(Circulation. 1999;100:2359.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
From the National Laboratory of the National Institute of Biostructures and Biosystems (C.E., M.B.S., P.M.), Osilo; Laboratorio di Patologia Vascolare (C.E., A.M., S.S., M.C.C.), Istituto Dermopatico dellImmacolata, Rome; Department of Pathology (R.M., D.C., R.M., G.O.), University of Parma, Parma; and Institutes of Biochemistry (M.G.T.), Internal Medicine and Department of Biomedical Sciences (P.M.), University of Sassari, Sassari, Italy.
Correspondence to Paolo Madeddu, MD, Institute of Internal Medicine, University of Sassari, Viale S. Pietro 8, 07100 Sassari, Italy. E-mail madeddu{at}ssmain.uniss.it
| Abstract |
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Methods and ResultsTo test whether the absence of bradykinin B2 receptors may affect cardiac structure and function, we examined the developmental changes in blood pressure (BP), heart rate, and heart morphology of bradykinin B2 receptor gene knockout (B2-/-), heterozygous (B2+/-), and wild-type (B2+/+) mice. The BP of B2-/- mice, which was still normal at 50 days of age, gradually increased, reaching a plateau at 6 months (136±3 versus 109±1 mm Hg in B2+/+, P<0.01). In B2+/- mice, BP elevation was delayed. At 40 days, the heart rate was higher (P<0.01) in B2-/- and B2+/- than in B2+/+ mice, whereas the left ventricular (LV) weight and chamber volume were similar among groups. Thereafter, the LV growth rate of B2-/- and B2+/- mice was accelerated, leading at 360 days to a LV weighttobody weight ratio that was 9% and 17% higher, respectively, than that of B2+/+ mice. In B2-/- mice, hypertrophy was associated with a marked chamber dilatation (42% larger than that of B2+/+ mice), an elevation in LV end-diastolic pressure (25±3 versus 5±1 mm Hg in B2+/+ mice, P<0.01), and reparative fibrosis.
ConclusionsThe disruption of the bradykinin B2 receptor leads to hypertension, LV remodeling, and functional impairment, implying that kinins are essential for the functional and structural preservation of the heart.
Key Words: bradykinin angiotensin myocardium hypertrophy heart failure blood pressure genes
| Introduction |
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Furthermore, the presence and functional relevance of a kallikrein-kinin system in the heart are firmly established16 17 18 19 Kinins, cleaved by kallikrein from substrate kininogen, stimulate the release of NO and prostacyclin through the activation of bradykinin (BK) B2 receptors. This action opposes Ang IIinduced vasoconstriction and exerts anti-ischemic, antiproliferative, and antiatherosclerotic effects, preserving myocardial stores of energy-rich phosphates and glycogen.16 20 21 22 23 24 Conversely, a dysfunctional kallikrein-kinin system may contribute to the pathogenesis of heart failure. In fact, reduced local kinin generation and blunted NO formation have been reported in failing human hearts.20 Furthermore, icatibant, a selective antagonist of the BK B2 receptor, reduces coronary blood flow and contractility and increases LV end-diastolic pressure in pacing-induced heart failure.25
Thus, to test the hypothesis that the absence of the BK B2 receptor may lead to cardiac dysfunction, we examined the functional and structural changes occurring in the hearts of BK B2 receptor knockout mice (B2-/-) during development. This genetic model has similarity with the natural history of patients with hypertension and ventricular hypertrophy, who are at high risk for cardiovascular complications and death.26 27 28 The informative potential of heterozygous mice (B2+/-), resembling a condition of partial deficiency, has been added to test whether a gene-dose effect on the cardiovascular phenotype may be present.
| Methods |
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B2-/- mice were kindly provided by Dr. Fred Hess (Merck Laboratories), and wild-type control animals (B2+/+) were obtained from Jackson Laboratories. B2+/- mice were derived through the mating of B2+/+ and B2-/-. Two days after birth, the sex of the pups from B2-/-, B2+/+, and B2+/- groups was determined, and each litter was culled to 5 male pups. The animals were identified and housed at a constant room temperature (24±1°C) and humidity (60±3%).
Hemodynamic Measurements
Body weight (BW), systolic blood pressure (SBP), and
heart rate (HR) of unanesthetized
B2+/+ (n=33),
B2+/- (n=12), and
B2-/- (n=38) mice were
measured from 40 to 360 days of age with the use of tail-cuff
plethysmography.27 At the end of the experiments, in
unanesthetized mice, mean blood pressure was measured with the
use of an intra-aortic catheter (PE-10; Clay Adams) with a Statham
transducer (Gould). In six anesthetized mice
(2,2,2-tribromoethanol, 88 mmol/100 g body wt IP; Sigma Chemical
Co) of each group, LV pressure and dP/dt at 40 mm Hg were
measured with a high-sensitivity pressure transducer (World Precision
Instruments) in a closed-chest preparation.
