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Divisions of Endocrinology and Metabolism and Nephrology and Hypertension, Department of Medicine, Georgetown University, Washington, D.C. 20007
Address all correspondence and requests for reprints to: Dr. Darren M. Roesch, 350 Building D, 4000 Reservoir Road NW, Washington, D.C. 20007. E-mail: roeschd{at}gunet.georgetown.edu
| Abstract |
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| Introduction |
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Estrogen replacement therapy (ERT) decreases mean arterial pressure, increases cardiac output, and significantly reduces the risk of CVD in postmenopausal women (11). Although 2550% of the cardiovascular benefits of ERT therapy have been attributed to the effects of estrogens on the lipid profile (11), most of the protective effects of ERT have not been adequately explained. Some studies have suggested that differential regulation of the RAAS by estrogen contributes to the cardiovascular benefits of ERT (12, 13). Recent studies suggest that the plasma renin concentration is decreased in postmenopausal women receiving ERT (12, 13), and ERT decreases angiotensin-converting enzyme (ACE) activity in monkeys (14) and ACE messenger RNA (mRNA) levels in rats (15). Despite these concurrent changes in the regulation of angiotensinogen, renin concentration, ACE expression and activity, PRA (13), plasma Ang II (14), and plasma aldosterone (12, 13) concentrations do not change significantly during ERT. However, ERT has been shown to decrease vascular smooth muscle type 1 AT receptor (AT1) mRNA expression (16) and attenuate vascular (17) and renal (18) responses to Ang II. Together, these findings suggest that reduced target tissue responsiveness to Ang II may constitute a significant component of the cardiovascular benefit of ERT.
Surprisingly, the effect of ERT on the responsiveness of the adrenal to Ang II has not been studied. We have recently observed that estradiol (E2) reduces maximal binding to AT1 receptors in the adrenal and pituitary of ovariectomized (OVX) rats (19). This finding is consistent with previous reports of E2-induced decreases in total AT binding in the adrenal and pituitary (20, 21) and suggests that E2 may attenuate Ang II-stimulated aldosterone secretion by decreasing the sensitivity of the adrenal and pituitary to Ang II. As Ang II infusions are known to stimulate ACTH release (22, 23), and ACTH has also been shown to increase aldosterone production in humans (24), rats (25), dogs (26), and sheep (27), it is impossible to study the effect of exogenous Ang II on aldosterone secretion without considering the contribution of Ang II-stimulated ACTH secretion. Before the late 1970s, the study of Ang II-induced aldosterone secretion was also hindered by the fact that when rats are fed standard laboratory chows that are typically high in sodium, the adrenal is minimally responsive to exogenous Ang II (28). Since then, dietary sodium deprivation has been shown to increase both the expression of adrenal AT receptors and the adrenal aldosterone response to Ang II (28). In this study we used a protocol that combines dietary sodium deprivation and dexamethasone (DEX) suppression of ACTH to produce 1) a high magnitude of Ang II-induced aldosterone secretion, 2) a return of plasma aldosterone levels to baseline after Ang II stimulation, and 3) an absence of Ang II-stimulated ACTH secretion. Using this improved protocol, we tested the effect of E2 on ACTH-independent adrenal responsiveness to Ang II in OVX rats. To assess whether the E2-induced decrease in pituitary AT1 receptor expression affects Ang II-induced ACTH secretion and contributes to decreased Ang II-induced aldosterone secretion, we also measured the effect of E2 on Ang II-induced aldosterone secretion in OVX rats that were not treated with DEX.
| Materials and Methods |
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Jugular vein catheterization
Silicone rubber catheters (id, 0.02 in.; od, 0.037
in.; Sil-Med Corp., Taunton, MA) were prepared by allowing a ball of
SILASTIC brand medical adhesive (Dow Corning Corp.,
Midland, MI) to dry around the perimeter 3.1 cm from one end of a
12.5-cm-long piece of tubing. Under methoxyflurane anesthesia
(Schering Plough Animal Health Corp., Union, NJ), the
short end of a catheter filled with heparinized (100 U/ml), sterile
0.15-M NaCl solution was inserted into the right jugular
vein. The catheter was anchored to the pectoral muscle by tying 40
surgical silk around the adhesive ball, and a 15-gauge trocar
(Becton Dickinson and Co., Sparks, MD) was used to
exteriorize the free end of the catheter in the dorsal scapular region.
