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Am J Physiol Heart Circ Physiol 276: H1567-H1573, 1999;
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Vol. 276, Issue 5, H1567-H1573, May 1999

Myocardial ischemia-reperfusion injury is exacerbated in absence of endothelial cell nitric oxide synthase

Steven P. Jones1, Wesley G. Girod1, Anthony J. Palazzo1, D. Neil Granger1, Matthew B. Grisham1, David Jourd'Heuil1, Paul L. Huang2, and David J. Lefer1

1 Department of Molecular and Cellular Physiology, Louisiana State University Medical Center, Shreveport, Louisiana 71130-3392; and 2 Harvard Medical School, Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129-2060


    ABSTRACT
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

Myocardial ischemia and reperfusion (MI/R) initiates a cascade of polymorphonuclear neutrophil (PMN)-mediated injury, the magnitude of which may be influenced by the bioavailability of nitric oxide (NO). We investigated the role of endothelial cell nitric oxide synthase (ecNOS) in MI/R injury by subjecting wild-type and ecNOS-deficient (-/-) mice to 20 min of coronary artery occlusion and 120 min of reperfusion. Myocardial infarct size represented 20.9 ± 2.9% of the ischemic zone in wild-type mice, whereas the ecNOS -/- mice had significantly (P < 0.01) larger infarcts measuring 46.0 ± 3.8% of the ischemic zone. Because P-selectin is thought to be involved with the pathogenesis of neutrophil-mediated I/R injury, we assessed the effects of MI/R on P-selectin expression in the myocardium of wild-type and ecNOS -/- mice. P-selectin expression measured with a radiolabeled monoclonal antibody (MAb) technique after MI/R in wild-type mice was 0.037 ± 0.009 µg MAb/g tissue, whereas ecNOS -/- coronary vasculature was characterized by significantly (P < 0.05) higher P-selectin expression (0.080 ± 0.013 µg MAb/g tissue). Histological examination of the postischemic myocardium revealed significantly (P < 0.01) more neutrophils in the ecNOS -/- (29.5 ± 2.5 PMN/field) compared with wild-type (5.0 ± 0.9 PMN/field) mice. A similar trend in infarct size and neutrophil accumulation was observed when wild-type and ecNOS -/- mice were subjected to 30 min of ischemia and 120 min of reperfusion. These novel in vivo findings demonstrate a cardioprotective role for ecNOS-derived NO in the ischemic-reperfused mouse heart.

mouse; neutrophils; infarction; leukocyte adhesion molecules


    INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

NITRIC OXIDE SYNTHASE (NOS) generates nitric oxide (NO) by converting L-arginine to L-citrulline (29). At present, there are three known isoforms of NOS designated: 1) neuronal NOS (nNOS or NOS 1), 2) inducible NOS (iNOS or NOS 2), and 3) endothelial cell NOS (ecNOS or NOS 3) (33). Previous investigations have shown the expression and function of the three different isoforms to vary with each organ and the physiological or pathophysiological state of the tissue. It is well accepted that ecNOS modulates a variety of tissue-specific events, including vasodilation (10), leukocyte-endothelial cell interactions (22), platelet adhesion (15), platelet aggregation (29, 40), microvascular permeability (21), and smooth muscle cell proliferation (12). However, the precise role of NO generated by ecNOS is not completely understood in many physiological and pathological states.

Myocardial ischemia and reperfusion (MI/R) injury is widely accepted as a stimulus for tissue destruction and possible cardiac failure (1). Accordingly, much attention has been directed toward elucidating the mechanisms of MI/R injury. Previous studies have shown this cascade of injury to be inflammatory in nature and involve interactions between circulating polymorphonuclear neutrophils (PMNs) and the coronary endothelium (30). Furthermore, PMN-mediated myocardial reperfusion injury is a sequential process involving three interdependent steps: 1) neutrophil rolling, 2) firm adhesion, and 3) transmigration (24).

