Cardiovascular sympathomimetic amine interactions in rats treated with monoamine oxidase inhibitors and the novel oxazolidinone antibiotic linezolid.

Linezolid (PNU-100766) is a new gram-positive oxazolidinone antibiotic that is effective at in vitro concentrations < or =4 microg/ml and in vivo doses < or =10 mg/kg. Because linezolid also competitively inhibits human monoamine oxidase-A (MAO-A; Ki = 55 microM), we monitored its effects on the cardiovascular responses to tyramine and amine cold remedies in comparison with standard MAO inhibitors. In anesthetized rats, the pressor response to 16 microg i.v. tyramine was potentiated by the MAO-A inhibitors clorgyline (0.1-1.0 mg/kg i.v.) and moclobemide (5.0-50 mg/kg p.o.), but not by the MAO-B inhibitor selegiline (0.15-15 mg/kg p.o.). Fifteen milligrams per kilogram intravenous linezolid weakly potentiated i.v. tyramine independent of changes in alpha-adrenoceptor reactivity, but this effect was not enhanced chronically (90-100 mg/kg/day). In conscious rats, 30 mg/kg/day oral linezolid (8 microg/ml plasma concentration) minimally affected the pressor response to 20 mg/kg oral tyramine, whereas 100 mg/kg/day linezolid (20 microg/ml plasma concentration) moderately potentiated this response similar to 3 mg/kg per day moclobemide. Linezolid's tyramine potentiation was reversible, attenuated by food, and independent of pseudoephedrine, phenylpropanolamine, and dextromethorphan interactions. These studies demonstrate that high-dose linezolid only moderately potentiates the cardiovascular effects of tyramine and validate these models for evaluating such MAO inhibitory interactions.

Cardiovascular effects of the R- and S-enantiomers of ibutilide in conscious beagle dogs.

To support its class III antiarrhythmic candidacy, we examined the acute cardiovascular effects of ibutilide and its R- and S-enantiomers in conscious beagle dogs. Eight dogs were given stepped i.v. doses (0.01, 0.1, and 1.0 mg/kg) of these agents while monitoring changes in mean arterial pressure (MAP), heart rate (HR), and lead II ECG QTc length (index of class III activity). None of the treatments affected MAP and only R-ibutilide slightly increased HR. The R-isomer was also slightly more potent in prolonging QTc at the lowest dose, but its mean peak QTc change (+44 msec) overlapped those achieved with racemic (+37 msec) and S-ibutilide (+41 msec). Plasma drug analyses showed that total drug levels (sum of enantiomers) were similar with each agent, averaging 1, 12, and 170 ng/ml at 30 min after the low, middle, and high doses, respectively. Nearly equal enantiomer proportions were seen after racemic ibutilide, and no chiral inversion was seen after enantiomer administration. All treatments were well tolerated without enhanced ventricular ectopy. These data demonstrate that in conscious dogs, racemic, R-, and S-ibutilide similarly prolong QTc independent of appreciable cardiovascular changes, differential pharmacokinetics, or dysrhythmias, thereby helping to establish racemic ibutilide as the optimal developmental candidate.

K-ATP-blocking diuretic PNU-37883A reduces plasma renin activity in dogs.

We determined the effects of the K-adenosine triphosphate (ATP)-blocking diuretic PNU-37883A on plasma renin activity (PRA) in conscious and anesthetized dogs. In conscious dogs, oral PNU-37883A (6-60 mg/kg) was less potent than hydrochlorothiazide (0.15-1.5 mg/kg) and furosemide (FURO; 0.3-3.0 mg/kg) but exhibited high natriuretic efficacy with little kaliuresis. Unlike the standard diuretics, PNU-37883A reduced PRA by 46-76%, and its high dose minimally affected 24-h urinary aldosterone excretion. PNU-37883A, 1 mg/kg i.v., also blunted the hyperreninemia induced by 1 mg/kg i.v. FURO. In cannulated dogs, 10 mg/kg i.v. PNU-37883A maximally increased fractional Na+ clearance 140% and reduced PRA 76%, but these effects were accompanied by a mean 13 mm Hg pressor effect. In anesthetized dogs, renal artery-infused PNU-37883A (3 mg/kg/h i.r.a.) increased Na+ excretion and reduced renal venous PRA independent of hemodynamics, whereas half this dosage selectively reduced renal venous PRA and renin release, independent of hemodynamics and natriuresis. These data demonstrate that the K-ATP blocker diuretic PNU-37883A reduces PRA in dogs after oral, i.v., and i.r.a. administration and could be a useful pharmacologic agent for exploring the role of K-ATP channels in regulating renin release.

