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J Am Soc Nephrol 11: 2133–2137, 2000 Desensitization of Soluble in Renal Cortex during Endotoxemia in Mice

MLADEN KNOTEK, MATTHEW ESSON, PATRICIA GENGARO, CHARLES L. EDELSTEIN, and ROBERT W. SCHRIER Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado.

Abstract. Acute endotoxemic renal failure involves renal va- phate (cGMP) increased significantly at6hand15has soconstriction, which presumably occurs despite increased ni- compared with control but normalized at 24 h after injection of tric oxide (NO) generation by inducible NO synthase in the lipopolysaccharide. Incubation of renal cortical slices in the kidney. The present study examined the hypothesis that the presence of a phosphodiesterase inhibitor isobutylmethylxan- renal vasoconstriction during endotoxemia occurs in part be- tine did not alter the pattern of changes in cGMP. Incubation of cause of desensitization of soluble guanylate cyclase (sGC). renal cortical slices with 2 mM resulted Endotoxic shock was induced in male B6/129F2/J mice by an in a similar accumulation of cGMP in slices taken from control intraperitoneal injection of Escherichia coli lipopolysaccha- and endotoxemic mice at 6 h and 15 h. However, in slices from ride. The endotoxemia resulted in shock and renal failure as 24-h endotoxemic mice, accumulation of cGMP in response to evidenced by a decrease in mean arterial pressure and an sodium nitroprusside was significantly lower. This lower increase in serum creatinine and urea nitrogen. Serum NO stimulability of sGC was not paralleled by a decrease in its increased in a time-dependent manner, reaching the highest abundance in renal cortex on immunoblot. Taken together, levels at 24 h, in parallel with induction of inducible NO these results demonstrate a desensitization of sGC in renal synthase in the renal cortex. In renal cortical slices cortex during endotoxemia, which may contribute to the asso- obtained from endotoxemic mice, cyclic guanosine monophos- ciated renal vasoconstriction.

Sepsis is frequently complicated by the development of acute desensitization occurs in the renal vasculature during endotox- renal failure (1). In experimental endotoxemia, acute renal emia in vivo, an unopposed vasoconstriction would contribute failure is observed in association with renal vasoconstriction to the acute renal failure. The present study was therefore (2,3). This renal vasoconstriction with sepsis occurs in the designed to examine whether desensitization of sGC occurs in setting of marked systemic vasodilatation, which is caused in the renal cortex of a mouse model of endotoxic shock and acute part by the vascular expression of inducible syn- renal failure. thase (iNOS) (4,5). Expression of iNOS has also been demon- strated during endotoxemia in the kidney (6). NO induces Materials and Methods vasodilatation by stimulation of soluble guanylate cyclase Experiments were carried out on male B6/129F2/J mice (Jackson (sGC), which catalyzes the synthesis of cyclic guanosine Lab., Bar Harbor, MA) weighing 20 to 30 g in accord with the NIH monophosphate (cGMP) (7). sGC is present in the as a Guide for the Care and Use of Laboratory Animals. heterodimer, consisting of an ␣ and a ␤ subunit (8). Besides iNOS, endotoxin also stimulates several vasoconstrictive sys- Surgery and Mean Arterial Pressure Measurement tems, such as renin-angiotensin (9,10) and endothelin (11,12). Mice were anesthetized with an intraperitoneal injection of 2,2,2 Hence, the vasoactive effect of endotoxin results from the tribromoethanol (Aldrich, Milwaukee, WI). During surgery, animals balance between vasodilatory and vasoconstrictive mediators. were kept on a heating pad. The right carotid artery was catheterized It has recently been shown that sGC undergoes in vitro desen- using a PE10 catheter connected to a PE50 catheter. Intracarotid mean sitization in response to prolonged stimulation with NO donors arterial pressure (MAP) was measured using Grass polygraph in (13) or lipopolysaccharide (LPS) (14) in cultured cells. If this conscious, unrestrained animals 24 h after injection of LPS. Mice were injected with LPS (30 mg/kg intraperitoneally) 1 h after surgery.

