Solvent relaxation in lipid bilayers with dansyl probes

The solvent relaxation properties of the dansyl group attached to two lipids (dansylphosphatidylethanolamine and dansylphosphatidylserine), a fatty acid (dansylundecanoic acid), and two drugs (dansylbenzocaine and dansylpropranolol) were compared in a variety of different lipid systems. Several methods for characterising solvent relaxation were compared in detail for dansylpropranolol in bilayer vesicles of egg phosphatidylcholine. It was shown that the relaxation process is non-monoexponential; nevertheless, for comparative purposes, a model was adopted in which the lifetime associated with the negative exponent in a two exponential decay analysis, obtained at a particular energy on the red edge of emission, was taken as an approximation to a 'solvent relaxation' rate. A negative exponent, indicative of solvent relaxation processes, occurring in the nanosecond time-scale, was found only for dansylpropranolol, dansylPE and dansylundecanoic acid. On addition of the spin probe, 5-doxylstearate, the negative exponent was unaffected in liquid-crystalline phase lipids but was no longer found in gel-phase lipid in the case of dansylpropranolol, while for dansylPE the relaxation time was reduced. On the basis of these types of measurement it was possible to distinguish between different lipid environments using the same probe or between different dansyl environments of the different probes in the same lipid in cases where this would have been difficult or impossible solely on the basis of steady-state or fluorescence lifetime measurements.

Semi-empirical conformational analysis of propranolol interacting with dipalmitoylphosphatidylcholine

A semi-empirical conformational analysis is used to compute the conformation of (+)-propranolol inserted in dipalmitoylphosphatidylcholine. In a first step, the minimal conformational energy of the isolated molecule at the hydrocarbon-water interface is calculated as the sum of the contributions resulting from the Van der Waals, the torsional, the electrostatic and the transfer energies. Five pairs of conformers of minimal energy are determined. They are compared to data available from other experimental approaches. In a second step, they are assembled with dipalmitoylphosphatidylcholine at the interface. Although propranolol is considered in its protonated form, the electrostatic interaction with dipalmitoylphosphatidylcholine is negligible as compared to the Van der Waals interaction. The area occupied per propranolol molecule is between 0.53 and 0.64 nm2/molecule. In the most probable modes of insertion of propranolol into the lipid layer, the naphthyl moiety of the compound interacts with the lipid acyl chains. The protonated amino group is located in the vicinity of the phosphate residue possibly causing an electrostatic interaction.

A possible role for beta-adrenergic receptors in the expression of audiogenic seizures

DBA/2 mice are genetically prone to audiogenic seizures and, when compared with seizure resistant C57BL/6 mice, were found to have an increased density of beta-adrenergic receptors in their midbrain at the age of peak seizure susceptibility. Propranolol, a beta-receptor blocking agent, attenuated all stages of the seizure syndrome. However, a comparison of the effects of its d- and l-isomers suggested that propranolol's anticonvulsant activity was due to its local anesthetic-like action. Pindolol, a more potent beta blocker that is at least 100 times less potent than propranolol with respect to local anesthetic-like activity, produced anticonvulsant effects in approximately the same systemic dose range as propranolol. This indicates that pindolol's anticonvulsant activity could be due to beta blockade and, taken together, these data suggest that beta-adrenergic receptors may play a role in the expression of audiogenic seizures in these animals.

Hyperthyroid Graves' disease causes insulin antagonism

Oral glucose tolerance and pancreatic suppression tests were carried out in six young hyperthyroid men before treatment and 2-4 weeks after thyroid function tests returned to normal and in six normal men matched for age and weight. Glucose intolerance was present in the hyperthyroid individuals. It improved, but did not return to normal, after treatment. Insulin secretion was increased, and the peak values were delayed in the patients. Treatment did not influence the amount or pattern of the insulin response. Steady state plasma glucose levels (milligrams per dl +/- SEM) were significantly (P less than 0.001) higher in the hyperthyroid patients before treatment (128.6 +/- 2.4) than in the normal subjects (86.1 +/- 3.1). Although after treatment, steady state plasma glucose levels (116.1 +/- 2.7) decreased significantly (P less than 0.001), they remained higher than those in normal subjects (P less than 0.01). Therefore, insulin action was impaired in hyperthyroidism and had not returned to normal by 2-4 weeks after thyroid function tests were in the normal range.

