Decreased uptake of 3H-serotonin and endogenous content of serotonin in blood platelets in hypertensive patients

Relation Between Platelet Reactivity Levels and Diabetic Retinopathy Stage in Patient with Type 2 Diabetes Mellitus by Using Multiplate Whole Blood Aggregometry

Purpose: To test the hypothesis of a possible association between platelet reactivity and the severity of diabetic retinopathy using Multiplate whole blood aggregometry in type 2 diabetes mellitus patients. Methods: Of 157 patients were divided to three groups based on the severity of diabetic retinopathy (normal, non-proliferative and proliferative [ordinal among group 1-2-3]). Platelet reactivity was measured using arachidonic acid response to the ASPI and ADP platelet test. The association between DR stage and the degree of platelet reactivity (predictor variable) ASPI, ADP, systolic blood pressure, age, hypertension, body mass index (BMI), HbA1c, creatinine, Microalbumin, platelet, triglyceride/HDL and Hscrp variables were evaluated using ordinal logistic regression models (Model 1). The association between DR presence (outcome variable (group 1 vs group 2 and 3)) and the presence of variables was evaluated using binary logistic regression models (Model 2). Results: A comparison of the laboratory parameters of the three groups revealed that the ASPI, ADP, glucose and HbA1c values were significantly higher in Group-3 than Group-1. ASPI (odds-ratio OR: 1.044[1.021-1.09], p < .001], ADP (OR: 1.033[1.010-1.10], p: 0.002] and HbA1c (OR: 2.42(1.22, 4.94), p < .001) were demonstrated to be associated with stage of DR while the other variables were not. In binary logistic regression (model-2) analysis; ASPI (OR: 1.061[1.031-1.1], p < .001], ADP (OR: 1.03(1.01, 1.06), p: 0.045] and HbA1c (OR: 4.37 (1.67, 11.36)], p: 0.002) were associated with DR while the other variables were not. Conclusion: Herewith, we demonstrated that higher platelet reactivity measured by multiplate ASPI and ADP was significantly associated with stages of DR. Therefore, these measurements may be useful to predict the severity of DR in the clinical practice of physicians.

Amino Acids and Hypertension in Adults

Accumulating evidence suggests a potential role of dietary protein among nutritional factors interfering with the regulation of blood pressure. Dietary protein source (plant versus animal protein), and especially, protein composition in terms of amino acids has been postulated to interfere with mechanisms underlying the development of hypertension. Recently, mounting interest has been directed at amino acids in hypertension focusing on habitual dietary intake and their circulating levels regardless of single amino acid dietary supplementation. The aim of the present review was to summarize epidemiological evidence concerning the connection between amino acids and hypertension. Due to the large variability in methodologies used for assessing amino acid levels and heterogeneity in the results obtained, it was not possible to draw robust conclusions. Indeed, some classes of amino acids or individual amino acids showed non-causative association with blood pressure as well as the incidence of hypertension, but the evidence was far from being conclusive. Further research should be prompted for a thorough understanding of amino acid effects and synergistic actions of different amino acid classes on blood pressure regulation.

Endothelin-1, nitric oxide, serotonin and high blood pressure in male adolescents

Background

Essential arterial hypertension (EAH) in adolescents represents a social burden. The endothelium is involved in the pathogenesis of EAH. Imbalance of key vasoactive factors – namely nitric oxide (NO) and endothelin-1 (ET-1) – is observed, and serotonin (5-HT) release is also impaired. The relationship between the factors and high blood pressure (BP) has been established mainly in preclinical studies and in the adult age. The aim of the present manuscript is to establish the association between plasma ET-1, serum NO and 5-HT, platelet 5-HT levels and BP in male adolescents, analyzing their concentrations in controls, prehypertensive and hypertensive children. Consequently, we want to evaluate ET-1, NO and 5-HT levels as preclinical biomarkers of EAH.

Methods

Outpatient adolescents, examined at Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, were recruited between 26th of May and 25th of September 2016. Predictor variables identified were plasma ET-1, serum NO and 5-HT levels and were evaluated in serum and platelets of case and control groups.

Results

Plasma ET-1 and serum 5-HT concentrations in prehypertensive and hypertensive children were higher than in controls, with hypertensive adolescents showing higher levels of both factors compared with prehypertensive adolescents. Platelet 5-HT levels were lower in prehypertensive and hypertensive children compared with controls, while serum NO levels were higher in prehypertensive children than in hypertensive children.

Conclusion

Measurable ET-1, NO and 5-HT are related to BP in adolescents and may serve as diagnostic biomarkers of EAH. Furthermore, they could help to better define prehypertensive and hypertensive children.

Oh, the places you'll go! My many colored serotonin (apologies to Dr. Seuss)

Serotonin [5-hydroxytryptamine (5-HT)] has a truly fascinating history in the cardiovascular world. Discovered in the blood, 5-HT has long been appropriately regarded as a vasoconstrictor. A multitude of in vitro studies of isolated vessels support that addition of 5-HT causes vascular contraction. In only a few cases was 5-HT a vasodilator. Moreover, the potency and threshold of 5-HT causing contraction is increased in arteries from hypertensive vs. normotensive subjects, both animal and human. As such, we and others have hypothesized that 5-HT would contribute to hypertension by elevating arterial tone. In stark contrast to these decades of findings, we observed that a chronic infusion of 5-HT into conscious rats caused a reduction in blood pressure and nearly normalized blood pressure of experimentally hypertensive rats. Going back to the early work of Irvine Page, one of the scientists who discovered 5-HT, reveals an early recognized but never understood ability of 5-HT to reduce systemic blood pressure. Our laboratory, in collaboration with colleagues around the world, has dedicated itself to understanding the mechanisms of 5-HT-induced reduction in blood pressure. This manuscript takes you through a brief history of the discovery of 5-HT, in vitro serotonergic pharmacology of blood vessels, in vivo work with 5-HT and our studies that suggests the venous vasculature, potentially in combination with small arterioles, may be important to the actions of 5-HT in reducing blood pressure. 5-HT has certainly ended up in a place I never expected it to go.

