The assay of the catecholamine content of small volumes of human plasma

Effects of adrenaline and potassium on QTc interval and QT dispersion in man

BACKGROUND

Hypoglycaemia alters cardiac repolarization acutely, with increases in rate-corrected QT (QTc) interval and QT dispersion (QTd) on the electrocardiogram (ECG); such changes are related to the counterregulatory sympatho-adrenal response. Adrenaline produces both QTc lengthening and a fall in plasma potassium (K+) when infused into healthy volunteers. Hypokalaemia prolongs cardiac repolarization independently however, and therefore our aim was to determine whether adrenaline-induced repolarization changes are mediated directly or through lowered plasma K+.

MATERIALS AND METHODS

Ten healthy males were studied on two occasions. At both visits they received similar l-adrenaline infusions but on one occasion potassium was also administered; infusion rates were adjusted to maintain circulating K+ at baseline. The QTc interval, QTd, peripheral physiological responses and plasma adrenaline and potassium concentrations were measured during both visits.

RESULTS

The QTc interval and QTd increased both with and without potassium clamping. Without K+ replacement, mean (SE) QTc lengthened from 378 (5) ms to a final maximum value of 433 (10) ms, and QTd increased from 36 (5) ms to 69 (8) ms (both P < 0.001). During K+ replacement, QTc duration at baseline and study end was 385 (7) ms and 423 (11) ms, respectively (P < 0.001), and QTd 38 was (4) ms and 63 (5) ms (P = 0.001).

CONCLUSIONS

These data suggest that disturbed cardiac repolarization as a result of increases in circulating adrenaline occurs independently of extracellular potassium. A direct effect of adrenaline upon the myocardium appears the most likely mechanism.

The temporal relationship between glycogen phosphorylase and activation of the pyruvate dehydrogenase complex during adrenaline infusion in resting canine skeletal muscle

The present study examined the effect of adrenaline infusion on the activation status of glycogen phosphorylase and the pyruvate dehydrogenase complex (PDC) and on the accumulation of glucose-6-phosphate (G-6-P) and acetylcarnitine in resting canine skeletal muscle. The study was performed in an effort to gain some insight into the temporal relationship between glycogen phosphorylase and PDC activation in vivo in skeletal muscle, which is currently unresolved. Multiple muscle samples were obtained from canine brachial muscle (n = 10) before and during (1, 3, 7 and 15 min) adrenaline infusion (0.14 microg (kg body mass)(-1) min(-1), I.V.). Adrenaline infusion increased glycogen phosphorylase "a" by > 2-fold above basal levels after 3 min (pre-infusion = 9.2 +/- 1.1 vs. 3 min = 22.3 +/- 4.0 mmol glucosyl units (kg dry muscle)(-1) min(-1), P < 0.05). The concentration of G-6-P increased transiently from its basal concentration at 1 min (pre-infusion = 1.5 +/- 0.2 vs. 1 min = 4.4 +/- 0.9 mmol kg dry muscle)(-1), P < 0.01), declined to its pre-infusion concentration at 3 min (P < 0.05), and then increased again after 7 min of infusion (P < 0.05). The PDC was activated following 7 min of adrenaline infusion (pre-infusion = 0.22 +/- 0.04 vs. 7 min = 1.04 +/- 0.15 mmol acetyl-CoA (kg wet muscle)(-1) min(-1), P < 0.01), and this degree of activation was maintained for the duration of infusion. During the first 3 min of infusion, the concentration of acetylcarnitine declined (pre-infusion = 3.8 +/- 0.3 vs. 3 min = 1.6 +/- 0.2 mmol (kg dry muscle)(-1), P < 0.05), before transiently increasing at 7 min above the 3 min concentration (3 min = 1.6 +/- 0.2 vs. 7 min = 5.1 +/- 1.0 mmol (kg dry muscle)(-1), P < 0.01). This is the first study to demonstrate that adrenaline can indirectly activate the PDC in skeletal muscle in vivo at rest. The results demonstrate that adrenaline increased glycogen phosphorylase activation and glycolytic flux within 3 min of infusion, but took several more minutes to activate the PDC. This temporal relationship, combined with a probable adrenaline-induced increase in metabolic rate (and thereby resting ATP demand), resulted in the biphasic changes in G-6-P and acetylcarnitine with infusion time.

