Circulation. 1995;92:114-119
(Circulation. 1995;92:114-119.)
© 1995 American Heart Association, Inc.
Role of Endothelin-1 in Beagles With Dehydromonocrotaline-Induced Pulmonary Hypertension
Morihito Okada, MD;
Chojiro Yamashita, MD;
Masayoshi Okada, MD;
Kenji Okada, MD
From the Department of Surgery, Division II, Kobe University School of
Medicine, Kobe, Japan.
Correspondence to Morihito Okada, MD, Department of Surgery, Division II,
Kobe University School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, 650 Kobe
City, Japan.
 |
Abstract
|
|---|
Background Although plasma levels of endothelin-1 (ET-1)
increase
in patients with pulmonary hypertension (PH), its role in PH
is
unknown. We investigated the contribution of endogenous ET-1
to
cardiopulmonary changes in beagles with dehydromonocrotaline
(DMCT)-induced
PH.
Methods and Results Eight 3-month-old beagles were given a single
injection of 3 mg/kg DMCT via the right atrium. During the 8 weeks
after injection, the mean pulmonary arterial pressure (PAP) and plasma
ET-1 level increased significantly from 11.6±2.3 to 35.9±7.1
mm Hg
and from 1.24±0.25 to 3.25±0.94 pg/mL, respectively. In
controls,
ET-1 infusion elevated the systemic arterial pressure (SAP) but did not
alter PAP. In PH beagles, ET-1 infusion increased SAP, which was
attenuated by FR139317 (an endothelin type [ET] A receptor
antagonist), and produced a dose-dependent decrease in PAP, which was
attenuated by RES-701-1 (an ETB receptor antagonist). In PH beagles,
FR139317 infusion decreased PAP, and RES-701-1 infusion increased PAP.
Sarafotoxin S6c (an ETB agonist) infusion decreased PAP in PH
beagles.
Conclusions These results suggest that endogenous ET-1 is
elevated in PH disease and may mitigate PH by acting on ETB
receptors.
Key Words: pulmonary heart disease endothelin
 |
Introduction
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The vascular endothelium plays an
important role in the control
of cardiovascular tone. Endothelin-1
(ET-1), a 21amino
acid polypeptide produced by vascular endothelial
cells, has
complex, potent vasoactive properties.
1 ET-1
has various hemodynamic
effects on the pulmonary circulation, including
sustained vasoconstriction,
vasorelaxation, or biphasic
responses.
2 3 4 5 6 7 8
These various
responses may depend on
factors such as age, species, preparation,
dosage, route, and pulmonary
vascular tone. Further investigation
is needed to clarify how ET-1 acts
on the pulmonary circulation.
Pulmonary hypertension (PH) is characterized by an increase in vascular
tone or an abnormal proliferation of smooth muscle cells in the
pulmonary vasculature. Elevated plasma concentrations of ET-1 have been
associated with PH.9 10 11 12
However, the role of ET-1 release
in abnormal pulmonary circulation remains unclear.
Monocrotaline, a pyrrolizine alkaloid extracted from the seeds of
Crotalaria spectabilis, is converted by the mixed-function
oxidase system of the liver into dehydromonocrotaline (DMCT), which
passes through and injures the pulmonary vascular bed after
subcutaneous injection in rats.13 14 DMCT induces
severe
PH in 3 to 4
weeks.13 14 15 16 17
We have established a model in
which PH is induced in beagles by right atrial injection of DMCT to
evaluate accurately the cardiopulmonary hemodynamics of
PH.18
The purpose of the present study was to investigate the role of
endogenous ET-1 in beagles with DMCT-induced PH. To investigate its
effects on vascular tone, ET-1 was infused into the pulmonary artery.
