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Energy metabolism and transduction in smooth muscle.

Early investigations into the nature of the coupling between energy transduction and metabolism in smooth muscle, particularly from the laboratories of Bülbring and Lundholm, suggested that specific metabolic pathways could independently supply energy for ion transport and actin-myosin interactions. Subsequent work has solidified the concept that oxidative phosphorylation is specifically coupled to tension generation and maintenance, whereas, aerobic glycolysis is not only a vital characteristic of smooth muscle metabolism, but also is likely to be independently coupled to Na-K transport at the plasmalemma. The independence of oxidative and glycolytic metabolism is reflected as a compartmentation of carbohydrate metabolism in the porcine carotid artery. The coupling of these independent metabolic pathways with specific energy utilizing processes, indicates a means by which energy production and transduction can be closely and efficiently regulated. The coupling of glycogenolysis to mitochondrial respiration may have evolved as a direct response to the energetic needs of VSM. That is, the large glycogenolytic response in the initial minutes of stimulation may be necessary to maximize the cellular production of ATP during the presteady state. Likewise, the coupling between aerobic glycolysis and Na-K transport indicates a sensitive and efficient means of coordinating energy metabolism with ion transport at the membrane level. Additionally, the regulation of substrate supply, i.e. glucose transport, also may be closely coordinated with changes in ion transport. One may speculate that alterations in the microenvironment of each compartment can independently regulate intermediary metabolism and therefore allow the cell to quickly and efficiently respond to localized stimuli. Thus, stimulation of Na-K transport could effectively regulate energy production at the membrane level without mobilizing or competing with the energy transduction of other cellular processes. This compartmentation of energy utilization may be highly advantageous, since oxidative metabolism is closely coordinated with mechanical activity and therefore regulation of blood flow. Future investigations will attempt to elucidate which intracellular signals which are responsible for the regulation of these functionally independent compartments of energy metabolism and transduction in VSM. In more general terms, our findings provide a basis from which future questions concerning the regulation of cellular metabolism must be directed. The cellular cytoplasm can no longer be envisioned as a homogeneous compartment, but rather a complex array of functional subcompartments which may be individual

Animals↗

Stimulation at the cervicomedullary junction in human subjects.

In awake human subjects, corticospinal axons can be activated at the level of the cervicomedullary junction by electrical or magnetic stimulation. Such stimuli evoke single descending volleys which activate motoneurones and elicit responses in muscles of the upper limb. These responses (cervicomedullary motor evoked potentials, CMEPs) have a large monosynaptic component and can be used to test motoneurone excitability in a variety of tasks. CMEPs can be elicited in resting muscle and during all strengths of voluntary contraction. Examination of CMEPs during and after voluntary contractions reveals changes in motoneurone excitability but also suggests activity-dependent changes in the efficacy of the corticospinal pathway. Because they test the same subcortical pathway as transcranial magnetic stimulation, but are unaffected by altered excitability at a cortical level, CMEPs often offer the most appropriate comparison to allow interpretation of changes in motor evoked potentials. The advantages and disadvantages of stimulation at the cervicomedullary junction as a test of motoneurone excitability are reviewed.

Electrodiagnosis↗

The Akt pathway: molecular targets for anti-cancer drug development.

The serine/threonine kinase Akt functions intracellularly as a cardinal nodal point for a constellation of converging upstream signaling pathways, which involve stimulation of receptor tyrosine kinases such as IGF-1R, HER2/Neu, VEGF-R, PDGF-R), and an assembly of membrane-localized complexes of receptor-PI-3K and activation of Akt through the second messenger PIP(3). The integration of these intracellular signals at the level of Akt and its kinase activity, regulates the phosphorylation of its several downstream effectors, such as NF-kappa B, mTOR, Forkhead, Bad, GSK-3 and MDM-2. These phosphorylation events in turn mediate the effects of Akt on cell growth, proliferation, protection from pro-apoptotic stimuli, and stimulation of neo-angiogenesis. Because Akt and its upstream regulators are deregulated in a wide range of solid tumors and hematologic malignancies, and in view of the aforementioned biologic sequelae of this pathway, the Akt pathway is considered a key determinant of biologic aggressiveness of these tumors, and a major potential target for novel anti-cancer therapies. This review focuses on ongoing translational efforts to therapeutically target Akt and its biologic sequelae, either at the level of Akt itself or at the levels of its upstream regulators and downstream effectors. Because Akt is also important for proliferative and anti-apoptotic signaling pathways critical for normal cells, particular emphasis is placed on the fine-tuning the targeting of individual components of this pathway to maximize the therapeutic index of anti-cancer strategies based on the PI-3K/Akt pathway.

