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Walsh University Walsh University Effects of Reduced Uterine Perfusion Pressure on Cerebral Artery Tone in Pregnant Rats Treated with Nanoparticles Containing VEGF Receptor A Thesis by Matthew D. Thomas Mathematics and Sciences Submitted in partial fulfillment of the requirements for a Bachelor of Science Degree with University Honors May 2016 Accepted by the Honors Program Jacqueline Novak, Ph.D., Advisor Date Adam Underwood, Ph.D., Reader Date Ty Hawkins, Ph.D., Honors Director Date Acknowledgments I would like to offer a special thanks to Dr. Jackie Novak and Dr. J.J. Ramirez for graciously sharing their time and knowledge and their persistent patience. Additionally, I would like to thank Dr. Adam Underwood for being the reader of this thesis and his assistance in the lab. I would like to thank Dr. Ty Hawkins, Dr. Koop Berry, and Walsh University’s Honors program for the wonderful opportunity to grow intellectually and personally. Lastly, I would like to thank my family for their continued support throughout this entire process. iv Table of Contents Figures, Tables, and Graphs………………………………….………….....…..………v Abstract and Introduction……………………………….….…………………….……1 Literature Review………..…………….………….…………………………..……...…4 Purpose……………………………………………...…….….…………………….……13 Methodology………………………………..…………….….…………………….……14 Results……………………………………………………….….………………….……26 Discussion……………………………………………..….….…………………….……37 Limitations……………………………………………….….…………………….……40 Conclusion……………………………………………….….……………………..……41 References……………………………….….…………………………….……….……42 Appendix………………………...……………………….….……………………...….A-1 v Figures, Graphs, and Tables Figure 1: Spiral Artery Remodeling………………………….………….....…..………6 Figure 2: VEGF’s 3D Structure...…………………………….………….....…..………7 Figure 3: Non-Viral Gene Transfection…..………………….………….....…..………9 Figure 4: Rupp Model Clip Placement ……………………….………….........……...11 Figure 5: Polyacrylamide Gel ………………………………….…………........…...…37 Graph 1: Percent Tone for SD 102 …………………..…….…...……….....…..…...…20 Graph 2: Percent Tone Comparison: Rupp/Sham ……………...…….....…..………29 Graph 3: Percent Tone Comparison: Sham-Trt/Sham ……………………………...30 Graph 4: Percent Tone Comparison: Rupp-Trt/Rupp ……………………………...31 Graph 5: Strain vs. Pressure ………………………...……….……….......…..…….…33 Graph 6: Myogenic Reactivity Uterine Arteries.…...……….………….....…….……35 Table 1: Sample Strain Calculation: SD 100 …………………………......…..…....…21 Table 2: Raw Data Diameter Measurements ………….…….………….....…........…26 Table 3: Average Percent Tone and Standard Error: Sham………………...………27 Table 4: Average Percent Tone and Standard Error: Rupp………………......….…27 Table 5: Average Percent Tone and Standard Error: Rupp-Trt……………...….…28 Table 6: Average Percent Tone and Standard Error: Sham-Trt………………....…28 Table 7: Average Strain: Sham ………….………………...….………….....….......…32 Table 8: Average Strain: Rupp ………….………………...….………….....…........…32 Table 9: Average Strain: Sham-Trt ………….………………........…….....…........…32 Table 10: Average Strain: Rupp-Trt ………….……………….......……......…….......32 1 Abstract Preeclampsia is a potentially fatal condition that affects maternal and fetal health at the utero-placental barrier. Researchers propose that preeclampsia is a result of an improper balance of angiogenic factors and their receptors, specifically a decreased amount of free vascular endothelial growth factor (VEGF) available to bind to membrane bound VEGF receptor.10 This imbalance is believed to impair spiral artery remodeling in the decidua, which results in maternal hypertension. The primary purpose of this study was to evaluate the effects of L-Tyrosine Polyphosphate (LTP) nanoparticles injections containing exogenous DNA which result in an up regulation of membrane bound VEGF receptor (VEGF-R2) had on the maternal and fetal health, specifically the cerebral arteries of the mother. We used the reduced uterine perfusion pressure (RUPP) model to induce preeclamptic-like symptoms in pregnant Sprauge-Dawley rats. The RUPP model reduced blood flow to the uterus by partially occluding the descending abdominal aorta and uterine-ovarian arcades, and had been proven to illicit physiologic changes similar to preeclampsia including altered vessel tone.18 The control group (Sham) underwent surgery, but did not receive the occluding clips, thus did not develop preeclamptic-like symptoms. Additionally, at the time of surgery the rats were either injected with LTP- nanoparticles or not, which resulted in four groups Rupp, Rupp-Treated, Sham, and Sham-Treated. The rats were euthanized at day 20 of pregnancy, and their posterior cerebral arteries (PCA) were removed. The vessels were hung on an isobaric arteriograph and subjected to an array of pressures to assess the vessels’ myogenic tones. We found that VEGF-R2 injections