[Cardiac effects of adenosine. Mechanism of action, pathophysiologic and clinical significance]

Trans-ethnic association study of blood pressure determinants in over 750,000 individuals

In this trans-ethnic multi-omic study, we reinterpret the genetic architecture of blood pressure to identify genes, tissues, phenomes and medication contexts of blood pressure homeostasis. We discovered 208 novel common blood pressure SNPs and 53 rare variants in genome-wide association studies of systolic, diastolic and pulse pressure in up to 776,078 participants from the Million Veteran Program (MVP) and collaborating studies, with analysis of the blood pressure clinical phenome in MVP. Our transcriptome-wide association study detected 4,043 blood pressure associations with genetically predicted gene expression of 840 genes in 45 tissues, and mouse renal single-cell RNA sequencing identified upregulated blood pressure genes in kidney tubule cells.

Ventricular fibrillation with intracoronary adenosine during fractional flow reserve assessment

Fractional flow reserve (FFR) measurement provides useful hemodynamic assessment of intermediate coronary stenoses affecting long term outcomes. While the gold standard remains intravenous adenosine, intracoronary (IC) bolus administration of adenosine is routinely used in clinical practice because of its ease of use and lower dose providing comparative hyperemia with the most common side effect being a transient atrioventricular block. A 62year old male underwent left heart catheterization after ruling in for non-ST elevation myocardial infarction (NSTEMI). Presenting electrocardiogram (ECG) showed an old left bundle branch block and T-wave inversions in lateral leads (QTc 494ms) with no significant electrolyte abnormalities. Coronary angiography revealed an intermediate lesion in mid left anterior descending coronary artery. FFR assessment with IC adenosine (24μg/mL of normal saline) was performed inducing ventricular fibrillation (VF). He was successfully defibrillated with a single 200J shock and no further arrhythmias were noticed during rest of his hospital stay.

Significance of the endothelin ETA receptor in the haemodynamic and inotropic effects of endothelin-1 in rats

The main aim of the present study was to investigate the direct inotropic effects of stimulation of the endothelin (ET) receptor ETA under in vivo conditions. It is well known that ETA receptor stimulation causes pronounced vasoconstriction. The ET-1-induced coronary vasoconstriction may lead to myocardial ischaemia and, consequently, to cardiodepressor effects that may mask the direct positive inotropic effect of ETA receptor stimulation. Thus, in the present study, steps were taken to avoid this possibility. In anaesthetized open-chest rats the haemodynamic and inotropic effects of ETA receptor stimulation were studied by monitoring responses evoked by ET-1 (1 nmol/kg of body weight) after ETB receptor blockade with BQ 788 (0.5 μmol/kg of body weight); these responses were compared with saline controls (after ETB receptor blockade). To avoid vasoconstrictor effects induced by ETA receptor stimulation, additional experiments were performed in the presence of the vasodilator adenosine (2.0 mg·kg−1 of body weight·min−1). Myocardial function was also examined during aortic clamping so as to circumvent the effect of changes in afterload. We studied further the effect of ETA receptor stimulation on myocardial energy metabolism. ETA receptor stimulation reduced cardiac output (−49% compared with control), raised total peripheral resistance (+173%) and reduced myocardial ATP content (−23%). Aortic clamping did not reveal a positive inotropic effect of ETA receptor stimulation. Furthermore, even though adenosine attenuated the decrease in cardiac output (−21%), the increase of total peripheral resistance (+48%) and prevented the fall of myocardial ATP content (+6%), this did not unmask a positive inotropic effect of ETA receptor stimulation. Thus we conclude that ETA receptor stimulation causes vasoconstriction and myocardial ischaemia, but has no positive inotropic effects in rats.