Animals↗

Potassium and sodium shifts during in vitro isometric muscle contraction, and the time course of the ion-gradient recovery.

Intracellular potassium ([K+]i), interstitial potassium ([K+]inter), intracellular sodium ([Na+]i), and resting membrane potential (RMP) were measured before and after repetitive stimulation of mouse soleus and EDL (extensor digitorum longus) muscles. At rest, RMP was -69.8 mV for soleus and -74.9 mV for EDL (37 degrees C). [K+]i was 168 mM and 182 mM, respectively. In soleus, free [Na+]i was 12.7 mM. After repetitive stimulation (960 stimuli) RMP had decreased by 11.9 mV for soleus and by 18.2 mV for EDL. [K+]i was reduced by 32 mM and 48 mM, respectively, whereas [K+]inter was doubled. In soleus [Na+]i had increased by 10.6 mM, demonstrating that the [K+]i-decrease is three times higher than the [Na+]i-increase. It is concluded that this difference reflects different activity induced movements of Na and K, and that the difference is not due to the Na/K pumping ratio. The possible involvement of the potassium loss in muscle fatigue is discussed. After stimulation RMP recovered with a time constant of 0.9 min for soleus and 1.5 min for EDL. Within the first minutes after stimulation the intracellular potassium concentration increased by 20.4 mM/min for soleus and 21.7 mM/min for EDL. Free [Na+]i decreased with less than 10 mM/min. The mechanisms underlying the different rate of changes are discussed.

Animals↗

Developmental changes in refractoriness of the cortical auditory evoked potential.

OBJECTIVE: This study examined morphological changes in the cortical auditory evoked potential (CAEP) waveform as a function of varying stimulation rate. Stimuli were presented in a paradigm which indirectly assesses the refractory properties of the underlying neuronal generators. METHODS: CAEPs were recorded in 50 normal-hearing children (3-12 years) and 10 young adults (24-26 years). A speech sound was presented in a stimulus train with sequentially decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360ms. Latencies and amplitudes of the P1, N1, and P2 components at the Cz electrode were examined as a function of stimulus rate and age. RESULTS: Results revealed significant changes in the CAEP as a function of age and stimulation rate. At younger ages the N1-P2 component was elicited only at the slowest stimulation rates, and was more clearly apparent at successively faster stimulation rates as age increased. CONCLUSIONS: We have described a stimulus paradigm that allows examination of the development of refractoriness by highlighting the interaction between age and rate on CAEP morphology. SIGNIFICANCE: Complex maturational patterns of CAEP components are best understood when the effects of both age and stimulus rate on the CAEP waveform are considered.

Acoustic Stimulation↗

Evidence for a role of the NMDA receptor in the frequency dependent potentiation of deep rat dorsal horn nociceptive neurones following C fibre stimulation.

Ten nociceptive neurones located deep (greater than 640 microns) in the dorsal horn of the intact halothane anaesthetized rat were activated by transcutaneous electrical stimulation of their receptive fields producing short latency A beta and C fibre evoked activity. Repetitive C fibre stimulation (16 stimuli at 0.5 Hz) produced "wind up", an increase in the evoked activity with suceeding stimuli and consequently post discharges of the neurones. Direct application of aminophosphonovaleric acid (AP5) onto the cord surface (250 or 500 micrograms) produced minor changes in A and C fibre inputs onto the cells but reliably reduced "wind up" and the post discharges of the neurones. The results suggest an involvement of the NMDA receptor in this potentiation of dorsal horn nociceptive neurones.

Action Potentials↗

Different reactions of control and epileptic rats to administration of APV or muscimol on thalamic or CA3-induced CA1 responses.