Cardiovascular and pharmacokinetic interactions between nicorandil and adjunctive propranolol, atenolol or diltiazem in conscious dogs.

In support of clinical antianginal studies, the vasodilator nicorandil (NIC) was combined with the beta-adrenergic receptor antagonists propranolol (PRO) and atenolol (ATN) and with the calcium channel blocker diltiazem (DTZ) to determine their cardiovascular and pharmacokinetic interactions. Beagle dogs were chronically cannulated to record mean arterial pressure, heart rate, and the lead II electrocardiogram under conscious conditions. Oral NIC (1, 3, and 10 mg/kg) was coadministered with i.v. PRO (5.0 mg/kg) or ATN (7.5 mg/kg), both of which lessened NIC's reflex tachycardia. ECG rhythm remained normal, but both beta-blockers restricted high dose NIC's QTc prolongation and ST segment depression. Intravenous DTZ (5-23 micrograms/kg/min) did not affect i.v. NIC's hypotensive profile (10-80 micrograms/kg/min) but attenuated its tachycardia, whereas NIC-reversed DTZ's PR interval shortening and frequency of ectopic beats. Similar cardiovascular interactions were seen with chronic oral DTZ (10 mg/kg/day) + NIC (3.0 or 7.5 mg/kg). Plasma analysis confirmed that none of the adjuncts affected NIC's disposition nor its concentration-dependent hypotensive response profile. These studies establish the cardiovascular effects of NIC when combined with PRO, ATN or DTZ in dogs, and outline paradigms useful for evaluating such antianginal drug combinations.

Cardiovascular effects of the K-ATP channel blocker U-37883A and structurally related morpholinoguanidines.

The cardiovascular effects of the K-ATP channel blocker U-37883A and 5 related morpholinoguanidines were determined in 6 experimental preparations. In anesthetized dogs, U-37883A (0.5-8.0 mg/kg i.v.) increased mean arterial pressure (MAP; +18%) and left ventricular (LV) effective refractory period (ERP; +35%), and decreased LV contractility (-41%). Higher doses of U-37883A (16-32 mg/kg) fatally reduced MAP (-84%), heart rate (HR; -57%) and LV contractility (-72%). In anesthetized rats, U-37883A (1.0-50 mg/kg i.v.) also maximally reduced MAP, HR and LV contractility by 68, 77 and 48%, respectively. U-37883A and its analogs were diuretic in conscious rats (1.5-15 mg/kg i.v.) and blocked pinacidil in rabbit mesenteric artery (EC50 = 0.5-50 microM). In rabbit papillary muscle, 50 microM U-37883A significantly reduced force of contraction (-33%) and prolonged conduction time (+244%). Milder papillary effects were seen with the N'-OH analog U-45194A, which did not depress LV contractility in intact rats. In conscious dogs, oral U-45194A (50 mg/kg) was diuretic but reduced LV stroke volume and increased peripheral vascular resistance. These studies characterize U-37883A's systemic cardiovascular and direct myocardial effects, and identify U-45194A as a less cardiac depressant analog having U-37883A-like diuretic and functional K-ATP channel blocking activities.

Cardiovascular interactions characterizing the vasodilator components of nicorandil in conscious dogs.

