Microvascular Endothelial Dysfunction Research Articles

Identification and transcriptomic assessment of latent profile pediatric septic shock phenotypes

BackgroundSepsis poses a grave threat, especially among children, but treatments are limited owing to heterogeneity among patients. We sought to test the clinical and biological relevance of pediatric septic shock subclasses identified using reproducible approaches.MethodsWe performed latent profile analyses using clinical, laboratory, and biomarker data from a prospective multi-center pediatric septic shock observational cohort to derive phenotypes and trained a support vector machine model to assign phenotypes in an internal validation set. We established the clinical relevance of phenotypes and tested for their interaction with common sepsis treatments on patient outcomes. We conducted transcriptomic analyses to delineate phenotype-specific biology and inferred underlying cell subpopulations. Finally, we compared whether latent profile phenotypes overlapped with established gene-expression endotypes and compared survival among patients based on an integrated subclassification scheme.ResultsAmong 1071 pediatric septic shock patients requiring vasoactive support on day 1 included, we identified two phenotypes which we designated as Phenotype 1 (19.5%) and Phenotype 2 (80.5%). Membership in Phenotype 1 was associated with ~ fourfold adjusted odds of complicated course relative to Phenotype 2. Patients belonging to Phenotype 1 were characterized by relatively higher Angiopoietin-2/Tie-2 ratio, Angiopoietin-2, soluble thrombomodulin (sTM), interleukin 8 (IL-8), and intercellular adhesion molecule 1 (ICAM-1) and lower Tie-2 and Angiopoietin-1 concentrations compared to Phenotype 2. We did not identify significant interactions between phenotypes, common treatments, and clinical outcomes. Transcriptomic analysis revealed overexpression of genes implicated in the innate immune response and driven primarily by developing neutrophils among patients designated as Phenotype 1. There was no statistically significant overlap between established gene-expression endotypes, reflective of the host adaptive response, and the newly derived phenotypes, reflective of the host innate response including microvascular endothelial dysfunction. However, an integrated subclassification scheme demonstrated varying survival probabilities when comparing patient endophenotypes.ConclusionsOur research underscores the reproducibility of latent profile analyses to identify pediatric septic shock phenotypes with high prognostic relevance. Pending validation, an integrated subclassification scheme, reflective of the different facets of the host response, holds promise to inform targeted intervention among those critically ill.Graphical abstract

Chronic β3 adrenergic agonist treatment improves brain microvascular endothelial function and cognition in aged mice.

Microvascular endothelial dysfunction, characterized by impaired neurovascular coupling, reduced glucose uptake, blood-brain barrier disruption, and microvascular rarefaction, plays a critical role in the pathogenesis of age-related vascular cognitive impairment (VCI). Emerging evidence points to non-cell autonomous mechanisms mediated by adverse circulating milieu (an increased ratio of pro-geronic to anti-geronic circulating factors) in the pathogenesis of endothelial dysfunction leading to impaired cerebral blood flow and cognitive decline in the aging population. In particular, age-related adipose dysfunction contributes, at least in part, to an unfavorable systemic milieu characterized by chronic hyperglycemia, hyperinsulinemia, dyslipidemia, and altered adipokine profile, which together contribute to microvascular endothelial dysfunction. Hence, in the present study, we aimed to test whether thermogenic stimulation, an intervention known to improve adipose and systemic metabolism by increasing cellular energy expenditure, could mitigate brain endothelial dysfunction and improve cognition in the aging population. Eighteen-month-old old C57BL/6J mice were treated with saline or CL (β3-adrenergic agonist) for 6 weeks followed by functional analysis to assess endothelial function and cognition. CL treatment improved neurovascular coupling responses and rescued brain glucose uptake in aged animals. In addition, CL treatment also attenuated blood-brain barrier leakage and associated neuroinflammation in the cortex of aged animals. More importantly, these beneficial changes in microvascular function translated to improved cognitive performance in radial arm water maze and Y-maze tests. Our results suggest that β3-adrenergic agonist treatment improves multiple aspects of brain microvascular endothelial function and can be potentially repurposed for treating age-associated cognitive decline.

The association of microvascular disease and endothelial dysfunction with vertebral trabecular bone mineral density : The MESA study.

Microvascular diseases of the eye, kidney, and brain are associated with endothelial dysfunction and increased hip fracture risk. To explore the basis for higher hip fracture risk, we comprehensively examined whether markers of microvascular disease and/or endothelial dysfunction are related to trabecular bone mineral density (BMD), a proximate risk factor for osteoporotic fractures. Among 6814 participants in the Multi-Ethnic Study of Atherosclerosis study (MESA), we derived thoracic vertebral trabecular BMD from computed tomography of the chest and measured urine albumin to creatinine ratios (UACR), retinal arteriolar and venular widths, flow mediated dilation (FMD) of the brachial artery after 5min of ischemia; and levels of five soluble endothelial adhesion markers (ICAM-1, VCAM-1, L-selectin, P-selectin, and E-selectin). Linear regression models were used to examine the association of trabecular BMD with markers of microvascular disease and with markers of endothelial dysfunction. We observed no significant associations of UACR, retinal arteriolar or venular widths, or FMD with BMD. We also observed no statistically significant association of spine trabecular BMD with levels of endothelial adhesion markers. Men and women had largely similar results. We conclude that there is little evidence to connect thoracic spine trabecular BMD to microvascular disorders or to endothelial dysfunction among multi-ethnic middle-aged and older adults. Other factors beyond trabecular BMD (e.g., bone quality or predisposition to falling) may be responsible for the associations of microvascular disease with osteoporotic fractures.

