Reduced Pulsatility Induces Periarteritis in Kidney: Role of the Local Renin–Angiotensin System

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 136; no. 1; pp. 150 - 158
• Main Authors: Ootaki, Chiyo, Yamashita, Michifumi, Ootaki, Yoshio, Kamohara, Keiji, Weber, Stephan, Klatte, Ryan S., Smith, William A., Massiello, Alex L., Emancipator, Steven N., Golding, Leonard A.R., Fukamachi, Kiyotaka
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.07.2008; AATS/WTSA; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angiotensin II - biosynthesis; Animals; Arteritis - pathology; Arteritis - physiopathology; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Cattle; Hemodynamics; Immunohistochemistry; Kidney - blood supply; Kidney - metabolism; Male; Medical sciences; Nephritis - pathology; Nephritis - physiopathology; Peptidyl-Dipeptidase A - metabolism; Pneumology; Pulsatile Flow; Receptors, Angiotensin - metabolism; Renal Artery - pathology; Renal Artery - physiopathology; Renin-Angiotensin System; pa; RVAD; eNOS; ACE; RAS; 27; 17; AT1R; TAH; Ang II; LVAD; right ventricular assist device; angiotensin II type 1 receptor; renin–angiotensin system; total artificial heart; periarterial areas; angiotensin II; endothelial nitric oxide synthase; left ventricular assist device; angiotensin-converting enzyme; Anesthesia; Renin angiotensin system; Circulatory system; Cardiology; Kidney
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.12.023

The need for pulsatility in the circulation during long-term mechanical support has been a subject of debate. We compared histologic changes in calf renal arteries subjected to various degrees of pulsatile circulation in vivo. We addressed the hypothesis that the local renin–angiotensin system may be implicated in these histologic changes. Sixteen calves were implanted with devices giving differing degrees of pulsatile circulation: 6 had a continuous flow left ventricular assist device (LVAD); 6 had a continuous flow right ventricular assist device (RVAD); and 4 had a pulsatile total artificial heart (TAH). Six other calves were histologic and immunohistochemical controls. In the LVAD group, the pulsatility index was significantly lower (0.28 ± 0.07 LVAD vs 0.56 ± 0.08 RVAD, vs 0.53 ± 0.10 TAH; P < 0.01), and we observed severe periarteritis in all cases in the LVAD group. The number of angiotensin II type 1 receptor–positive cells and angiotensin converting enzyme–positive cells in periarterial areas was significantly higher in the LVAD group (angiotensin II type 1 receptor: 350 ± 139 LVAD vs 8 ± 6 RVAD, vs 3 ± 2 TAH, vs 3 ± 2 control; P < .001; angiotensin-converting enzyme: 325 ± 59 LVAD vs 6 ± 4 RVAD, vs 6 ± 5 TAH, vs 3 ± 1 control; P < .001). The reduced pulsatility produced by a continuous flow LVAD implantation induced severe periarteritis in the kidneys. The local renin–angiotensin system was up-regulated in the inflammatory cells only in the continuous flow LVAD group.