The incision was closed with 9-mm wound clips (Becton Dickinson and Co., Franklin Lakes, NJ), and the catheter was plugged with
a 1-cm piece of 21-gauge stainless steel wire (Small Parts, Inc., Miami
Lakes, FL).
Ang II infusion
Ang II was dissolved in sterile 0.15 M NaCl and
infused using Razel syringe pumps at the rates specified in the
infusion protocols (Razel Scientific Instruments, Inc., Stamford,
CT).
Blood sampling
Each jugular catheter was connected to a 100-cm long piece of
polyethylene tubing (id, 0.76 mm; od, 1.22 mm; PE-60, Becton Dickinson and Co.) filled with heparinized (50 U/ml) saline
using a 1-cm-long piece of 21-gauge stainless steel hypodermic tubing
(Small Parts, Inc.). The dead space in this catheter was approximately
0.5 ml. The catheter was routed to the exterior of the animals cage,
and a three-way stopcock (VWR Scientific, Bridgeport, NJ) was
connected to the end of the catheter with a 21-gauge blunt needle. The
rats were allowed to recover from the stress of handling for at least
30 min before beginning a study. Blood samples were withdrawn slowly
(over 12 min), and a volume of heparinized saline (50 U/ml) equal to
the sample volume was infused after each sample. Food, water, and
saline were not provided during the blood-sampling experiments. Blood
samples were collected in 3-ml Vacutainer blood collection tubes
(Becton Dickinson and Co.) containing EDTA or sodium
heparin.
Effect of DEX on the dose response of Ang II-induced aldosterone
secretion in NaCl-deprived rats
Twelve male rats were fed a NaCl-deficient diet (TD 95087,
Harlan Teklad, Madison, WI) for 7 days. On day 5, jugular vein
catheters were inserted, and on day 7, aldosterone secretion was
studied after graded 30-min infusions of Ang II at rates of 1.7, 3.3,
33, and 330 ng/min. As several investigators have found that Ang II
infusions increase plasma ACTH (22, 23), four of the rats
were pretreated with an ip injection of dexamethasone sodium phosphate
(DEX; 100 µg) 3 h before beginning the study. The following
pattern was repeated until all four infusions were completed: a
baseline sample was taken (0.5 ml), a dose of Ang II was infused over
30 min, a sample was taken 30 min after beginning the infusion (0.5
ml), another sample was taken 30 min after the end of the infusion (0.5
ml), and the next infusion was begun immediately thereafter.
Effects of E2 on PRA,
aldosterone, plasma Na+, plasma
K+, osmolality, hematocrit, and plasma protein
in OVX, NaCl-deprived rats
OVX rats were treated daily with sc injections of peanut oil
(0.2 ml; n = 12) or E2 (10 mg in 0.2 ml
peanut oil; n = 12) for 14 days. On days 1014, the rats were fed
TD 95087. On day 12, catheters were inserted into the right jugular
veins of half of the animals [6 OVX and 6 OVX and
E2 treated (OVX+E2)]. On
day 14, an iv blood sample (2.5 ml) was collected from these animals in
tubes containing heparin for measurement of aldosterone, plasma
Na+, plasma K+, osmolality,
hematocrit, and plasma protein. The other 12 animals (6 OVX and 6
OVX+E2) were killed by decapitation on day 14,
and a sample of trunk blood was collected in tubes containing EDTA for
measurement of PRA.