Although numerous studies have investigated the possible function of NO in pathological sequelae, no area of NO physiology has attracted more attention than its involvement in I/R injury. Many studies indicate an important capacity for NO-mediated cardioprotection in MI/R injury. Previous MI/R studies have shown that NO donors attenuate I/R arrhythmias (37, 45) and myocardial infarct (Inf) size (27, 36), and improve postischemic coronary blood flow and contractile function (35, 36). Recently, it has also been demonstrated that inhaled NO protects against I/R injury (9). Similarly, other studies have shown that administration of the NO precursor L-arginine produces comparable results with respect to MI/R injury (34, 35, 46). Furthermore, studies have revealed that the benefits of L-arginine and NO donors in MI/R injury are likely related to attenuation of leukocyte-endothelial cell interactions (22, 27) and the anti-oxidant actions of NO (11, 23).

In sharp contrast to the reports demonstrating cardioprotective actions of NO in the setting of MI/R injury there are also a number of studies suggesting that NO can be cytotoxic and actually contribute to myocardial cell injury following coronary ischemia and reperfusion (31, 38, 41, 48). Administration of NOS inhibitors before ischemia has been shown to reduce myocardial infarction (38, 48) and the extent of reperfusion injury (41) following coronary ischemia and reperfusion. Finally, it has been proposed that NO formed in the coronary circulation contributes to cell signaling involved in the pathophysiology of MI/R injury (31).

Previous experimental studies on the role of NO in MI/R were complicated by the lack of specificity and the side effects of traditional NOS inhibitors as well as the complex pharmacology of NO-donating agents. Recently transgenic mice have been developed that are deficient in ecNOS and therefore are incapable of endothelial cell NO production. It has previously been reported that these mice exhibit a complete lack of vascular reactivity to the endothelium-dependent vasodilator acetylcholine and are hypertensive (17, 43). Therefore, the ecNOS null mouse is an excellent model system for investigation of the potential physiological and pathophysiological actions of endothelial cell-derived NO. In the present study, we examined the effects of coronary artery occlusion and reperfusion in both wild-type and ecNOS-deficient (-/-) mice to fully elucidate the role of NO in MI/R injury. Specifically, we determined the extent of myocardial cell necrosis, neutrophil accumulation, and coronary vascular P-selectin expression in mice following acute MI/R injury.


    MATERIALS AND METHODS
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

Transgenic mice. ecNOS -/- mice were generated by Fishman and colleagues, as described previously (17, 43). SV129 mice (Jackson Laboratories) were utilized as the control (wild-type mice) animals for the ecNOS -/- mice. All mice utilized in the study were between 12 and 16 wk old. All experimental procedures complied with the Guide for the Care and Use of Laboratory Animals, DHHS Publication No. (NIH) 86-23, Revised 1985, approved by the American Physiological Society, and with federal and state regulations.

Measurement of ecNOS mRNA by RT-PCR. Total RNA was extracted from the mouse lung using the acid guanidium-phenol-chloroform extraction method described by Chomczynski and Sacchi (4).

First-strand cDNA synthesis was performed at 42°C for 20 min using 2 µg total RNA from mouse lung in a 20-µl reaction mixture containing 50 mM Tris · HCl, pH 8.3, 75 mM KCl, 3 mM MgCl2, 10 mM dithiothreitol, 20 µM dNTP (an equal mixture of dATP, dGTP, dCTP, and dTTP), 1 µM oligo(dT), and 200 U Superscript RT (GIBCO-BRL, Gaithersburg, MD). Denaturation was performed at 65°C for 5 min, followed by primer annealing at 42°C for 5 min, before addition of the enzyme. The mouse ecNOS fragment (from 3049 to 3402) was amplified using forward primer (5'-GACTGGCATTGCACCCTTCCGG-3'), corresponds to 3049 to 3070, and reverse primer (5'-GTTGCCAGAATTCTCTGCACGG-3'), corresponds to 3402 to 3381 of the mouse ecNOS gene (14). This PCR product was cloned using PCR 2.1-TOPO Cloning Kit (gift from Invitrogen, Carlsbad, CA). The fragment of ecNOS was verified by sequencing the insert in the plasmid. The glyceraldehyde-3-phosphate dehydrogenase (GAPDH) fragment (from 300 to 614) was amplified using forward primer (5'-CACCACCATGGAGAAGGCTG-3'), corresponds to 300 to 319, and reverse primer (5'-ATGATGTTCTGGGCAGCCCC-3'), corresponds to 614 to 5595 of the rat GAPDH gene (44).

