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Gender differences in effects of pinacidil but not diazoxide on heart automatism in the isolated guinea pig right atria.

UNLABELLED: The aim of this paper was to investigate the effects of pinacidil and diazoxide, the activators of sarcolemmal and mitochondrial ATP-sensitive K(+) channels (K(ATP)), respectively, on heart rate and force of contraction in female and male guinea pigs. Experiments were performed on the isolated, spontaneously beating, right atria obtained from guinea pigs of both genders. First series of experiments were performed in the spring and repeated in the fall. It was found that diazoxide induced similar negative chronotropic effects in females (-logIC(50) = 4.34 +/- 0.05, E(max) = -90 +/- 6 beats min(-1)) and males (-logIC(50) = 4.42 +/- 0.1, E(max) = -91 +/- 6 beats min(-1)). Additionally, significant positive inotropic effect sensitive to 5-hydroxydecanoate was noted only in males (about 30% above control level at 300 microM). No differences in effects of diazoxide in the spring and in the fall were noted. On the other hand, pinacidil induced significant decrease in heart rate in female guinea pigs only in the fall (-logIC(50) = 4.79 +/- 0.15, E(max) = -77 +/- 9 beats min(-1)), but in males similar negative chronotropic action in the spring (-logIC(50) = 4.53 +/- 0.12, E(50) = -63 +/- 5 beats min(-1)) and in the fall (-logIC(50) = 4.75 +/- 0.2, E(max) = -59 +/- 8 beats min(-1)) was observed. Glibenclamide (10 microM), but not 5-hydroxydecanoate (300 microM) reversed negative chronotropic action of both, pinacidil and diazoxide. No significant inotropic action of pinacidil was observed. CONCLUSIONS: Although negative chronotropic effects of pinacidil and diazoxide are related to activation of sarcolemmal K(ATP) channels, only pinacidil affects heart rate of female and male guinea pigs in a different way. This difference is probably hormone-dependent as it appeared only in the spring.

Adenosine Triphosphate↗

Differential effects of diazoxide, cromakalim and pinacidil on adrenergic neurotransmission and 86Rb+ efflux in rat brain cortical slices.

The effects of diazoxide, cromakalim and pinacidil on depolarization-evoked tritium overflow from the rat brain cortical slices preloaded with [3H]noradrenaline were studied. Diazoxide inhibited both transmural nerve stimulation (TNS)- and 25 mM K(+)-evoked tritium overflows more potently than cromakalim. Diazoxide effects were only partially antagonized and cromakalim ones were totally reversed by 1 microM glibenclamide. Diazoxide, but not cromakalim, reduced the 45 mM K(+)-evoked tritium overflow, which was not antagonized by glibenclamide. Both diazoxide and cromakalim stimulated 86Rb+ efflux to a similar extent, the effects being completely abolished by glibenclamide. Glibenclamide (> or = 3 microM) by itself enhanced the TNS-evoked tritium overflow. Pinacidil increased both TNS- and K+ (25 and 45 mM)-evoked tritium overflows with little effect on 86Rb+ efflux. Pinacidil-induced increase in the TNS-evoked tritium overflow was still observed in the presence of cocaine or hydrocortisone. Pinacidil failed to affect the inhibitory action of xylazine on the TNS-evoked tritium overflow, whereas phentolamine attenuated it. These results indicate that ATP-sensitive K+ channels are present in the adrenergic nerve endings of rat brain. These channels seem to be pharmacologically different from those reported for vascular smooth muscles and pancreatic beta-cells.

Animals↗

Effects of the K+ channel activators, RP 52891, cromakalim and diazoxide, on the plasma insulin level, plasma renin activity and blood pressure in rats.