The physiology and pharmacology of CA1 is changed in epilepsy. There is evidence that the thalamic input to CA1 has a somewhat different physiological effect compared with the CA3 input. In this study we sought to determine whether this difference in physiology persists in epilepsy, and whether there are changes in the pharmacologic profile of these responses. Under urethane two stimulating electrodes were placed in mid to ventral CA3 and in the midline thalamus of control or epileptic rats. One glass micropipette electrode was placed into CA1 for recording. After the baseline acquisition of CA1-evoked responses to single- or paired-pulse stimulation, the stimuli were repeated with local application of either the GABAA agonist muscimol or the NMDA antagonist dl-2-amino-5-phosphonovalerate (APV). The CA1 response of epileptic rats had a smaller population postsynaptic potential (PSP) and spike amplitudes, longer PSP duration, multiple spikes, and the paired-pulse (at 20-ms intervals) facilitation in contrast to the paired-pulse depression seen in control and kindled rats. The duration of the PSP as well as the amplitude and number of spikes were reduced by administration of APV or muscimol into CA1 in both control and epileptic rats. In control rats, APV enhanced the depression induced by maximal paired thalamic or CA3 stimulation at 20-ms intervals and reduced the facilitation of threshold stimulation into no change. In contrast, muscimol in control rats reversed the depression induced by paired maximal stimulation into a mild facilitation and reduced the facilitation of threshold stimulation. In epileptic rats neither APV nor muscimol had a significant effect on the changes of the CA1 responses induced by maximal or threshold paired stimulation. This initial in vivo study demonstrated that the physiology and pharmacology of CA1 in epileptic rats are different from control rats. Although there are physiological differences in the evoked responses that are linked to the site of stimulation in the control and epileptic group, the pharmacology in each condition is independent of the site of stimulation.

2-Amino-5-phosphonovalerate↗

Salivary secretion: stimulatory effects of chewing-gum versus paraffin tablets.

Paraffin tablets are commonly used in clinical saliva tests whereas chewing-gum is recommended to increase salivation in xerostomic patients. The aim of this study was to compare the effect on salivation of these stimuli. Saliva stimulated by chewing-gum or paraffin tablets was sampled on separate occasions from eight healthy subjects (25-45 yr). Whole or parotid saliva were collected for 6 min (1 min + 5 min) and 21 min (1 min + 5 min x 4), respectively. pH of saliva was measured with and without the addition of HC1 (titrated pH). Total parotid protein was measured using the microBSA-assay. Initially, flow rates were significantly higher during the chewing of gum vs. paraffin tablets (whole saliva 5.18 vs. 2.99 ml/min, parotid saliva 0.83 vs. 0.42 ml/min). Conversely, during final chewing periods, parotid flow rates, pH, and titrated pH were significantly higher during paraffin chewing. When comparing the stimuli, parotid protein output was higher initially during gum chewing, but in the final period paraffin chewing elicited the higher output. It was concluded that the clinical test of paraffin chewing gives a good estimate of the expected whole saliva response to chewing-gum. Furthermore, extended chewing of paraffin tablets seemed to influence parameters of parotid saliva positively.

Adult↗

Properties of excitatory synaptic connections mediated by the corpus callosum in the developing rat neocortex.

Despite the major role of excitatory cortico-cortical connections in mediating neocortical activities, little is known about these synapses at the cellular level. Here we have characterized the synaptic properties of long-range excitatory-to-excitatory contacts between visually identified layer V pyramidal neurons of agranular frontal cortex in callosally connected neocortical slices from postnatal day 13 to 21 (P13-21) rats. Midline stimulation of the corpus callosum with a minimal stimulation paradigm evoked inward excitatory postsynaptic currents (EPSCs) with an averaged peak amplitude of 56.5 +/- 5 pA under conditions of whole cell voltage clamp at -70 mV. EPSCs had fixed latencies from stimulus onset and could follow stimulus trains (1-20 Hz) without changes in kinetic properties. Bath application of 2,3-dihydro-6-nitro-7-sulfamoyl-benzo(F)quinoxaline (NBQX) abolished these responses completely, indicating that they were mediated by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors (AMPARs). Evoked responses were isolated in picrotoxin to yield purely excitatory PSCs, and a low concentration of NBQX (0.1 microM) was used to partially block AMPARs and prevent epileptiform activity in the tissue. Depolarization of the recorded pyramidal neurons revealed a late, slowly decaying component that reversed at approximately 0 mV and was blocked by D-2-amino-5-phosphonovaleric acid. Thus AMPA and N-methyl-D-aspartate receptors (NMDARs) coexist at callosal synapses and are likely to be activated monosynaptically. The peak amplitudes and decay time constants for EPSCs evoked using minimal stimulation (+/-40 mV) were similar to spontaneously occurring sEPSCs. Typical conductances associated with AMPA and NMDAR-mediated components, deduced from their respective current-voltage (I-V) relationships, were 525 +/- 168 and 966 +/- 281 pS, respectively. AMPAR-mediated responses showed age-dependent changes in the rectification properties of their I-V relationships. While I-Vs from animals >P15 were linear, those in the younger (<P16) age group were inwardly rectifying. Although Ca2+ permeability in AMPARs can be correlated with inward rectification, outside-out somatic patches from younger animals were characterized by Ca2+-impermeable receptors, suggesting that somatic receptors might be functionally different from those located at synapses. While the biophysical properties of AMPAR components of callosally-evoked EPSCs were similar to those evoked by stimulation of local excitatory connections, the NMDA component displayed input-specific differences. NMDAR-mediated responses for local inputs were activated at more hyperpolarized holding potentials in contrast with those evoked by callosal stimulation. Paired stimuli used to assay presynaptic release properties showed paired-pulse depression (PPD) in animals <P16, which converted to facilitation (PPF) in older animals, suggesting a developmental transition from low probability of transmitter release to high P(r) at these synapses and/or alterations in the properties of the underlying postsynaptic receptors. Physiologic properties of neocortical e-e connections are thus input specific and subject to developmental changes in their postsynaptic receptors.

