Enhanced responsiveness of smooth muscle, impaired endothelium-dependent relaxation and the genesis of coronary spasm

Endothelial Influence on Vessel Wall Induced Vasospasm after Balloon Angioplasty

Aortic segments from 47 New Zealand rabbits were used, of which 14 were denuded of endothelium. Balloon angioplasty was performed on the aortic segments in vitro. The inner surfaces were perfused and the perfusates then given to vessel segments with or without endothelium. The contraction evoked was then counteracted by adding either vasoactive intestinal polypeptide (VIP), substance P (SP), acetylcholine (ACh), or nitroglycerin (NTG) in increasing concentrations. Perfusates from aortic segments with or without endothelium and previously treated with angioplasty induced vasoconstriction of similar magnitude in the segments used for vasomotor investigation irrespective of whether the endothelium was intact in these or not. Endothelial dependent dilators (ACh, SP) did not counteract the contraction whereas endothelial independent dilators did (NTG, VIP). Neither the induction nor the reversal of vessel wall induced vasoconstriction after balloon angioplasty seems to depend on the presence of endothelial cells.

The role of myocardial revascularization preceding noncardiac surgery

Of about 6.7 million Americans who have coronary artery disease, approximately 700,000 undergo various noncardiac operations annually in the United States. Perioperative cardiac complications remain the leading cause of morbidity and mortality not related to the primary operative procedure; the mechanisms of perioperative ischemia and infarction are unclear. Currently, clinicians, using a combination of clinical and laboratory findings, can estimate the risk of noncardiac surgical procedures with a high degree of precision, but much less is known about the preferred approach to patient management after noninvasive risk stratification. Coronary angiography and revascularization are frequently recommended for those determined by functional tests to be at moderate and high risk, but the risks of revascularization are often substantially higher among these patients. No randomized, controlled trials exist to guide patient management. Quantitative decision analysis based on published nonrandomized data suggests that coronary angiography with selective myocardial revascularization should be performed to reduce the risk of noncardiac surgery only if the risk of noncardiac surgery is greater than 5% and the risk of coronary angiography with selective revascularization is less than 3%. On the other hand, if independent indications exist for myocardial revascularization, it should generally be performed before the noncardiac operation.

Hemodynamic changes associated with reduction in total cholesterol by treatment with the HMG-CoA reductase inhibitor pravastatin

Hemodynamic changes associated with the lowering of total cholesterol (TC) by the water-soluble HMG-COA reductase inhibitor pravastatin were investigated in 59 patients with hypercholesterolemia (TC level at least 220 mg/dl) who received pravastatin therapy for 6 months. The patients were divided into two groups according to the reduction in TC: a > or = 15% reduction group and a < 15% reduction group. The changes in hemodynamics were compared before and after pravastatin treatment. No changes in blood pressure, heart rate or aortic damping factor were found in either group. However, significant decreases in pulse wave velocity and total peripheral resistance, and increase in cardiac output were seen in the > or = 15% reduction group. All these hemodynamic parameters remained unchanged in the < 15% reduction group. The 12 patients with a clear pravastatin-induced reduction in TC maintained over a 5-year period showed no changes in blood pressure, heart rate or aortic damping factor, but the reductions in pulse wave velocity and total peripheral resistance, and increase in cardiac output were maintained. These changes in hemodynamics were not dependent on aortic elasticity, and appeared to result from improved peripheral hemodynamics. Lowering of TC levels by pravastatin results in improvement in the peripheral endothelium-dependent vasodilation disorder associated with hypercholesterolemia.

Effects of LDL on intracellular free calcium and nitric oxide-dependent cGMP formation in porcine endothelial cells

