Hemodynamic parameters in patients undergoing surgery for pheochromocytoma/paraganglioma: a retrospective study.

BACKGROUND: Pheochromocytoma (PHEO) and paraganglioma (PGL) are rare neuroendocrine tumors characterized by hemodynamic instability, caused by the paroxysmal release of catecholamines. Patients may develop cardiovascular complications in the perioperative phase due to the massive release of catecholamines, particularly during anesthetic induction and surgical manipulation of the tumor. The aim of this retrospective study was to evaluate the risk factors involved in perioperative hemodynamic instability in patients who underwent surgery for chromaffin tumors. METHODS: Forty patients (median age 55 [36.50-64.50]) undergone surgery for PHEO/abdominal PGL from January 2011 to December 2016 at the AOU Careggi (Florence, Italy) were retrospectively evaluated. Systolic, diastolic, and mean blood pressure were considered at baseline and during surgery. Patients with blood pressure steadily < 140/90 mmHg before surgery were considered "adequately prepared". A preoperative therapy with doxazosin, a selective alpha-1 blocker, was started in all patients for at least 14 days prior to the surgery. The presence of hemodynamic instability was reported. RESULTS: Comparing males and females, a significant difference in doxazosin daily dose (p = 0.018), systolic blood pressure (p = 0.048), and in the proportion of adequately prepared patients (p = 0.031) emerged. A positive correlation between preoperative daily dose of doxazosin, tumor size (B = 0.60, p < 0.001), and urinary normetanephrine levels (B = 0.64, p < 0.001) was also observed. Hemodynamic instability occurred in 30.0% of patients. The absence of adequate preparation (p = 0.012) before surgery, urinary normetanephrine levels (NMNur p = 0.039), and surgery time (minutes) (p = 0.021) resulted as risk factors of hemodynamic instability in our series. The use of intraoperative drugs was higher in patients with hemodynamic instability (p < 0.001). A pre-surgical SBP level of > 133 mmHg (OR = 6 CI95% 1.37-26.20, p = 0.017) and an intraoperative SBP and MBP levels of > 127 mmHg (OR = 28.80 CI95% 2.23-371.0, p = 0.010) and > 90 mmHg (OR = 18.90 CI95% 1.82-196.0, p = 0.014), respectively, were identified as effective thresholds to recognize patients at higher risk of HI. CONCLUSIONS: A preoperative therapy with alpha-blockers is useful, but not sufficient to avoid surgical risks. Patients with higher pre-surgical levels of NMNur, pre-surgical SBP > 133 mmHg, and/or intraoperative SBP > 127 mmHg and MBP > 90 mmHg, should be carefully monitored. A multidisciplinary approach is indispensable to optimize the management of PHEOs/abdominal PGLs in order to reduce surgical complications.

Normetadrenaline and metadrenaline induce rat thoracic aorta/prostate contraction via α1D/1A-adrenoceptor stimulation.

Certain catecholamine metabolites exert significant pharmacological effects. Herein, we evaluated the pharmacological activities of catecholamine metabolites in the rat thoracic aorta, prostate, and spleen to determine whether these metabolites affect the contractile functions of smooth muscle tissue via direct action on α-adrenoceptors and α-adrenoceptor subtypes. Among the catecholamine metabolites examined, normetadrenaline and metadrenaline (10-4 M each) produced relatively strong contractions in the rat thoracic aorta. Maximum aortic contractions induced by normetadrenaline (≈70% of phenylephrine (3 × 10-7 M)-induced contractions) and metadrenaline (≈45%) were significantly smaller than those induced by phenylephrine (≈95%). Normetadrenaline and metadrenaline (10-4 M each) inhibited phenylephrine (3 × 10-7 M)-induced aortic contractions, which were not affected by propranolol (10-6 M), by 5-20%. Normetadrenaline- and metadrenaline (3 × 10-5 M each)-induced aortic contractions were strongly inhibited by prazosin (10-8 M; an α1-adrenoceptor antagonist) and BMY 7378 (10-8-10-7 M; a selective α1D-adrenoceptor antagonist). Metadrenaline (3 × 10-5 M)-induced aortic contractions were also significantly inhibited by silodosin (10-9 M; a selective α1A-adrenoceptor antagonist). Normetadrenaline and metadrenaline (3 × 10-5 M each) caused silodosin (10-9 M)-sensitive prostate contractions but did not cause a prominent spleen contraction. Maximum prostate contractions induced by metadrenaline (≈100% of phenylephrine (3 × 10-5 M)-induced contractions) were nearly identical to those induced by phenylephrine (≈100%) but were significantly larger than those induced by normetadrenaline (≈80%). These findings suggest that normetadrenaline and metadrenaline act as a partial α1D/α1A-adrenoceptor agonist and partial α1D-adrenoceptor/full α1A-adrenoceptor agonist, respectively, functioning as adrenaline system stabilizers in α1D/α1A-adrenoceptor-abundant smooth muscle tissues.