Furthermore, to determine the mechanism of its vasoaction, FR139317, an
endothelin type (ET) A receptor antagonist,19 20
RES-701-1, an ETB receptor antagonist,21 and
sarafotoxin S6c, an ETB agonist,22 were infused, and
ET-1 was infused in the presence of FR139317 and RES-701-1.
 |
Methods
|
|---|
Eight purebred beagles (mean age, 3 months; weight, 5.1±0.8
kg)
were used to prepare PH models. All animals were kept in
clean cages
with regular food and sterile water as desired and
received humane care
in compliance with the
Principles of Laboratory Animal Care
formulated by the Institute of Laboratory Animal
Resources and the
Guide for the Care and Use of Laboratory Animals published
by the National Institutes of Health. DMCT was prepared
as described by
Mattocks.
23 Beagles were given a single injection
of 3
mg/kg DMCT via the right atrium and were investigated before
and after
4 or 8 weeks of treatment. Each beagle was anesthetized
with sodium
pentobarbital (25 mg/kg IV) and permitted to breathe
spontaneously.
Each study took place after the beagles had rested
supine in a quiet
laboratory for a minimum of 30 minutes at
room temperature (20°C to
24°C). Under sterile conditions,
a 5F Swan-Ganz catheter (Baxter
Healthcare) was advanced from
the femoral vein to the pulmonary artery,
and another catheter
was placed in the femoral artery for hemodynamic
measurements.
The pressures were monitored continuously with an
oscillograph
(363, NEC San-ei Instruments Ltd). Systemic arterial
pressure,
central venous pressure, pulmonary arterial pressure,
pulmonary
capillary wedge pressure, and cardiac output were measured.
A
blood sample was collected from the pulmonary artery, and
its plasma
ET-1 level was measured. Each blood sample was placed
in a chilled tube
containing EDTA and aprotinin; after centrifugation
the plasma was
stored at -30°C until used. After ET-1 was
extracted through a C18
(Waters Associates), the concentration
was measured by radioimmunoassay
by using an antibody to ET-1
(Peninsula Lab Inc) and
125I-labeled ET-1 (Amersham Japan Co).
This assay for ET-1
scarcely cross-reacts with ET-2, ET-3, or
big ET-1 (cross-reactivity,
<0.1%).
A diagrammatic representation of this study is shown in Fig
1
. After a stable baseline was achieved, baseline values
were obtained with infusion of each vehicle. These values
represented the solvent values for further comparison. The
vehicle for each drug was infused for 20 minutes, followed by infusion
of the drug for an additional 20 minutes. Measurements were performed
during the last 5 minutes of each infusion. A 24-hour recovery period
was allowed between protocols. The following protocols were performed
in control (baseline) and PH beagles at 4 and 8 weeks after injection
of DMCT. In protocol 1, ET-1 (Peptide Institute Inc) was infused at a
dose of 10 or 100
ng · kg-1 · min-1
for a 20-minute period. In protocol 2, after the first 10-minute
pretreatment infusion of FR139317 (200
µg · kg-1 · min-1;
Fujisawa
Pharmaceutical Co, Ltd) or RES-701-1 (100
µg · kg-1 · min-1; Kyowa
Hakko
Kogyo Co, Ltd), ET-1 was infused at a dose of 100
ng · kg-1 · min-1 with
continuing
infusion of FR139317 or RES-701-1 for a 20-minute period. In protocol
3, FR139317 or RES-701-1 was infused at a dose of 200 or 100
µg · kg-1 · min-1,
respectively, for a 20-minute period. In protocol 4, sarafotoxin S6c
(Peptide Institute Inc) was infused at 5 and 50
ng · kg-1 · min-1 for
consecutive
20-minute periods.

