Chronic anemia is associated with systemic endothelial dysfunction

Abstract

BackgroundIn acute myocardial infarction and heart failure, anemia is associated with adverse clinical outcomes. Endothelial dysfunction (ED) is characterized by attenuated nitric oxide (NO)-mediated relaxation responses which is poorly studied in chronic anemia (CA). We hypothesized that CA is associated with ED due to increased oxidative stress in the endothelium.MethodsCA was induced by repeated blood withdrawal in male C57BL/6J mice. Flow-Mediated Dilation (FMD) responses were assessed in CA mice using ultrasound-guided femoral transient ischemia model. Tissue organ bath was used to assess vascular responsiveness of aortic rings from CA mice, and in aortic rings incubated with red blood cells (RBCs) from anemic patients. In the aortic rings from anemic mice, the role of arginases was assessed using either an arginase inhibitor (Nor-NOHA) or genetic ablation of arginase 1 in the endothelium. Inflammatory changes in plasma of CA mice were examined by ELISA. Expression of endothelial NO synthase (eNOS), inducible NO synthase (iNOS), myeloperoxidase (MPO), 3-Nitrotyrosine levels, and 4-Hydroxynonenal (4-HNE) were assessed either by Western blotting or immunohistochemistry. The role of reactive oxygen species (ROS) in ED was assessed in the anemic mice either supplemented with N-Acetyl cysteine (NAC) or by in vitro pharmacological inhibition of MPO.ResultsThe FMD responses were diminished with a correlation to the duration of anemia. Aortic rings from CA mice showed reduced NO-dependent relaxation compared to non-anemic mice. RBCs from anemic patients attenuated NO-dependent relaxation responses in murine aortic rings compared to non-anemic controls. CA results in increased plasma VCAM-1, ICAM-1 levels, and an increased iNOS expression in aortic vascular smooth muscle cells. Arginases inhibition or arginase1 deletion did not improve ED in anemic mice. Increased expression of MPO and 4-HNE observed in endothelial cells of aortic sections from CA mice. NAC supplementation or inhibition of MPO improved relaxation responses in CA mice.ConclusionChronic anemia is associated with progressive endothelial dysfunction evidenced by activation of the endothelium mediated by systemic inflammation, increased iNOS activity, and ROS production in the arterial wall. ROS scavenger (NAC) supplementation or MPO inhibition are potential therapeutic options to reverse the devastating endothelial dysfunction in chronic anemia.

Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV

“…However, the exact mechanisms by which HIV viral proteins disrupt NO homeostasis are unclear. Studies by Chennupati et al and Wischmann et al highlight the relationship between chronic anemia and reduced nitric oxide production due to heightened inflammation and increased formation of ROS [144,145]. The presence of chronic anemia in HIV patients adds complexity to the interaction among the immune system, endothelium, and erythropoiesis.…”

Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke

“…Weakened vessels are prone to rupture, which can block blood flow and cause stroke [45,47]. Chronic anemia leads to high cardiac output, increasing shear forces on blood vessel walls [48,49].…”

“…There is also increased activation of platelets in SCD, which promotes clot formation [24]. Chronic anemia leads to high cardiac output, increasing shear forces on blood vessel walls [48,49]. Children with SCD have a very high risk of stroke, estimated at 10% to 15% [4,50].…”