Pharmacology of bepridil.

Bepridil is an antianginal agent with multiple therapeutic actions. It decreases calcium influx through potential-dependent and receptor-operated sarcolemmic calcium channels and acts intracellularly as a calmodulin antagonist and calcium sensitizer. Thus, in cardiac muscle it enhances the sensitivity of troponin C to calcium, stimulates myofibrillar adenosine triphosphatase activity, removes calmodulin's inhibitory effect on sarcoplasmic reticulum calcium release, and inhibits sodium-calcium exchange--actions that tend to offset the effects of calcium influx blockade on cardiac contractile force. However, in vascular smooth muscle where the calcium-calmodulin complex promotes muscle contraction by activating myosin light-chain kinase phosphorylation of contractile proteins, calmodulin antagonism, coupled with bepridil's blockade of calcium influx, leads to vasorelaxation. In animal models of ischemia, bepridil and other calmodulin inhibitors show antiarrhythmic efficacy following reperfusion. Additionally, interfering with calmodulin's role in sympathetic nerve terminal function may help to limit the ischemia-induced catecholamine release that contributes to arrhythmogenesis. Bepridil shows a lidocaine-like fast kinetic block of inward sodium current (as distinct from the slow or intermediate kinetic inhibition expressed by encainide or quinidine, respectively). This inhibition is pH-dependent; activity is expressed to a greater degree at lower pH levels. This, this potentially antiarrhythmic mechanism is activated by conditions of ischemia. Bepridil's blockade of outward potassium currents and its inhibition of sodium-calcium exchange increase action potential duration and ventricular refractoriness, prolong the QT interval, and form the basis for a class III antiarrhythmic mechanism. Because hypokalemia also prolongs the QT interval, the addition of bepridil in the presence of hypokalemia can lead to excessive prolongation. Bepridil both increases myocardial oxygen supply through coronary vasodilation and decreases myocardial oxygen demand through mild heart rate and afterload reduction, and shows potential antiarrhythmic activity through class IB, III, and IV mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of calcium channel blocker overdose-induced toxicity in the conscious dog.

STUDY OBJECTIVE: To evaluate the effects of nifedipine, diltiazem, and verapamil overdose on systemic hemodynamics and blood flows to the coronary, superior mesenteric, renal, and iliac arteries in the unanesthetized dog. DESIGN: Nonblinded, controlled animal study. SETTING: Research laboratory of a large pharmaceutical company. TYPE OF PARTICIPANTS: Nineteen healthy mongrel dogs obtained from a commercial supplier. INTERVENTIONS: Under general anesthesia, flow probes were placed about the ascending aorta, circumflex coronary, superior mesenteric, renal, and iliac arteries; a micromanometer was implanted into the tip of the left ventricle; and a catheter was inserted into the descending aorta. Experiments were performed after a recovery period of at least two weeks. MEASUREMENTS AND MAIN RESULTS: Arterial blood pressure, heart rate, cardiac output, left ventricular pressure, and regional blood flows were measured prior to drug administration, and after 0.03, 0.1, 0.3, 1.0, and 3.0 mg/kg IV administration of the study drugs. Dogs receiving diltiazem or verapamil also received a dose of 10.0 mg/kg. When the blood pressure had been reduced from baseline by 30%, 1.43 mg/kg nifedipine IV (six dogs) decreased total peripheral resistance by 51%, increased cardiac output by 35%, and increased heart rate by 132%. Coronary blood flow and iliac blood flow increased 93% and 45%, respectively, but mesenteric blood flow and renal blood flow were not significantly altered. Diltiazem (eight) and verapamil (seven) at equivasodepressor doses (1.43 to 4.43 mg/kg) caused less peripheral vasodilation and reflex tachycardia. At severely toxic levels when arterial blood pressure fell by 50%, all three drugs decreased cardiac output. Nifedipine still increased heart rate. Diltiazem and verapamil caused high-grade atrioventricular block, resulting in bradycardia. All three drugs caused a redistribution of cardiac output favoring the coronary bed over the other beds. CONCLUSIONS: In the conscious dog, calcium channel blocker-induced hypotension at the moderate level is associated with disparate effects on systemic hemodynamics, probably resulting from differential reflex sympathetic activation. However, at a more severe level, their toxic effects are similar and manifested predominantly by their actions on the slow calcium channel.

Antiarrhythmic and antifibrillatory properties of McN-4130 in several animal models.