cGMP Studies Received December 21, 1999. Accepted March 30, 2000. Correspondence to Dr. Robert W. Schrier, Professor and Chairman of Medi- Mice were injected intraperitoneally with 40 mg/kg LPS and were cine, University of Colorado Health Sciences Center, Box B178, Denver, CO killed at 6 h, 15 h, or 24 h after injection of LPS. Renal cortical slices 80262. Phone: 303-315-6677; Fax: 303-315-7702; E-mail: robert.schrier@ were obtained on ice using a Stadie-Riggs microtome (Thomas Sci- uchsc.edu entific, Swedesboro, NJ). For ex vivo cGMP measurement, slices were 1046-6673/1111-2133 placed in 0.1 N HCl and were frozen in liquid nitrogen. For in vitro Journal of the American Society of Nephrology experiments, slices were placed into Erlenmeyer flasks in buffer

Copyright © 2000 by the American Society of Nephrology containing 110 mM NaCl, 18 mM NaHCO3, 5 mM KCl, 1 mM CaCl2, 2134 Journal of the American Society of Nephrology J Am Soc Nephrol 11: 2133–2137, 2000

2mMNa2HPO4, 1 mM MgSO4, 5 mM glucose, 2 mM glutamine, 10 mM Na butyrate, 4 mM Na lactate, and HEPES (pH 7.4 at 37°C and saturated with 95% O2/5% CO2) and 5 mM isobutylmethylxanthine (IBMX), on ice. The flasks were then transferred to a water bath at 37°C and preincubated for 5 min, after which an additional 15-min incubation was carried out in the presence or absence of 2 mM sodium nitroprusside (SNP). Incubation was terminated by adding to samples an excessive amount of ice-cold phosphate-buffered saline. The slices were subsequently homogenized using glass-Teflon homogenizer (20 strokes/2000 rpm) and spun at 4500 rpm/15 min. Protein concentra- tion of the supernatant was determined using the Bradford method with bovine serum albumin as standard. Further processing of the samples for determination of cGMP was carried out according to the manufacturer’s instructions using a commercially available RIA kit (Amersham, Arlington Heights, IL).

Serum Creatinine, Blood Urea Nitrogen, and NO Measurement Serum creatinine and blood urea nitrogen (BUN) were determined using a creatinine analyzer and BUN analyzer, respectively (Beckman Instruments, Inc., Fullerton, CA). Serum NO was measured using an NO chemiluminescence analyzer (Sievers Instruments, Inc., Boulder, CO).

Western Blot for iNOS and sGC Renal cortex was homogenized using glass-Teflon homogenizer (20 strokes, 2000 rpm) in a lysis buffer (50 mM Tris-HCl, 150 mM NaCl, 1 mM ethylenediaminetetraacetate, 1% Triton-100 [pH 7.2]) plus proteinase inhibitors (20 ␮M leupeptin, 20 ␮M pepstatin A, and 200 ␮M phenylmethysulfonylfluoride). The homogenate was centri- fuged at 4500 rpm for 15 min. Supernatant protein was measured by the Bradford method using bovine serum albumin as a standard. Supernatant samples were mixed with sample buffer containing 50 mM Tris, 0.5% glycerol, 0.01% bromophenol blue, and 0.75% sodium dodecyl sulfate (pH 6.8). Samples containing 200 ␮g (iNOS) or 50 ␮g (sGC) of protein were fractionated by Tris/glycine/sodium dodecyl sulfate 7.5% polyacrylamide gel electrophoresis and transferred to a nitrocellulose membrane (Millipore, Bedford, MA). Nonspecific bind- ing was reduced by the incubation of membranes for 1 h at room temperature with 5% low-fat milk in 50 mM Tris, 150 mM NaCl, 0.1% Tween20 (pH 7.5) (TTBS). Membranes were subsequently incubated for 1 h with a polyclonal anti-iNOS antibody (a gift from Dr. Bruce Kone, University of Texas-Houston Trauma Research Cen- ter) or polyclonal anti-sGC antibody (Calbiochem, San Diego, CA). An additional 1-h incubation was performed with a secondary anti- body, anti-rabbit IgG coupled to horseradish peroxidase (Amersham), at 1:1000 dilution in TTBS. Detection of the protein bands was carried out using enhanced chemiluminescence (Amersham). Positive control for sGC purified from bovine lung was obtained from Alexis Bio- chemicals (San Diego, CA).

