Synergistic effect of calcitonin gene-related peptide on adenosine-induced vasodepression in rats

Inhibition of potassium channels in critical illness

PURPOSE OF REVIEW

The development of refractory arterial hypotension represents a significant problem in the treatment of critically ill patients, especially during sepsis. Increased activation of ATP-sensitive potassium channels in vascular smooth muscle cells is critically implicated in the pathophysiology of sepsis-induced vasodilation and vascular hyporesponsiveness to catecholamines. Pharmacological blockade of ATP-sensitive potassium channels has been proposed as a goal-directed therapeutic approach to stabilize hemodynamics in septic patients.

RECENT FINDINGS

In different animal models of sepsis, ATP-sensitive potassium channel inhibition with intravenously infused sulfonylureas effectively reversed sepsis-induced systemic vasodilation and hypotension. Two recent clinical trials, however, failed to demonstrate beneficial effects of enterally administered glibenclamide on norepinephrine requirements and blood pressure in septic shock patients. Relevant problems related to ATP-sensitive potassium channel blockade with sulfonylureas in human septic shock include the route of administration (enteral versus intravenous) and the dose itself (benefit-risk relationship). In addition, significant adverse events may result from unspecific inhibition of nonvascular ATP-sensitive potassium channels.

SUMMARY

Inhibition of ATP-sensitive potassium channels remains an attractive option to treat excessive vasodilation in the presence of systemic inflammation. Before this knowledge can be translated into clinical practice, however, future research is needed to define the role of ATP-sensitive potassium channels in critical illness and their specific inhibition in different tissues in more detail.

Investigation of the Mechanisms Underlying the Gastroprotective Effect of Nicorandil

AIM

This study investigated possible mechanisms underlying the gastroprotective effect of nicorandil on experimentally-induced gastric lesions in rats.

METHODS

Rats were randomly assigned to vehicle-, nicorandil (10 mg/kg)-, glibenclamide (6 mg/kg)-, nicorandil + glibenclamide- and cimetidine-pretreated groups, in addition to non-stressed control group, to demonstrate whether the K(ATP )channel opening contributed to nicorandil's gastroprotection. Lesions were induced by water immersion-restraint stress (WIRS) and ulcer indices were determined. Gastric juice parameters (pH, acid output, pepsin and mucin concentrations) were determined. Another set of rats was divided into control, saline-pretreated and nicorandil (10 mg/kg)-pretreated groups. Rats underwent WIRS and their stomachs were used for determination of gastric mucosal lipid peroxides, histamine, PGE(2), and total nitrites levels.

RESULTS

Nicorandil displayed significant protection against gastric lesions formation, abolished by concomitant administration of glibenclamide. Nicorandil significantly reduced gastric acid and pepsin secretion, but upon coadministration with glibenclamide, these effects were blocked. Additionally, nicorandil significantly reduced gastric mucosal lipid peroxides and total nitrites, but did not affect PGE(2) and histamine levels.

CONCLUSION

Results confirm a gastroprotective effect for nicorandil, the mechanism of which comprises K(ATP) channel opening, free radical scavenging, decrease of pepsin and acid secretion and prevention of the detrimental rise in nitric oxide during WIRS.

Nicorandil, its denitrated metabolite, SG-86 and naturally occurring vasodilators synergistically interact on adenosine-induced vasodepression in rats: special reference to adrenomedullin

To investigate synergistic effects among nicorandil, its main metabolite, SG-86 and endogenous vasodilators such as adrenomedullin (ADM), vasoactive intestinal polypeptide (VIP) and calcitonin gene-related peptide (CGRP), the effects of ADM, VIP and CGRP as well as nicorandil and SG-86 alone, and their low-dose combination were examined on adenosine-induced vasodepression in anesthetized rats. Single bolus i.v. injections of adenosine (3-100 micrograms/kg) caused a dose-dependent reduction of arterial blood pressure, accompanied by slight decreases (except for 100 micrograms/kg) in heart rate. i.v. infusion of nicorandil (10 micrograms/kg/min), SG-86 (100 micrograms/kg/min) ADM (1 ng/kg/min), VIP (30 ng/kg/min) or CGRP (1 ng/kg/min) alone, or the low-dose combination of either nicorandil (1 microgram/kg/min), and SG-86 (10 micrograms/kg/min) or either nicorandil or SG-86 and endogenous vasodilators, significantly potentiated the vasodepression produced by bolus i.v. adenosine, but not that by bolus i.v. acetylcholine (0.1 microgram/kg). The observed enhancement did not occur in the presence of glibenclamide (20 mg/kg i.v.). The present results indicate that nicorandil, SG-86 and endogenous vasodilators reciprocally interact, partly in link with KATP channels in vascular smooth muscle.

