David J. Dzielak

Immune System Dysfunction Contributes to the Aetiology of Spontaneous Hypertension

Spontaneously hypertensive rats (SHRs) have a depressed T lymphocyte system, especially a reduced activity of the suppressor T cells, and it has been postulated that an auto-immune defect may be important in the aetiology of hypertension in these rats. In an earlier study we demonstrated that chronic immunosuppressive therapy prevents approximately 50% of the hypertension in the SHR. In the present study, an attempt was made to correct the immune imbalance by implanting thymic tissue from normotensive rats into SHRs. Weekly thymic implants from Wistar donor rats into 16-week-old SHRs produced a maximal reduction (P less than 0.05) in the tail-cuff pressure, after 4 weeks, to a level of 156 +/- 2.3 mmHg (n = 8) in thymus-implanted SHRs versus 189 +/- 2.5 mmHg (n = 6) in sham-implanted SHRs. Also, neonatal thymic implants delayed development of spontaneous hypertension and attenuated the final hypertensive state. Mean arterial pressure averaged 186 +/- 2.8 mmHg in 22-week-old, neonatally sham-implanted SHRs, while it was reduced (P less than 0.05) to 164 +/- 4.2 mmHg in the neonatally thymus-implanted SHRs at this time. The thymic implants had little effect on total T cell, helper T cell or suppressor T cell counts. However, the antihypertensive effect of the thymic implants was associated with a substantial increase in the blastogenic responsiveness of suppressor T cells from the SHRs. These results support the hypothesis that immunological dysfunction plays an important role in the aetiology of spontaneous hypertension.

Diastolic Compliance Is Reduced in Obese Rabbits

Obesity often leads to symptoms of cardiopulmonary congestion associated with normal systolic but abnormal diastolic function. This study analyzed alterations in passive diastolic compliance in obesity using the rabbit model. New Zealand White rabbits were fed a normal (n=8) or 10% added fat diet (n=8). After 12 weeks, rabbits fed the high fat diet developed obesity (5.34+/-0.11 versus 3.68+/-0. 04 kg, P</=0.05) and left ventricular hypertrophy (1.37+/-0.07 versus 0.98+/-0.03 g dry weight, P</=0.05). Compliance was assessed with the isolated heart preparation by analyzing the passive end-diastolic left ventricular pressure-volume relationship. The pressure-volume relation was fit to an exponential function by regression analysis; results showed that the modulus of stiffness was greater in obese than in lean rabbits (1.21+/-0.16 versus 0. 83+/-0.05, P</=0.05), indicating that diastolic compliance was reduced. Computer simulation analyses suggested that an isolated reduction in diastolic compliance may contribute to elevated cardiac filling pressures and exercise intolerance. These data suggest that diastolic compliance is reduced early in the development of obesity and may be an important component in the reduction of cardiac reserve in obesity.

Role of the renal nerves in one-kidney, one clip hypertension in rats.

The effects of renal denervation on the onset and maintenance of one-kidney, one clip Goldblatt (1K1C) hypertension were determined. Renal denervation was performed at the time of 1K1C surgery, and was repeated at 3-week intervals to prevent renal nerve regeneration. Denervation delayed the onset of 1K1C hypertension by about 5 weeks, but the final hypertensive state was unaltered. Mean arterial pressure (MAP) averaged 196 +/- 11.4 mm Hg in six rats at 9 weeks after 1K1C surgery and 194 +/- 11.3 mm Hg in eight renal-denervated rats at this time. The delay in the development of 1K1C hypertension following renal denervation could not be explained by interference with renin release. This delay in the development of hypertension could be prevented, however, in renal-denervated 1K1C rats by substituting saline for the drinking water. Two weeks after 1K1C surgery and a high sodium diet, MAP averaged 164 +/- 6.4 mm Hg in eight rats rats with intact renal nerves and 173 +/- 4.8 mm Hg in nine renal-denervated rats. Intact renal nerves are not necessary for the development or maintenance of 1K1C hypertension. Renal denervation delays development of 1K1C hypertension, possibly by delaying the ability of these rats to retain sodium.