Role of plasmacytoid dendritic cells in vascular dysfunction in mice with renovascular hypertension

Endothelial dysfunction and inflammation are clinically significant risk factors for cardiovascular diseases in hypertension. Although immune cells play a role in hypertension, the impact of plasmacytoid dendritic cells in established renovascular hypertension-induced cardiovascular complications is not fully understood. We investigated plasmacytoid dendritic cells' contribution to arterial endothelial dysfunction and inflammation in renovascular hypertension.A two-kidney one-clip (2K1C) model for four weeks in both male and female mice was used to induce renovascular hypertension. We treated mice with or without anti-PDCA-1 antibodies for one week to deplete the plasmacytoid dendritic cells. Renovascular hypertension causes cardiac hypertrophy, lung edema, and microvascular endothelial dysfunction associated with inflammation induction in mice. Moreover, renovascular hypertension affects the profile of immune cells, including dendritic cells and macrophages, with variations between male and female mice. Interestingly, the depletion of plasmacytoid dendritic cells significantly reduces blood pressure, cardiac hypertrophy, lung edema, inflammation, and oxidative stress and improves microvascular endothelial function via the endoplasmic reticulum (ER) stress, autophagy, and mTOR-dependent mechanisms.Plasmacytoid dendritic cells significantly contribute to the development of cardiovascular complications in renovascular hypertension by modulating immune cells, inflammation, oxidative stress, and ER stress.

Sphingosine-1-Phosphate Promotes Resiliency to External Stress in the Human Microvasculature

Exposure to external stress (e.g. high pressure, high glucose) promotes human microvascular endothelial dysfunction and reduces the overall magnitude of flow-induced dilation (FID). We have previously shown that treatment with sphingosine-1-phosphate (S1P), a sphingolipid known to activate pro-survival pathways in endothelial cells, restores nitric oxide (NO) as the primary mediator of flow-induced dilation (FID) in arterioles from patients with coronary artery disease. Whether pre-treatment with S1P can prevent stress-induced microvascular endothelial dysfunction remains unknown. Our hypothesis is that pre-conditioning with S1P will promote resiliency to external stress (high intraluminal pressure) and prevent stress-induced reduction of FID. Human resistance arterioles (100-250μm) from otherwise healthy adults (one risk factor or less for coronary artery disease) were dissected from discarded surgical adipose tissue and treated with S1P (1μM) or vehicle control for 16-20 hr prior to the flow experiment. Vessels were cannulated for videomicroscopy and stressed with elevated intraluminal pressure (150mmHg, 30 min) then pre-constricted with endothelin-1 prior to initiating flow to elicit dilation. Arterioles treated with vehicle and exposed to high intraluminal pressure exhibited an overall reduction in vasodilatory capacity to flow (37.3%±8.6) compared to non-stressed, vehicle treated microvessels (66.1%±5.5). However, the ability to dilate to flow was preserved in microvessels pre-treated with S1P and exposed to high pressure (74.8%±6.7) compared to vehicle and high pressure (37.3%±8.6). These data suggest that S1P-activated pathways may foster resilience by reversing stress-induced microvascular endothelial function. Targeting S1P signaling may offer a novel therapeutic strategy to prevent microvascular dysfunction and the myriad diseases it causes, such as large vessel atherosclerosis, and heart failure with preserved ejection fraction. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

L-Citrulline Supplementation Improves Leg Endothelial Function and Blood Flow Responses to Plantarflexion Exercise in Hypertensive Postmenopausal Women

Menopause and hypertension are associated with macro- and microvascular endothelial dysfunction at rest. Arginine deficiency and low nitric oxide (NO) synthesis may contribute to reduced muscle blood flow (BF) and oxygen delivery to exercising muscles. Improving BF to calf muscles may enhance physical activity. L-Citrulline supplementation (CIT) has improved resting macrovascular endothelial function via increased arginine availability for NO synthesis. Thus, the purpose of this study was to examine the effects of CIT on resting microvascular endothelial function and BF responses to plantarflexion exercise (PFE) in hypertensive postmenopausal women. We hypothesized that CIT would improve microvascular function and BF responses to PFE compared to placebo (PL). Twenty-one hypertensive postmenopausal women were randomized to 4 weeks of CIT (10g/day, n=10) or PL ( n=11). Superficial femoral macro- (flow-mediated dilation; FMD) and microvascular function (5s average peak blood velocity and flow during reperfusion) were assessed by ultrasound at 0 and 4 weeks. Femoral artery BF and vascular conductance (VC) were measured via ultrasound at rest and during 3-minute stages of rhythmic PFE at 5%, 15%, and 30% of 1-repetition maximum (1RM) at 0 and 4 weeks. BF and VC responses to PFE were analyzed as the change from rest to the last minute of each stage. There were no differences between groups in FMD, 5s peak velocity and flow during reperfusion, and vascular responses to PFE at 0 weeks. CIT significantly increased FMD (CIT:Δ1.28 ± 0.42 vs PL:Δ0.01 ± 0.40%, p = 0.04) and 5s peak velocity (CIT:Δ17.44 ± 4.21 vs PL:Δ0.09 ± 4.01 cm/s, p = 0.01) and flow (CIT:Δ220 ± 54 vs PL:Δ35 ± 51 mL/min, p = 0.02) during reperfusion compared to PL. CIT had no effect on BF and VC responses to 5% PFE ( p > 0.05). CIT significantly augmented BF responses to 15% PFE (CIT:Δ82 ± 16 vs PL:Δ22 ± 15 mL/min, p < 0.01) and 30% PFE (CIT:Δ156 ± 33 vs PL:Δ38 ± 32 mL/min, p < 0.01) and VC responses to 15% PFE (CIT:Δ0.80 ± 0.16 vs PL:Δ0.11 ± 0.15 mL*100mmHg/min, p < 0.01) and 30% PFE (CIT:Δ1.49 ± 0.29 vs PL:Δ0.24 ± 0.27 mL*100mmHg/min, p < 0.01) compared to PL. Improvements in FMD were not correlated with BF or VC responses to PFE ( p > 0.05). Improvements in 5s peak velocity were positively correlated with BF responses to 15% PFE ( r = 0.498, p = 0.02) and 30% PFE ( r = 0.532, p = 0.01), and with VC responses to 15% PFE ( r = 0.542, p = 0.01) and 30% PFE ( r = 0.633, p < 0.01). Similarly, augmented 5s flow was positively correlated with BF ( r = 0.461, p = 0.04) and VC ( r = 0.558, p = 0.01) responses to 30% PFE. These findings indicate that CIT improved superficial femoral artery macro- and microvascular endothelial function at rest. However, only improvements in microvascular endothelial function influenced vascular function during leg exercise in hypertensive postmenopausal women. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Insulin-Mediated Capillary Recruitment Is Absent in the Cutaneous Microvasculature of Women with a History of Gestational Diabetes Mellitus

