Selective action of diltiazem on cerebral vascular smooth muscle in the rabbit: antagonism of extrinsic but not intrinsic maintained tone

Smooth Muscle Ion Channels and Regulation of Vascular Tone in Resistance Arteries and Arterioles

Vascular tone of resistance arteries and arterioles determines peripheral vascular resistance, contributing to the regulation of blood pressure and blood flow to, and within the body's tissues and organs. Ion channels in the plasma membrane and endoplasmic reticulum of vascular smooth muscle cells (SMCs) in these blood vessels importantly contribute to the regulation of intracellular Ca2+ concentration, the primary determinant of SMC contractile activity and vascular tone. Ion channels provide the main source of activator Ca2+ that determines vascular tone, and strongly contribute to setting and regulating membrane potential, which, in turn, regulates the open-state-probability of voltage gated Ca2+ channels (VGCCs), the primary source of Ca2+ in resistance artery and arteriolar SMCs. Ion channel function is also modulated by vasoconstrictors and vasodilators, contributing to all aspects of the regulation of vascular tone. This review will focus on the physiology of VGCCs, voltage-gated K+ (KV) channels, large-conductance Ca2+-activated K+ (BKCa) channels, strong-inward-rectifier K+ (KIR) channels, ATP-sensitive K+ (KATP) channels, ryanodine receptors (RyRs), inositol 1,4,5-trisphosphate receptors (IP3Rs), and a variety of transient receptor potential (TRP) channels that contribute to pressure-induced myogenic tone in resistance arteries and arterioles, the modulation of the function of these ion channels by vasoconstrictors and vasodilators, their role in the functional regulation of tissue blood flow and their dysfunction in diseases such as hypertension, obesity, and diabetes. © 2017 American Physiological Society. Compr Physiol 7:485-581, 2017.

Some extracardiac effects of diltiazem and other calcium entry blockers

Calcium entry blockers have a well documented relaxing effect of smooth muscle, vascular as well as non-vascular. Mainly as a consequence of this action, the drugs have been used for treatment of several non-cardiac disorders where hyperactivity of smooth muscle is considered to have an important role in the pathogenesis. In this short review some of these extracardiac effects of calcium entry blockers are discussed and also their clinical application.

Noradrenaline-Induced Smooth Muscle Relaxation in the Specific Region of Canine Facial Vein: Implications for Facial and Cranial Circulation

This study was performed to investigate the heterogeneity of physiological and pharmacological properties in segments of the facial veins with special reference to selective brain cooling. Canine facial veins were isolated and the isometric tension of each segment was measured using the organ bath technique. Vessels in the segments of the facial veins that run opposite to the buccal cavity automatically produced myogenic tone and tended to show spontaneous contractions, but vessels in other segments did not. When no contractile agent was used for precontraction, noradrenaline and adrenaline produced dose-dependent relaxations in the former venous segments, but contractions in the latter ones. A Schild plot analysis for metoprolol against denopamine and for ICI118,551 against salbutamol showed that the venous segments running opposite the buccal cavity contained both beta(1)- and beta(2)-adrenoceptors, but the other venous segments contained only beta(2)-adrenoceptors. Electrical field stimulation-induced tetrodotoxin-sensitive relaxations in the former venous segments were diminished by pretreatment with metoprolol, but not with ICI118,551, indicating that the electrical stimulation-induced relaxation may be related to the activation of beta(1)-adrenoceptors in the venous smooth muscles. In conclusion, the heterogeneity of the functional properties, especially in the distribution of beta-adrenoceptors, in different segments of canine facial veins was observed in the present study, and autoregulatory mechanisms, humoral mechanisms, and neural mechanisms were suggested to affect cranial venous drainage.

Comparison of green tea extract and epigallocatechin gallate on blood pressure and contractile responses of vascular smooth muscle of rats

The present study was conducted to investigate the effects of green tea extract (GTE) on arteral blood pressure and contractile responses of isolated aortic strips of the normotensive rats and to establish the mechanism of action. The phenylephrine (10(-8) approximately 10(-5) M)-induced contractile responses were greatly inhibited in the presence of GTE (0.3 approximately 1.2 mg/mL) in a dose-dependent fashion. Also, high potassium (3.5 x 10(-2) approximately 5.6 x 10(-2) M)-induced contractile responses were depressed in the presence of 0.6 approximately 1.2 mg/mL of GTE, but not affected in low concentration of GTE (0.3 mg/mL). However, epigallocatechin gallate (EGCG, 4 approximately 12 microg/mL) did not affect the contractile responses evoked by phenylephrine and high K+. GTE (5 approximately 20 mg/kg) given into a femoral vein of the normotensive rat produced a dose-dependent depressor response, which is transient. Interestingly, the infusion of a moderate dose of GTE (10 mg/kg/30 min) made a significant reduction in pressor responses induced by intravenous norepinephrine. However, EGCG (1 mg/kg/30 min) did not affect them. Collectively, these results obtained from the present study demonstrate that intravenous GTE causes a dose-dependent depressor action in the anesthetized rat at least partly through the blockade of adrenergic alpha1-receptors. GTE also causes the relaxation in the isolated aortic strips of the rat via the blockade of adrenergic alpha1-receptors, in addition to the unknown direct mechanism. It seems that there is a big difference in the vascular effect between GTE and EGCG.