Serotonin and blood pressure regulation

5-Hydroxytryptamine (5-HT; serotonin) was discovered more than 60 years ago as a substance isolated from blood. The neural effects of 5-HT have been well investigated and understood, thanks in part to the pharmacological tools available to dissect the serotonergic system and the development of the frequently prescribed selective serotonin-reuptake inhibitors. By contrast, our understanding of the role of 5-HT in the control and modification of blood pressure pales in comparison. Here we focus on the role of 5-HT in systemic blood pressure control. This review provides an in-depth study of the function and pharmacology of 5-HT in those tissues that can modify blood pressure (blood, vasculature, heart, adrenal gland, kidney, brain), with a focus on the autonomic nervous system that includes mechanisms of action and pharmacology of 5-HT within each system. We compare the change in blood pressure produced in different species by short- and long-term administration of 5-HT or selective serotonin receptor agonists. To further our understanding of the mechanisms through which 5-HT modifies blood pressure, we also describe the blood pressure effects of commonly used drugs that modify the actions of 5-HT. The pharmacology and physiological actions of 5-HT in modifying blood pressure are important, given its involvement in circulatory shock, orthostatic hypotension, serotonin syndrome and hypertension.

5-hydroxtryptamine receptors in systemic hypertension: an arterial focus

BACKGROUND

Serotonin (5-hydroxytryptamine [5-HT]) was named for its isolation from blood serum (sero-) and ability to contract smooth muscle (-tonin). Thus, its relationship with the cardiovascular system began with its discovery.

AIMS

This review will focus on the effects of 5-HT and its receptors in the vasculature, with a focus on their involvement in high blood pressure (hypertension). Two seemingly contradictory bodies of evidence exist that make it difficult to assign any one function to 5-HT in vascular control of blood pressure.

RESULTS

 In vitro, 5-HT is an established vasoconstrictor, the effects of which are amplified in hypertension. By contrast, 5-HT (or its precursor 5-hydroxytryptophan) lowers blood pressure when given chronically in vivo. We will discuss ideas that might help us understand these differences, discuss relatively new pharmacology parameters (e.g. biased, inverse agonism) as they pertain to 5-HT receptors, and pose questions that are vital to answer so as to understand the role played by 5-HT in control of blood pressure, especially as it pertains to vascular function.

CONCLUSIONS

Our goal is to understand if the actions of 5-HT in hypertension are physiologically and clinically relevant. The community understands 5-HT has complex cardiovascular effects, and clinical studies have proven equivocal in terms of the involvement of 5-HT. This article provides a balanced view of evidence/literature that illustrates involvement of 5-HT in hypertension as controversial. It contributes new pharmacological knowledge of 5-HT compounds, and poses timely questions as to how this field can move forward. The take home message is that the cardiovascular effects of 5-HT are markedly complex such that we have not yet answered the question of whether 5-HT is beneficial or detrimental to hypertension.

Molecular mechanisms of SERT in platelets: regulation of plasma serotonin levels

The serotonin transporter (SERT) on platelets is a primary mechanism for serotonin (5HT) uptake from the blood plasma. Alteration in plasma 5HT level is associated with a number of cardiovascular diseases and disorders. Therefore, the regulation of the transporter's activity represents a key mechanism to stabilize the concentration of plasma 5HT. There is a biphasic relationship between plasma 5HT elevation, loss of surface SERT, and depletion of platelet 5HT. Specifically, in platelets, plasma membrane SERT levels and platelet 5HT uptake initially rise as plasma 5HT levels are increased but then fall below normal as the plasma 5HT level continues to rise. Therefore, we propose that elevated plasma 5HT limits its own uptake in platelets by down-regulating SERT as well as modifying the characteristics of SERT partners in the membrane trafficking pathway. This review will summarize current findings regarding the biochemical mechanisms by which elevated 5HT downregulates the expression of SERT on the platelet membrane. Intriguing aspects of this regulation include the intracellular interplay of SERT with the small G protein Rab4 and the concerted 5HT-mediated phosphorylation of vimentin.

5-hydroxytryptamine in the cardiovascular system: focus on the serotonin transporter (SERT)

1. The function of the serotonin transporter (SERT) is to take up and release serotonin (5-hydroxytyptamine (5-HT)) from cells and this function of SERT in the central nervous system (CNS) is well-documented; SERT is the target of selective serotonin reuptake inhibitors used in the treatment of CNS disorders, such as depression. 2. The aim of the present review is to discuss our current knowledge of 5-HT and SERT in the cardiovascular (CV) system, as well as their function in physiological and pathophysiological states. 3. The SERT protein has been located in multiple CV tissues, including the heart, blood vessels, brain, platelets, adrenal gland and kidney. Modification of SERT function occurs at both transcriptional and translational levels. The functions of SERT in these tissues is largely unexplored, but includes modulation of cardiac and smooth muscle contractility, platelet aggregation, cellular mitogenesis, modulating neuronal activity and urinary excretion. 4. Recent studies have uncovered potential relationships between the expression of SERT gene promoter variants (long (l) or short (s)) with CV diseases. Specifically, the risk of myocardial infarction and pulmonary hypertension is increased with expression of the ll promoter, a variant associated with increased expression and function of SERT. The relationship between promoter variants and other CV diseases has not been investigated. 5. Newly available experimental tools, such as pharmacological compounds and genetically altered mice, should prove useful in the investigation of the function of SERT in the CV system. 6. In summary, the function of SERT in the CV system is just beginning to be revealed.