We conducted cardiovascular interaction studies in conscious dogs to characterize the cyclic GMP and KATP channel opener (PCO)-dependent peripheral vasodilator components of nicorandil (NIC). Intravenously (i.v.) administered NIC (6-24 microg/kg/min for 6 h) reduced arterial blood pressure (BP) and increased heart rate (HR), and 15 mug/kg/min NIC was simulated by combining the cyclic GMP vasodilator nitroglycerin (NTG 1-5 microg/kg/min i.v.) with the PCO minoxidil (MNX 0.23 microg/kg i.v.). Tolerance to NTG-induced vasodilation was accelerated by oral isosorbide dinitrate (ISD 400 mg/2.5 days), and MNX was antagonized by the KATP blocker U-37883A (6 microg/kg/min i.v.). U-37883A attenuated NIC-induced hypotension with a mild tachycardia, whereas chronic ISD attenuated and delayed NIC-induced hypotension, with a pronounced tachycardia. Chronic ISD plus U-37883A completely blocked NIC-induced hypotension, although NIC-induced tachycardia persisted. These studies demonstrate that the cyclic GMP component of NIC induces a minimally tachycardiac acute vasodilation at lower drug concentrations resistant to K ATP blockade but cross-tolerant to ISD. Conversely, the PCO component of NIC induces a more tachycardiac vasodilation at higher concentrations free of ISD cross-tolerance but sensitive to KATP blockade. Therefore, low-dose NIC free of adjunctive nitrates should optimize its cyclic GMP vasodilator component for clinical indications.

Effects of K-ATP blocking guanidine diuretics during experimental kaliuresis in rats and dogs.

Several guanidine diuretics related to the renal tubular K-ATP blocker U-37883A were compared to standard diuretics under high K+ excretion conditions. In conscious rats, oral KCl(0.28 mEq) increased K+ excretion 3-fold. This kaliuresis was further enhanced by oral diuretic doses of ethoxzolamide (1 and 2 mg/kg), hydrochlorothiazide (HCTZ; 0.3 and 0.9 mg/kg), and furosemide (18 mg/kg), but was significantly blunted by oral triamterene (1 and 10 mg/kg). By comparison, diuretic doses of U-37883A and analogs U-18177 (10 and 30 mg/kg) and U-38658A (3 and 9 mg/kg) did not affect K+ excretion. In conscious dogs, oral U-18177A (10 mg/kg) and HCTZ (1 mg/kg) were compared during 3- to 13-fold kaliuresis induced by oral isotonic saline (200 mL), oral KCl (30.8 mEq), subcutaneous deoxycorticosterone acetate (1.0 mg/kg), and oral acetazolamide (20 mg/kg). HCTZ was diuretic and further increased K+ excretion and its fractional clearance by 42 and 34%, respectively. Conversely, U-18177A was diuretic and slightly reduced these kaliuretic parameters by 11 and 20%. Thus, the guanidines U-18177 and U-37883A exert a relatively eukalemic diuresis under normal and high K+ excretion conditions, and their putative renal tubular K-ATP blocking action seems an effective means of inducing diuretics with less K+ imbalance than with standard diuretics.

Diuretic activity of N'-disubstituted morpholinoguanidine analogs of U-37883A in rats and dogs.

U-37883A is a K+ sparing diuretic which selectively blocks openers of vascular ATP-sensitive K channels. Many N'-disubstituted morpholinoguanidine (N'-DMG) analogs of U-37883A were synthesized and tested for diuretic activity. In conscious rats, 10-100 mg/kg orally of the most active N'-DMGs increased urine volume (V) and Na+ excretion by up to 4-fold with little kaliuresis. The N'-DMGs U-37997A and U-38658A were less potent than standard diuretics, but did not induce the K+ loss seen with hydrochlorothiazide and furosemide or the K+ retention of amiloride and triamterene. In conscious dogs, 10 mg/kg i.v. of the N'-DMGs U-40389A and U-52090 increased V and Na+ excretion by over 7-fold with little kaliuresis. Despite their attractive diuresis, all of the N'-DMGs had narrow margins of safety. Reflecting their direct myocardial depressant action, in isolated rat hearts, bolus intracoronary U-37883A, U-18177A, and U-38658A (0.25-10 mumol) severely reduced the rate (-10 to -100%) and force (-9 to -100%) of contraction. These studies characterize the eukalemic diuretic activity of N'-DMG analogs of U-37883A, and demonstrate the marked cardiac depression characteristic of the morpholinoguanidine diuretic series.

