De Vriese An S, Blom Henk J, Heil Sandra G, Mortier Siska, Kluijtmans Leo A J, Van de Voorde Johan, Lameire Norbert H
Renal Unit, University Hospital, Gent, Belgium.
Circulation. 2004 May 18;109(19):2331-6. doi: 10.1161/01.CIR.0000129138.08493.4D. Epub 2004 Apr 26.
Endothelial dysfunction is an early event in the development of vascular complications in hyperhomocysteinemia. Endothelial cells release a number of vasodilators, including NO and prostacyclin. Several lines of evidence have indicated the existence of a third vasodilator pathway, mediated by endothelium-derived hyperpolarizing factor (EDHF). EDHF is a major determinant of vascular tone in small resistance vessels. The influence of hyperhomocysteinemia on EDHF is unknown. The present in vivo study evaluates the integrity of the EDHF pathway in the renal microcirculation of rats with acute and chronic hyperhomocysteinemia.
EDHF-mediated vasodilation was evaluated as the renal blood flow (RBF) response to intrarenal acetylcholine during systemic NO synthase and cyclooxygenase inhibition. Acute hyperhomocysteinemia induced by intravenous homocysteine did not affect EDHF-mediated vasodilation. In contrast, intravenous methionine with subsequent hyperhomocysteinemia impaired the EDHF-mediated RBF response. When the methionine infusion was preceded by adenosine periodate oxidized to prevent the cleavage of S-adenosylhomocysteine to homocysteine and adenosine, a similar impairment of EDHF was observed, but with normal homocysteine levels. Animals with chronic hyperhomocysteinemia induced by a high-methionine, low-B vitamin diet during 8 weeks had a severely depressed EDHF-mediated vasodilation compared with those on a standard diet. Endothelium-independent vasodilation to deta-NONOate and pinacidil was not affected in acute and chronic hyperhomocysteinemia, demonstrating intact vascular smooth muscle reactivity.
EDHF-dependent responses are impaired in the kidney of hyperhomocysteinemic rats. Because EDHF is a major regulator of vascular function in small vessels, these findings have important implications for the development of microangiopathy in hyperhomocysteinemia.
内皮功能障碍是高同型半胱氨酸血症血管并发症发生过程中的早期事件。内皮细胞释放多种血管舒张剂,包括一氧化氮(NO)和前列环素。多项证据表明存在由内皮衍生超极化因子(EDHF)介导的第三条血管舒张途径。EDHF是小阻力血管血管张力的主要决定因素。高同型半胱氨酸血症对EDHF的影响尚不清楚。本体内研究评估急性和慢性高同型半胱氨酸血症大鼠肾微循环中EDHF途径的完整性。
在全身性一氧化氮合酶和环氧化酶抑制期间,将肾血流量(RBF)对肾内乙酰胆碱的反应作为EDHF介导的血管舒张进行评估。静脉注射同型半胱氨酸诱导的急性高同型半胱氨酸血症不影响EDHF介导的血管舒张。相反,静脉注射蛋氨酸及随后出现的高同型半胱氨酸血症损害了EDHF介导的RBF反应。当在蛋氨酸输注之前用高碘酸盐氧化腺苷以防止S-腺苷同型半胱氨酸裂解为同型半胱氨酸和腺苷时,观察到类似的EDHF损害,但同型半胱氨酸水平正常。与标准饮食的动物相比,用高蛋氨酸、低B族维生素饮食诱导8周的慢性高同型半胱氨酸血症动物的EDHF介导的血管舒张严重受损。急性和慢性高同型半胱氨酸血症中对硝普钠和吡那地尔的非内皮依赖性血管舒张未受影响,表明血管平滑肌反应性完整。
高同型半胱氨酸血症大鼠肾脏中依赖EDHF的反应受损。由于EDHF是小血管血管功能的主要调节因子,这些发现对高同型半胱氨酸血症微血管病的发展具有重要意义。