Effect of nitroglycerin and papaverine on coronary flow in man

Mixed lineage kinase domain-like pseudokinase-mediated necroptosis aggravates periodontitis progression

Necroptosis is a form of cell death that is reportedly involved in the pathogenesis of periodontitis. The role of Mlkl-involved necroptosis remains unclear. Herein, this project aimed to explore the role of MLKL-mediated necroptosis in periodontitis in vitro and in vivo. Expression of RIPK3, MLKL, and phosphorylated MLKL was observed in gingival tissues obtained from healthy subjects or patients with periodontitis. The cell viability of Porphyromonas gingivalis lipopolysaccharide (LPS-Pg)-treated cells was detected. In wild type or Mlkl deficiency mice with ligature-induced periodontitis, alveolar bone loss and osteoclast activation were assessed. mRNA levels of inflammatory cytokines in bone marrow-derived macrophages were tested by qRT-PCR. Increased expression of RIPK3, MLKL, and phosphorylated MLKL was observed in gingival tissues obtained from patients with periodontitis. Porphyromonas gingivalis lipopolysaccharide (LPS-Pg)-treated cells developed necroptosis after caspase inhibition and negatively regulated the NF-κB signaling pathway. In mice with ligature-induced periodontitis, Mlkl deficiency reduced alveolar bone loss and weakened osteoclast activation. Furthermore, genetic ablation of Mlkl in LPS-Pg-treated bone marrow-derived macrophages increased the mRNA levels of tumor necrosis factor-α, interleukin (Il)-1β, Il-6, cyclooxygenase 2, matrix metalloproteinase 9, and receptor activator of nuclear factor kappa-B ligand. Our data indicated that MLKL-mediated necroptosis aggravates the development of periodontitis in a Mlkl-deficient mouse. This will provide a new sight for the understanding of etiology and therapies of periodontitis. KEY MESSAGES: MLKL expression was up-regulated in inflamed human gingival tissue. Mlkl deficiency affected the progression of periodontitis. Necroptosis played a major role in mice periodontitis model. Knockout of Mlkl had a significant effect on inflammatory responses.

Hemodynamic and angiographic comparison of intravenous nitroglycerin and nicardipine mainly in subjects without coronary artery disease

Twenty patients were studied during cardiac catheterization to compare hemodynamic and quantitative angiographic effects of intravenous nicardipine and nitroglycerin. After baseline measurements, nicardipine or nitroglycerin was administered by randomized continuous infusion beginning at 10 micrograms/min titrated to achieve a 10 to 12% reduction in systemic arterial pressure. Hemodynamic measurements and angiography were then repeated. Nicardipine did not change heart rate, and a small decrease (82 +/- 4 vs 75 +/- 4 beats/min) was observed with nitroglycerin, whereas mean arterial pressure decreased similarly (-11%) in both groups. Nicardipine increased (+13%) and nitroglycerin decreased (-21%) cardiac output. Although both drugs were associated with significant reductions in pulmonary artery wedge and pulmonary artery pressures, changes were greater with nitroglycerin for pulmonary artery wedge (-49% vs -26%) and pulmonary artery (-39% vs -13%) pressures, whereas only nitroglycerin reduced right atrial pressure significantly. Neither drug altered left ventricular ejection fraction or pulmonary vascular resistance, and only nicardipine decreased systemic vascular resistance significantly. Quantitative coronary angiography (videodensitometry) showed dilation of the left main, proximal, mid and distal anterior descending and circumflex segments by both nitroglycerin and nicardipine. Nicardipine dilated small (< 2 mm2) and large (> 2) arterial segments equally, whereas nitroglycerin showed a proportionately greater effect on small vessels.

Vasodilator drug effects on internal mammary artery and saphenous vein grafts

The internal mammary artery is a dynamic conduit used for myocardial revascularization in which potential exists for spasm as well as for vasodilation. This study investigated vasodilator drug effects on the mammary artery using nitroprusside and nitroglycerin in vitro to measure the inhibition of contraction of human internal mammary artery and in vivo to examine blood flow through a canine mammary artery. In the in vitro study, ring segments of human internal mammary arteries were suspended on strain gauges in muscle baths containing 37 degrees C Krebs solution for measurement of isometric tension in vitro. Arterial contraction was stimulated with 70 mM potassium and 10 microM norepinephrine, and inhibition of contraction by vasodilators was measured. Nitroprusside was more potent and effective than was nitroglycerin in inhibiting potassium and norepinephrine contraction. The in vivo study utilized a canine (n = 8) right heart bypass preparation that allowed precise control of cardiac output, blood pressure and heart rate, which were maintained constant. The internal mammary artery graft and the saphenous vein graft perfused the same coronary artery bed. Electromagnetic flow probes measured graft flow (with the other graft occluded) before and after 15 min of drug infusion (1 microgram/kg per min). Nitroglycerin significantly increased mammary artery flow 36 +/- 13%, whereas nitroprusside significantly decreased it 12 +/- 2%. Saphenous vein grafts responded differently; graft blood flow decreased with nitroglycerin and increased with nitroprusside. Thus, although nitroprusside was more effective than nitroglycerin in inhibiting mammary artery contraction in vitro, it decreased internal mammary artery graft flow measured in vivo. Nitroglycerin had the opposite effect, increasing mammary graft flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans