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Figure 1. Schematic of experimental protocols. ET-1 indicates
endothelin-1; FR, FR139317; RES, RES-701-1; and S6c, sarafotoxin
S6c.
|
|
Protocols 2, 3, and 4 were performed in a few randomly selected
beagles. FR139317 at 40
µg · kg-1 · min-1 or
RES-701-1 at
20 µg · kg-1 · min-1
resulted in
minimum hemodynamic changes. FR139317 at 1000
µg · kg-1 · min-1,
RES-701-1
at 500
µg · kg-1 · min-1, and
sarafotoxin S6c at 250
ng · kg-1 ·min-1 caused
changes similar to those induced by FR139317 at 200
µg · kg-1 · min-1,
RES-701-1
at 100 µg · kg-1 · min-1,
and sarafotoxin S6c at 50
ng · kg-1 · min-1,
respectively. From these results, we selected the doses of the drugs.
ET-1 and sarafotoxin S6c were dissolved with 5% dextrose in water and
delivered via the pulmonary artery by an infusion pump. Control
experiments were performed on each beagle by administering 5% dextrose
in water alone during the infusion period. FR139317 was dissolved in 1N
NaOH. RES-701-1 was dissolved in dimethyl sulfoxide. Each drug was
dissolved in sterile normal saline with the above-mentioned solution
and further diluted in normal saline. All solutions were prepared on
the day of the study and kept on ice until administered. The constant
infusion rate was 1 mL/min. The experiments were performed on every
beagle in the same order at baseline and at 4 and 8 weeks after DMCT.
All parameters were measured by polygraph (model 363; NEC San-ei
Instruments Ltd) and continuously recorded (model 8M14; NEC San-ei
Instruments Ltd). The values of arterial blood gases, which were
analyzed from samples obtained from the femoral artery, remained within
suitable limits. Cardiac output was measured with thermodilution
techniques and expressed as the mean of the values recorded after each
of five injections of saline (3 mL at 1°C to 5°C). Vascular
resistances were calculated by using standard formulas. The percent
change in each parameter was calculated as (postinjection
value-preinjection value)/preinjection value.
Statistical Analysis
All data are given as mean±SD.
Data and parameters were
compared by using multiway ANOVA to determine the effect of study
groups and time points. When ANOVA demonstrated significance, each
difference was tested by using the Scheffé F test. Any
value of P<.05 was accepted as statistically
significant.
 |
Results
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Development of PH in DMCT Beagles
The effects of DMCT
injection on hemodynamics and plasma ET-1
level
are shown in Table 1

. A single injection of DMCT
produced a
significant elevation in pulmonary arterial pressure
compared
with the preinjection value by the fourth week, after which
it
increased rapidly. During the 8 weeks after injection, mean
pulmonary
arterial pressure and pulmonary vascular resistance
increased
significantly from 11.6±2.3 to 35.9±7.1
mm Hg and from
193±76 to
1414±552 dyne ·
s · cm
-5, respectively.
Systemic arterial pressure and
systemic vascular resistance remained
relatively stable. The
heart rate did not vary significantly, although
it did increase
by several beats per minute. The cardiac output at 8
weeks after
injection was significantly reduced from the preinjection
value.
The plasma ET-1 level was elevated significantly from 1.24±0.25
to
3.25±0.94 pg/mL at 8 weeks.
Hemodynamic Changes Caused by ET-1 Infusion and the Effects of
FR139317 or RES-701-1 Pretreatment (Protocols 1 and 2)
Table
2
shows the hemodynamic changes caused by
ET-1 infusion and the pretreatment effects of FR139317 or RES-701-1
before and at the fourth and eighth week after DMCT injection.
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Table 2. Hemodynamic Changes Caused by ET-1 Infusion and the
Effects of FR139317 or RES-701-1 Pretreatment (Protocols 1
and 2)
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|
ET-1
infusion at 100
ng · kg-1 · min-1
significantly
increased the mean systemic arterial pressure in both PH and control
beagles at the fourth week, but it did not alter heart rate, mean
pulmonary arterial pressure, cardiac output, systemic vascular
resistance, or pulmonary vascular resistance. Systemic arterial
pressure was not affected in either group by FR139317 or RES-701-1.