5-HT in systemic hypertension: foe, friend or fantasy?

Since its discovery by Erspamer in the 1930s and identification by Page in the 1950s, 5-HT (5-hydroxytryptamine; serotonin) has been an elusive candidate as a substance that plays a role in the disease of high blood pressure, also known as hypertension. In both animal and human hypertension, arterial contraction to 5-HT is profoundly enhanced. Additionally, 5-HT is a vascular smooth muscle cell mitogen. Because both increased arterial contractility and smooth muscle growth contribute to the disease of hypertension, it is logical to believe that 5-HT is a potential cause of disease, and thus a foe. However, decades of research have produced conflicting results as to the potential role of 5-HT in hypertension. This review will discuss historical findings which both support and refute the involvement of 5-HT in hypertension, and pose some new questions that may reveal novel ways for 5-HT to modify vascular control of blood pressure.

Simultaneous Determination of Serotonin and 5-Hydroxyindole-3-acetic Acid in Human Urine by Automated Precolumn Derivatization and Semi-microbore Column Liquid Chromatography with Fluorescence Detection

An improved high-performance liquid-chromatographic (HPLC) assay for the simultaneous determination of serotonin (5-HT) and 5-hydroxyindole-3-acetic acid (5-HIAA) in human urine is reported. Following the automated precolumn derivatization of urinary 5-HT and 5-HIAA with benzylamine, the derivatives are separated by isocratic elution on a reversed-phase C18 semi-microbore column, and are fluorometrically detected at an excitation wavelength of 345 nm and an emission wavelength of 480 nm. The detection limits of 5-HT and 5-HIAA are 7 and 5 nmol/l in urine (0.7 and 0.5 fmol/20-microl injection). The proposed automatic method permits a highly selective and sensitive determination of 5-HT and 5-HIAA in human urine without any sample purification.

5-HT2B-receptor antagonist LY-272015 is antihypertensive in DOCA-salt-hypertensive rats

We previously demonstrated a change in the receptors mediating 5-hydroxytryptamine (5-HT)-induced contraction in arteries of deoxycorticosterone acetate (DOCA)-salt-hypertensive rats. Specifically, contraction to 5-HT is mediated primarily by 5-HT2A receptors in arteries from normotensive sham rats and by both 5-HT2A and 5-HT2B receptors in arteries from hypertensive rats. We hypothesized that the 5-HT2B receptor may play a role in maintaining the high blood pressure of DOCA-salt-hypertensive rats, and herein we provide data connecting in vitro and in vivo findings. The endothelium-denuded isolated superior mesenteric artery of DOCA-salt rats displayed a marked increase in maximum contraction to the newly available 5-HT2B-receptor agonist BW-723C86 compared with that of arteries from sham rats, confirming that the 5-HT2B receptor plays a greater role in 5-HT-induced contraction in arteries from DOCA-salt rats. In chronically instrumented rats, the 5-HT2B-receptor antagonist LY-272015 (0.3, 1.0, and 3.0 mg/kg iv at 30-min intervals) was given cumulatively 1 time/wk during 4 wk of continued DOCA-salt treatment. LY-272015 did not reduce blood pressure of the sham-treated rats at any time or dose. However, LY-272015 (1.0 and 3. 0 mg/kg) significantly reduced mean blood pressure in a subgroup of week 3 (-20 mmHg) and week 4 DOCA-salt (-40 mmHg) rats that had extremely high blood pressure (mean arterial blood pressure approximately 200 mmHg). Blockade of 5-HT2B receptors by in vivo administration of LY-272015 (3.0 mg/kg) was verified by observing reduced 5-HT-induced contraction in rat stomach fundus, the tissue from which the 5-HT2B receptor was originally cloned. These data support the novel hypothesis that 5-HT2B-receptor expression is induced during the development of DOCA-salt hypertension and contributes to the maintenance of severe blood pressure elevations.

