Cooling enhances alpha 2-adrenoceptor-mediated vasoconstriction in human hand veins

Interindividual variability in cold-pressor pain sensitivity is not explained by peripheral vascular responding and generalizes to a C-nociceptor-specific pain phenotype

ABSTRACT

Pain sensitivity of healthy subjects in the cold-pressor (CP) test was proposed to be dichotomously distributed and to represent a pain sensitivity trait. Still, it has not been systematically explored which factors influence this pain sensitivity readout. The aim of this study was to distinguish potential contributions of local tissue-related factors such as perfusion and thermoregulation or gain settings in nociceptive systems. Cold-pressor-sensitive and CP-insensitive students screened from a medical student laboratory course were recruited for a CP retest with additional cardiovascular and bilateral local vascular monitoring. In addition, comprehensive quantitative sensory testing according to Deutscher Forschungsverbund Neuropathischer Schmerz standards and a sustained pinch test were performed. Cold pressor was reproducible across sessions (Cohen kappa 0.61 ± 0.14, P < 0.005). At 30 seconds in ice water, CP-sensitive subjects exhibited not only more pain (78.6 ± 26.3 vs 29.5 ± 17.5, P < 0.0001) but also significantly stronger increases in mean arterial blood pressure (12.6 ± 9.3 vs 5.6 ± 8.1 mm Hg, P < 0.05) and heart rate (15.0 ± 8.2 vs 7.1 ± 6.2 bpm, P < 0.005), and lower baroreflex sensitivity, but not local or vasoconstrictor reflex-mediated microcirculatory responses. Cold-pressor-sensitive subjects exhibited significantly lower pain thresholds also for cold, heat, and blunt pressure, and enhanced pain summation, but no significant differences in Aδ-nociceptor-mediated punctate mechanical pain. In conclusion, differences in nociceptive signal processing drove systemic cardiovascular responses. Baroreceptor activation suppressed pain and cardiovascular responses more efficiently in CP-insensitive subjects. Cold-pressor sensitivity generalized to a pain trait of C-fiber-mediated nociceptive channels, which was independent of local thermal and vascular changes in the ice-water-exposed hand. Thus, the C-fiber pain trait reflects gain setting of the nociceptive system.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

Hands and feet: physiological insulators, radiators and evaporators

The purpose of this review is to describe the unique anatomical and physiological features of the hands and feet that support heat conservation and dissipation, and in so doing, highlight the importance of these appendages in human thermoregulation. For instance, the surface area to mass ratio of each hand is 4-5 times greater than that of the body, whilst for each foot, it is ~3 times larger. This characteristic is supported by vascular responses that permit a theoretical maximal mass flow of thermal energy of 6.0 W (136 W m(2)) to each hand for a 1 °C thermal gradient. For each foot, this is 8.5 W (119 W m(2)). In an air temperature of 27 °C, the hands and feet of resting individuals can each dissipate 150-220 W m(2) (male-female) of heat through radiation and convection. During hypothermia, the extremities are physiologically isolated, restricting heat flow to <0.1 W. When the core temperature increases ~0.5 °C above thermoneutral (rest), each hand and foot can sweat at 22-33 mL h(-1), with complete evaporation dissipating 15-22 W (respectively). During heated exercise, sweat flows increase (one hand: 99 mL h(-1); one foot: 68 mL h(-1)), with evaporative heat losses of 67-46 W (respectively). It is concluded that these attributes allow the hands and feet to behave as excellent radiators, insulators and evaporators.