Effects of nicorandil on experimentally induced gastric ulcers in rats: a possible role of K(ATP) channels

The anti-ulcer effects of nicorandil [N-(2-hydroxyethyl)nicotinamide nitrate ester] were examined on water-immersion plus restraint stress-induced and aspirin-induced gastric ulcers in rats, compared with those of cimetidine. Nicorandil (3 and 10 mg/kg) given orally to rats dose-dependently inhibited the development of acid-related damage (water-immersion- and aspirin-induced gastric lesions) in the models. Cimetidine (50 mg/kg, p.o.) also had anti-ulcer effects in the same models. However, in the presence of glibenclamide (20 mg/kg, i.v.), an antagonist of K(ATP) channels, nicorandil did not inhibit the formation of gastric lesions. Nicorandil (10 mg/kg) given intraduodenally (i.d.), like cimetidine (50 mg/kg), significantly reduced the volume of the gastric content, total acidity and total acid output in the pylorus ligation model. Glibenclamide reversed the changes caused by i.d. nicorandil. I.v. infusion of nicorandil (20 microg/kg per min) significantly increased gastric mucosal blood flow, without affecting blood pressure and heart rate, but the increase in the blood flow was not observed after i.v. treatment with glibenclamide (20 mg/kg). These results indicate that nicorandil administered orally to rats produces the anti-ulcer effect by reducing the aggressive factors and by enhancing the defensive process in the mucosa through its K(ATP)-channel-opening property.

Comparison of the potentiating effects of nicorandil and its denitrated metabolite (SG-86) on the adenosine-induced vasodepression in rats

The potentiating activity of SG-86[N-(2-hydroxyethyl)nicotinamide], a denitrated metabolite of nicorandil, on the adenosine-induced vasodepression was compared with that of nicorandil in anesthetized rats. Single bolus i.v. adenosine (3-100 micrograms/kg) produced dose-dependent reductions of blood pressure, accompanied by slight decreases (except for 100 micrograms/kg) in heart rate. The adenosine-induced vasodepression was significantly enhanced during i.v. infusion of either SG-86 (100 micrograms/kg per min) as well as nicorandil (10 micrograms/kg per min). The enhancement of adenosine action by them did not occur in the presence of glibenclamide (20 mg/kg i.v.). Single bolus i.v. injections of SG-86 (0.3-30 mg/kg), except for 30 mg/kg, which caused a glibenclamide-sensitive decrease by about 5-10 mmHg in mean arterial blood pressure, had no effects on blood pressure and heart rate, whereas those of nicorandil (30-300 micrograms/kg) elicited overt reduction of blood pressure, accompanied by decreases in heart rate. The present results revealed that SG-86, like nicorandil, significantly enhanced the vasodepressor response to adenosine, probably in part through KATP channel activation, and that the activity of SG-86 was about 10 times less potent than that of nicorandil.

Adrenomedullin synergistically interacts with endogenous vasodilators in rats: a possible role of K(ATP) channels