via nanoparticles significantly reduced maternal hypertension (p < 0.5)32 significantly improved uterine artery myogenic responsiveness (p < 0.5)32, significantly increased fetal weight (p < 0.5)32, and most likely reduces myogenic tone of the posterior cerebral arteries. Western Blotting was also performed to compare the amount of phosphorylated VEGF-R2 present in the in the various groups. The results of the Western Blotting were inconclusive. The results suggest that VEGF-R2 injections via nanoparticles did improve spiral artery angiogenesis improving maternal health. Introduction Preeclampsia is a serious medical condition that is one of the leading causes of preterm births and maternal fatalities worldwide, and affects between 2-9% of all pregnancies.1,2,3 Clinically, preeclampsia is defined as new onset hypertension associated with pregnancy after 20 weeks gestation with the presence of endothelial dysfunction, hyperuricemia, and proteinuria- abnormally high amounts of protein found in the urine.2 Severe preeclampsia can lead to either stroke or a condition called eclampsia, which is 2 the occurrence of seizures resulting from preeclamptic hypertension.4,5 The pathology of preeclampsia is unknown, which makes the condition difficult to treat. Researchers believe that the hypertension that occurs in preeclampsia results from improper remodeling of spiral arteries in the uterine lining. The spiral arteries are important for supplying blood to the feto-placental unit since, they supply blood to the intervillous space.3,6,7,10 In preeclampsia, cells located in the placenta called cytotrophoblasts (CTB) do not adequately invade and untwist the spiral arteries during a process called placentation, thus hindering angiogenesis, which the process of making new blood vessels3,6,10 Due to lack of remodeling, the spiral arteries are smaller in diameter, therefore requiring maternal blood pressure to increase in order to sufficiently supply blood to the placenta and fetus.6 Increasing maternal mean arterial pressure (MAP) causes systemic hypertension and many of the symptoms associated with preeclampsia, including potentially fatal strokes and seizures. 4,5 Vascular endothelial growth factor (VEGF), an angiogenic factor, is thought to have a positive impact on CTB’s during placentation, enhancing spiral artery remodeling.6 Norris et al. hypothesize that CTB’s are activated by the binding of VEGF to VEGF receptors such as Fms-like tyrosine kinase 1 (Flt-1) during a healthy pregnancy, and a decrease in VEFG binding to membrane bound receptors could lead to preeclampsia via the improper remodeling of spiral arteries.10 Increasing the amount of VEGF bound to the membrane bound Flt-1 may lead to proper placentation, thus treating preeclampsia. One option would be to directly administer exogenous VEGF; however, VEGF has been proven to be carcinogenic.11 A safer option to treat preeclampsia, is to increase the amount VEGF receptor present on 3 cells of the uterus, therefore increasing the amount of VEGF bound to Flt-1 without the risk of cancer. This study focused on the effect that VEGF-R2 injections had on the vasculature of pregnant rats. Several laboratories had shown that the reduced uterine perfusion pressure (RUPP) model alters vasculature, specifically angiogenic factors and myogenic tone, similar to what is observed in preeclamptic patients making RUPP the most accurate animal model for preeclampsia.12,13,14 The RUPP model was utilized to induce preeclamptic like symptoms, then VEGF-R2 was administered via microscopic packages called nanoparticles. The effectiveness of the treatment was determined by comparing the myogenic tone of the posterior cerebral arteries (PCA) between rats injected with VEGF- R2 and the non-injected control. Vessels in the brain were studied to evaluate the potential that VEGF-R2 injections for reducing the incidence of strokes. The PCA was chosen because it was a representation of the other cerebral arteries, it had relatively low arterial branching, and was consistent with other previous studies. Western Blot Analysis was performed to determine if VEGF-R2’s effects occur systemically or only near the injection site in the uterus. Fellow researchers in our lab used the same animals to assess how these injections affect uterine artery reactivity and mean arterial pressure (MAP). We hypothesized by increasing the amount of VEGF receptor via nanoparticle injections, the balance between VEGF and the membrane bound VEGF-R2 receptor would be restored, allowing for proper spiral artery angiogenesis to occur. We believed the proper angiogenesis will decrease MAP and improve the health of the maternal posterior cerebral arteries by reducing tone which could reduce risk of stroke. Additionally, we expected
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