Cooling augments vasoconstriction mediated by 5-HT1 and alpha2-adrenoceptors in the isolated equine digital vein: involvement of Rho kinase

The vasculature of the equine digit fulfils an important role in thermoregulation. In other species, it has been found that cooling may enhance the response of cutaneous vessels to 5-hydroxytryptamine (5-HT) and alpha(2)-adrenoceptor agonists. Translocation of alpha(2)-adrenoceptors to the smooth muscle cell membrane, mediated by Rho kinase, is thought to be involved in the cooling-enhanced response in mouse tail arteries. However, little is known about the effect of cooling on 5-HT receptor function. The present investigation compared the response of 5-bromo-6-(2-imidazolin-2-ylamino) quinoxaline (UK14304:1 nM to 30 microM), methoxamine (0.1 nM to 30 microM; in the presence of yohimbine 0.1 microM), 5-carboxamidotryptamine (5-CT; 0.1 nM to 10 microM) and alpha-methyl 5-HT (0.1 nM to 10 microM) in the isolated equine digital vein at 30 degrees C and 22 degrees C. The effect of the Rho kinase inhibitor, fasudil (1 microM), and the recovery of the response after the irreversible blockade of surface receptors with phenoxybenzamine (10 microM) or 2-ethoxy-1-ethoxycarbonyl-1,2-dihydroquinoline (EEDQ;10 microM), was established. Moderate cooling significantly increased the maximum response to alpha-methyl 5-HT, 5-CT and UK14304 and shifted their response curves to the left. Cooling also augmented the phenoxybenzamine- and EEDQ-resistant response to UK14304 and 5-CT, respectively. Fasudil had no effect on the contractile response at 30 degrees C, but completely abrogated the effect of cooling on the response to 5-CT and UK14304. The response to methoxamine was not significantly affected by cooling. These results suggest that Rho kinase plays an important role in the cooling-enhanced response mediated by 5-HT(1B/D) receptors and alpha(2)-adrenoceptors. The exact mechanism by which Rho/Rho kinase enhances the functional responses mediated by these receptors in these vessels has yet to be determined.

Influence of several methodological procedures utilized to obtain in vitro vascular preparations on endothelial activity

Several maneuvers usually employed to set up isolated vascular preparations could effect the endothelium-dependent relaxation (EDR). The effects of five such maneuvers were studied in rings of rat aorta: 1) Type of anesthesia, 2) Cold storage of the vessels, 3) Length of the stabilization period, 4) Repeated contractions during stabilization, and 5) Performance of washouts during stabilization. Repeated contractions with norepinephrine (NE) 0.1 microM after stabilization altered neither the contraction nor the EDR induced by acetylcholine (Ach) 1 microM. Pentobarbital anesthesia and cold storage of the preparations for 24 h significantly decreased the EDR without effecting the contractile response of the rings. The absence of washouts during stabilization increased the contractions to either NE 0.1 microM or KCl 80 mM by nearly 50%. This increase was prevented by endothelial disruption or, in the presence of intact endothelium, by repeated washouts or by incubation with Bosentan 22 microM. It is concluded that 1) Anesthesia of the animals and cold storage of the preparations can alter the EDR even in the absence of contractile changes in the smooth muscle, and 2) Accumulation of endothelin during the incubation period, even if not producing changes in the resting tension, can substantially alter the subsequent response to vasoactive interventions.

Local cooling alters neural mechanisms producing changes in peripheral blood flow by spinal cord stimulation

This study was performed to investigate the respective role of sensory afferent and sympathetic fibers in peripheral vasodilatation induced by spinal cord stimulation at different hindpaw skin temperatures. Cooling the skin was used as a strategy to enhance sympathetic activity [Am. J. Physiol.: Heart Circ. Physiol. 263 (1992) H1197]. Cutaneous blood flow in the footpad of anesthetized rats was recorded using laser Doppler flowmetry. Local cooling (<25 degrees C) or moderate local cooling (25-28 degrees C) of the hindpaw was produced with a cooling copper coil. Spinal cord stimulation delivered at clinically relevant parameters and with 30%, 60%, and 90% of motor threshold induced the early phase of vasodilatation in the cooled and the moderately cooled hindpaw. In addition, spinal cord stimulation at 90% of motor threshold produced the late phase of vasodilatation only in the cooled hindpaw, which was possible to block by the autonomic ganglion-blocking agent, hexamethonium. The early responses to spinal cord stimulation in the moderately cooled hindpaw were not affected by hexamethonium. In contrast, both the early and the late phase responses were eliminated by CGRP (8-37), an antagonist of the calcitonin gene-related peptide receptor. After dorsal rhizotomy, spinal cord stimulation at 90% of motor threshold elicited hexamethonium-sensitive vasodilatation in the cooled hindpaw (late phase). These results suggest that spinal cord stimulation-induced vasodilatation in the cooled hindpaw (<25 degrees C) is mediated via both the sensory afferent (early phase of vasodilatation) and via suppression of the sympathetic efferent activity (late phase) although the threshold for vasodilatation via the sympathetic efferent fibers is higher than that via sensory nerves. In contrast, vasodilatation via sensory afferent fibers may predominate with moderate temperatures (25-28 degrees C). Thus, two complementary mechanisms for spinal cord stimulation-induced vasodilatation may exist depending on the basal sympathetic tone.

