Follistatin improves vascular function by inhibiting oxidative stress and inducing browning of perivascular adipose tissue in essential hypertension

Background Essential hypertension, characterized by vascular dysfunction, remains a leading modifiable cause of death globally. Perivascular adipose tissue (PVAT), which normally reduces vasoconstriction, becomes less anticontractile in hypertension due at least in part to increased reactive oxygen species (ROS). Brown PVAT has emerged as a protective regulator of vascular tone. Follistatin, an activin antagonist, induces browning of peripheral adipose tissue depots via AMPK. We recently reported improved blood pressure, vascular function and reduced vascular ROS by follistatin in the spontaneously hypertensive rat (SHR) model of essential hypertension. Here, we investigate whether follistatin reduces ROS and induces browning in SHR PVAT to restore PVAT function. Methods SHR were treated with vehicle, follistatin or hydralazine for 8 weeks. Mesenteric white and thoracic brown PVAT from SHR and normotensive Wistar-Kyoto were utilized, with wire myography used to assess vascular function. Nitric oxide (NO) and nitrite were measured in PVAT using DAF-2 FM fluorescence or Griess reagent, respectively. PVAT ROS and browning markers were assessed biochemically and via immunohistochemistry. PVAT was treated ex vivo for 3 days to assess mechanisms of browning. Unbiased proteomic analysis of PVAT was performed using liquid chromatography-mass spectrometry. Results SHR PVAT dysfunction, manifest as a pro-contractile effect, was inhibited by follistatin through reducing ROS, enhancing NO bioavailability and inducing browning. Activin neutralization and AMPK phosphorylation mediated the beneficial effect of follistatin on SHR PVAT. Hydralazine-induced blood pressure reduction did not replicate follistatin effects, suggesting vascular benefits of follistatin are mediated by direct PVAT modulation. Proteomic analysis showed that follistatin shifts PVAT proteome towards normal state, upregulating processes associated with adipose tissue browning. Conclusion Follistatin restores PVAT-mediated vascular relaxation via ROS reduction, activin neutralization and AMPK-dependent browning, positioning the potential for PVAT as a therapeutic target for vascular dysfunction in essential hypertension.