Heart Morphology
In B2+/+,
B2+/-, and
B2-/- mice at 40 (n=23, 28,
and 20, respectively), 180 (n=10, 16, and 18, respectively), and 360
days of age (n=5, 5, and 7, respectively), hearts were arrested in
diastole with cadmium chloride (100 nmol), excised from
blood vessels, dissected free, rinsed in saline, blotted, weighed, and
fixed in 10% buffered formalin. Lung wet weight was also determined
(n=6 each group).
Ventricular Wall and Chamber Diameter
Measurements
The free walls of the right ventricle (RV) and the LV, including
the septum, were dissected free, and their weights were recorded.
Myocardial volume was calculated by dividing its weight by the specific
gravity of muscle tissue (ie, 1.06 g/mL). The major cavitary axis of
the LV from the apex to the aortic valve was measured under a stereo
microscope (Wild M 600) with a calibrated ocular accurate to 0.1
mm. Transverse chamber diameters and LV wall thickness were determined
with an analyzer (Image Pro Plus 3.0; accuracy 0.01 mm)
with images acquired with a videocamera (Sony) through the stereo
microscope (magnification x16). The cavitary volume was computed with
use of the Dodge equation.29
Analysis of Ventricular Fibrosis
Transverse slices were embedded in paraffin, and 5-µm-thick
sections were cut and stained with Massons trichrome. Sections were
examined at a calibrated magnification of x100 with an ocular reticle
containing 42 sampling points (Wild Heerbrugg Instruments). This
reticle defines a sectional area of 0.85
µm2. The points overlying the foci of
perivascular or reparative fibrosis were counted separately to compute
the volume fraction of myocardial fibrosis.
Myocyte Transverse Diameter and Sarcomere Length
The transverse diameter of longitudinally oriented myocytes of
the LV was measured at the level of the nucleus at a magnification of
x1000. One hundred measurements were collected in each LV. At the same
magnification, the lengths of
10 sarcomeres were evaluated, for a
total of 200 measurements.
Reverse-Transcription Polymerase Chain Reaction Analysis
Total RNA was isolated from frozen hearts (n=3 each group)
according to the RNAzol B method. cDNA was made from total RNA
according to the manufacturers instructions (Stratagene).
The primers for amplification of a 157-bp product of the
-skeletal actin transcript were
-actin L (5'-GCT CTC TCT CCT CAG
GAC C-3') and
-actin R (5'-GGA GCA AAA CAG AAT GGC TGG C-3'). These
primers are specific to the 3' untranslated region of
-actin RNA.
Polymerase chain reaction amplification was performed under the
following conditions: denaturing for 1 minute at 94°C, annealing for
1 minute at 61°C, and elongation for 1 minute at 72°C for 35
cycles. The primers used for amplification of a 287-bp product of
angiotensin AT1a receptor isoform
were AT1a L (GAT AAT TAT GGC GAT TGT GC) and
AT1a R (TGC TCA TTT TCG TAG ACA GG). For
amplification of a 303-bp product of angiotensin
AT1b receptor isoform, the primers were
AT1b L (ATT CAG TTT TCT GGA TGT GC) and
AT1b R (TCC ACT TCA AAA CAA TAC GC). For both
sets of primers, the conditions were denaturation at 95°C, annealing
at 56°C, and elongation at 72°C for 30 cycles. RNA levels were
normalized through amplification of
glyceraldehyde-3-phosphate dehydrogenase.
Biochemical Assays
To determine the myocardial adenylate concentration,
hearts (B2+/+, n=6;
B2+/-, n=6; and
B2-/-, n=9) were washed in
saline, frozen, and then stored at -80°C until assay. Pulverized
samples were suspended in 60% methanol (in 100 mmol/L Tris
· HCl buffer), homogenized, and then centrifuged
for 20 minutes at 10 000g. The supernatant was dried,
resuspended in 25 µL of ultrapure water, and analyzed with
capillary electrophoresis (P/ACE 2100 System; Beckman Instruments).
Protein concentration was determined according to Lowry et
al.30
Plasma concentration of atrial natriuretic factor and endothelin-1 (ET-1) was determined (n=6 each group) with the use of radioimmunoassays (Phoenix) after extraction of the peptides with Sep-Pack C-18 Cartridges (Waters).
