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Departments of 1 Medicine and 3 Biochemistry, Vanderbilt University Medical School, Nashville, Tennessee 37232; and 2 Department of Pharmacology, New York Medical College, Valhalla, New York 10595
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ABSTRACT |
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Hypertension
is a leading cause of cardiovascular, cerebral, and renal disease
morbidity and mortality, and epidemiological evidence suggests a role
for sex-dependent mechanisms in the pathophysiology of hypertension. We
show here that treatment of rats with 5
-dihydrotestosterone increases the activity of the kidney arachidonate
/
-1 hydroxylase and the biosynthesis of 20-HETE (165 and 177% of control untreated male and female rats, respectively) and raises the systolic blood pressures of male and females rats by 46 and 57 mmHg, respectively. These androgen effects are associated with an upregulation in the
kidney levels of CYP 4A8 mRNA and a decrease in CYP 4A1 transcripts. Dissected renal microvessels, the target tissue for most of the prohypertensive actions of 20-HETE, show an androgen-dependent upregulation of vascular CYP 4A8 mRNA and a fourfold increase in
20-HETE synthase activity. We propose that androgens regulate renal
function and systemic blood pressure through a combination of
transcriptional and hemodynamic mechanisms that are ultimately responsible for the regulation of renovascular tone and function.
P-450 eicosanoids; androgens; CYP 4A8
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INTRODUCTION |
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A NOW CONSIDERABLE
BODY of evidence shows that microsomal P-450s (CYPs)
participate in the in vivo metabolism of arachidonic acid (AA) and that
products of this P-450-catalyzed pathway are in vitro
modulators of renal ion transport and vascular reactivity and may be
involved in the regulation of systemic blood pressure (3, 4, 22,
29). During catalytic turnover, the P-450
monooxygenase(s) metabolize AA via
/
-1 hydroxylation (AA
/
-1 hydroxylase) to 19- and 20-HETE and/or epoxidation (AA
epoxygenase) to 5,6-, 8,9-, 11,12-, or 14,15-epoxyeicosatrienoic acids
(EETs) (4, 5). Recombinant CYPs 4A1, 4A2, 4A8, and to a
lesser extent 4A3, support the hydroxylation of AA to either 20-HETE or
to mixtures of 19- and 20-HETE (4, 16, 19, 31). All four
CYP 4A isoforms are expressed in the male rat kidney (4, 16, 19,
31), with CYPs 4A1 and 4A2/4A3 characterized as the predominant
microsomal AA
/
-1 hydroxylases (16). The
transcriptional regulation of rat CYPs P-450 4A1 and 4A2/4A3
by the peroxisomal proliferator activated receptor-
(45), as well as the sexually dimorphic,
testosterone-sensitive expression of rat CYPs 4A2 and 4A8 and of murine
Cyp 4a12, has been reported (18, 20, 40, 42).
Studies with the spontaneously hypertensive-Wistar Kyoto (SHR/WKY) rat
model of spontaneous hypertension, an extensively characterized model
of genetic hypertension (29), suggest a role for renal CYP
4As in the pathophysiology of the disease (3, 29). Thus based on 1) temporal associations between the increases in
blood pressure, renal CYP 4A expression and 20-HETE formation (3, 29), 2) experimental manipulations of CYP 4A activity
and/or expression (29, 32, 43), and 3) the
renovascular effects of 20-HETE (3, 22, 29), a
prohypertensive role was proposed for this eicosanoid and for the CYP
4A AA
/
-1 hydroxylases (29). More recently, the
characterization of Cyp 4a14(
/
) mice showed the animals'
hypertensive phenotype was sexually dimorphic and associated with an
increased kidney Cyp 4a12 AA
/
-1 hydroxylase activity
(20).
Prevalence, complexity, and multiple medical and socioeconomic
consequences make hypertension a major health challenge, and, notwithstanding extensive research, its early diagnosis and treatment remains mostly symptomatic and empirical. The study of the molecular causes of hypertension is complicated by a variety of etiologies and
the frequent coexistence of additional pathological conditions. Nonetheless, extensive genetic segregation and linkage analyses indicate multigenic factors as responsible for a significant component of human essential hypertension (13-15, 25, 33).