Renal and vascular effects of chemically distinct ATP-sensitive K+ channel blockers in rats.

The ATP-sensitive K+ channel blocker U-37883A was given intravenously (i.v.) to rats to determine if pharmacologic diversity among ATP-sensitive K+ channels observed in vitro is also apparent in vivo. Vascular K+ channel blockade was quantified as inhibition of the decrease in blood pressure (BP) produced by a standard dose of the K+ channel opener pinacidil. Renal natriuretic effects were evaluated by an increase in urinary Na+ excretion. In both instances, effects of U-37883A, a guanidine, were compared with those of the sulfonylurea glyburide. In addition, the ability of these K+ channel blockers to lower plasma glucose levels was compared. U-37883A was nine times more potent than glyburide as a natriuretic and a comparable six times more potent than glyburide in blocking pinacidil, suggesting common features between ATP-sensitive K+ channels in vascular smooth muscle (VSM) and renal tubules. In contrast, a dose of U-37883A that blocked pinacidil and increased Na+ excretion had no effect on plasma glucose, whereas a dose of glyburide that was natriuretic and equally as effective against pinacidil as U-37883A decreased plasma glucose, suggesting that ATP-sensitive K+ channels in pancreatic beta cells and renal tubules have dissimilar binding sites and/or features. U-37883A appeared to be more renal/vascular selective, an observation entirely consistent with previous findings in vitro. Our results represent the first in vivo suggestion of structural differences among the channel and/or accessory proteins from this family of K(+)-selective channels.

Selective in vivo antagonism of pinacidil-induced hypotension by the guanidine U37883A in anesthetized rats.

The pyridylcyanoguanidine pinacidil exerts its hypotensive effect by opening ATP-sensitive potassium channels (K+ATP) in vascular smooth muscle. Direct glyburide-like antagonism of pinacidil-induced vasorelaxation by the guanidine U37883A (4-morpholinecarboximidine-N-1-adamantyl-N'- cyclohexylhydrochloride) has recently been demonstrated in isolated rabbit mesenteric artery. We herein report the first detailed in vivo cardiovascular interaction between U37883A and pinacidil in an anesthetized rat model. U37883A, administered from 0.1 to 3.0 mg/kg i.v. 10 min subsequent to pinacidil, immediately and dose-dependently reversed pinacidil's steady-state hypotensive effects by 29-100% (ED50 = 0.4 mg/kg), while reversal of pinacidil's tachycardiac effects from 10 to 79% was evident with 0.1-1.0 mg/kg i.v. U37883A (ED50 = 0.5 mg/kg). In contrast to these effects, pretreatment with 0.3-3.0 mg/kg i.v. U37883A only moderately inhibited the acute pinacidil-induced hypotension by 6-58%. Because U37883A's separate bradycardiac effects lowered basal heart rate, U37883A pretreatment precipitated a paradoxical 15-51% augmentation of sustained pinacidil-induced tachycardia, although absolute heart rates were below those seen with pinacidil alone. Qualitatively similar K+ATP blocking effects by U37883A were also observed in rats treated with the K+ATP openers (PCOs) cromakalim (BRL 34915), RPS 49365 and minoxidil. However, U37883A-treated rats remained responsive to the hypotensive action of both i.v. sodium nitroprusside and isoproterenol and buccal nifedipine. This study corroborates prior in vitro and in vivo findings and establishes that the guanidine U37883A is an effective and relatively selective blocker of PCO-induced vasodilation in the anesthetized rat. U37883A also appears more effective at closing basally and pinacidil-opened K+ATP than preventing K+ATP opening by pinacidil in vivo.

Synthesis and diuretic activity of alkyl- and arylguanidine analogs of N,N'-dicyclohexyl-4-morpholinecarboxamidine in rats and dogs.