An electron microscope autoradiographic study of the neuronal and extraneuronal localization of labeled amine in the heart of the bat after administration of tritiated norepinephrine.

The localization of labeled amine in the heart of the bat after administration of tritiated norepinephrine (NE) was studied by means of electron microscope autoradiography. Monoamine oxidase was inhibited so that the distribution of amine in both neuronal (Uptake(1)) and extraneuronal (Uptake(2)) sites could be analyzed. Labeling was nonrandom in both the atrial and ventricular myocardium. The highest relative specific activity was found in neural processes which showed morphological criteria of terminal adrenergic axons. Analysis of the distribution of label around the labeled axonal varicosities indicated that the radioactive amine was more concentrated peripherally than centrally in these structures. Label was also found over cardiocytes in both atrium and ventricle. The pattern of this labeling indicated that the radioactive amine was associated with myofilaments. In the ventricle, I bands were most heavily labeled, indicating a probable association of radioactive amine with thin filaments. Labeling was prevented by administration of phenoxybenzamine and decreased only in cardiocytes by normetanephrine. The nonrandom distribution of labeled amine within cardiocytes supports the view that Uptake(2) represents not only a second mechanism of inactivation of the sympathetic neurotransmitter, but may also be involved in the mediation of some of the action of NE on cardiac muscle.

Local inhibition of uptake2 transporters augments stress-induced increases in serotonin in the rat central amygdala.

Organic cation transporter 3 (OCT3) is a corticosterone-sensitive, low-affinity, high-capacity transporter. This transporter functions, in part, to clear monoamines, including serotonin (5-HT), from the extracellular space. The central nucleus of the amygdala (CeA) is an important structure controlling fear- and anxiety-related behaviors. The CeA has reciprocal connections with brainstem nuclei containing monoaminergic systems, including serotonergic systems arising from the dorsal raphe nucleus, which are thought to play an important role in modulation of CeA-mediated behavioral responses. Organic cation transporter 3 (OCT3) is expressed in the CeA, but little is known about the role of OCT3 within the CeA in modulating serotonergic signaling. We hypothesized that inhibition of OCT3-mediated transport in the CeA during restraint stress would increase extracellular 5-HT. In Experiment 1, rats received unilateral reverse dialysis of either corticosterone or normetanephrine, which interfere with OCT3-mediated transport, into the CeA under home cage control conditions. In Experiment 2, rats received unilateral reverse dialysis of corticosterone, normetanephrine, or vehicle into the CeA, while undergoing a 40-min period of restraint stress. Infusion of these drugs had no effect on extracellular concentrations of 5-HT during home cage control conditions, but, in contrast, markedly increased extracellular concentrations of 5-HT during restraint stress, relative to vehicle-treated controls. These findings suggest a role for OCT3 in the CeA in control of serotonergic signaling during stressful conditions.

Inhibition of uptake 2 (or extraneuronal monoamine transporter) by normetanephrine potentiates the neurochemical effects of venlafaxine.