Nitric oxide (NO)-mediated, endothelium-dependent vasodilation is reduced in atherosclerotic arteries. A number of in vivo studies suggest that infusion of the substrate of NO synthase, L-arginine, partly counteracts this effect. We studied the potential inhibitory effects of native and of oxidized low density lipoproteins (n-LDL, ox-LDL) on NO-dependent cyclic guanidine monophosphate (cGMP) formation in porcine aortic endothelial cells and the role of extracellular L-arginine in counteracting this process. NO-dependent cGMP production in the cells (passage 1; preincubated in L-arginine-free medium for 24 h) was stimulated for 3 min with bradykinin (BK 1 nM) or the calcium-ionophore A23187 (100 nM) or by a 20 min incubation with L-arginine (L-Arg 0.1 mM, 20 min). The endothelium-independent NO-donor, sodium nitroprusside (SNP 1 microM) was used as control stimulus. Experiments were performed in the presence of LDL which was kept as much as possible under antioxidative conditions, further referred to as n-LDL (1 mg/ml), or LDL which was oxidized by incubation with copper (ox-LDL 0.1 mg/ml). The NG-nitro-L-arginine (L-NNA, inhibitor of NO-synthase) -sensitive intracellular cGMP concentration was taken as a measure of endothelial NO formation and determined by radioimmunoassay. BK-induced changes of intracellular free Ca2++ were measured immediately after washout of LDL using the FURA-2 method. n-LDL reduced the cGMP-levels in unstimulated cells as well as the cGMP increase in response to bradykinin (-10%) and the calcium-ionophore A23187 (-80%). The SNP-induced cGMP-increase was, however, not affected. L-arginine increased the intracellular cGMP concentration under both conditions by a similar amount, without affecting intracellular free calcium. Uptake of 3H-L-arginine was not significantly altered by n-LDL treatment. Ox-LDL significantly reduced SNP-induced cGMP-increases but did not alter bradykinin-induced cGMP increases. The BK-induced increase of intracellular free calcium was even enhanced after exposure of the cells to ox-LDL. L-arginine increased cGMP by a similar amount as in untreated cells. It is concluded that both n-LDL and ox-LDL can reduce the NO-dependent cGMP formation in cultured endothelial cells, albeit by different mechanisms. However, a limitation of the uptake or availability of extracellularly applied L-arginine does not appear to be a causal factor, at least not after 2 h exposure.

Noradrenergic vasorelaxation of porcine coronary arteries is enhanced by direct, acute exposure to 17 beta-estradiol

1. We tested whether responses of isolated coronary arteries to adrenergic agents are altered by overnight (18-22 hr) or acute exposure to physiological levels of 17 beta-estradiol. 2. Sensitivity to relaxation by norepinephrine (-log M ED50) was enhanced significantly in isolated arteries after acute exposure to 10(-9) M 17 beta-estradiol. Neither alpha-adrenergic contraction to norepinephrine, nor beta-adrenergic relaxation to isoproterenol was affected by acute exposure to 17 beta-estradiol. 3. Responses of coronary arteries to relaxation or contraction by norepinephrine, as well as relaxation by isoproterenol, were not altered by overnight incubation with 17 beta-estradiol or by removal of the endothelium. 4. We conclude that relaxation of coronary arteries by norepinephrine is enhanced by acute, direct exposure to physiological levels of 17 beta-estradiol. This enhancement does not result from effects of estradiol to suppress alpha-adrenergic contraction to norepinephrine or increase coronary beta-adrenergic receptor sensitivity.

Differences in endothelium-dependent relaxation in various arteries from Watanabe heritable hyperlipidaemic rabbits with increasing age

1. Endothelium-dependent relaxation in response to acetylcholine (ACh) and the calcium ionophore A23187 was examined in aorta, coronary, basilar and renal arteries isolated from Watanabe heritable hyperlipidaemic (WHHL) rabbits of 2, 6 and 12 months of age, with normolipidaemic heterozygous WHHL rabbits as controls. 2. In the rings of WHHL rabbit aortae and coronary arteries preconstricted with vasoconstrictors, endothelium-dependent relaxation in response to ACh was attenuated with age compared to the heterozygous WHHL rabbits. A significant negative correlation was found between the total cholesterol content and the relaxation response to ACh in the aortae or coronary arteries from 6 and 12 month old WHHL rabbits. 3. In the rings of basilar arteries, endothelium-dependent relaxations to ACh were not modified with age. Similarly, in the rings of renal arteries, the relaxation response to ACh was not changed with age, but in the 6 and 12 month preparations, after the age of 6 months, a contraction following the relaxation appeared at higher concentrations of ACh (10(-7) to 10(-6) mol/L). The contraction was endothelium-dependent and inhibited by indomethacin. 4. A23187-induced endothelium-dependent relaxations were also markedly attenuated in the aorta and significantly in the coronary artery with age. 5. Endothelium-independent relaxation to sodium nitroprusside was not changed in all arteries from WHHL rabbits of different ages. 6. These findings indicate that in the aorta and coronary artery of the WHHL rabbit, the endothelium-dependent relaxation to ACh and A23187 becomes impaired with increasing age (i.e., with the progression of cholesterol deposition in the arterial wall) but is preserved in the basilar and renal artery.