Furthermore, gender differences in incidence and severity have also
suggested the involvement of a sex-dependent mechanism in the
pathogenesis of human hypertension (1, 10, 14, 25, 27, 34,
35). We report here that treatment of rats with
5
-dihydrotestosterone (DHT), a metabolic stable androgen, induces
the expression of kidney CYP 4A8, increases the capacity of the renal
microcirculation to synthesize prohypertensive 20-HETE (3, 4, 22,
29), and causes systemic hypertension.
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MATERIALS AND METHODS |
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All animal experiments were done following the American
Physiological Society's guiding principles and in accordance with the
Institute for Laboratory Animal Research's Guide for Care and
Use of Laboratory Animals. Sprague-Dawley rats (280-350 g) (Harlan Sprague Dawley) were treated by daily injections (
50 µl ip)
of either corn oil or a suspension of testosterone (TST) or DHT in corn
oil (40-120 mg/kg body wt) and allowed free access to water and
standard rat chow (Ralston Purina Mills, St. Louis, MO). Blood
pressures were determined by the tail cuff method at an ambient
temperature of 30°C. Trained animals were allowed to become familiar
with the environment and were maintained in the measuring chamber for
at least 1 h before measurements. Blood pressures were obtained
after four consecutive readings with values within ±5% of their mean.
Measurements were done using a blood pressure analyzer instrument
(model 178, IITC, Life Sciences, Woodlands Hills, CA) following the
manufacturer's instructions.
Isolation of microsomal fractions and renal microvessels.
Anesthetized (Nembutal, 5 mg/kg ip) rats were killed and their kidneys
were removed and freed of connective tissue; microsomal fractions were
isolated by differential centrifugation (6). Renal
microvessels were dissected exactly as described (28, 41).
Briefly, the abdominal aorta (below the renal arteries) of
pentobarbital sodium-anesthetized rats was cannulated, the superior
mesenteric and aorta above the renal arteries were ligated, and the
kidneys were perfused first with ice-cold Tyrode buffer and then with
Tyrode buffer containing 6% albumin and 1% Evan's blue solution.
Kidneys were removed, sliced into hemisections, and pushed through a
180-µm mesh screen. The vascular trees trapped on the screen were
digested in Tyrode buffer containing 1 mg/ml collagenase, 1 mg/ml
soybean trypsin inhibitor, 1 mg/ml DTT, 1 mg/ml albumin, and the
following: 10 µM Na-succinate, 10 µM L-alanine, 6 mM
sodium lactate, 2 mM sodium L-glutamate. Vessels were
incubated 60 min at 37°C with shaking and superfusion with
O2 gas. The tissue suspension was filtered (75 µm, nylon
filter), and the digested tissue was resuspended in Tyrode buffer and
rinsed several times. Microvessels, primarily preglomerular arteries,
were collected, free of tubular components, by microdissection under a
stereomicroscope (Fig. 1).
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Enzymatic studies.
Microsomal incubations with [1-14C]arachidonic acid
(2-8 µCi/µmol, 70-100 µM, final concentration) were
performed exactly as described (5, 6). Timed aliquots were
extracted with acidified ethyl ether and analyzed by reversed-phase
HPLC with online
-detection (6). Initial velocities (in
pmol of product formed · mg of protein
1 · min
1) were
calculated from the linear portions of product concentration vs.
incubation time plots.
Nucleic acid hybridizations and immunoelectrophoresis. Total kidney RNAs were isolated by the guanidinium isothiocyanate/CsCl method (16), electrophoresed in 1.2% agarose gels containing 0.2 M formaldehyde, transferred to nitrocellulose membranes, and hybridized to the following 32P-labeled sequence specific probes: 1) P-450 4A1: 542 bp extending from nucleotide 1558 to 2100 (30), 2) P-450s 4A2/4A3: 486 bp extending from nucleotide 1514 to 2000 (30), and 3) P-450 4A8: 636 bp, extending from nucleotide 1564 to 2200 (30). Probes were labeled with [32P]dCTP using a Nick Translation kit (Pharmacia Biotechnology, Uppsala, Sweden) following the manufacturer's instructions. Hybridizations were done at 42° in Hybrisol (Oncor, Galtherburg, MD), and, after several washes in SSC/SDS mixtures, the membranes were exposed to X-ray film.