By the eighth week, however, ET-1 at 100
ng · kg-1 · min-1
significantly
increased the mean systemic arterial pressure and increased systemic
vascular resistance, which were attenuated by FR139317, and
significantly decreased mean pulmonary arterial pressure and pulmonary
vascular resistance, which were attenuated by RES-701-1 (Fig
2
). Heart rate and cardiac output were unchanged during
the eighth week of PH. As a consequence, in PH beagles during the
eighth week postinjection, ET-1 caused a decrease in pulmonary arterial
pressure mediated by the ETB receptor in spite of an increase in
systemic arterial pressure being mediated by the ETA receptor.

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Figure 2. Bar graph. During dehydromonocrotaline-induced
pulmonary hypertension at 8 weeks after injection, a decrease in mean
pulmonary arterial pressure produced by endothelin-1 (ET-1; 100
ng · kg-1 · min-1) was
attenuated by
RES-701-1 (100
µg · kg-1 · min-1)
but not by FR139317 (200
µg · kg-1 · min-1), and an
increase
in mean systemic arterial pressure produced by ET-1 was attenuated only
by FR139317. In controls, the pretreatment effects of FR139317 or
RES-701-1 on mean pulmonary or systemic arterial pressure were not
significant. Values are mean±SD. *P<.05 vs ET-1
alone.
|
|
Hemodynamic Changes Caused by FR139317, RES-701-1, or Sarafotoxin
S6c Infusion (Protocols 3 and 4)
Table 3
shows the
hemodynamic changes caused by
FR139317, RES-701-1, or sarafotoxin S6c infusion in control and in PH
beagles at the fourth and eighth week after DMCT injection. FR139317
infusion at 200
µg · kg-1 · min-1
decreased the systemic and pulmonary arterial pressures in both control
and PH beagles. There was a significant decrease in pulmonary arterial
pressure in PH beagles even during the fourth postinjection week (Fig
3
), and a significant decrease in pulmonary vascular
resistance in PH at the eighth week postinjection. RES-701-1 infusion
at 100 µg · kg-1 · min-1
significantly increased the pulmonary arterial pressure (Fig 3
)
and
pulmonary vascular resistance in PH beagles at the eighth week
postinjection. Although sarafotoxin S6c did not alter systemic
hemodynamics in PH beagles, at 50
ng · kg-1 · min-1 it
significantly
decreased the mean pulmonary arterial pressure (Fig 4
)
and pulmonary vascular resistance. FR139317 at 200
µg · kg-1 · min-1,
RES-701-1
at 100 µg · kg-1 · min-1,
or
sarafotoxin S6c at 50
ng · kg-1 · min-1 did not
significantly alter heart rate, mean systemic arterial pressure,
cardiac output, or systemic vascular resistance in any group.

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Figure 3. Bar graphs. FR139317 (200
µg · kg-1 · min-1)
significantly
decreased and RES-701-1 (100
µg · kg-1 · min-1)
significantly
increased mean pulmonary arterial pressure during pulmonary
hypertension (PH). Values are mean±SD. *P<.05 vs
preinfusion.
|
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Figure 4. Bar graph. Sarafotoxin S6c produced dose-dependent
decreases in mean pulmonary arterial pressure in pulmonary hypertension
(PH). Values are mean±SD. *P<.05 vs
preinfusion.
|
|
 |
Discussion
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Although PH is known to occur in many diseases, a form of PH
exists
that has no known cause, ie, the mechanism by which PH develops
when
there is no underlying disease remains unknown. To understand
PH,
which is basically an ongoing and fluctuating physiological
abnormality,
experimental approaches are useful. Some known examples of
experimental
PH occur with arteriovenous shunt, pulmonary vessel
banding,
hypoxia, and monocrotaline
injection.
13 14 15 16 17
Following
subcutaneous injection into rats, monocrotaline is swiftly
converted
by the mixed-function oxidase system in the liver into DMCT,
which
first passes through and injures the pulmonary vascular bed.
