Dipeptidyl peptidase 4 inhibitor reduces intimal hyperplasia in rabbit autologous jugular vein graft under poor distal runoff  Akio Koyama, MD, Kimihiro.

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Dipeptidyl peptidase 4 inhibitor reduces intimal hyperplasia in rabbit autologous jugular vein graft under poor distal runoff  Akio Koyama, MD, Kimihiro Komori, MD, PhD, Ryo Otsuka, RPT, Ms, Junko Kajikuri, PhD, Takeo Itoh, PhD  Journal of Vascular Surgery  Volume 63, Issue 5, Pages 1360-1370 (May 2016) DOI: 10.1016/j.jvs.2014.12.048 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Effects of vildagliptin on morphometric changes in autologous vein grafts, as assessed at 28 days after the operation. A and B, Microscopic findings revealed by elastica van Gieson staining in control group (A) and vildagliptin group (B). The inner (white) arrowhead indicates internal elastic lamina; the outer (yellow) arrowhead shows external elastic lamina. C-F, Morphometric analysis for lumen area (C), intimal thickness (D), medial thickness (E), and intima/media index (F) (n = 4, control group; n = 5, vildagliptin group). Four sections were obtained from each vein graft, and each section was stained by the elastica van Gieson method. The intimal thickness was measured at eight randomly selected different sites per section, and these values were averaged. The four sections were each examined in the same way, and the values were averaged to represent intimal hyperplasia in that graft. The extent of intimal hyperplasia was expressed as an intima/media index (intima thickness divided by media thickness). Results are expressed as values for individual grafts and as mean ± standard error of the mean (error bars). ∗P < .05, ∗∗P < .01, ∗∗∗P < .001 vs control group. Measurements were made by blinded researchers who were not otherwise involved in the present study. Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Effects of vildagliptin on endothelial cell Ca2+ concentration ([Ca2+]i) (A and B) and vascular smooth muscle cell (VSMC) membrane potential (C and D) in vein grafts. Neither the basal [Ca2+]i (A) nor the resting membrane potential (C) in the vildagliptin group was significantly different from that in the control group. Acetylcholine (ACh, 3 μM) had no effect on endothelial cell [Ca2+]i (B) or VSMC membrane potential (D) in either the control or vildagliptin group. [Ca2+]i is expressed as the Fura-2 ratio (F340/F380). Data are shown as mean ± standard error of the mean (n = 4, in each case). Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Effects of vildagliptin on resting membrane potential and 5-hydroxytryptamine (5-HT)-induced depolarization in vascular smooth muscle cells (VSMCs) in vein grafts. A and B, Actual traces of 5-HT (0.1 μM)-induced depolarization in control group (A) and vildagliptin group (B). C, Resting VSMC membrane potential. D, 5-HT (0.1 μM)-induced depolarization in VSMCs. Data are shown as mean ± standard error of the mean (n = 4, in each case). Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Effects of vildagliptin on acetylcholine (ACh)-induced endothelium-dependent relaxation in vein grafts. A, Effects of ACh (30 nM to 10 μM) on the contraction induced by prostaglandin F2α (PGF2α) in endothelium-intact preparations [E(+)] from control group (n = 4) and vildagliptin group (n = 6) and also in endothelium-denuded preparations [E(−)] from vildagliptin group (n = 5). B, Effects of Nω-nitro-l-arginine (l-NNA) on ACh-induced response in endothelium-intact preparations from vildagliptin group. After ACh-induced responses had been recorded before application of l-NNA [l-NNA(−)], l-NNA was applied for 60 minutes, and ACh-induced responses were again obtained in the presence of l-NNA [l-NNA(+)] (n = 3). The concentration of PGF2α was adjusted to obtain similar amplitudes of contraction before and after application of l-NNA (Table I). The contraction induced by PGF2α before application of ACh was normalized as a relative tension of 1.0 for each preparation. Data are shown as mean ± standard error of the mean. ∗∗∗P < .001 vs vildagliptin group E(+), †††P < .001 vs l-NNA(−). Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Effects of Nω-nitro-l-arginine (l-NNA) on the contractions induced by high K+ and 5-hydroxytryptamine (5-HT) in vein grafts. A and B, Actual traces recorded from endothelium-intact vein grafts from control group (A) and vildagliptin group (B). After the responses induced by high K+ (128 mM) and 5-HT (10 nM to 10 μM) had been recorded, l-NNA (0.1 mM) was applied for 60 minutes and high K+ and 5-HT were again applied in the presence of l-NNA. 5-HT was applied at concentrations of (1) 10 nM, (2) 30 nM, (3) 0.1 μM, (4) 0.3 μM, (5) 1 μM, (6) 3 μM, and (7) 10 μM. C and D, Absolute tension induced by 128 mM K+ (C) or 10 μM 5-HT (D) before [l-NNA(−)] and after [l-NNA(+)] application of l-NNA in endothelium-intact [E(+)] or endothelium-denuded [E(−)] preparations in control group (black, n = 4) and vildagliptin group (red, n = 4). ∗P < .05 vs l-NNA(−). E and F, Summary of the effects of l-NNA on 5-HT-induced contraction in endothelium-intact [E(+)] or endothelium-denuded [E(-)] preparations in control group (E, n = 4) and vildagliptin group (F, n = 4). Data are shown as mean ± standard error of the mean. ∗P < .05, ∗∗∗P < .001 vs l-NNA(−). Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 Rate of relaxation after removal of 10 μM 5-hydroxytryptamine (5-HT) or 128 mM K+. Endothelium-denuded preparations were treated with 5-HT (n = 3, A) or high K+ (n = 4, B) to obtain the maximum contraction, followed by rapid washout to induce relaxation. Tension was normalized to the maximum tension in each case. Time required for half-relaxation for 5-HT (C) and high K+ (D). Data are shown as mean ± standard error of the mean. ∗P < .05 vs “Control.” Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 Histologic images of elastica van Gieson (A and B) and Masson trichrome (C and D) staining in vein grafts from control group (A and C) and vildagliptin group (B and D). Similar observations were made in three other preparations. E, Area occupied by collagen within intima/media was calculated and is shown as a percentage of the total intima/media area. The measurement was made at eight randomly selected different sites per section, and these values were averaged. The four sections were each examined in the same way, and the values were averaged for that graft. Data are shown as mean ± standard error of the mean for four samples from each group. *P < .05 vs “Control.” Measurements were made by blinded researchers who were not otherwise involved in the present study. Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 8 Immunohistochemical staining of matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), and tissue inhibitor of metalloproteinase 2 (TIMP-2) in vein grafts from control group (left panel) and vildagliptin group (right panel). A-D, DAB staining: (A) negative control staining without primary antibody; (B) TIMP-2 staining; (C) MMP-9 staining; (D) MMP-2 staining. Expressions of TIMP-2 and MMP-9 were not apparently different between the two groups, but that of MMP-2 was apparently less in the vildagliptin group than in the control group. Similar observations were made in three other preparations. E, Immunofluorescence intensities for MMP-2 were detected by confocal laser scanning microscopy. F, Summary of the immunofluorescence results. The measurement was made at eight randomly selected different sites per section, and these values were averaged. The four sections were each examined in the same way, and the values were averaged for that graft. Data are shown as mean ± standard error of the mean for four samples from each group. *P < .05 vs “Control.” Measurements were made by blinded researchers who were not otherwise involved in the present study. Journal of Vascular Surgery 2016 63, 1360-1370DOI: (10.1016/j.jvs.2014.12.048) Copyright © 2016 Society for Vascular Surgery Terms and Conditions