Neuronal nitric oxide synthase-derived hydrogen peroxide effect in grafts used in human coronary bypass surgery.

Recently, H2O2 has been identified as the endothelium-dependent hyperpolarizing factor (EDHF), which mediates flow-induced dilation in human coronary arteries. Neuronal nitric oxide synthase (nNOS) is expressed in the cardiovascular system and, besides NO, generates H2O2 The role of nNOS-derived H2O2 in human vessels is so far unknown. The present study was aimed at investigating the relevance of nNOS/H2O2 signaling in the human internal mammary artery (IMA) and saphenous vein (SV), the major conduits used in coronary artery bypass grafting. In the IMA, but not in the SV, ACh (acetylcholine)-induced vasodilatation was decreased by selective nNOS inhibition with TRIM or Inhibitor 1, and by catalase, which specifically decomposes H2O2 Superoxide dismutase (SOD), which generates H2O2 from superoxide, decreased the vasodilator effect of ACh on SV. In the IMA, SOD diminished phenylephrine-induced contraction in endothelium-containing, but not in endothelium-denuded vessels. Importantly, while exogenous H2O2 produced vasodilatation in IMA, it constricted SV. ACh increased H2O2 production in both sets of vessels. In the IMA, the increase in H2O2 was inhibited by catalase and nNOS blockade. In SV, H2O2 production was abolished by catalase and reduced by nNOS inhibition. Immunofluorescence experiments showed the presence of nNOS in the vascular endothelium and smooth muscle cells of both the IMA and SV. Together, our results clearly show that H2O2 induced endothelium-dependent vascular relaxation in the IMA, whereas, in the SV, H2O2 was a vasoconstrictor. Thus, H2O2 produced in the coronary circulation may contribute to the susceptibility to accelerated atherosclerosis and progressive failure of the SV used as autogenous graft in coronary bypass surgery.

Nitric oxide modulates reactivity to angiotensin II in internal mammary arterial grafts in hypertensive patients without associated risk factors.

We investigated the effects of extraendothelial nitric oxide (NO) on angiotensin II (Ang II) reactivity in internal mammary artery (IMA) rings, as well as the impact of hypertension without associated risk factors in this response. Vascular reactivity, NO levels, and resting membrane potentials were determined in hypertensive (HT) and normotensive (NT) IMA rings. Only rings with endothelial dysfunction were included. Ang II produced a dose-dependent contraction that was higher in HT rings. Response to Ang II was potentiated by Nω-nitro L-arginine methyl ester (L-NAME) in NT but not in HT rings. The antioxidant agents tempol and diphenyleneiodonium (DPI) reverted the hyperreactivity to Ang II in HT rings. Extraendothelial NO was present in both NT and HT rings. However, NT rings showed higher values. L-NAME and S-methyl-L-thiocitrulline inhibited NO release in all cases. L-arginine reverted this inhibition. Both tempol and DPI increased NO release in both NT and HT rings. The number of vascular smooth muscle cells (VSMC) and anti-α-actin positive areas were lower in HT than in NT rings, without variations in wall thickness or wall/lumen ratio. With regard to resting membrane potential, we found in HT rings that the depolarization induced by Ang II was abolished by tempol. These findings suggest that extraendothelial NO counterregulates Ang II contractility in IMA rings; however, its action could be altered in hypertensive situations even though the patients did not have associated risk factors. We suggest two mechanisms: increased oxidative stress and a decreased ability of nNOS in VSMC to produce NO.

[Prostacyclin production in internal mammary ano radial arteries and saphenous veins of diabetic and non diabetic subjects]. / Producción de prostaciclina en arteria radial de diabéticos: Comparación con la vena safena y arteria mamaria interna y su relevancia en el pronóstico de estos bypass coronarios.

BACKGROUND: Myocardial revascularization surgery has used several vessels as coronary grafts including internal mammary and radial arteries which have a better prognosis than saphenous vein. Their long-term patency has been associated with the release of endothelium vasodilator and anti-aggregating products such as prostacyclin. Diabetes induces endothelial dysfunction and a high number of diabetics require revascularization. AIM: To assess the capacity to synthesize prostacyclin of different vessels from diabetics. MATERIAL AND METHODS: Internal mammary and radial arteries and saphenous veins obtained from 10 diabetic and 10 non diabetic patients subjected to coronary artery bypass surgery were studied. The capacity to synthesize prostacyclin was assessed in these vessels measuring its hydrolysis product, the 6-keto-PGFla by radioimmunoassay. RESULTS: Internal mammary arteries and saphenous veins from diabetics synthesized a lower amount of prostacyclin than those from non-diabetics. The radial artery produced similar amounts of prostacyclin in both groups. This response was associated with an increase of the conversion of the precursor arachidonic acid to prostacyclin. The saturating concentrations of this acid required to achieve the maximal stimulation were higher in the radial artery (20 microM) than in the internal mammary artery and saphenous vein (10 microM), suggesting that the enzymatic activity of the radial artery was not affected by diabetes. CONCLUSIONS: The radial artery appears as the best replacement vessel for coronary surgery in diabetics. Its favorable biochemical profile and potential lower long-term occlusion rate may be relevant for a better prognosis of myocardial revascularization in these patients.