Adenosine increases ventilation rate, cardiac performance and haemolymph velocity in the American lobster Homarus americanus

The effects of adenosine and adenine nucleotides on haemolymph velocity and on heart rate and scaphognathite frequency were investigated in the American lobster Homarus americanus. The infusion of 0.25-2.4 nmol g(−1) min(−1) adenosine produced steady-state concentrations of 2–3 micromol l(−1) adenosine and approximately 80 micromol l(−1) inosine in the haemolymph. No hanges in haemolymph concentration of AMP, hypoxanthine, xanthine or IMP were observed. Adenosine increases haemolymph velocity in the sternal artery from 55+/−29 to 204+/−53 mm s(−1) and in the posterior aorta from 21+/−7 to 54+/−28 mm s(−1)and reduces haemolymph velocity in the lateral arteries from 98+/−92 to 74+/−69 mm s(−1). Heart rate is increased from 69.3+/−7.4 to 81.2+/−6.2 beats min(−1) and scaphognathite frequency from 86.9+/−29.0 to 147.1+/−35.0 beats min(−1). The effects of adenosine are rapidly reversed after the cessation of the infusion of this purine. The adenylates cause similar but lesser changes and the effects are protracted, probably because of low in vivo activities of nucleotidases.

Hemodynamic and Inotropic Effects of Antiarrhythmic Drugs Used to Treat Paroxysmal Supraventricular Arrhythmias

Episodes of sustained paroxysmal supraventricular tachycardias can be terminated by antiarrhythmic drugs given intravenously. The cardiodepressive effects of these drugs are an important limitation of this therapeutic procedure. The dose-dependent circulatory and myocardial effects of the nucleoside adenosine (0.5, 2.0, 5.0 mg/kg/minute) and the class I antiarrhythmic drug ajmaline (1.0, 2.0, 4.0 mg/kg) were investigated in 73 open-chest rats. Hemodynamic measurements in the intact circulation and isovolumic registrations (peak isovolumic left ventricular systolic pressure and peak isovolumic dP/dtmax) were compared with saline controls. Adenosine has a short-lasting, negative, chronotropic effect that causes a dose-dependent reduction of cardiac output (-34%, -54%, -65% vs control). The peak isovolumic left ventricular systolic pressure (LVSP) is not changed significantly by adenosine (-6%, -4%, +5% vs control). The negative chronotropic effect of ajmaline with consecutive reduction of cardiac output is less pronounced (cardiac output: -18%, -20%, -38% vs control). The highest dose of ajmaline causes a significant reduction of peak isovolumic LVSP (-2%, -1%, -7% vs control). Adenosine has an impressive negative chronotropic effect with a consequent marked decrease of cardiac output. The reduction of cardiac output by adenosine is more pronounced compared with ajmaline. Nevertheless, adenosine has-in contrast to ajmaline-no cardiodepressive effects in vivo.

Adenine nucleotide degradation in cultured chick heart muscle cells

Cultured chick heart muscle cells degrade ATP during metabolic inhibition via ADP to AMP. Whether AMP is primarily deaminated to IMP or dephosphorylated to adenosine depends on the 'metabolic block' (glycolysis vs. oxidative phosphorylation). Inhibition of glycolysis (deoxyglucose) results in an inosine/adenosine ratio greater than 1 in the supernatant, whereas the nucleoside ratio is less than or equal to 1 during inhibition of oxidative phosphorylation (hypoxia, rotenone). EHNA, a blocker of adenosine deaminase, has little effect on inosine release during metabolic inhibition, consistent with the reported low activity of adenosine deaminase in cardiac muscle cells. The amount of adenosine and inosine released can be largely attenuated by two nucleoside carrier inhibitors, nitrobenzyl-thioinosine and dipyridamole, which suggests that nucleosides are produced intracellularly and subsequently released. These results indicate that the amount of inosine or adenosine released from the cardiomyocyte during impaired energy metabolism (e.g. ischemia) can be controlled by the metabolic state of the cell.