Effect of E2 on
ACTH-independent and ACTH-dependent Ang II-induced aldosterone
secretion in OVX, NaCl-deprived rats
To determine the effect of E2 on
ACTH-independent Ang II-induced aldosterone secretion, OVX rats were
treated with sc injections of peanut oil (0.2 ml; n = 17) or
E2 (10 µg; n = 17) for 14 days. All rats
were fed TD 95087 on days 814. On day 11, silicone catheters were
inserted into the right jugular vein. On days 1214, injections of DEX
(25 µg in 1 ml sterile isotonic saline, injected ip) were given every
12 h at lights-on and lights-off for a total of five injections.
This DEX injection protocol has been shown to inhibit ACTH responses to
potent ACTH-releasing stimuli (29, 30, 31). On day 14,
aldosterone secretion was studied after a 30-min infusion of Ang II
(330 ng/min) in conscious ambulatory animals.
To determine whether the observed effects of the Ang II infusion on aldosterone secretion were mediated via the AT1 receptor subtype, some of the OVX (n = 4; OVX+L) and some of the OVX+E2 (n = 6; OVX+E2+L) rats were given a 2.5-mg iv bolus of the AT1 selective antagonist losartan (L; dissolved in 1 ml sterile, isotonic saline) 30 min before beginning the infusion of Ang II (control rats were given an iv bolus of 1 ml sterile isotonic NaCl 30 min before beginning the infusion). In a recent study this dose and route of losartan administration were shown to eliminate the pressor response to an iv infusion of Ang II (32).
Plasma samples were collected at baseline and 30 (1.2 ml), 60 (0.7 ml), and 120 (0.9 ml) min after the beginning of the Ang II infusion for measurement of aldosterone and ACTH. Each sample volume was immediately replaced with an equal volume of sterile isotonic NaCl. Blood samples were collected in 3-ml Vacutainer blood collection tubes (Becton Dickinson and Co.) containing EDTA (for ACTH) or sodium heparin (for aldosterone). As plasma ACTH normally varies between 1545 pg/ml during the course of the day in female rats (33), animals that attained baseline ACTH levels greater than 45 pg/ml and stimulated ACTH levels greater than 100 pg/ml were excluded from subsequent analysis.
To determine the effect of E2 on ACTH-dependent Ang II-induced aldosterone secretion, 10 female rats were OVX and treated with sc injections of peanut oil (0.2 ml; n = 5) or E2 (10 µg; n = 5) for 14 days. All rats were fed TD 95087 on days 814, and jugular catheters were inserted on day 11. On day 14, plasma samples were collected as described above for measurement of aldosterone and ACTH after a 30-min infusion of Ang II (330 ng/min).
Blood analyses
Hematocrits were measured using a microhematocrit centrifuge and
a microcapillary reader. Blood samples were stored on ice until
centrifugation at 3000 rpm in a refrigerated centrifuge. Plasma was
stored at -20 C until assayed. Plasma Na+ and
K+ were measured with ion-selective electrodes
using a Synchron Elise Electrolyte System (Beckman Coulter, Inc., Brea, CA). Plasma osmolality was measured using Advanced
Osmometer model 3D3 (Advanced Instruments, Inc., Norwood, MA). Plasma
proteins were determined using a clinical refractometer (type
57112020, Schuco, Carle Place, NY). PRA was measured by RIA
(GammaCoat Plasma Renin Activity, DiaSorin, Inc., Stillwater, MN). Plasma aldosterone was measured by RIA
(Coat-A-Count Aldosterone, Diagnostic Products, Los
Angeles, CA). Using 200 µl plasma, this assay detects plasma levels
ranging from 251200 pg/ml. Stimulated samples were diluted in the
supplied zero calibrator. Plasma ACTH was measured by RIA (ACTH Double
Antibody RIA, DiaSorin, Inc.). When 100 µl plasma are
assayed, this method detects plasma ACTH concentrations ranging from
20500 pg/ml. When plasma aldosterone or ACTH levels were below the
limit of assay detection, the values were reported as the limit of
detection.