In normo- or hyperglycemic (i.v. infusion of 50 mg/kg/min glucose over 30 min) pithed rats, diazoxide (1 mg/kg/min i.v. over 20 min) significantly reduced plasma insulin content. By contrast, cromakalim, nicorandil or RP 52891 even at doses 40-fold higher than those producing the same hypotensive effect as diazoxide in intact anesthetized normotensive rats, failed to change insulin plasma levels. Glibenclamide (0.01-0.3 mg/kg i.v.) pretreatment antagonized dose-dependently the hypoinsulinemic activity of diazoxide with an i.v. ED50 value of 49 +/- 1 microgram/kg. In pithed rats, diazoxide increased markedly plasma renin activity. This effect was almost inhibited completely by 20 mg/kg i.v., but not at all by a 1-mg/kg i.v. dose of glibenclamide. In pentobarbital-anesthetized rats, diazoxide (0.5-2 mg/kg/min i.v. over 20 min) produced decreases in mean carotid artery blood pressure which were antagonized dose-dependently by glibenclamide (5-20 mg/kg i.v.). This sulfonylurea (20 mg/kg i.v.) also prevented the hypotensive effects of several i.v. administered K+ channel activators (cromakalim, RP 52891 and nicorandil) but not those of numerous hypotensive agents such as acetylcholine, adenosine, bradykinin, clonidine, histamine, salbutamol, dihydralazine, papaverine, platelet aggregating factor, nitroglycerin, nitroprusside, nitrendipine and diltiazem. Although glibenclamide lowered plasma glucose levels, its blocking activity vis-à-vis the hypotension evoked by cromakalim was not affected when its hypoglycemic effects were reversed with an i.v. injection of glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Inhibition of calcium release of diazoxide studied in the isolated rat kidney.

Isolated kidneys of normotensive Wistar rats (NWR) and of genetically hypertensive Kyoto rats (SHR) were perfused. Contraction of intrarenal vascular smooth muscle cells were induced by barium ions (0.1 to 1.0 mmol) as well as by high potassium concentrations (40 mmol). It was shown that barium stimulates intracellular calcium stores to release activator calcium. Repeated stimulation with barium under calcium-free perfusion conditions resulted in depletion of these stores. In kidneys of SHR rats the tension development in response to barium was stronger as compared with NWR rats and the time needed to deplete the stores was prolonged. This suggests that smooth muscle cells of SHR rats contain more sequestered calcium. Diazoxide inhibited the barium contracture rapidly, reversibly and dose dependently. The inhibition was non-competitive. Percentual inhibition was equal in NWR and in SHR rat kidneys. Moreover, diazoxide did not block the calcium influx across the sarcolemma membrane. The magnitude of the potassium contractures depended entirely upon the extracellular calcium concentration. In the range of 0.1 to 1.0 mmol calcium, tension development varied linearly with log calcium concentration. Diazoxide also inhibited the potassium contractures, provided normally filled calcium stores were available. The combined results strongly suggest that diazoxide prevents intracellular calcium stores to release calcium and, furthermore, that this action is the basic mechanism of the vasodilating activity of diazoxide in smooth muscle cells of rat intrarenal vessels.

Animals↗

Absence of effect of diazoxide on sodium and water handling in the isolated perfused rat kidney.

The effect of the thiazide derivative diazoxide on water and sodium handling of the isolated perfused rat kidney was studied. In kidneys of normotensive rats no influence on diuresis, glomerular filtration rate or sodium and potassium excretion rates could be detected whereas hydrochlorothiazide showed the anticipated effects. The diuretic effect of the latter compound was not inhibited nor potentiated by pretreatment with diazoxide. In kidneys of hypertensive rats, studied at different ages: 10, 20, 30, and 45 weeks respectively, no acute effects of diazoxide on tubular function were found either. Diazoxide and hydrochlorothiazide both resulted into a small drop of renal perfusion pressure indicating that renal vascular resistance was lowered. The results suggest that the water and sodium retention frequently observed in patients treated with diazoxide are not caused by a direct effect of the drug on tubular function but are mediated by its peripheral and/or intrarenal vascular effects.

Animals↗

Nonemergency use of slow infusions of diazoxide.