Random screening identified N,N'-dicyclohexyl-4-morpholinecarboxamidine (U-18177, 1) as an orally effective nonkaliuretic diuretic in rats. The diuretic profile of 1 and its 1-adamantyl analog (U-37883A, 4) was confirmed orally in dogs, when they were less potent than standard diuretics but showed furosemide-like natriuresis at > or = 100 mumol/kg. However, acute 1 at 61 and 90 mumol/kg iv resulted in lethal cardiac toxicity in dogs. Many analogs of 1 exhibited qualitatively similar diuretic profiles, but none was sufficiently safe to warrant development. Compound 1 also reversed minoxidil's vasodilation in dogs, which led to vascular interaction studies suggesting that analog 4 may block ATP-sensitive K channels. This K channel-blocking mechanism may contribute to the diuretic activity of the series. This is the first report broadly characterizing the diuretic activity of 1 and representative guanidine analogs in rats and dogs and its toxicity and minoxidil-blocking effects in dogs.

In vitro and in vivo inhibition of rat vascular smooth muscle cell migration and proliferation by a 2-aminochromone U-86983.

Vascular smooth muscle cell migration and proliferation are the primary events that govern neointimal thickening and thus they determine the extent to which delayed restenosis occurs after percutaneous transluminal coronary angioplasty. In this study, the in vitro and in vivo smooth muscle cell antichemotactic and antiproliferative properties of a 2-aminochromone, 2-(4-morpholinyl)-8-(3-pyridinylmethoxy)-4H-1-benzopyran-4-one (U-86983), were examined. Migration and proliferation of early-passage rat vascular smooth muscle cells were inhibited by U-86983 in a concentration-dependent manner (IC50S, approximately 10 microM and 3.5 microM, respectively). Longer-term studies showed that the proliferation of smooth muscle cells was inhibited by U-86983 for at least 7 days and was fully reversible on removal of the drug. In addition, the effect of U-86983 on neointimal formation was examined in rats subjected to left common carotid artery balloon dilatation injury. Continual (2-week) i.v. administration of U-86983 (216 mg kg-1 day-1) resulted in a mean plasma drug concentration of 2.39 micrograms/ml (blood level, approximately 3.5 microM) and a 42% (P = .003) reduction in the neointima/media ratio of the injured artery. In agreement with the in vitro reversibility results, administration of U-86983 for only 2, 4 or 7 days did not affect significantly the neointimal thickness measured at 14 days, which indicated that the stimuli for smooth muscle cell migration and/or proliferation were still present 1 week after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro vasorelaxant and in vivo cardiovascular effects of S-nitrosothiols: comparison to and cross tolerance with standard nitrovasodilators.

The in vitro vasorelaxant and in vivo cardiovascular effects of synthetic S-nitrosothiols (RSNOs) were compared to standard nitrovasodilators. S-Nitroso-glutathione (GSNO), S-nitroso-N-acetylcysteine (NACysNO), S-nitroso-galactopyranose (GPSNO), S-nitroso-thioglycerol (TGSNO) and S-nitroso-homocysteine (HCysNO) relaxed phenylephrine (PE) contracted rabbit aorta at 50% effective concentrations (EC50s) of 3-46 nM. While nitroglycerin (GTN) exhibited in vitro tolerance after preincubation, the RSNOs were considerably less cross tolerant to GTN. In conscious dogs, GSNO, NACysNO and GPSNO (1-20 mcg/kg/min i.v.) paralleled nitroprusside (SNP) in reducing mean arterial and central venous pressure (MAP; CVP) with mild tachycardia. GSNO, NACysNO and SNP were more hypotensive and more resistant to isosorbide dinitrate (ISDN) cross tolerance than GTN. NACysNO showed mild self tolerance with low infusion (2.5 mcg/kg/min x 4h x 3 days) and blunted GTN's hypotension. These studies demonstrate that GSNO and NACysNO are SNP-like vasodilators in conscious dogs, which exhibit less cross tolerance to ISDN than GTN. Further, RSNOs relax vascular smooth muscle seemingly independent of nitric oxide (NO) liberation, and nitrate tolerance may involve reduced RSNO formation or NO release rather than desensitized guanylate cyclase (GC).

