<p>The fluid dynamics of blood in the systemic circulation modulates production of nitric oxide (NO), a potent vasodilator. Non-invasive techniques such as the flow-mediated dilation (FMD) test and physiologic phenomena associated with autonomic stress induce hyperemia and subsequently higher levels of wall shear stress (WSS), stimulating endothelial nitric oxide synthase (eNOS) expression. In the current clinical practice, WSS–a key regulator of endothelial function–is commonly estimated assuming a parabolic velocity distribution, despite the evidence that the temporal changes of pulsatile blood flow over the cardiac cycle modulate vasodilation in mammals. This work investigates the effect of cardiovascular stress on local WSS distributions and the potential for near-wall accumulation of nitrite, the vasoactive storage form of NO in the bloodstream. The specific aims of the project are therefore as follows: 1) develop a reduced-order model of the major systemic vasculature at rest, during a flight-or-flight response, and under moderate levels of aerobic exercise; 2) derive a velocity-driven Womersley solution for pulsatile flow to support accurate estimation of pulsatile WSS in the clinical setting; and 3) quantify cumulative transport of nitrite in a multiscale model of bifurcating vasculature utilizing computational fluid dynamics (CFD). Development of these open-source, translatable methods enable accurate quantification of hemodynamics and species transport during cardiovascular stress. Results detailed herein extend our knowledge about regulation of regional blood flow during autonomic stress, suggest a convergent evolutionary theory for having a complete circle of Willis, and potentially clarify reproducibility concerns associated with the FMD test. </p>

In vivo, la pression artérielle au niveau des artères cérébrales est pulsée, alors que ex vivo, l’étude de la fonction cérébrovasculaire est majoritairement mesurée en pression statique. L’impact de la pression pulsée sur la régulation du tonus myogénique et sur la fonction endothéliale cérébrale est inconnu. Nous avons posé l’hypothèse selon laquelle en présence d'une pression pulsée physiologique, la dilatation dépendante de l’endothélium induite par le flux et le tonus myogénique seraient optimisés. L’objectif de notre étude est d’étudier ex vivo l’impact de la pression pulsée sur le tonus myogénique et la dilatation induite par le flux dans les artères cérébrales de souris. Nous avons utilisé un artériographe pressurisé couplé à un système générant une onde pulsée de fréquence et d’amplitude réglables. Les artères cérébrales moyennes (≈160 μm de diamètre) ont été isolées de souris C57BL6 âgées de 3 mois et pressurisées à 60 mm Hg, en pression statique ou en pression pulsée. En pression statique, le tonus myogénique est faible mais est potentialisé par le L-NNA (un inhibiteur de la eNOS) et la PEG-catalase (qui dégrade le H2O2), suggérant une influence des produits dilatateurs dérivés de la eNOS sur le tonus myogénique. En présence de pression pulsée (pulse de 30 mm Hg, pression moyenne de 60 mm Hg, 550 bpm), le tonus myogénique est significativement augmenté, indépendamment du L-NNA et de la PEG-catalase, suggérant que la pression pulsée lève l’impact de la eNOS. En pression statique ou pulsée, les artères pré-contractées se dilatent de façon similaire jusqu’à une force de cisaillement de 15 dyn/cm2. Cette dilatation, dépendante de l’endothélium et de la eNOS, est augmentée en condition pulsée à une force de cisaillement de 20 dyn/cm2. En présence de PEG-catalase, la dilatation induite par le flux est diminuée en pression statique mais pas en pression pulsée, suggérant que la pression statique, mais pas la pression pulsée, favorise la production de O2 -/H2O2. En effet, la dilatation induite par le flux est associée à une production de O2 -/H2O2 par la eNOS, mesurable en pression statique, alors que la dilatation induite par le flux en pression pulsée est associée à la production de NO. Les différences de sensibilité à la dilatation induite par le flux ont été abolies après inhibition de Nox2, en condition statique ou pulsée. La pression pulsée physiologique régule donc l’activité de la eNOS cérébrale, en augmentant le tonus myogénique et, en présence de flux, permet la relâche de NO via la eNOS. / While in vivo arterial blood pressure in cerebral arteries is pulsatile, in vitro cerebral arterial function is generally assessed under a static pressure. Thus, whether pulse pressure regulates cerebral endothelial shear stress sensitivity and myogenic tone is unknown. We hypothesized that a physiological pulse pressure induces a better flow-mediated dilation and