Determinants of cardiac augmentation by elevations in intrathoracic pressure

We studied the cardiovascular effects of phasic increases in intrathoracic pressure (ITP) by high-frequency jet ventilation in an acute pentobarbital-anesthetized intact canine model both before and after the induction of acute ventricular failure by large doses of propranolol. Chest and abdominal pneumatic binders were used to further increase ITP. Respiratory frequency, percent inspiratory time, mean ITP, and swings in ITP throughout the respiratory cycle were independently varied at a constant-circulating blood volume. We found that pertubations in mean ITP induced by ventilator adjustments accounted for all observable steady-state hemodynamic changes independent of respiratory frequency, inspiratory time, or phasic respiratory swings in ITP. Changes in ITP were associated with reciprocal changes in both intrathoracic vascular pressures (P less than 0.01) and blood volume (P less than 0.01). When cardiac function was normal, left ventricular (LV) stroke volume decreased, whereas in acute ventricular failure, LV stroke volume increased in response to increasing ITP when apneic LV filling pressure was high (greater than or equal to 17 Torr) and did not change if apneic LV filling pressure was low (less than or equal to 12 Torr). However, in all animals in acute ventricular failure, LV stroke work increased with increasing ITP. Our study demonstrates that the improved cardiac function seen with increasing ITP in acute ventricular failure is dependent upon adequate LV filling and decreased LV afterload in a manner analogous to that seen with arterial vasodilator therapy in heart failure.

A method for evaluating different modes of action of an antiarrhythmic drug in man. The effects of propafenone on sinus nodal functions

In vitro experiments have shown that the antiarrhythmic effects of propafenone are due to a direct depressant action and to a beta-blocking activity. In this study a method was used to evaluate the direct effect and the autonomically mediated actions of an antiarrhythmic agent in a clinical setting. An electrophysiological study was performed twice, at an interval of 24 hr, in 17 patients (age: 52 +/- 17 years) with normal resting and intrinsic heart rate. In the first study the overall effect of intravenous propafenone (1.5-2 mg/kg) was evaluated by comparing the sinus node parameters obtained during the basal state and after drug administration. In the second study the direct depressant effect of the drug was evaluated by comparing the electrophysiological variables obtained following autonomic blockade (propranolol 0.2 mg/kg and atropine 0.04 mg/kg) and after propafenone. In the first study there was no significant change in the sinus cycle length and corrected sinus node recovery time and only a small (9.1%) increase in sinuatrial conduction time, whereas in the second study these variables increased significantly. The degree of increase in sinus cycle length and corrected sinus node recovery time was significantly higher in the second study than in the first one. These data suggest that: (1) propafenone has direct depressant effect on sinus automaticity but this effect is counteracted by autonomically mediated actions (most likely of vagolytic type); (2) the beta-blocking effect of the drug demonstrated in isolated atria is not seen in a clinical setting.

Disorders of prolactin and growth hormone secretion

A large range of tests is now available to help us understand, diagnose and manage GH-related growth disorders. The traditional provocative tests of GH secretion will identify short children with severe GH deficiency. However, evidence is emerging that these pharmacological tests may not be sufficiently sensitive to identify some subjects with GH deficiency arising from neurosecretory disturbance of GH release. There is a need for a simple sensitive test that will detect subtle GH secretion of this type. hGRF administration is a reliable test of GH reserve and, when used in combination with conventional tests, may help to identify GH-deficient children with hypothalamic GRF deficiency. Whether the GH responses following GRF administration reflects physiological GH secretory activity needs to be established. The diagnosis of acromegaly is made on clinical grounds. The abnormal GH responses to glucose and TRH support the diagnosis, but by themselves should not be considered to be diagnostic of acromegaly. An elevated Sm C level also helps to establish the diagnosis, although Sm C concentrations may be elevated to the same degree in pregnancy and during puberty. The use of Sm C to monitor disease activity remains to be established. Circulating GRF levels should be measured in patients with acromegaly so that ectopic production of GRF can be identified.

