BackgroundIntrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in chick embryos. The aim of this study was to further characterize cardiac disease in hypoxic chick embryos.MethodsChick embryos were exposed to hypoxia and cardiac structure was examined by histological methods one day prior to hatching (E20) and at adulthood. Cardiac function was assessed in vivo by echocardiography and ex vivo by contractility measurements in isolated heart muscle bundles and isolated cardiomyocytes. Chick embryos were exposed to vascular endothelial growth factor (VEGF) and its scavenger soluble VEGF receptor-1 (sFlt-1) to investigate the potential role of this hypoxia-regulated cytokine.Principal FindingsGrowth restricted hypoxic chick embryos showed cardiomyopathy as evidenced by left ventricular (LV) dilatation, reduced ventricular wall mass and increased apoptosis. Hypoxic hearts displayed pump dysfunction with decreased LV ejection fractions, accompanied by signs of diastolic dysfunction. Cardiomyopathy caused by hypoxia persisted into adulthood. Hypoxic embryonic hearts showed increases in VEGF expression. Systemic administration of rhVEGF165 to normoxic chick embryos resulted in LV dilatation and a dose-dependent loss of LV wall mass. Lowering VEGF levels in hypoxic embryonic chick hearts by systemic administration of sFlt-1 yielded an almost complete normalization of the phenotype.Conclusions/SignificanceOur data show that hypoxia causes a decreased cardiac performance and cardiomyopathy in chick embryos, involving a significant VEGF-mediated component. This cardiomyopathy persists into adulthood.

Background-Low birth weight is associated with an increased incidence of cardiovascular diseases, including hypertension, later in life. This suggests that antenatal insults program for fetal adaptations of the circulatory system. In the present study, we evaluated the effects of mild hypoxia on cardiac function, blood pressure control, and arterial structure and function in near-term chick embryos. Methods and Results-Chick embryos were incubated under normoxic (21% O 2 ) or hypoxic (15% O 2 ) conditions and evaluated at incubation day 19 by use of histological techniques, isolated heart preparations, and in vivo measurements of sympathetic arterial tone and systemic hemodynamics. Chronic hypoxia caused a 33% increase in mortality and an 11% reduction in body weight in surviving embryos. The lumen of the ascending aorta in hypoxic embryos was 23% smaller. Left ventricular systolic pressure was 22% lower, and heart weight/body weight ratio was 14% higher. In resistance arteries of hypoxic embryos, in vivo baseline tone was 23% higher, norepinephrine sensitivity was similar, and norepinephrine release from sympathetic nerves increased 2-fold, indicating sympathetic hyperinnervation. Mean arterial pressure and heart rate were similar under resting conditions, but chronically hypoxic embryos failed to maintain blood pressure during acute stress. Conclusions-This study indicates that mild hypoxia during embryonic development induces alterations in cardiac and vascular function and structure and affects hemodynamic regulation. These findings reveal that antenatal insults have profound effects on the control and design of the circulatory system that are already established at birth and may program for hypertension and heart failure at a later age.

The vascular system is generated and maintained by reactions of blood vessels to stimuli of several types. The basic outline of the vascular system is determined during development by genetic programming, guided by the unique temporal and spatial patterns of structural and molecular features available in the embryo. With establishment of blood flow, control of vascular development is increasingly taken over by feedback signals derived from vascular function, including blood flow and pressure, in addition to those derived from the metabolic state of the tissue. Mechanical and molecular signals also govern the post-natal structural adaptation of vascular beds in response to functional requirements, both during normal, physiological conditions (growth, exercise) and during pathophysiological conditions including ischaemic diseases and tumour growth. The orderly structure of vascular beds emerges as each vessel segment reacts to the local conditions and stimuli that it experiences, according to a common set of genetically determined responses. In this process of angioadaptation, the properties and architecture of vascular beds are determined by the continuous interplay between vascular and cellular reactions to haemodynamic and molecular signals and the functional implications of these reactions, constituting a complex feedback system. Here, studies on vascular development and adaptation in response to haemodynamic and molecular factors are integrated, with emphasis on arterial-venous network development and structural adaptation of vessels.

Abstract-We investigated intrauterine growth restriction, endothelial function, and uterine artery blood flow characteristics in a transgenic preeclampsia rat model with an activated renin-angiotensin system. We compared preeclamptic Sprague-Dawley (SD-PE) rats with normal pregnant Sprague-Dawley and nonpregnant Sprague-Dawley rats. We used transabdominal ultrasound and found that SD-PE rat embryos developed intrauterine growth restriction. Isolated uterine arteries from SD-PE rats incubated with phenylephrine exhibited an increased contractile response, whereas a single high dose of acetylcholine resulted in an impaired vasorelaxation compared with controls. Incremental acetylcholine doses increased relaxation of SD-PE vessels at low acetylcholine doses but caused a paradoxical contraction at higher acetylcholine doses. Indomethacin and a thromboxane-receptor antagonist (SQ 29,548) blocked this effect, suggesting maternal prostanoid-dependent endothelial dysfunction. SD-PE rats had a decreased prostacyclin (6-keto-prostaglandin F1␣):thromboxane ratio in the serum compared with normal pregnant Sprague-Dawley rats or nonpregnant SpragueDawley. Surprisingly, the Doppler resistance index decreased during pregnancy in SD-PE compared with normal pregnant Sprague-Dawley rats, suggesting unimpaired uteroplacental flow in the uterine artery. Umbilical flow was unchanged with absent end-diastolic flow in all of the groups. Renin-angiotensin system activation-induced preeclampsia is associated with altered placentation, modified resistance index, and endothelial dysfunction. A disturbed prostacyclin:thromboxane ratio could be an important mediator. Key Words: preeclampsia Ⅲ uterine artery Ⅲ rat Ⅲ endothelial dysfunction Ⅲ intrauterine growth restriction Ⅲ Doppler ultrasound P reeclampsia affects 3% to 5% of all pregnant women and remains one of the major causes of maternal and fetal morbidity and mortality. 1 The maternal syndrome involves endothelial dysfunction with a disturbed endothelial prostanoid balance, oxidative stress, and inflammation. The pathophysiology involves insufficient trophoblast invasion, incomplete placental spiral artery remodeling, and increased blood flow impedance in the maternal uterine vessels. 2 Placental insufficiency leads to fetal intrauterine growth restriction (IUGR). Modeling preeclampsia in experimental animals is difficult. We described a transgenic preeclampsia rat model earlier. 3 Rat dams transgenic for the human angiotensinogen gene (hAogen) develop proteinuria and hypertension in the second half of pregnancy when mated with sires transgenic for the human renin gene (female hAogen transgenic rat [TGR]ϫmale hRen TGR). The reverse mating (female hRen TGRϫmale hAogen TGR) and other controls do not show these features. Human plasma renin concentration increased from 0 to Ϸ900 ng of angiotensin (Ang) I per milliliter per hour in late gestation, and the plasma hAogen concentration was 50-to 100-fold higher than controls. 3 Activating AT1 receptor antibodies (AT1-AA) were also detected in...