Women with a history of gestational diabetes mellitus (GDM) have a significantly greater risk of developing cardiovascular disease and type II diabetes compared to women who had an uncomplicated pregnancy (HC). Although the mechanisms underlying this increased risk are unclear, emerging evidence suggests that microvascular endothelial dysfunction, mediated via reduced nitric oxide (NO)-dependent dilation, persists after pregnancy complicated by GDM. Whether this microvascular dysfunction reduces insulin-mediated responses in these women is unexplored. We hypothesized that insulin-mediated capillary recruitment would be attenuated in women with a history of GDM via NO-dependent mechanisms. 24 women (n=12/group; HC: 35±1 years, 24±4 months post-partum; GDM: 33±1 years, 21±3 months postpartum) underwent intradermal microdialysis, which involved the placement of 2 fibers in the ventral forearm for the local delivery of 10−4M insulin alone or 10−4M insulin+15mM NG-nitro-L-arginine methyl ester (L-NAME, NO-synthase inhibitor). The cutaneous blood flow response to post-occlusive reactive hyperemia (PORH; 5 minutes) was assessed before and during insulin perfusion. Red blood cell flux was measured continuously over each microdialysis site by laser-Doppler flowmetry. Cutaneous vascular conductance was calculated (CVC=flux/mean arterial pressure), normalized to maximum (%CVCmax), and presented as PORH area under the curve (AUC, %CVCmax• sec−1). Microvascular capillary recruitment was assessed as ΔAUC (pre-insulin AUC - insulin AUC). Insulin perfusion increased PORH in HC (pre-insulin: 4066±490 vs. insulin: 7848±978 AUC; p=0.03) but had no effect in GDM (pre-insulin: 3765±293 vs. insulin: 6196±779 AUC; p=0.26). Insulin perfusion did not increase PORH at the L-NAME site in either group (p>0.05). Within groups, L-NAME perfusion reduced insulin-mediated capillary recruitment in HC (control: 3781±1109 vs. L-NAME: 470±945 ΔAUC; p=0.04) but not GDM (control: 2431±796 vs. L-NAME: -41±1014 ΔAUC, p=0.11). These data suggest that insulin-mediated capillary recruitment assessed by PORH in the cutaneous circulation is mediated by NO-dependent mechanisms in healthy women with a history of uncomplicated pregnancy and attenuated in healthy women with a history of GDM. This reduction in insulin-mediated microvascular responses may contribute to the increased risk of cardiovascular disease and type II diabetes in these women. UI Fraternal Order of Eagles Diabetes Research Center Catalyst Grant; NIH HL169201. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Endothelial DRP1 mediates microvascular dysfunction in the human and rat microcirculation independent of ROS production