Effect of E2 on adrenal AT1
receptor expression in OVX, NaCl-deprived rats
To determine whether E2 reduces
AT1 receptors in the adrenals of NaCl-deprived
rats, OVX rats were treated with oil (n = 6) or
E2 (n = 6) for 14 days as described in the
protocol above. On days 814 the rats were fed TD 95087. On days
1214, three OVX and three OVX+E2 rats were
treated with five ip injections of DEX as described above. On day 14,
all rats were killed, and adrenals were removed for radioligand binding
analysis.
Adrenals were homogenized by Polytron in 10 vol homogenization buffer (50 mM Tris-HCl and 1 mM EDTA, pH 7.4) supplemented with 10 µg/ml leupeptin, 0.2 U/ml aprotinin, 10 µg/ml antipain, and 0.1 mM phenylmethylsufonylfluoride at 4 C. The homogenate was filtered through four-ply gauze and centrifuged at 48,000 x g for 15 min. The pellet was resuspended in homogenization buffer and centrifuged at 48,000 x g for 15 min. The second pellet was resuspended in binding buffer (10 mM Na2HPO4, 100 mM NaCl, and 5 mM EDTA, pH 7.4). Protein concentrations of adrenal membranes were determined by the Bradford method using BSA as the standard (Bio-Rad Laboratories, Inc., Richmond, CA).
Adrenal membranes (510 µg/tube) were sonicated for 5 sec with a
Sonifer cell disrupter immediately before being incubated with
increasing concentrations (0.054 nM) of
125I-[Sar1,Ile8]Ang
II (Peptide Radioiodination Center, Pullman, WA) for 2 h at room
temperature in 0.3 ml binding buffer supplemented with 0.1% BSA. Bound
tracer was rapidly separated from unbound tracer by washing filters
four times with ice-cold PBS using a Brandel vacuum harvester (model
M-24, Gaithersburg, MD). Radioactivity was measured in a
-counter
(Cobra, Packard, Downers Grove, IL). Preincubation of glass-fiber
filters with 10% BSA overnight was used to reduce nonspecific
absorption of the radioligand to the filters. To determine changes in
AT1 receptor expression, membranes were incubated
the presence of increasing concentrations of
125I-[Sar1,Ile8]Ang
II and 10 µM PD-123,319 (AT2
receptor antagonist). For each curve, nonspecific binding was
determined at each concentration of
125I-[Sar1,Ile8]Ang
II in the presence of 200 nM Ang II and 10 µM
PD-123,319. Specific binding was defined as the total radioligand bound
minus nonspecific binding. All binding analyses were conducted on the
adrenal membrane preparation made from each animal (three OVX, three
OVX+E2, three OVX+DEX, and three
OVX+E2+DEX rats), and all determinations were
performed in triplicate. Data from each animal were fit to the equation
y =
x(Bmax)/(Kd +
x), where Bmax is the total number of
receptors, and Kd is the equilibrium dissociation
constant) using nonlinear regression and the program PRISM
(GraphPad Software, Inc., San Diego, CA). The relationship
between bound and bound/free was plotted (34), and lines
were computer generated (slope = -1/Kd;
y-intercept = -slope x
Bmax) using the average values for
Bmax and Kd obtained by
nonlinear regression.
Statistical analyses
The integrated (s) aldosterone response in each animal was
calculated using the program PRISM. Integrated aldosterone responses,
AT1 receptor binding values, and basal values for
PRA, aldosterone, plasma Na+, plasma
K+, osmolality, hematocrit, and protein were
compared using an unpaired t test. To analyze the effects of
both treatment (DEX or E2) and time on plasma
aldosterone and ACTH levels, values were analyzed by two-way ANOVA
corrected for repeated measures, and individual means were compared
using the Student-Newman-Keuls post-hoc test. Data are
expressed as the mean ± SEM.