Immunoelectrophoresis (10% wt/vol acrylamide, 100 × 60 × 1 mm slabs; PVDF membranes) were done as published (16). Antigen-antibody reactions were detected using a SuperSignal Substrate Western Blotting kit (Pierce, Rockford, IL) and the manufacturer's instructions. Polyclonal anti-CYP 4A1 and 4A2 antibodies were raised and purified as described (16). CYPs 4A1 and 4A2 were expressed and purified as reported (16).| |
RESULTS AND DISCUSSION |
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The prohypertensive properties of 20-HETE were deduced from
studies in isolated renal cells and perfused kidney preparations (3, 22, 26, 29) showing that the eicosanoid blocked
Na+ and K+ transport in medullary thick
ascending limb of Henle cells, inhibited medullary
K+ channels, and caused the vasoconstriction of renal
afferent arterioles (3, 22, 26, 29). These studies
indicated a role for 20-HETE in pressure natriuresis and urinary
Na+ excretion (22, 26, 29). Chemical or
antisense nucleotide inhibition of kidney CYP 4A activity or
biosynthesis reduced 20-HETE formation and normalized the blood
pressures of hypertensive SHR (32, 43). Moreover, kidney
microsomes from hypertensive Cyp 4a14(
/
) mice generated 20-HETE at
rates higher than microsomes from Cyp 4a14(+/+) mice, a response
associated with the androgen-mediated induction of Cyp 4a12 in Cyp
4a14(
/
) mice (20).
To characterize the role of androgens in the regulation of the
microsomal AA monooxygenase activity and 20-HETE biosynthesis, kidney
microsomes from control and DHT-treated rats were incubated with AA in
the presence of NADPH. As reported (5), microsomes from
control male and female rats metabolize AA to 19-and 20-HETE as the
predominant products and to mixtures of 5,6-, 8,9-, 11,12-, and
14,15-EETs (Table 1). Regardless of
gender, 20-HETE is the principal product of renal AA
/
-1
hydroxylases (Table 1) (5, 6). Treatment with DHT had only
minimal effects on the overall rates of AA metabolism by male or female
kidney microsomes but caused distinct increases in 20-HETE formation
(Table 1) and a marked reduction in renal AA epoxygenase activity
(Table 1). Immunoelectrophoresis analysis indicated that these
reductions in epoxygenase activity were accompanied by DHT-mediated
decreases in microsomal anti-2C23 immunoreactive proteins (not shown).
At difference with the kidney microsomal enzymes, AA epoxidation is the
major reaction catalyzed by liver microsomes isolated from male or
female rats (Table 2) (4).
Importantly, and as shown in Table 2, treatment of male or female rats
with DHT had only minimal effects on the activity of the liver
microsomal AA
/
-1 hydroxylase or epoxygenase, suggesting that the
androgen effects on AA metabolism are kidney specific (Table 2).
Similar increases in renal 20-HETE biosynthetic capacity and the
upregulation of Cyp 4a12, the murine homologue of rat CYP 4A8, are seen
in hypertensive Cyp 4a14(
/
) mice or in androgen-treated Cyp
4a14(+/+) mice (20).
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To explore the CYP P-450 isoform specificity of the
DHT-induced changes in enzyme activity, total kidney RNA was hybridized to probes specific for CYPs 4A1 and 4A8 and to a probe that recognizes both CYP 4A2 and 4A3. The high degree of nucleotide sequence homology displayed by the CYP 4A2 and 4A3 mRNAs (~97% sequence identity) (16, 30) precludes their individualization by nucleic
hybridization techniques. As shown in Fig.
2, the adult male rat kidney expresses CYPs 4A2/3, 4A8, and 4A1 transcripts (16, 19, 31), whereas in females, CYP 4A1 and 4A8 appear to be the predominant kidney CYP 4A
mRNAs, and CYP 4A2/4A3 is nearly undetectable (Fig. 2) (16). In males and females, DHT caused a marked decrease
in the concentration of CYP 4A1 transcripts and the upregulation of the
organ CYP 4A8 mRNA levels (Fig. 2). Conversely, the kidney levels of
CYP 4A2/4A3 transcripts are regulated by DHT in a gender-specific fashion, i.e., slightly downregulated in males and upregulated in
females (Fig. 2). In summary, DHT shows similar qualitative effects on
the male and female CYP P-450 4A8 and 4A1 genes, and its
effects in CYP 4A2/4A3 appear to be gender specific (Fig. 2).