Introduction: Microvascular endothelial dysfunction is a strong, independent, and modifiable risk factor for the development of coronary artery disease (CAD). Under physiological conditions, an increase in blood flow stimulates endothelial cells (EC) to release nitric oxide (NO) which mediates microvascular dilation. Under pathological conditions, such as CAD, NO-mediated dilation is lost but dilator capacity is preserved by mitochondria-derived hydrogen peroxide (H2O2), a reactive oxygen species (ROS). Recent work in rodent models suggests that ATP is required for NO-mediated and increasing evidence suggests that the balance between mitochondrial ATP vs. ROS production contributes to this phenotypic switch. Mitochondrial fission, an autoregulatory process primarily mediated by DRP1, is associated with various cardiometabolic diseases and is a direct contributor to increased reactive oxygen species (ROS) formation and decreased production of ATP. However, the role of DRP1 in the endothelium and it impacts on vascular function is unknown. Hypothesis: We hypothesize that mitochondrial fission, mediated by DRP1, is a critical regulator of microvascular redox balance. Methods: Microvessels (~50-200μm) were obtained from discarded human adipose surgical tissue from individuals with and without CAD or from rat mesentery and subjected to pressure myography (flow-mediated dilation; FMD). A fluorescent mitochondrial-specific ATP probe was measured in vessels after 10 minutes at maximal shear stress. DRP1 overexpression was achieved by adeno-associated viral (AAV) gene transfer and downregulated via DRP1 targeted siRNA (si-DRP1). To show physiologic and translational relevance, a transgenic rat model with a cre-inducible endothelial-specific overexpression of DRP1 (DRP Tg) was created to test the in vivo effects of EC-DRP1 overexpression. To test whether reduction of ROS improved the observed phenotype, vessels were acutely treated ex vivo in the organ chamber with TEMPOL, a cytosolic antioxidant, and mito-tempo, a mitochondrial antioxidant. Two-way ANOVA, post-hoc analysis was performed using PRISM to best understand the effects of the treatment and pressure-gradient. T-test was performed for comparison analyses between patients with/without CAD. Results:Fluorescent analysis of showed that ATP is increased in vessels obtained from patients without CAD compared to those with CAD (6.3 vs 1.1, mean fluorescent intensity, N=3, p<0.05). In vessels obtained from patients without CAD, AAV-mediated DRP1 overexpression switches the mediator of FMD from NO to H2O2 (inhibitable by PEG-Catalase, max dilation 83.2% vs. 20.2%, N=6, p<0.05). Conversely, arterioles obtained from patients with CAD treated with si-DRP1 restores NO-mediated dilation (inhibitable by L-NAME, max dilation 94.6% vs. 41.7%, N=5, p<0.05). In the rat microcirculation, FMD is significantly impaired in EC-DRP1 rats compared to littermate controls (max dilation 41.2% vs. 80.3%, N=9, p<0.05). Scavenging of ROS (TEMPOL and mito-Tempo) does not restore the phenotype in both human and rat microcirculation suggesting DRP1 mediates dysfunction independent of ROS, which is in line with preliminary observations of reduced flow-induced ATP levels in vessels from patients with CAD. Significance: These data indicate that ROS may be secondary to mitochondrial fission rather than causal to the microvascular phenotype observed in patients with CAD. Therefore, targeting endothelial mitochondrial fission may be of therapeutic benefit to treat cardiovascular disease. AHA Diversity Research Pre-Doctoral Award (CGH), 5P30ES030283-04 (AJL), 5R01HL133029-5 (AB), 5R21OD018306-2 (AB). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Acute and chronic hyperglycemia blunts microvascular reactivity in postmenopausal women with type 2 diabetes

Type 2 diabetes (T2D) is strongly associated with increased risk of cardiovascular diseases via endothelial dysfunction. Hyperglycemia causes microvascular endothelial dysfunction and reduces muscle perfusion. Near-infrared spectroscopy (NIRS) measures microvascular reactivity in skeletal muscle during vascular occlusion/reperfusion. However, the impact of acute and chronic hyperglycemia on macrovascular endothelial function (brachial flow-mediated dilation, FMD) and microvascular reactivity (NIRS-derived tissue oxygen saturation index, TOI) has not been examined in postmenopausal women with and without T2D. We hypothesized that T2D women would have decreased FMD and TOI responsiveness in the fasted condition and greater vascular impairments during acute hyperglycemia compared to controls.Ten T2D (61 ± 5 years) and 10 normoglycemic postmenopausal women (CON, 62 ± 7 years) participated in the study. Hemoglobin A1C (HbA1C) and blood glucose were measured by finger prick at baseline (fasted condition). Brachial artery FMD was evaluated using ultrasound. Forearm muscle TOI magnitude and slope during arterial occlusion and reperfusion periods were measured using NIRS. An oral glucose tolerance test (OGTT) was performed to induce acute hyperglycemia. Blood glucose, FMD, and TOI were measure at baseline and 1 hour (1-h) after OGTT. Abdominal fat was assessed by waist circumference and visceral adipose tissue (VAT) obtained by a whole-body dual-energy X-ray absorptiometry scan.Fasting HbA1C and glucose, waist circumference, and VAT were higher in T2D compared to CON (all p < 0.05). The increase in blood glucose at 1-h was higher in T2D (Δ143 ± 15 mg/dl) compared to CON (Δ49 ± 5 mg/dl) (p < 0.01). FMD at baseline and the decreases in FMD at 1-h were similar in T2D (Δ-2.2 ± 0.2%) and CON groups (Δ-1.9 ± 0.4%) (all p < 0.01). At baseline, T2D showed blunted TOI occlusion magnitude (T2D: -16 ± 1 vs. CON: -21 ± 2%), TOI occlusion slope (T2D: -0.05 ± 0.01 vs. CON: -0.07 ± 0.01), TOI reperfusion magnitude (T2D: 21 ± 2 vs. CON: 32 ± 3%), and TOI reperfusion slope (T2D: 0.79 ± 0.10 vs. CON: 1.19 ± 0.14) compared to CON (all p < 0.05). At 1-h, T2D exhibited lower TOI occlusion magnitude (T2D: -17 ± 2 vs. CON: -24 ± 3%), TOI occlusion slope (T2D: -0.06 ± 0.01 vs. CON: -0.08 ± 0.01), TOI reperfusion magnitude (T2D: 23 ± 2 vs. CON: 33 ± 4%), and TOI reperfusion slope (T2D: 0.90 ± 0.19 vs. CON: 1.14 ± 0.15) compared to CON (all p < 0.05). HbA1C, a measure of chronic hyperglycemia, was positively correlated with VAT (r = 0.514, p = 0.02) and TOI occlusion slope (r = 0.460, p = 0.04) and negatively correlated with TOI reperfusion magnitude (r = -0.506, p = 0.02) and slope at baseline (r = -0.493, p = 0.03). In conclusion, women with T2D exhibited blunted microvascular reactivity despite similar FMD compared with normoglycemic women in the fasted condition. Acute hyperglycemia further blunted microvascular function, but not macrovascular endothelial function, in women with T2D. Blunted microvascular reactivity was associated with chronic hyperglycemia and elevated VAT in postmenopausal women. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Chronic Estrogen Treatment Promotes Human Microvascular Endothelial Dysfunction Through Sex-Specific Regulation of Ceramide Formation