| Results |
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| Discussion |
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The AT1 receptor subtype predominates in adrenal glomerulosa cells (36) and in the pituitary (37), and AT1-selective antagonists completely abolish Ang II-stimulated aldosterone secretion in vivo (38). As Ang II-induced aldosterone secretion was completely blocked by pretreating the OVX, NaCl deprived, DEX-treated rats used in this study with the AT1-selective antagonist losartan, the E2-induced decrease in the plasma aldosterone response to an Ang II infusion is probably attributable to decreased adrenal AT1 expression. However, the mechanism by which E2 reduces adrenal AT1 expression is currently unknown. An estrogen response element (ERE) has been identified in the 5'-flanking region of the AT1 receptor gene (39), suggesting that E2 may directly regulate adrenal AT1 receptor transcription. In addition, this laboratory has recently discovered cytosolic proteins (BP) that bind to the 5'-leader sequence (5'LS) of the AT1 receptor mRNA (40). We observed that the magnitude of 5'LS-BP complex formation inversely correlates with tissue-specific E2-induced changes in maximal AT1 binding. Furthermore, in vitro translation of the AT1 receptor mRNA is decreased when these studies are conducted in the presence of cytosolic extracts obtained from a tissue rich in 5'LS-BP activity. Thus, we proposed that E2 may also indirectly modulate AT1 receptor translation by modifying the expression and/or activity of 5'LS-BP (19).
It is interesting to note that despite equally high PRA and aldosterone levels in both OVX and OVX+E2 rats, plasma Na+ was significantly increased, and plasma K+ was significantly decreased in E2-treated rats. One interpretation of this finding is that E2 enhances the efficacy of the high circulating concentrations of aldosterone. The sodium-retaining effects of estrogens have been known for many years (41). Two recent observations support the hypothesis that estrogens actually enhance chronic mineralocorticoid activity, at least in the kidney: 1) a study of postmenopausal women indicated that ERT increased renal sodium reabsorption after a hypertonic saline infusion without altering plasma aldosterone levels (42); and 2) E2 increased the expression of a mineralocorticoid receptor (MR)-regulated protein, the thiazide-sensitive NaCl cotransporter, in the distal convoluted tubule (43, 44). Although a few studies have investigated the effects of estrogens on MR expression in the brain (45), the results of these studies have been contradictory. Moreover, there are no known reports of the effects of estrogens on MR expression in the kidney. Thus, it is possible that ERT alters renal responsiveness to aldosterone by modifying MR expression, and that this effect leads to increased plasma Na+ and decreased plasma K+.
Although the mechanism by which E2 alters plasma Na+ and K+ remains to be determined, this effect of E2 on plasma K+ may contribute to the effects of E2 on pituitary and adrenal AT1 receptor expression. In the rat, adrenal AT receptor density directly correlates with dietary potassium intake (46, 47), and adrenal responsiveness to Ang II is increased by a high K+ diet (48, 49). Moreover, when rats are fed potassium-deficient diets, PRA and Ang II concentrations are increased, whereas plasma aldosterone concentrations remain unchanged (46). This constellation of low potassium-induced changes in RAAS activity closely corresponds to the increases in plasma angiotensinogen, PRA, and Ang II concentration that have been associated with the physiological effects of E2 (50) and suggests that E2-induced changes in potassium homeostasis play an important role in modulating adrenal sensitivity to Ang II.
