Vascular leak in the organs refers to extravasation, or leakage of blood plasma through gaps produced in the endothelium of post capillary venules in the organs. This plasma extravasation or increased vascular permeability, which may arise from some type of an inflammatory response, may have grave consequences. Thus, it is important that this phenomenon, its causes, modulators, and consequences, are studied and understood, and likewise, that investigators have good tools and protocols with which to study them. The endothelial gaps may be produced via a number of stimuli, but usually are produced by the action of peptide neurotransmitters and/or tachykinins on the endothelia. One of the major naturally occurring mediators of this process, which results in increased plasma extravasation, is the undecapeptide tachykinin neuropeptide, substance P1.
Methods to investigate and measure vascular permeability or plasma extravasation, which use the albumin-binding property of Evans blue dye, have been developed, and are usually known for their accuracy, simplicity, economy, safety, and ability to allow the determination of plasma extravasation from several tissues at once, if so desired2,3,4,5,6,7,8,9. This Evans blue protocol for assessing plasma extravasation in the organs of FVBN mice uses all these, but adds some important modifications that make it generally useful and adaptable for future studies, involving the average laboratory that conducts or will conduct important studies of factors associated with plasma extravasation or vascular permeability. In this protocol, substance P is introduced to the mice at 1 nmol/kg, which augments the extravasation of plasma by 1.5-fold. This increases the sensitivity of the protocol, resulting in more easily observable and obtainable results. Other factors that impact permeability, such as various other peptides, chemicals, or some forms of toxic injury, may be used or studied by other laboratories, as desired. Jugular vein injections are used in this protocol to introduce Evans blue and substance P systemically, which requires terminal surgery. However, jugular vein injections5,7,10, even after consideration of the necessary terminal surgical techniques, are easier to master and lead to the production of more consistent results than other venous injections, including tail vein injections4,9. Although it may be possible for Evans blue to be delivered by retro-orbital venous sinus injections, no references in the literature have been found that use this method of delivery of Evans blue. However, as for tail vein injections, the high degree of expertise and practice to reproducibly master this technique greatly limits its use for successful Evans blue injections. In contrast, the alternative jugular vein injection method as described in our protocol, offers a technically obtainable solution. A crucial procedure for perfusion of the mouse's veins, performed just after the sacrifice of the Evans blue-perfused mouse, removes excess Evans blue dye, and has been standardized in this protocol. Previously described methods of perfusion have been carefully examined and modified to obtain the present procedure.Other modifications described here are all optimized, straightforward, and inexpensive.
There are some important limitations of the Evans blue dye method. For example, low sensitivity sometimes associated with this method may prevent some additional gross pathological and histological examination of tissues from Evans blue-injected animals. However, these and other limitations have led to the development of alternative methods and models that, nonetheless, still use Evans blue. The measurement of Evans blue by fluorescence (rather than by visual-range) spectroscopy may increase the sensitivity of the method. Additionally, fluorescence microscopy of Evans blue-stained tissues was developed to allow for observation of vascular leak in more distinct locations11. Also, whole-body imaging and scanning of a live animal previously injected with Evans blue12 allows for investigation of Evans blue concentrations in a continuous manner, rather than at one specific chosen time point of the experiment. However, this method requires the availability of appropriate imaging facilities, and may be very expensive. Modifications involving Evans blue and performed in an in vitro type of model, such as in a cell culture or chick chorioallantoic model13 (CAM) have also been described. These models are monitored by fluorescence and intravital14 microscopy, and allow the quantification of vascular permeability changes over time, but may raise questions regarding accurate modeling of in vivo conditions and may also be expensive.
There have been other methods developed to determine and quantify vascular leak or permeability, which do not involve the administration of Evans blue. These methods may employ an appropriate fluorescent molecule (such as albumin or fluorescein), or an isotopically labeled or otherwise tagged molecule, to live animals (or to cell culture or chorioallantoic (CAM) models13, followed by non-invasive imaging (PET scanning, MRI, intravital microscopy, whole body scanning) or by invasive imaging (fluorescent microscopy)3,12,15. Although these techniques may offer a number of advantages over other Evans blue methods, they also have disadvantages, which may include their considerable complexities, requisite expertise, resources, and high monetary costs.
Neprilysin16 (the peptidase enzyme NEP, also known as CD10, MME, or Enkephalinase) has been suggested to be involved in inhibiting plasma extravasation, at least in part, through the enzymatic metabolism and inactivation of endogenous substance P. Thus, in tissues in which the cell surface peptidase NEP occurs, there may be an attenuation of the effect of substance P, presumably by the peptidase activity of NEP.
Initially, we tested for substance P-induced plasma extravasation utilizing this modified Evans blue protocol, with FVBN wild type (WT) and NEP knockout (KO) mice. NEP involvement in substance P-augmented plasma extravasation was suspected from these initial studies, and we describe these and further experiments involving NEP's role in plasma extravasation. However, the focus of this manuscript is not NEP or its role in plasma extravasation, but rather the plasma extravasation experiments themselves. The NEP results are representative of the kind of results that may be obtained through use of this modified protocol. The Evans blue method to measure plasma extravasation has been optimized and modified, as described in detail below for FVBN mice.