Risk for cardiovascular disease (CVD) is elevated in individuals assigned female at birth and women of trans experience (assigned male at birth) undergoing long-term estrogen therapy (e.g. contraception, gender-affrmation). We have previously shown that chronic estrogen treatment induces microvascular endothelial dysfunction in human arterioles collected from those assigned male and female at birth. The mechanism via which estrogen causes microvascular damage remains unknown. Estrogen can increase expression of the ceramide-forming enzyme neutral sphingomyelinase (NSmase), and elevated ceramides promote cellular oxidative stress. Together, we hypothesize that estrogen induces microvascular endothelial dysfunction via NSmase-mediated ceramide formation. Human arterioles from otherwise healthy adults were treated with 17β-estradiol (E2; 100nM) +/- NSmase inhibitor (GW4869; 4μM, 24hrs). Vascular response to increasing flow rates was assessed using live videomicroscopy. Sex-specific human umbilical vein endothelial cells were treated with E2+/-GW4869 (48hrs), and H2O2 levels were measured using the fluorescent indicator peroxy yellow 1 (PY1). Endothelial ceramide levels were measured using liquid chromatography, tandem mass spectrometry. Exposure to estrogen impaired dilation to flow in arterioles from those assigned male and female at birth, an effect that was prevented by inhibition of NSmase (%Mean Dilation±SE; E2 vs E2+GW4869; male: 11.20±4.99% vs 48.43±7.15%, n=3 both, p=0.037; female: 1.78±1.99% vs 40.35±8.46%, n=5 both, p=0.006; two-way ANOVA). Estrogen treatment increased endothelial H2O2 production in cells from both sexes which was diminished by GW4869 treatment (%Change from control±SE; E2 vs E2+GW4869; male: 20.90±5.86% vs 2.85±1.99%, n=11 both, p=0.009*; female: 63.33±13.65%, n=10 vs 25.25±7.64%, n=9, p=0.031*, unpaired t-test*). Endothelial long-chain ceramide levels were higher in cells from biological males compared to females (pmol/nmol phosphate; male 5.90±2.19, n=4 vs female 2.18±0.86, n=5; p=0.009*). While estrogen treatment increased cellular ceramides in both sexes, ceramide accumulation was greater in cells from biological males compared to females (%change from baseline: 65.97±53.64% vs 6.08±7.86%, p=0.041*). Together, these results show that estrogen-induced microvascular endothelial dysfunction can be prevented through inhibition of NSmase-mediated ceramide formation. There is also notable sexual dimorphism in endothelial ceramide levels both at baseline and in response to estrogen. This study offers mechanistic insight into how chronic estrogen therapy may contribute to microvascular dysfunction and elevate the risk of CVD in patients. Furthermore, it presents the inhibition of NSmase as a plausible therapeutic approach to safeguard microvascular integrity during estrogen therapy. NHLBI R01HL160752 (J.K.F.), NHLBI K08HL141562 (J.K.F.), and AHA predoctoral fellowship grant 909315 (G.S.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hemoglobin-Mediated Oxidation of Low-Density Lipoprotein (oxLDL) Contributes to Lung Microvascular Endothelial Dysfunction Via Lectin-Like Oxidized LDL Receptor 1 (LOX-1)

Introduction: Lung microvascular endothelial barrier disruption is a critical feature of acute lung injury during several pathologies, including sepsis. Plasma cell-free hemoglobin (CFH) is elevated in approximately 80% of patients with sepsis and is independently associated with development of acute respiratory distress syndrome (ARDS) and mortality. However, the precise signaling mechanisms involved in CFH-mediated lung microvascular barrier dysfunction are incompletely understood. One potential mechanism by which CFH might disrupt the microvascular endothelial barrier is through its known ability to oxidize lipids and lipoproteins, including low-density lipoprotein (LDL). Oxidized LDL (oxLDL) is a known endothelial barrier disruptor, primarily signaling through scavenger receptors such as lectin-like oxidized LDL receptor 1 (LOX-1). We hypothesized that CFH-mediated oxidation of LDL exacerbates lung microvascular endothelial barrier dysfunction via LOX-1. Methods: For experimental studies, LDL was oxidized by combining LDL with CFH in a test tube overnight at 37°C and oxidation of LDL was quantified by TBARS assay. In primary human lung microvascular endothelial cells (HLMVEC), barrier dysfunction was assessed with expert permeability testing (XPerT) assay. HLMVEC were stimulated with vehicle control (PBS), LDL (0.05 mg/mL), CFH (0.5 mg/mL), or LDL oxidized by CFH (LDL+CFH) with or without one-hour pre-treatment of hemoglobin scavenger haptoglobin (1:1) or LOX-1 inhibitor BI-0115 (Boehringer Ingelheim, 10 μM). Cleaved caspase-3 (CST 9661, 1:500) was assessed with immunofluorescence microscopy. To test whether CFH and oxLDL are associated in clinical sepsis, circulating levels of CFH and oxLDL were measured in 60 sepsis patients via ELISA. Results: Oxidation of LDL by CFH (p=0.0006 by TBARS) exacerbated HLMVEC barrier dysfunction (p<0.0001 by XPerT) but was partially prevented by scavenging CFH with haptoglobin (p<0.0001 by XPerT) or blocking LOX-1 receptor (p<0.0001 by XPerT). Oxidation of LDL by CFH stimulation of HLMVEC also increased caspase-3 activation (p<0.0001 by immunofluorescence of cleaved caspase-3). In sepsis patients, circulating oxLDL levels correlated with CFH (r=0.4, p=0.002). Conclusions: Oxidation of LDL by CFH contributes to lung microvascular endothelial injury via LOX-1 receptor and activation of caspase-3; targeting this pathway may hold therapeutic potential to treat pathologies in which CFH is elevated, including sepsis-induced acute lung injury/ARDS. Funding: Parker B. Francis Fellowship (JEM); NIH K99HL166865 (JEM), R01HL158906 (LBW), R01HL164937 (LBW), R21GM144915 (LBW, JAB), R35HL150783 (JAB), RF1AG075341 (JAB). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Use of Statins in Heart Failure with Preserved Ejection Fraction: Current Evidence and Perspectives.