Statistical Analyses Values are expressed as mean Ϯ SEM. Multiple group comparisons were done using the ANOVA, with a post hoc Newman-Keuls test. A P value of less than 0.05 was considered significant. Figure 1. (A) Endotoxic shock in mice 24 h after administration of lipopolysaccharide (LPS). Mean arterial pressure (MAP) was mea- sured in conscious mice. Each data point represents mean Ϯ SEM Results from four animals. *, P Ͻ 0.05 versus control. (B, C) Acute renal Endotoxic Shock and Renal Failure failure 24 h after administration of LPS. Each data point represents Administration of endotoxin resulted in a decrease of MAP mean Ϯ SEM from 15 animals. *, P Ͻ 0.05; **, P Ͻ 0.01 versus from 106.7 Ϯ 4.9 to 61.7 Ϯ 8.8 mmHg (P Ͻ 0.05) at 24 h control. J Am Soc Nephrol 11: 2133–2137, 2000 Desensitization of Soluble Guanylate Cyclase 2135

Figure 3. Cyclic guanosine monophosphate (cGMP) concentration in renal cortex during endotoxemia. Renal cortical slices were obtained from mice after indicated periods of endotoxemia. cGMP was deter- mined by RIA, as described in the Materials and Methods section. Each data point represents mean Ϯ SEM from 6 to 10 animals. *, P Ͻ 0.05 versus control.

renal cortical slices obtained from control and endotoxemic mice. There was no difference in the increase in cGMP content after incubation with SNP of renal cortical slices obtained from control mice and mice after 6 h and 15 h of endotoxemia. Figure 2. Induction of inducible nitric oxide synthase (iNOS) during However, the response of cGMP to SNP in slices from mice endotoxemia. (A) Time-dependent increase in serum NO during en- after 24 h of endotoxemia was significantly decreased, as dotoxemia. Each data point represents mean Ϯ SEM from four to six compared with control and 6 h and 15 h (Figure 4A). In the animals. *, P Ͻ 0.05; **, P Ͻ 0.01 versus control. (B) Expression of absence of SNP, cGMP in renal cortical slices followed a iNOS protein in renal cortex during endotoxemia. Renal cortex (200 similar pattern as ex vivo (Figure 3); specifically, an increase in ␮g protein/lane) was blotted with a polyclonal anti-iNOS antibody, as cGMP occurred at 6 h and 15 h, and return to control levels ϩ detailed in the Materials and Methods section. , positive control. occurred at 24 h of endotoxemia (Figure 4B). Expression of sGC, determined by the Western blot of renal cortex, was not significantly different at 24 h as compared with 12 hr (Figure (Figure 1A). The 24-h mortality in response to LPS was 26.5%. 5). Development of acute renal failure was evidenced by an ele- vation of serum creatinine and BUN, measured 24 h after Discussion administration of LPS (Figure 1, B and C). Acute renal failure occurs in almost 50% of patients with (1). The main pathophysiologic mechanism is Induction of iNOS and Changes in cGMP in Renal intense renal vasoconstriction (2,3), which occurs in the pres- Cortex during Endotoxemia ence of systemic arterial . The NO-cGMP system To document induction of iNOS, serum NO and iNOS is considered to be the main vasodilatory mechanism in exper- protein expression in renal cortex were determined in control imental endotoxemia or sepsis, mainly because of induction of mice and endotoxemic mice at 6 h, 15 h, and 24 h after iNOS (4,5). In parallel to the induction of iNOS, there is injection of LPS. Serum NO increased in a time-dependent activation of several vasoconstrictor systems, which counteract manner, reaching maximum at 24 h after LPS (Figure 2A). A the vasodilatory and hypotensive effects of NO. Among the similar time course of iNOS protein expression was observed vasoconstrictors, angiotensin II and endothelin play a promi- on Western blot of renal cortex obtained from endotoxemic nent role (9–12). It has been shown, for example, that angio- mice (Figure 2B). To determine whether changes in cGMP tensin-converting inhibitors (15) or nonselective en- parallel those of NO and iNOS protein expression, cGMP was dothelin receptor antagonists decrease systemic vascular measured in renal cortical slices obtained from control or resistance and/or increase hypotension in endotoxemic animals endotoxemic mice after different periods of endotoxemia. Re- (15–18). There is also evidence for the involvement of the nal cortical cGMP was increased at 6 h and 15 h after LPS but vasoconstrictors angiotensin II (15) and endothelin (15,17) in returned to control concentrations at 24 h (Figure 3). renal vascular responses to endotoxemia. That renal vasocon- striction occurs with sepsis despite increased iNOS in the Stimulation of sGC kidney (6) led to our hypothesis that desensitization of sGC To examine the cause of the decreased cGMP concentration may occur during the course of endotoxemia. at 24 h, we determined stimulation of sGC by SNP in vitro in Mice strains may differ with respect to their sensitivity to 2136 Journal of the American Society of Nephrology J Am Soc Nephrol 11: 2133–2137, 2000