Surgical procedures. Animals were anesthetized with pentobarbital sodium (100 mg/kg ip). Anesthesia was maintained via supplemental doses of pentobarbital sodium (30 mg/kg ip) as needed. A midline incision was made from the xiphoid process to the submentum. The salivary glands were separated from the midline to allow access to the trachea. A tracheotomy was then performed to facilitate breathing. A section of polyethylene 90 tubing was inserted into the animal's trachea and connected via a loose junction to a Harvard respirator (model 683 rodent respirator, Harvard Apparatus). The respirator's tidal volume was set at 1.0 ml/min, and the rate was set at 120 strokes/min and was supplemented with 100% oxygen. The right carotid artery was then cannulated with polyethylene 10 tubing to monitor hemodynamics and to facilitate the infusion of Evans blue at the end of the experiment.

After an equilibration period of 10 min, a thoracotomy was performed. Using an electrocautery (model 100, Geiger Instrument), we made an incision to the left of the sternum. The pericardial sac was then removed. Ligation of the left anterior descending (LAD) coronary artery was performed using a 7-0 silk suture attached to a BV-1 needle (Ethicon). A small piece of polyethylene tubing was used to secure the ligature without damaging the artery. The chest wall was approximated and covered with Parafilm wax paper to prevent desiccation. At the appropriate time (20 or 30 min of ischemia), the 7-0 silk ligature was cut and removed from the heart. Reperfusion was visually confirmed in all animals using a dissecting microscope. Animals that did not undergo complete LAD reperfusion were excluded from the study. At 5 min of myocardial ischemia wild-type mice received a bolus injection of epinephrine (1 µg in 50 µl saline) via the carotid artery catheter to maintain systemic blood pressure similar to that observed in ecNOS -/- mice. Epinephrine (1 µg) was administered to wild-type mice throughout the experimental protocol as needed to maintain blood pressure at levels observed in the ecNOS -/- animals.

Myocardial P-selectin expression. Radiolabeled P-selectin and control monoclonal antibodies (MAb) were prepared as previously described (8). All mice were instrumented with carotid artery and jugular vein catheters. Coronary vascular P-selectin expression in wild-type (n = 5) and ecNOS -/- (n = 3) mice was assessed following sham myocardial ischemia (20 min) and reperfusion (20 min). Additionally, expression of P-selectin in the coronary vasculature was assessed following MI/R in wild-type (n = 4) and ecNOS -/- (n = 4) mice. All animals underwent 20 min of LAD occlusion followed by 20 min of reperfusion. At 15 min of reperfusion, radiolabeled antibodies were injected. Monoclonal radiolabeled (125I) antibody directed against P-selectin (RB40.34, PharMingen) and a nonbinding radiolabeled (131I) antibody (P-23, Pharmacia-Upjohn) were slowly administered through the jugular vein. After 5 min of circulation (20 min of reperfusion), a 50-µl plasma sample was drawn. The animal was then perfused with 15 ml of warm (pH 7.4), heparinized bicarbonate-buffered saline, while being exsanguinated to flush the excess P-selectin MAb and nonbinding control antibody. LAD religation was followed by infusion of ~2 ml of 1% Evans blue to delineate the ischemic zone from the nonischemic zone. The heart was then excised and serially sectioned. The nonischemic and ischemic zones were separated and weighed, and regional cardiac radioactivity was measured using an automatic gamma counter (1480 Wizard, Wallac) to determine MI/R induced P-selectin expression.