Two distinct norepinephrine (NE) transporter mechanisms (uptake 1 and uptake 2) regulate extracellular NE concentrations. An association has been observed between the gradual improvement in patients treated with antidepressants that inhibit the NE transporter (NET/uptake 1) and increases in urinary normetanephrine, the O-methylated NE metabolite and potent inhibitor of uptake 2. These observations led to the hypothesis that increased levels of normetanephrine, and consequently inhibition of uptake 2, may partly be responsible for the clinical efficacy of some antidepressants. To investigate this hypothesis, we employed microdialysis techniques in the rat frontal cortex to monitor extracellular changes in normetanephrine following chronic administration of the clinically effective antidepressant, venlafaxine (a serotonin (5-HT) and NE reuptake inhibitor). We evaluated the neurochemical effects of inhibiting uptake 2 alone, or in conjunction with venlafaxine, on extracellular levels of NE and 5-HT. Chronic venlafaxine administration (14 days, 10 mg/kg, s.c.) elicited significant increases in cortical NE and 5-HT while producing a non-significant trend to increase cortical levels of normetanephrine. Additional studies revealed that combining normetanephrine with venlafaxine (10 mg/kg, i.p.), at a dose of normetanephrine (10 mg/kg, i.p.) that did not produce changes in extracellular levels of NE on its own, potentiated antidepressant-induced increases in extracellular NE. We also report mouse behavioral data involving the tail suspension test that complement the neurochemical observations. These preclinical findings, taken together, suggest that inhibiting both uptake 1 and uptake 2 via venlafaxine and normetanephrine, respectively, elicits a greater increase in cortical levels of NE than inhibiting either transporter alone.

Corticosterone Potentiation of Cocaine-Induced Reinstatement of Conditioned Place Preference in Mice is Mediated by Blockade of the Organic Cation Transporter 3.

The mechanisms by which stressful life events increase the risk of relapse in recovering cocaine addicts are not well understood. We previously reported that stress, via elevated corticosterone, potentiates cocaine-primed reinstatement of cocaine seeking following self-administration in rats and that this potentiation appears to involve corticosterone-induced blockade of dopamine clearance via the organic cation transporter 3 (OCT3). In the present study, we use a conditioned place preference/reinstatement paradigm in mice to directly test the hypothesis that corticosterone potentiates cocaine-primed reinstatement by blockade of OCT3. Consistent with our findings following self-administration in rats, pretreatment of male C57/BL6 mice with corticosterone (using a dose that reproduced stress-level plasma concentrations) potentiated cocaine-primed reinstatement of extinguished cocaine-induced conditioned place preference. Corticosterone failed to re-establish extinguished preference alone but produced a leftward shift in the dose-response curve for cocaine-primed reinstatement. A similar potentiating effect was observed upon pretreatment of mice with the non-glucocorticoid OCT3 blocker, normetanephrine. To determine the role of OCT3 blockade in these effects, we examined the abilities of corticosterone and normetanephrine to potentiate cocaine-primed reinstatement in OCT3-deficient and wild-type mice. Conditioned place preference, extinction and reinstatement of extinguished preference in response to low-dose cocaine administration did not differ between genotypes. However, corticosterone and normetanephrine failed to potentiate cocaine-primed reinstatement in OCT3-deficient mice. Together, these data provide the first direct evidence that the interaction of corticosterone with OCT3 mediates corticosterone effects on drug-seeking behavior and establish OCT3 function as an important determinant of susceptibility to cocaine use.

Uptake of 3,4-dimethoxyphenylethylamine-1-14C (14C-DMPEA) by rat tissues in vitro.

Rat heart and spleen slices were incubated with 3,4-dimethoxyphenylethylamine-1-14C(14C-DMPEA) in Krebs medium at 37 C. At the end of 5-20 min of incubation, the heart did not take up the radioactivity while the spleen did. The Km and Vmax values of uptake in the spleen were 1 x 10(-4) M and 20 nmole/g per min, respectively, and the uptake was reduced to 16.0-35.1% in the cold (4 C) and to 40.3-64.0% in Na+-free medium. Thus, the uptake was an energy-dependent active process but was only partially Na+-dependent. Spleen slices incubated with 14C-DMPEA-free medium for 15 min following incubation with 14C-DMPEA retained 41.0-74.8% of radioactivity. The uptake was insensitive to norepinephrine (0.313 and 0.939 muM), dopamine (9.98 muM), 5-hydroxytryptamine (5 muM), cocaine (14.8 muM), 1-amphetamine (0.3 and 300 muM), d-amphetamine (300 muM), and normetanephrine (45.7 muM). 6-Hydroxydopamine treatment of rats, which produced 93% reduction in the splenic norepinephrine content, did not significantly reduce uptake. Thus, the uptake of DMPEA into the spleen is not by adrenergic neurones.