Ca2+-dependence and nifedipine-sensitivity of vascular tone and contractility in the isolated superfused spiral modiolar artery in vitro

The regulation of the vascular diameter of the spiral modiolar artery may play a major role in the regulation of cochlear blood flow and tissue oxygenation since the spiral modiolar artery provides the main blood supply to the cochlea. The goal of the present study was to determine whether vascular tone and contractility of the spiral modiolar artery depend on the presence of extracellular Ca2+ and involves nifedipine-sensitive Ca2+ channels. The spiral modiolar artery was isolated and superfused in vitro and the diameter was measured continuously by video microscopy. Isolated segments of the spiral modiolar artery had an outer diameter of 61 +/- 3 microm (n = 59) and displayed vasomotion characterized by 5-15 clearly distinguishable constrictions per min. Removal of Ca2+ from the superfusion medium caused a reversible relaxation and cessation of vasomotion and was used to determine the magnitude of basal vascular tone. The basal vascular tone consisted of a sustained reduction of the vascular diameter to 95.1 +/- 0.3% (n = 51) of the maximal diameter in Ca2+-free medium. Nifedipine reduced the basal vascular tone with an IC50 of (1.1 +/- 0.3) x 10(-9)) M although 22% of the basal vascular tone was insensitive to nifedipine. Elevation of the K+ concentration from 3.6 to 150 mM caused a transient vasoconstriction which was dependent on the presence of extracellular Ca2+. Nifedipine fully inhibited K+-induced vasoconstriction with an IC50 of (2.0 +/- 0.7) x 10(-9) M. Norepinephrine (10(-4) M) caused a transient vasoconstriction and an increase of vasomotion at branch points of the spiral modiolar artery. Norepinephrine-induced vasoconstriction was fully inhibited in the absence of Ca2+ and partially inhibited by 10(-7) M nifedipine. These observations suggest that the spiral modiolar artery contains voltage-dependent nifedipine-sensitive Ca2+ channels which are involved in the maintenance of basal vascular tone as well as in the mediation of K+- and norepinephrine-induced contractility. Further, the data suggest that cytosolic Ca2+ stores, if present in the spiral modiolar artery, are of limited capacity compared to other vessels.

Effect of calcium antagonists on regional cerebral blood flow in transplanted rat brain tumors

We studied the effect of intracarotid infusion of various calcium antagonists on regional CBF (rCBF) in the C6 rat glioma by a hydrogen clearance method. Nimodipine at doses of 0.1, 0.5 and 1 microgram/kg/min was found to produce tumor-specific increases in the rCBF (40.2 +/- 18.4%, p < 0.01, 67.8 +/- 32.6%, p < 0.001 and 37.3 +/- 37.2%, p < 0.05, respectively) without affecting systemic blood pressure. Regarding the time course of the nimodipine effects, at a dose of 0.5 micrograms/kg/min, rCBF in the tumor showed maximum value at fifteen minutes after the start of the intracarotid infusion. Diltiazem at doses of 5, 20, and 40 micrograms/kg/min also increased tumor rCBF in a dose-dependent manner (27.9 +/- 12.5%, p < 0.001, 52.0 +/- 21.8%, p-AN 0.001 and 54.5 +/- 18.4%, p < 0.001, respectively). Both nifedipine and flunarizine significantly increased the rCBF in the tumor, while they did not cause a higher percent increase of the rCBF when compared with those of nimodipine and diltiazem. No significant percent increase of the rCBF in the tumor was observed in verapamil treated rats. These results indicate that tumor vessels may have an altered response to calcium antagonists, especially to nimodipine and diltiazem, when compared to normal brain capillaries. The varied responses to calcium antagonists could be explained by their differences in tissue selectivity and affinity to calcium channels.

The relaxant action of betaxolol on isolated bovine retinal microarteries

We investigated the possible effects on retinal blood flow of betaxolol, a beta blocker which is used as antiglaucomatous medication. Ring segments of retinal microarteries were isolated from bovine eyes and mounted in an organ bath for measurement of contractile force. The effects of betaxolol were studied during K(+)-, stretch-, and serotonin-induced contractions, to enable comparison to the effects of the standard beta blocker propranolol and the Ca2+ channel blocker verapamil. Betaxolol relaxed K(+)-induced contractions in a dose-dependent manner. The drug relaxed the phasic part of the K(+)-induced contractions more than the tonic part. Betaxolol had no effect on stretch-induced contractions. The tonic part of the serotonin-induced contractions showed a trend to decrease in response to betaxolol. These highly specific effects of betaxolol resembled the effects of propranolol. Since betaxolol has significantly less membrane stabilizing activity than has propranolol, this activity is not responsible for the relaxant action of beta blockers on retinal microarteries. The action of both beta blockers resembled the action of the Ca2+ channel blocker verapamil.

Transduction mechanisms involved in the regulation of myogenic activity

Vascular smooth muscle has the ability to exist in a state of maintained partial constriction. This state of partial activation is initiated and/or maintained by the mechanical effects of distending pressure acting on the vascular wall. The intrinsic ability of vascular smooth muscle to respond to these mechanical forces is referred to as the myogenic mechanism. Within the past decade the signaling mechanisms responsible for mechanotransduction of myogenic phenomena have been the focus of extensive research. Two areas of active investigation include (1) the modulation of membrane ionic conductances by pressure/stretch and (2) the pressure/stretch-induced generation of second messengers known to be involved in vascular smooth muscle contraction. This review summarizes recent work aimed at understanding the mechanotransduction process in vascular smooth muscle.

Effect of nicardipine and diltiazem on internal carotid artery blood flow velocity and local cerebral blood flow during cerebral aneurysm surgery for subarachnoid hemorrhage

STUDY OBJECTIVE

To determine the hemodynamic effects of a bolus injection of nicardipine 1 mg or diltiazem 5 mg on local cerebral blood flow (LCBF) and internal carotid blood flow velocity (ICBFV) with isoflurane anesthesia.

DESIGN

Randomized study.

SETTING

Inpatient neurosurgery and anesthesia clinic at a city hospital.

PATIENTS

26 patients with subarachnoid hemorrhage who were scheduled for cerebral aneurysm clipping.