Role of elastic fibers in cooling-induced relaxation

The objective of this work was to confirm the main role of elastic fibers in differing responses of certain vessels during cooling from 37 to 8 degrees C. Previous results have shown that the nature of the vessel (conduit vessel vs muscular vessel) determines the different behavior (dilatation vs contraction) of isolated vessel segments when temperature decreases from 37 to 8 degrees C. In this work, it has been demonstrated that vessels with a great amount of elastic fibers show a dilatation when cooling. On the other hand, muscular vessels with fewer elastic fibers, such as the renal artery, undergo a contraction. The output of calcium from intracellular stores causes contraction of the renal artery during cooling. In this vessel, vasodilatation occurs only when mechanisms of smooth muscle contraction are inactive, as is the case with vessels that have undergone a cold storage period of 48 h. The results presented in this work confirm that there are two main effects, which directly depend on the vessel origin. In conduit arteries, the decrease of temperature induces a vascular relaxation, dependent on the elastic component of the vessel wall. In muscular vessels, the predominant effect is cooling-induced contraction due to an increase of intracellular calcium. This cooling-induced contraction needs the vessel to be in optimal conditions with an active metabolism of the muscular cells. These results are a crucial issue in the sense of explaining several biomedical mechanisms where hypothermia is implicated. The type of vessel implicated in procedures, such as isolated organ perfusion, extracorporeal circulation, and bypass surgery, must be taken into account.

Control of vascular tone in notothenioid fishes is determined by phylogeny, not environmental temperature

We examined potential vasomotor control mechanisms in an Antarctic fish (Trematomus bernacchii; usual core temperature approximately -1 degrees C), comparing sensitivity to agonists by means of the cumulative dose response and potency with reference to depolarization by 50 mM KCl. In efferent branchial arteries, norepinephrine (NE) produced approximately 20% of the maximal KCl tension and ~40% in the presence of 10(-3)M sotalol, suggesting a modest contribution of alpha- and beta-adrenergic tonus [half-maximal response (pEC(50)) = 6.29 +/- 0.37 M]. Carbachol (CBC) and serotonin (5-HT) had different sensitivities (pEC(50) = 4.50 +/- 0.40 and 6.82 +/- 0.08 M, respectively) but similar potencies (21.6 +/- 11.1 and 31.1 +/- 5.3% of KCl). A related species from warmer waters around New Zealand, Paranotothenia angustata, had similar vascular reactivity for NE (pEC(50) = 5.48 +/- 0.31 M), CBC (pEC(50) = 4.94 +/- 0.22 M), and methysergide-sensitive vasoconstriction with 5-HT (pEC(50) = 6.22 +/- 0.40 M). Agonist potencies were 9, 65, and 45% that of KCl, respectively. Bovichtus variegatus, a member of the phylogenetic sister group to the notothenioids, also gave broadly similar responses. In contrast, Dissostichus mawsoni, a pelagic Antarctic notothenioid, showed a dominance of vasodilatation over vasoconstriction, with sensitive isoprenaline (pEC(50) = 6.66 +/- 0.05 M) but weak serotonergic (5.2 +/- 1.5% KCl) responses. The unusual dominance of serotonergic control appears to be primarily a consequence of evolutionary lineage rather than low environmental temperature, but the pattern may be modified according to functional demand.