Systemic inflammation and coronary microvascular endothelial dysfunction are essential pathophysiological factors in heart failure (HF) with preserved ejection fraction (HFpEF) that support the use of statins. The pleiotropic properties of statins, such as anti-inflammatory, antihypertrophic, antifibrotic, and antioxidant effects, are generally accepted and may be beneficial in HF, especially in HFpEF. Numerous observational clinical trials have consistently shown a beneficial prognostic effect of statins in patients with HFpEF, while the results of two larger trials in patients with HFrEF have been controversial. Such differences may be related to a more pronounced impact of the pleiotropic properties of statins on the pathophysiology of HFpEF and pro-inflammatory comorbidities (arterial hypertension, diabetes mellitus, obesity, chronic kidney disease) that are more common in HFpEF. This review discusses the potential mechanisms of statin action that may be beneficial for patients with HFpEF, as well as clinical trials that have evaluated the statin effects on left ventricular diastolic function and clinical outcomes in patients with HFpEF.

Activation of Piezo-1 Prevents Human Microvascular Endothelial Dysfunction During Acute Inhibition of Ceramide Formation

Despite the well-known damaging effects of elevated intracellular ceramides on human microvascular function, our recent work has shown that inhibition of ceramide formation through neutral sphingomyelinase (NSmase) promotes endothelial dysfunction in arterioles from healthy adults, manifested as endothelial production of hydrogen peroxide (H2O2), rather than nitric oxide (NO), in response to flow (flow-induced dilation; FID). Recent evidence suggests that ceramide prevents inactivation of Piezo-1, a shear-sensitive Ca2+ channel and inhibition of Piezo-1 reduces endothelial nitric oxide synthase (eNOS) activation in response to flow. Together, we hypothesized that ceramide-induced Piezo-1 activation is required to maintain NO-mediated FID in human microvessels and thus agonism of Piezo-1 during NSmase inhibition will prevent endothelial dysfunction. Arterioles (100-250μm) from healthy adults were dissected from discarded surgical adipose tissue. Vessels were cannulated in organ chambers, pre-constricted with endothelin-1, and changes in internal diameter in response to increases in flow were measured with videomicroscopy. Peroxy yellow 1 (PY1) fluorescent probe was used to assess endothelial H2O2 production in human umbilical vein endothelial cells (HUVECs). Mean% maximal dilation or fluorescent intensity±SE with two-way repeated measures ANOVA is reported. FID was preserved with Piezo-1 agonism (Yoda-1, 1μM, 30min) during NSmase inhibition (GW4869 4μM, 30min; 73±16.8, n=4 vs control 73±8.2, n=9; p>0.05), however FID was diminished in the presence of the eNOS inhibitor L-NAME (100μM; -2.6±11.3, n=5; p<0.05). A similar switch to NO-mediated FID was seen with C2-ceramide (5μM)+GW4869 (70.1±9.7 vs +L-NAME -3±9.7, n=4 both; p<0.05). NSmase inhibition increased H2O2 production in HUVECs (5.2±7.4 vs 83.0±31.6, n=6; p<0.05), an effect that was diminished with Yoda-1 (5.1±7.5, n=4; p<0.05) and C2-ceramide (10.7±9.2, n=5; p<0.05). These data suggest a role for Piezo-1 in NSmase-induced NO-signaling and provide mechanistic insight into how ceramide may exert beneficial effects within the human microvasculature. This research is supported by the National Institute of Health (NHLBI) R01HL160752 (JKF) and the American Heart Association (AHA) Predoctoral Fellowship 909315 (GSK). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Antidepressant Treatment Preserves Microvascular Endothelium-Dependent Dilation in Women Who Have Had Preeclampsia