Furthermore, the androgen-mediated increase in microsomal 20-HETE
synthase shown in Table 1 occurred in the presence of DHT-induced
1) reductions in renal CYP 4A1 mRNA levels (Fig. 2), 2) moderate decreases (males) or increases (females) in
renal CYP 4a2/4a3 transcripts (Fig. 2), and 3) increases in
kidney CYP 4A8 transcripts that are gender independent (Fig. 2). Taken
together, the results of the Northern analysis suggested that the
upregulated expression of CYP4A8 was responsible for the increased AA
-hydroxylase activity of microsomes isolated from DHT-treated rats.
The sexually dimorphic, TST-sensitive expression of kidney CYP 4A2 and
4A8 mRNAs was reported to be both testosterone/gender dependent and independent (18, 40, 42). High degrees of CYP 4A sequence homology, limited selectivity of the DNA probes (18, 40,
42), and differences in rat strain and/or age (16, 18, 40,
42) are likely responsible for these apparently conflicting
results. Nonetheless, our results confirm those of Stromstead et al.
(40) and are in agreement with data obtained with mice,
where Cyp 4a12, the murine homologue of CYP 4A8, is expressed in the
male but not in the female kidney, is androgen responsive in males and females, and is upregulated in hypertensive Cyp 4a14(
/
) null mice (20).
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Immunoelectrophoresis of kidney microsomes from DHT-treated and
untreated rats using a CYP 4A1 antibody unreactive toward CYP 4A2/4A3
(16) and a CYP4A2 antibody cross-reactive toward CYP 4A3
and 4A1 (16) showed that DHT caused a decrease in CYP 4A1
levels in males and females, and of 4A2/4A3 in males, confirming their
downregulation by the androgen (Fig. 3).
Also, these studies confirmed published results (16) and
showed that female kidney microsomes contain nearly undetectable
amounts of CYP 4A2/4A3-immunoreactive proteins, even after the apparent
transcriptional upregulation of the CYP 4A2 gene by DHT (Figs. 2 and
3). This dissociation between CYP 4A2 mRNA expression and microsomal
CYP 4A2/4A3 protein levels was reported a few years ago and was
attributed to a posttranscriptional control of CYP 4A2/4A3 biosynthesis
in the female kidney (16). The androgen-mediated increase
in microsomal metabolism (Table 1) and kidney expression of CYP 4A8
mRNAs (Fig. 2), in conjunction with decreases in the levels of
microsomal CYP 4A1- and 4A2/4A3-immunoreactive proteins (Fig. 3),
provides further support to the proposition that the DHT-mediated
induction of the kidney microsomal CYP 4A8 is responsible for most of
the increased 20-HETE biosynthetic capacity of the organ (Table 1).
However, since the immunoreactivity of CYP 4A8 toward the CYP 4A1 and
4A2 antibodies is unknown, its contribution to renal AA hydroxylation
is yet to be defined unequivocally. Finally, and as reported
(19), purified recombinant CYP 4A8 catalyzed the
metabolism of AA to generate 19- and 20-HETE in a 1:10 molar
ratio and at a rate of 0.40 ± 0.08 min
1
(n = 3).
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To analyze the functional consequences of the androgen-induced
upregulation in renal 20-HETE synthase expression and activity, adult
male rats were treated with TST or its metabolically stable analog DHT,
and, after 2 wk, their blood pressures were compared with that
of vehicle-treated controls. The administration of androgens (40 mg/animal) caused marked increases in the systemic blood pressure of
male rats (Fig. 4). Compared with
controls, the systolic, diastolic, and mean arterial blood pressures
(MABP) of TST- and DHT-treated rats increased by ~17 and 29; 19 and
46; and 15 and 21 mmHg, respectively (Fig. 4). Similarly, the
administration of DHT to female rats led to substantial increases in
arterial systolic, and MABP (57 and 33 mmHg, respectively) (Fig.
5). As it was observed in mice (20), the MABP of control and hypertensive DHT-treated
females is significantly lower than those of comparable males (Figs. 4 and 5). It is of interest that sexual dimorphism in the incidence and
severity of hypertension is a frequent feature of the most common forms
of human hypertension, with premenopausal females exhibiting systemic
blood pressures that are significantly lower than males (1, 11,
27, 34, 35). The pressure effects of DHT were 1) time
dependent in that blood pressures began to increase after the first
week of treatment, reached a maximum at the end of the second week, and
remained constant for at least one additional week (not shown) and
2) dose dependent in that they become apparent with daily
doses of DHT
20 mg and reached a maximum between 40 and 50 mg · animal
1 · day
1
(not shown). Substantial increases in plasma DHT concentrations were
required to increase the activity of the renal 20-HETE synthase and to
raise blood pressures to the levels shown in Figs. 4 and 5 (Table
3). Regardless of gender, maximal
increases in enzyme activity and blood pressure were observed when the
plasma DHT levels were between 150 to 250 ng DHT/ml plasma (Table 3).