Histochemical fluorescence studies on noradrenaline accumulation by Uptake 2 in the isolated rat heart.

1. The distribution of noradrenaline accumulated by Uptake(2) (Iversen, 1965) in the isolated perfused rat heart has been observed using histochemical fluorescence microscopy.2. On the basis of the technique used, noradrenaline seems to be predominantly associated with the cardiac muscle cells, but sympathetic nerves and other cardiac structures also serve as retention sites.3. Phenoxybenzamine, normetanephrine and perfusion with noradrenaline at 20 degrees C all decreased noradrenaline accumulation.4. Lowered temperature significantly increased the perfusion pressure and significantly decreased the [(14)C]-sorbitol space in perfused hearts.5. The implications of these results are discussed.

The role of uptake2 in the extraneuronal metabolism of catecholamines in the isolated rat heart.

1. (+/-)-(3)H-NA and labelled metabolites of NA were estimated in rat hearts after perfusion with various concentrations of NA in the range 0.01-50.0 mug/ml. Labelled metabolites of NA accounted for only a small proportion of the total uptake of radioactivity at low perfusion concentrations, but accounted for 50% of the total uptake at 1 mug NA/ml., thereafter declining to progressively smaller proportions at higher perfusion concentrations.2. If the formation of labelled metabolites of (3)H-NA was blocked by a combination of monoamine oxidase and catechol-O-methyl transferase inhibitors, the accumulation of unchanged (3)H-NA was doubled when hearts were perfused with 1 mug NA/ml.3. In hearts perfused with 0.5 mug NA/ml., an accumulation of unchanged (3)H-NA was demonstrated in the presence of a combination of metabolic inhibitors and metaraminol. This appeared to be due to Uptake(2), since the accumulation of NA under these conditions could be prevented by a low concentration of normetanephrine.4. Phenoxybenzamine prevented extraneuronal uptake (Uptake(2)) and metabolism of (3)H-NA with an estimated ID50 of 2.5 muM. The inhibition of Uptake(2) by phenoxybenzamine (2.0 muM) was diminished at very high NA concentrations, suggesting that the drug may act competitively with NA.5. It was concluded that Uptake(2) operates at all catecholamine concentrations in the rat heart, but that in the lower range (less than 2.5 mug/ml. for NA and less than 0.75 mug/ml. for adrenaline) any catecholamine taken up by this process is rapidly metabolized. Thus the accumulation of unchanged amine is seen only at high perfusion concentrations.6. The relevance of these results to an understanding of the possible physiological and pharmacological importance of Uptake(2) is discussed.

Noradrenaline release in rats during prolonged cold-stress and repeated swim-stress.

1 Plasma noradrenaline concentration in rats was measured during prolonged cold-stress and repeated swim-stress. 2 Cold exposure for 6 h caused a rise in plasma noradrenaline which reached a peak at 4 h. 3 Administration of desmethylimipramine and normetanephrine to block neuronal and extra-neuronal uptake of noradrenaline raised plasma noradrenaline concentration without changing the pattern of the response to cold exposure. 4 Repeated cold exposure on subsequent days produced no change in the pattern of plasma noradrenaline concentration. 5 Five successive 1-min swims at 30-min intervals caused a rise in plasma noradrenaline concentration which was maximal after the third swim. 6 It is suggested that prolonged and repeated activation of sympathetic nerve terminals leads to a decline in noradrenaline release.

Noradrenaline uptake by non-innervated smooth muscle.

