Recovery from hind limb ischemia is less effective in type 2 than in type 1 diabetic mice: Roles of endothelial nitric oxide synthase and endothelial progenitor cells

Abstract

ObjectiveWe sought to directly compare the effects of type 1 and type 2 diabetes on postischemic neovascularization and evaluate the mechanisms underlying differences between these groups. We tested the hypothesis that type 2 diabetic mice have a greater reduction in endothelial nitric oxide synthase (eNOS) expression, a greater increase in oxidative stress, and reduced arteriogenesis and angiogenesis, resulting in less complete blood flow recovery than type 1 diabetic mice after induction of hind limb ischemia.MethodsHind limb ischemia was generated by femoral artery excision in streptozotocin-treated mice (model of type 1 diabetes), in Leprdb/db mice (model of type 2 diabetes), and in control (C57BL/6) mice. Dependent variables included eNOS expression and markers of arteriogenesis, angiogenesis, and oxidative stress.ResultsPostischemia recovery of hind limb perfusion was significantly less in type 2 than in type 1 diabetic mice; however, neither group demonstrated a significant increase in collateral artery diameter or collateral artery angioscore in the ischemic hind limb. The capillary/myofiber ratio in the gastrocnemius muscle decreased in response to ischemia in control or type 1 diabetic mice but remained the same in type 2 diabetic mice. Gastrocnemius muscle eNOS expression was lower in type 1 and 2 diabetic mice than in control mice. This expression decreased after induction of ischemia in type 2 but not in type 1 diabetic mice. The percentage of endothelial progenitor cells (EPC) in the peripheral blood failed to increase in either diabetic group after induction of ischemia, whereas this variable significantly increased in the control group in response to ischemia. EPC eNOS expression decreased after induction of ischemia in type 1 but not in type 2 diabetic mice. EPC nitrotyrosine accumulation increased after induction of ischemia in type 2 but not in type 1 diabetic mice. EPC migration in response to vascular endothelial growth factor was reduced in type 1 and type 2 diabetic mice vs control mice. EPC incorporation into tubular structures was less effective in type 2 diabetic mice. Extensive fatty infiltration was present in ischemic muscle of type 2 but not in type 1 diabetic mice.ConclusionType 2 diabetic mice displayed a significantly less effective response to hind limb ischemia than type 1 diabetic mice.Clinical RelevanceDiabetes is important in the pathogenesis of peripheral artery disease. The present study demonstrates that the vascular response to acute hind limb ischemia is dependent on the type of diabetes present. Type 2 diabetic mice (Leprdb/db) demonstrated significantly less effective blood flow recovery than type 1 diabetic mice (streptozotocin-induced). Moreover, the differences between diabetic groups appeared contingent, at least in part, on differences in endothelial nitric oxide, oxidant stress, and endothelial progenitor cell function between the two diabetic groups. Although direct extrapolation of animal data to the human experience must be made with caution, these findings indicate that the type of diabetes present, and not just the presence of diabetes per se, may be important in the initiation of progression of peripheral artery disease