Electrophysiologic testing in patients with the long QT syndrome

Electrophysiologic studies were performed in 15 patients with syncope and/or cardiac arrest who had the long QT syndrome and 11 control subjects who had normal QT intervals. The syndrome was familial in five patients and idiopathic in 10. All patients had a prolonged QT (546 +/- 68 msec, mean +/- SD) and corrected QT (550 +/- 51 msec). Incremental atrial pacing at cycle lengths of 600 to 400 msec resulted in shortening of the QT interval, but there was no significant difference in the magnitude or percent of shortening of the QT interval between patients with the long QT syndrome and control subjects. Intravenous propranolol did not influence the QT interval measured at fixed atrial-paced cycle lengths in patients with either the familial or idiopathic form of the syndrome. Programmed right and left ventricular stimulation with up to three extrastimuli before and during isoproterenol infusion did not induce sustained ventricular tachycardia or ventricular fibrillation in any of the patients. However, rapid polymorphic nonsustained ventricular tachycardia was induced in six of the 15 patients (40%). Neither the inducibility of nonsustained ventricular tachycardia nor the results of electropharmacologic testing with beta-blockers proved to be of any prognostic value during the mean follow-up period of 28 +/- 17 months. Electrophysiologic studies are of limited value in the diagnosis and treatment of patients with the long QT syndrome.

Autonomic blockade and sick sinus syndrome. New concept in the interpretation of electrophysiological and Holter data

Autonomic blockade is commonly employed as a test of sinus node dysfunction. We compared primary and secondary atrial postpacing pauses and postextrasystolic sino-atrial responses before and after autonomic blockade in 56 patients with the clinical diagnosis of sick sinus syndrome. Pharmacological autonomic blockade was achieved by atropine 0.04 mg kg-1 and propranolol 0.2 mg kg-1, i.v. In a group of patients with a normal intrinsic heart rate the number of positive electrophysiologic variables associated with sinus node dysfunction declined after autonomic blockade. In 91% of these patients, sinus node function was characterized by a normal intrinsic recovery time, gradual exponential return to the constant sinus cycle length, and biphasic postextrasystolic return responses. Three patients in this group had intrinsic SA-block revealed by atrial pacing and verified by Holter monitoring. Besides normal intrinsic pacemaker properties in 53% of patients, rhythm monitoring revealed severe sinus node dysfunction as manifested by bradycardia and the tachycardia-bradycardia syndrome. SA-block and sinus arrest up to 29120 ms. In the abnormal intrinsic heart rate group, disturbed intrinsic rhythmicity was characterized in all by a prolonged corrected intrinsic recovery time (2320 +/- 2740 ms [+/- SD]), arrhythmia and/or bradycardia in the secondary postpacing cycles, chaotic postextrasystolic patterns, or prolonged sinoatrial conduction times. Significantly slow minimal heart rates during sleep significantly prolonged average sinus cycle lengths and positive ECGs for sinoatrial disorders in the waking period were present on the 24-h rhythm recording. It is concluded that intrinsic heart rate obtained by autonomic blockade is the best and most simple method for the diagnosis of intrinsic sinus node dysfunction. Combined autonomic blockade and electrophysiological tests can be of great value in unmasking the severity and degree of intrinsic dysfunction and analyzing the abnormality of secondary pacemaker function. These investigations, however, are rather insensitive and therefore ineffective in detecting autonomic sinus node dysfunction. To assess the role and significance of the autonomous neurovegetative tone in the genesis of sinoatrial disorders, rhythm monitoring is required.

Neural control of pancreatic insulin and somatostatin secretion

This study had a dual purpose. First, the effects of pancreatic buffer flow on whole organ hormone output were investigated. Second, the receptor mechanisms by which sympathetic nerve stimulation alters the secretion rates of somatostatin and insulin were assessed. Pancreata of mongrel puppies were perfused in situ with nonrecirculated Krebs-Ringer bicarbonate buffer (150 mg/dl glucose). Buffer flow was adjusted between 0.2 and 4 ml/min X g pancreas. Insulin secretion rate (nanograms per min/g pancreas; ISR) as well as pancreatic O2 and glucose consumption increased as flow increased between 1 and 2 ml/min X g, where each reached a maximum plateau. Thus, ISR was shown to be dependent on flow over the middle range of flow investigated. In separate experiments, bilateral stimulation of the splanchnic nerves or pancreatic arterial infusion of norepinephrine to a final concentration of 60 microM decreased ISR and the somatostatin secretion rate (SSR). Adrenergic suppression of ISR was antagonized by phentolamine and phenoxybenzamine. Adrenergic inhibition of SSR was blocked only by phenoxybenzamine. Propranolol had no effects. We conclude that norepinephrine is sufficient to account for sympathetic inhibition of ISR and SSR (e.g. it is not necessary to postulate another transmitter) and that this inhibition may be transmitted through an effect on the islet vasculature or an effect on the islet cells themselves. The types of alpha-adrenoceptors mediating the adrenergically induced decrease in ISR differ from those causing the decrease in SSR.