1. Uptake of noradrenaline (NA) into the non-innervated smooth muscle cells of the human umbilical artery and the chick amnion has been studied with the fluorescence histochemical technique for localizing monoamines. Comparison has been made with uptake into sympathetically innervated smooth muscle of the rabbit ear artery.2. Accumulation of NA within non-innervated smooth muscle cells is observed histochemically after exposure to much lower concentrations of NA (10(-7) g/ml) than in sympathetically innervated smooth muscle cells, where accumulation occurs with NA (10(-5) g/ml).3. In contrast to innervated smooth muscle, uptake of NA (10(-4) g/ml) by non-innervated smooth muscle is characterized by lack of inhibition by phenoxybenzamine, normetanephrine and cold, although some inhibition is apparent at lower NA concentrations. Retention of NA during prolonged washing in NA-free Krebs demonstrates that it is strongly bound within the non-innervated smooth muscle cells, particularly in the nucleus.4. After inhibition of catechol-O-methyl transferase, the accumulation of NA in innervated smooth muscle closely resembles that in non-innervated smooth muscle.

An examination of the negative feedback function of presynaptic adrenoceptors in a vascular tissue.

1 The hypothesis was examined that presynaptic alpha-adrenoceptors exert a negative feedback function regulating noradrenergic transmission.2 Renal artery strips from cattle, pre-incubated with [(3)H]-noradrenaline, were stimulated with 300 pulses at 5 different frequencies, spanning the physiological range, and the efflux of tritium assessed both in the absence and presence of functional presynaptic receptors.3 Considerable variation in the synaptic level of free and active noradrenaline with increasing frequency was apparent from the rates of development and the magnitudes of the mechanical responses but the overflow of tritium was constant at 1, 2, 10 and 15 Hz and slightly elevated at 5 Hz, providing no evidence for presynaptic modulation of release.4 Phenoxybenzamine (3.3 x 10(-5) M) enhanced the overflow of tritium most at the lowest frequency tested and to a similar extent at the other test frequencies, except 10 Hz where its effect was slightly reduced.5 The conditions of the present experiments appeared optimal for the operation of the negative feedback system and the failure to observe an increased effectiveness of the antagonist with increasing frequency indicates that the physiological relevance of such a system is highly questionable and suggests that it may not function at all.

Further evidence for a central hypotensive action of alpha-methyldopa in both the rat and cat.

1. alpha-Methyldopa (300 mg/kg i.p.) produced a fall in blood pressure in conscious genetic hypertensive rats. Pretreatment with intraventricular 6-hydroxydopamine prevented this hypotensive effect of alpha-methyldopa, whilst intravenous 6-hydroxydopamine reduced but did not prevent the hypotension.2. The hypotensive effect of alpha-methyldopa was prevented or reversed by intraventricular injection of phentolamine (200 mug/rat).3. Pressor responses obtained by stimulation of the entire sympathetic outflow in the Gillespie & Muir preparation, were unaffected by pretreatment with alpha-methyldopa (300 mg/kg i.p.).4. Vasoconstrictor responses to periarterial nerve stimulation of the isolated renal artery preparation of the rat were markedly reduced by pretreatment with alpha-methyldopa. Furthermore, alpha-methylnoradrenaline was found to have one-eighth the vasoconstrictor potency of noradrenaline in this particular artery preparation.5. Pressor responses obtained by stimulation of the posterior hypothalamus or midbrain reticular formation in the rat anaesthetized with urethane were markedly reduced by pretreatment with alpha-methyldopa. FLA-63, a selective dopamine-beta-hydroxylase inhibitor, prevented the reduction of the pressor responses to hypothalamic stimulation produced by alpha-methyldopa.6. Stimulation of the posterior hypothalamus in the anaesthetized cat caused both an increase in sympathetic nerve activity and a rise in blood pressure. These responses were markedly reduced 3-4 h after the injection of alpha-methyldopa (100 mg/kg i.v.).7. These results strongly suggest that the central actions of alpha-methyldopa are important for its hypotensive effect, although a possible peripheral effect cannot be excluded.

Drug-induced changes in the release of ( 3 H)-noradrenaline from field stimulated rat iris.