4-morpholinecarboximidine-N-1-adamantyl-N'-cyclohexylhydrochloride (U-37883A): pharmacological characterization of a novel antagonist of vascular ATP-sensitive K+ channel openers.

This study describes the in vitro and in vivo characteristics of a guanidine 4-morpholinecarboximidine-N-1-adamantyl-N'-cyclohexyl-hydroc hloride (U-37883A), as an antagonist of vascular ATP-sensitive K+ channels (KATP). In isolated rabbit mesenteric artery, the antagonistic effects of U-37883A (0.5-5 microM) were studied against vasorelaxation produced by cromakalim (0.5 microM), minoxidil sulfate (5 microM), pinacidil (1 microM) and RP-49356 (1 microM). The dose-response curves for U-37883A against all four potassium channel openers were similar with U-37883A, IC50S ranging from 0.78 to 1.4 microM, suggesting that U-37883A is producing inhibition by acting at a step that is common to all four potassium channel openers during their activation of the vascular KATP. In contrast, U-37883A at 10 microM did not inhibit relaxation dose-response curves by nitroglycerine, forskolin or D600. U-37883A (1 or 10 microM) effectively inhibited as well as reversed 42K efflux-stimulated by cromakalim (1 microM) or minoxidil sulfate (5 microM). Finally, U-37883A (3 mg/kg i.v.) was found to inhibit significantly as well as reverse hypotension produced by minoxidil (1 mg/kg i.v. or 3 mg/kg p.o.), cromakalim (0.5 mg/kg p.o.) and pinacidil (0.3 mg/kg i.v.) in rats, cats and dogs. In contrast, the in vivo responses to phenylephrine, nitroglycerine, sodium nitroprusside or isoproterenol were not altered. U-37883A thus appears to be the first nonsulfonylurea shown to block consistently and selectively the in vitro as well as the in vivo pharmacological responses to various potassium channel openers. This structurally novel KATP antagonist therefore would be useful for further characterizing the mechanisms of pharmacological modulation of the KATP in a variety of cell systems.

Unique natriuretic properties of the ATP-sensitive K(+)-channel blocker glyburide in conscious rats.

Small-conductance, ATP-sensitive K(+)-channels (KATP) localized in apical membranes of both thick ascending limb of the loop of Henle and cortical collecting duct cells may be involved in Na+ reabsorption and K+ secretion in the mammalian kidney. Possible pharmacologic tools to evaluate such an hypothesis may be the antidiabetic sulfonylureas which block K(+)-channels in pancreatic beta-cells. In saline-loaded conscious rats, glyburide (GLY) dose-dependently increased urinary Na+ excretion with little change in urinary K+ excretion after i.p. administration (10-100 mg/kg). In renal clearance studies, GLY at 25 mg/kg i.v. increased Na+ excretion 350% during the first hour post-treatment without affecting K+ excretion, glomerular filtration rate, mean arterial pressure or heart rate. GLY at 50 mg/kg was no more natriuretic than the 25 mg/kg dose, whereas 12.5 mg/kg of GLY increased Na+ excretion 200%. The change in Na+ excretion produced by 25 mg/kg of GLY in streptozotocin-induced diabetic rats was significantly greater than the change after drug vehicle in these animals. It is unlikely that the natriuresis produced by GLY is secondary to changes in plasma insulin and/or glucose because the doses used were far above GLY's insulin-releasing action (i.e., all natriuretic doses would have produced maximal insulin release) and GLY was natriuretic in streptozotocin-induced diabetic rats. It is possible that GLY interferes with reabsorption of Na+ by blocking KATP and thereby interrupting K+ recycling and Na(+)-2Cl(-)-K+ cotransport in the loop of Henle.

Gait on a shoestring: falls and foot separation in parkinsonism.

A novel device for monitoring gait, which can be used in confined spaces, is described. In addition to distance/time assessment of gait, it measures foot separation whilst walking. A field trial illustrates its potential in the investigation of falls.

Salmonellosis associated with 'Combi-oven' cooked egg.