Serotonin and heart rate in hypertensive and normotensive subjects

Plasma and platelet levels of 5-hydroxytryptamine (5 HT) may be altered in essential hypertension. To establish the determinants and correlates of 5 HT in plasma and platelets, we studied 53 untreated subjects with essential hypertension (26 men; 30 whites; mean supine blood pressure 172/101 mm Hg; mean age 49.3 +/- 1.5 years) and 61 normotensive subjects (37 men; 47 whites; mean supine blood pressure 128/78 mm Hg; mean age 42.8 +/- 1.6 years). Plasma and platelet 5 HT were assayed by reverse-phase high performance liquid chromatography with electrochemical detection. No significant difference was found in platelet-poor plasma or platelet 5 HT levels in hypertensive or normotensive subjects (plasma: 43.0 +/- 4.2 and 39.6 +/- 4.4 nmol/L; platelet: 1.65 +/- 1.22 and 1.70 +/- 1.39 nmol/10(9) cells in hypertensive and normotensive subjects, respectively). No significant correlation was found between plasma or platelet 5 HT and systolic or diastolic blood pressure (plasma: r = 0.01 and 0.01 in normotensive subjects and r = 0.01 and -0.14 in hypertensive subjects; platelet: r = 0.12 and 0.13 in normotensive subjects and r = 0.02 and -0.09 in hypertensive subjects). However, plasma 5 HT was associated with supine and standing pulse rates (supine: r = 0.27, p = 0.05 in normotensive subjects and r = 0.54, p < 0.001 in hypertensive subjects; standing: r = 0.19 and r = 0.46, p < 0.001, respectively). Significant relations were also found between platelet 5 HT levels and supine and standing heart rate in the subjects mentioned above (supine: r = 0.28, p = 0.05 in normotensive subjects and r = 0.64, p < 0.001 in hypertensive subjects; standing: r = 0.24 and r = 0.51, p < 0.001, respectively). These associations were stronger in the hypertensive group as a whole, and they held when adjustment was made for differences in age and total blood cholesterol. The present study showed that plasma and platelet 5 HT are not significantly altered in hypertensive subjects. However, plasma and platelet 5 HT levels showed a significant association with supine and standing pulse rate predominantly in hypertensive subjects. This is consistent with experimental evidence of a positive chronotropic effect of 5 HT on perfused hearts and it suggests a possible role of plasma serotonin in the regulation of heart rate.

3,4-Dimethoxybenzylamine as a sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in human platelet-poor plasma

3,4-Dimethoxybenzylamine is shown to be a highly sensitive pre-column fluorescence derivatization reagent for the determination of serotonin in plasma by high-performance liquid chromatography. The reagent reacts selectively with 5-hydroxyindoles including serotonin in slightly alkaline media in the presence of potassium hexacyanoferrate(III) to give highly fluorescent derivatives. The derivatives of six standard 5-hydroxyindoles (5-hydroxytryptophan, 5-hydroxyindole-3-acetic acid, serotonin, 5-hydroxyindole-3-acetamide, N-acetyl-5-hydroxytryptamine and 5-hydroxytryptophol) are separated within 18 min by isocratic elution using acetonitrile-10 mM phosphate buffer (pH 6.0)-50 mM 1-hexanesulfonic acid on a Wakosil II 5C18RS reversed-phase column. The detection limits (signal-to-noise ratio=3) for the indoles were 1.0-5.7 fmol in a 100-microl injection volume. The method was applied to the measurement of serotonin in human platelet-poor plasma.

Reduced platelet serotonin content and release in familial hypercholesterolaemia

Plasma and platelet serotonin (5-HT) concentrations, and resting and collagen-induced 5-HT release in platelet-rich plasma were studied in normal and familial hypercholesterolaemic (FH) subjects. Platelet 5-HT concentrations were significantly reduced (-37%, P < 0.01) in FH patients whilst mean plasma concentrations, although increased, were not significantly different from those in normal subjects. Platelet 5-HT correlated negatively with plasma cholesterol when the data for normal subjects and FH, patients were combined (r = -0.48, P = 0.005). It also correlated negatively with low-density lipoprotein (LDL) (FH data, r = -0.59, P = 0.03; normal and FH data, r = -0.49, P = 0.004) but positively with high-density lipoprotein (HDL) (FH r = 0.79, P = 0.001; normal and FH, r = 0.37, P = 0.03). Collagen (5-160 micrograms/ml) stimulated platelet 5-HT release occurred in a concentration-dependent manner. In FH patients stimulated 5-HT release was reduced (10 micrograms/ml collagen, -40%, P < 0.05) and accompanied by increased collagen EC50 values (P < 0.02). Resting 5-HT release was increased substantially in FH patients but not significantly. Our data provide evidence for a relationship between circulating cholesterol and platelet serotonergic mechanisms. It is proposed that abnormalities relating to platelet-plasma 5-HT dynamics, perhaps due to enhanced platelet activity or decreased platelet uptake, may contribute to the cardiovascular complications in FH.

Evidence for separate serotonin and catecholamine compartments in human platelets

Serotonin (5-HT) and the catecholamines (CA), noradrenaline (NA) and adrenaline (Ad), are platelet dense-granule constituents which influence platelet activity and vessel tone. Platelets accumulate 5-HT via an active process whilst CA uptake occurs mainly by passive diffusion. The platelet contents and collagen-stimulated efflux of 5-HT, NA and Ad were examined in normal individuals to establish whether relationships exist between these monoamines. Regression analysis revealed that platelet 5-HT was not related to platelet NA or Ad levels. Platelet NA, however, correlated positively with Ad (r = 0.61, P < 0.01). Collagen-induced release of all three monoamines occurred in a dose-dependent manner. The collagen EC50 values for 5-HT and CA release, however, differed and were greater for 5-HT release: 9.6 +/- 0.8 vs. 3.8 +/- 0.2 microgram/ml collagen, 5-HT vs. NA, P < 0.001; 9.6 +/- 0.8 vs. 3.9 +/- 0.5 microgram/ml, 5-HT vs Ad, P < 0.001. These data may reflect differences regarding the triggering mechanisms for 5-HT and CA release and provide evidence for separate compartments of intra-platelet 5-HT and CA and possibly distinct populations of 5-HT and CA containing dense granules and/or platelets.