Impaired postprandial adipose tissue blood flow response is related to aspects of insulin sensitivity

Obesity has been associated with dysfunctional postprandial adipose tissue blood flow (ATBF), but it has also been recognized that the interindividual response is highly variable. The present work aimed at characterizing this variability. Fifteen subjects were given 75 g oral glucose, and abdominal subcutaneous ATBF was monitored by the (133)Xe washout method. Determinants of insulin sensitivity based on nonesterified fatty acid (NEFA) suppression after oral glucose administration [ISI(NEFA)] were higher in the top tertile ATBF response group (1.29 +/- 0.09 vs. 0.90 +/- 0.08 in the lower tertiles, P = 0.01). ISI(NEFA) was related to ATBF response (r(s) = 0.73, P < 0.002) as well as insulin sensitivity based on postprandial glycemia [ISI(gly), r(s) = 0.58, P < 0.05], whereas the homeostasis model assessment (HOMA) index (r(s) = -0.39, P = 0.16) was not. The relationship between increase in ATBF and ISI(NEFA) was independent of BMI (P = 0.015) in multivariate analysis. Subjects with a high ATBF response had significantly higher increase of plasma norepinephrine (P < 0.05), indicating a link between postprandial insulinemia, sympathetic activation, and ATBF response. There is a close relationship between insulin sensitivity and the regulation of postprandial ATBF, independent of adiposity. Impaired regulation of ATBF seems to be another facet of the insulin resistance syndrome.

Cannabinoids inhibit pre- and postjunctionally sympathetic neurotransmission in rat mesenteric arteries

The effects of cannabinoids on sympathetic neurotransmission in the rat isolated perfused mesenteric arterial bed, were investigated. Electrically evoked sympathetic neurogenic vasocontraction was inhibited by the cannabinoid receptor agonists 11-hydroxy-dimethylheptyl-Delta(8)-tetrahydrocannabinol (HU210), (-)-cis-3-[2-hydroxy-4-(1,1-dimethylheptyl)phenyl]trans-4-(3-hydroxypropyl)-cyclohexanol (CP55,940) and methanandamide, and by (+)-11-hydroxy-Delta(8)-tetrahydrocannabinol (HU211), a (+)-stereoisomer of HU210. The inhibition was unaffected by cannabinoid CB(1) and CB(2) receptor antagonists. Electrically evoked release of endogenous noradrenaline from sympathetic nerves was inhibited by HU210, but not by HU211. Inhibition was blocked by a cannabinoid CB(1), but not a CB(2), receptor antagonist. HU210 attenuated contractions to noradrenaline, and all of the cannabinoids blocked contractions to KCl. Capsaicin pre-treatment had no significant effect on HU210- and CP55,940-mediated inhibition of sympathetic neurogenic contraction, but partly blocked inhibition mediated by methanandamide. These data show that cannabinoids can inhibit, by distinct pre- and postjunctional actions, sympathetic neurotransmission in the rat mesenteric arterial bed. The pre-junctional action is mediated by a cannabinoid CB(1)-like receptor, but the postjunctional action does not appear to involve either cannabinoid CB(1) or CB(2) receptors.

Effects of insulin on adipose tissue blood flow in man

Adipose tissue blood flow (ATBF) rises after nutrient ingestion. It is not clear whether this is due to insulin. The aim of this study was to investigate the role of insulin in the regulation of subcutaneous ATBF. We have investigated the role of insulin in the regulation of ATBF in normal, healthy subjects in a three-step procedure to determine the functional level at which insulin may potentially exert its effect. Fifteen subjects were studied on two occasions. On the first visit, 75 g oral glucose was given. In the second, similar plasma concentrations of insulin and glucose were achieved by dynamic intravenous infusions of insulin and glucose. The increase in ATBF after oral glucose (4.2 +/- 1.4 ml min(-1) (100 g tissue)(-1), P = 0.01) was significantly greater (P < 0.05) than that after intravenous infusions (1.5 +/- 0.6 ml min(-1) (100 g tissue)(-1) P < 0.05). For the local delivery of potentially vasoactive substances and simultaneous measurement of ATBF, we describe a novel combination of methods, which we have called 'microinfusion'. We have used this technique to show that locally infused insulin, even at pharmacological concentrations, had no demonstrable effect on ATBF in nine subjects. We conclude that whilst insulin does not have a direct effect on ATBF, it is likely to be an important mediator, possibly acting via sympathetic activation. In the postprandial state, other candidate peptides and hormones are also likely to play important roles.

Oxidation of adrenaline and noradrenaline by solved molecular oxygen in a FIA assembly

A simple and effective procedure is proposed for the study and simultaneous determination of adrenaline and noradrenaline. The fluorimetric determination of both substances is performed in a flow injection assembly and by oxidation of both drugs with the solved molecular oxygen. The influence of different parameters is empirically studied and the interpretation of the reaction mechanism is also added. The determination of adrenaline is monitored at 450 nm and the outputs at 520 nm correspond to the adrenaline and noradrenaline global amount; for both lectures lambda(exc) 329 nm. The influence of temperature is relevant and analytical determination occurred at 55 degrees C by immersing the sample loop in a water bath. The linear range for adrenaline is over 0.5-20 microg ml(-1), limit of detection for both compounds is 0.2 microg ml(-1): the influence of foreign compounds as potential interferents is also tested; and, finally the procedure is applied to determination of both chatecolamines in synthetic samples.