An ideal coronary vasodilator for studying coronary flow reserve in humans would rapidly produce maximal coronary vasodilation, be short acting to permit repeated measurements, and not alter systemic hemodynamics. The two commonly used vasodilators (dipyridamole and meglumine diatrizoate) do not satisfy these criteria; meglumine diatrizoate does not produce maximal hyperemia and dipyridamole has a long duration of effect (greater than 30 min). In this study we used a subselective coronary Doppler catheter to measure the dose-response kinetics of a shorter acting vasodilator, intracoronary papaverine. In 10 patients with normal coronary vessels, the maximal vasodilator response to papaverine was compared with that to intravenous dipyridamole (0.56 mg/kg infused over 4 min) and intracoronary meglumine diatrizoate. The increase in coronary blood flow velocity after the maximal dose of papaverine (4.8 +/- 0.4 peak/resting velocity ratio, mean +/- SEM) was nearly identical to that seen after infusion of dipyridamole (4.8 +/- 0.6) and was significantly greater than that after meglumine diatrizoate (3.1 +/- 0.2, p less than .01). At maximal hyperemia, mean arterial blood pressure fell 9 +/- 2% (mean +/- SEM) after intracoronary papaverine, 8 +/- 4% after dipyridamole, and 3 +/- 3% after meglumine diatrizoate. The dose-response kinetics of intracoronary papaverine were studied in 13 patients with normal coronary arteries. In the left coronary artery, maximal vasodilation (5.4 +/- 0.6) was achieved with 8 mg in six of eight patients and with 12 mg in all patients. In the right coronary artery, maximal vasodilation (4.8 +/- 0.7) was achieved with 6 mg in four or five patients and with 8 mg in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms

Coronary flow reserve, exercise thallium-201 scintigraphy and exercise radionuclide ventriculography were compared in 18 patients with chest pain and angiographically normal coronary arteries. Regional exercise thallium-201 perfusion was abnormal in three patients, regional exercise wall motion was abnormal in three other patients and results of both tests were abnormal in one additional patient. Left ventricular ejection fraction responses were abnormal in five of these seven patients. The coronary flow reserve of arterial distributions with abnormal perfusion or regional dysfunction was significantly lower than that of distributions associated with normal radionuclide results (1.42 +/- 0.23 versus 2.58 +/- 0.83, p less than 0.001). All patients with abnormal scintigraphic results had low coronary flow reserve (less than 1.95) in at least one distribution. Perfusion abnormalities appeared to be more localized in the arterial distributions with the lowest flow reserve. Only two patients had low flow reserve (less than 1.95) with normal scintigraphic results; both were hypertensive. These data suggest that abnormal exercise scintigraphic findings in patients with angiographically normal coronary arteries and chest pain are indicative of true blood flow or perfusion abnormalities.

Regional myocardial perfusion at rest and during intracoronary papaverine in patients with coronary artery disease

Regional myocardial perfusion was measured in 32 patients with the xenon-133 washout technique at rest and after 5 mg of intracoronary papaverine. Areas of decreased perfusion and/or decreased vasodilation were identified visually from computer-generated functional images. The locations of arteries and stenoses, obtained from identically positioned cineangiograms, were overlaid on the functional images. Perfusion rates for 62 myocardial regions were calculated and correlated with the percentage of stenosis. There was no association between degree of stenosis and perfusion at rest. Regional myocardial perfusion increased after papaverine in regions supplied by coronary arteries without stenoses (0% to 25%), 88.6 +/- 4.7 ml/min/100 gm. This increase was significantly greater (p less than 0.001) than the increase in regions supplied by 51% to 75% stenoses (23.7 +/- 6.3 ml/min/100 gm), or 76% to 99% stenoses (12.9 +/- 6.3 ml/min/100 gm), or 100% stenoses (2.5 +/- 3.8 ml/min/100 gm). Thus there was an inverse relationship between the increase in myocardial perfusion stimulated by papaverine and the degree of coronary artery stenosis measured angiographically. In regions supplied by two stenoses in series, vasodilation produced less of an increase than a single stenosis of a similar degree.