Effects of a new calcium antagonist, CD-832, on experimental coronary artery spasm in miniature pigs

The effects of a new calcium antagonist, CD-832, on experimental coronary artery spasms were studied in Göttingen miniature pigs. Pigs underwent endothelial denudation at the left anterior descending coronary artery using a balloon catheter. Changes in the diameter of the denuded and nondenuded site in response to an intracoronary administration of serotonin (10 micrograms/kg) or histamine (10 micrograms/kg) were assessed quantitatively by selective coronary arteriography 1 week after endothelial denudation. Percent reductions of the coronary artery diameter induced by serotonin or histamine in the denuded site were significantly greater than those in the nondenuded site (p < 0.01). Coronary artery spasm induced by serotonin or histamine in the denuded site was attenuated in a dose-dependent manner by intravenous infusion of CD-832 (10 and 30 micrograms/kg/min) or nifedipine (1 and 3 micrograms/kg/min). The degrees of inhibition of coronary artery spasm by CD-832 were similar to those produced by nifedipine. CD-832 and nifedipine at the high dose caused comparable increases in the basal coronary artery diameter. These results suggest that CD-832 may be a useful drug for the treatment of coronary artery spasm.

Impaired coronary blood flow response to acetylcholine in patients with coronary risk factors and proximal atherosclerotic lesions

We examined whether coronary risk factors and atherosclerotic lesions in the study artery were associated with impaired endothelium-dependent dilation of coronary resistance arteries. Acetylcholine (ACH) at graded doses (1, 3, 10 and 30 micrograms/min) and papaverine (10 mg) were selectively infused into the left anterior descending coronary artery of 28 patients, in whom the study artery was angiographically normal (n = 16) or with mild stenosis < or = 40% (n = 12). Coronary blood flow (CBF) was estimated from the product of mean CBF velocity measured by an intracoronary Doppler catheter and the arterial cross-sectional area of the study artery determined by quantitative arteriography. ACH increased CBF in a dose-dependent manner. However, the maximum CBF response to ACH varied widely among patients (from 50% to 660%). By multivariate analysis, the presence of atherosclerotic lesions in the study artery was an independent predictor for impaired CBF response to ACH (P < 0.01). Hypertension (P < 0.001), hypercholesterolemia (r = -0.52, P < 0.005), age > or = 50 yr (P < 0.01) and total number of coronary risk factors (r = -0.62, P < 0.001) were associated with the impaired increase in CBF with ACH by univariate analysis. The percent increase in CBF evoked with papaverine did not correlate with these risk factors. The results suggest that mild atherosclerotic lesions in the study artery and coronary risk factors are accompanied by impaired endothelium-dependent dilation of coronary resistance arteries evoked with ACH. Endothelial dysfunction of coronary resistance arteries may result in altered regulation of myocardial perfusion in patients with mild coronary atherosclerosis and coronary risk factors.

Mechanism of ergonovine-induced hyperconstriction of the large epicardial coronary artery in conscious dogs a month after arterial injury