optimized myogenic tone. The aim of this study was to test in vitro the impact of pulse pressure on myogenic tone and eNOS-dependent flow-mediated dilation in mouse cerebral arteries. Using a custom computer-controlled pneumatic system generating a pulse pressure (used at 30 mm Hg, rate of 550 bpm) coupled to an arteriograph, isolated posterior cerebral arteries from 3-month old C57Bl/6J mice were pressurized at 60 mm Hg, either in static or pulse pressure conditions. Shear stress from 2 to 20 dyn/cm2 was applied and flow-mediated dilation measured. Without pulse pressure, myogenic tone was low but potentiated by both L-NNA (eNOS inhibitor) and PEG-catalase (catalyses H2O2), suggesting an influence of eNOS-derived dilator products on myogenic tone. Pulse pressure significantly increased myogenic tone, independently of L-NNA and PEG-catalase, suggesting that pulse pressure prevents the impact of eNOS. In both static and pulse pressure conditions, cerebral arteries did not dilate to shear stress in the presence of L-NNA or after endothelial denudation, confirming the endothelial origin of the dilatory response. Up to 15 dyn/cm2, shear stress elicited similar flow-mediated dilation in static and pulse pressure conditions; at 20 dyn/cm2, however, flow-mediated dilation were higher in the presence of pulse pressure. PEG-catalase reduced flow-mediated dilation in static but not in pulse pressure, suggesting that in static conditions eNOS is responsible for O2 -/H2O2 production. Indeed, eNOS-derived O2 -/H2O2 production was measured during flow-mediated dilation in static pressure, while pulse pressure promoted eNOS-derived NO production. Differences in flow-mediated dilation between static and pulse pressure conditions were abolished after Nox2 inhibition. In conclusion, pulse pressure modulates cerebrovascular eNOS activity: at rest, pulse pressure inhibits eNOS, increasing myogenic tone. In the presence of flow, pulse pressure permits a shear stress-dependent eNOS-derived NO release, leading to higher flow-mediated dilation.

A disfunção erétil (DE) tem alta prevalência entre hipertensos e tem sido considerada marcador precoce de risco cardiovascular. A presença e gravidade da DE bem como a resposta clínica aos inibidores da fosfodiesterase tipo 5 (PDE5) parecem depender da biodisponibilidade do óxido nítrico (NO) endotelial e da extensão da doença aterosclerótica. O objetivo deste estudo foi avaliar a resposta clínica da vardenafila usada em dois regimes terapêuticos em hipertensos com DE vasculogênica e sem doença cardiovascular maior, correlacionando a gravidade da DE e a eficácia da vardenafila com dados antropométricos, laboratoriais, escore de risco cardiovascular e parâmetros vasculares funcionais e estruturais. A resposta clínica à vardenafila nos dois regimes foi avaliada conforme o percentual de respostas positivas à questão 3 do Perfil do Encontro Sexual (PES3). Os parâmetros vasculares considerados foram a espessura médio-intimal (EMI) da carótida comum, a dilatação mediada pelo fluxo (DMF) da artéria braquial e a dilatação nitrato-mediada (DNM). Foram incluídos 100 homens hipertensos com idade entre 50 e 70 anos, sendo 74 portadores de DE vasculogênica e 26 com função erétil normal que serviram de grupo controle. Nos pacientes com DE, o índice de massa corporal, relação cintura-quadril, EMI da carótida, níveis séricos de triglicerídeos, colesterol total e LDL foram significativamente maiores que no grupo controle. Após o uso de vardenafila on demand (fase 1), os pacientes com mais de 50% de respostas positivas ao PES3 ou 50% de respostas afirmativas e um incremento de 6 pontos ou mais em relação ao Índice Internacional de Função Erétil (IIEF-FE) basal e/ou resposta positiva a Questão de Avaliação Global (QAG), foram considerados respondedores. O escore do IIEF-FE basal se correlacionou negativamente com a EMI da carótida (r=-0,48, P<0,001) e com o escore de Framingham (r= -0,41, P<0,001) no grupo com DE. Houve forte correlação positiva entre a resposta clínica à vardenafila com a DMF (r= 0,70, P<0,001), que não se observou entre o sub-grupo de diabéticos. Os 35 pacientes considerados não-respondedores na fase 1 foram randomizados e, em desenho duplo-cego, receberam vardenafila ou placebo diariamente durante cinco semanas, podendo usar 10 mg de vardenafila uma hora antes da atividade sexual (fase2). Houve resposta clínica positiva em 38,8% dos que receberam a vardenafila na fase 2 e esta resposta se correlacionou com a frequência sexual (r= 0,68, P<0,01) e com o escore de Framingham (r= -0,65, P<0,01), com a EMI da carótida (r= -0,61, P=0,01) e com o LDL-colesterol (r= -0,64, P<0,01). A vardenafila foi bem tolerada