The effect on adipose tissue blood flow of isoenergetic meals containing different amounts and types of fat

OBJECTIVE

To investigate the factors regulating the increase in adipose tissue blood flow following meals.

DESIGN

Eight subjects were fed three isoenergetic meals; two high-fat meals rich in either saturated or polyunsaturated fatty acids and one low-fat, high-carbohydrate meal.

MEASUREMENTS

Blood samples were taken and adipose tissue blood flow was measured before and for 6 h after the meal. Plasma glucose, insulin, non-esterified fatty acid, total and chylomicron-triacylglycerol and catecholamine concentrations were measured.

RESULTS

Adipose tissue blood flow rose to a peak after all three meals (P<0.05 for each). The three meals stimulated adipose tissue blood flow at similar times. There was a marked and statistically significant similarity in the time course of changes in blood flow and insulin concentrations. In contrast, noradrenaline concentrations peaked later than adipose tissue blood flow (P=0.014).

CONCLUSION

Adipose tissue blood flow may be 'carbohydrate-stimulated' rather than 'fat-stimulated', with insulin having a vasodilatory role in adipose tissue as in skeletal muscle.

Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes

BACKGROUND

Intensive treatment to achieve good glycaemic control in diabetic patients is limited by a high frequency of hypoglycaemia. The glucose concentrations at which symptoms and release of counter-regulatory hormones takes place have not been studied in patients with well controlled type-2 diabetes.

METHODS

We studied seven well controlled, non-insulin treated, type-2 diabetic patients (mean HbA1c [corrected according to Diabetes Control and Complications Trial] 7.4%, SD 1.0) and seven healthy controls matched for age, sex, and body mass index with a stepped hyperinsulinaemic hypoglycaemic glucose clamp. Symptoms, cognitive function, and counter-regulatory hormone concentrations were measured at each glucose plateau, and the glucose value at which there was a significant change from baseline was calculated.

FINDINGS

Symptom response took place at higher whole-blood glucose concentrations in diabetic patients than in controls. Counter-regulatory release of epinephrine, norepinephrine, growth hormone, and cortisol showed a similar pattern--eg, at blood glucose concentrations of 3.8 mmol/L [SD 0.4] vs 2.6 [0.3] for epinephrine.

INTERPRETATION

Glucose thresholds for counter-regulatory hormone secretion are altered in well controlled type-2 diabetic patients, so that both symptoms and counter-regulatory hormone release can take place at normal glucose values. This effect might protect type-2 diabetic patients against episodes of profound hypoglycaemia and make the achievement of normoglycaemia more challenging in clinical practice.

Performance of a psychomotor skill following rest, exercise at the plasma epinephrine threshold and maximal intensity exercise

The purpose of this study was to examine the effect of exercising at the epinephrine threshold and at Maximum Power Output on the performance of a skill that requires both decision-making and motor performance. Participants (N=12) undertook an incremental test to exhaustion from which their epinephrine threshold and Maximum Power Output were calculated. They were then examined on a soccer skill test following rest and exercise that was previously determined to elicit their epi nephrine threshold and Maximum Power Output. The soccer test examined the participants' speed and accuracy of response. Speed of response was measured by voice reaction time and whole body reaction time. No significant effects of exercise were shown for any of the variables. The need for further research using more complex skill tests and the use of discontinuous exercise protocols, rather than continuous ones, is recommended.

Exercise, plasma catecholamine concentrations and decision-making performance of soccer players on a soccer-specific test

The main aim of this study was to compare the decision-making performance of college soccer players on a soccer-specific, tachistoscopically presented test, at rest and while exercising at their adrenaline threshold and at their maximum power output. These were determined following an incremental test to exhaustion on a cycle ergometer. After the initial maximum power test, participants (n = 9) were allowed 10 habituation trials on the soccer decision-making test. Participants' decision-making performance was tested at rest, while cycling at a power output that had previously been determined to elicit their adrenaline threshold and while cycling at maximum power output. Accuracy and speed of decision were the dependent variables. A one-way repeated-measures analysis of variance showed no significant effect of exercise on accuracy, and showed speed of decision to be significantly affected by exercise. Tukey post-hoc tests showed that speed of decision at rest was significantly slower than in the other two conditions, which did not differ significantly from one another. Based on allocatable resources theories of arousal and performance, we conclude that the adrenaline threshold may be indicative of increases in the resources available to the individual. Furthermore, we considered that exercise at maximum power output may only induce a moderate rather than a high level of arousal.