Women with a history of preeclampsia (hxPE) demonstrate persistent microvascular endothelial dysfunction which may contribute to the progression of cardiovascular disease. Women with hxPE also have higher rates of depression compared to women with a history of healthy pregnancy. Interestingly, accumulating evidence indicates that antidepressant treatment may have vasculoprotective effects and attenuate preeclampsia risk. However, whether antidepressant treatment impacts microvascular function in these women remains unknown. Therefore, we examined the effect of chronic antidepressant use on microvascular function in women with hxPE. We hypothesized that antidepressant-treated women with hxPE would have greater endothelium-mediated microvascular vasodilation than unmedicated women with hxPE. Five women with hxPE who were currently treated with an antidepressant (hxPE+AD; 36±3 years; 26±7 months postpartum), six who were not (hxPE-AD; 34±2 years; 26±5 months postpartum), and six unmedicated women with a history of uncomplicated pregnancy (HC; 37±1 years; 35±7 months postpartum) participated in one study visit. We measured cutaneous vascular conductance (CVC=laser doppler flowmetry flux/MAP) responses to graded perfusion of acetylcholine (10−10-10−1 mM) via microdialysis in a control (lactated Ringer's) site and a site treated with 15 mM NG-nitro-L-arginine methyl ester [L-NAME; nitric oxide (NO) synthase inhibitor]. hxPE-AD had reduced endothelium-dependent dilation compared to HC (acetylcholine ³10−3 mM; P<0.03). hxPE+AD had greater endothelium-dependent dilation compared to hxPE-AD (acetylcholine 10−2 and 10−3 mM; P<0.02) and there were no differences between hxPE+AD and HC (all P>0.05). L-NAME reduced endothelium-dependent dilation in all groups (all P<0.001), and there was no difference between groups in NO-dependent dilation [area under the curve (AUC) at a control site − AUC at a L-NAME treated site; P=0.522]. These data suggest that microvascular endothelium-dependent dilation is preserved in women with a history of preeclampsia treated with an antidepressant, potentially mediated through non-NO-dependent mechanisms. Funding: American Heart Association CDA 937990. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Early microvascular coronary endothelial dysfunction precedes pembrolizumab-induced cardiotoxicity. Preventive role of high dose of atorvastatin.

Immune checkpoint inhibitors (ICIs) exhibit remarkable antitumor activity and immune-related cardiotoxicity of unknown pathomechanism. The aim of the study was to investigate the ICI class-dependent cardiotoxicity in vitro and pembrolizumab's (Pem's) cardiotoxicity in vivo, seeking for translational prevention means. Cytotoxicity was investigated in primary cardiomyocytes and splenocytes, incubated with ipilimumab, Pem and avelumab. Pem's cross-reactivity was assessed by circular dichroism (CD) on biotechnologically produced human and murine PD-1 and in silico. C57BL6/J male mice received IgG4 or Pem for 2 and 5weeks. Echocardiography, histology, and molecular analyses were performed. Coronary blood flow velocity mapping and cardiac magnetic resonance imaging were conducted at 2weeks. Human EA.hy926 endothelial cells were incubated with Pem-conditioned media from human mononuclear cells, in presence and absence of statins and viability and molecular signaling were assessed. Atorvastatin (20mg/kg, daily) was administered in vivo, as prophylaxis. Only Pem exerted immune-related cytotoxicity in vitro. Pem's cross-reactivity with the murine PD-1 was confirmed by CD and docking. In vivo, Pem initiated coronary endothelial and diastolic dysfunction at 2weeks and systolic dysfunction at 5weeks. At 2weeks, Pem induced ICAM-1 and iNOS expression and intracardiac leukocyte infiltration. At 5weeks, Pem exacerbated endothelial activation and triggered cardiac inflammation. Pem led to immune-related cytotoxicity in EA.hy926 cells, which was prevented by atorvastatin. Atorvastatin mitigated functional deficits, by inhibiting endothelial dysfunction in vivo. We established for the first time an in vivo model of Pem-induced cardiotoxicity. Coronary endothelial dysfunction precedes Pem-induced cardiotoxicity, whereas atorvastatin emerges as a novel prophylactic therapy.

TLN1 synergizes with ITGA5 to ameliorate cardiac microvascular endothelial cell dysfunction.

The complex process of atherosclerosis is thought to begin with endothelial cell dysfunction, and advanced atherosclerosis is the underlying cause of coronary artery disease (CAD). Uncovering the underlying mechanisms of CAD-related endothelial cell injury may contribute to the treatment. Cardiac microvascular endothelial cells (CMVECs) were treated with oxidised low-density lipoprotein (ox-LDL) to mimic an injury model. The involvement of Talin-1 (TLN1) and integrin alpha 5 (ITGA5) in the proliferation, apoptosis, angiogenesis, inflammatory response, and oxidative stress in CMVECs were assessed. TLN1 overexpression assisted CMVECs in resistance to ox-LDL stimulation, with alleviated cell proliferation and angiogenesis, reduced apoptosis, inflammatory response, and oxidative stress. TLN1 overexpression triggered increased ITGA5, and ITGA5 knockdown reversed the effects of TLN1 overexpression on the abovementioned aspects. Together, TLN1 synergized with ITGA5 to ameliorate the dysfunction in CMVECs. This finding suggests their probable involvement in CAD, and increasing their levels is beneficial to disease relief.

Kinase PIM1 governs ferroptosis to reduce retinal microvascular endothelial cell dysfunction triggered by high glucose.

