Name: induction and characterization of pulmonary hypertension in mice using the hypoxia/su5416 model
Uploaded: 2020-06-03T12:30:00
Description: Watch this Scientific Journal Video about Induction and Characterization of Pulmonary Hypertension in Mice using the Hypoxia/SU5416 Model at JoVE.com

This work was supported by grants from the American Heart Association (AHA- 17SDG33370112 and 18IPA34170258) and from the National Institutes of Health NIH K01 HL135474 to Y.S. O.B was supported by the Deutsche Herzstiftung.

Prior to any animal experimentation obtain the local institutional animal care committee authorization. The current experiments were performed after approval by the Institutional Animal Care and Use Committee (IACUC) at the Icahn School of Medicine at Mount Sinai.
1. PH induction
<ol>
	<li>Preparation
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		<li>Before beginning the study, carefully plan the experimental design. Ensure that mice are subjected to hypoxia at the same time point as the first SU5416 injection. An example of the...

<ol>
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R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Natural+killer+cell+therapy+and+aerosol+interleukin-2+for+the+treatment+of+osteosarcoma+lung+metastasis.">Natural killer cell therapy and aerosol interleukin-2 for the treatment of osteosarcoma lung metastasis.</a> Pediatric Blood Cancer. 61 (4), 618-626 (2014).</li><li>Lattouf, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Picrosirius+red+staining:+a+useful+tool+to+appraise+collagen+networks+in+normal+and+pathological+tissues.">Picrosirius red staining: a useful tool to appraise collagen networks in normal and pathological tissues.</a> Journal of Histochemistry and Cytochemistry. 62 (10), 751-758 (2014).</li><li>Penumatsa, K. 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This protocol describes how to model PH in mice by combining two pathological stimuli: chronic hypoxia and SU5416 injection (Hypoxia/SU5416)18. In an attempt to correlate this mouse model with the human PH condition, one inevitably must look at the current PH classification, shown in Table 1. PH in almost all forms is characterized by pulmonary vasoconstriction and aberrant proliferation of endothelial and smooth muscle cells. This leads to elevated pressure in the pulmonary arter...

Pulmonary Hypertension (PH) is a pathophysiological condition, defined by a mean pulmonary arterial (PA) pressure exceeding 25 mm Hg at rest, as assessed by&#160;right heart catheterization1,2. There is a variety of diseases that can lead to PH. In an attempt to organize the PH-associated conditions, several classification systems have been developed. The current clinical classification categorizes the multiple PH-associated diseases in 5 different groups1. This distinction is of importance since various groups of patients have diseases that differ in their clinical presentation, pathology, prognosis, and response to treatment2. Table 1 summarizes the current classification, complemented with the basic histopathological characteristics of each disease.
<img alt="Table 1" src="/files/ftp_upload/59252/59252tbl1.jpg" /> 
Table 1: Overview of the clinical classification of PH, along with the main histopathological features within the groups. Suitability of the Hypoxia/SU5416 protocol for modeling PH. This table has been modified from19.&#160;PH: Pulmonary Hypertension, PAH: Pulmonary Arterial Hypertension
Despite significant advances in the treatment of PH-associated diseases, PH still remains without a cure, with a 3-year mortality rate ranging between 20% and 80%3. This indicates the imperative need for understanding the underlying mechanisms of PH and, thereafter, the development of novel therapies to prevent, slow down the progression, and cure the disease. Animal models are of crucial importance to this scope. Currently, various models exist to study PH. The interested reader is referred to the excellent reviews on this topic2,3,4. Bearing in mind the variety of diseases leading to PH, it is obvious that the diverse conditions of human PH cannot be perfectly recapitulated in one animal model. The animal models available can be categorized in i) single-hit, ii) two-hit, iii) knockout, and iv) overexpression models3. In the single-hit models, PH is induced by a single pathological stimulus, whereas two-hit models combine two pathological stimuli with the goal of inducing more severe PH and thus more closely imitate the complex human disease. Besides the etiological differences, the several stimuli result in PH modeling differences that depend also on the species and the genetic background of the animals4.
One of the most commonly used classic PH rodent models is the chronic hypoxia model2. Hypoxia is known to induce PH in humans as well as in several animal species. Hypoxia has the advantage of being a physiologic stimulus for PH (Table 1). However, while the degree of hypoxia used for inducing PH in rodents is much more severe than in humans, the single insult (hypoxia) leads only to a mild form of vascular remodeling. This does not imitate the severity of the human disease. The addition of a second-hit, an extra stimulus for inducing PH, showed promising results: injection of the compound SU5416 to rodents combined with the hypoxic stimulus induces a more severe PH phenotype2,5,6. SU5416 is an inhibitor of vascular endothelial growth factor (VEGF) receptor-2. It blocks the VEGF receptors and leads to endothelial cell apoptosis. Under hypoxic conditions, this stimulates the proliferation of a subset of apoptosis-resistant endothelial cells. Furthermore, SU5416 leads to smooth muscle cell proliferation. The combination of these effects results in pathologic vascular remodeling of the pulmonary circulation and leads to elevated PA pressure and right ventricular remodeling2,5,7. The model was first described in rats6 and later on applied to mice4,5,7. The mouse model exhibits less severe vascular remodeling compared to rats. Furthermore, when returned to normoxia, PH continues to progress in rats, while in mice it is partially reversible.&#160;
The following protocol describes all the steps for modeling PH in mice using the Hypoxia/SU5416 method (planning, timeline, execution). Additionally, the characterization of the model is described in this protocol: functionally (by invasively measuring the right ventricular (RV) pressure using the open chest technique), morphometrically (by dissecting and weighing both the right and left ventricles), as well as histologically (by evaluating pulmonary vascular remodeling, right ventricular cardiomyocyte hypertrophy and fibrosis).&#160;
All the steps and methods described in this protocol can be easily implemented by investigators at any experience level. While the functional measurements of the RV using the open chest technique (described here) is not the gold standard method in the field, it has the advantage that it can be quickly learned and accurately reproduced even by a less experienced experimenter.&#160;