Aging↗

Differential effects of muscle contraction from various body parts on neuromagnetic somatosensory responses.

We studied eight healthy subjects with a whole-scalp 306-channel neuromagnetometer to explore the effect of motor activity from different body parts on somatosensory responses to left median nerve stimulation. The stimuli produced clear tactile sensation without any motor movement. In the rest condition, the subject had no task. During contraction conditions, the subject had to maintain submaximal isometric contraction in masseter, left deltoid, left thenar, or left tibialis muscles. Short-latency responses from the primary somatosensory cortex did not change during contraction. Responses from both the right (contralateral) and left second somatosensory cortices (SII) were significantly enhanced during contraction of the left thenar muscles. Responses from the left SII were significantly enhanced also during contraction of the left deltoid muscles, but they were decreased during contraction of the masseter and left tibialis anterior muscles. This study implies that SII activation is modulated by motor activity and that the effect depends on the topographical proximity of the stimulated and contracted body parts.

Adult↗

Electrical stimulation of the midbrain central gray facilitates lateral vestibulospinal activation of back muscle EMG in the rat.

Electrical stimulation in the midbrain central gray in urethane-anesthetized female rats increased responses of the deep back muscles lateral longissimus and medial longissimus to stimulation of the lateral vestibular nucleus (LVN). During central gray stimulation, LVN stimuli led to larger muscle responses, recruitment of new motor units, and decreased latency of muscle response. Effective central gray sites are hypothesized to act through axons descending to medullary reticular formation. Results are consistent with participation of these neuronal groups in the activation of lordosis behavior, a vertebral dorsiflexion that requires deep back muscle contraction, but these electromyographic results could also be relevant for other behaviors that require vertebral postural adjustments.

Action Potentials↗

A comparison of the effects of noxious and innocuous counterstimuli on experimentally induced itch and pain.

We have studied experimentally induced itch (using histamine iontophoresis) and pain (using topical mustard oil) in healthy human volunteers, measured using visual analogue scale (VAS) ratings. The effects of the following counterstimuli were evaluated: innocuous vibration; innocuous transcutaneous electrical nerve stimulation (TENS); innocuous warming of skin; noxious heating of skin; noxious chemical skin stimulation (using mustard oil); mildly noxious constant current transdermal electrical stimulation. Innocuous stimuli applied 2 min after histamine or mustard oil challenge produced a modest reduction of itch and pain ratings (20-30%), which did not persist for more than 20 sec when the counterstimuli were removed. These changes may well be due to distraction. The same stimuli (in some cases applied for periods of up to 1 h) given prior to the histamine or mustard oil, produced no significant reduction in evoked itch or pain. Noxious stimuli of all types applied 2 min after histamine or mustard oil challenge produced a consistent and significant inhibition of itch (22.8-52.7%) which outlasted the period of counterstimulation application. In contrast, these stimuli had no significant effects on chemically induced pain. The anti-pruritic state produced by brief noxious stimuli were effective for periods of more than 30 min. The differential effects of noxious counterstimuli on itch and pain do not support the suggestion that itch is a subliminal form of pain. Noxious counterstimuli are likely to act via a central rather than peripheral mechanism. The novel finding that a persistent anti-pruritic state can be induced by transdermal constant current may be useful in conditions of clinical itch.

Adult↗

Patterned activity in stratum lacunosum moleculare inhibits CA1 pyramidal neuron firing.

