The endothelium is a crucial component of the vascular system, and its proper function is vital for microcirculatory function and by extension cardiovascular health. Hence, endothelial dysfunction... Show moreThe endothelium is a crucial component of the vascular system, and its proper function is vital for microcirculatory function and by extension cardiovascular health. Hence, endothelial dysfunction is involved in a majority of cardiovascular disease and poses a high societal burden. Endothelial nitric oxide bioavailability is essential for a healthy microcirculation. The first half of this thesis investigates the reliability of imaging techniques that non-invasively assess the microcirculation and nitric oxide bioavailability, including laser speckle contrast imaging, Doppler flowmetry, dark field microscopy, skin fluorescence imaging and near infrared spectroscopy. In addition, the vascular effects of a mixed meal and a far-infrared light emitting patch, as measured with the imaging methods, are assessed. Finally, differences in microcirculatory function in people with mitochondrial disorders and healthy volunteers are explored. In the second half of the thesis, first-in-human and proof-of-mechanism studies with a soluble guanylyl cyclase stimulator and a phosphodiesterase inhibitor are described, drugs thought to enact some of their effects through modulation of vascular function downstream of nitric oxide. The thesis concludes with a critical appraisal of the investigated imaging modalities and their potential for inclusion in future clinical trials with drugs aiming to affect the microcirculation. Show less
In this study, the effect of heterozygous germline mutations in the heparan sulfate (HS) glycosaminoglycan chain co-polymerases EXT1 and EXT2 on glomerular barrier function and the endothelial... Show moreIn this study, the effect of heterozygous germline mutations in the heparan sulfate (HS) glycosaminoglycan chain co-polymerases EXT1 and EXT2 on glomerular barrier function and the endothelial glycocalyx in humans is investigated. Heparan sulfate (HS) glycosaminoglycans are deemed essential to the glomerular filtration barrier, including the glomerular endothelial glycocalyx. Animal studies have shown that loss of HS results in a thinner glycocalyx. Also, decreased glomerular HS expression is observed in various proteinuric renal diseases in humans. A case report of a patient with an EXT1 mutation indicated that this could result in a specific renal phenotype. This patient suffered from multiple osteochondromas, an autosomal dominant disease caused by mono-allelic germline mutations in the EXT1 or EXT2 gene. These studies imply that HS is indeed essential to the glomerular filtration barrier. However, loss of HS did not lead to proteinuria in various animal models. We demonstrate that multiple osteochondroma patients do not have more microalbuminuria or altered glycocalyx properties compared to age-matched controls (n = 19). A search for all Dutch patients registered with both osteochondroma and kidney biopsy (n = 39) showed that an EXT1 or EXT2 mutation does not necessarily lead to specific glomerular morphological phenotypic changes. In conclusion, this study shows that a heterozygous mutation in the HS backbone elongating enzymes EXT1 and EXT2 in humans does not result in (micro)albuminuria, a specific renal phenotype or changes to the endothelial glycocalyx, adding to the growing knowledge on the role of EXT1 and EXT2 genes in pathophysiology. Show less
Within this thesis, several diseases central in the field of cardiovascular disease will be outlined. First, the central dogma of molecular biology, RNA biology in general, RNA (alternative... Show moreWithin this thesis, several diseases central in the field of cardiovascular disease will be outlined. First, the central dogma of molecular biology, RNA biology in general, RNA (alternative)splicing and the role of RNA-binding proteins within these processes will be discussed to enhance the accessibility to non-molecular biologists. Subsequently, the current literature and insights into the RNA-binding protein Quaking will be outlined. Thereafter, a brief summary of the role of many distinct RNA-binding proteins (RBPs) in the cardiovascular system is provided, detailing their importance in the heart and cells of the blood vessels. This review provides some historical and biological perspectives, while simultaneously highlighting many recent advances in our understanding of RBP function in cardiovascular health and disease. By harnessing established and novel techniques, including RNA-sequencing, this thesis will describe the role of Quaking in vascular stenosis, atherosclerosis, inflammation and endothelial barrier function. Collectively, Quaking can be described as a genome-wide governor of RNA-processing that results in the proper translation into functional proteins. This thesis describes which RNA transcripts are under control of Quaking, which alternative transcripts are being generated through modulation by Quaking, while also describing the unique role for this protein in health and cardiovascular and renal disease. Show less