[Alterations of the cAMP-adenylate cyclase system in the failing human heart. Consequences for the therapy with inotropic drugs]

In heart failure, an increase in the activity of the sympathetic nervous system takes place to maintain perfusion pressure to vital organs, resulting in increased levels of noradrenaline in the blood of these patients. This permanent stimulation produces a down-regulation of cardiac beta-adrenoceptors. Since noradrenaline acts primarily on the cardiac beta 1-adrenoceptor subtype, beta 1-adrenoceptors decrease in number, whereas the beta 2-adrenoceptor subpopulation remains unchanged in most instances. Consequently, the positive inotropic response to beta-adrenoceptor agonists is diminished. However, there is also a decrease in the positive inotropic effect of beta 2-adrenoceptor agonists, histamine and cAMP-phosphodiesterase inhibitors such as milrinone, whereas the positive inotropic effect of cAMP-independent Na(+)-channel activators such as DPI 206-106 and the effects of cardiac glycosides are not diminished. These observations suggest a more generalised alteration of the cAMP-adenylate cyclase system in the failing heart. Stimulatory guanine nucleotide-binding protein (Gs) couples receptors to adenylate cyclase that stimulate cAMP formation, such as beta-adrenoceptors, histamine receptors and glucagon receptors. In the failing human heart, Gs content has been reported to remain unchanged as compared with that in non-failing myocardium. However, there is a 35%-40% increase in inhibitory guanine nucleotide-binding proteins (Gi), which are involved in the receptor-mediated inhibition of adenylate cyclase. Taken together, two defects of the cAMP-adenylate cyclase system have been identified: an increase in Gi content and a decrease in the number of beta-adrenoceptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine deaminase and porcine meat quality. II. Effects of adenosine analogues on plasma free fatty acids, glucose and lactate in pigs representing high and low adenosine deaminase red cell activity

The adenosine analogues 5'-(N-ethyl) carboxamidoadenosine (NECA) and N6-(phenylisopropyl) adenosine (R-PIA) were shown to differ in their effect on the plasma level of free fatty acids (FFA), glucose and lactate in pigs representing low (Ada 0) and high (Ada A) red cell adenosine deaminase activity. At the same dosage range (0.001-0.005 mg/kg) R-PIA produced a much stronger suppression of the FFA level than NECA, indicating that A1 adenosine receptors predominate in porcine adipose tissue. Pretreatment with 8-phenyltheophylline completely abolished the antilipolytic effect of both adenosine analogues. NECA in contrast to R-PIA elevated the blood glucose concentration, suggesting that A2 adenosine receptors are involved in the stimulation of glycogenolysis. This effect of NECA was not altered by a beta-adrenoceptor blockade providing evidence for a direct effect of adenosine on glycogenolysis. Whereas the changes in plasma FFA following NECA administration were of similar magnitude in Ada A and Ada 0 pigs, the changes in the blood glucose concentration were different in these two groups of pigs.

Effects of 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), a highly selective adenosine receptor antagonist, on force of contraction in guinea-pig atrial and ventricular cardiac preparations

The effects of the A1 adenosine receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX) on force of contraction were examined in isolated electrically driven auricles and papillary muscles from guinea-pigs in the absence and presence of (-)-N6-phenylisopropyladenosine (PIA) and 5'-N-ethylcarboxamidadenosine (NECA). In auricles DPCPX (30-1000 mmol/l) alone increased force of contraction. DPCPX produced only a minor inhibition of phosphodiesterase I-III activity. PIA and NECA alone exerted concentration-dependent negative inotropic effects and the concentration-response curves for PIA and NECA were shifted competitively to the right by the adenosine receptor antagonist DPCPX with similar potency and efficacy. The pA2-value for the inhibition of the effects of PIA and NECA were 9.1 and 8.8, respectively. In papillary muscles DPCPX alone had no inotropic effect. In the presence of isoprenaline PIA and NECA alone exerted concentration-dependent negative inotropic effects and again DPCPX shifted the concentration-response curves for PIA and NECA competitively to the right with similar potency and efficacy. The pA2-value for the inhibition of the effects of PIA and NECA were 9.3 and 9.0, respectively. It is concluded that DPCPX is a potent competitive A1 adenosine receptor antagonist in guinea-pig atrial and ventricular cardiac preparations. Since PIA and NECA were equally potent the cardiac adenosine receptor may constitute a subtype of A1 adenosine receptors differing from the receptor in other tissues such as fat cells. Furthermore, DPCPX has a positive inotropic effect in atrial tissue which cannot be attributed to the A1 receptor antagonism.