Serotonin metabolism in the fetus in preeclampsia

We investigated serotonin (5-HT) metabolism in the fetus in preeclampsia by measuring free 5-HT, 5-hydroxyindoleacetic acid (5-HIAA) and tryptophan concentrations in umbilical cord plasma and amniotic fluid, and 5-HT content in platelets by high performance liquid chromatography with electrochemical detection. Free 5-HT and 5-HIAA levels in umbilical cord plasma were significantly higher in the severe preeclamptic group (S) than those in the non-preeclamptic group (N). The plasma 5-HIAA/5-HT ratio in group S was significantly lower than that in group N. Platelet 5-HT content in group S tended to be lower than that in group N. Mean plasma beta-thromboglobulin concentration in group S was significantly higher than that in group N. There was no significant difference in plasma tryptophan levels between group S and N. These findings suggest that the higher levels of plasma free 5-HT in umbilical cord plasma in preeclampsia are attributable to excess release of 5-HT from platelets as well as lower monoamine oxidase activity.

Serotonergic mechanisms in hypertension

Serotonin and abnormal serotonergic activity (both central and peripheral) may play a role in pathogenesis of essential hypertension. Serotonin acts chiefly via three types of receptors namely S1, S2 and S3 serotonergic receptors. Besides being vasoactive, it has some inotropic and chronotropic properties and also affects blood rheology. It has stimulating effect on renin and aldosterone secretion. The action of other vasoactive substances like norepinephrine and angiotensin II are amplified. All these physiological effects of serotonin strongly support the hypothesis that it may be involved in hypertension. The advent of serotonin antagonists in lowering blood pressure has further substantiated this hypothesis.

Central serotonergic uptake mechanisms in hypertensive rats: effects of clonidine and centhaquin

The binding of a highly specific ligand for serotonin (5-HT) uptake sites, [3H]paroxetine, was studied in brain regions of normotensive Wistar-Kyoto rats (WKY) and spontaneous hypertensive rats (SHR). [3H]Paroxetine bound to a single, high affinity binding site in the brain. In midbrain, the density (Bmax values) of [3H]paroxetine binding were significantly reduced (27.16%) in SHR as compared to WKY. The affinity (Kd values) were found to be similar in SHR and WKY. The Kd and Bmax values of [3H]paroxetine binding were found to be similar in spinal cord, pons and medulla and cerebral cortex of WKY and SHR. The effect of centrally acting hypotensive agents, clonidine and centhaquin, on [3H]paroxetine binding was also determined and compared with imipramine, a known 5-HT uptake inhibitor. Clonidine did not displace [3H]paroxetine binding at any concentration (10(-4) to 10(-7) M). On the other hand, centhaquin, which produces hypotension similar to clonidine, could displace [3H]paroxetine binding in a concentration dependent manner. In cerebral cortex and brainstem (midbrain, pons and medulla) membranes, the IC50 values of imipramine and centhaquin for [3H]paroxetine binding were found to be similar in WKY and SHR. The IC50 of centhaquin in displacing paroxetine from 5-HT uptake sites, was 10 times lower in the cerebral cortex and 4 times lower in the brainstem membranes when compared to imipramine. Clonidine had no effect on 5-HT uptake sites. The results indicate that (1) the density of 5-HT uptake sites is reduced in the midbrain of hypertensive rats, and (2) centhaquin, a centrally acting hypotensive agent, acts on 5-HT transporter sites.(ABSTRACT TRUNCATED AT 250 WORDS)

5HT2-receptors and serotonin release: their role in human platelet aggregation

Involvement of 5HT2 receptors in human platelet aggregation was assessed by studying the effect of ADP, epinephrine and thrombin on 3H-5HT release from platelets. The release experiments were made with a perfusion method to preserve any compound, released or formed by platelet, from interacting with platelet itself. In these conditions, aggregation does not occur, as confirmed by Scanning Electron Microscopy. These release experiments showed that the platelet activation by such agents is coupled with 5-HT release. The aggregation experiments, made on different aliquots of the same platelet-rich plasma (PRP), showed that the released 5-HT, interacting with its own receptors on platelet activated surface, determines aggregation. In fact, although it is known that 5-HT added to PRP was only able to induce a moderate platelet aggregation, the 5-HT2 antagonist ketanserin counteracted the aggregation induced by ADP, epinephrine and thrombin. These results suggest that a 5HT2 antagonist could be therapeutically important in those pathological states in which serotonin, released by activated platelets, may increase aggregation.

Factors influencing platelet serotonin uptake in essential hypertension

In a study of the mechanism(s) of platelet serotonin uptake alteration in essential hypertension, a total of 90 blood samples were analysed for platelet count and platelet serotonin uptake. These included 20 blood samples each of hypertensives, controls before and after cross-incubation experiments and 10 samples of hypertensives after control of blood pressure. It was observed that serotonin uptake was markedly reduced in hypertensive platelets. Diminished serotonin uptake in essential hypertension correlated directly with diastolic and mean arterial blood pressure and inversely with plasma total cholesterol values. In cross-incubation experiments using control platelets and hypertensive plasma, there was a significant reduction in platelet serotonin uptake (303.06 +/- 86.28 cpm/10(8) vs. 204.26 +/- 66.45 cpm/10(8); P less than 0.001), whereas hypertensive platelets when incubated with control plasma, showed increased serotonin uptake (233.50 +/- 75.19 cpm/10(8) vs. 312.64 +/- 79.54 cpm/10(8); P less than 0.01). Upon control of blood pressure, the platelet serotonin uptake improved significantly (205.45 +/- 70.0 cpm/10(8) vs. 266.77 +/- 61.68 cpm/10(8); P less than 0.05-0.01). From these results, it appears that reduced platelet serotonin uptake in essential hypertension is a reversible phenomenon probably governed by the presence of plasma factor(s) and/or altered platelet-membrane function.