Mechanisms of partial renal infarct hypertension

Contributions of both the renin-angiotensin and immune systems to the aetiology of renal infarct hypertension were examined in Sprague-Dawley rats. Partial renal infarction was produced by ligating and sectioning two out of three branches of the left renal artery. The right kidney remained intact. Renal infarction resulted in rapid development of stable hypertension. One week following infarction, the plasma renin activity (PRA) increased more than threefold. However, PRA returned to control levels 4 weeks after infarction. Chronic immunosuppressive therapy with cyclophosphamide at most only attenuated the development of renal infarct hypertension associated with this transient renin elevation. However, cyclophosphamide prevented the later maintenance phase of the hypertension, and could also completely reverse established infarct hypertension. Activation of the renin-angiotensin system plays a role in the onset of partial renal infarct hypertension, but an intact immune system is required for maintenance of the hypertension. It is hypothesized that immunological reactions against renal tissue maintain renal infarct hypertension.

Spontaneous Hypertension Is Primarily the Result of Sympathetic Overactivity and Immunologic Dysfunction

Abstract Overactivity of the sympathetic nervous system and immunologic dysfunction have been shown to contribute to development and maintenance of hypertension in the Okamoto spontaneously hypertensive rat (SHR). In this study, the combined effects of reduction in sympathetic activity and immunologic manipulation on spontaneous hypertension have been determined. Neonatal SHRs received sham implants or implants of thymic tissue from Wistar donor rats. In addition, the thymus-implanted SHRs underwent bilateral renal denervation when they were 6 weeks old. At the same time, the sham-implanted SHRs underwent sham renal denervation. The denervations or sham operations were repeated when the SHRs were 9, 12, 15, and 18 weeks old. Wistar-Kyoto (WKY) rats also underwent serial sham renal denervations. Tail-cuff pressure measurements indicated that approximately 75% of the chronic hypertension in the SHRs was prevented by the combination of thymic implants and renal denervations. Direct arterial pressure measurements confirmed these results; when the rats were 21 weeks old, mean arterial pressure averaged 177 ± 5.5 mm Hg in sham-operated SHRs, 134 ± 2.7 mm Hg in implanted, denervated SHRs, and 121 ±2.1 mm Hg in sham-operated WKY rats. These data indicate that overactivity of the sympathetic nervous system and immunologic dysfunction account for the majority of the hypertension in the Okamoto SHR.

Interleukin-2 and spontaneous hypertension.

There are conflicting reports with regard to the antihypertensive effectiveness of interleukin-2 in the spontaneously hypertensive rat Recently, the original claim of a normalization of arterial pressure in the spontaneously hypertensive rat after a single administration of interleukin-2 has been disputed. Therefore, the present study was performed to determine whether the administration of interleukin-2 was effective in attenuating both the development and maintenance of hypertension in the spontaneously hypertensive rat Both young prehypertensive spontaneously hypertensive rats and adult spontaneously hypertensive rats with established hypertension received a single subcutaneous dose of 5,000 units/kg human recombinant interleukin-2. Arterial pressure was monitored at weekly intervals in both control and treated animals by the tail-cuff technique. Interleukin-2 administered as a one time single injection had no effect on the development of hypertension in the young animals or on the maintenance of hypertension in the adult animals. Interleukin-2 also was administered as a continuous infusion via osmotic minipumps at dose levels of 5,000 and 50,000 units/kg/wk to both young and adult spontaneously hypertensive rats. Continuous administration of interleukin-2 also had no effect on the development or maintenance of spontaneous hypertension. Therefore, this study firmly demonstrates that interleukin-2 has no effect on the onset or maintenance of hypertension in the spontaneously hypertensive rat

Emerging concepts in cardiovascular disease: should elevated serum uric acid be considered a risk factor?

Uric acid is the final breakdown product of purine metabolism in man. There is a growing body of evidence that indicates that elevated uric acid levels increase the probability of developing hypertension and cardiovascular disease. The frequency of hyperuricaemia in untreated hypertensive individuals ranges from 25 - 50%. Furthermore, elevated serum uric acid has been reported to increase the probability of developing hypertension by 87% and to increase the mortality rate from ischaemic heart disease. Several studies have reported that changes in serum cholesterol parallel changes in serum uric acid in both order and magnitude. Most recently, hyperuricaemia has been added to the constellation of abnormalities that comprise Syndrome X. The pathophysiology of hyperuricaemia and the link between hyperuricaemia, hypertension and cardiovascular disease are poorly understood. It is entirely possible that hyperuricaemia is part of a pathologic process that underlies fundamental alterations in renal function, as well as other metabolic pathophysiologies that ultimately lead to hypertension and cardiovascular disease.