Statistical Analysis
Data are expressed as mean±SEM. Multivariate
repeated measures ANOVA was performed to test for interaction between
time and grouping factor. In multiple comparisons among independent
groups in which ANOVA and F test indicated significant
differences, the statistical value was determined according to the
Bonferroni method. Differences within and between groups were
determined with paired or unpaired Students t tests,
respectively. A P value of <0.05 was considered
statistically significant.
| Results |
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Heart Morphology
Cross sections of the hearts of knockout and wild-type mice are
shown in Figure 2
. Due to a differential
growth rate (Table
), at 180 days,
the LV weight (LVW) of B2-/-
and B2+/- mice was 51% and
29% higher than that of B2+/+
mice (P<0.01); at 360 days, however, no significant
difference was detected among groups. A similar pattern was observed in
RV weight (RVW). The early acceleration in LV growth of
B2-/- mice was confirmed after
normalization by body weight (BW): at 180 days, the LVW/BW ratio was
13% (P<0.01) and 28% (P<0.001) higher than
that of B2+/- and
B2+/+ mice, respectively (Figure 3A
). In the second interval, a 2.2-fold
increase was seen only in B2+/-
mice (P<0.05). Thus, at 360 days, the LV/BW ratio was 9%
higher in B2-/- and 17%
higher in B2+/- than in
B2+/+ mice. No difference in
RVW/BW ratio was observed among groups with maturation (Figure 3B
). At 360 days, lung weight was greater in
B2-/- than in
B2+/+ mice (7.97±0.53 versus
5.49±0.21 mg/g body wt, P<0.002)
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A conspicuous increase in LV transverse chamber diameter occurred
in B2-/- mice (1.8-fold),
equally distributed in the 2 intervals (Figure 4A
). This increase was greater
(P<0.05) than that of
B2+/+ or
B2+/- mice (1.4- and 1.5-fold,
respectively). A slight elongation in LV chamber length was observed in
both B2+/+ and
B2-/- mice, with no further
change later (Figure 4B
). As a result of the changes in these
linear dimensions, a 4.0-fold enlargement of LV chamber was found in
B2-/- mice compared with 2.6-
and 2.3-fold increases in B2+/-
and B2-/- mice, respectively
(P<0.001 for both comparisons).
|
At variance with the compensatory remodeling found in
heterozygous mice, in B2-/-
mice, the growth in wall thickness and myocardial mass was inadequate
to compensate chamber enlargement (Table
). In fact, at
360 days, the ratio of mass to chamber volume for knockout mice was
27% (P<0.01) and 24% (P<0.05) lower than that
for B2+/+ and
B2+/- mice, respectively
(Figures 4C
and 4D
). Diastolic LV wall stress,
calculated from hemodynamic and anatomic data, was
114% higher in B2-/- mice
than in B2+/+ mice at 180 days
(54±9 versus 25±6 dynes/mm2;
P<0.001), and at 360 days, it reached 126±15
dynes/mm2, a value 655% higher
(P<0.001) than that of
B2+/+ mice (17±8
dynes/mm2).
As shown in the Table
, at 360 days, the myocytes of
B2+/- and
B2-/- mice were 17% and 15%
thinner than those of B2+/+ mice
(P<0.05 for both comparisons). Sarcomere length was similar
among groups at all ages examined.
At 40 days, the structure of ventricular
myocardium did not reveal pathological alterations in any
group. Later, distinct foci of fibrosis were present in the LV,
mainly in the subendocardium but also scattered throughout the wall
(Figure 5
). Compared with
B2+/+ mice (Figure 6
),
B2-/- mice showed an increase
in perivascular and reparative fibrosis at 180 days (178% and 930%,
respectively, P<0.05) and an even greater increase at 360
days (1013% and 1397%, respectively, P<0.01). No
reparative fibrosis was seen in the RV.
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Gene Expression in Heart
At 40 days, the mRNA levels of
-skeletal actin were 8.0- and
4.1-fold greater in the hearts of
B2-/- and
B2+/-, respectively, than
B2+/+ mice (Figure 7
). This pattern persisted in adult
animals. By contrast, the expression of AT1
receptor isoforms was similar among groups at all ages examined (data
not shown).
|
Biochemical Assays
At 360 days, the adenylate content was significantly
(P<0.01) reduced in the hearts of
B2-/- mice (22.62±1.04 versus
30.22±2.15 and 32.66±1.77 nmol/mg protein in
B2+/- and
B2+/+, respectively). At the
same age, plasma concentrations of ANF were increased in
B2-/- mice (222±46 versus
18±11 pg/mL in B2+/+,
P<0.05), whereas no group difference was detected regarding
circulating ET-1 levels (3.34±1.31 versus 4.15±0.87 pg/mL,
P=NS).