Previous studies have implicated targeting Pim-1 proto-oncogene, serine/threonine kinase (PIM1) as a preventive measure against high glucose-induced cellular stress and apoptosis. This study aimed to reveal the potential role and regulatory mechanism of PIM1 in diabetic retinopathy. Human retinal microvascular endothelial cells (hRMECs) underwent high glucose induction, and fluctuations in PIM1 levels were assessed. By overexpressing PIM1, its effects on the levels of inflammatory factors, oxidative stress indicators, migration and tube formation abilities, tight junction protein expression levels, and ferroptosis in hRMECs were identified. Afterwards, hRMECs were treated with the ferroptosis-inducing agent erastin, and the effect of erastin on the above PIM1 regulatory functions was focused on. PIM1 was downregulated upon high glucose, and its overexpression inhibited the inflammatory response, oxidative stress, cell migration, and tube formation potential in hRMECs, whereas elevated tight junction protein levels. Furthermore, PIM1 overexpression reduced intracellular iron ion levels, lipid peroxidation, and levels of proteins actively involved in ferroptosis. Erastin treatment reversed the impacts of PIM1 on hRMECs, suggesting the mediation of ferroptosis in PIM1 regulation. The current study has yielded critical insights into the role of PIM1 in ameliorating high glucose-induced hRMEC dysfunction through the inhibition of ferroptosis.

Update on Hemodialysis-Induced Multiorgan Ischemia: Brains and Beyond.

Hemodialysis is a life-saving treatment for patients with kidney failure. However, patients requiring hemodialysis have a 10-20 times higher risk of cardiovascular morbidity and mortality than that of the general population. Patients encounter complications such as episodic intradialytic hypotension, abnormal perfusion to critical organs (heart, brain, liver, and kidney), and damage to vulnerable vascular beds. Recurrent conventional hemodialysis exposes patients to multiple episodes of circulatory stress, exacerbating and being aggravated by microvascular endothelial dysfunction. This promulgates progressive injury that leads to irreversible multiorgan injury and the well-documented higher incidence of cardiovascular disease and premature death. This review aims to examine the underlying pathophysiology of hemodialysis-related vascular injury and consider a range of therapeutic approaches to improving outcomes set within this evolved rubric.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

Towards the preclinical diagnosis of diabetic retinopathy and diabetic macular oedema using tear samples

Aims/Purpose: A wide spectrum of molecular‐genetic events, including inflammation (INF), angiogenesis (ANG), apoptosis (AP) and the concurrence of miRNAs and target genes, are involved in diabetic retinopathy (DR) and diabetic macular oedema (DMO). To unravel the complex pathogenesis of DR and DMO, we focus on the microvascular endothelial dysfunction (MVED) pathophysiologic pathways.Methods: Volunteers of both sexes, aged 35–80 years were enrolled and distributed into type 2 diabetics (T2DM), with DR (+DRG; n = 35), without DR (−DRG; n = 35), with DMO (DMOG; n = 28), and controls (CG; n = 40). Sociodemographic and comorbid data, ophthalmologic parameters, and molecular‐genetic variables related to INF, ANG, and AP, assayed in tear samples, were recorded. Statistics were performed by the R Core Team (2022) program.Results: Most of our participants were middle‐aged (mean age was 58 ± 11 years). Differential expression profile in tears was found statistically significant for SOCS6 gene (involved in INF) target of hsa‐miR‐155‐5p, VEGF‐A gene (implicated in ANG) target of hsa‐miR‐15b‐5p, and the BCL2L2 gene (AP effector) target of hsa‐miR‐10a‐5p, in both the +DRG and DMOG, as compared to the −DRG and CG.Conclusions: We confirm that INF, ANG, and AP, regulated by the hsa‐miR‐155‐5p, hsa‐miR‐15b‐5p and hsa‐miR‐10a‐5p, and its respective target genes SOCS6, VEGF‐A, and BCL2L2, expressed in tears, are key players in the development of structural and functional chorioretinal changes associated with MVED in DR/DMO patients. We may propose the above insights as potential diagnostic‐prognostic biomarkers for better managing the diabetic eyes and vision.

MiR-98-3p alleviates lipopolysaccharide-induced pulmonary microvascular endothelial barrier dysfunction by targeting DKK3 in sepsis-induced acute lung injury.

Endothelial barrier dysfunction is critical for the pathogenesis of sepsis-induced acute lung injury (ALI). Lipopolysaccharide (LPS)-stimulated human pulmonary microvascular endothelial cells (HPMECs) are widely used as the cell model of sepsis-associated ALI for exploration of endothelial barrier dysfunction. Dickkopf (DKK) family proteins were reported to mediate endothelial functions in various diseases. The present study explored the effect of Dickkopf-3 (DKK3) on endothelial barrier permeability, angiogenesis, and tight junctions in LPS-stimulated HPMECs. RT-qPCR was required for detecting DKK3 and miR-98-3p expression. The angiogenesis of HPMECs was evaluated by tube formation assays. Monolayer permeability of HPMECs was examined by Transwell rhodamine assays. The protein expression of DKK3 and tight junctions in HPMECs was measured via western blotting. Luciferase reporter assay was used to verify the interaction between miR-98-3p and DKK3. LPS treatment inhibited angiogenetic ability while increasing the permeability of HPMECs. DKK3 expression was upregulated while miR-98-3p level was reduced in LPS-treated HPMECs. DKK3 knockdown alleviated HPMEC injury triggered by LPS stimulation. MiR-98-3p targeted DKK3 in HPMECs. Overexpression of miR-98-3p protects HPMECs from the LPS-induced endothelial barrier dysfunction, and the protective effect was reversed by DKK3 overexpression. MiR-98-3p ameliorates LPS-evoked pulmonary microvascular endothelial barrier dysfunction in sepsis-associated ALI by targeting DKK3.