Comparison of single and combined tests for the evaluation of plasma growth hormone secretion in normal short children

Growth hormone (GH) response to provocative tests was compared in normal short children. Seven of 23 children failed to respond to insulin hypoglycemia. Using insulin hypoglycemia followed by L-dopa only 2 of 23 children did not respond and giving bromocriptine combined with insulin hypoglycemia only 1 of 8 children failed to respond. All children submitted to propranolol followed by exercise (n = 14) and to bromocriptine followed by exercise (n = 6) responded with a satisfactory increase in plasma GH levels. The increase elicited by propranolol and exercise was higher than that induced by insulin hypoglycemia alone (p less than 0.005), exercise alone (p less than 0.05) or L-dopa after insulin hypoglycemia (p less than 0.01). The rise of GH induced by bromocriptine and exercise was higher than that obtained with insulin hypoglycemia alone (p less than 0.05). This study suggests that both adrenergic and dopaminergic mechanisms are involved in exercise induced GH release and confirms that combined tests are more useful than a single test to evaluate GH secretion.

Roles of glucagon and epinephrine in hypoglycemic and nonhypoglycemic glucose counterregulation in humans

Studies of two models of human glucose counterregulation, glucose recovery from insulin-induced hypoglycemia and the transition from exogenous glucose delivery to endogenous glucose production late after glucose ingestion, indicate that the principles of rapid hypoglycemic and nonhypoglycemic glucose counterregulation in these models are the same. 1) Neither is solely explicable on the basis of dissipation of insulin; 2) glucagon plays a primary counterregulatory role in both; 3) epinephrine compensates largely for deficient glucagon secretion in both; and 4) counterregulation fails to occur only in the absence of both glucagon and epinephrine in both. Thus, prevention as well as correction of hypoglycemia is effectively accomplished by redundant glucose counterregulatory systems, primarily glucagon and secondarily epinephrine, coupled with dissipation of insulin in humans. Other hormones, neural mechanisms, or autoregulation may be involved but need not be invoked and are not sufficiently potent to prevent or correct hypoglycemia when both of the key glucose counterregulatory hormones, glucagon and epinephrine, are deficient. Although confirmed in that they predict the impact of disease-related deficiencies of glucagon, epinephrine, or both, the extent to which these principles can be generalized to additional models of glucose counterregulation remains to be established. However, they provide a basis for plausible, testable hypotheses concerning the physiology and pathophysiology of glucose counterregulation.

Betaxolol and propranolol in glucagon stimulation of growth hormone

Both betaxolol and propranolol, beta blockers with different pharmacological properties, increase the reliability of somatotropic testing with glucagon. The combination of glucagon and betaxolol, however, is much better tolerated than that of glucagon and propranolol. The use of a beta 1 cardioselective adrenoceptor block for growth hormone testing is recommended.

[Sinoatrial and intra-atrial conductive disorders. The value of recording the sinus node potential]

Direct recording of the sinus node potential in the bipolar mode using two electrodes of a quadripolar recording catheter positioned in the region of the sinus node at the junction of the superior vena cava to the right atrium was performed in 24 patients. Asynchronous overdrive atrial pacing was carried out using Strauss 'technique. Pharmacological denervation was carried out using intravenous propranolol (0,02 mg/kg) and atropine (0,04 mg/kg) using Jose's technique. An intravenous injection of a bolus of 20 mg of ATP was given in 3 cases. The sinus potential was identified by morphological criteria and confirmed after carotid sinus compression and atrial extrastimuli to exclude artefacts, especially the end of ventricular repolarisation of the preceding complex. The sinoatrial conduction time measured directly under basal conditions was considered normal when within 80 to 150 ms. Direct measurement of the sinus potential in the diagnosis of sinus node dysfunction seems to be less useful than the indirect techniques. On the other hand, it does confirm the diagnosis of sinoatrial block: five cases of special interest are described; in four cases the degree of sinoatrial block was variable: a significant increase of sinoatrial conduction time under basal conditions in 1 case; paroxysmal 3rd degree sinoatrial block revealed by programmed atrial stimulation in 2 cases; 2nd degree 2/1 sinoatrial block after injection of ATP in which the direct sinoatrial conduction time and sinus node function had been considered to be normal (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