Whereas similar androgen-mediated pressure and CYP 4A metabolic effects have been reported for hypertensive Cyp 414(
/
) and androgen-treated mice (20), they are evident at androgen plasma levels that
are substantially lower those required in rats (20). Many
of the transcriptional effects of androgens in kidney are mediated by a
kidney specific androgen receptor (2, 8) that regulates genes such as those coding for the kidney androgen-regulated protein, renin, angiotensinogen, and
-glucuronidase (2, 8, 12, 24). It has been shown that, compared with other target tissues, the androgen-dependent regulation of kidney genes requires high doses
and long exposure times (9, 12, 17, 44). Furthermore, the
upregulation of androgen-sensitive renal P-450 isoforms was also reported to be slow and to require high doses (17).
The time-delayed changes in renal mRNA levels observed with kidney androgen responsive genes (2, 8, 12, 24) indicates a complex, receptor-mediated signaling pathway as opposed to more direct
effects of the androgen in gene transcription. Finally, the reasons for
the high androgen requirement and the delayed response of the kidney
androgen receptor are unknown, but they could serve to provide
effective protection against acute variation in the plasma androgen
concentrations.
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The known biochemical and functional segmentation of the nephron
facilitates associations between functional roles and protein expression patterns. The distribution of rat CYP 4A isoforms in dissected segments of the rat nephron has been inferred from
measurements of enzymatic activity or PCR amplification (23,
39). In situ hybridization data showed abundant and selective
expression of 4a12 transcripts in the renal cortex and medullary rays
of hypertensive Cyp 4a14(
/
) null mice (20). The
presence of this 20-HETE synthase in close physical contact with the
glomerular microcirculation suggested that paracrine or endocrine
mechanisms could be responsible for the proposed vasoconstrictor
functions of 20-HETE, an issue that, for technical reasons, could not
be addressed in mice. To establish whether the target tissue of the
proposed 20-HETE prohypertensive effects, i.e., the renal vasculature
expresses an androgen-sensitive AA
-hydroxylase activity, we
dissected vessels from the kidneys of control and DHT-treated rats and
confirmed their vascular purity by phase contrast microscopy (Fig. 1).
Although the microdissection technique used yields mostly preglomerular
arteries (28, 41), the relative contents of afferent,
interlobular, or arcuate arterioles was not determined, and efforts
were directed toward a complete separation of the vascular and renal
tissues. Microvessels from control rats metabolize AA to mixtures of
/
-alcohols and EETs, with 20-HETE as their major product (Fig.
6). Animal treatment with DHT increased
the 20-HETE biosynthetic capacity of the vessels by approximately
fourfold and reduced the AA epoxygenase activity to a minimum (Fig. 6).
Nucleic acid hybridization of total RNA from these microvessels using a
CYP 4A8 specific probe showed that DHT caused the upregulation of the
CYP 4A8 gene (Fig. 7). Finally,
semiquantitative RT-PCR analysis confirmed the hybridization data (Fig.
7) and provided further support to the idea that renal microvasculature
expresses an active, androgen-sensitive CYP 4A8 20-HETE synthase.
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Extensive functional studies have documented the vasoconstrictor
effects of synthetic 20-HETE in the renal microcirculation (3, 4, 22, 26, 29), and the presence of an AA
/
-1 hydroxylase in
isolated rat kidney microvessels has been reported (28,
41). Some of the prohypertensive effects of 20-HETE have been
attributed to increased afferent glomerular arteriolar resistance and
the associated changes in pressure-natriuresis, resulting from
increases in its local production (22, 26, 29). Moreover,
hypertensive Cyp 4a14(
/
) mice showed increased renal vascular
resistance and impaired autoregulatory efficiency (20). We
conclude that the androgen treatment caused an increase in the
formation of vasoconstrictor, prohypertensive 20-HETE in its target
tissue, the renal microcirculation, and that vasoconstriction, and
attendant changes in renal resistance are responsible for the observed
increases in systemic blood pressures. Whereas the proposed mechanism
is in agreement with the known functional properties of 20-HETE, as
well as with its proposed roles in renal hemodynamics (3, 4, 22,
26, 29), alternate, P-450-independent effects of the
androgens in the regulation of systemic blood pressure cannot be ruled out.