Slow infusions of diazoxide were administered to 10 hypertensive patients who had stable, nonaccelerated hypertension. The 10-min diazoxide infusion was associated with a 16% average reduction in arterial pressure, a 21% average increase in heart rate, a 16% average increase in cardiac output, and a 36% reduction in total peripheral resistance. These changes in hemodynamic parameters lasted for an average of 70 min. It was concluded that slow infusions of diazoxide produce a consistent and predictable antihypertensive effect in patients with stable, nonaccelerated hypertension. Slow infusions of diazoxide may have a limited use in nonemergency situations where an abrupt change in arterial pressure is to be avoided and a parenteral antihypertensive agent is needed.

Adult↗

Modulation of GABA transmission by diazoxide and cromakalim in the globus pallidus: implications for the treatment of Parkinson's disease.

An ATP-sensitive potassium channel (KATP) is known to modulate insulin release from pancreatic beta cells. It has been proposed that potassium channels related to KATP in the nervous system might similarly modulate neurotransmitter release. We have therefore investigated the effects of KATP opening agents on GABA release in the globus pallidus. Diazoxide and cromakalim decreased the K(+)-evoked release of [3H]GABA from pallidal slices. The maximum inhibition observed for diazoxide (59%) and cromakalim (66%) was achieved at a concentration of 100 microM. The effects of both cromakalim and diazoxide were significantly antagonized by the concurrent application of the sulfonylurea glibenclamide (100 microM). Intrapallidal injections of diazoxide in the reserpine-treated rat model of Parkinson's disease reduced akinesia in a dose-dependent manner. These data suggest that manipulation of neuronal potassium channels with pharmacological properties similar to KATP may prove useful in the treatment of Parkinson's disease.

Animals↗

Concentration-dependent effects of tolbutamide, meglitinide, glipizide, glibenclamide and diazoxide on ATP-regulated K+ currents in pancreatic B-cells.

The influence of the hypoglycemic drugs tolbutamide, meglitinide, glipizide and glibenclamide on ATP-dependent K+ currents of mouse pancreatic B-cells was studied using the whole-cell configuration of the patch-clamp technique. In the absence of albumin, tolbutamide blocked the currents half maximally at 4.1 mumol/l. In the presence of 2 mg/ml albumin half maximal inhibition of the currents was observed at 2.1 mumol/l meglitinide, 6.4 nmol/l glipizide and 4.0 nmol/l glibenclamide. The hyperglycemic sulfonamide diazoxide opened ATP-dependent K+ channels. Half maximally effective concentrations of diazoxide were 20 mumol/l with 0.3 mmol/l ATP and 102 mumol/l with 1 mmol/l ATP in the recording pipette. Thus, the action of diazoxide was dependent on the presence of ATP in the recording pipette. The free concentrations of the drugs which influenced ATP-dependent K+ currents were comparable with the free plasma concentrations in humans and the free concentrations which affected insulin secretion in vitro. The results support the view that the target for the actions of sulfonylureas and of diazoxide is the ATP-dependent K+ channel of the pancreatic B-cell or a structure closely related to this channel.

Adenosine Triphosphate↗

Morphologic effects of diazoxide and diphenylhydantoin on insulin secretion and biosynthesis in B cells of mice.

The action of diazoxide, an antidiuretic agent, and diphenylhydantoin, an antiepileptic (DPH), both with strong hyperglycemic side effects on the pancreatic B cells, was examined by electron microscopy and cytochemistry, with the following findings. 1. Effects on secretory apparatus: the severe hyperglycemic syndrome following a single injection of diazoxide (200 mg/kg) or DPH (150 mg/kg) did not change the granularity of the B cells. Ultrastructurally a marked increase of lysosomal digestion of secretory granules (crinophagy) was observed in almost all B cells. Crinophagy may be regarded as a result of an impaired discharge of secretory granules during simultaneous maintenance of biosynthesis. It is also possible that changes of the electrophysical properties of the granule surfaces may play an additional role in crinophagy. 2. Effect on synthesizing apparatus: in B cells subtotally degranulated by the injection of anti-insulin serum (AIS), regranulation occurred more rapidly after the additional administration of diazoxide or DPH than without these compounds. This fact may imply that, under the hyperglycemic conditions tested, diazoxide or DPH have no effect on the synthesizing capacity of the B cells.

