Kiyoji Asano

Plasma Fas Ligand, an Inducer of Apoptosis, and Plasma Soluble Fas, an Inhibitor of Apoptosis, in Patients With Chronic Congestive Heart Failure

OBJECTIVES This study sought to examine plasma levels of soluble Fas/APO-1 receptor (sFas), an inhibitor of apoptosis, and soluble Fas ligand (sFas-L), an inducer of apoptosis, and their relation to each other and to other clinical variables, such as New York Heart Association functional class, tumor necrosis factor (TNF) and interleukin-6 (IL-6) in congestive heart failure (CHF). BACKGROUND It has been recently reported that apoptotic cell death occurs in myocytes of dogs with CHF. Hypoxia is frequently seen in advanced CHF and can stimulate Fas/APO-1 receptors (Fas) to induce apoptosis in cultured myocytes. Fas and Fas ligand (Fas-L) are cell-surface proteins and representative apoptosis-signaling molecules. Fas on the cell membrane induces apoptosis when it binds Fas-L or sFas-L. However, plasma sFas, a molecule lacking the transmembrane domain of Fas, blocks apoptosis by inhibiting binding between Fas and Fas-L or sFas-L on the cell membrane. At present, it is unknown whether plasma sFas-L and plasma sFas increase in the presence of cardiac disease. METHODS The study included 70 patients (mean [+/-SEM] age 65 +/- 2 years, range 21 to 93) with chronic CHF (coronary artery disease in 28, dilated cardiomyopathy in 27, valvular heart disease in 15) and 62 age- and gender-matched normal control subjects. Plasma levels of sFas, sFas-L, TNF-alpha and IL-6 were measured by enzyme-linked immunosorbent assays using monoclonal anti-human antibodies. RESULTS There was no significant difference in sFas-L levels between normal subjects and patients in functional classes I to IV; however, sFas increased with severity of functional classification, independent of the underlying disease. sFas levels were significantly higher even in patients in functional class II than in normal subjects and those in functional class I, and were highest in patients in functional class IV (normal subjects; 2.2 +/- 0.1 ng/ml; functional class I: 2.2 +/- 0.2 ng/ml; functional class II: 3.1 +/- 0.2 ng/ml; functional class III: 3.9 +/- 0.3 ng/ml; functional class IV: 5.1 +/- 0.6 ng/ml). Plasma sFas levels were significantly higher in patients with elevated pulmonary artery wedge pressure and a decresed cardiac index than in those with values in the normal range. In patients in functional class IV, there was no significant difference in plasma sFas levels between the survivors and non-survivors during 6-month follow-up. However, plasma levels of sFas tended to decrease in nine patients with clinical improvement (baseline sFas: 5.2 +/- 0.8 ng/ml; 6-month sFas: 4.3 +/- 0.5 ng/ml, p = 0.07) but were similar in patients with no change in functional class. TNF-alpha and IL-6 were increased significantly only in patients in functional class IV, as previously reported, but were not related to sFas. CONCLUSIONS We found elevated levels of plasma sFas and no increase in plasma sFas-L in human CHF. The increase in sFas may play an important role in the pathophysiologic mechanisms of CHF.

An increase of soluble Fas, an inhibitor of apoptosis, associated with progression of COPD

In chronic obstructive pulmonary disease (COPD) which consists of emphysema and chronic bronchitis, alveolar tissue and/or bronchiolar walls are progressively destroyed. This suggests cell death by necrosis and/or apoptosis although no direct evidence of apoptosis has been reported. It was speculated that the apoptosis-related factors are associated with the progression of COPD. Fas/Apo-1 receptor (Fas), Fas ligand (Fas-L) and soluble Fas ligand (sFas-L) are inducers, while soluble Fas (sFas) is an inhibitor of apoptosis. In this study, plasma sFas and sFas-L were measured in 19 COPD patients receiving supplemental O2 (severe COPD) and 20 COPD patients not receiving supplemental O2 (mild/moderate COPD). Twenty-two age- and sex-matched healthy volunteers (healthy controls) and 20 patients receiving supplemental O2 and with level of hypoxaemia similar to severe COPD due to other pulmonary diseases (disease controls) were also examined. Plasma sFas-L was within normal limits in all groups. Plasma sFas levels were similar among healthy controls, disease controls, and mild/moderate COPD patients, but significantly increased in severe COPD (2.6 +/- 1.1, 2.6 +/- 0.2, 2.8 +/- 0.2 and 4.8 +/- 1.0 ng ml-1, respectively). Although PaO2 was lower in severe COPD than in mild/moderate COPD, and PaCO2 was higher in severe COPD than in mild/moderate COPD, they were close between severe COPD and disease controls. Tumour necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6) and C-reactive protein (CRP) were increased in patients with COPD, but were similar in both severe and mild/moderate COPD patients. We conclude that increased plasma sFas, which is independent of hypoxaemia, and increases in PaCO2, TNF-alpha, IL-6 and inflammation, may be associated with progression of COPD.