Myocardial histology. Routine histological staining was performed on multiple sections of midventricular cardiac sections to determine the extent of neutrophil (PMN) infiltration. Wild-type (n = 3) and ecNOS -/- (n = 3) hearts were subjected to 20 min of myocardial ischemia and 120 min of reperfusion and stained as previously described. In additional studies, wild-type (n = 4) and ecNOS -/- (n = 4) mouse hearts were subjected to 30 min of LAD occlusion and 120 min of reflow and then submitted for the aforementioned staining protocol.

The hearts were stored overnight in 4% paraformaldehyde at 4°C. The tissue was cut into sections and dehydrated using graded acetone washes at 4°C. Tissue sections were embedded in plastic (Immunobed, Polysciences), and 4-µm-thick sections were cut and transferred to Vecatabond-coated slides (Vector Laboratories). The slides were soaked in 95% ethanol for 10 min to remove some of the plastic embedding and to allow the tissue to stain. After the 10-min ethanol wash, the tissue sections were stained with either hematoxylin solution Gill No. 3 for 10 min (Sigma) or Giemsa stain for 3 min (Sigma). The slides were then observed microscopically, and the number of PMNs was counted per field of view. For each of the hearts examined, the number of PMNs were counted in three fields.

Determination of area at risk and Inf size. At the conclusion of the 2-h period of reperfusion, the LAD was religated with 7-0 silk suture, and 1.2 ml of 1.0% Evans blue (Sigma) was retrogradely injected into the carotid artery catheter to delineate the in vivo area at risk (AAR).

At the end of the protocol, the heart was excised and fixed in 1.5% solution of SeaPlaque agarose gel (FMC BioProducts). After the gel solidified, the heart was sectioned perpendicular to the long axis in 1-mm portions using a McIlwain tissue chopper (Brinkmann Instruments). The 1-mm sections were placed in individual wells of a six-well cell culture plate with the basal side exposed. Each slice was then counterstained with 3.0 ml of 1.0% 2,3,5-triphenyltetrazolium chloride (Sigma) solution for 5 min at 37°C. Each slice was weighed and visualized under an Olympus SZ4045 (Olympus America) dissecting microscope equipped with a Sony charge-coupled device iris-color video camera (Sony Electronics). The left ventricular area, AAR, and area of infarction for each slice were then determined by computer planimetry using National Institutes of Health Image (v1.57) software. The size of the myocardial infarction was determined by the following previously described equation (32): weight of infarction equals (A1 × Wt1) + (A2 × Wt2) + (A3 × Wt3) + (A4 × Wt4) + (A5 × Wt5), where A is percent area of infarction by planimetry from subscripted numbers 1-5 representing sections and Wt is the weight of the same numbered sections.

Statistical analyses. The data were analyzed with ANOVA and Scheffé's post hoc test. All values are reported as means ± SE. Statistical significance was set at P < 0.05.


    RESULTS
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

Detection of ecNOS mRNA. RT-PCR was performed on two wild-type and two ecNOS -/- lungs for the detection of ecNOS mRNA. As shown in Fig. 1, the distinct bands indicate that ecNOS mRNA is present in both wild-type animals. Conversely, the corresponding bands are completely absent in the ecNOS -/- animals. This confirms the absence of ecNOS in our ecNOS -/- mice.


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Fig. 1.   RT-PCR analysis for endothelial cell nitric oxide synthase (ecNOS) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA in lungs of wild-type (WT) mice and ecNOS-deficient (-/-) mice (ecNOSKO).

Hemodynamic measurements. Mean arterial blood pressure (MABP) and heart rate (HR) were recorded in all groups throughout the experimental protocols. In addition, we calculated the rate-pressure product (RPP, MABP × HR/1,000) as an index of oxygen demand. The data for the 20 min of myocardial ischemia and 120 min of reperfusion are reported in Table 1. Table 2 summarizes the hemodynamic data from the 30 min of myocardial ischemia and 120 min of reperfusion group. The ecNOS -/- mice exhibited significantly (P < 0.05) higher baseline MABP and RPP values compared with wild-type mice in both the 20- and 30-min myocardial ischemia protocols. Also, at 60 min of reperfusion, the ecNOS -/- had a significantly (P < 0.05) lower mean RPP. The remainder of the time points did not demonstrate significantly different values.

