coincubation of 2 microM isoproterenol with 2 microM alpha-thrombin reduced (P less than 0.01) the thrombin-induced increase in albumin clearance and the observed morphological changes. This attenuation was not caused by inhibition of thrombin's enzymatically active site, since isoproterenol did not impair thrombin's fibrinogen clotting activity nor its amidolytic cleavage of an artificial substrate (Spectrozyme-TH). Coincubation of 20 microM propranolol, a beta-adrenergic antagonist, with 2 microM isoproterenol and thrombin blocked the permeability-decreasing effect of isoproterenol. Both 2 microM isoproterenol and 2 pM alpha-thrombin alone decreased (P less than 0.01) albumin clearance below the DMEM control value. These results suggest that isoproterenol can reduce the thrombin-induced increase in endothelial permeability in vitro by directly maintaining actin filaments and the shape of endothelial cells.

Phallacidin prevents thrombin-induced increases in endothelial permeability to albumin.

Calf pulmonary artery endothelial monolayers cultured on polycarbonate filters were utilized to study 125I-labeled albumin permeability and actin filament distribution in response to thrombin challenge. Thirty-minute exposure to alpha-thrombin (10(-7) M) significantly increased albumin clearance rates. These changes were associated with marked alterations in actin filament distribution, resulting in loss of peripheral actin bands and an increase in the number of cytoplasmic stress fibers. Because the actin peripheral filaments are thought to play an important role in junctional stability, we postulated that stabilization of actin filaments should protect against thrombin-induced barrier disruptions. Pretreatment of cells with 0.3 microM 7-nitrobenz-2-oxa-1,3-diazole (NBD)-phallacidin, a specific actin-stabilizing agent, prevented the changes in actin filament distribution and markedly attenuated the increase in albumin permeability. Because of the potential toxicity of phallatoxins, we evaluated the effects of pretreatment on cell viability and growth parameters. There were no differences in viability, seeding efficiency, or doubling times in cells treated with 0.3 microM NBD-phallacidin in comparison to controls. Our data support the hypothesis that actin filaments, particularly peripheral bands, contribute significantly to the maintenance of barrier function in cultured endothelial cells.

Thrombin-induced increase in albumin permeability across the endothelium.

We studied the effect of thrombin on albumin permeability across the endothelial monolayer in vitro. Bovine pulmonary artery endothelial cells were grown on micropore membranes. Morphologic analysis confirmed the presence of a confluent monolayer with interendothelial junctions. Albumin permeability was measured by the clearance of 125I-albumin across the endothelial monolayer. The control 125I-albumin clearance was 0.273 +/- 0.02 microliter/min. The native enzyme, alpha-thrombin (10(-6) to 10(-10) M), added to the luminal side of the endothelium produced concentration-dependent increases in albumin clearance (maximum clearance of 0.586 +/- 0.08 microliter/min at 10(-6) M). Gamma (gamma) thrombin (10(-6) M and 10(-8) M), which lacks the fibrinogen recognition site, also produced a concentration-dependent increase in albumin clearance similar to that observed with alpha-thrombin. Moreover, the two proteolytically inactive forms of the native enzyme, i-Pr2 P-alpha-thrombin and D-Phe-Pro-Arg-CH2-alpha-thrombin, increased the 125I-albumin clearance (0.610 +/- 0.09 microliter/min and 0.609 +/- 0.02 microliter/min for i-Pr2 P-alpha-thrombin and D-Phe-Pro-Arg-CH2-alpha-thrombin at 10(-6) M, respectively). Since the modified forms of thrombin lack the fibrinogen recognition and active serine protease sites, the results indicate that neither site is required for increased albumin permeability. The increase in albumin clearance with alpha-thrombin was not secondary to endothelial cell lysis because lactate dehydrogenase concentration in the medium following thrombin was not significantly different from baseline values. There was also no morphological evidence of cell lysis. Moreover, the increase in 125I-albumin clearance induced by alpha-thrombin was reversible by washing thrombin from the endothelium. The basis for the increased albumin permeability following the addition of alpha-thrombin appears to be a reversible change in endothelial cell shape with formation of intercellular gaps.

Serum factors other than albumin are needed for the maintenance of normal capillary permselectivity in rat hindlimb muscle.