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			<td height="21" style="height:21px;width:319px;">Acetic acid glacial</td>
			<td style="width:231px;">Roth</td>
			<td style="width:119px;">3738.1</td>
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			<td height="21" style="height:21px;width:319px;">Acetone, Histology Grade</td>
			<td style="width:231px;">The Lab Depot</td>
			<td style="width:119px;">VT110D</td>
			<td></td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">ADVantage Pressure-Volume System</td>
			<td style="width:231px;">Transonic</td>
			<td style="width:119px;">ADV500</td>
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			<td height="21" style="height:21px;width:319px;">Bouin&#39;s solution</td>
			<td style="width:231px;">Sigma</td>
			<td style="width:119px;">Ht10132</td>
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			<td height="21" style="height:21px;width:319px;">Cautery System</td>
			<td style="width:231px;">Fine Science Tools</td>
			<td style="width:119px;">18000-00</td>
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			<td height="21" style="height:21px;width:319px;">Connection tubing and valves</td>
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			<td height="21" style="height:21px;width:319px;">Cotton-Tipped Applicators</td>
			<td style="width:231px;">Covidien</td>
			<td style="width:119px;">8884541300</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Coverslips, 24 x50 mm</td>
			<td style="width:231px;">Roth</td>
			<td style="width:119px;">1871</td>
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			<td height="21" style="height:21px;width:319px;">Data Acquisition and Analysis</td>
			<td>Emka</td>
			<td style="width:119px;">iox2</td>
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			<td height="21" style="height:21px;width:319px;">Direct Red 80</td>
			<td style="width:231px;">Sigma</td>
			<td style="width:119px;">365548-5G</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">DMSO (Dimethyl Sulfoxide)</td>
			<td style="width:231px;">Sigma Aldrich</td>
			<td style="width:119px;">276855</td>
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			<td height="21" style="height:21px;width:319px;">Dry ice</td>
			<td style="width:231px;"></td>
			<td style="width:119px;"></td>
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			<td height="21" style="height:21px;width:319px;">Dumont # 5 forceps</td>
			<td style="width:231px;">Fine Science Tools</td>
			<td style="width:119px;">11251-10</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Dumont # 7 Fine Forceps</td>
			<td style="width:231px;">Fine Science Tools</td>
			<td style="width:119px;">11274-20</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Embedding molds</td>
			<td style="width:231px;">Sigma Aldrich</td>
			<td style="width:119px;">E-6032</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Eosin Solution Aqueous</td>
			<td style="width:231px;">Sigma</td>
			<td style="width:119px;">HT110216</td>
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		<tr height="42">
			<td height="42" style="height:42px;width:319px;">Ethanol, laboratory Grade</td>
			<td style="width:231px;">Carolina Biological Supply Company</td>
			<td style="width:119px;">861285</td>
			<td></td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Fast Green FCF</td>
			<td style="width:231px;">Sigma</td>
			<td style="width:119px;">F7252-5G</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Fine scissors</td>
			<td style="width:231px;">Fine Science Tools</td>
			<td style="width:119px;">14090-09</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Goat Serum</td>
			<td style="width:231px;">invitrogen</td>
			<td style="width:119px;">16210-064</td>
			<td></td>
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			<td height="21" style="height:21px;width:319px;">Heating pad&#160;</td>
			<td style="width:231px;">Gaymar&#160;</td>
			<td style="width:119px;">T/Pump</td>
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			<td height="21" style="height:21px;width:319px;">Hematoxylin 2</td>
			<td style="width:231px;">Thermo Scientific</td>
			<td style="width:119px;">7231</td>
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			<td height="21" style="height:21px;width:319px;">Hypoxic chamber</td>
			<td style="width:231px;">Biospherix</td>
			<td style="width:119px;">A30274P</td>
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			<td height="21" style="height:21px;width:319px;">Induction chamber</td>
			<td style="width:231px;">DRE Veterinary</td>
			<td>12570</td>
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		<tr height="42">
			<td height="42" style="height:42px;width:319px;">Intubation catheter (i.v. catheter SurFlash (20 G x 1&#34;) )</td>
			<td style="width:231px;">Terumo&#160;</td>
			<td>SR*FF2025</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Iris scissors</td>
			<td style="width:231px;">Fine Science Tools</td>
			<td style="width:119px;">14084-08</td>
			<td></td>
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		<tr height="42">
			<td height="42" style="height:42px;width:319px;">Isoflurane</td>
			<td style="width:231px;">Baxter</td>
			<td style="width:119px;">NDC-10019-360-40</td>
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		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Isoflurane vaporizer</td>
			<td style="width:231px;">DRE Veterinary</td>
			<td>12432</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Mice (C57BL/6)</td>
			<td style="width:231px;">Charles River</td>
			<td style="width:119px;"></td>
			<td></td>
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		<tr height="21">
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			<td style="width:119px;">21-031-CV</td>
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		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Piric Acid- Saturated Solution 1.3 %</td>
			<td style="width:231px;">Sigma</td>
			<td style="width:119px;">P6744-1GA</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Pressure volume catheter</td>
			<td style="width:231px;">Transonic</td>
			<td style="width:119px;">FTH-1212B-4018</td>
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		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Retractor</td>
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			<td style="width:119px;">SURGI-5001</td>
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			<td style="width:119px;">P360</td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">SU 5416</td>
			<td style="width:231px;">Sigma Aldrich</td>
			<td style="width:119px;">S8442</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Surgical Suture, black braided silk, 5.0</td>
			<td style="width:231px;">Surgical Specialties Corp.&#160;</td>
			<td style="width:119px;">SP116</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Surgical tape</td>
			<td style="width:231px;">3M</td>
			<td style="width:119px;">1527-1</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Syringe 10 ml</td>
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			<td height="21" style="height:21px;width:319px;">Toluol</td>
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			<td style="width:119px;">9558.3</td>
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			<td height="21" style="height:21px;width:319px;">Ventilator&#160;</td>
			<td style="width:231px;">CWE</td>
			<td style="width:119px;">SAR-830/P</td>
			<td></td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">WGA Alexa Fluor&#160;</td>
			<td style="width:231px;">Thermo Scientific</td>
			<td style="width:119px;">W11261</td>
			<td></td>
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		<tr height="21">
			<td height="21" style="height:21px;width:319px;">Xylene</td>
			<td style="width:231px;">Roth</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

