Gestational diabetes promotes future maternal cardiovascular disease through endothelin activation and suppressed NO/cGMP/PRKG and AMPK/SIRT1 signaling pathways.

Abstract

Women with gestational diabetes mellitus (GDM) are more likely to develop cardiovascular disease (CVD) within 3 to 10 yr following pregnancy. Despite a return to normoglycemia shortly after gestation, GDM mothers still possess an increased risk of future CVD. In this study, we use a novel preclinical hormonal model of GDM to examine the mechanisms underlying future vascular and cardiac dysfunction in mothers with a history of GDM. We treated 16-wk-old pregnant C57BL/6J mice with the insulin receptor antagonist (S961; 30 nmol/kg sc) from gestational day 7 (second trimester of pregnancy) until delivery to induce GDM. GDM mice developed systolic and diastolic dysfunction, arterial stiffness, hypertension, increased cardiac mass, and exercise intolerance at 10 wk postpartum compared with saline-treated pregnant or S961-treated virgin mice. We also observed decreased plasma nitric oxide (NO) and increased endothelin-1 (ET-1) in GDM. The aorta of S961-induced GDM mice had increased pulse wave velocity, impaired vascular relaxation, remodeling, elevated reactive oxygen species (ROS) production and adhesion molecules, increased ET-1 type A receptor expression, and reduced sirtuin-1 (SIRT1) expression. The left ventricle of S961-induced GDM mice exhibited fibrosis, thickness, and increased ROS production. In addition, alterations in cardiac kinase activity in the nitric oxide/cyclic guanosine monophosphate/protein kinase G (NO/cGMP/PRKG) and AMP-activated protein kinase (AMPK) alpha pathways were observed at 10 wk postpartum using novel PamGene kinome technology. Thus, endothelin activation, suppressed NO/cGMP/PRKG signaling, impaired AMPK, and altered SIRT1 may be responsible for the development of vascular stiffness and cardiac dysfunction in mothers with a history of GDM.NEW & NOTEWORTHY Mechanisms underlying the future development of CVD in mothers with GDM were investigated using a mouse model of GDM that mimics the condition observed in human GDM. Examining the aorta in the later life of the GDM model reveals increased arterial stiffness and endothelin activation associated with vascular remodeling. In addition, kinome analysis reveals suppressed cardiac NO/cGMP/PRKG and impaired AMPK-SIRT1 signaling pathways, which corroborate the impaired ventricular relaxation observed in later life in GDM mothers.