                              
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Table 1.   Hemodynamic data for wild-type and ecNOS -/- mice following 20 min of LAD occlusion and 120 min of reflow


                              
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Table 2.   Hemodynamic data for wild-type and ecNOS -/- mice following 30 min of myocardial ischemia and 120 min of reperfusion

Left ventricular mass. Chronic hypertension has been shown to result in left ventricular hypertrophy. We measured the body weight and the left ventricular weight of each to assess the degree of left ventricular hypertrophy in the ecNOS -/- mice. The heart weight (mg)-to-body weight (g) ratio for ecNOS -/- mice was 3.04 ± 0.20 (n = 14) and for ecNOS -/- and 2.90 ± 0.17 for wild-type animals [P = not significant (NS)].

Myocardial P-selectin expression. The dual-radiolabeled MAb technique was used to quantify the in vivo coronary endothelial cell expression of P-selectin following 20 min of coronary ischemia and 20 min of reperfusion. The data for the sham I/R experiments revealed no difference (P = NS) between wild-type (0.001 ± 0.001 µg MAb/g tissue) and ecNOS -/- (0.004 ± 0.004 µg MAb/g tissue) mouse hearts. Interestingly, P-selectin expression (Fig. 2) in the nonischemic zone following 20 min of myocardial ischemia and 20 min of reperfusion was significantly (P < 0.05) higher in the ecNOS -/- hearts (0.041 ± 0.010 µg MAb/g tissue) than in the wild-type hearts (0.010 ± 0.005 µg MAb/g tissue). Furthermore, P-selectin was expressed at significantly (P < 0.05) higher levels in the ischemic zone of the ecNOS -/- hearts compared with the wild-type hearts. Mean P-selectin expression was 0.080 ± 0.013 µg MAb/g tissue in the ecNOS -/- ischemic zone and 0.037 ± 0.009 µg MAb/g tissue in the wild-type ischemic zone.


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Fig. 2.   Coronary P-selectin expression in wild-type (n = 4) and ecNOS -/- hearts (n = 4) after 20 min of coronary artery ischemia and 20 min of reperfusion. P-selectin expression (µg MAb/g heart tissue) was measured using a radiolabeled monoclonal antibody (MAb) directed against murine P-selectin. P-selectin expression was significantly (P < 0.05) enhanced in both nonischemic and ischemic zones of ecNOS -/- hearts compared with the wild-type hearts.

Myocardial neutrophil accumulation. Neutrophil counts within the ischemic zone determined following 20 min of myocardial ischemia and 120 min of reperfusion are presented in Fig. 3A. The ecNOS -/- hearts contained significantly more (P < 0.01) neutrophils than the wild-type hearts (29.5 ± 2.5 vs. 5.0 ± 0.9 PMN/field).


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Fig. 3.   A: myocardial polymorphonuclear neutrophil (PMN) accumulation following 20 min of myocardial ischemia and 120 min of reperfusion in wild-type (n = 3) and ecNOS -/- (n = 3) mouse hearts. A total of 3 fields were examined in each heart, and the number of PMN/field was determined. Myocardial PMN accumulation was significantly (** P < 0.01) greater in ecNOS -/- hearts compared with wild-type hearts. B: myocardial neutrophil (PMN) accumulation following 30 min of myocardial ischemia and 120 min of reperfusion in wild-type (n = 4) and ecNOS -/- (n = 4) mouse hearts. A total of 3 fields was examined in each heart, and the number of PMN/field was determined. Myocardial PMN accumulation was significantly (** P < 0.01) greater in ecNOS -/- hearts compared with wild-type hearts.