| Discussion |
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The tachycardia observed in B2-/-, similar to that found in rats with prenatal blockade of the BK B2 receptor,34 confirms that kinins are involved in the early programming of the cardiovascular phenotype. Because norepinephrine release is diminished in B2-/- mice,35 the elevated basal HR might be the consequence of sensitization of sinoatrial ß-adrenoceptors to catecholamines. Other possible explanations include perturbation in the activity of intrinsic cardiac cholinergic neurons,36 perturbation of transduction mechanisms linked to ß-adrenoceptors, and alteration in the central baroreflex control of HR.37 38
It appears likely that Ang II contributes to the development of
cardiac remodeling in mice with partial or total deficiency of the BK
B2 receptor. The results of our previous studies
demonstrated that in B2-/-
mice, the interrupted receptor signaling leads to
blunted basal activation of NO pathway, leaving unbalanced Ang
IIinduced vasoconstriction.27 However, the elevation in
BP was only moderate in B2-/-
mice, and a load-independent mechanism may be operative.39
The observation that myocardial hypertrophy was present
in heterozygous mice at 180 days, when BP was just starting to diverge
from normal, is consistent with this hypothesis. In addition,
reactivation of fetal
-skeletal actin expression (an immediate-early
gene response reportedly induced by Ang II independent of its
vasoconstrictor action)40 41 in the heart of
B2-/- mice precedes any
increase in BP. The counterregulatory influence of kinins on Ang
IIinduced myocardial growth has been documented in animal models with
renin-dependent hypertension42 43 and in in vitro
preparations of cardiomyocytes cocultured with
endothelial cells.44 Consistently,
we found that early, lifelong administration of an
AT1 receptor antagonist prevents
myocardial hypertrophy and fibrosis in
B2-/- mice while only
temporarily blunting the tendency to develop hypertension (Paolo
Madeddu, unpublished results, 1999). Interestingly, plasma renin
activity and cardiac expression of the renin gene are not altered in
B2-/- mice at 6
months,27 and as demonstrated here,
AT1 receptor expression is also unaffected by the
mutation even at later stages of the life. ET-1 is well known to play a
role in myocyte growth,45 and the formation of ET-1 can be
inhibited with BK via the B2
receptor.46 However, we found that circulating levels of
ET-1 are normal in B2-/-
mice.
The development of ventricular dysfunction and failure in this knockout model is documented by anatomic, functional, and biochemical data. Combined, these abnormalities simulate the characteristic findings of decompensated cardiac hypertrophy seen in humans.47 In accordance with Laplaces law, the hearts of B2-/- mice are exposed to a substantial increase in the diastolic circumferential wall stress. It should be pointed out, however, that computed data may underestimate the stress on a per-cell basis due to the amount of myocyte replaced by reparative fibrosis. The distribution of myocardial fibrosis mainly in the subendocardium, the layer most exposed to the increased intraventricular diastolic pressure, again seems to confirm the importance of mechanical factors in the development of heart failure in this model. The decrease in myocardial adenylate content suggests an intrinsic alteration in energy buildup in the failing hearts of B2-/- mice. A shortage of myocardial energy reserves might have exaggerated the consequences of the pressure overload on the heart, leading to an abnormal growth response and accelerated myocyte death. A gene-dose effect influenced the severity of myocardial changes in mutant animals. Heterozygosity, in fact, was characterized by proportional increases in chamber volume and myocardial mass without cardiac dysfunction.
In conclusion, our results indicate that a partial deficiency of the BK B2 receptor causes LV hypertrophy and that total deficiency induces decompensated hypertrophy and failure similar to the hypertrophic hypertensive cardiomyopathy seen in humans, demonstrating the essential role of kinins in the preservation of myocardial structure and function.
Note Added in Proof
After the accpetance of this article, on the occasion of
the 53rd Annual Fall Conference of the Council for High Blood Pressure
Research, Pierra Meneton et al showed that disruption of tissue
kallikrein gene triggers dilated cardiomyopathy in mice (Meneton P,
Block-Favre M, Hagege A, Gasc JM, Huang W, Neubauer M, Duffy J, Menard
J, Alhenc-Galas F. Targeted disruption of the tissue kallikrien gene
triggers cardiac abnormalities typical of a dilated cardiomyopathy.
Hypertension. 1999;34:333. Abstract.) These data reinforce
the view that the kallikrein kinin system is important for normal heart
maturation.
| Acknowledgments |
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| Footnotes |
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Received May 12, 1999; revision received June 24, 1999; accepted July 13, 1999.
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