Increased serotonin platelet uptake after tianeptine administration in depressed patients

Tianeptine is a new antidepressant drug reported to enhance serotonin (5-hydroxytryptamine [5-HT]) uptake in rat brain. The effect of tianeptine on 5-HT platelet uptake was studied in 10 depressed patients treated for 28 days. Tianeptine increases Vmax of 5-HT platelet uptake during treatment without inducing any change in Km. As early as 2 hr after the first administration, Vmax increased significantly (+23%, alpha = 0.01). Although of a lesser magnitude, 5-HT platelet uptake remains increased after chronic administration (+14% on day 10 and +13% on day 28). This suggests that tianeptine affects 5-HT platelet uptake sites, either directly or via an action on modulators of 5-HT uptake. These results, in contrast with the action of other tricyclic antidepressants, confirm the original action of tianeptine on 5-HT platelet metabolism.

5-Hydroxytryptamine kinetics and activation of blood platelets in patients with essential hypertension

To investigate possible alterations in 5-hydroxytryptamine (5HT) kinetics and sensitivity of blood platelets in patients with essential hypertension, 45 essential hypertensive patients and 45 normotensive healthy subjects matched in pairs for age, sex, and smoking status were compared. There were 18 women and 27 men in each group, ranging from 30 to 73 years of age. Results of essential hypertensive patients differed in several ways from those of normotensive subjects. In essential hypertensive patients, maximal 5HT uptake velocity (Vmax) decreased with increasing blood pressure and age and was reduced the most in older men. Vmax was positively related to the EC50 of 5HT for inducing a shape change reaction. In essential hypertensive patients, both Vmax of 5HT uptake and the EC50 of 5HT for shape change showed positive correlations with the 5HT content in platelets; the former relation was different between the essential hypertensive and normotensive groups (F = 5.53; p = 0.02). These results indicate reduced uptake of 5HT by blood platelets and suggest enhanced 5HT plasma concentrations in local areas, especially vascular lesions in essential hypertensive patients. Increased periplatelet concentrations of 5HT may lead to preactivation of platelets and possibly stimulation of vascular smooth muscle via their 5HT2-receptors. These changes are likely to be involved in the pathogenesis of increased thromboembolic complications in essential hypertensive patients, particularly in older men.

Platelet serotonergic mechanisms in ischaemic heart disease

The uptake, basal content and efflux of serotonin (5-HT) from the platelets of patients of ischaemic heart disease (I.H.D.) was studied and compared with normal platelets. A significant increase in uptake and basal content of 5-HT as well as increase in 5-HT efflux was observed as compared to control. Our data indicate that I.H.D. is associated with platelet serotonergic dysfunction which seems to indicate that the platelets are preactivated in I.H.D.

Impaired uptake of 5 hydroxytryptamine platelet in essential hypertension: clinical relevance

Serotonin (5-hydroxytryptamine; 5HT) kinetics and platelet activation by 5HT were studied in patients with essential hypertension (n = 45), and in matched normotensive subjects (n = 45). Platelet response to 5HT and plasma beta-thromboglobulin increased with age in men, both normotensives and hypertensives. Beta-thromboglobulin and 5-hydroxyindoleacetic acid (5HIAA) excretion were higher in hypertensive men than in women. In women, no changes in platelet activity or 5HIAA excretion were found. 5HT plasma concentrations increased with blood pressure. Platelet 5HT uptake (Vmax and KM) were the lowest in hypertensive men greater than or equal to 60 years of age. This may indicate that 5HT uptake in vivo in normotensives is far below maximum (VNT much less than Vmax), whereas in hypertensive men it may be close to maximum (VHT approximately Vmax). This could reflect significantly higher 5HT plasma concentrations in vivo hypertensives than in normotensives. The reduced uptake (which was found only in hypertensive men) may indicate an insufficient compensation of the enhanced 5HT release from aggregating platelets in older men, in whom platelet activity is enhanced in vivo. It is concluded that the defect in platelet 5HT uptake in hypertensives--along with the enhanced platelet aggregation--may contribute to a critical increase in 5HT plasma concentrations locally. An increase in 5HT concentrations leads to biochemical changes (higher 5HIAA excretion) as well as to an enhanced stimulation by 5HT. This may be of clinical relevance especially in older men, in whom 5HT2-receptor mediated responses are enhanced.

Comparison of ketanserin and enalapril in the treatment of mild-to-moderate essential hypertension

In a double-blind 3-month study in mild-to-moderate essential hypertensive patients over 50 years of age, ketanserin, a selective S2-serotoninergic antagonist with additional alpha 1-adrenergic blocking properties, has been compared with enalapril, an angiotensin-converting enzyme inhibitor. Supine and upright blood pressures and heart rates were recorded for placebo and during active treatment (-4, -2, 0, 2, 4, 6, 8, 10, and 12 weeks). Metabolic profile (plasma glucose, creatinine, sodium, potassium, total and HDL-cholesterol, triglycerides, uric acid) was monitored during treatment with placebo and at the end of the study. Mean blood pressure was equally and significantly (p less than 0.001) lowered by both drugs from 2 weeks of treatment, whereas no changes occurred in mean heart rate or in biochemical variables. Dizziness was observed in three patients on ketanserin and in one patient on enalapril, whereas headache occurred in only one patient on enalapril. These data indicate that ketanserin is as effective and well tolerated as enalapril in hypertensive patients over 50 years of age.