The results of the neutrophil counts from the ischemic zones of wild-type and ecNOS -/- hearts following 30 min of LAD occlusion and 120 min of reflow are presented in Fig. 3B. Significantly more (P < 0.01) neutrophils were sequestered in the ecNOS -/- hearts (68.6 ± 4.0 PMN/field) compared with the wild-type control hearts (24.7 ± 3.4 PMN/field).

Myocardial AAR and Inf size. Summary data for AAR and Inf size following 20 min of coronary occlusion and 120 min of reflow are shown in Fig. 4A. Both groups of animals experienced similar-sized ischemic zones per left ventricle (LV) (ecNOS -/- AAR equals 46.0 ± 3.8% of LV; wild type AAR equals 43.3 ± 2.9% of LV; P = NS). Inf size was 20.9 ± 3.4% of the AAR in wild-type mice and 46.7 ± 4.0% of the AAR in ecNOS -/- mice (P < 0.01).


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Fig. 4.   A: graph of area at risk (AAR) per left ventricle (LV) and infarct (Inf) per AAR after 20 min of coronary ischemia and 120 min of reperfusion. There was no significant difference in AAR/LV between wild-type (n = 10) and ecNOS -/- (n = 9) hearts. However, ecNOS -/- hearts had significantly (** P < 0.01) larger Inf/AAR than wild-type hearts. B: summary data for AAR/LV and Inf/AAR after 30 min of left anterior descending occlusion and 120 min of reflow. The AAR/LV were not significantly different between wild-type (n = 7) and ecNOS -/- (n = 7) hearts. However, ecNOS -/- hearts exhibited significantly more (** P < 0.01) necrosis (Inf/AAR) than wild-type hearts.

Data for AAR/LV and Inf/AAR following 30 min of LAD ischemia and 120 min of reperfusion are presented in Fig. 4B. Although both groups of animals were subjected to similar (P = NS) areas of ischemia (ecNOS -/- AAR equals 54.4 ± 3.2%; wild-type AAR equals 46.6 ± 2.1%), the portion of this area rendered necrotic (Inf/AAR) was significantly more extensive (P < 0.01) in the ecNOS -/- hearts (58.4 ± 2.9%) compared with the wild-type controls (33.0 ± 7.5%).


    DISCUSSION
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

There are a number of salient findings revealed in this study. The most impressive finding of this study is the extreme disparity in myocardial infarct size between a wild-type mouse and a mouse that does not produce NO from ecNOS. This dichotomy between the wild-type and ecNOS -/- mice was observed after both 20 and 30 min of myocardial ischemia followed by 120 min of reperfusion. This clearly emphasizes the cardioprotection afforded by constitutive generation of NO. The infarct data alone indicate that NO seems to be a cornerstone of the intrinsic defenses of the body against MI/R-induced myocardial cell injury. The results of the present study agree with and extend previous observations of exogenous NO-exerting cardioprotective effects (19, 27, 37), whereas NOS inhibitors exacerbated myocardial injury following ischemia and reperfusion (16, 35).

Using gene-targeted knockout mice, we focused on the role of physiological levels of NO production rather than administration of NO donors or NOS inhibitors. Our approach avoided the possible hazards associated with these previous studies because the use of either of these methods involves determining the appropriate agent, dose, route of administration, half-life, and time of administration. In addition, NOS inhibitors can range from isoform selective to entirely nonselective. In the present study, we have eliminated these precarious steps with the use of genetically altered mice. However, there are some considerations to be made concerning the use of these mice. Although the measured parameters of oxygen demand did not differ significantly between ecNOS -/- and wild-type mice during ischemia, there may be constitutive changes in the cardiac phenotype of the ecNOS -/- mice due to long-standing hypertension. In addition, the vasoreactivity of the ecNOS -/- mice may be impaired. Consequently, we cannot completely rule out the possibility of delayed or no reflow.