1. Isolated rat irides were incubated with [(3)H]-noradrenaline [(3)H-NA] (10(-7)M), superfused with buffer and then stimulated by an electrical field. The effect of desipramine, clonidine, phentolamine, phenoxybenzamine, GD131, normetanephrine and 4-tropolone-acetamide on the stimulation-induced overflow of [(3)H]-NA was tested by adding the drug to the superfusing buffer. The effect of pretreatment with phentolamine or phenoxybenzamine on the stimulation-induced overflow of [(3)H]-NA was also studied.2. The effect of desipramine, clonidine, phentolamine, phenoxybenzamine and GD131 on uptake of [(3)H]-NA in isolated irides was determined.3. Desipramine moderately increased the stimulation-induced overflow at concentrations which almost completely inhibited neuronal uptake. It was calculated that in the isolated rat iris 30-40% of the released [(3)H]-NA is inactivated by reuptake into the nerve terminal. This figure may represent the true reuptake percentage in this preparation. Desipramine-induced inhibition of [(3)H]-NA release from the nerve terminal, possibly via a negative feed-back mechanism, may also contribute to this low figure.4. Phentolamine and phenoxybenzamine, in concentrations or doses which did not inhibit neuronal uptake of [(3)H]-NA, consistently increased the stimulation-induced overflow. This increase was further augmented when neuronal uptake was inhibited.5. The alpha-adrenoceptor stimulating drug clonidine decreased the stimulation-induced overflow.6. GD131, normetanephrine and 4-tropolone-acetamide did not greatly affect the stimulation-induced overflow of [(3)H-NA].7. It is concluded that the increased [(3)H]-NA overflow obtained after alpha-adrenoceptor blockade is due to an increased [(3)H]-NA release from the nerve terminals.

Mode of action of alpha-methylnoradrenaline on temperature and oxygen consumption in young chickens.

1. Temperature, oxygen consumption, electromyographic activity, plasma non-esterified fatty acids and blood sugar were estimated in conscious unrestrained young chickens under conditions of thermoneutrality (31 degrees C) and below thermoneutrality (16 degrees C). In some chickens carotid arterial pressure was also recorded.2. At thermoneutrality, alpha-methylnoradrenaline lowered temperature and oxygen consumption in intact or chronically vagotomized chicks. alpha-Methylnoradrenaline was ineffective on temperature in chicks with transection of the brain-stem posterior to the hypothalamus but anterior to the respiratory centre. Hypothermia due to alpha-methylnoradrenaline was associated with a significant reduction of plasma non-esterified fatty acids but blood sugar was not significantly altered. Lowering of temperature by alpha-methylnoradrenaline occurred despite vasoconstriction which would hinder heat loss.3. Temperature and oxygen consumption were reduced by alpha-methylnoradrenaline in chronically thyroidectomized chicks to the same extent as in intact chicks but recovery did not occur unless the chicks were taken from the metabolism chamber and warmed artificially. In contrast, chronically thyroidectomized chicks given replacement thyroxine were relatively resistant to alpha-methylnoradrenaline.4. Oxygen consumption of tissue slices from different parts of the chick's brain, including the diencephalon, was not altered by alpha-methylnoradrenaline over an extensive dose range. The effects of alpha-methylnoradrenaline on temperature and oxygen consumption in intact chickens were unlikely, therefore, to be due to depressed metabolism of neurones.5. In an environment below thermoneutrality (16 degrees C) temperature was considerably reduced and carotid arterial pressure fell 40-50 mmHg. In contrast, electromyographic activity, oxygen consumption and plasma non-esterified fatty acids were markedly raised whereas blood sugar was insignificantly elevated.6. In experiments at 16 degrees C, alpha-methylnoradrenaline markedly reduced oxygen consumption although values were still higher than those at thermoneutrality. Temperature fell further, but whereas the reductions in oxygen consumption and temperature were long-lasting, electromyographic activity (shivering) was only transiently diminished. Plasma non-esterified fatty acids were reduced after alpha-methylnoradrenaline but not significantly so; blood sugar was not significantly altered. The time-course for recovery of oxygen consumption following a-methylnoradrenaline paralleled recovery from its blood pressure effects but the effect on oxygen consumption was not a consequence of the blood pressure changes. The effects of a-methylnoradrenaline on temperature, oxygen consumption and electromyographic activity were similar to those of another central depressant, pentobarbitone.