We did not observe a significant effect of E2 on basal aldosterone levels in rats that were not treated with DEX. Similarly, other studies have not reported a significant effect of ERT on plasma aldosterone concentrations (12, 13). It is possible that an existing effect of E2 on basal aldosterone concentrations is obscured by individual animal variations and/or environmental stress-induced variations in plasma ACTH. We also did not observe a significant effect of E2 on basal aldosterone levels in the NaCl-deprived, OVX rats that were treated with DEX. However, DEX decreased basal plasma aldosterone levels in the NaCl-deprived rats that were used in this study to near the assay detection limit, so any effect E2 may have had on basal aldosterone concentrations in DEX-treated rats would not have been detected by our assay. The mechanism by which DEX, given as a single injection 3 h before sampling or as a series of five injections over the course of 3 days, decreased basal aldosterone levels in NaCl-deprived rats to near the assay detection limit is unclear. In the past, DEX inhibition of ACTH has been used to reveal the circadian relationship between PRA and aldosterone independently of variation in plasma ACTH (51), suggesting that PRA and aldosterone secretion are not inhibited by DEX. However, others have shown that the natural glucocorticoid, cortisol, attenuates nitroprusside-stimulated PRA in adult ewes (52), suggesting that the synthetic glucocorticoid, DEX, may contribute to inhibition of basal aldosterone levels in NaCl-deprived rats by decreasing PRA. Further study is needed to determine the mechanism by which DEX decreases basal aldosterone concentrations in NaCl-deprived rats and to clarify the potential effects of E2 on basal aldosterone concentration.
Although the physiological relevance of the E2-induced decrease in adrenal AT1 receptor expression and Ang II-induced aldosterone secretion remains to be determined, it is reasonable to consider the possibility that an E2-induced decrease in acute adrenal aldosterone responses may contribute to the cardiovascular benefits of ERT. Recent studies suggest that aldosterone can have rapid effects on cardiovascular function. The hypertensive effects of mineralocorticoids are mediated at least in part via actions in the brain. Intracerebroventricular (icv) infusions or injections of mineralocorticoids increase blood pressure (53, 54), and icv MR antagonists block the hypertensive effects of mineralocorticoids (55, 56) and decrease blood pressure when administered alone (54, 57). A recent study demonstrated that icv administration of a MR antagonist affects blood pressure and renal excretion of water and electrolytes as early as 30 min after icv injection (57). As these studies have found rapid effects of centrally administered adrenal steroids on cardiovascular function, and steroids are known to rapidly diffuse across the blood-brain barrier (58), we propose that by modifying relatively acute changes in plasma aldosterone concentration, E2 may exert significant effects on the central regulation of cardiovascular function.
It is also well known that when laboratory animals are treated chronically with mineralocorticoids, such as deoxycorticosterone acetate, and diets high in sodium, they develop hypertension (59). This model of hypertension is characterized by increased vascular responsiveness to Ang II, increased vascular resistance, and decreased baroreflex sensitivity; all of these factors are thought to be risk factors for myocardial infarction and stroke (59). The recently completed Randomized Aldactone Evaluation Study supports the likelihood that aldosterone has potential deleterious cardiovascular effects. Blockade of aldosterone receptors with spironolactone substantially reduced the risk of both morbidity and mortality among patients with severe heart failure who were also receiving standard ACE inhibition therapy (60). Therefore, if an E2-induced decrease in acute adrenal aldosterone responses also contributes to decreased chronic mineralocorticoid effects, this could clearly be cardioprotective.
In summary, our results demonstrate that in DEX-treated rats, E2 attenuates Ang II-induced secretion independently of plasma ACTH. This finding indicates that E2 simultaneously reduces adrenal AT1 receptor expression and adrenal responsiveness to Ang II. In both DEX-treated and control rats, the magnitude of the E2-induced decrease in the integrated aldosterone response to Ang II correlated closely with the measured decrease in adrenal AT1 binding. In addition, we have shown that in rats that are NaCl deprived but not treated with DEX, E2 also attenuates Ang II-induced ACTH secretion. This finding suggests that E2 attenuates adrenal aldosterone responses to surges in plasma Ang II in NaCl-deprived rats partly by decreasing pituitary responsiveness to Ang II. Taken together, these results suggest that by decreasing the expression of brain, pituitary, and adrenal AT1 receptors, E2 attenuates acute adrenal aldosterone responses to Ang II. We propose that this effect may contribute to the cardioprotective effects of ERT.
| Footnotes |
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2 Supported by a National Research Service Award (HL-10419). ![]()
Received May 19, 2000.
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