Despite the number of therapeutic interventions currently available for treating hypertension, approximately one-third of adult patients in the United States currently being treated remain hypertensive (43). As the number of hypertensive patients continues to grow, it is becoming increasingly important to investigate the different types of hypertension in order to have a greater understanding of the pathogenesis and identify potential targets for treatment. Neurogenic hypertension refers to hypertension resulting from a centrally mediated mechanism, likely involving a sustained increase in sympathetic nervous system activity. The renin-angiotensin aldosterone system (RAAS) is a physiological cascade responsible for restoring blood pressure when it drops. The rate-limiting step involves the enzyme renin. Although there is evidence of local RAAS activity in the brain, expression of renin in the brain is very low (125). The (pro)renin receptor ((P)RR) is able to bind and activate both renin and (pro)renin. Because the (P)RR and (pro)renin expression is high in the brain, it is possible that local RAAS activity is orchestrated by the (P)RR. In this study, we investigated if neuroinflammatory conditions could foster an environment that would allow for a rise in sympathetic nervous system activity (SNA) resulting from brain RAAS activity and the (P)RR. By treating neuronal cell cultures with proinflammatory cytokines, an anti-inflammatory agent, and (pro)renin, we explored any changes or differences in mRNA expression levels. Additionally, the effects of antioxidants were investigated. The results of this study showed that cells lacking antioxidants were more vulnerable to cellular stress and inflammation in the presence of increased (pro)renin. Proinflammatory stress was correlated with increased mRNA expression of proinflammatory and immune system regulatory genes in addition to increased expression of angiotensin II type I receptor, a vital component of RAAS. This could indicate that neuroinflammatory stress can be exacerbated and contribute to increased RAAS activity in the brain mediated by the (P)RR.

Insulin resistance (IR) is considered to be an important factor influencing the progression of atherosclerosis and is associated with higher morbidity and mortality. IR is a common feature of diabetes mellitus Type 2 and obesity. Many authors consider IR being the crucial abnormality of the metabolic syndrome which is characterized by the essential hypertension, hyperliproteinemia, visceral obesity, endothel dysfunction and many other abnormalities. Impaired insulin action (IR) is also described in diabetes mellitus Type 1, however this phenomenon has not been fully explained. The subjects of dissertation thesis was directed on the IR importance in diabetic Type 1 patients as well as on the renin angiotensin system inhibition in patients with IR and metabolic syndrome with impaired glucose homeostasis. Hyperinsulinemic euglycemic clamp is used in combination with indirect calorimetry to estimate the IR in vivo in humans. In our project we focused on a) the existence of the metabolic inflexibility phenomenon in type 1 diabetic patients b) the methodological evaluation of the hyperinsulinemic euglycemic clamp procedure in the same group c) the influence of renin angiotensin system inhibition with angiotensin II type 1 receptor inhibitor telmisartan in patients with metabolic syndrome and impaired glucose...

The locus coeruleus (LC) is a putative site of action for angiotensin II in the brain. Immunocytochemical studies have identified angiotensin II-like immunoreactive material in nerve terminals innervating the LC, and the LC contains one of the highest densities of angiotensin II receptor binding sites in the rat brain. Recent studies using selective neurotoxins suggest that the binding sites for angiotensin II in the LC are present on noradrenergic perikarya. Angiotensin II receptors are now known to exist as two subtypes that are distinguishable both pharmacologically and biochemically. Radioligand binding studies using agonists and antagonists selective for these angiotensin II receptor subtypes indicate that the rat LC contains a mixture of the two known angiotensin II receptor subtypes, but that the PD123177-sensitive AIIβ receptor subtype is predominant. Comparisons of spontaneously hypertensive rats with normotensive rats indicates that angiotensin II and its receptors in the LC are elevated in the hypertensive rat strain. Studies of the biochemical and physiological actions of angiotensin II in the LC have not yet established an agreed-upon function for angiotensin II in this nucleus.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19606号 / 医博第4113号 / 新制||医||1015(附属図書館) / 32642 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 YOUSSEFIAN Shohab, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly reached pandemic proportions, and knowledge about this virus and coronavirus disease 2019 (COVID-19) has expanded rapidly. This review focuses primarily on mechanisms that contribute to acute cardiac injury and dysfunction, which are common in patients with severe disease. The etiology of cardiac injury is multifactorial, and the extent is likely enhanced by pre-existing cardiovascular disease. Disruption of homeostatic mechanisms secondary to pulmonary pathology ranks high on the list, and there is growing evidence that direct infection of cardiac cells can occur. Angiotensin converting enzyme 2 (ACE2) plays a central role in COVID-19 and is a necessary receptor for viral entry into human cells. ACE2 normally not only eliminates angiotensin II (Ang II) by converting it to Ang (1-7), but also elicits a beneficial response profile counteracting that of Ang II. Molecular analyses of single nuclei from human hearts have shown that ACE2 is most highly expressed by pericytes. Given the important roles that pericytes have in the microvasculature, infection of these cells could compromise myocardial supply to meet metabolic demand. Furthermore, ACE2 activity is crucial for opposing adverse effects of locally generated Ang II, so virus-mediated internalization of ACE2 could exacerbate pathology by this mechanism. While the role of cardiac pericytes in acute heart injury by SARS-CoV-2 requires investigation, expression of ACE2 by these cells has broader implications for cardiac pathophysiology.