Animals↗

Decrease of some metabolic and physiologic effects of diazoxide by propranolol in rat.

Diazoxide significantly decreased the blood pressure and relaxed the uterine muscle in anaesthetized normotensive rats. A marked elevation of blood glucose followed the intravenous injection of diazoxide. The hyperglycemic and the uterine relaxing response could be significantly decreased by injection of propranolol prior to diazoxide. The hypotensive effect was not diminished by propranolol, however. In liver and uterus the content of cAMP was increased following diazoxide treatment in vivo. The rise in cAMP could be completely inhibited by propranolol, indicating a beta-receptor stimulation being the cause of the cAMP elevation.

Animals↗

Comparative study of the effects of cromakalim (BRL 34915) and diazoxide on membrane potential, [Ca2+]i and ATP-sensitive potassium currents in insulin-secreting cells.

Patch-clamp and single cell [Ca2+]i measurements have been used to investigate the effects of the potassium channel modulators cromakalim, diazoxide and tolbutamide on the insulin-secreting cell line RINm5F. In intact cells, with an average cellular transmembrane potential of -62 +/- 2 mV (n = 42) and an average basal [Ca2+]i of 102 +/- 6 nM (n = 37), glucose (2.5-10 mM): (i) depolarized the membrane, through a decrease in the outward KATP current, (ii) evoked Ca2+ spike potentials, and (iii) caused a sharp rise in [Ca2+]i. In the continued presence of glucose both cromakalim (100-200 microM) and diazoxide (100 microM) repolarized the membrane, terminated Ca2+ spike potentials and attenuated the secretagogue-induced rise in [Ca2+]i. In whole cells (voltage-clamp records) and excised outside-out membrane patches, both cromakalim and diazoxide enhanced the current by opening ATP-sensitive K+ channels. Diazoxide was consistently found to be more potent than cromakalim. Tolbutamide, a specific inhibitor of ATP-sensitive K+ channels, reversed the effects of cromakalim on membrane potential and KATP currents.

Adenosine Triphosphate↗

The effects of diazoxide on total lung resistance in the anesthetized paralyzed guinea-pig.

The initial effects of diazoxide on dynamic pulmonary compliance (CL) and flow resistance (RL) were measured in paralyzed, anesthetized guinea-pigs. Diazoxide (10, 20 or 40 mg/kg) caused a dose-related increase in RL and decrease in CL. The increase in RL could be selectively abolished by glossopharyngealotomy or decentralization, and by pretreatment with mepyramine (0.1 mg/kg) or disodium cromoglycate (10 mg/kg). Pretreatment with indomethacin (0.1 mg/kg) or acetylsalicylic acid (1 mg/kg) selectively eliminated the decreases in compliance observed after diazoxide. It is concluded that diazoxide initially constricts both large (RL) and small (CL) airways. The constriction of the large airways may involve a release of histamine, whereas the constriction of the small airways may be mediated by a prostaglandin or prostaglandin-like substance.

Airway Resistance↗

A potent diazoxide analogue activating ATP-sensitive K+ channels and inhibiting insulin release.