Hypothermia and rewarming after hypothermic exposure alter venous relaxation

Hypothermia has pathophysiological consequences on endothelial and smooth muscle cell function. This study investigates the impact on venous relaxation of hypothermia and rewarming following hypothermic exposure. In vitro isometric relaxation responses of norepinephrine precontracted rabbit external jugular veins to a panel of endothelium-dependent and -independent agonists were assessed in controls at 37 degrees C, and in an experimental group after cooling to 20 degrees C and after rewarming to 37 degrees C. On cooling, the endothelium-dependent responses to acetylcholine became multiphasic with initial contraction at low concentrations followed by relaxation at higher concentrations, the maximum of which was significantly diminished compared to controls. Incubation with indomethacin did not affect this response. Rewarming re-established a monophasic dose-dependent acetylcholine induced relaxation response but the maximal response was significantly augmented. This augmentation in relaxation on rewarming could be prevented by preincubation with indomethacin. The maximal response to calcium ionophore was reduced at 20 degrees C and augmented upon rewarming to 37 degrees C. All veins relaxed in a dose-dependent manner to the non-endothelium-dependent agonists forskolin and sodium nitroprusside; the maximal responses were significantly reduced at 20 degrees C and returned to normal upon rewarming. This study suggests that short-term exposure of venous tissue to hypothermia impairs the vessel's ability to produce endothelium-dependent relaxation. Rewarming does not re-establish normal endothelium-dependent relaxation but results in an enhanced, partially indomethacin-sensitive, response which appears to be independent of changes in non-endothelium-dependent mediated relaxation.

Direct angiotensin converting enzyme inhibitor-mediated venodilation

BACKGROUND

The vasodilator effects of angiotensin converting enzyme inhibitors have been ascribed to systemic inhibition of the angiotensin II generation. However, local mechanisms of vasodilation also have been suggested. We tested whether the angiotensin converting enzyme inhibitor enalaprilat mediated local vasodilation in human dorsal hand veins.

METHODS

We infused enalaprilat and assessed changes in dorsal hand vein compliance using the linear variable differential transducer technique. Enalaprilat-mediated effects were assessed in small and large veins and in the presence and absence of one of two vasoconstrictors: exogenous norepinephrine or physiologic vasoconstriction by cooling.

RESULTS

We infused locally in small dorsal hand veins at skin temperatures of less than 29.0 degrees C (baseline distention < 0.35 mm) in the absence of exogenous vasoconstrictors, enalaprilat mediated dose-dependent vasodilation (median effective dose [ED50], 12 ng/min to a maximal effect of 162% +/- 15% of baseline, p < 0.01). Maximal enalaprilat-mediated vasodilation was comparable to dilation mediated by insulin (175% +/-17% of baseline; p = 0.21) and less than dilation mediated by nitroglycerin (221% +/- 20% of baseline; p = 0.011). At skin temperatures > 31 degrees C, enalaprilat mediated dose-dependent vasodilation in small vessels only when vessels were preconstricted with norepinephrine (ED50 = 5.1 ng/min, maximal enalaprilat-mediated effect of 164% +/- 21% of baseline; p < 0.05).

CONCLUSIONS

These data suggest enalaprilat mediates local vasodilation in dorsal hand veins, with an ED50 comparable to plasma enalaprilat concentrations achieved with oral enalapril therapy. This effect is dependent on vessel size and on the presence of preconstruction. Local vasodilator effects may be important in the clinical hemodynamic effects of angiotensin converting enzyme inhibitors.

Responses of noradrenergic nerves in rabbit ear-artery before and after experimental frost-bite