The endothelial glycocalyx is a thin layer consisting of sugar moieties on the endothelium of the whole vasculature. This layer has been shown to play a role in inflammation coagulation and... Show moreThe endothelial glycocalyx is a thin layer consisting of sugar moieties on the endothelium of the whole vasculature. This layer has been shown to play a role in inflammation coagulation and permeability in the vasculature. In this thesis we studied the structure and composition of the endothelial glycocalyx. We developed a model to induce an anti-inflammatory endothelial glycocalyx in vitro, using physiolgoical shear stress. Furthermore, we studied the role of this glycocalyx in the glomerular capillaries. Here we show that the endothelial glycocalyx contributes to the filtration barrier in the glomeruli. Consequently this implies that damage of this glycocalyx might be a first step in the development of vasculature-born renal failure, like in Type 2 diabetes. The other way around, we also studied the effect of renal failure on the systemic glycocalyx. Using a non-invasive method, we estimated glycocalyx thickness in the sublingual vasculature of patients with end stage renal disease and patients who received a kidney transplant. Interestingly, the endothelial glycocalyx was highly perturbed during end stage renal disease, but comparable to healthy controls after a kindye transplantation. Altogether the endothelial glycocalyx might be a central mediator in the development of both renal and cardiovascular disease. Show less
Current therapies for patients with atherosclerosis are targeted primarily on reducing blood cholesterol, but this fails to prevent a large number of cardiovascular events.95 In order to identify... Show moreCurrent therapies for patients with atherosclerosis are targeted primarily on reducing blood cholesterol, but this fails to prevent a large number of cardiovascular events.95 In order to identify new therapeutic strategies for treating atherosclerosis, it is important to study the interactions between the cells that make up the atherosclerotic lesion. This thesis describes the role of endothelial cells and macrophages during lesion formation, as well as the expression patterns of sterol sensors in vascular smooth muscle cells present in the lesion. These new insights contribute to our understanding of atherosclerosis open up new avenues of atherosclerosis research Show less
Blood-flow-induced shear stress plays an important role in cardiovascular development and disease. How endothelial cells sense shear stress remains to be elucidated. We postulated that the primary... Show moreBlood-flow-induced shear stress plays an important role in cardiovascular development and disease. How endothelial cells sense shear stress remains to be elucidated. We postulated that the primary cilium is a component of the endothelial shear sensor. This luminal cell protrusion contains microtubules and is connected to the microtubular cytoskeleton. We identified cilia on endothelial cells of the embryonic heart in areas of low or oscillatory shear stress. This shear-related distribution is reminiscent of the distribution of atherosclerotic lesions in the adult arterial system, as lesions develop at sites of low or oscillating shear (athero-prone flow). Ciliated endothelial cells are exclusively present at these atherosclerotic predilection sites in adult mice. Athero-prone (oscillatory) but not athero-protective (steady or pulsatile) flow induces ciliation of cultured endothelial cells. Moreover, the endothelial shear response is dependent on the microtubular cytoskeleton and primary cilia sensitise the endothelium for shear. Taken together, these data demonstrate that primary cilia are induced by athero-prone flow and that ciliated cells are more sensitive to shear stress. We conclude that the endothelial biosensor for shear stress is the microtubular cytoskeleton and that the attached primary cilium functions as a signal amplifier in areas subjected to athero-prone flow. Show less
Vascular maladaptation prior and during implantation may lead to serious complications during pregnancy, perinatally, but also later in life (Barker hypothesis). The consequences later in life... Show moreVascular maladaptation prior and during implantation may lead to serious complications during pregnancy, perinatally, but also later in life (Barker hypothesis). The consequences later in life often appear to be related to endothelial dysfunction. Angiogenesis, the formation of new blood vessels from pre-existing ones, is an important endothelial function and plays a key role in the process of implantation and placentation. Two epidemiological studies described here, show that myocardial infarction is related to low birth weight and that assisted procreation adversely affects birth weight. An optimal intra-uterine environment forms the basis for a good perinatal outcome and is created by a receptive endometrium in which angiogenesis is crucial. To study endometrial angiogenesis, human endometrial endothelial cells were isolated. The high expression of u-PA by these cells was found to contribute to their high angiogenic properties. Furthermore, these cells depend on MT3-MMP to form tubes. The ovarian steroids overall regulate endometrial angiogenesis indirectly via the endometrial stromal cells. During implantation, the embryo takes over as the main (local) regulator by inducing angiogenesis at its implantation site through the expression of VEGF. These results provide more insight in the (patho-)physiology of endometrial angiogenesis and in the role of the embryo in this. Show less