AIMS/HYPOTHESIS: To characterise the effects of BPDZ 73 (7-chloro-3-isopropylamino-4H-1,2,4-benzothiadiazine 1,1-dioxide), a newly synthesised diazoxide analogue, on insulin secretory cells. METHODS: Measurements of 86Rb, 45Ca outflow, membrane potential, [Ca2+]i, insulin release in secretory cells as well as measurements of smooth muscle contractile activity and glycaemia were carried out. RESULTS: The analogue BPDZ 73 induced a dose-dependent decrease in insulin output. The IC50 value averaged 0.73 +/- 0.05 mumol/l. The drug increased the rate of 86Rb (42K substitute) outflow from perifused rat pancreatic islets. This effect was inhibited by glibenclamide, a KATP channel blocker. Measurements of DiBAC4(3) fluorescence further indicated that BPDZ 73 hyperpolarised the insulin secreting cells. It also decreased 45Ca outflow from pancreatic islets perifused throughout in the presence of 16.7 mmol/l glucose and extracellular Ca2+. By contrast, the drug did not affect the increase in 45Ca outflow mediated by K+ depolarisation. In single beta cells, BPDZ 73 inhibited the glucose-induced but not the K(+)-induced rise in [Ca2+]i. Moreover, in Wistar rats, i.p. injection of BPDZ 73 provoked a considerable increase in blood glucose concentration whereas diazoxide induced a modest rise in glycaemia. Lastly, the vasorelaxant properties of BPDZ 73 were slightly less pronounced than those of diazoxide. CONCLUSION/INTERPRETATION: The inhibitory effect of BPDZ 73 on the insulin-releasing process results from the activation of KATP channels with subsequent decrease in Ca2+ inflow and [Ca2+]i. The drug seems to be a KATP channel opener, more potent and more selective than diazoxide for insulin secreting cells.

Adenosine Triphosphate↗

Combined intravenous administration of diazoxide and beta-blocking agent in acute treatment of severe hypertension or hypertensive crisis.

Twenty-nine patients with severe hypertension (n = 14) or hypertensive crisis (n = 15) were treated with diazoxide infusion and intravenous injection of a beta blocker. In 13 patients diazoxide was administered first. It gradually reduced mean arterial pressure (MAP) by 16.1 +/- 2.1% (mean +/- SEM), and increased heart rate (HR) by 27.3 +/- 4.1% and plasma renin activity (PRA) by 48.9 +/- 13.0%. Beta blockade thereafter lowered MAP by only 1.2 +/- 1.9% despite reductions of HR by 35.6 +/- 2.2% and of PRA by 17.1 +/- 5.9%. In 16 other patients a beta blocker, when given first, reduced MAP by 3.5 +/- 1.2%, HR by 18.9 +/- 1.8%, and PRA by 24.2% +/- 4.4%. Diazoxide infusion thereafter gradually reduced MAP further by 21.9 +/- 1.9% and raised HR and PRA to pretreatment levels. No complications were observed. Beta blockade before diazoxide infusion effectively prevents a rise in HR above control levels while its acute effect on blood pressure is negligible. It is advisable to use this combined treatment in all situations where the occurrence of tachycardia might be dangerous.

Adrenergic beta-Antagonists↗

Intravenous diazoxide therapy in hypertensive crisis.

Ninety-one doses of diazoxide were administered intravenously to 41 patients with hypertensive crises. Diastolic blood pressure was reduced from an average of 139 to 98 mm Hg within 10 minutes. On the basis of a retrospective analysis of the response of diastolic blood pressure, it was possible to determine within 10 minutes of injection whether a second dose would be required. Therapy was judged to be effective in 38 of 41 patients; 35 percent of injections were ineffective. Concomitant administration of furosemide was not shown to have a beneficial antihypertensive effect. Mean blood urea nitrogen was 59.5 mg/100 ml initially and was not significantly different 2 weeks after therapy. None of the patients demonstrated clinical evidence of diazoxide-induced deterioration of coronary circulation. Electrocardiograms obtained 2 weeks after diazoxide therapy failed to show evidence of new ischemic changes. Only 9 percent of patients complained of side effects, and these were transient and relatively innocuous. It is concluded that diazoxide is both safe and efficacious in the management of hypertensive crises.

Adult↗

Minibolus diazoxide in the management of severe hypertension in pregnancy.