INTERVENTIONS

A bolus injection of either nicardipine or diltiazem was administered to patients whose systolic blood pressure increased to over 150 mmHg after opening of the dura.

MEASUREMENTS AND MAIN RESULTS

After the bolus injection, both drugs rapidly decreased arterial blood pressure. Nicardipine increased LCBF [before injection, 42.1 +/- 12.3 ml/100 g/min; after injection, 47 +/- 10.7 ml/100g/min; (p < 0.05 vs control); after recovery, 42.4 +/- 11.1 cm/sec], but diltiazem did not change LCBF. Nicardipine 1 mg moderately increased ICBFV [before injection, 34.2 +/- 9.3 cm/sec; after injection, 40.6 +/- 8.7 cm/sec (p < 0.01 vs. control); after recovery, 34.1 +/- 8.9 cm/sec], but diltiazem did not change ICBFV. In addition, venous partial oxygen pressure and saturation of the internal jugular did not change throughout the study. There was a close correlation between presurgical neurologic status and LCBF (rs = -0.743; p < 0.01) and ICBFV (rs = -0.721; p < 0.01).

CONCLUSIONS

Nicardipine increased LCBF and ICBFV, but diltiazem did not change either. These results suggest that both drugs are useful and safe for the treatment of intraoperative hypertension during cerebral aneurysm surgery.

Intracellular Ca2+ release in cerebral arteries

Vasoconstricting agonists elevate the intracellular Ca2+ concentration and induce tension development in vascular smooth muscle cells by inducing both Ca2+ influx from the extracellular space and Ca2+ release from cellular stores. The relative importance of Ca2+ release has been found to vary between different sites in the vasculature. This review examines the role of Ca2+ release in the activation of cerebral arteries produced by several vasoconstricting stimuli. Although the activation of cerebral arteries by agonists such as 5-hydroxytryptamine and noradrenaline has typically been found to have little dependence on Ca2+ release, other vasoconstrictors such as thromboxane A2, which may be released from the endothelium by other agonists, appear to induce a substantial intracellular Ca2+ release in cerebral arteries. The limited efficacy of Ca2+ influx blockers in the treatment of delayed cerebrovascular constriction occurring as a result of subarachnoid haemorrhage suggests that intracellular mechanisms such as Ca2+ release and/or the activation of protein kinase C may be important determinants of vasoconstriction under pathological conditions.

Vasodilators during cerebral aneurysm surgery

The objective of this review is to review the anaesthetic implications of vasoactive compounds particularly with regard to the cerebral circulation and their clinical importance for the practicing anaesthetist. Material was selected on the basis of validity and application to clinical practice and animal studies were selected only if human studies were lacking. Hypotensive drugs have been used to induce hypotension and in the treatment of intraoperative hypertension during cerebral aneurysm surgery. After subarachnoid haemorrhage, cerebral blood flow is reduced and cerebral vasoreactivity is disturbed which may lead to brain ischaemia. Also, cerebral arterial vasospasm decreases cerebral blood flow, and may lead to delayed ischaemic brain damage which is a major problem after subarachnoid haemorrhage. Recently, the use of induced hypotension has decreased although it is still useful in patients with intraoperative aneurysm rupture, giant cerebral aneurysm, fragile aneurysms and multiple cerebral aneurysms. In this review, a variety of vasodilating agents, prostaglandin E1, sodium nitroprusside, nitroglycerin, trimetaphan, adenosine, calcium antagonists, and inhalational anaesthetics, are discussed for their clinical usefulness. Sodium nitroprusside, nitroglycerin and isoflurane are the drugs of choice for induced hypotension. Prostaglandin E1, nicardipine and nitroglycerin have the advantage that they do not alter carbon dioxide reactivity. Local cerebral blood flow is increased with nitroglycerin, decreased with trimetaphan and unchanged with prostaglandin E1. Intraoperative hypertension is a dangerous complication occurring during cerebral aneurysm surgery, but its treatment in association with subarachnoid haemorrhage is complicated in cases of cerebral arterial vasospasm because fluctuations in cerebral blood flow may be exacerbated. Hypertension should be treated immediately to reduce the risk of rebleeding and intraoperative aneurysmal rupture and the choice of drugs is discussed. Although the use of induced hypotension has declined, the control of arterial blood pressure with vasoactive drugs to reduce the risk of intraoperative cerebral aneurysm rupture is a useful technique. Intraoperative hypertension should be treated immediately but the cerebral vascular effects of each vasodilator should be understood before their use as hypotensive agents.

Verapamil and migraine prophylaxis: mechanisms and efficacy

Calcium channel blockers have demonstrated efficacy in investigative use for prophylaxis of migraine and cluster headaches. In particular, verapamil, with its low side-effect profile, appears to be a promising alternative to the currently available agents for prophylactic treatment of chronic recurring headaches. Although its exact mechanisms of action in this application are unknown, verapamil exerts a vasodilatory effect on cerebral arteries and interacts with serotonergic systems involved in migraine pathogenesis. A review of studies from the past decade indicates that verapamil may be as effective as traditional therapies as prophylaxis for the major types of chronic recurring headache.