The role of catecholamines in the production of ischaemia-induced ventricular arrhythmias in the rat in vivo and in vitro.

The role of catecholamines in the production of ischaemia-induced ventricular arrhythmias in vivo and in vitro was studied using coronary artery ligation in the rat. Increases in plasma catecholamine concentrations during coronary artery ligation in pentobarbitone-anaesthetized animals were prevented by either acute adrenalectomy or chronic adrenal demedullation, but these procedures did not protect against the occurrence of ventricular arrhythmias. Thus plasma catecholamines were not obligatory mediators of arrhythmogenesis. Three protocols were used in vitro to evaluate the possible influence of intramyocardial release of noradrenaline, produced by the local conditions of ischaemia, on the production of ventricular arrhythmias. During coronary artery ligation in isolated perfused hearts, no enhanced output of 3H could be detected from [3H]-noradrenaline loaded hearts, even in the presence of inhibitors of catecholamine uptake processes, although washout of lactate from ischaemic regions was readily demonstrable. Both optical isomers of propranolol were equally effective in reducing the incidence of arrhythmias, implying a non-specific effect, since the (+)-isomer possesses considerably less beta-adrenoceptor blocking activity. The equipotency of optical isomers of propranolol combined with a lack of effect of atenolol suggested that arrhythmia production was not a consequence of beta-adrenoceptor stimulation. The alpha-adrenoceptor blockers phentolamine and prazosin, both exerted antiarrhythmic actions of similar potency, but phenoxybenzamine and trimazosin had no significant effects. An evaluation of the pharmacological properties of the alpha-adrenoceptor blockers showed that those drugs which had demonstrable local anaesthetic properties also exerted significant antiarrhythmic effects. No relationship was found between potency of alpha-adrenoceptor blockade and antiarrhythmic efficacy. The overall conclusion from these multifaceted approaches was that catecholamines were not necessary mediators of the early phase of ventricular arrhythmias in the rat.

The removal of noradrenaline in the pulmonary circulation of rat isolated lungs.

1. Removal of noradrenaline by isolated lungs of the rat, perfused via the pulmonary artery with Krebs bicarbonate solution has been studied.2. A constant removal (40.2%) was observed over a concentration range of 2-50 ng noradrenaline/ml (12-300 nM). At 100 ng/ml (600 nM), the removal is significantly reduced to 33.5%.3. The removal of noradrenaline was inhibited by cocaine (1 muM), but not by normetanephrine (5 muM), metaraminol (10 muM), phenoxybenzamine (10 muM) and 5-hydroxytryptamine (110 and 560 nM).4. We conclude that the removal of noradrenaline in the lungs does not involve an uptake process comparable with those previously described for this amine. The uptake process for noradrenaline in the lung is similar to that for 5-hydroxytryptamine and may be unique to this tissue.

Mechanism of efflux of noradrenaline from adrenergic nerves in rabbit atria.

1. The mechanism of efflux of (-)-[(3)H]-noradrenaline was examined in rabbit atria, which were pretreated with reserpine and pargyline.2. Between 40 and 100 min, efflux occurred predominantly from a single intraneuronal compartment.3. Efflux was rapidy increased by (-)- and (+)-noradrenaline, tyramine and (+/-)-metaraminol, but not by (+/-)-isopropylnoradrenaline or (+/-)-normetanephrine. The increase in efflux produced by (-)-noradrenaline was inhibited by cocaine and desipramine but not by lidocaine.4. Spontaneous effluxes, and those accelerated by (-)-noradrenaline, were temperature-sensitive.5. Efflux was increased by ouabain, omission of K(+), metabolic inhibition and lowering of the external Na(+) concentration. These effects were significantly reduced by cocaine and desipramine but not by lidocaine.6. These findings provide evidence that the efflux of [(3)H]-noradrenaline from adrenergic nerves occurs by a cocaine-sensitive, carrier-mediated process. The characteristics of the efflux process are compatible with, but not conclusive proof for, the Na(+)-gradient hypothesis.