Severe hypertension poses immediate and potentially lethal maternal risks. Prompt reduction in blood pressure should be an urgent priority, with concomitant anticonvulsant therapy. Previous reports confirm intravenous diazoxide to be an effective agent. Concern exists over adverse reactions associated with bolus injection of the standard 300 mg dose. Many physicians are unaware that diazoxide may be given in increments. This study describes the use of diazoxide in 34 patients with severe preeclampsia. They received minibolus injections of 30 mg every 1 to 2 minutes. The maximum dose required was 150 mg and no maternal hypotension occurred. Maternal side effects were minimal and no cases of fetal distress occurred; a perinatal mortality was zero. It appears that minibolus diazoxide rapidly lowers maternal blood pressure without the adverse effects described with a standard bolus dose. Its advantages are contrasted with the limitations of conventional hydralazine therapy.

Apgar Score↗

Control of insulin secretion by sulfonylureas, meglitinide and diazoxide in relation to their binding to the sulfonylurea receptor in pancreatic islets.

Sulfonylureas inhibit an ATP-dependent K+ channel in the B-cell plasma membrane and thereby initiate insulin release. Diazoxide opens this channel and inhibits insulin release. In mouse pancreatic islets, we have explored whether other targets for these drugs must be postulated to explain their hypo- or hyperglycaemic properties. At non-saturating drug concentrations the rates of increase in insulin secretion declined in the order tolbutamide = meglitinide greater than glipizide greater than glibenclamide. The same rank order was observed when comparing the rates of disappearance of insulin-releasing and K+ channel-blocking effects. The different kinetics of response depend on the lipid solubility of the drugs, which controls their penetration into the intracellular space. Allowing for the different kinetics, the same maximum secretory rates were caused by saturating concentrations of tolbutamide, meglitinide, glipizide and glibenclamide. A close correlation between insulin-releasing and K+ channel-blocking potencies of these drugs was observed. The relative potencies of tolbutamide, meglitinide, glipizide and glibenclamide corresponded well to their relative affinities for binding to islet-cell membranes, suggesting that the binding site represents the sulfonylurea receptor. The biphasic time-course of dissociation of glibenclamide binding indicates a complex receptor-drug interaction. For diazoxide there was no correlation between affinity of binding to the sulfonylurea receptor and potency of inhibition of insulin secretion. Thus, opening or closing of the ATP-dependent K+ channel by diazoxide or sulfonylureas, respectively, appears to be due to interaction with different binding sites in the B-cell plasma membrane. The free concentrations of tolbutamide, glipizide, glibenclamide and diazoxide which are effective on B-cells are in the range of therapeutic plasma concentrations of the free drugs. It is concluded that the hypo- and hyperglycaemic effects of these drugs result from changing the permeability of the ATP-dependent K+ channel in the B-cell plasma membrane.

ATP-Binding Cassette Transporters↗

Comparative effects of LN 5330 and diazoxide on insulin release and 86Rb+ permeability in perifused rat islets of Langerhans.

The benzothiadiazine derivative LN 5330 (chloro-7 trifluoromethyl-6 benzothiadiazine-1,2,4-dioxide-1,1) has been shown to inhibit insulin secretion and calcium uptake. The present study was carried out to investigate the effects of LN 5330 on insulin release and 86Rb- efflux from perifused rat pancreatic islets; a comparison was made with the structural analogue diazoxide. In the presence of 8.3 mM glucose, LN 5330 (100 microM) accelerated 86Rb+ efflux while reducing insulin output from the islets. LN 5330 induced a dose-dependent acceleration of 86Rb+ efflux and appeared to be a more potent activator of 86Rb+ efflux than diazoxide. The stimulatory effect of LN 5330 on 86Rb+ efflux persisted in the absence of extracellular calcium. In the absence of glucose, 86Rb+ permeability also increased, LN 5330 being again significantly more efficient than diazoxide at an equimolar concentration. These data indicate that the benzothiadiazine derivative LN 5330 inhibits insulin secretion by increasing the potassium permeability of the plasma membrane. It is suggested that, like diazoxide, this drug could activate the ATP-sensitive K+ channel.

Animals↗