This study investigated the mechanism of ergonovine-induced hyperconstriction of coronary artery in conscious dogs that had undergone endothelial denudation one month earlier. The diameter of the large epicardial coronary artery was continuously measured by a sonomicrometer in 12 dogs in which two pairs of 10-MHz piezoelectric crystals had been surgically implanted at the denuded and nondenuded sites of coronary arteries. A month after the endothelial denudation, intravenous ergonovine (0.01, 0.1, 0.3, and 1.0 mg) produced transient dilation followed by dose-dependent constriction. The degrees of dilation were comparable between the denuded and nondenuded sites. The magnitudes of constriction induced by ergonovine were significantly larger in the denuded site than in the nondenuded site: the percent reductions in diameter evoked with 0.3 mg ergonovine were 14.4 +/- 2.3% and 3.8 +/- 0.8% (p less than 0.01) at the denuded and nondenuded sites, respectively. The magnitudes of constriction induced by intravenous phenylephrine (0.02, 0.06, and 0.2 mg) were comparable in the denuded and nondenuded sites. Methysergide (a nonselective serotonergic blocker) in a dose of 0.5 mg/kg significantly inhibited vasoconstriction induced by ergonovine (0.3 mg) from 13.1 +/- 1.1% to 2.7 +/- 1.0% (p less than 0.01) at the denuded site and from 4.2 +/- 0.6% to 0.8 +/- 0.3% (p less than 0.05) at the nondenuded site. Diltiazem (1.0 mg/kg) selectively inhibited the ergonovine-induced hyperconstriction. Ketanserin (0.5 mg/kg), prazosin (1.0 mg/kg), or indomethacin (5.0 mg/kg) did not prevent the ergonovine-induced hyperconstriction. Histological study revealed intimal thickening and regenerated endothelium in the denuded site.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of cocaine on epicardial coronary artery reactivity in miniature swine after endothelial injury and high cholesterol feeding. In vivo and in vitro analysis

The purpose of this study was to determine the effects of cocaine on vasoreactivity in the swine model. Eight miniature pigs underwent regional endothelial denudation of the left anterior descending coronary artery and were then fed a high cholesterol diet. Cross-sectional area (CSA) of coronary arteries was measured by quantitative angiography. Before denudation, intravenous cocaine (1, 3, and 10 mg/kg) decreased CSA of epicardial vessels by 19-44%. At 3 mo after the denudation, the percent reduction in CSA of the denuded vessels induced by the 10 mg/kg dose was significantly augmented compared to nondenuded vessels (59 +/- 5% vs. 48 +/- 4%, P less than 0.05). Under in vitro conditions where isometric force of isolated ring segments was measured, methoxamine (an alpha 1 agonist) or BHT-920 (an alpha 2 agonist) produced similar degrees of contraction of denuded and control vessels; however, cocaine in concentrations up to 3 x 10(-3) M did not produce contraction. These responses were unaffected by removal of the endothelium. Histologically, myointimal thickening was noted at the denuded site. The present study demonstrates an enhanced vasoreactivity of atherosclerotic coronary arteries to cocaine in vivo, the mechanism of which appears to be mediated by endogenous vasoactive substances rather than by a direct action of cocaine on vascular smooth muscle.

Putative mechanisms of the impairment of endothelium-dependent relaxation of the aorta with atheromatous plaque in heritable hyperlipidemic rabbits

Attenuation of acetylcholine-induced endothelium-dependent relaxation of thoracic aortas excised from Watanabe heritable hyperlipidemic (WHHL) rabbits linearly correlated with the percent area coated with atheromatous plaque. To elucidate mechanisms related to this reduced endothelium-dependent relaxation in the presence of atherosclerosis, the acetylcholine-induced release of endothelium-derived relaxing factor (EDRF) was assessed functionally as a percent relaxation of the precontracted detector strips obtained from the tunica media beneath the intact intima or the atheromatous plaque in the same aortic ring preparation. Relaxations of the normal detectors to effluents containing EDRF of thoracic aortas during stimulation by acetylcholine (3 x 10(-6) M) in heterozygous and homozygous WHHL rabbits were 73 +/- 5% and 59 +/- 9% (p less than 0.01) of the phenylephrine-induced precontraction, respectively. Relaxations of the atherosclerotic detectors to effluents (EDRF) through the aortas during stimulation by acetylcholine (3 x 10(-6) M) in heterozygous and homozygous WHHL rabbits were 16 +/- 4% and 14 +/- 5%, respectively--values significantly smaller than those seen in the normal detectors. When superoxide dismutase was added to the perfusate of the donors from homozygous and heterozygous WHHL rabbits, atherosclerotic detectors relaxed by effluents stimulated by acetylcholine to 73% and 65% (p less than 0.01 versus before the addition of superoxide dismutase) of the normal detector, respectively. Relaxations induced by sodium nitroprusside as well as the contractions by acetylcholine, phenylephrine, and KCl (118 mM) were comparable in detector strips from the normal and atherosclerotic portions. Thus, not only is the amount of EDRF released by acetylcholine reduced in the presence of atherosclerosis, the tunica media beneath the atheromatous plaque is also to some extent responsible for the superoxide-induced inactivation of EDRF.