A new approach to the measurement and classification of forms of supersensitivity of autonomic effector responses.

1 It is proposed that sensitizations of autonomic effectors to agonists by drugs or procedures be considered in two main categories: those involving changes in the effective concentration of agonist at receptors (type I) and those involving changes in the responding tissue beyond the initial combination of agonist and receptors (type II). Type I sensitizations are appropriately described by determining the dose-ratio (horizontal shift of the dose-response curve) and type II sensitizations by assessing the change in the magnitude of the response.2 The inadequacy of the dose-ratio in assessing sensitizations related to an altered physiology of the responding tissue is illustrated by means of hypothetical examples with particular reference to the slopes of dose-response curves and altered maximal responses.3 An evaluation of the enhancement of responses of rabbit aortic strips to agonists by reserpine indicates that it is a type II sensitization. The shifts of dose-response curves to noradrenaline, isoprenaline, normetanephrine and 5-hydroxytryptamine after reserpine-treatment, were described both by the dose-ratio and by the increment in the magnitude of the response at various contraction amplitudes. The dose-ratio varied unpredictably for each agonist depending on the response level selected for comparison and also varied between agonists. However, the mm increment in response magnitude after reserpine approximated a constant value. Responses to potassium which by horizontal procedures were assessed among the least increased, were found to be enhanced the most when considered as a type II sensitization.4 It is concluded that both type I and type II procedures should be applied when dealing with an unidentified sensitization and that the data be critically assessed. The appropriate use of these procedures can aid in identifying and clarifying sensitizations, as well as in elucidating the sequence of steps between receptor activation and response in an effector.

Actions of noradrenaline, other sympathomimetic amines and antagonists on neurones in the brain stem of the cat.

1. The effects of (-)-noradrenaline ((-)-NA) and related compounds on brain stem neurones in decerebrate unanaesthetized cats have been investigated using the technique of iontophoretic application from micropipettes.2. Four types of response to (-)-NA have been described. These were short lasting inhibition, long lasting inhibition, excitation, and a biphasic response consisting of short lasting inhibition followed by excitation. A variable amount of desensitization of the excitatory response, but not of inhibitory responses, was observed.3. Experiments in which small currents were used to pass (-)-NA from pipettes with smaller tips did not lead to any appreciable change in the proportions of neurones excited or inhibited.4. A variety of sympathomimetic agonists was tested. Short lasting inhibition was less sensitive than excitation to changes in molecular structure. Long lasting inhibition was more sensitive to molecular change and was not mimicked by some of the agonists which mimicked short lasting inhibition.5. Although agonists without one ring hydroxyl had weaker effects than those with both, compounds in which both ring hydroxyl groups were absent (beta-hydroxyphenylethylamine, ephedrine and amphetamine) mimicked excitation strongly. It is possible that the compounds without both ring hydroxyl groups had some effect other than simple agonistic activity.6. A dissociation was observed between responses to dopamine and (-)-NA. p-Tyramine mimicked dopamine, rather than (-)-NA.7. Neither the alpha-agonist, phenylephrine nor the beta-agonist, isoprenaline mimicked neuronal responses to (-)-NA. The alpha-antagonists phentolamine and phenoxybenzamine and the beta-antagonists dichloroisoprenaline, propranolol and D(-)-INPEA and combinations of propranolol with phentolamine or phenoxybenzamine were ineffective in blocking either excitation or inhibition. Thus, the central receptors appear to be different from peripheral alpha- and beta-receptors.8. The most effective antagonist of excitation was (-)-alpha-methylnoradrenaline. Metaraminol and dihydroergotamine also had some antagonistic activity. None of the compounds tested blocked inhibition. The effects of (-)-alpha-methylnoradrenaline have been discussed in relation to the hypotensive action of alpha-methyldopa.