Abstract: TH-OR055

Sodium-Sensitive Blood Pressure Response in Type 1 Diabetes Is Accompanied by Impeded Skin Lymphangiogenesis

Session Information

Category: Hypertension

  • 1104 Hypertension: Clinical and Translational - Salt and Hypertension

Authors

  • Wenstedt, Eliane F.E., Academic Medical Center, Amsterdam, Netherlands
  • Rorije, Nienke M.G., Academic Medical Center, Amsterdam, Netherlands
  • Olde Engberink, Rik Hg, Academic Medical Center, Amsterdam, Netherlands
  • Van den born, Bert-jan, Academic Medical Center, Amsterdam, Netherlands
  • Aten, Jan, Academic Medical Center, Amsterdam, Netherlands
  • Vogt, Liffert, Academic Medical Center, Amsterdam, Netherlands
Background

Studies showed that sodium can be non-osmotically stored within the skin. In response to high sodium diet (HSD), skin sodium content increases and macrophages are attracted, inducing lymphangiogenesis. Disruption of this system has been shown to lead to sodium-sensitive hypertension. This study investigates the effects of HSD on skin lymphatic and blood capillaries as well as blood pressure (BP) in type 1 diabetic patients (DM1).

Methods

We performed a randomized crossover study in males with DM1 and healthy controls. All subjects pursued an 8-day low sodium diet (LSD: <50 mmol Na+/day) and HSD (>200 mmol Na+/day). Diet order was randomized and time in-between diets was 1-2 weeks. After each diet, BP measurements and skin biopsies were obtained. Macrophages (CD68), vascular endothelium (CD31) and lymphatic endothelium (D2-40) were identified through immunohistochemistry.

Results

This study included 8 patients with DM1 and 12 controls who were similar regarding age, BMI and eGFR. In DM1 patients, mean arterial pressure was higher after HSD as compared to LSD (mean (SE) 85(2) vs. 80(1) mmHg, p=0.03) whereas in controls no differences were observed (78(1) vs. 78(2) mmHg, p=0.66). HSD increased lymphatic cross sectional surface area in controls (p=0.01) but not in DM1 patients (fig 1a). Less CD68+ macrophages were present in DM1 patients compared to controls (p<0.001) (fig 1b). In both groups, there was a strong association between lymphatic capillary density and macrophage density (DM1 r=0.57 p=0.02; controls r=0.71 p=0.02).

Conclusion

The sodium-sensitive BP increase in DM1 patients is accompanied by impeded skin lymphangiogenesis and reduced skin macrophage content. Lymphangiogenesis may help to prevent sodium-sensitive hypertension.