Differing calcium sensitivities of human cerebral and digital arteries, human metatarsal veins, and rat aorta

1. The effects of the voltage dependent calcium channel blocking agent nifedipine, and of a calcium free bathing medium, on the responses of human blood vessels obtained postmortem to various agonists have been compared with those of the rat aorta. The human vessels studied were digital arteries, basilar arteries and metatarsal veins. 2. Responses to potassium chloride (5-80 mM), noradrenaline (10(-9)-10(-4) M), 5-hydroxytryptamine (10(-8)-10(-4) M) and U46619 (10(-11)-10(-6) M), in the presence and absence of nifedipine (1, 10, and 100 nM) or in a calcium-free bathing medium, were assessed using an area-under-curve analysis. 3. In general, the order of sensitivity of the vessels to inhibition of agonist induced contractures by nifedipine was basilar arteries greater than metatarsal veins = digital arteries = rat aorta. 4. For all the vessels, the order of sensitivity for antagonism of responses to the agonists by nifedipine was potassium chloride greater than 5-hydroxytryptamine = noradrenaline greater than U46619. 5. A calcium free bath inhibited responses of digital arteries to potassium chloride more than noradrenaline, 5-hydroxytryptamine or U46619, and responses of rat aorta to a greater extent than responses of the digital arteries. 6. In the rat aorta, a calcium-free bath inhibited responses to all agonists (except KCl) to a greater degree than did nifedipine. 7. We conclude that inhibition of extracellular calcium entry through voltage dependent calcium channels affects contractile responses of different blood vessels to different extents, and, within the same blood vessel, responses to different contractile agonists to different extents.

The selective potentiation of noradrenaline-induced tone by Bay K 8644 in the rabbit basilar artery

A number of studies indicate that relative to the maximal tone possible, for example, to histamine, noradrenaline produces only weak contractile responses in the rabbit basilar artery. Various factors, including a limited number of alpha-adrenoceptors, have been proposed to account for the reduced response to noradrenaline. We examined the effect of the Ca2+-channel activator, Bay K 8644 (0.1 and 1.0 nM) on dose-response curves to noradrenaline, histamine, calcium (Ca2+) and potassium (K+) in ring preparations of rabbit basilar artery and central ear artery. These concentrations of Bay K 8644 (0.1 and 1.0 nM) increased the magnitude of tension developed by noradrenaline (contractility) in the basilar artery, but did not alter its sensitivity (ED50) to the adrenergic vasoconstrictor. Bay K 8644 (0.1 and 1.0 nM) did not alter the contractility or sensitivity to histamine or K+ of the rabbit basilar artery. When dose-response curves to Ca2+ were made in K+-depolarized rabbit basilar artery rings, Bay K 8644 (0.1 and 1.0 nM) dose-dependently augmented tone generated by readmission of Ca2+. Bay K 8644 (0.1 and 1.0 nM) did not alter responses to noradrenaline, histamine, or K+ in rabbit central ear artery preparations. These results are compatible with a voltage-dependent mechanism of action of Bay K 8644 in the rabbit basilar artery, which may be partially depolarized in the resting state. We propose that in addition to other factors, the contractile response of rabbit basilar arteries is limited by a weak or inefficient coupling of alpha-adrenoceptors to Ca2+ channels.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations of mechanical properties in canine basilar arteries after subarachnoid hemorrhage

The purpose of this study was to examine the hypotheses that structural stiffening of the arterial wall contributes to chronic cerebral vasospasm, and that alteration in properties of smooth muscle takes place after subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage and subsequent chronic vasospasm were induced in dogs by two cisternal injections of autologous blood (on Day 0 and Day 2). Vasospasm was confirmed by angiography performed on Day 0 and Day 7. Animals in the control group underwent angiography only. On Day 8, the mechanical properties of the basilar arteries were studied in vitro. Passive compliance, measured under total inhibition of spontaneous myogenic tone with diltiazem (10(-4) M) plus papaverine (10(-4) M) was smaller in the SAH group. The length-contraction curve was shifted to the left and the optimum length for maximum contraction (Lmax) was significantly shorter in the spastic blood vessels. The spontaneous myogenic tone was augmented in the SAH group, resulting in an increase in resting tension at each length. By contrast, the maximum contractions in response to KCl and uridine 5'-triphosphate were markedly reduced in the SAH group, without changes in sensitivity to these agents. These differences in mechanical properties were observed in rings both with and without endothelium. The results indicate that, in chronic vasospasm, stiffening of the noncontractile component of the vasculature takes place as well as alterations in the contractile component, both of which presumably contribute to the shift in resting length-tension relationship and length-contraction relationship of the artery. The decreased distensibility, the increase in resting tension, and the shortening of the Lmax all favor a smaller diameter of the artery after SAH, possibly contributing to vasospasm.

Endothelium-mediated spontaneous response in aortic rings of deoxycorticosterone acetate-hypertensive rats

Aortic rings isolated from normotensive Sprague-Dawley rats (CONT) exhibited spontaneous tone when the preparations were stretched. After administering deoxycorticosterone acetate (DOCA), the rats became hypertensive, and this spontaneous tone increased remarkably. The spontaneous tone was dependent on the extracellular calcium concentration. Incubation with the calcium entry blocker D-600 attenuated the spontaneous response to a greater degree in rings from DOCA rats than in rings from CONT rats. Nifedipine relaxed the already developed spontaneous tone. Removal of the endothelium greatly depressed spontaneous tone, but did not diminish the contraction caused by norepinephrine. On the basis of our findings, we conclude that 1) spontaneous tone depends on calcium influx, presumably through specific stretch-operated membrane channels, 2) these stretch-dependent channels are blocked by D-600 and nifedipine, 3) spontaneous tone is enhanced in DOCA hypertension, and 4) the endothelium appears to act as a receptor for stretch, mediating--at least in part--the spontaneous contractile response by releasing a constrictor agent.

