Gadolinium Effect of Experimental Orthostatic Hypotension

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1 [Index FAC] [FVCC Index] Otras Unidades Temáticas /Other Thematics Units Gadolinium Effect of Experimental Orthostatic Hypotension Zarco Olvera G., Pastelín Hernández G. Departamento de Farmacología, Instituto Nacional de Cardiología "Ignacio Chávez", Tlalpan, México D.F., México. ABSTRACT Introduction: Gadolinium is a lanthanide that blocks stretch-activated ion channels (SAIC's) within the vascular endothelium. Stimulation of such SAIC's increases nitric oxide release, therefore, vasodilation is observed. Objective: Investigate how can gadolinium administration modify arterial pressure and cardiac frequency in a experimental orthostatic hypotension model. Materials and methods: Six mongrel dogs (18 ± 2 kg) were anesthesized with sodium penthobarbital (35 mg/kg, i.v.). The animal was artificially ventilated with a positive pressure pump. The dog was placed in dorsal decubitus at a special table, were inclination angles were varied (20, 40, 60 and 90 ). Gadolinium was administrated at 5 mg/kg, i.v., after control inclination changes. Arterial pressure was recorded with a quimiograph. DII electrocardiogram was registered using a VR-6 polygraph. Left intraventricular pressure and dp/dt were also recorded by placing a femoral catheter. Results: Mean arterial pressure prior to gadolinium administration was 93 mmhg at 0, 89 mmhg at 20, 79 mmhg at 40, 75 mmhg at 60 and 65 mmhg at 90. After gadolinium administration, mean arterial pressure values were 80, 75, 73, 73 and 45 mmhg, respectively. Therefore, gadolinium does not induce changes in arterial pressure as previously induced by postural changes in our experimental model. Conclusion: Gadolinium administration, after a change in position, does not statistically decreases arterial pressure. By such, SAIC's stimulation does not play a key role in the experimental orthostatic hypotension. INTRODUCTON Orthostatic hypotension is characterized by a decrease in systolic pressure greater than 20 mmhg or more than 10 mmhg in diastolic pressure by sudden changes in position from clinostatism to orthostatism. This decrease is commonly observed in the elderly and it's frequently accompanied with sudden heart attack [1-3]. For the latter to happen, a distension of the heart vessels should occur and it's probably due to a smooth muscle relaxation within these vessels, generated by blood flow. These signals regulate the vascular endothelium and, in turn, facilitate the release of endothelium-derived vasoactive substances such as prostacicline (PI2), adenosine (ADO), nitric oxide (NO), endothelins, ATP, histamine, among others. Additionally, activation of K + and Ca 2+ - selective channels as well as stretch-activated ion channels takes place. NO is generally regarded as an endogenous vasodilator and is a chemical component in humans, animals, plants, etc. Within the vessels, is a transmitting molecule, synthesized in the endothelial cells and act on adjacent smooth muscle cells in order to keep vasodilation and blood flow. L -arginine is NO precursor, a

2 process in which nitric oxide synthase (NOS) actively participates. NOS have at least two isoforms: one located in the vascular endothelium and neurons, which has been labeled as the constitutive isoform, acting in short periods, which leads to vasodilation. The so-called inducible isoform is found in macrophages, synthesizing NO in large quantities during a long period of time so bacterias and parasites could be destroyed. Constitutive NOS isoform is inactive in the endothelium until a rise in Ca 2+ concentration is observed. In the endothelial cells, agonists such as acetylcholine, ADP, bradikinine, or stress can act as stimuli that lead to increases in intracellular Ca 2+. Calmodulin, a Ca 2+ - fixing protein, binds to Ca 2+ and a Ca 2+ - calmoduline complex is formed. Once it has done so, this complex activates inducible NOS isoform, which arises NO concentrations until Ca 2+ is depleted. At the smooth muscle, NO can activate an enzyme known as soluble guanylyl cyclase (sgc), converting by so GTP to cgmp. All the previously describe functions are Ca 2+ - dependent, whose intracellular Ca 2+ concentration is flowtriggered. One possibility for this increase is the activation of stretch-activated ion channels, which are located on the cell membrane of the vascular endothelium, being these channels affected by shear-stress [4] Gadolinium (Gd) is a metallic element (lanthanide) than in its oxidation 3+ state is a non-selective blocker of stretch-activated ion channels [5,6]. If stretch-activated ion channels have a significant role in postural hypotension mechanisms, gadolinium administration will block the hemodynamic effects produced by sudden changes from orthostatism to clinostatism. MATERIALS AND METHODS For this study, we employed six mongrel dogs (18 ± 2 kg), with no sex preference, anesthetized until surgical anesthesia was achieved (sodium penthobarbital, 33 mg/kg, i.v.). We performed a tracheotomy to place a ventilation cannula (tidal volume 30 ml/kg). The femoral vein was cannulated to administrate an isotonic saline solution (ISS). The animal was placed on dorsal deccubitus on a special table, in which position was changed by varying inclination angles (20, 40, 60 and 90, respectively). ECG on DII, left intraventricular pressure and dp/dt were recorded on a VR-6 polygraph. On a quimiograph, we recorded arterial pressure. Gadolinium (III) chloride as continuously infused. Results are expressed as mean ± MES. Statistically significance was assessed using one-way ANOVA followed by Student's t -test. P values less than 0.05 were considered as statistically different. RESULTS Our results showed that mean arterial pressure (MAP) was 90 mmhg at 20, 88 mmhg at 40, 79 mmhg at 60 and 65 mmhg at 90. These changes are more evident on the first 30 seconds, and recovery is observed. Cardiac frequency tends to be increased, although with no statistically significantly differences. Gadolinium administration did not modify the observed changes on MAP induced in our model by postural changes. CONCLUSIONS Gadolinium administration, at a sudden position change, did not significantly modify MAP decrease on our experimental model of orthostatic hypotension. FIGURES CAPTIONS