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Wie sich in den letzten Jahren gezeigt hat, ist Fettgewebe nicht nur ein inerter Fettspeicher, sondern produziert auch eine Vielzahl endokrin wirksamer Substanzen, die unter anderem auch an der Blutdruckregulation beteiligt sind. Da Adipositas ein wichtiger Risikofaktor für die Entwicklung der Hypertonie ist, sollte im Rahmen dieser Dissertation ein System zur quantitativen Untersuchung der Genexpression in Primärkulturen humaner Adipocyten entwickelt werden und dessen Funktionalität am Beispiel der hormonellen Regulation der Gene des Renin-Angiotensin-Systems demonstriert werden. Dies beinhaltete die Etablierung der Adipocytenisolierung und -kultivierung, eines Stimulationsassays, die Entwicklung einer der besonderen Größe und dem hohen Fettgehalt der Zellen angepaßten Zellzahl- und Vitalitätsbestimmungsmethode, die Untersuchung vier verschiedener RNA-Extraktionsmethoden auf ihre Eignung für Adipocyten und die Etablierung eines besonders sensitiven RT-PCR Systems zur Untersuchung der Genexpression mittels einer fluoreszenzmarkierten Sonde. Exemplarisch konnte anhand der Renin-Angiotensin-System-Gene die Funktionalität der Methoden demonstriert werden, indem nicht nur die Genexpression aller Komponenten des Renin-Angiotensin-Systems in humanen Adipocyten nachgewiesen wurden, sondern auch gezeigt werden konnte, dass Hydrocortison sowohl die Genexpression als auch die Dichte des Angiotensin II Typ 1-Rezeptors in der Adipocytenmembran stimuliert. Dieser Aspekt könnte möglicherweise nicht nur bei der besonderen Adipositasform des Cushing-Syndroms, sondern auch für die Entstehung der zentralen Adipositas von Bedeutung sein. / Adipose tissue has functions above-and-beyond storing fat. It also produces a variety of different endocrine substances, some of which influence blood pressure regulation. Obesity is a well known risk factor for the development of hypertension Thus, the genes regulating expression of vasoactive molecules in adipose tissue, possibly contributing to an increase in blood pressure are of great interest. The aim of this work was to develope a system for quantitative gene expression analysis in primary cultured human adipocytes and to demonstrate its utility for studying the hormonal regulation of genes encoding the renin-angiotensin-system. We established procedures for the isolation and culture of human adipocytes, as well as a stimulatory assay. We also developed methods for the determination of cell number and vitality. Above this, four RNA extraction protocols were evaluated regarding their suitability for adipocytes, and a very sensitive RT-PCR system for gene expression analysis using fluorescent labeled probes was established. As an example for the functionality of these methods we showed that all genes of the renin-angiotensin-system are expressed in human adipocytes. We also demonstrated that hydrocortisone stimulates the gene expression as well as the density of the angiotensin II receptor type 1 on cultured human adipocytes. This finding may be of interest for the development of the obesity phenotype found in cushing syndrome, but could also contribute to the development of central obesity.