Effects of calcium antagonists on intracerebral penetrating arterioles in rats

There is no direct information on the effect of calcium antagonists on intracerebral penetrating arterioles, which are responsible for a significant part of total cerebrovascular resistance. In a study on rats, the effects of four calcium antagonists (diltiazem, verapamil, nifedipine, and nimodipine) on isolated intracerebral penetrating arterioles with mean resting diameters (+/- standard error of the mean) of 52.3 +/- 3.0 micron were investigated. Vessel diameters were monitored in vitro by means of a video microscope dimensional analyzer under constant transmural pressure (60 mm Hg) after cannulation. Each calcium antagonist produced maximal dilation of about 50% (diltiazem 46.4% +/- 5.6%, verapamil 53.1% +/- 6.0%, nifedipine 46.9% +/- 6.1%, and nimodipine 47.1% +/- 5.4%) with varied sensitivity (median effective dose (ED50): diltiazem 1.52 X 10(-6) M, verapamil 1.08 X 10(-7) M, nifedipine 8.65 X 10(-9) M, and nimodipine 1.62 X 10(-9) M). Dilation effects persisted for a significantly longer time after washout with calcium antagonists such as diltiazem (15.5 +/- 1.8 minutes), nifedipine (19.0 +/- 3.9 minutes), and nimodipine (30.0 +/- 1.6 minutes) than after washout with adenosine (8.5 +/- 1.0 minutes). It appeared that the magnitude of vasodilation was greater and the duration of dilation after washout longer in intracerebral penetrating arterioles than that reported for pial arterioles, although sensitivity to each calcium antagonist was quite similar to that reported for larger cerebral arteries. These data provide a possible explanation for the apparent disparity between clinical efficacy and angiographically determined vessel diameter when patients with cerebral vasospasm are treated with calcium antagonists. These agents may have a greater effect on intracerebral penetrating arterioles than on angiographically visible larger arteries.

Effects of isosorbide dinitrate and diltiazem on Ca2+ flux and contraction in artery

We studied the effects of isosorbide dinitrate and diltiazem on histamine-stimulated 45Ca fluxes and contractions of isolated porcine coronary artery. Isosorbide dinitrate was slightly more potent as an inhibitor of intracellular compared to extracellular calcium-dependent contraction. Isosorbide dinitrate inhibited histamine-stimulated calcium efflux and intracellular calcium-dependent contraction over similar concentration ranges. Isosorbide dinitrate partially inhibited histamine-stimulated calcium influx, but this effect was significant only at high concentration and correlated weakly with inhibition of contraction that was dependent on extracellular calcium. Diltiazem more potently inhibited extracellular vs. intracellular calcium-dependent contraction. Diltiazem partially inhibited histamine-stimulated calcium efflux and intracellular calcium-dependent contraction to similar extents (55-60%) and produced similar concentration-response relationships for inhibition of histamine-stimulated calcium influx and extracellular calcium-dependent contraction. The data suggest that alterations of cellular calcium metabolism are major mechanisms of vascular smooth muscle relaxation by isosorbide dinitrate and diltiazem, but that the specific alterations differ for the two drugs. Isosorbide dinitrate may inhibit contraction primarily by enhancing intracellular calcium sequestration, but possibly also by inhibiting agonist-stimulated calcium influx at high isosorbide dinitrate concentrations. Diltiazem primarily inhibits stimulated calcium influx, but may also inhibit intracellular calcium release.

Cerebrovascular and cerebral effects of nimodipine--an update

A survey is given on the vascular and neuronal effects of calcium antagonists under physiological and pathological conditions. Special emphasis is put on vasospasm caused by subarachnoid haemorrhage and on postischaemic cerebral hypoperfusion following different forms of cerebral ischaemia, and on the attempts to influence these phenomena pharmacologically. Regarding its neuronal effects it seems likely that nimodipine potently blocks calcium entry during pathological conditions like cerebral ischaemia and spreading cortical depression. Positive effects also have been seen during epileptic seizures and withdrawal syndromes, whereas calcium entry under normal physiological conditions does not appear to be affected. Possible clinical consequences are discussed.

Diltiazem protects against functional changes in chronic cerebrovasospasm in monkeys

Diltiazem given 48 hours before experimental subarachnoid hemorrhage protects the cerebral vasculature of monkeys against the widespread cerebrovascular spasm seen on angiography after 5-6 days and against associated neurologic defects. In vitro examination of the cerebral arteries from treated monkeys shows that compared with untreated animals, the functional changes in the vascular smooth muscle cells, the increase in arterial wall stiffness, and the decrease in contractility, all of which were prominent in untreated monkeys, were relatively small. Other changes such as abnormal spontaneous myogenic tone, decreased responsiveness to constrictor and dilator nerve activation, and other indexes of neuronal function were little influenced by the drug. We suggest that chronic cerebrovasospasm may be initiated by the combined action of exceptionally high concentrations of a number of putative spasmogens causing injury to the larger cerebral arteries. However, the later development of intractable spasm is related to the location of blood clot and to the involvement of the vascular wall in an inflammatory process. The combined insult results in pathologic changes in the artery wall resulting in increased thickness and stiffness. Diltiazem acts on cerebrovascular smooth muscle in lower concentrations than on smooth muscle in other vascular beds, interfering with calcium entry through receptor-operated and potential-sensitive channels, and may protect against calcium-induced cell death through these and additional actions. Protection against early events presumably prevents the genesis of the subsequent chronic state.