Apoptotic Cell Loss following Cell Proliferation in Renal Glomeruli of Otsuka Long-Evans Tokushima Fatty Rats, a Model of Human Type 2 Diabetes

Background: The mechanism of glomerular cell loss during the late stage of diabetic nephropathy is unknown. Methods: We examined cell population, proliferation, apoptosis, and immunohistochemical expression of apoptosis-related proteins, Bcl-2 and Bax, in renal glomeruli of the Otsuka Long-Evans Tokushima Fatty (OLETF) rat, an animal model of human type 2 diabetes. 10-, 30-, 50-, and 70-week-old rats were used (n = 5–8). Control was the Long-Evans Tokushima Otsuka (LETO) rat. Results: The cell population in renal glomeruli of OLETF rats progressively increased with age, but decreased at 70 weeks old. High cell proliferative activity based on proliferating cell nuclear antigen (PCNA) expression was limited during the early stage, whereas by in situ nick end-labeling (TUNEL), Taq polymerase based in situ ligation, and electron microscopy, apoptosis was detected during the late stage (50 and 70 weeks old). Augmented expression of Bax, but not of Bcl-2, was evident in glomeruli of OLETF rats during the late stage, which contributed to an increased Bax/Bcl-2 ratio. Conclusion: It appears that high cell proliferative activity and the subsequent cell loss via apoptosis counterbalance each other and determine glomerular cell population of OLETF rats. Augmented Bax expression may be one of the important regulators of this apoptosis.

Modulation of noradrenaline release through presynaptic α2-adrenoceptors in congestive heart failure

Stimulation of presynaptic alpha 2-adrenoceptors inhibits the release of noradrenaline from sympathetic nerve endings; however, the extent to which it operates in patients with congestive heart failure is still unknown. To investigate the degree of negative feedback to the release of noradrenaline via presynaptic alpha 2-adrenoceptors at sympathetic nerve endings, we measured plasma noradrenaline levels before and after the injection of phentolamine (i.e., plasma noradrenaline concentration at rest, plasma noradrenaline concentration after phentolamine injection [NAph], and the phentolamine-induced increase in plasma noradrenaline [delta NAph]). Plasma noradrenaline concentration at rest, NAph, and delta NAph increased in a stepwise manner from New York Heart Association class I to class III. A positive correlation was found between the plasma noradrenaline at rest and delta Naph (n = 123, r = 0.697, p < 0.001). These results suggest that the enhanced release of plasma noradrenaline is substantially buffered by the mechanism of noradrenaline release-inhibitory presynaptic alpha 2-adrenoceptors in patients with congestive heart failure, and this buffer serves to protect organs such as the heart from excess sympathetic stimulation.

Plasma soluble Fas and soluble Fas ligand in chronic glomerulonephritis

It has been reported that glomerular cells with apoptosis and positive Fas immunoreactivity are seen in proliferative glomerulonephritis (PGN). Fas induces apoptosis when it binds to Fas ligand (Fas-L) or soluble Fas-L (sFas-L). However, soluble Fas (sFas) blocks apoptosis by inhibiting binding between Fas and Fas-L or sFas-L. That is, Fas, Fas-L, and sFas-L are inducers of apoptosis, but sFas is an inhibitor of apoptosis. We studied the relationship between the plasma levels of sFas and sFas-L in 32 patients with various types of adult chronic glomerulonephritis. Patients with serum creatinine levels >1.5 mg/dl (132.6 µmol/l) were excluded. The plasma levels of sFas-L were within the normal limits in all patients. The plasma levels of sFas in the patients with minimal-change (n = 8) and membranous nephropathy (n = 7) were similar to the age- and sex-matched controls. However, the plasma sFas levels were significantly elevated in patients with mesangial PGN (n = 10) and membranoproliferative glomerulonephritis (n = 7)(3.4 ± 0.9 and 3.9 ± 1.5 ng/ml, respectively) as compared with the age- and sex-matched controls (controls: 2.1 ± 0.4 and 2.2 ± 0.6 ng/ml, respectively). In PGN, according to increase of histological grade and decrease of creatinine clearance, the number of TUNEL-positive cells in glomeruli is decreased in spite of an increase of the Fas positivity, and plasma sFas is increased. The degree of proliferative change is determined by the balance between proliferation and apoptosis and/or necrosis. Therefore, increased plasma sFas in PGN may inhibit apoptosis in glomeruli and may be one of the progressing factors in PGN. Thus, we conclude that an increase in plasma sFas levels is important to the protection of apoptosis in PGN.