During July 1989, four cases of Salmonella enteritidis (later identified as PT24) infection were reported by laboratories in Bristol. All those infected had dined at a restaurant in the city. An epidemiological investigation revealed that a number of restaurant staff and 56 customers who had completed a questionnaire had also been ill with gastrointestinal illness. An association was found between illness and eating egg mayonnaise. A 'Combi-oven' egg-cooking technique has been identified as the most likely cause of this outbreak. In view of the widespread commercial use of this cooking method the evidence related to this outbreak is given in detail.

Evaluation of the Lamtec anaesthetic agent monitor.

The Lamtec agent monitor is a compact anaesthetic analyser designed to measure halothane, isoflurane and enflurane. It shows good linearity and stability. The faster model can be used for end-tidal measurements up to 25 breaths per minute. Calibration using a standard of the gas to be measured is recommended.

Pathogenesis of cardiovascular alterations in dogs treated with minoxidil.

Minoxidil and other potent vasodilators cause coronary arterial injury, right atrial hemorrhagic lesions, and subendocardial necrosis in dogs. This paper discusses the pathogenesis of coronary arterial and right atrial lesions associated with minoxidil in the dog. Acute coronary vascular injury characterized by segmental medial hemorrhage and necrosis and perivascular inflammation occurred only during the first few days of treatment, after which tolerance to further acute injury developed. At 30 d or more of treatment, coronary vascular injury was characterized by perivascular fibrosis rarely attended by medial distortion or hyperplasia and subintimal thickening, changes consistent with responses to previous injury. Right atrial hemorrhagic lesions, unlike coronary vascular injury, often became progressively more extensive with continued treatment. At 3 d, atrial hemorrhage and inflammation were confined to the subepicardium of the right atrium, evidently around affected subepicardial branches of the right coronary artery. At 30 d, fibrovascular proliferative right atrial lesions (granulation tissue with evidence of continual hemorrhage) extended from the epicardium to the myocardium, with eventual replacement of the atrial wall by mature connective tissue at 1 yr of treatment. Minoxidil-induced cardiovascular lesions were not prevented by treatment with a beta-blocker (propranolol), or an alpha-blocker (dibenzylene), or by sympathetic neural activity suppression (surgical sympathectomy or constant carotid sinus nerve stimulation), suggesting that the sympathetic response to the pharmacologic activity of minoxidil was not responsible for the induction of the cardiovascular lesions. Minoxidil-related vascular lesions were confined to the most pharmacologically responsive segment of the arterial system, the coronary arteries, suggesting that medial injury may have been associated with tensile changes in the arterial wall.

The effects of indomethacin on the systemic and regional vasodilator responses to minoxidil in the conscious dog.

To define the role of endogenous prostaglandin (PG) synthesis in the vasodilator response to minoxidil (MNX), whole body and regional hemodynamics were measured in conscious, MNX-pretreated dogs before and after the administration of the cyclooxygenase inhibitor indomethacin (INDO). Twenty minutes after an i.v. dose of 2.0 mg/kg, INDO did not affect the reductions in mean arterial pressure and total peripheral resistance achieved with 1.0 mg/kg of MNX i.v. INDO appeared to selectively reverse MNX's vasodilation in the skin and stomach, as vascular resistance in these two tissues increased to pre-MNX levels. Since INDO also exerts a selective vasoconstriction in the skin and stomach of conscious, nonpretreated dogs (Humphrey and Zins, 1983), the fact that skin and stomach resistances were near baseline with this drug combination implies that MNX continues to exert a net vasodilation in these vascular beds. In contrast to INDO's negligible hemodynamic interactions, MNX's vasodilation was nearly completely reversed by continuous i.v. infusions of the direct vasoconstrictor arginine vasopressin (ADH) administered at a mean dose of 35 mU/kg/min. MNX's reversal by ADH was not matched by maximally effective i.v. infusions of the alpha-adrenergic agonist norepinephrine at a mean dose of 0.4 micrograms/kg/min. These results indicate that the sustained peripheral vasodilation seen with MNX in the conscious dog is not dependent upon the synthesis of endogenous, PG-like dilator substances, as defined by concomitant INDO administration.