Characteristics of adrenoceptors and [3H]nitrendipine receptors of porcine vascular smooth muscle: differences between coronary artery and aorta

Characteristics of the bindings of [3H](-)dihydroalprenolol, [125I](-)iodocyanopindolol, [3H]prazosin, [3H]yohimbine, and [3H]nitrendipine to porcine coronary membranes were investigated and the results compared with studies of porcine aortic membranes. In the equilibrium binding study carried out in sarcolemma-enriched fractions, there were no major differences in the Kd values of these radioligands between coronary artery and aorta. However, the densities of beta-, alpha 1-, and alpha 2-adrenoceptors and [3H]nitrendipine receptors of coronary artery were 258, 12, 12, and 561 fmol/mg protein, respectively, while those of aorta were 37, 525, 1,000, and 215 fmol/mg protein. beta-Adrenergic agonists competed with [3H](-)dihydroalprenolol binding sites in coronary artery, the order of potency being (-)isoproterenol greater than (-)norepinephrine greater than (-)epinephrine greater than (+)isoproterenol. In case of aorta, the order was (-)isoproterenol greater than (-)epinephrine greater than (-)norepinephrine. The competition by (+/-)bisoprolol (beta 1-selective antagonist) and ICI 118,551 (beta 2-selective antagonist) for [125I](-)iodocyanopindolol binding sites in coronary artery resulted in nonlinear Hofstee plots (beta 1:beta 2 = 90%:10%). In case of aorta, linear Hofstee plots were obtained. From these results, we conclude that coronary beta-receptors in pigs are predominantly of beta 1-type, while those of aorta are of beta 2-type; regarding the relative population of adrenoceptors, coronary artery is beta-dominant (beta/alpha = 11), while aorta is alpha-dominant (beta/alpha = 0.02); compared with alpha-adrenoceptors, coronary artery has a greater number of [3H]nitrendipine binding sites (nitrendipine/alpha-adrenoceptor = 23) than aorta (nitrendipine/alpha-adrenoceptor = 0.14).

Evidence that intraluminal pressure affects high potassium- and serotonin-induced contractions differently in the bovine middle cerebral artery: an in vitro study

The effects of changing intraluminal pressure on contractions induced by 70 mM potassium (K+) and 10(-7), 10(-6), and 10(-5) M serotonin (5-HT) were studied in vitro in bovine middle cerebral arteries. Changes in vessel outside diameter in whole-mounted cylindrical sections of artery were detected with a photoelectric infrared device. High K+-or 5-HT (10(-5)M)-induced contractions peaked at 25 mm Hg and were significantly correlated with increasing intraluminal pressure between 25 and 175 mm Hg. Contractions induced with lower concentrations of 5-HT (10(-6), 10(-7) M), norepinephrine, and histamine peaked at 75 mm Hg but were not significantly correlated with rising pressure. Phentolamine (2 X 10(-6) M) added to the extraluminal bath had negligible influence on pressure's ability to affect K+- and 5-HT-induced contractions differently. Reducing bath temperature to 27 degrees C reduced the K+ response at each pressure, but similar temperature changes had little affect on the 5-HT-induced contractions. The K+ response became less sensitive to increasing pressure at low temperatures. Nifedipine (10(-7) M) almost totally eliminated K+-induced contractions, while significantly reducing the responses to all concentrations of 5-HT. The 5-HT responses appeared more sensitive to increasing intraluminal pressure in the presence of nifedipine. Maximum Ca++-induced contractions in the presence of 10(-5) M 5-HT and high K+ occurred at 25 mm Hg, while Ca++-induced contractions and Ca++-induced contractions in the presence of 10(-7) 5-HT or K+ plus 5-HT were maximum at 75 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of oxygen and glucose deprivation on vasoactivity in isolated bovine middle cerebral arteries

The effects of oxygen and glucose deprivation on vasoactivity were investigated using helical strips of bovine middle cerebral artery. Hypoxia, created by reducing the PO2 of the bath, or oxidative inhibition with 2,4 dinitrophenol (DNP) or sodium azide, significantly reduced contractions induced by serotonin. Normal tonic contractions induced with fresh and aged whole blood, or 5-HT became phasic and quickly relaxed to baseline in a hypoxic environment. Glucose elimination from the Krebs medium, or the inhibition of the glycolytic pathway with iodoacetic acid (IAA), did not significantly reduce serotonin-induced contractions. However, contractions were inhibited more with the combination of oxygen and glucose deprivation, or DNP + IAA, than with oxygen deprivation alone. Efforts to produce rigor in this preparation by oxygen/substrate reduction or metabolic inhibition were unsuccessful. Tonic contractions induced by 70 mM potassium became phasic as the Ca++ concentration was reduced. Contractions resulting from the readdition of Ca++ to arteries exposed to calcium-free high potassium solution were significantly reduced in the presence of oxidative and/or glycolytic inhibitors. The uptake of 45Ca++, as measured by the lanthanum technique, decreased as the bath PO2 was reduced in both serotonin stimulated and unstimulated arteries. Glucose deprivation alone did not affect 45Ca++ uptake. This study suggests that hypoxia has a direct inhibitory affect on cerebral vasoactivity mediated by reductions in sarcoplasmic Ca++ uptake.

Diltiazem: dose it affect vasospasm?

Calcium antagonists are being investigated for their role in preventing or ameliorating the vasospasm associated with subarachnoid hemorrhage. We have done a phase I and phase II type trial of diltiazem. No effect on spasm was documented. A tendency to increase the bleeding time was noted, but no detrimental clinical effect occurred. The rebleed rate was not changed. It appears that further study of diltiazem through a proper randomized study would not be cost- or time-effective.

Effects of verapamil on the response of the guinea-pig tracheal muscle to carbachol