CA1 pyramidal cells are the primary output neurons of the hippocampus, carrying information about the result of hippocampal network processing to the subiculum and entorhinal cortex (EC) and thence out to the rest of the brain. The primary excitatory drive to the CA1 pyramidal cells comes via the Schaffer collateral (SC) projection from area CA3. There is also a direct projection from EC to stratum lacunosum-moleculare (SLM) of CA1, an input well positioned to modulate information flow through the hippocampus. High-frequency stimulation in SLM evokes an inhibition sufficiently strong to prevent CA1 pyramidal cells from spiking in response to SC input, a phenomenon we refer to as spike-blocking. We characterized the spike-blocking efficacy of burst stimulation (10 stimuli at 100 Hz) in SLM and found that it is greatest at approximately 300-600 ms after the burst, consistent with the time course of the slow GABA(B) signaling pathway. Spike-blocking efficacy increases in potency with the number of SLM stimuli in a burst, but also decreases with repeated presentations of SLM bursts. Spike-blocking was eliminated in the presence of GABA(B) antagonists. We have identified a candidate population of interneurons in SLM and distal stratum radiatum (SR) that may mediate this spike-blocking effect. We conclude that the output of CA1 pyramidal cells, and hence the hippocampus, is modulated in an input pattern-dependent manner by activation of the direct pathway from EC.

Animals↗

Motor evoked potentials and central motor conduction: studies of transcranial magnetic stimulation with recording from the leg.

To determine central conduction times in the corticospinal pathways of humans using magnetic stimulation, we have developed a method for consistently recording conduction times between the motor cortex and the L4-5 level of the spinal cord. In 30 subjects, motor evoked potentials (MEPs) were recorded from the tibialis anterior muscle following contralateral motor cortex and peroneal nerve stimulation. In 18 of these subjects, the L4-5 intervertebral space was stimulated. The stimuli consisted of single, painless, short-duration magnetic pulses. In 12 subjects, measurements were made during voluntary ankle dorsiflexion, and during vibration of the TA tendon at rest. All subjects had measureable MEP latencies of 30.3 +/- 2.2 msec (mean +/- S.D.). The central motor conduction time (CMCT) was calculated using both a direct as well as an indirect method. The direct method in 18 subjects had a mean value of 16.2 +/- 1.7 msec, while the indirect method in all 30 subjects was 13.8 +/- 1.8 msec. No significant correlation of the CMCT was found with either age or height in these subjects. Ankle dorsiflexion significantly reduced the MEP latency and increased the amplitude, whereas vibration of the TA tendon significantly increased the amplitude alone. We conclude that MEPs may be consistently and painlessly measured in the lower extremity using magnetic stimulation in adults. Facilitation of the MEPs was produced more consistently by voluntary contraction than by vibratory stimulation of the tibialis anterior muscle tendon. Finally, CMCT was independent of both age and height in our study population.

Adult↗

Electroconvulsive seizure behavior in Drosophila: analysis of the physiological repertoire underlying a stereotyped action pattern in bang-sensitive mutants.

Drosophila bang-sensitive mutants display a remarkable stereotyped behavioral sequence during mechanical disturbances. This seizure repertoire consists of initial and delayed bouts of spasm interposed with paralysis and followed by recovery of activity and a period of refractoriness to further stimulation. Electroconvulsive stimuli across the brain induced a similar seizure behavior in tethered flies, in which corresponding electrophysiological events could be readily recorded in indirect flight muscles [dorsal longitudinal muscles (DLMs)] of the giant fiber (GF) pathway. The DLM physiological repertoire consisted of initial and delayed discharges (IDs and DDs), a response failure and recovery, followed by a refractory period. Interestingly, wild-type flies also displayed the same electroconvulsive repertoire, albeit inducible only at higher stimulus intensities and with briefer expression. The DLM repertoire presumably originated from activities of distinct neural circuits subserving normal function and reflected the general sequence of excitation and depression of the nervous system as a whole, as shown by simultaneous recordings along the different body axes. The well characterized GF pathway facilitated localization of circuits responsible for response failure and ID and DD motor patterns by surgical manipulations, recording-stimulating site analysis, and genetic mosaic studies. A flight pattern generator is most likely the major contributor to shaping the DD pattern, with modifications by active integration of individual motor neurons and associated interneurons. The robust electroconvulsive repertoire of DLMs provides a convenient window for further genetic analysis of the interacting neural mechanisms underlying a stereotyped action pattern in Drosophila, which shows striking parallels with aspects of seizure in mammalian species.