Figure 5. Western blot of sGC in renal cortex. Pos, positive control; C, untreated controls; 12, 12 h after LPS; 24, 24 h after LPS.

desensitization of sGC by pretreatment of cultured cells with NO donors or LPS is mediated at least partly by a decreased abundance in sGC ␣ or ␤ subunit (13,14). However, we did not demonstrate decreased protein expression of sGC in our mouse model of sepsis using an antibody generated against both subunits of sGC. In the case of particulate GC, the role of dephosphorylation in its desensitization has been demonstrated (19), and this possibility needs to be studied with sGC. In summary, desensitization of sGC may have important functional consequences for the kidney in endotoxemia, be- cause the resultant diminished vasodilatory influence of NO would allow an unopposed action of renal vasoconstrictors, such as angiotensin and endothelin. This sGC desensitization could then mimic the results observed with nonselective inhi- bition of NO synthase, which is known to increase renal vasoconstriction and worsen renal failure in rat endotoxemia (20). Thus, the present results demonstrate desensitization of sGC in renal cortex of endotoxemic mice, which may contrib- Figure 4. (A) Stimulation of soluble guanylate cyclase (sGC) in vitro ute to the maintenance of vasoconstrictor-mediated acute renal with sodium nitroprusside (SNP). cGMP concentration in renal cor- failure during endotoxemia. tical slices obtained at indicated periods of endotoxemia was deter- mined after incubation for 15 min in the presence of isobutylmethyl- xanthine (IBMX) with 2 mM SNP. Each data point represents mean Ϯ References SEM from four to six animals. *, P Ͻ 0.05 versus control. (B) 1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Stimulation of sGC in vitro. cGMP concentration in renal cortical Wenzel RP: The natural history of the systemic inflammatory slices obtained at indicated periods of endotoxemia was determined response syndrome (SIRS): A prospective study. JAMA 273: after incubation for 15 min in the presence of IBMX without SNP. 117–123, 1995 Each data point represents mean Ϯ SEM from four to six animals. *, 2. Badr KF: Sepsis-associated renal vasoconstriction: Potential tar- P Ͻ 0.05 versus control. gets for future therapy. Am J Kidney Dis 20: 207–213, 1992 3. Kikeri D, Pennel JP, Hwang KH, Jacob AI, Richman AV, Bour- goignie JJ: Endotoxemic acute renal failure in awake rats. Am J LPS, and a relatively high dose of LPS was needed to induce Physiol 250: F1098–F1106, 1986 shock and renal failure in B6/129 mice in the present study. In 4. Wright CE, Rees DD, Moncada S: Protective and pathological these mice, a time-dependent increase in serum NO, with a roles of nitric oxide in endotoxin shock. Cardiovasc Res 26: concomitant increase in iNOS protein expression in renal cor- 48–57, 1992 tex, was demonstrated. However, after an increase in renal 5. Szabo C, Southan GJ, Thiemermann C: Beneficial effects and cortical cGMP at 6 h and 15 h after LPS, cGMP decreased to improved survival in rodent models of septic shock with S- control level at 24 h. This observation could be due to desen- methylisothiourea sulfate, a potent and selective inhibitor of sitization and/or downregulation of sGC or to increased activ- inducible nitric oxide synthase. Proc Natl Acad Sci USA 91: ity of phosphodiesterases. Subsequent in vitro experiments 12472–12476, 1994 6. Liu S, Adcock IM, Old RW, Barnes PJ, Evans TW: Lipopoly- using buffer containing IBMX, a phosphodiesterase inhibitor, saccharide treatment in vivo induces widespread tissue expres- excluded an increased degradation of cGMP at 24 h of endo- sion of inducible nitric oxide synthase mRNA. Biochem Biophys toxemia. Rather, stimulation of sGC was diminished, because Res Commun 196: 1208–1213, 1993 the NO donor, SNP, evoked a much smaller increase in cGMP 7. Moro MA, Russel RJ, Cellek S, Lizasoain I, Su Y, Darley-Usmar in slices obtained at 24 h, as compared with slices from earlier VM, Radomski MW, Moncada S: cGMP mediates the vascular time points. It has been shown in some in vitro studies that and platelet actions of nitric oxide: confirmation using an inhib- J Am Soc Nephrol 11: 2133–2137, 2000 Desensitization of Soluble Guanylate Cyclase 2137

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