The effects of verapamil on the contraction of the guinea-pig tracheal smooth muscle induced by calcium (Ca2+) or barium (Ba2+) were investigated in three different conditions: (a) in excess K solution, (b) in the presence of carbachol, and (c) in excess K solution containing carbachol. In order to clarify the contractions, the effects of removal and readdition of the divalent cations were also investigated. In Ca2+-loaded tissues, application of carbachol in Ca-free medium produced a transient contraction, the magnitude of which decreased the longer the duration of exposure to Ca2+-free solution. In Ca2+-depleted, Ba2+-loaded tissues, application of carbachol in a Ba2+- and Ca2+-free medium produced a transient contraction the magnitude of which decreased the longer the duration of exposure to the Ba2+- and Ca2+-free solution. After exposure to Ca2+-free solution for 40 min, the sensitivity of the tissue to Ca2+ was greater in the presence of 30 microM carbachol (ED50 = 0.06 mM) than in the presence of 40 mM K+ (ED50 = 0.3 mM). The Ca2+-sensitivity in the presence of 30 microM carbachol plus K+ (40 mM) was not different from that in the presence of 30 microM carbachol alone. In Ca2+-free solution, the sensitivity of the tissue to Ba2+ in the presence of 40 mM K+ (ED50 = 1.4 mM) was not different from that observed in the presence of 30 microM carbachol (ED50 = 1.3 mM). 6 After exposure to Ca2+-free solution, verapamil produced a parallel rightward shift in the concentration-response curves to added Ca2+ and Ba2+ in the presence of either 40 mM K+, 30 microM carbachol or 40mM K+ plus 30 microM carbachol. 7 The pA2 values of verapamil against Ca2+ responses in the presence of 40 mM K+, 30 microM carbachol and 40 mM K+ plus 30 microM carbachol were 7.0, 6.5 and 6.5, respectively. The pA2 values of verapamil against Ba2+ responses under these conditions were 7.1, 7.0 and 7.1, respectively. 8 It is concluded that the sustained contraction produced by carbachol requires the influx of Ca2+ and that Ba2+ can substitute for Ca2+ in this process. Furthermore, the ionic channels which admit Ca2+ may be modified by carbachol to different degrees depending on the presence of Ca2+ or Ba2+. Such changes alter the affinity of the channel to verapamil.

Diltiazem: possible hematologic complications

Calcium blockers are being investigated for a potential role in the prevention and treatment of cerebral vasospasm. They have been found to inhibit platelet function both with in vivo and with in vitro experiments. Clinical evidence of abnormal platelet function is sparse, however. We are presenting three patients who developed increased bleeding times that reverted to normal when the diltiazem was discontinued. This may lead to serious consequences in the presence of an unsecured aneurysm and for patients facing major intracranial surgery.

Experimental chronic cerebrovascular spasm in the monkey: an assessment of the functional changes in the cerebral arteries and their protection by diltiazem

The structure and function of cerebral arteries obtained from a monkey model of chronic cerebral vascular spasm 5 days after hemorrhage have been examined. Narrowing of the larger cerebral arteries demonstrated by angiography at all sites of measurement seems to be due primarily to an increased wall rigidity associated with cellular damage, the resultant inflammatory response and large, long-lasting spontaneous increases in muscle tone. Changes in agonist sensitivity were extremely variable. The reduction of contractility of the vessel wall to a mean of 30% of control diminished the consequence of any changes in active tone characteristics. Neurogenic control on the side of the lesion was remarkably depressed. When treated with diltiazem, beginning 1 day before induction of hemorrhage and continuing to the time of sacrifice, arterial diameter was reduced at only 1 of the 6 standard sites of measurement and then by only a small amount. Neurologic effects invariably seen in the untreated monkeys were prevented by diltiazem. Many of the changes in the artery wall, including structural alterations, were diminished by the drug. Abnormal spontaneous myogenic tone was present but was less in the diltiazem-treated group; however, nerve damage and its functional consequences were not prevented. It is concluded that diltiazem, presumably by preventing the accumulation of intracellular calcium within the cell, prevents the initial events in the evolution of chronic cerebrovasospasm or narrowing. This is probably achieved by a diminishing of the direct vasoconstrictor effects and the toxicity of putative spasmogens released from blood clots, nerves and the brain on the vascular smooth muscle, thus interrupting the sequence leading to pathologic change.

Blocking effect of diltiazem on thiopentone-induced vasoconstriction in isolated canine internal carotid arteries

Stainless-steel cannulas were inserted into isolated internal carotid arteries of the dog to observe vasoconstrictor responses to thiopentone. Thiopentone at a relatively large dose (100-3,000 micrograms) induced vasoconstrictor responses in a dose-dependent manner. A dose of 1 mg thiopentone usually produced a definite increase in perfusion pressure of greater than 50 mm Hg. These effects were not influenced by treatment with phentolamine in doses that significantly suppressed noradrenaline-induced vasoconstrictor responses. Diltiazem inhibited the constriction in response to thiopentone as well as that to potassium chloride in a noncompetitive antagonistic manner. It is suggested that the constriction induced by thiopentone may be due in part to activation of the calcium-inward channel in the wall of the internal carotid artery.

Effect of diltiazem on experimental chronic cerebral vasospasm in the monkey

The influence of diltiazem on chronic cerebral vasospasm was studied following subarachnoid hemorrhage (SAH) in a primate model. The model mimics the human experience including the production of neurological deficits. Six monkeys were pretreated with diltiazem (25 mg/kg twice daily) for 2 days prior to surgical production of an SAH and for 5 days after the hemorrhage. This group was compared with six untreated monkeys that also sustained an SAH. The mean diameter of cerebral arteries measured at six angiographic sites was 60.6% of the pre-SAH diameter for the untreated group and 99.7% for the diltiazem-treated group. These values are significantly different (p less than 0.0005). There was no neurological deficit in the pretreated animals. The mean diameter of the "most constricted vessel" in each experiment was 22% of the prehemorrhage diameter for the untreated and 84% for the treated group (p less than 0.0005). Arterial pressure was unaffected by the dosage regimen. These experiments with this primate model of chronic cerebral vasospasm demonstrate that vascular narrowing and neurological deficit can be markedly attenuated by diltiazem pretreatment.