Action Potentials↗

Short-term down-regulation of the brain-specific, PtdIns(3,4,5)P3/Ins(1,3,4,5)P4-binding, adapter protein, p42IP4/centaurin-alpha 1 in rat brain after acoustic and electric stimulation.

The protein p42(IP4), expressed mainly in brain, specifically recognizes two second messenger molecules, Ins(1,3,4,5)P(4) (IP(4)), a water soluble metabolite of IP(3) and the lipid PtdIns(3,4,5)P(3) (PIP(3)), the product of the growth factor-activated enzyme PI-3-kinase. Here, we studied whether there is short-term regulation of the expression level of p42(IP4) in limbic brain areas following acoustic and electric stimulation. The stimuli down-regulated the mRNA and protein levels within 2h in amygdala, hypothalamus and cingulate/retrospenial cortex. p42(IP4) mRNA decreased by about 50% for about 24h, but recovered to control values after 72 h. The present results are the first indication of a specific role of p42(IP4) in the short-term regulation of a behavioral response. They indicate that p42(IP4), an adapter protein in PIP(3)-dependent cellular signaling, may play an important role in the signal transduction pathways regulating plasticity in neuronal cells.

Acoustic Stimulation↗

Matching the neural adaptation in the rat ventral cochlear nucleus produced by artificial (electric) and acoustic stimulation of the cochlea.

To investigate neural adaptive properties, near-field evoked potentials were recorded from a chronically implanted electrode in the ventral cochlear nucleus in awake Long-Evans rats exposed to acoustic stimuli or receiving intracochlear electric stimulation. Stimuli were 250-ms trains of repetitive acoustic clicks (10, 30 and 50 dB SPL) or biphasic electric pulses (30, 50 and 70 microA) with intratrain pulse rates ranging from 100 to 1000 pulses per second (pps). The amplitude of the first negative (N(1)) to positive (P(1)) component of the average evoked potentials was measured for each consecutive individual pulse in the train. While a progressive exponential decrease in N(1)-P(1) amplitude was observed as a function of the position of the pulse within the train for both types of stimulation, the decrement of electric responses (adaptive pattern) was substantially less prominent than that observed for acoustic stimuli. Based on this difference, the present work was extended by modifying electric stimuli in order to try to restore normal adaptation phenomena. The results suggest the feasibility of mimicking acoustic adaptation by stimulation with exponentially decreasing electric pulse trains, which may be clinically applicable in the auditory implant field.

Acoustic Stimulation↗

[Coronary endothelial dysfunction in hypertension].

Intracoronary injection of acetylcholine leads to coronary vasodilatation in normal subjects and vasoconstriction in hypertensive subjects, suggesting an abnormality of endothelial function in hypertension. In order to study the response to physiological stimulation which induces endothelium-dependent vasodilatation, the effects of sympathetic stimulation (cold pressor test) and of the increase in flow velocity in the left anterior descending artery were analysed in 10 control and 26 hypertensive subjects. All had angiographically normal coronary arteries and normal lipid profiles. None of the subjects were smokers or diabetic. During the cold test (12 patients), the flow velocity increased by 47 +/- 26% (p < 0.05) in controls and by 68 +/- 48% (p < 0.01) in the hypertensives. Dilatation of the coronary arteries was observed in controls (+12.0 +/- 4.5%, p < 0.001) and constriction in the hypertensives (-10.3 +/- 8.5%, p < 0.001). Injection of papaverine in the distal left anterior descending artery (14 patients) induced proximal dilatation in controls (+17.0 +/- 10.6%, p < 0.001) and was ineffective in hypertensives (-0.4 +/- 1.5%), whereas the flow velocity increased by 521 +/- 129% and 406 +/- 120% (p < 0.001) respectively. Intracoronary injection of 2 mg of isosorbide dinitrate induced comparable dilatation in control subjects (+30.0 +/- 12.9%, p < 0.001) and in the 26 hypertensives (+22.8 +/- 6.5%, p < 0.001). In 10 hypertensive patients, intravenous injection of an angiotensin converting enzyme inhibitor, perindoprilat, immediately re-established the vasodilatory response to these two stimuli. The authors conclude that the coronary responses to physiological stimuli (sympathetic stimulation, increase in flow velocity) are altered in hypertensive subjects with angiographically normal coronary arteries with no other risk factors. Normal vasomotion may be restored by an angiotensin converting enzyme inhibitor.

Adult↗