To
model PH, relatively large animals are needed to accurately
measure
cardiopulmonary hemodynamics. However, an injection
of monocrotaline in
beagles did not result in progressive PH.
We have established PH in
beagles by using DMCT.
18 Vascular
endothelial injury
caused by DMCT is nonspecific, and because
DMCT-induced PH is
established after the causative agent is
removed, this experimental
model has promising similarities
to PH in humans, which develops long
after its induction by
various factors. Serial hemodynamic measurements
made after
injection of DMCT revealed that PH developed by the fourth
week
after injection. The right ventricle/left ventricle plus septum
weight
ratio (calculated as an index of right ventricular hypertrophy)
and
the medial thickness in the muscular pulmonary arteries showed
transition
patterns simultaneous with the increase in pulmonary artery
pressure.
The progressively increasing plasma ET-1 concentration
suggested
that ET-1 may be involved in either the cause of or response
to
PH. Patients with either the primary or secondary form of PH
have
elevated plasma ET-1
levels
9 10 11 12 and have
injured
vascular
endothelial cells in the pulmonary but not the systemic
circulation.
24 A study of ET-1like immunoreactivity by
immunocytochemical
analysis and ET-1 mRNA by in situ hybridization
in lung specimens
has demonstrated that PH is associated with the
increased expression
of ET-1 by vascular endothelial cells and that
local production
of ET-1 might contribute to the vascular abnormalities
associated
with this disorder.
25 Circulating ET-1 may play
a selective
role in cardiopulmonary system changes. Despite a threefold
rise
in the plasma ET-1 level in DMCT-induced PH, the decrease, rather
than
the increase, in systemic arterial pressure may have been due
to
severe PH disease.
Endothelins are endothelial cellderived peptides with potent
vasoactions. Most reports show that ET-1 causes
vasoconstriction,1 26 27 28
but systemic as well as pulmonary
vasodilatation have been reported with some
preparations.4 8 29 30 31 32
The present study indicates
that while ET-1 does not change pulmonary hemodynamics in control
subjects, it does cause dose-dependent pulmonary vasodilatation in
DMCT-induced canine PH. Miyauchi et al33 report that the
vasocontractile response to ET-1 is significantly smaller in
monocrotaline-treated than in control rats on day 25 in the ring
preparation of the pulmonary artery, although it did not differ
significantly on either day 6 or day 14 in the pulmonary artery or on
day 25 in the aorta. Their report indicates that the reduction in the
vasoconstrictive response to ET-1 occurs specifically in the pulmonary
artery at the progressive PH stage.
The pulmonary vasodilatation observed in the present study is
consistent with the finding that ET-1 produces relaxation of pulmonary
vessels that have a high basal tone, such as in the neonatal pulmonary
circulation,2 8 34 during
hypoxia,32 and
after the administration of U46619.4 Therefore, the
vasodilator response to ET-1 may depend on a high baseline vasomotor
tone. Particularly in the pulmonary circulation, hemodynamic responses
to ET-1 have been inconsistent and
conflicting.2 3 4 8 32 34 35 36 37 38 39
The differences in results
may be explained by differences in the species and age of the animal,
the experimental model, and the route and dose of ET-1. This is the
first in vivo study of PH response to ET-1 in beagles. Systemic
arterial pressure and vascular resistance increased with or without PH,
suggesting that ET-1 induced systemic vasoconstriction independent of
vascular tone. In the present study, DMCT did not affect the
response to ET-1 by the systemic circulation, indicating that the
vasodilatory response to ET-1 was specific to the pulmonary
circulation. Although the cause of the differences in results is
unclear, DMCT may alter the response of the pulmonary endothelium to
ET-1 after injury.