The present study also demonstrates increased myocardial necrosis accompanied by enhanced neutrophil accumulation in the ischemic-reperfused myocardium of the ecNOS -/- mice. This investigation confirmed a large disparity between wild-type and ecNOS -/- mice in terms of neutrophil infiltration after both 20 and 30 min of coronary occlusion and 120 min of reperfusion. These data implicate neutrophils as a key mediator for the exaggerated myocardial injury resulting from ischemia and reperfusion in the ecNOS -/- mice. There is a large body of evidence suggesting that MI/R injury is largely an inappropriate immune response that is mediated by neutrophils (7, 30). It has previously been demonstrated that neutrophils contribute to MI/R injury in a variety of animals models and in humans (18, 20). In addition, anti-neutrophils agents are cardioprotective in the setting of myocardial reperfusion injury (30). Neutrophil-mediated myocardial injury is dependent on the interaction of adhesion glycoproteins expressed on the surface of circulating neutrophils (L-selectin, P-selectin glycoprotein ligand-1, and CD11/CD18) with the counter receptors expressed on the surface of the coronary endothelium [P-selectin, E-selectin, and intercellular adhesion molecule 1 (ICAM-1)] (2, 7, 24). NO released by the endothelium has been shown to inhibit the surface expression of a number of endothelial cell adhesion molecules, including P-selectin (5, 13), E-selectin (6), vascular cell adhesion molecule 1 (42), and ICAM-1 (6, 42). In addition, NO has also been shown to inhibit the activation of nuclear transcription factor kappa B, which is thought to regulate numerous inflammatory and immune responses involving endothelial cell adhesion molecule expression (39). Moreover, the antiadhesive actions of NO are thought to be in part related to the anti-oxidant actions of NO in the microcirculation (11).

The upregulation of P-selectin following MI/R is understood to be an early and necessary step for neutrophil tethering to the coronary endothelium (24, 28). Consequently, the degree of P-selectin expression determines the abundance of rolling neutrophils that may eventually adhere to the endothelium, extravasate into the tissue, and thereby mediate necrosis. Previous investigations have shown that inhibition of P-selectin with MAb (25, 47) directed against P-selectin or a soluble carbohydrate ligand (3, 26) attenuated myocardial necrosis following MI/R. The P-selectin expression data from the present study extend these observations further. We observed that the absence of ecNOS (as confirmed by RT-PCR) resulted in a significant increase in coronary P-selectin expression following MI/R. This indicates that NO generated by ecNOS at least partially governs P-selectin expression subsequent to ischemia and reperfusion of the myocardium.

In conclusion, the present study clearly reinforces previous studies that suggest the vital role that endothelial cell-derived NO plays in vascular homeostasis within the coronary circulation. Abolition of ecNOS dramatically exacerbated the extent of myocardial reperfusion injury following acute coronary artery ischemia and reperfusion. In addition, the level of coronary P-selectin expression and PMN infiltration into the ischemic-reperfused myocardium was markedly increased in mice lacking the gene for ecNOS. The results of this study provide further support for the anti-neutrophil actions of NO in the setting of acute inflammation and also suggest that NO may be of tremendous value for the treatment of MI/R injury.


    ACKNOWLEDGEMENTS

We thank DeRoyal Surgical (Powell, TN) and Ethicon Surgical (Somerville, NJ) for the generous donation of surgical supplies.


    FOOTNOTES

We acknowledge the expert assistance of Dr. Alexander Minchenko for performing the RT-PCR experiments.

This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases Grant PO1-DK-43785 to D. N. Granger and by Grant JDF-195065 from the Juvenile Diabetes Foundation to D. J. Lefer.

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. §1734 solely to indicate this fact.

Address for reprint requests and other correspondence: D. J. Lefer, Dept. of Molecular and Cellular Physiology, LSU Medical Center, 1501 Kings Highway, Shreveport, Louisiana 71130 (E-mail: dlefer{at}lsumc.edu).

Received 27 August 1998; accepted in final form 4 January 1999.


    REFERENCES
TOP
ABSTRACT
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES

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Am J Physiol Heart Circ Physiol 276(5):H1567-H1573
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