Schwankungen des arteriellen Blutdrucks (BP) im niederfrequenten Bereich (LF, 0.02-0.2 Hz) sind möglicherweise Ausdruck von endokrinen Regulationssystemen bei der Aufrechterhaltung der kardiovaskulären Homöostase, wie beispielsweise des Renin-Angiotensin-Systems (RAS). Bei Untersuchungen an Ratten mit sogenannter "one-clip, two-kidney" (1C-2K) Goldblatt Hypertonie wurde ein Anstieg der LF Komponente des BP-Powerspektrums unter aktiviertem RAS gefunden. Trotz der bisherigen Untersuchungen blieb jedoch die Frage ungeklärt, ob dieser Anstieg LF(BP)-Power auf einer Stimulation des RAS beruht, oder durch die Blutdruckerhöhung selbst bedingt ist. Aus diesem Grund wurden die Auswirkungen eines stimulierten RAS auf BP-Oszillationen im LF-Bereich in dieser Studie untersucht, während ein Blutdruckanstieg pharmakologisch verhindert wurde. Zweiundzwanzig normotensive Wistar- und siebzehn normotensive Brown-Norway-Katholiek-Ratten wurden aus diesem Grunde chronisch mit einem Telemetriesender instrumentiert. Es erfolgten Blutentnahmen zur Reninaktivitsbestimmung, der BP wurde jeden zweiten Tag telemetrisch aufgezeichnet. Nach drei Wochen wurden die Tiere in zwei Behandlungsgruppen aufgeteilt. Entweder wurden die Tiere einer Behandlung mit Placebo zugewiesen (n=14 bei den Wistar-Ratten und n=8 bei den Brown-Norway-Katholiek-Ratten), oder sie erhielten eine Behandlung mit Hydralazin (n=8 bei den Wistar-Ratten und n=9 bei den Brown-Norway-Katholiek-Ratten, 40-120 mg/kg/Tag). Ein Silberclip (innerer Durchmesser 200 Mikrometer) wurde auf die linke Nierenarterie plaziert, eine erneute Blutentnahme erfolgte und der BP wurde für weitere drei Wochen gemessen. Hiernach wurde die Behandlung beendet, der Clip von der Nierenarterie entfernt und eine letzte Blutabnahme erfolgte. Abschließende Blutdruck-Registrierungen wurden über einen Zeitraum von drei Wochen durchgeführt. Die Power im LF-Bereich wurde aus den aufgezeichneten Blutdrucksignalen berechnet. Nach Implantation eines Nierenclips stieg der BP bei den mit Placebo behandelten Tieren signifikant an (+37 +/- 5.7 mmHg bei den Wistar-Ratten und +50 +/- 7.4 mmHg bei den Brown-Norway-Katholiek-Ratten, p / Low frequency (LF, 0.02-0.2 Hz) blood pressure (BP) fluctuations may result from cardiovascular regulation by endocrine systems such as the renin-angiotensin system (RAS). Studies employing one-clip, two-kidney (1C-2K) Goldblatt hypertension in rats demonstrated an increase in the LF component of the BP power spectrum. However it remains controversial, whether this increase in LF(BP)-Power is due to the stimulation of the RAS or to the elevation in BP itself. Therefore, we investigated the effect of RAS stimulation on LF(BP) fluctuation while the increase in BP was prevented pharmacologically. Twenty-two normotensive Wistar and seventeen Brown-Norway Katholiek rats were chronically instrumented with telemetric BP sensors, blood samples for measurement of the renin activity were taken and BP was monitored every other day. Three weeks later, rats were subjected to oral treatment with either placebo (n=14 in the Wistar rats and n=8 in the Brown-Norway Katholiek rats) or hydralazine (n=8 in the Wistar rats and n=9 in the Brown-Norway Katholiek rats, 40-120 mg/kg/day). A stainless steel clip (inner diameter 200 micrometer) was placed on the left renal artery, again blood samples were taken and BP was recorded for another three weeks. Finally, treatment was discontinued, the clip was removed from the renal artery, a last blood sample was taken and BP was monitored for a final period of three weeks. LF spectral power was calculated off-line from the recorded BP signal. After renal artery clipping BP significantly increased in placebo-treated rats (+37 +/- 5.7 mmHg in the Wistar rats, +50 +/- 7.4 mmHg in the Brown-Norway Katholiek rats, p