em ambos os regimes terapêuticos. Concluímos que nessa amostra de hipertensos, a gravidade da DE foi relacionada a parâmetros vasculares estruturais (EMI), enquanto a resposta clínica à vardenafila on demand foi mais diretamente dependente da função vascular momentânea (DMF). Houve benefício na utilização de vardenafila diariamente com o objetivo de resgatar a eficácia do inibidor quanto à melhora do desempenho sexual. A falta de eficácia clínica ao inibidor da PDE5 em ambos os regimes terapêuticos pode servir como marcador clínico que identifica homens hipertensos com um risco cardiovascular aumentado. / Erectile dysfunction (ED) is a high prevalent disease in hypertensive subjects and has been considered an early cardiovascular risk marker. EDs presence and severity, as well as clinical response to phosfodiesterase type 5 (PDE5) inhibitors, vary according to nitric oxide (NO) availability and atherosclerosis extension. We investigated whether vasculogenic ED severity and clinical response to vardenafil used on demand or continuously were associated with structural and functional vascular changes in patients with uncomplicated hypertension. Our main efficacy criterion was per patient percentage of positive answers on Sexual Encounter Profile question 3(SEP3). Vascular parameters considered were intima-media thickness (IMT), flow-mediated dilation (FMD) on brachial artery and nitrate-mediated dilation. A total of 100 hypertensive men aging between 50 and 70 years were included. Among these patients, 74 had vasculogenic ED and 26 presented normal erectile function according to erectile domain of International Index of Erectile Function (IIEF-EF). Among those with ED, body mass index, waist-rip ratio, carotid IMT, triglycerides, total cholesterol and LDL-cholesterol were significantly higher than controls. After vardenafil on demand usage during phase 1, patients with more than 50% of positive answers on SEP3 or 50% and more than 6 points on IIEF basal score or positive answer to global evaliation question were considered responders. IIEF basal score correlated inversely with carotid IMT (r=-0.48, P<0.001) and with Framingham risk score (r= -0.41, P<0.001) in ED group. Clinical response to vardenafil strongly correlated with FMD (r= 0.70, P<0.001), except among diabetics. Non responders (n=35) on phase 1 were included on phase 2 when, after randomization, they received vardenafil 10 mg nightly or placebo during five weeks. Open vardenafil on demand were allowed one hour before sexual intercourse, and 38.8% of active group improved and became responders to vardenafil. Clinical response on phase 2 correlated with sexual frequency (r= 0.68, P<0.01), Framingham score (r= -0.65, P<0.01), carotid IMT (r= -0.61, P=0.01) and LDL-cholesterol (r= -0.64, P<0.01). We concluded that in hypertensive males with vasculogenic ED and no other clinical evidence of atherosclerosis, ED severity correlated with structural parameters (carotid IMT), while phosphodiesterase-5 effectiveness correlated with functional vascular aspects (brachial FMD). There were positive impact with continuous vardenafil on non responders to on demand regime and that could be an option to salvage strategy. Lack of PDE5 inhibitor efficacy in both therapeutic strategies could point out to higher cardiovascular risk and could be considered a useful clinical marker.

A disfunção erétil (DE) tem alta prevalência entre hipertensos e tem sido considerada marcador precoce de risco cardiovascular. A presença e gravidade da DE bem como a resposta clínica aos inibidores da fosfodiesterase tipo 5 (PDE5) parecem depender da biodisponibilidade do óxido nítrico (NO) endotelial e da extensão da doença aterosclerótica. O objetivo deste estudo foi avaliar a resposta clínica da vardenafila usada em dois regimes terapêuticos em hipertensos com DE vasculogênica e sem doença cardiovascular maior, correlacionando a gravidade da DE e a eficácia da vardenafila com dados antropométricos, laboratoriais, escore de risco cardiovascular e parâmetros vasculares funcionais e estruturais. A resposta clínica à vardenafila nos dois regimes foi avaliada conforme o percentual de respostas positivas à questão 3 do Perfil do Encontro Sexual (PES3). Os parâmetros vasculares considerados foram a espessura médio-intimal (EMI) da carótida comum, a dilatação mediada pelo fluxo (DMF) da artéria braquial e a dilatação nitrato-mediada (DNM). Foram incluídos 100 homens hipertensos com idade entre 50 e 70 anos, sendo 74 portadores de DE vasculogênica e 26 com função erétil normal que serviram de grupo controle. Nos pacientes com DE, o índice de massa corporal, relação cintura-quadril, EMI da carótida, níveis