Similarities between these results and components of the hypertensive phenotype of SHR rats and Cyp 4a14 knockout mice strongly suggest that, as proposed earlier (29), kidney P-450 4A isoforms participate in the control of systemic blood pressure (20). For example, blood pressures in hypertensive female SHR are significantly lower than in males (10, 36-38), castration reduces the MABPs of hypertensive SHR by 30-40 mmHg (11, 36-38), and the normotensive effects of castration in the male SHR are reversed by TST replacement (11, 34-38). Furthermore, androgen-induced changes in the pressure-natriuresis relationship of SHR have been reported (36). We now extend those studies and show that the androgen-sensitive component of the SHR hypertensive phenotype is in fact associated with the male hormone-mediated regulation of CYP 4A8 and with an increased biosynthesis of prohypertensive 20-HETE in the renal microcirculation.
The biochemical and functional data presented here, in conjunction with
the phenotypic characterization of Cyp 4a14(
/
) mice (20), provide a conceptually different and innovative
approach to the study of systemic blood pressure regulation. Figure
8 summarizes our view of the mechanism
involved in the pressure response to changes in androgen plasma levels
and introduces a combination of transcriptional and hemodynamic
elements as the key components of the pressure response. We postulate
that unique CYP 4A isoforms (Cyp 4a14 in mice) catalyze the formation
of a yet to be characterized mediator that controls circulating
androgen levels (20) (Fig. 8). Studies with the Cyp
4a14(
/
) mouse showed that 1) the disruption of this gene
does not alter the microsomal metabolism of TST (20) and
2) none of the murine Cyp 4a isoforms metabolizes TST
(20). Increased plasma androgen levels induce CYP 4A8 (Cyp
4a12 in mice) gene expression (by acting either directly at the gene
loci or through a signaling pathway) and cause attendant increases in renovascular 20-HETE biosynthesis (Fig. 8). Systemic hypertension results from alterations in nephron hemodynamics, including afferent arteriole autoregulation and renal blood flow (22), caused
by increased levels of vasoconstrictor 20-HETE (22, 26,
29) (Fig. 8). Additionally, the observed androgen-mediated
reductions in kidney epoxygenase activity (Table 1) could further
accentuate the hypertensive response by decreasing the biosynthesis of
antihypertensive EETs (3-5, 7, 22, 29). This
interpretation is in agreement with the known renal effects of these
eicosanoids and their proposed pathophysiological roles
(3-5, 7, 22, 26, 29) and suggest transcriptional
events as additional targets for future therapeutic approaches.
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Inasmuch as epidemiological data suggest associations between gender,
sex hormones, and the pathophysiology of human hypertension, these
studies may have important clinical implications. CYP 4A11, the human
homologue of rat and mouse CYP 4A8 and 4a12, respectively, is an AA
/
-1 hydroxylase expressed in the human kidney (21) and, therefore, a novel and attractive candidate gene for future studies of the genetic and molecular basis of human hypertension. It is
now widely accepted that the identification and characterization of
genes involved in the pathogenesis of hypertension will advance our
understanding of the disease and its causes, but, more importantly will
lead to the development of novel and rational targets for diagnosis and
clinical intervention.
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ACKNOWLEDGEMENTS |
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The authors are grateful to National Institute of Diabetes and Digestive and Kidney Diseases Grants 38266 (to J. Capdevila) and 28350 (to M. Waterman) and National Heart, Lung, and Blood Institute Grant 34300 (to M. Schwartzman) for generous support of these studies. Blood pressure measurements were carried out at the Vanderbilt University Small Animal Physiology Core Laboratory, a shared facility supported, in part, by an NCI Center Grant (CA 68485).
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FOOTNOTES |
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Address for reprint requests and other correspondence: J. H. Capdevila, Medical Center North S-3223, Vanderbilt Univ., Nashville, TN 37232.
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. Section 1734 solely to indicate this fact.
First published January 16, 2003;10.1152/ajpregu.00459.2002
Received 29 July 2002; accepted in final form 28 November 2002.
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