3 Figure 1: Effect of sudden position changes on arterial pressure. Value represents mean ± MES; N=6; P<0.05 Figure 2: Effect of sudden position change from clinostatism to orthostatism on left intraventricular pressure. Value represents mean ± MES; N=6; P<0.05 Figure 3: Effect of sudden position change from clinostatism to orthostatism on mechanic systole duration. Value represents mean ±

4 MES; N=6; P<0.05 Figure 4: Effect of sudden position change from clinostatism to orthostatism on dp/dt left intraventricular pressure. Value represents mean ± MES; N=6; P<0.05 Figure 5: Effect of sudden position change from clinostatism to orthostatism on the presence of Gd. Value represents mean ± MES; N=6; P<0.05 BIBLIOGRAPHY 1. Patel A, Maloney A, Damato AN. On the frequency and reproducibility of orthostatic blood pressure changes in healthy community-dwelling elderly during 60-degree head-up tilt. American Heart Journal 1993; 126: Borst C, van Brederdone JFM, Wieiling W, van Montfrans GA, Dunning AJ. Mechanisms of initial blood pressure response to postural change. Clinical Science 1984; 67: Imholz BPM, Dambrink JHA, Karemaker JM, Wieling W. Orthostatic circulatory control in the elderly evaluated by non-invasive continous blood pressure measurement. Clinical Science 1990; 79: Lipsitz LA, Connelly CM, Kelley-Gagnon Ma, Kiely DK, Abernethy D, Waksmonski C. Cardiovascular adaptation to orthostatic stress during vasodilator therapy. Clinical Pharmacology & Therapeutics 1996; 60: Li GR, Baumgarten CM. Modulation of cardiac Na+ current by gadolinium, a blocker of stretch-induced arrhythmias. American Journal of Physiology Heart and Circulatory Physiology 2001; 280: H272-H Nicolisi AC, Kwok CS, Contney SJ, Olinger GN, Bosnjak ZJ. Gadolinium prevents stretch-mediated contractile

5 dysfunction in isolated papillary muscles. American Journal of Physiology Heart and Circulatory Physiology 2001; 280: H1122-H1128. Publication: October 2005 Top Your questions, contributions and commentaries will be answered by the lecturer or experts on the subject in the Clinical Cardiology ist. Please fill in the form and press the "Send" button. Question, contribution or commentary: Name and Surname: Country: Argentina address: Send Erase Dr. Diego Esandi Scientific Committee Dra. Silvia Nanfara Scientific Committee Prof. Dr. Armando Pacher Technical-Steering Committee CETIFAC - Bioingeniería UNER Webmaster Updated: 08/17/2005

27 part 2. Laith Abu Shekha. Mamoon Al-qatameen

27 part 2. Laith Abu Shekha. Mamoon Al-qatameen 27 part 2 Laith Abu Shekha Mamoon Al-qatameen Ebaa Alzayadneh In this sheet we will continue talking about second messengers for hormone that can t cross PM. D. Ca +2 as a second messenger: Another second