Interactions of spironolactone with (+)-[3H]-isradipine and (-)-[3H]-desmethoxyverapamil binding sites in vascular smooth muscle

Zinc ions efflux from lymphocytes in vitro in the presence of a calcium and magnesium ionic environment and its changes following administration of verapamil

The total and ouabain-dependent rate constants of efflux of zinc (Zn) ions from lymphocytes isolated from healthy subjects were measured in vitro in an environment containing calcium (Ca) and magnesium (Mg) ions. Both the total (ERCt-Zn) and ouabain-dependent (ERCos-Zn) rate constants were higher in the presence of Mg2+, with the the oubain-dependent efflux significantly different 0.29+/-0.07 vs 0.13+/-0.02 with and without Mg2+, respectively (p<0.001). After the addition of verapamil, an increase of ERCE-Zn was observed in both ionic environments and was higher and statistically significant in the presence of Mg2+: 1.94+/-0.64 vs 2.97+/-1.16 (p<0.025). These results suggest that verapamil has an enhancing effect on Zn efflux from isolated lymphocytes, suggesting that calcium channel blockers might result in better Zn homeostatic regulation in diseases of the cardiovascular system.

Effects of canrenone on aorta and right ventricle of the rat

Canrenone is a major active metabolite of spironolactone and, in addition to the antimineralocorticoid effect, shares with the parent compound the action as a partial agonist with respect to ouabain on the Na+-K+ ATPase. We have investigated whether canrenone, through its action on Na+-K+ ATPase, reverses rat aorta contractions induced by ouabain and has vasorelaxant properties unrelated to its interaction with ouabain. Contractile responses of endothelium-deprived aorta to 1 mM ouabain, 0.1 microM phenylephrine, 10 microM serotonin, and 60 mM K+ were relaxed by canrenone (50-250 microM), with maximum inhibitions of 85.3%, 55.3%, 56.7%, and 64.2%, respectively. Canrenone shifted to the right the concentration-response curve for Ca2+ in depolarized aorta and did not affect the response to 10 mM caffeine. In rat right ventricular strips driven at 0.1 Hz, canrenone exerted negative inotropic effect. The relaxation of ouabain-induced contraction may be due, at least in part, to an interaction between canrenone and ouabain on the Na+-K+ ATPase. Inhibition of calcium entry through calcium channels either in aorta or ventricles is the most parsimonious hypothesis of mechanism underlying the effect of canrenone on contractile responses of rat aorta to agonists and high K+ and the negative inotropic effect on ventricular strips.

Angiotensin-converting enzyme inhibitor and spironolactone combination therapy. New objectives in congestive heart failure treatment

Secondary aldosteronism has deleterious effects in patients with congestive heart failure (CHF) and can contribute to congestion, ventricular arrhythmias, and sudden death. Mortality is higher in patients with elevated levels of plasma aldosterone. Aldosterone increases as CHF progresses as a result of activation of the renin-angiotensin-aldosterone system (RAAS). This is further amplified by the routine use of diuretics. Angiotensin-converting enzyme (ACE) inhibitors produce a profound and consistent inhibition of angiotensin II production, but they exert only a mild and transient antialdosterone effect. In a number of studies involving ACE inhibitors, plasma aldosterone levels at the end of the trial do not differ significantly from baseline. Spironolactone, a specific aldosterone receptor antagonist, may exert an independent and additive effect to that of ACE inhibitors. Apart from its renal effects, recent evidence suggests that spironolactone may exert direct cardiac and vascular effects inhibiting cardiac collagen hypertrophy and limiting vascular constriction. Combining an ACE inhibitor and spironolactone may achieve a more complete inhibition of the whole RAAS and may produce further clinical benefits. The efficacy and safety of such a combination has not been properly addressed. In the CONSENSUS trial, plasma potassium and creatinine levels were not necessarily adversely affected when enalapril was added to the regimens of patients receiving spironolactone, a condition existing in > 40% of the patients enrolled in this study. One prospective open study and other anecdotal reports suggest that combining spironolactone and ACE inhibitors resulted in clinical improvement without serious side effects in patients who could not tolerate further increases in the ACE inhibitor dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of mechanical and hormonal factors in cardiac remodeling and the biologic limits of myocardial adaptation

Patients with chronic congestive heart failure manifest > or = 1 of the following abnormalities: diastolic dysfunction, systolic dysfunction, and arrhythmias. Diastolic dysfunction, one of the first symptoms to occur during hypertensive cardiopathy, depends on both active relaxation of the cardiac muscle and passive ventricular compliance. The ability of the ventricles to relax depends on normal calcium metabolism and adenosine triphosphate concentration. Ability to extrude intracellular calcium is depressed in the hypertrophied, overloaded heart as compared with the normal myocardium. Myocardial fibrosis is the major cause of increased diastolic ventricular stiffness. Left ventricular (LV) hypertrophy and myocardial fibrosis also greatly increase the likelihood of ventricular arrhythmias, in particular by prolonging the QRS interval and facilitating the occurrence of reentry arrhythmias. Findings in animal studies have indicated that such fibrosis, which involves excessive collagen deposition, is independent of LV hypertrophy and that LV hypertrophy does not necessarily result in myocardial fibrosis. Instead, the development of myocardial fibrosis is sensitive to circulating levels of both angiotensin II and aldosterone, and the fibrotic response to each of these substances is independent. The aldosterone antagonist spironolactone prevents myocardial fibrosis in several animal models, thus confirming the importance of aldosterone in the genesis of excessive collagen deposition.

Effects of antiandrogens and progesterone on isolated rat uterus

1. The effect of progesterone (P, 6 x 10(-6)-6 x 10(-5) M) and the antiandrogens cyproterone acetate (CPA, 10(-7)-10(-5) M), flutamide (F, 10(-6)-6 x 10(-5) M) and spironolactone (S, 10(-6)-6 x 10(-5) M) on the KCl-induced tonic contraction of the isolated rat uterus have been assayed. 2. The antiandrogens relaxed, in a dose-dependent way, the KCl-induced contraction (EC50, 2.804 +/- 0.506 x 10(-6); 1.671 +/- 0.308 x 10(-5); and 3.042 +/- 0.14 x 10(-5) M, respectively for CPA, S and F). P also relaxed the KCl-induced contraction (EC50, 2.436 +/- 0.524 x 10(-5) M). 3. CaCl2 (0.1-10 mM) counteracted the relaxing effect of CPA, S, F, and P, respectively, up to 100, 80.63, 60.66 and 90.57%. 4. The 17-OH-progesterone derivative CPA, but not S or F, reduces at small doses (6 x 10(-8) M), but not at higher concentrations (6 x 10(-7)-6 x 10(-6) M), the relaxing effect of progesterone.