Effects of native and oxidized low density lipoproteins on formation and inactivation of endothelium-derived relaxing factor

The influence of native (N-) and oxidized (Ox-) low density lipoproteins (LDLs) on endothelium-dependent vasomotion is still controversial. We investigated the short-term effects of N-LDL and Ox-LDL on the formation of endothelium-derived relaxing factor (EDRF) in native and cultured endothelial cells and on its inactivation after release from the cells. N-LDL was isolated from fresh human plasma via sequential ultracentrifugation and oxidized by incubation with Cu2+. EDRF released from cultured endothelial cells was inactivated by both N-LDL and Ox-LDL (1 mg/ml) as detected in a bioassay system. N-LDL reduced the EDRF-mediated vasodilations of the detector segments by 38.5 +/- 5.3%, and Ox-LDL, by 55.5 +/- 4.6%. The effects of lipoproteins on EDRF formation were studied in cultured endothelial cells preincubated with either N-LDL or Ox-LDL (1 mg/ml for 1 hour) and stimulated for EDRF release with bradykinin after washout of the lipoproteins. EDRF was assessed by measuring its stimulatory effect on the activity of a purified, soluble guanylate cyclase. Both N-LDL and Ox-LDL did not reduce the bradykinin-induced EDRF formation. Consistent with this finding, acetylcholine-induced, EDRF-mediated dilations of intact rabbit femoral artery segments were not impaired by luminal exposure to N-LDL or Ox-LDL (1 mg/ml for 1 hour). However, these relaxations were significantly reduced by preincubation of aortic ring preparations with the same concentrations of the same charges of N-LDL and Ox-LDL. In conclusion, neither N-LDL nor Ox-LDL acutely impairs the formation of EDRF but does inactivate EDRF after its release from endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of native and oxidized low-density lipoproteins on endothelium-dependent and endothelium-independent vasomotion

Native and oxidized low-density lipoproteins (LDL) were investigated for their direct influence on EDRF-formation, EDRF-activity, and vascular smooth muscle tone. Native (n) LDL, isolated from fresh human plasma, was oxidized by Cu(2+)-incubation. EDRF released from cultured endothelial cells was inactivated by both n-LDL and ox-LDL (1 mg/ml) as detected in a bioassay system. n-LDL reduced the EDRF-mediated vasodilations of the detector segments by 38.5 +/- 5.3%, and ox-LDL by 55.5 +/- 4.6%. The effects of lipoproteins on EDRF-formation were studied on cultured endothelial cells, preincubated with either n-LDL or ox-LDL (1 mg/ml, 1 h) and stimulated for EDRF-release with bradykinin after washout of the lipoproteins. EDRF was assessed by measuring its stimulatory effect on the activity of a purified soluble guanylate cyclase. Preincubation with both n-LDL and ox-LDL did not reduce the bradykinin-induced EDRF-formation. Accordingly, acetylcholine-induced, EDRF-mediated dilations of intact rabbit femoral artery segments were not impaired by luminal exposure to n-LDL or ox-LDL (1 h, 1mg/ml). Effects of n-LDL and ox-LDL on vascular smooth muscle tone were investigated in isolated perfused rabbit femoral arteries. Perfusion of endothelium-intact and -denuded segments with ox-LDL (80-500 micrograms protein/ml) caused no or only weak vasoconstrictions in the absence of contractile agonists. However, in the presence of ox-LDL, vasoconstrictions to threshold concentrations of norepinephrine (NE), serotonin (5-HT), phenylephrine (PE) or potassium were significantly enhanced. Native LDL (80-1000 micrograms/ml) had no effect on vascular tone, neither in presence nor in absence of contractile agonists. Preincubation with verapamil, diltiazem, and nitrendipine inhibited vasoconstrictions evoked by ox-LDL. The contractile responses to ox-LDL were significantly greater in endothelium-denuded segments than in endothelium-intact segments. In conclusion, neither n-LDL nor ox-LDL acutely impair the formation of EDRF, but do inactivate EDRF after its release from endothelial cells. n-LDL has no direct influence on vascular smooth muscle tone, but ox-LDL greatly enhances vasoconstrictions to various contractile agonists by direct interaction with vascular smooth muscle. Thus, in regions of lipoprotein-accumulation in the arterial wall, both n-LDL and ox-LDL may favor inappropriate vasoconstrictions.