Endothelin receptors are ubiquitous in mammalian tissue. The existence
of at least two receptor subtypes, ETA and ETB, has been demonstrated
and their cDNAs cloned.40 41 ETA receptors appear to
be
present mainly on vascular smooth muscle cells, mediating the
vasoconstrictor effects of ET-1, whereas ETB receptors on endothelial
cells mediate the vasodilator response to ET-1. Under certain
conditions, however, ETB receptors may also mediate the vasoconstrictor
response to ET-1.42 43 Reports that monocrotaline
injures
the endothelium of the pulmonary artery but not of systemic arteries
and causes an elevation in pulmonary vascular permeability and the
exudation of plasma components through the pulmonary vascular
wall44 45 suggest that increased ET-1 in DMCT beagles
can
easily penetrate the pulmonary vessel wall. It is likely that this
event changes endothelin receptor regulation, thereby altering the
response to ET-1 in the pulmonary artery. Endothelin antagonists are
crucial tools for elucidating the pathophysiological role of
endothelin. FR139317, a newly synthesized selective ETA receptor
antagonist,19 decreases systemic and pulmonary vascular
tone with or without PH, although the differences are not statistically
significant. At 8 weeks after DMCT, the vasodepressor effects of
FR139317 on systemic arterial pressure and vascular resistance were not
significant, but the effects on pulmonary arterial pressure and
vascular resistance were significant. These data indicate that in PH,
vasodilation by FR139317 primarily affects the pulmonary rather than
the systemic circulation. On the other hand, RES-701-1, an ETB receptor
antagonist,21 increases pulmonary vascular tone in PH and
does not affect the other hemodynamics. The fact that in the eighth
week of DMCT-induced PH the systemic vasoconstrictor response to ET-1
was attenuated by FR139317 and the pulmonary vasodilator response to
ET-1 was attenuated by RES-701-1 suggested that when PH was well
established, the vasoresponse mediated by ETA receptors might be
dominant in the systemic circulation, and via ETB receptors might be
dominant in the pulmonary circulation. Furthermore, to investigate ETB
receptors, we used sarafotoxin S6c, a highly selective agonist of brain
ETB receptors.22 Sarafotoxin S6c produced vasodilatation
not in baseline arteries but in PH arteries, which indicated that the
vasodilatory response in PH appeared to be mediated via ETB receptors.
These findings suggest an important role of ET-1 in suppressing PH. It
is possible that ETB receptors predominate in the pulmonary circulation
of DMCT-induced PH. Li et al46 indicate enhancement
of pulmonary ET-1 gene expression associated with upregulation of
ETB receptor expression and maintenance of normal ETA receptor
expression in rat lung during chronic hypoxic PH.
The present study suggests that complex interactions of vasoactive
materials locally produced by endothelial cells regulate vascular tone.
Any imbalance of this regulation can induce disorders such as essential
hypertension or PH.47 The role of ET-1 in these regulatory
mechanisms is unclear. In addition, it remains unclear whether
endogenous ET-1, the circulating plasma levels of which are increased
in PH, is responsible for the vascular tone or is serving in
counterregulation.9 11 DMCT induces damage to
endothelial
cells and may alter normal ET-1 responses, including the production and
effects of ET-1, and receptor density. The major finding is that
endogenous ET-1 tends to improve PH through ETB receptors. One
potential disadvantage of the ETB receptor antagonist may be the
blockade of this improvement. This study helps elucidate the
pathogenesis of PH and has important implications for drug development
and the potential therapeutic use of endothelin antagonists. Although
further investigation in humans is necessary, our results suggest that
ETB receptors play an important role in PH.
 |
Acknowledgments
|
|---|
We thank Fujisawa Pharmaceutical Co, Ltd, Tsukuba, Japan, for
supplying
FR139317, and Kyowa Hakko Kogyo Co, Ltd, Tokyo, Japan, for
supplying
RES-701-1.
Received October 12, 1994;
revision received December 20, 1994;
accepted December 29, 1994.
 |
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