Kinetics of serotonin in platelets in essential hypertension

In a study of the kinetics of 5-hydroxytryptamine (5-HT) in platelets in 26 hypertensive subjects with a mean systolic and diastolic blood pressure of 153.9 +/- 26.9 and 106.9 +/- 9.1 mm Hg respectively, it has been observed that in hypertensive platelets there was a marked decrease in 5-HT uptake and content, an increase in 5-HT efflux and an accompanying increase in Plasma 5-HT and 5-HIAA levels. Regression analysis of the data indicated a significant correlation between rise in diastolic blood pressure and these changes in 5-HT kinetics.

Intraplatelet serotonin in patients with diabetes mellitus and peripheral vascular disease

Intraplatelet serotonin (5-HT) content was determined in 23 patients with type I (insulin-dependent) diabetes mellitus (IDDM), 23 patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM), 29 patients with peripheral vascular disease (PVD) and 34 age-matched normal subjects. Intraplatelet 5-HT content in normal subjects showed an age-related decline (r = -0.45; P less than 0.008), as has been previously demonstrated. The median 5-HT content in platelets of the young normal subjects was 4.36 (range: 3.62-6.79) nmol 10(-9) platelets, while that in the elderly normal subjects was 3.87 (range: 2.8-6.0) nmol 10(-9) platelets and that in young + elderly subjects was 4.05 (range: 2.8-6.8) nmol 10(-9) platelets. The median intraplatelet 5-HT content was significantly lower (P less than 0.002) in IDDM patients: 3.0 (range 1.3-6.3), NIDDM patients: 2.5 (range 1.7-5.8), PVD patients: 2.42 (range 0.94-4.98) nmol 10(-9) platelets than that in all young + elderly healthy subjects. The presence of hypertension in DM patients caused a small but significant (P less than 0.05) decrease in intraplatelet 5-HT content, whilst its presence had no effect in PVD patients. In a smaller study, it was established that NIDDM and PVD patients have significantly (P less than 0.002) greater plasma 5-HT concentrations than controls. Insulin-dependent diabetes mellitus patients had greater plasma 5-HT concentrations but this did not achieve statistical significance despite a 66% increment in its value.(ABSTRACT TRUNCATED AT 250 WORDS)

Serotoninergic mechanisms in hypertension. Focus on the effects of ketanserin

Aggregating platelets release serotonin, which induces contraction of most vascular smooth muscle by activation of S2-serotoninergic receptors. Serotonin released in the circulation may contribute to the increase in peripheral resistance of hypertension as the responsiveness of blood vessels from hypertensive animals and humans to the vasoconstrictor action of the monoamine is augmented. The data obtained with the new antihypertensive agent ketanserin may favor that interpretation. Ketanserin is a selective S2-serotoninergic antagonist with additional alpha 1-adrenergic blocking properties. In humans, it has a terminal half-life of 12 to 25 hours and is eliminated predominantly by the liver. The hemodynamic profile of ketanserin is that of a vasodilator drug with actions on both resistance and capacitance vessels. On short-term intravenous administration, it lowers blood pressure in hypertensive patients with minimal reflex changes in cardiovascular function. When given orally long term to hypertensive patients, ketanserin causes a sustained reduction in arterial blood pressure, comparable to that obtained with either beta-adrenergic blockers or diuretics. Several studies have shown a greater efficacy in older (greater than 60 years of age) than in younger patients independent of starting pressure. Side effects mainly consist of dizziness, somnolence, and dry mouth, but they are usually not severe. The mechanism underlying the antihypertensive effect of ketanserin is unclear. It cannot be attributed to either S2-serotoninergic or alpha 1-adrenergic blockade alone, but an interaction between the two effects appears to be required.

Study of in vivo platelet activation in uncomplicated essential hypertension

Beta-thromboglobulin (BTG) and platelet factor 4 (PF4), platelet alpha-granule specific proteins, and serotonin (5-HT) which is stored in dense granules are released when platelets are activated. To investigate in vivo platelet activation in uncomplicated essential hypertension, platelet 5-HT and PF4 contents, plasma BTG and PF4 concentrations, as well as urinary BTG levels were assessed in normotensive and hypertensive subjects. Plasma BTG and PF4 concentrations and urinary BTG levels were comparable in both groups. Mean platelet 5-HT content was significantly decreased in hypertensive subjects without modification of the intraplatelet PF4 content. These data suggest first of all that the decrease in platelet 5-HT content is due mainly to the inhibition of platelet 5-HT uptake previously described, and second of all that no significant in vivo platelet activation occurs in essential hypertensive subjects devoid of cardiovascular complications.

Reduced serotonin content and uptake in platelets from patients with essential hypertension: is a ouabain-like factor involved?