séricos de triglicerídeos, colesterol total e LDL foram significativamente maiores que no grupo controle. Após o uso de vardenafila on demand (fase 1), os pacientes com mais de 50% de respostas positivas ao PES3 ou 50% de respostas afirmativas e um incremento de 6 pontos ou mais em relação ao Índice Internacional de Função Erétil (IIEF-FE) basal e/ou resposta positiva a Questão de Avaliação Global (QAG), foram considerados respondedores. O escore do IIEF-FE basal se correlacionou negativamente com a EMI da carótida (r=-0,48, P<0,001) e com o escore de Framingham (r= -0,41, P<0,001) no grupo com DE. Houve forte correlação positiva entre a resposta clínica à vardenafila com a DMF (r= 0,70, P<0,001), que não se observou entre o sub-grupo de diabéticos. Os 35 pacientes considerados não-respondedores na fase 1 foram randomizados e, em desenho duplo-cego, receberam vardenafila ou placebo diariamente durante cinco semanas, podendo usar 10 mg de vardenafila uma hora antes da atividade sexual (fase2). Houve resposta clínica positiva em 38,8% dos que receberam a vardenafila na fase 2 e esta resposta se correlacionou com a frequência sexual (r= 0,68, P<0,01) e com o escore de Framingham (r= -0,65, P<0,01), com a EMI da carótida (r= -0,61, P=0,01) e com o LDL-colesterol (r= -0,64, P<0,01). A vardenafila foi bem tolerada em ambos os regimes terapêuticos. Concluímos que nessa amostra de hipertensos, a gravidade da DE foi relacionada a parâmetros vasculares estruturais (EMI), enquanto a resposta clínica à vardenafila on demand foi mais diretamente dependente da função vascular momentânea (DMF). Houve benefício na utilização de vardenafila diariamente com o objetivo de resgatar a eficácia do inibidor quanto à melhora do desempenho sexual. A falta de eficácia clínica ao inibidor da PDE5 em ambos os regimes terapêuticos pode servir como marcador clínico que identifica homens hipertensos com um risco cardiovascular aumentado. / Erectile dysfunction (ED) is a high prevalent disease in hypertensive subjects and has been considered an early cardiovascular risk marker. EDs presence and severity, as well as clinical response to phosfodiesterase type 5 (PDE5) inhibitors, vary according to nitric oxide (NO) availability and atherosclerosis extension. We investigated whether vasculogenic ED severity and clinical response to vardenafil used on demand or continuously were associated with structural and functional vascular changes in patients with uncomplicated hypertension. Our main efficacy criterion was per patient percentage of positive answers on Sexual Encounter Profile question 3(SEP3). Vascular parameters considered were intima-media thickness (IMT), flow-mediated dilation (FMD) on brachial artery and nitrate-mediated dilation. A total of 100 hypertensive men aging between 50 and 70 years were included. Among these patients, 74 had vasculogenic ED and 26 presented normal erectile function according to erectile domain of International Index of Erectile Function (IIEF-EF). Among those with ED, body mass index, waist-rip ratio, carotid IMT, triglycerides, total cholesterol and LDL-cholesterol were significantly higher than controls. After vardenafil on demand usage during phase 1, patients with more than 50% of positive answers on SEP3 or 50% and more than 6 points on IIEF basal score or positive answer to global evaliation question were considered responders. IIEF basal score correlated inversely with carotid IMT (r=-0.48, P<0.001) and with Framingham risk score (r= -0.41, P<0.001) in ED group. Clinical response to vardenafil strongly correlated with FMD (r= 0.70, P<0.001), except among diabetics. Non responders (n=35) on phase 1 were included on phase 2 when, after randomization, they received vardenafil 10 mg nightly or placebo during five weeks. Open vardenafil on demand were allowed one hour before sexual intercourse, and 38.8% of active group improved and became responders to vardenafil. Clinical response on phase 2 correlated with sexual frequency (r= 0.68, P<0.01), Framingham score (r= -0.65, P<0.01), carotid IMT (r= -0.61, P=0.01) and LDL-cholesterol (r= -0.64, P<0.01). We concluded that in hypertensive males with vasculogenic ED and no other clinical evidence of atherosclerosis, ED severity correlated with structural parameters (carotid IMT), while phosphodiesterase-5 effectiveness correlated with functional vascular aspects (brachial FMD). There were positive impact with continuous vardenafil on non responders to on demand regime and that could be an option to salvage strategy. Lack of PDE5 inhibitor efficacy in both therapeutic strategies could point out to higher cardiovascular risk and could be considered a useful clinical marker.