Endothelium and blood flow mediated vasomotion in the conscious dog

Numerous in vitro studies have demonstrated the important role of the vascular endothelium on the vasoactivity of vascular smooth muscle. Experimentation, particularly in conscious animals, is required to study the integrated role of endothelium in the regulation of vascular tone. This article reviews some of the evidence demonstrating endothelium mediated vasodilation and inhibition of vasoconstriction by the endothelium in the chronically instrumented conscious animal. Furthermore, a role for endothelial cells has been shown in the mechanism of blood flow-mediated vasodilation. Finally, the endothelium, through elaboration of constricting factors, e.g., endothelin, can also induce potent vasoconstriction. In the conscious animal endothelin elicits markedly differing degrees of vasoconstriction among the various regional vascular beds.

Oxidized low density lipoproteins potentiate vasoconstrictions to various agonists by direct interaction with vascular smooth muscle

In hypercholesterolemia, low density lipoproteins (LDLs) may be oxidized by monocytes/macrophages in the arterial wall. Therefore, we investigated the effect of LDL and its oxidative derivatives (ox-LDL) on vascular tone in isolated perfused rabbit femoral arteries. Perfusion of endothelium-intact and endothelium-denuded segments with ox-LDL (80 micrograms protein/ml) caused no or only weak vasoconstrictions in the absence of contractile agonists. However, in the presence of ox-LDL, vasoconstrictions to threshold concentrations of norepinephrine, serotonin, phenylephrine, or potassium were significantly enhanced. This enhancement correlated with the degree of oxidation. When ox-LDL was administered at higher concentrations (greater than 200 micrograms protein/ml), it evoked moderate vasoconstrictions even in the absence of contractile agonists. Native LDL had no effect on vascular tone. Preincubation with verapamil, diltiazem, and nitrendipine inhibited vasoconstrictions evoked by ox-LDL, both in the presence and in the absence of a contractile agonist. The contractile responses to ox-LDL were significantly greater in endothelium-denuded segments than in endothelium-intact segments. At the above concentrations, ox-LDL had no influence on endothelium-derived relaxing factor-mediated vasodilations. These data indicate that ox-LDL enhances agonist-induced vasoconstrictions by a direct effect on the vascular smooth muscle. We therefore suggest that ox-LDL is an important factor that may increase the risk of inappropriate vasoconstriction in hypercholesterolemia, independent of its putative cytotoxic effect on the endothelium.

Influence of transluminal angioplasty on the prostanoid release from the arterial wall

Vasospasm and thrombosis complicate percutaneous transluminal angioplasty (PTA). To study if the release of the prostanoids PGI2 and TxA2 are affected by PTA, the following experiment was undertaken: In ten rabbits, the upper or lower half of the aorta was randomised either to transluminal angioplasty or control segment. After excision the segments were simultaneously but separately perfused ex vivo with Hank's balanced salt solution for five consecutive 15 min periods. Arachidonic acid was added to the perfusate for the last 15 min period. PGI2 and TxA2 were measured by radioimmunoassay in the perfusate as the stable degradation products 6-keto-PGF1 alpha and TxB2. After perfusion, the two aortic segments were prepared for scanning electron microscopy (SEM). Angioplasty decreased the basic release of PGI2 as well as the response to arachidonic acid. This is likely to be due to endothelial denudation as seen by SEM. The release of TxA2 from the vessel wall was very low and was not increased by dilatation. The influence of angioplasty on the prostanoid system may be of importance in the complications of vasospasm and thrombosis.