Characterization of two different calcium entry pathways in small mesenteric arteries from rat

The effects of Ca2+ removal, nifedipine, and La3+ on contractions induced by 124 mM K+ and 10 microM noradrenaline (NA) were investigated in small mesenteric arteries from rat. Ring segments of the arteries were suspended between two steel wires in a 2.5 ml muscle bath, and the mechanical activity recorded "isometrically". The tonic components of the contractile responses to both K+ and NA were critically dependent on the presence of Ca2+ in the bath solution. Nifedipine effectively relaxed K+-contracted arteries, whereas those activated by NA were considerably less affected by the drug. Application of NA to arteries depolarized by K+ in the presence of nifedipine induced a sustained tonic contraction, which was only approximately 20% smaller than that elicited by NA in "standard" Krebs solution, implicating pharmacomechanical coupling. Unlike nifedipine, La3+ inhibited K+- and NA-induced contractions to approximately the same extent. Re-application of Ca2+ to "Ca2+-depleted" preparations exposed to K+ and/or NA induced concentration-dependent contractions. The experimental results suggested that the effects of K+ and NA on the membrane permeability to Ca2+ were additive. The Ca2+-induced contractions were more inhibited by nifedipine in K+-depolarized than in NA-exposed arteries. It is concluded that K+ and NA utilize partly different Ca2+ entry pathways to increase the myoplasmic Ca2+ concentration in rat mesenteric arteries. Whereas K+ seems to promote the influx Ca2+ by activation of CA2+ channels sensitive to the membrane potential, the nature of the receptor-operated Ca2+ entry pathway remains to be established.

The effects of a calcium antagonist (nimodipine) on basal cerebral blood flow and reactivity to various agonists

In vitro studies suggest that cerebrovascular contraction is more dependent on the influx of calcium to smooth muscle than general systemic arteries. The present study tested the in vivo effects of a calcium influx blocker (nimodipine) on cerebral blood flow and metabolism in 16 baboons. The 133xenon clearance technique was used together with careful control of EEG and blood gases. With normal blood gases intravenous nimodipine infusion (1 microgram/kg/min) produced an 18% increase in cerebral blood flow with no alteration in cerebral oxidative metabolism or blood pressure. Higher doses (above 10 micrograms/kg/min) resulted in a decreased arterial blood pressure and a return to control cerebral flow. Infusion of the dose producing maximal increase in flow, decreased the cerebral reactivity to altered PCO2 (n = 5). These results suggest that nimodipine may be a relatively selective cerebrovascular dilator.

Assessing calcium antagonism on vascular smooth muscle: a comparison of three methods

Three methods relying on depolarization-induced contraction of rabbit aortic rings were compared. The effects of hyperosmolarity induced by adding KCl to the bath and of a lowered NaCl concentration due to an exchange of NaCl for KCl were assessed. A dihydropyridine derivative (PY 108-068) and verapamil were used as antagonists. For the first method, 50.3 mM KCl was either added to the bath to reach a final concentration of 55 mM, or KCl was exchanged for NaCl to keep the bath isoosmotic. We found a noncompetitive antagonism and the results obtained from cumulative concentration-response curves appeared to be based on the slow tonic contraction. For the second method, the rings were suspended in a calcium-free Krebs-Henseleit (KH) or TRIS bath solution containing also 55 mM of KCl and calcium was added as an agonist. We found a competitive inhibition of the calcium effects. The slope of the Schild Plot was, however, -1.3 for PY 108-068 and -0.5 for verapamil. Very high concentrations of calcium had relaxant effects and thus distorted the results. For the third method, the rings were contracted by KCl and then relaxed by adding the calcium antagonist to the bath. Isoosmotic solution and solution made hyperosmotic with sucrose were also used. Hyperosmolarity by itself contributed to the tension development. In hyperosmolar solution, the calcium antagonists appeared to be less active. Such bath conditions can therefore considerably bias the results. The first and the second method, in combination with experiments using receptor stimulating agents such as noradrenaline, appear to be most suitable for investigating calcium antagonists on blood vessels.

Calcium antagonist and the peripheral circulation: differences and similarities between PY 108-068, nicardipine, verapamil and diltiazem

1 The effects of two dihydropyridines, PY 108-068 (PY) and nicardipine (N), and two other calcium antagonists, verapamil (V) and diltiazem (D), on regional blood flow were measured in open-chest cats, anaesthetized with chloralose-urethane.2 Each substance was infused at 3 different dose rates, each for 10 min. The total doses given were 5 plus 10 plus 35 (total of 50) mug/kg for PY, 10 plus 70 (total of 100) mug/kg for N and 100 plus 200 plus 700 (total of 1000) mug/kg for V and D.3 All substances lowered blood pressure and increased total peripheral conductance. Heart rate was lowered only by V, D and PY. Cardiac output was markedly increased only by the diyhydroypridine derivatives; D had small and V almost no effects.4 All substances increased coronary flow and redistributed it in favour of the subepicardial layer. All substances also increased blood flow to the brain. The effects of verapamil were comparatively small.5 Skeletal muscle flow was increased strongly by the two dihydropyridine derivatives. D and V had negligible effects.6 Blood flow to stomach and small intestine was only slightly increased. Flow to the kidneys increased slightly in diltiazem-treated animals but did not change with all other treatments. Flow to the liver, the adrenals, and the spleen remained unchanged or showed a tendency to decrease.7 The organ conductances which reflect the active changes in vascular tone better than blood flow values, showed that there was a tendency towards vasodilatation even in most organs where blood flow tended to decrease.8 Results obtained in an earlier series of experiments with nifedipine were very similar to those described here for N, except that nifedipine was about twice as potent.9 Calcium antagonists were thus neither general peripheral vasodilators nor did they show a uniform pattern of preferential sites of action. The most important common features were increases in coronary and cerebral blood flow and the most important differences the divergent effects of the dihydropyridines on one side and V and D on the other side on skeletal muscle flow. The size of this vascular bed may help to explain why dihydropyridines appear to be particularly potent as peripheral vasodilators.