Evaluation of the effects of systemic nitroglycerin on perfusion of ischemic myocardium in coronary heart disease assessed intraoperatively by antegrade blood flow through intact saphenous vein bypass grafts

To evaluate systemic nitroglycerin (NTG) effects on reduced perfusion of ischemic myocardium in coronary disease, intravenous NTG actions on coronary circulatory dynamics were directly assessed intraoperatively during aortocoronary bypass surgery in 24 patients. Thus metered antegrade blood flow was measured through 56 separate intack saphenous vein bypass grafts to analyze NTG perfusion response in the obstructed native coronary artery (CA). In 34 bypassed CA with proximal luminal diameter narrowing greater than 50% to 90%, NTG reduced (p less than 0.01) graft flow (GF) 82 to 63 cc/min, thereby indicating that NTG dilated proximal stenoses with resultant increased CA flow. In 11 bypassed CA obstructed greater than 90% to 100% with well developed collaterals distally, NTG decreased (p less than 0.05) GF 64 to 53 cc/min, thus indicating enhanced collateral flow. In contrast, in 11 bypassed CA obstructions greater than 90% to 100% without collaterals, that NTG increased (p less than 0.02) GF 91 to 100 cc/min indicated NTG nonresponsiveness of the severely diseased CA. Thus systemic NTG improves perfusion to ischemic myocardium subserved by diseased coronaries with less than 90% stenosis or by greater than 90% obstructed vessels with substantial collaterals distally.

Sodium nitroprusside as a coronary vasodilator in man. I. Effect of intracoronary sodium nitroprusside on coronary arteries, angina pectoris, and coronary blood flow

The effect of the intra-arterial injection of 5 to 10 microng of sodium nitroprusside on the caliber of normal and diseased coronary arteries was evaluated in 21 patients during diagnostic cardiac catheterization. In addition, the effect of intra-graft injection of 5 microng of the same agent on the blood flow in aorta-right coronary artery saphenous vein bypass grafts was also evaluated intra-operatively in two patients. The compound induced an increase in the caliber of both normal and stenosed coronary arteries as well as an increase of flow in the grafts. Consistent with measurements of coronary flow response to sodium nitroprusside, angina pectoris which developed in four patients during cardiac catheterization was immediately relieved and the ischemic ST-segment depression significantly reversed after injection of 5 to 10 microng of the drug into the left main coronary artery. Within the dose range used, the drug caused no significant effect on systemic blood pressure or apparently deleterious electrophysiologic changes. No side effects were observed. We conclude that the primary direct action of sodium nitroprusside in the human coronary artery is vasodilatory.

Coronary reperfusion: effects of vasodilators (papaverine and adenosine)

Reperfusion of a coronary artery is followed by a decline of the myocardial blood flow to both the ischemic (reperfused) and border regions, and the appearance of a transmural flow gradient favoring the epicardium. These findings were ascribed to vascular changes in the reperfused coronary bed. The behavior of the myocardial blood flow was investigated (1) after 4 hours of reperfusion following the intracoronary infusion of vasodilators (papaverine and adenosine) and (2) following the intravenous administration of papaverine during the total period of reperfusion. Intracoronary infusion of vasodilators increased flow (147 per cent) to all the layers of the reperfused myocardium but failed to alter the transmural distribution of flow. The flow response to these vasodilators in the normal vascular bed consisted of a marked increase in flow (385 per cent) and a normal, uniform distribution, suggesting that the development of anatomical vascular changes reduced the capacity of the reperfused vasculature to increase flow, and that these changes were more marked in the endocardial layer. The intravenous papaverine infusion during reperfusion normalized the total flow and its distribution in the zone bordering the reperfused myocardium but not to the ischemic, suggesting perhaps that papaverine may be useful in protecting potentially salvageable myocardium.

Sodium nitroprusside as a coronary vasodilator in man: a comparison of the effects of sodium nitroprusside and papaverine hydrochloride on aortocoronary saphenous vein graft flow

Blood flow in aortocoronary saphenous vein grafts was studied in response to intragraft injection of sodium nitroprusside and papaverine hydrochloride. Following injection of 50 mug of sodium nitroprusside, mean graft flow increased from 40.1 +/- 4.5 to 81.3 +/- 8.5 ml per minute. Administration of 30 mg of papaverine hydrochloride caused mean graft flow to rise from 35.4 +/- 3.9 to 70 +/- 7.9 ml per minute. Sodium nitroprusside increases aortocoronary graft flow, the doubling effect of 50 mug of the drug being of the same order of magnitude as that induced by 30 mg of papaverine hydrochloride.

Pentaerythritol trinitrate and glyceryl trinitrate on myocardial oxygen consumption and haemodynamics in the dog

1. The effects of pentaerythritol trinitrate (pentrinitrol) and glyceryl trinitrate on myocardial oxygen consumption and myocardial and systemic haemodynamics were studied in anaesthetized open-chest dogs. An in vivo oximeter in the coronary sinus permitted continuous determination of arteriovenous oxygen difference and myocardial oxygen consumption. All parameters were determined simultaneously at various intervals after drug administration. 2. Myocardial oxygen consumption was diminished by both nitrates for more than 16 min. Changes in arteriovenous oxygen difference and coronary sinus oxygen content were variable between drugs. Following an initial transient increase, coronary blood flow was reduced by both nitrates. Aortic blood pressure, aortic blood flow, left ventricular end-diastolic pressure and left ventricular dP/dt were also reduced. Heart rate and contractile force were not appreciably altered by either nitrate. 3. The decrease in myocardial oxygen consumption appears to be associated with the haemodynamic profile of these drugs. Both nitrates produced comparable reductions in preload (left ventricular end-diastolic pressure) and afterload (aortic pressure) as well as dP/dt.