Platelet serotonin (5-HT) content was investigated in 35 essential hypertensive patients and in 58 normotensive subjects. A significant decrease of platelet 5-HT content was observed in both hypertensive men and women in respect to normotensive controls. This decreased platelet 5-HT content appears to be linked to a reduced capacity of platelets to take up 5-HT. Maximal velocity of 5-HT uptake was shown to be reduced in platelets from hypertensive patients and significantly correlated to platelet 5-HT content. No concomitant change of uptake Michaelis constant (KM) was observed. The great sensitivity of human platelets to very low concentrations of ouabain was demonstrated when incubation times were prolonged. The decreased Vmax observed in platelets from hypertensive patients and reproduced by ouabain inhibition could conceivably be linked to the presence of a circulating ouabain-like factor in hypertension.

The 5-hydroxytryptamine system of blood platelets: physiology and pathophysiology

The 5-hydroxytryptamine (5HT)-system of human blood platelets consists of a relatively specific uptake mechanism for 5HT at the plasma membrane, intracellular storage organelles (dense bodies), a metabolizing enzyme (monoaminoxidase B) and a 5HT2-receptor whose stimulation leads to activation of the phosphatidylinositide turnover, a rise in free cytoplasmic Ca2+, phosphorylation of proteins and a shape change reaction. There is neither a relevant 5HT-biosynthesis nor a marked physiological 5HT-turnover in platelets. Under physiological conditions the platelet 5HT-system may have a role as a scavenger for free extracellular 5HT and in hemostasis. Disturbances which have been described in pathophysiological states include impairment of 5HT-uptake (hypertension, migraine), impairment of 5HT-storage (storage pool deficiencies, thromboembolic disorders, hypertension) and increased sensitivity to activating agents like 5HT (cardiovascular disorders, diabetes). Besides their role in physiology and pathophysiology platelets may be useful partial models for vascular smooth muscle cells.

Development and validation of an improved radioimmunoassay for serotonin in platelet-rich plasma

A radioimmunoassay (RIA) using a 125I-tracer is described for measurement of serotonin (5-hydroxytryptamine, 5-HT) in human platelet-rich plasma (PRP). Antisera were raised against 5-HT-succinamate conjugated to bovine albumin and, to improve assay sensitivity, the analyte was made chemically similar to the immunogen by conversion to N-acetylserotonin prior to assay, using the specific amino reagent N-acetoxysuccinimide. The assay shows good correlation with a high-pressure liquid chromatography (HPLC) reference method (5-HT RIA = 1.007 X 5-HT HPLC + 29.3, r = 0.936, p less than 0.001, n = 40), indicating that no significant cross-reactions were detected. Samples of PRP are diluted 1/20 to fall within the working range (80-15% B/B0) of the assay, which is 4.75-325 nmol/l, (0.95-65.0 pmol/tube), corresponding to 95-6500 nmol/l in PRP. Intra- and interassay coefficients of variation were 5.0-10.5% and 12.0-21.2% respectively for serotonin concentrations of 250-2,500 nmol/l added to platelet-poor plasma. With this improved assay, it is possible to analyse up to 100 samples/day, compared with 10-20 samples/day by HPLC.

Hyperreactivity of platelets from spontaneously hypertensive rats. Role of external magnesium

Thrombin-induced serotonin secretion from platelets from age-matched spontaneously hypertensive rats (SHR) and control Wistar-Kyoto rats (WKY) was compared in the presence of different Ca2+ and Mg2+ concentrations. Platelets from SHR were more reactive than those of WKY, and the difference was more marked in 11-week-old than in younger rats. The responses to three concentrations of extracellular Ca2+ and one extracellular Mg2+ concentration of 10(-3) M were compared. A high external Ca2+ concentration (2 X 10(-3) M) increased secretion in platelets of both strains without suppressing the difference between them. Platelets from SHR were more sensitive than those from WKY to a low external Ca2+ concentration (2 X 10(-6) M). Platelet secretion which is independent of external Ca2+ concentration was higher in platelets from SHR than in those from WKY. External Mg2+ exerted an inhibitory effect on serotonin secretion in both types of platelets, but platelets from SHR were less sensitive to Mg2+ than were those from WKY. This inhibitory effect appeared to be complex. It could be observed in the absence of external Ca2+, and in this case, the difference in reactivity between platelets SHR and WKY depended on the external Mg2+ concentration (up to 2 X 10(-3) M). Furthermore, a Mg2+ -induced antagonism of the stimulatory effect of external Ca2+ concentration appeared at higher concentrations of extracellular Mg2+ and was more potent in platelets from WKY than in those from SHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Platelet serotonin content and uptake in spontaneously hypertensive rats

Platelet serotonin (5-HT) content and uptake were studied in male SHR and WKY at various ages. Blood was withdrawn from the carotid artery under anesthesia and 5-HT levels determined from platelet rich plasma (PRP) using a HPLC technique coupled with an electrochemical detection method. Platelet 5-HT uptake was studied by incubating PRP at 37 degrees C for 10 sec with increasing concentrations of 3H-5HT. Lineweaver- Burk plots of 3H-5HT uptake were linear suggesting simple Michaelis- Menten uptake kinetics. The SHR had more platelets than age-matched controls and consequently a higher blood circulating pool of 5-HT. Nevertheless, the 5-HT platelet levels were similar to those of their age-matched rats. The 5 week-old SHR and WKY had greater numbers of platelets and higher 5-HT platelet levels than the older rats of both strains. The affinity constants (Km) and the maximal velocities (Vmax) of platelet 5-HT uptake did not differ significantly between the 12 week- and the 6 month-old SHR and WKY. These data suggest that the SHR do not show the same impairment in platelet 5-HT metabolism as observed in essential hypertension in man.