induction and characterization of pulmonary hypertension in mice using the hypoxia/su5416 model

Pulmonary Hypertension (PH) is a pathophysiological condition, defined by a mean pulmonary arterial pressure exceeding 25 mm Hg at rest, as assessed by right heart&#160;catheterization. A broad spectrum of diseases can lead to PH, differing in their etiology, histopathology, clinical presentation, prognosis, and response to&#160;treatment. Despite significant progress in the last years, PH remains an uncured disease. Understanding the underlying mechanisms can pave the way for the development of new therapies. Animal models are important research tools to achieve this goal. Currently, there are several models available for recapitulating PH. This protocol describes a two-hit mouse PH model. The stimuli for PH development are hypoxia and the injection of SU5416, a vascular endothelial growth factor (VEGF) receptor antagonist. Three weeks after initiation of Hypoxia/SU5416, animals develop pulmonary vascular remodeling imitating the histopathological changes observed in human PH (predominantly Group 1). Vascular remodeling in the pulmonary circulation results in the remodeling of the right&#160;ventricle (RV). The procedures for measuring RV pressures (using the open chest method), the morphometrical analyses of the RV (by dissecting and weighing both cardiac ventricles) and the histological assessments of the remodeling (both pulmonary by assessing vascular remodeling and cardiac by assessing RV cardiomyocyte hypertrophy and fibrosis) are described in detail. The advantages of this protocol are the possibility of the application both in wild type and in genetically modified mice, the relatively easy and low-cost implementation, and the quick development of the disease of interest (3 weeks). Limitations of this method are that mice do not develop a severe phenotype and PH is reversible upon return to normoxia. Prevention, as well as therapy studies, can easily be implemented in this model, without the necessity of advanced skills (as opposed to surgical rodent models).

In this protocol, we describe in detail the creation of the Hypoxia/SU5416 model for inducing PH in mice. Furthermore, we detail&#160;all the needed steps for performing&#160;pulmonary vascular and cardiac evaluation at the end of the observation period.
An overview of the experimental design for this model is shown in Figure 1A13,14. Mice are subjected to normobaric hypoxia (10% O2</...

Watch this Scientific Journal Video about Induction and Characterization of Pulmonary Hypertension in Mice using the Hypoxia/SU5416 Model at JoVE.com

Induction and Characterization of Pulmonary Hypertension in Mice using the Hypoxia/SU5416 Model

This protocol describes the induction of pulmonary hypertension (PH) in mice based on the exposure to hypoxia and the injection of a VEGF receptor antagonist. The animals develop PH and right ventricular (RV) hypertrophy 3 weeks after the initiation of the protocol. The functional and morphometrical characterization of the model is also presented.

Pulmonary Hypertension (PH) is a pathophysiological condition, defined by a mean pulmonary arterial pressure exceeding 25 mm Hg at rest, as assessed by ...

Research

JoVE Journal

Medicine

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