Producción de prostaciclina en arteria radial de diabéticos: comparación con la vena safena y arteria mamaria interna y su relevancia en el pronóstico de estos bypass coronarios / Prostacyclin production in internal mammary ano radial arteries and saphenous veins of diabetic and non diabetic subjects

Background: Myocardial revascularization surgery has used several vessels as coronary grafts including internal mammary and radial arteries which have a better prognosis than saphenous vein. Their long-term patency has been associated with the reléase of endothelium vasodilator and anti-aggregating producís such as prostacyclin. Diabetes induces endothelial dysfunction and a high number of diabetics require revascularization. Aim: To assess the capacity to synthesize prostacyclin of different vessels from diabetics. Material and methods: Internal mammary and radial arteries and saphenous veins obtained from 10 diabetic and 10 non diabetic patients subjected to coronary artery bypass surgery were studied. The capacity to synthesize prostacyclin was assessed in these vessels measuríng its hydrolysis product, the 6-keto-PGFla by radioimmunoassay. Results: Internal mammary arteries and saphenous veins from diabetics synthesized a lower amount of prostacyclin than those from non-diabetics. The radial artery produced similar amounts of prostacyclin in both groups. This response was associated with an increase of the conversión of the precursor arachidonic acid to prostacyclin. The saturating concentrations of this acid required to achieve the maximal stimulation were higher in the radial artery (20 µM) than in the internal mammary artery and saphenous vein (10 µM), suggesting that the enzymatic activity of the radial artery was not affected by diabetes. Conclusions: The radial artery appears as the best replacement vessel for coronary surgery in diabetics. Its favorable biochemical profile and potential lower long-term occlusion rate may be relevant for a better prognosis of myocardial revascularization in these patients.

pH effects on high conductance Ca2+-activated K+ channels (BK(Ca)) in human internal mammary artery smooth muscle cells.

INTRODUCTION: In vascular smooth muscle cells, different types of K+ channels participate in the regulation of membrane potential and consequently in the contractile behavior of the vessel. There is little information about the properties and role of K+ channels in human internal mammary artery (HIMA), the vessel of choice for coronary revascularization. METHODS: Patch-clamp technique on isolated HIMA smooth muscle cells was used. RESULTS: This work presents for the first time single-channel properties of the high conductance Ca2+-activated K+ channel (BK(Ca)) of HIMA. It presents a single-channel conductance of 228+/-4 pS (n=44, 8 cells), is sensitive to 100 nM iberiotoxin, and its open probability is Ca2+- and voltage-dependent. Inside-out results show that BK(Ca) channels in HIMA are directly activated by increasing the pH of intracellular media (NPo=0.096+/-0.032 at pH 7.4 and NPo=0.459+/-0.111 at pH 7.6, n=12 cells, p<0.05) and inhibited by lowering this pH (NPo=0.175+/-0.067 at pH 7.4 and NPo=0.051+/-0.019 at pH 6.8, n=13 cells, p<0.05). CONCLUSIONS: The evidences presented about single-channel properties and intracellular pH sensitivity of BK(Ca) from HIMA smooth muscle cells provide useful information to elucidate physiological or pathological mechanisms in this vessel, as well as for future studies where drugs could have BK(Ca) channels as targets for pharmacological therapies.

New concept regarding chest pain due to hypoxia of the internal mammary arteries in more than 1,600 operated patients with cerebral thoracic neurovascular syndrome (CTNVS).

In this article we describe the role of compression of the vertebral, subclavian, internal mammary, internal carotid arteries, brachial plexus and coiling and kinking of the vertebral and basilar arteries, the faulty irrigation of blood supply and oxygen of the cerebellum and basal ganglia and other areas of the brain followed by metabolic processes. Among the effects are: a decrease in the secretion of dopamine at the level of the putamen, which produces the symptoms of symptomatic Parkinson's disease, chorea due to chronic transitory faulty blood supply and oxygen to the caudate nucleus, ballism by hypoxia at the level of sub-thalamic and thalamus nuclei and athetosis in the lenticular nucleus. This compression is caused by hypertrophy of the anterior scalenus muscles and the cervical ribs at the level of the vertebrae C6-C7; by the sternocleidomastoid at the level of the cervical atlas, by the pectoralis minor muscles and coiling and kinking of the vertebral, basilar and the internal carotid arteries. The decreased blood supply to the cerebellum and basal ganglia is the cause of the cerebral thoracic neuro vascular syndrome (CTNVS) and its neurological complications, among which are ipsilateral paralysis, symptomatic Parkinson's disease, functional Alzheimer's disease multiple sclerosis and others. We are presently engaged in genetic studies to widen our understanding of these illness.