Cyclic GMP in Liver Cirrhosis—Role in Pathophysiology of Portal Hypertension and Therapeutic Implications

The NO-cGMP signal transduction pathway plays a crucial role in tone regulation in hepatic sinusoids and peripheral blood vessels. In a cirrhotic liver, the key enzymes endothelial NO synthase (eNOS), soluble guanylate cyclase (sGC), and phosphodiesterase-5 (PDE-5) are overexpressed, leading to decreased cyclic guanosine-monophosphate (cGMP). This results in constriction of hepatic sinusoids, contributing about 30% of portal pressure. In contrast, in peripheral arteries, dilation prevails with excess cGMP due to low PDE-5. Both effects eventually lead to circulatory dysfunction in progressed liver cirrhosis. The conventional view of portal hypertension (PH) pathophysiology has been described using the “NO-paradox”, referring to reduced NO availability inside the liver and elevated NO production in the peripheral systemic circulation. However, recent data suggest that an altered availability of cGMP could better elucidate the contrasting findings of intrahepatic vasoconstriction and peripheral systemic vasodilation than mere focus on NO availability. Preclinical and clinical data have demonstrated that targeting the NO-cGMP pathway in liver cirrhosis using PDE-5 inhibitors or sGC stimulators/activators decreases intrahepatic resistance through dilation of sinusoids, lowering portal pressure, and increasing portal venous blood flow. These results suggest further clinical applications in liver cirrhosis. Targeting the NO-cGMP system plays a role in possible reversal of liver fibrosis or cirrhosis. PDE-5 inhibitors may have therapeutic potential for hepatic encephalopathy. Serum/plasma levels of cGMP can be used as a non-invasive marker of clinically significant portal hypertension. This manuscript reviews new data about the role of the NO-cGMP signal transduction system in pathophysiology of cirrhotic portal hypertension and provides perspective for further studies.

Carvedilol induces biased β1 adrenergic receptor-nitric oxide synthase 3-cyclic guanylyl monophosphate signalling to promote cardiac contractility

Aims β-blockers are widely used in therapy for heart failure and hypertension. β-blockers are also known to evoke additional diversified pharmacological and physiological effects in patients. We aim to characterize the underlying molecular signalling and effects on cardiac inotropy induced by β-blockers in animal hearts. Methods and results Wild-type mice fed high-fat diet (HFD) were treated with carvedilol, metoprolol, or vehicle and echocardiogram analysis was performed. Heart tissues were used for biochemical and histological analyses. Cardiomyocytes were isolated from normal and HFD mice and rats for analysis of adrenergic signalling, calcium handling, contraction, and western blot. Biosensors were used to measure β-blocker-induced cyclic guanosine monophosphate (cGMP) signal and protein kinase A activity in myocytes. Acute stimulation of myocytes with carvedilol promotes β1 adrenergic receptor (β1AR)- and protein kinase G (PKG)-dependent inotropic cardiac contractility with minimal increases in calcium amplitude. Carvedilol acts as a biased ligand to promote β1AR coupling to a Gi-PI3K-Akt-nitric oxide synthase 3 (NOS3) cascade and induces robust β1AR-cGMP-PKG signal. Deletion of NOS3 selectively blocks carvedilol, but not isoproterenol-induced β1AR-dependent cGMP signal and inotropic contractility. Moreover, therapy with carvedilol restores inotropic contractility and sensitizes cardiac adrenergic reserves in diabetic mice with minimal impact in calcium signal, as well as reduced cell apoptosis and hypertrophy in diabetic hearts. Conclusion These observations present a novel β1AR-NOS3 signalling pathway to promote cardiac inotropy in the heart, indicating that this signalling paradigm may be targeted in therapy of heart diseases with reduced ejection fraction.

Abstract 106: GYY4137 Attenuates Post-Ischemic Adverse Remodeling and Modulates ANP-Mediated cGMP Signal Transduction

Myocardial infarction is the most frequent proximate cause of heart failure, which remains a leading cause of death in the developed world. Hydrogen sulfide (H 2 S) is emerging as an important endogenous modulator in diverse physiological and pathophysiological events. We hypothesized that the slow-releasing water-soluble H 2 S donor GYY4137 (GYY) may exert cardioprotective effects through modulation of neurohormonal response to cardiac injury. We have found that treatment for 1 week with GYY (100mg/Kg/48hr, IP) after acute myocardial infarction in rats, provides powerful sustained preservation of left ventricular (LV) dimensions and function in vivo, compared to untreated infarcted (MI), placebo- and D-propargylglycine- (PAG, an inhibitor of endogenous H 2 S synthesis) treated animals 2 and 7 days after infarct (n=6/group/time-point). LV dimensions and function in GYY-treated animals were comparable to healthy sham-operated rats. GYY-treated hearts displayed a significantly lower percentage of LV fibrosis than MI, placebo and PAG hearts, whereas PAG treated animals had significantly bigger scar size relative to GYY, at days 2 and 7 after MI. A higher density of blood vessels was found in the scar area of GYY-treated animals compared to all other infarcted groups at days 2 (P<0.0002) and 7 (P<0.01) post-MI. Furthermore, treatment with GYY resulted in increased levels of plasma atrial natriuretic peptide (ANP) compared to all groups at days 2 and 7 after MI, while cardiac mRNA expression of ANP was also significantly increased in GYY-treated rats compared to Sham (P<0.001), and all the infarcted groups (P<0.05) at day 2 after MI. Concordantly, ANP second messenger cGMP was increased in plasma at day 7 in GYY rats compared to sham and all infarcted groups (p<0.05), paralleled by higher cGMP-dependent protein kinase type I (cGKI) protein levels than sham (P<0.01), and vasodilator-stimulated phosphoprotein phosphorylation (pVASP) at the cGKI preferred site (Ser239) compared to sham and PAG (P<0.05) at day 2 post-MI. In conclusion, our data suggest that H2S attenuates adverse remodeling and may exert post-ischemic cardioprotective (pro-angiogenic, anti-fibrotic) effects in part through modulation of ANP-mediated cGMP signal transduction.