Simultaneous evaluation of left- and right-sided heart pumping function during dynamic leg exercise in patients with mild chronic congestive heart failure, with special reference to afterload and plasma noradrenaline

SummaryWe simultaneously measured increases in mean pulmonary capillary wedge pressure (ΔPCW), mean right atrial pressure (ΔRA), and cardiac index (ΔCI) in response to dynamic leg exercise in 81 patients with mild congestive heart failure to clarify the relationship between the left-sided and right-sided pumping function of the heart. The ratio of ΔCI to ΔPCW was used as an index of left-sided heart performance and the ΔCI/ΔRA as an index of right-sided heart performance. We also determined systemic vascular resistance, as an index of afterload on the left heart; pulmonary vascular resistance, as an index of afterload on the right heart; and the plasma level of noradrenaline before and during dynamic leg exercise. Patients with ΔCI/ΔPCW > 0.18l/min/m2 per mmHg were regarded as having a well functioning left heart, and the patients with ΔCI/ΔPCW ≤ 0.18l/min/m2 per mmHg as having a poorly functioning left heart. Patients with ΔCI/ΔRA > 0.311l/min/m2 per mmHg were regarded as having a well functioning right heart, and those with ΔCI/ΔRA ≤ 0.311/l/min/m2 per mmHg as having a poorly functioning right heart. Patients were classified into three groups: well functioning left and right heart (normal group;n = 40), poorly functioning left and right heart (bilateral group;n = 34), and poorly functioning left heart and well functioning right heart (left-sided group;n = 7). The systemic vascular resistance index decreased during leg exercise in all patients. The decrease was smaller in the bilateral group and the left-sided group than in the normal group. The pulmonary vascular resistance index increased during exercise in the bilateral group but was unchanged in the normal group and the left-sided group. The plasma level of noradrenaline increased during exercise in all patients, but the increase was greater in the bilateral and left-sided groups than in the normal group. Pretreatment with phentolamine, an α-adrenoceptor antagonist, inhibited the increase in the pulmonary vascular resistance index and restored the decrease in the systemic vascular resistance index during exercise in the bilateral group. Our results showed that systemic vascular resistance, which represents afterload on the left heart, increased in the presence of impaired left-sided heart pumping function and pulmonary vascular resistance, which represents afterload on the right heart, increased in the presence of impaired right-sided heart pumping function. The inhibited decrease in systemic vascular resistance and the increase in pulmonary vascular resistance during exercise were associated with α-adrenoceptor-mediated vasoconstriction caused by the increase in the plasma level of noradrenaline.

Baroreflex Modifies the Effect of Vasodilators on Systemic Capacitance Vessel in Dogs

We examined whether the vasodilating effect of vasodilators on systemic capacitance vessels is modified by the baroreflex when a fall in arterial blood pressure was induced by the vasodilators in dogs. We estimated the dilation of the systemic capacitance vessels from the fall in mean circulatory pressure (MCP), proposed by Guyton et al. and the dilation of the systemic capacitance vessels from the fall in the total peripheral resistance (TPR). The dose-response curve for percent change in TPR to graded doses of nitroglycerin (NG, 0.8–200 µg/kg) in the untreated group was not different from that in the total spinal anesthesia (TSA) group in which the baroreflex was eliminated. The TSA group gave a dose-response curve for percent change in MCP to NG on the low dose side of NG as compared with the untreated group. NG increased both plasma levels of nor-epinephrine (NA) and epinephrine (A) in the untreated group. However, NG hardly affected plasma levels of NA or A in the TSA group. Milrinone significantly decreased the TPR and there was no significant difference in the percent change in TPR between the untreated and TSA groups. Milrinone did not change the MCP in the untreated group, but decreased it in both TSA group and the group pretreated with α-blocker, suggesting that baroreflex-mediated vasoconstriction is mediated through α-adrenoceptors in the capacitance vessels. Milrinone also increased plasma levels of NA and A in the untreated group but not in the TSA group.