Les maladies cardiométaboliques sont les principales causes de décès dans le monde, et au Canada elles sont responsables d'environ 700 000 décès par année. Le diabète de type 2 et la maladie coronarienne sont les maladies cardiométaboliques les plus répandues. Malgré des avancées pharmacologiques, la prévalence de ces maladies demeure élevée, ce qui souligne l'importance des thérapies complémentaires qui améliorent le contrôle glycémique ainsi que la fonction vasculaire afin de prévenir les complications liées à ces maladies. Depuis quelques années, l’exposition à la chaleur reçoit une attention accrue pour son potentiel thérapeutique. En outre, des études scientifiques suggèrent que l’exposition à la chaleur pourrait diminuer la glycémie et améliorer la fonction vasculaire. Cependant, le potentiel thérapeutique de l'exposition à la chaleur demeure sous-étudié chez les personnes atteintes du diabète de type 2 ou de la maladie coronarienne. L’objectif général de cette thèse était d’évaluer les effets aigus de l’exposition à la chaleur sur des marqueurs de la fonction cardiométabolique auprès de gens ayant un diabète de type 2 ou une maladie coronarienne. L’article 1 a déterminé l’effet aigu d’une immersion en eau chaude sur la sensibilité à l’insuline, la fonction vasculaire, les concentrations des protéines de choc thermique plasmatique (eHSP70/90) et intracellulaire (iHSP70/90), les marqueurs inflammatoires (IL-6, IL1-RA, NFKB) ainsi que sur les médiateurs de l'action de l'insuline (IRS-1, GLP-1) comparativement à une immersion thermoneutre au sein d’une population ayant le diabète de type 2. Les résultats démontrent qu’une immersion en eau chaude n’améliore pas la sensibilité à l’insuline, ni la fonction vasculaire et elle n’affecte pas les concentrations de HSP70 / 90 et les marqueurs inflammatoires. L’article 2 a déterminé l’effet aigu d’une exposition dans un sauna Finlandais sur la fonction vasculaire, des marqueurs de dysfonction endothéliale (VCAM-1, ICAM-1) et des marqueurs inflammatoires (IL-6, IL-10, TNF-α, IL-1β, CRP) auprès de personnes ayant une maladie coronarienne. Les résultats démontrent qu’une séance de sauna Finlandais améliore la fonction endothéliale et augmente la concentration circulante d’IL-6 sans affecter d’autres marqueurs inflammatoires (IL-10, TNF-α, IL-1β, CRP) ainsi que des marqueurs de dysfonction endothéliale. Combinées, les deux études de cette thèse démontrent que l’exposition passive à la chaleur n’améliore pas de façon aiguë les marqueurs cardiométaboliques chez les personnes diabétiques de type 2. Par contre, la chaleur exerce un effet bénéfique sur la fonction endothéliale chez les personnes ayant une maladie coronarienne. / Cardiometabolic diseases are the leading cause of death globally, and in Canada they are responsible for approximately 700 000 deaths each year. Type 2 diabetes and coronary artery disease are the most prevalent cardiometabolic diseases. Despite advancements in pharmacological treatments, the prevalence of these diseases remains high which underlines the importance of complementary therapies to prevent complications related to these diseases. In recent years, heat exposure has received attention for its therapeutic potential. Studies have demonstrated that heat exposure could be an effective method to decrease glycemia and improve vascular function. However, the therapeutic potential of heat exposure remains understudied in people with type 2 diabetes or coronary artery disease. The general objective of this thesis was to evaluate the acute effects of heat exposure on cardiometabolic markers in people with type 2 diabetes and coronary artery disease. The first article of this thesis determined the acute effect of hot water immersion on insulin sensitivity, vascular function, plasma (eHSP70 / 90) and intracellular (iHSP70 / 90) heat shock protein concentrations, inflammatory markers (IL- 6, IL1-RA, NFKB) as well as mediators of insulin action (IRS-1, GLP-1) compared to thermoneutral water immersion in a population with type 2 diabetes. Findings from this study demonstrate that acute hot water immersion does not improve insulin sensitivity, vascular function or affect HSP70 / 90 concentrations and inflammatory markers. The second article of this thesis determined the acute effects of Finnish sauna bathing on vascular function, markers of endothelial dysfunction (VCAM-1, ICAM-1) and inflammatory markers (IL-6, IL-10, TNF- α, IL-1β, CRP) in older adults with coronary artery disease. Results from this study demonstrate that one bout of Finnish sauna bathing improves endothelial function and increases the circulating concentration of IL-6 without affecting other markers of inflammation (IL-10, TNF-α IL-1β, CRP) or endothelial dysfunction. Combined, these results show that acute heat exposure does not acutely improve cardiometabolic markers in people with type 2 diabetes. On the other hand, heat exposure has a beneficial effect on endothelial function in people with coronary artery disease.