To examine synergistic interactions among naturally occurring vasodilators, we investigated the effects of i.v. infusion of adrenomedullin (ADM) alone and in combination with low-dose vasoactive intestinal polypeptide (VIP) or calcitonin gene-related peptide (CGRP) on adenosine-induced vasodepression in rats. I.v. infusion of the combination of low-dose ADM (0.1 ng kg(-1) min(-1)) and VIP (3 ng kg(-1) min(-1)), as well as that of ADM (1 ng kg(-1) min(-1)) alone, significantly enhanced the vasodepressor responses to bolus i.v. doses of adenosine (3-100 microg kg(-1)), but not those to acetylcholine (0.1 microg kg(-1)). The observed potentiation did not occur in the presence of glibenclamide (20 mg kg(-1) i.v.), an antagonist of K(ATP) channels. Simultaneous i.v. infusion of low-dose ADM and CGRP (0.1 ng kg(-1) min(-1)) failed to enhance the effects of adenosine as well as acetylcholine. In the whole-cell voltage clamp experiments using single cells of the rat mesenteric artery, ADM (10(-11)-10(-7) M) as well as CGRP (10(-11)-10(-7) M) produced increases of inward current in a concentration-dependent manner. The ADM-induced current was not affected by iberiotoxin, a specific blocker of large conductance Ca2+-activated K+ channels, but suppressed markedly by glibenclamide and CGRP(8-37), a selective antagonist of CGRP1 receptors. From the results, we conclude that several naturally occurring vasodilators involving ADM synergistically interact, probably in link with K(ATP) channels, and furthermore that ADM may act, in part through CGRP1 receptor activation.

Synergism between low-dose nicorandil and neuropeptides on adenosine-induced vasodepression in rats

We hypothesized that the effect of nicorandil may be enhanced by interaction with naturally occurring vasodilators. To clarify this hypothesis, the effects of low-dose nicorandil alone and in combination with low doses of vasoactive intestinal polypeptide (VIP) or calcitonin gene-related peptide (CGRP) on adenosine-induced vasodepression were studied in rats. Intravenous (i.v.) bolus injections of adenosine (3-100 microg kg(-1)) elicited dose-dependent decreases in blood pressure, accompanied by slight decreases (except for 100 microg kg(-1)) in heart rate. Simultaneous i.v. infusion of either nicorandil (1 microg kg(-1) min(-1)) and VIP (0.003 microg kg(-1) min(-1)) or CGRP (0.1 ng kg(-1) min(-1)) significantly enhanced the adenosine-induced vasodepression, although each agent alone in the dose used had no effects on vasodepressor responses to adenosine. The potentiation of the effect of adenosine was not observed in the presence of 3,7-dimethyl-1-propargylxanthine (DMPX) (1 mg kg(-1), i.v.) or glibenclamide (20 mg kg(-1), i.v.). The present results suggest that low-dose nicorandil modifies the response to adenosine in interaction with low levels of endogenous neuropeptides such as VIP and CGRP, and that the reciprocal interaction is mediated partly through K(ATP) channel activation in vascular smooth muscle.

Reciprocal interactions among neuropeptides and adenosine in the cardiovascular system of rats: a role of K(ATP) channels

Possible reciprocal interactions among vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP) and adenosine were investigated in anesthetized rats. Changes in arterial blood pressure were taken as a parameter to evaluate the interactions. The i.v. bolus injections of VIP (0.3 or 1 microg kg(-1)), CGRP (0.1 or 0.3 microg kg(-1)) and adenosine (1-100 microg kg(-1)), like acetylcholine (0.1 microg kg(-1)), produced reductions of blood pressure, accompanied by slight changes (less than 5% except for 100 microg kg(-1) adenosine) in heart rate (HR). The vasodepressor responses to VIP and CGRP were significantly augmented by i.v. infusion of adenosine (3 microg kg(-1) min(-1)). The vasodepressor responses to adenosine and CGRP by VIP (0.03 microg kg(-1) min(-1)), and those to adenosine and VIP by CGRP (1 ng kg(-1) min(-1)) were also enhanced. The response to acetylcholine remained unchanged before and during i.v. infusion of either VIP, CGRP or adenosine. The i.v. infusion of cromakalim (0.1 microg kg(-1) min(-1)) also augmented the responses to VIP, CGRP and adenosine, but not to acetylcholine, whereas a single bolus i.v. injection of glibenclamide (20 mg kg(-1)) significantly attenuated each one of them. The present results suggest that endogenous vasodilators, such as VIP, CGRP and adenosine, reciprocally interact in the body, at least partly through ATP-sensitive K+ channels.