Hypertension is a critical public health issue worldwide, and in the United States, it is the leading cause of heart disease, stroke, and kidney failure, contributing to more than 1,100 deaths per day. It is proposed that the renal medulla combats increased blood pressure by releasing a neutral lipid from the lipid droplets of medullary interstitial cells, termed medullipin, which induces diuresis- natriuresis and vasodepression. The renal medulla is enriched with fatty acid lipid ethanolamides including the endocannabinoid anandamide (AEA), palmitoylethanolamide (PEA), and oleoylethanolamide (OEA), along with their primary hydrolyzing enzyme fatty acid amide hydrolase (FAAH). Our lab is investigating the relationship of these lipid ethanolamides and their metabolites to medullipin. We have shown that intramedullary infusion of AEA stimulated diuresis-natriuresis without changing mean arterial pressure (MAP) in an acute surgical model using anesthetized normotensive C57BL/6J mice. The hypothesis that infusion of a FAAH-selective inhibitor, PF-3845, would produce similar responses as exogenous AEA was tested. Intramedullary infusion of PF-3845 stimulated diuresis-natriuresis, decreased MAP, and increased lipid ethanolamide concentrations in kidney tissue in C57BL/6J mice. Since the decrease in MAP observed with PF-3845 was not consistent with the results of exogenous AEA, this study hypothesized that increased PEA concentrations in the renal medulla observed with PF-3845 produced the decrease in MAP. Therefore, the effects of PEA administration into the renal medulla were investigated. Intramedullary infusion of PEA stimulated diuresis and natriuresis without changing MAP in normotensive C57BL/6J mice. However, intramedullary PEA administration to mice made hypertensive using L-NAME, an inhibitor of nitric oxide synthase, was assessed. Intramedullary infusion of PEA stimulated diuresis, but also decreased MAP in L-NAME-induced hypertensive mice. The mechanism of PEA-induced diuresis was evaluated for the contributions of its FAAH-mediated hydrolysis and the CB1 receptor. Intramedullary infusion of PEA stimulated diuresis in FAAH knockout mice and CB1 knockout mice. The possible source of PEA in the renal medulla was investigated using renal medullary interstitial cells cultured from mice. In cultured mouse medullary interstitial cells (MMICs), treatment with PF-3845 increased cytoplasmic lipid droplets detected by Sudan Black B (SBB) staining and increased PEA in the culture medium. Physiologic stimuli that may regulate PEA production and release from MMICs were also evaluated. Increased osmolarity increased NAPE-PLD protein levels, increased SBB stained droplets in MMICs, and increased PEA concentrations in the culture medium. Overall, it is concluded that the PEA-induced diuretic and natriuretic effect is independent of FAAH-mediated hydrolysis and the CB1 receptor, and that PEA can serve as an antihypertensive regulator in the renal medulla that may be regulated by medullary interstitial cells.

The relationship between the endocannabinoid system in the renal medulla and the long-term regulation of blood pressure is not well understood. To investigate the possible role of the endocannabinoid system in renomedullary interstitial cells, mouse medullary interstitial cells (MMICs) were obtained, cultured and characterized for their responses to treatment with a selective inhibitor of fatty acid amide hydrolase (FAAH), PF-3845. Treatment of MMICs with PF-3845 increased cytoplasmic lipid granules detected by Sudan Black B staining and multilamellar bodies identified by transmission electron microscopy. HPLC analyses of lipid extracts of MMIC culture medium revealed a 205nm-absorbing peak that showed responsiveness to PF-3845 treatment. The biologic activities of the PF-3845-induced product (PIP) isolated by HPLC were investigated in anesthetized, normotensive surgically-instrumented mice. Intramedullary and intravenous infusion of PIP at low dose rates (0.5-1 AU/10 min) stimulated diuresis and natriuresis, whereas at higher doses, these parameters returned toward baseline but mean arterial pressure (MAP) was lowered. Whereas intravenous bolus doses of PIP stimulated diuresis, GFR and medullary blood flow (MBF) and reduced or had no effect on MAP, an intraperitoneal bolus injection of PIP reduced MAP, increased MBF, and had no effect on urinary parameters. Genetic or pharmacological ablation of the cannabinoid type 1 receptors in mice completely abolished the diuretic and vasodepressor properties of intramedullary infused PIP, suggesting that the PF-3845-induced product requires the presence of CB1 receptors in order to elicit its renal effects. In a radioactive competition binding assay, using Chinese hamster ovary cells expressing CB1 receptors, PIP successfully displaced the CB1 selective inverse agonist [3H] SR141716A, revealing that the lipid extract was able to compete for binding to CB1 receptors. Finally, we investigated the tubular location of diuretic activity that the PF-3845-induced lipid fraction exhibits. In a renal function in vivo experiment, we pre-treated anesthetized mice with an intramedullary infusion of one of four well-known diuretics. This procedure was followed by an intramedullary infusion of PIP (1AU). Only inhibition of the proximal tubule sodium reabsorption diminished the diuretic activity of the PF-3845-induced product, suggesting that the lipid fraction requires a physiologically intact proximal tubular reabsorption mechanism for it to produce diuresis. These data support a model whereby PF-3845 treatment of MMICs results in increased secretion of a neutral lipid which acts directly to promote diuresis and natriuresis and indirectly through metabolites to produce vasodepression. Efforts to identify the structure of the PF-3845-induced lipid and its relationship to the previously proposed renomedullary antihypertensive lipids are ongoing.