To investigate the effects of different perfusates on capillary permeability, we determined the capillary filtration coefficient (CFC), the capillary diffusion capacity (PS) for Cr-EDTA and clearance of albumin during isogravimetric conditions and maximal vasodilatation in the isolated, perfused rat hindquarter preparation. Experiments were conducted in 30 rats with different perfusates. We were able to confirm the classical 'protein effect'. Absence of proteins, using pure dextran solution as perfusate, induced a 45% increase in CFC and a three-fold increase in albumin clearance. However, we also found evidence for a 'serum effect'. Hence, the clearance of albumin was normal when the serum content exceeded 5% (v/v) in perfusates otherwise composed of albumin in Tyrode, but increased three-fold from 0.0305 to 0.0912 ml (min X 100 g)-1 when the rats were perfused with albumin in Tyrode with no serum present, without any change in CFC, PS for Cr-EDTA or vascular resistance to flow. Thus, certain non-dialysable serum factors, other than albumin, seem to be needed for the maintenance of normal capillary permselectivity in rat hindquarters. These factors are probably needed for the capillary membrane to maintain its character of a negatively charged barrier.

Age-related changes in albumin elimination in female WAG/Rij rats.

Albumin elimination rates were determined in 3-, 12-, 24- and 36-month-old female WAG/Rij rats. No change in elimination half-life was found with age. However, as there was an increase in the whole-body albumin pool, a concomitant increase in albumin clearance was observed at between 12 and 36 months of age. It was concluded that the increase in clearance between 12 and 24 months of age was only due to a change in the animal's physiology, whereas between 24 and 36 months of age it was also due to changes in the albumin molecule. The age-related changes in albumin clearance were thought not to be caused by changes in the albumin excretion via the urine or via the gastrointestinal tract.

Determinants of the penetration of proteins through the glomerular barrier in insulin-dependent diabetes mellitus.

To investigate the determinants of the glomerular filtration of proteins in insulin-dependent diabetic patients we studied the fractional clearance of albumin (theta Alb) and IgG (theta IgG) and the selectivity index (SI = IgG clearance/Alb clearance) in 32 subjects with macroproteinuria (albustix positive), in 29 subjects with microproteinuria (albustix negative), and in 24 healthy control subjects. Fractional clearances of both albumin and IgG were higher in macroproteinuric than in microproteinuric patients, with both groups having higher values than controls (all P less than 0.001). In microproteinuric patients with albumin excretion rate (AER) not exceeding 60 micrograms/min, there was a highly significant correlation between the clearance of albumin and that of IgG. The SI was normal for AERs up to 30 micrograms/min, but above that albumin filtration increased disproportionately and SI progressively fell. In insulin-dependent diabetics with macroproteinuria, there was a negative correlation between SI and glomerular filtration rate (GFR) (r = -0.68; P less than 0.001); the lower SI (0.133 +/- 0.06) at higher GFRs also was due to a preferential increase in albumin clearance. Selectivity was progressively lost as GFR declined, and the SI returned to normal values when GFR fell below 10 ml/min/1.73 m2; this was due to a progressively higher rise in the fractional clearance of IgG relative to albumin. We suggest that glomerular filtration of proteins is governed by different determinants at different stages of the disease. In microproteinurics with AER below 60 micrograms/min, increased intraglomerular pressure seems primarily responsible for the higher proportional filtration of both albumin and IgG.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of ischemia and oxygen radicals on mucosal albumin clearance in intestine.

Mucosal albumin clearance was measured in jejunal segments of dogs under control conditions, after arterial occlusions of varying duration (15 min-4 h), and during intraluminal perfusion with hypoxanthine-xanthine oxidase. Albumin clearance rates were estimated from the luminal perfusion rate and the activity of protein-bound 125I in the perfusate and plasma. Arterial occlusion of 30-min to 4-h duration produced a significant increase in mucosal albumin clearance. The magnitude of the rise in albumin clearance was directly related to the duration of arterial occlusion. Pretreatment with superoxide dismutase, a superoxide radical scavenger, or allopurinol, a xanthine oxidase inhibitor, did not prevent the increased albumin clearance induced by 1 h of occlusion. Intraluminal perfusion with hypoxanthine-xanthine oxidase significantly increased mucosal albumin clearances. This increase was prevented by superoxide dismutase. The results of this study indicate that arterial occlusions and enzymatically generated superoxide radicals increase mucosal albumin clearance.