Experiments were designed to determine the effects of sub-zero temperatures on the function of the noradrenergic innervation of a peripheral blood-vessel. The central ear-artery of the rabbit was used for this purpose. The ear was exposed to temperatures of -6, -9 or -18 degrees C in vivo for 15 min. After 1 day (24 h) or 6 days in vivo, the central ear-artery was dissected free, incubated in [3H]-noradrenaline (NA) and stimulated in vitro with high potassium (75 mM) for 5 min to evoke release of [3H]-NA. The release of [3H]-NA was Ca(2+)-dependent. One day after exposure to -6, -9 or -18 degrees C, increases of 45-57 and 44-72% and a reduction of 12-35% were observed, respectively, in three successive potassium-evoked NA-releases. After 6 days in vivo an increase of 30-34% was observed following exposure to -6 degrees C, while no alteration was observed after exposure to -9 degrees C. A reduction of 84-89% was recorded after exposure to -18 degrees C. Following this exposure to -18 degrees C, there was also a great reduction in the evoked release of [3H]-NA compared with the spontaneous release, whereas this correlation did not change after exposure to -6 and -9 degrees C. The total uptake of [3H]-NA was unchanged after freezing the tissue at -6 degrees C, but was substantially reduced after exposure to -9 and -18 degrees C. A short period of in vivo restoration (6 days, enhanced the uptake of [3H]-NA.(ABSTRACT TRUNCATED AT 250 WORDS)

Haemodynamic changes and oxygen uptake during crossclamping of the thoracic aorta in dexmedetomidine pretreated dogs

This study was designed to test the hypothesis that the alpha 2 adrenergic agonist, dexmedetomidine (DEX), decreases tissue oxygen demand thereby increasing tolerance to hypoxic insult. In 17 anaesthetized dogs, cardiac output was measured with thermodilution, blood flow through the inferior caval vein was determined using an electromagnetic flowmeter, and oxygen consumption was calculated by the Fick principle. The animals were divided into three groups: control group (n = 5), D3 and D30 groups (n = 6 for each group) treated with two doses of DEX (3 micrograms.kg-1 and 30 micrograms.kg-1, respectively) prior to aortic crossclamping. Upon crossclamping of the thoracic aorta, the cardiac index decreased in all three groups with the largest decrease in the D30 group, and the smallest decrease in the control group. Blood flow through the inferior vena cava decreased in all three groups of animals while blood flow through the superior caval vein increased in the control group, did not change in the D3 group, and decreased in the D30 group. Oxygen saturation in mixed venous blood increased in the control group, did not change in the D3 group and decreased in D30 group. Blood flow and oxygen uptake in the lower part of the body decreased in all groups. Oxygen consumption in the upper part of the body decreased equally in all three groups. Arterial lactate concentrations increased almost two-fold in the control group while it increased by only 30% in animals treated with DEX. A lesser increase in lactate concentrations and oxygen extraction in tissues below aortic crossclamping is consistent with the hypothesis that DEX decreases tissue oxygen requirement which might prove particularly useful in clinical situations where tissue hypoxia is expected.

Effect of cooling on smooth muscle response to 5-hydroxytryptamine in human hand veins

5-Hydroxytryptamine has been suggested to be a mediator in peripheral cold-induced vasospasm. In order to investigate the contribution of different 5-hydroxytryptamine receptor subtypes in the contractile response during cooling, segments of subcutaneous hand veins obtained from 50 patients undergoing hand surgery were examined in vitro in organ baths. The temperature in the bath was initially 37 degrees C and was either continuously lowered to 10 degrees C or kept constant at 37 degrees C, 29 degrees C. Cooling to 25 degrees C augmented the contractile response to 5-hydroxytryptamine in intact as well as in endothelium-denuded segments. The 5-hydroxytryptamine2 receptor antagonist ketanserin antagonized the contractile response to 5-hydroxytryptamine at 37 degrees C, and in addition abolished the cold-induced enhancement of the response during cooling. This points to a major role of the 5-hydroxytryptamine2 receptor in the cold-induced augmentation of the response to 5-hydroxytryptamine, which was further supported by increased contractions to the 5-hydroxytryptamine2 receptor agonist alpha-methyl-5-hydroxytryptamine during cooling. Contractile responses were also obtained by the selective 5-hydroxytryptamine1-like receptor agonist GR43175 interpreted to indicate the presence of a smaller 5-hydroxytryptamine1-like receptor population. However, the response to GR43175 was unaffected by cooling. These results warrant further investigations of the role of 5-hydroxytryptamine in cold-induced peripheral vasospasm.