Comparative pharmacology of the angiotensin II receptor antagonists.

The non-peptide angiotensin II (AII) receptor antagonists are a new class of compounds that are continuing to be developed as therapeutic agents for the treatment of hypertension, heart failure (HF) and chronic renal disease (CRD). Several of these compounds are currently available for therapeutic use in the USA and the European community with several more in clinical trials and in development. Compounds in this new class are as effective as angiotensin converting enzyme (ACE) inhibitors in treating hypertensive patients and appeared to have a similar therapeutic profile to ACE inhibitors in patients with HF and CRD. One clinical advantage of the AII receptor antagonists over ACE inhibitors is an improved side-effect profile with the absence of the persistent dry cough associated with ACE inhibitor therapy. To date, it is clear that the AII receptor antagonists are effective antihypertensive agents. Clinical trials are currently in progress to determine the therapeutic efficacy of these drugs in the treatment of HF and progressive renal disease.

Local Modulation of Neurotransmitter Release in Bovine Splenic Vein

Bovine splenic vein has an abundant sympathetic innervation. Isolated strips were used to examine whether autoinhibition of norepinephrine release from the noradrenergic nerve terminals could be demonstrated under various experimental conditions and whether additional local regulatory modulators of transmitter release could also be implicated. In particular, the possibility of a histamine interaction with presynaptic inhibitory receptors was examined because ultrastructural evidence disclosed a close spatial relationship between mast cells and noradrenergic nerve terminals in the vessel wall. To investigate the presence of presynaptic alpha-receptors the competitive blocking agent phentolamine was included in the superfusion medium at concentrations ranging from 1 to 50 microM during electrical field stimulation at frequencies between 1 and 10 Hz. Transmitter outflow was measured as fractional tritium release. Low frequency stimulation (1 Hz) with 1 microM phentolamine resulted in the typical increase in norepinephrine release characteristics for presynaptic alpha-receptor inhibition. In contrast, high frequency (10 Hz) stimulation in the presence of 50 microM phentolamine caused an unexpected decrease in norepinephrine outflow. This unusual result can be explained by additional pharmacological actions of phentolamine unrelated to alpha-receptor blockade, e.g. histamine release from the mast cells which subsequently can act on presynaptic inhibitory histamine receptors. This effect, manifested at higher phentolamine concentrations, would overcome the alpha-receptor blockade. The presence of histamine receptors was supported by the results from electrical stimulation in the presence of exogenous histamine. Histamine decreased norepinephrine outflow while increasing basal tension and the contractile response of the vein strip. Unexpectedly, these effects appeared to be mediated by histamine receptors of the H1-type because they were reduced after pyrilamine but unaffected by agonists and antagonists to receptors of the H2-type. It is speculated that interactions between mast cells and noradrenergic nerve terminals may serve to maintain homeostasis in the bovine splenic vein.

A Successful Model of Small Bowel Autotransplantation in the Dog

Experimental small bowel transplantation has continued to be a complex procedure with high mortality. We investigated the technical aspects of small bowel transplantation in an effort to define a procedure that would result in an improved survival rate. Three methods of graft harvesting were examined in a model of canine small bowel autotransplantation. Harvesting the graft by first flushing with room-temperature lactated Ringers followed by iced lactated Ringers resulted in the best preservation and subsequently the best survival rate (71%). Flushing with iced lactated Ringers alone resulted in survival rates of 22 and 50% in two additional groups. We also investigated two methods of graft reanastomosis. Although either venous drainage regimen appears to be suitable, graft venous reanastomosis to the host portal vein resulted in a slightly higher postoperative weight than reanastomosis to the host inferior vena cava. A model of small bowel transplantation with a high long-term survival rate has been developed. This model can now be applied to studies of the various physiological aspects of small bowel transplantation.