Enhanced atrioventricular nodal conduction in man: electrophysiologic effects of pharmacologic autonomic blockade

Enhanced atrioventricular nodal conduction (EAVC) comprises a portion of the spectrum of atrioventricular node electrophysiology in which physiologic slowing of atrioventricular conduction is diminished. To evaluate the basis of EAVC in humans, we compared the effect of pharmacologic autonomic blockade on electrophysiologic characteristics of atrioventricular nodal conduction and refractoriness in 10 patients with EAVC and 12 patients without EAVC (non-EAVC). The effects of autonomic blockade (0.2 mg/kg iv propranolol and 0.04 mg/kg iv atropine) on sinus cycle length and atrial refractory period were similar in both EAVC and non-EAVC patients. After autonomic blockade, minimum atrial paced cycle length with 1:1 atrioventricular conduction lengthened in EAVC patients (control, 268 +/- 25 msec; blockade, 307 +/- 34 msec; p less than .01), but remained unchanged in non-EAVC patients (control, 392 +/- 69 msec; blockade, 382 +/- 49 msec; p = NS). Similarly, atrioventricular nodal functional refractory periods tended to lengthen in EAVC patients, while remaining unchanged or shortening in non-EAVC patients. Furthermore, although autonomic blockade reduced differences between EAVC and non-EAVC patients, both minimum cycle length with 1:1 atrioventricular conduction and atrioventricular functional refractory period remained shorter in EAVC than in non-EAVC patients (p less than .02). Thus, baseline differences in autonomic atrioventricular nodal control differ in EAVC and non-EAVC patients, but do not fully account for differences in atrioventricular nodal electrophysiologic properties in these patients. Consequently, underlying structural functional factors may play an important role in determining the range of atrioventricular nodal electrophysiologic characteristics in man.

Adrenergic blockade alters glucose kinetics during exercise in insulin-dependent diabetics

We investigated the effects of alpha and/or beta adrenergic blockade (with phentolamine and/or propranolol) on glucose homeostasis during exercise in six normal subjects and in seven Type I diabetic subjects. The diabetics received a low dose insulin infusion (0.07 mU/kg X min) designed to maintain plasma glucose at approximately 150 mg/dl. In normals, neither alpha, beta, nor combined alpha and beta adrenergic blockade altered glucose production, glucose uptake, or plasma glucose concentration during exercise. In diabetics, exercise alone produced a decline in glucose concentration from 144 to 116 mg/dl. This was due to a slightly diminished rise in hepatic glucose production in association with a normal increase in glucose uptake. When exercise was performed during beta adrenergic blockade, the decline in plasma glucose was accentuated. An exogenous glucose infusion (2.58 mg/kg X min) was required to prevent glucose levels from falling below 90 mg/dl. The effect of beta blockade was accounted for by a blunted rise in hepatic glucose production and an augmented rise in glucose utilization. These alterations were unrelated to changes in plasma insulin and glucagon levels, which were similar in the presence and absence of propranolol. In contrast, when the diabetics exercised during alpha adrenergic blockade, plasma glucose concentration rose from 150 to 164 mg/dl. This was due to a significant increase in hepatic glucose production and a small decline in exercise-induced glucose utilization. These alterations also could not be explained by differences in insulin and glucagon levels. We conclude that the glucose homeostatic response to exercise in insulin-dependent diabetics, in contrast to healthy controls, is critically dependent on the adrenergic nervous system.

Assessment of parasympathetic control of heart rate by a noninvasive method

The degree of parasympathetic control of heart rate was assessed by the abolition of respiratory sinus arrhythmia with atropine. Peak-to-peak variations in heart periods (VHP) before atropine injection correlated significantly (r = 0.90, P less than 0.001) with parasympathetic control, indicating that VHP alone may be used as a noninvasive indicator of the parasympathetic control of heart rate. Pharmacologic blockade of beta-adrenergic supply in a separate group of normal volunteers did not alter the relationship between VHP and parasympathetic control, indicating that the condition of the experiment (complete rest in a quiet atmosphere) allows the use of VHP alone without pharmacologic interventions to characterize the vagal control of heart rate in humans.