McN-4130 is an experimental compound having antiarrhythmic and antifibrillatory activity in several animal models. In anesthetized, open-chest pigs subjected to total occlusion and subsequent reperfusion of the left anterior descending coronary artery, McN-4130 dose-dependently (2.5-10.0 mg/kg i.v.) protected against fibrillation and death. Mean arterial pressure was not significantly affected, but heart rate was dose-dependently reduced. In anesthetized normal dogs, McN-4130 increased ventricular fibrillation threshold for up to 45 min. This increase in fibrillation threshold was associated with concurrent increases in ventricular conduction time and ventricular effective refractory period. In conscious dogs subjected to occlusion of the left anterior descending coronary artery 24 h previously, McN-4130, 2.5 and 5.0 mg/kg i.v., significantly reduced the rate of ventricular arrhythmias for up to 45 min. McN-4130 was more effective and had a longer duration of action than comparable doses of lidocaine and disopyramide. McN-4130 was orally effective in this model at 10 mg/kg. These results indicate that McN-4130, a structurally unique experimental antiarrhythmic compound, may be useful as a ventricular antiarrhythmic agent with antifibrillatory properties.

Regulation of jejunal blood flow and oxygenation during glucose and oleic acid absorption.

To differentiate the mechanisms whereby actively absorbed glucose and passively absorbed oleic acid increase blood flow and oxygen uptake during their absorption, the effects of these two nutrients on jejunal blood flow, arteriovenous oxygen difference [(a-v)O2], O2 uptake, absorption, rubidium extraction, and capillary permeability-surface area product (PS) were compared in anesthetized dogs. Oleic acid (37 mM) produced significantly greater hyperemia (+28.2%) than glucose (270 mM) did (+12.5%). As estimated by (a-v)O2, tissue oxygen extraction was decreased by oleic acid (-12%) but increased by glucose (+6.5%); the increases in O2 uptake by these two nutrients did not differ significantly. Glucose absorption was accompanied by an increase in rubidium extraction and capillary PS (+11.3%), whereas oleic acid absorption was not. Unlike glucose, intra-arterial infusion of oleic acid decreased vascular resistance and increased blood flow equally to the mucosa and muscularis layers. A significant relation existed between oleic acid absorption and blood flow but not between glucose absorption and blood flow. The enhancement of glucose-induced hyperemia by bile was not related to glucose absorption. Unmasking of oleic acid-induced hyperemia by bile is unrelated to oleic acid absorption but is related to solubility of oleic acid in aqueous solution. The above findings suggest that glucose absorption affects both resistance and exchange vessels, whereas oleic acid absorption affects primarily resistance vessels.

Time course of jejunal blood flow, O2 uptake, and O2 extraction during nutrient absorption.

Experiments were performed on anesthetized dogs to determine whether responses of jejunal blood flow, arteriovenous O2 difference, O2 uptake (VO2), and glucose absorption to luminal placement of predigested food or glucose would change with time during 30- and 60-min placement periods and to determine whether bile alters the responses. During the initial 15 min, food, glucose, food plus bile, and glucose plus bile produced a 13, 10, 51, and 30% increase in flow, respectively. During the next 15 min, flow returned to control levels, while arteriovenous O2 difference significantly increased with food or glucose; with glucose plus bile, flow decreased to 28% above control. In the case of food plus bile, flow decreased to 26% above control at 30 min and returned to control 50 min after placement. Despite the fluctuation in flow, the increase in VO2, and glucose absorption stayed at a steady level throughout the entire placement period. Bile significantly enhanced the increases in both flow and VO2 produced by food or glucose, prolonged the hypermia, delayed the significant rise in arteriovenous O2 difference, and had no effect on glucose absorption. In conclusion, the relative contributions of blood flow and O2 extraction to the enhanced VO2 produced by luminal food and glucose change with time, and bile significantly alters the magnitude or time course of changes in the above three variables.

Effects of pressure overload, left ventricular hypertrophy on beta-adrenergic receptors, and responsiveness to catecholamines.

Pressure overload left ventricular (LV) hypertrophy was produced by banding the ascending aorta of puppies and allowing them to grow to adulthood. LV free wall weight per body weight increased by 87% from a normal value of 3.23 +/- 0.19 g/kg. Hemodynamic studies of conscious dogs with LV hypertrophy and of normal, conscious dogs without LV hypertrophy showed similar base-line values for mean arterial pressure, heart rate, and LV end-diastolic pressure and diameter. LV systolic pressure was significantly greater, P less than 0.01, and LV stroke shortening was significantly lss, P less than 0.01, in the LV hypertrophy group. In both normal and LV hypertrophy groups, increasing bolus doses of norepinephrine or isoproterenol produced equivalent changes in LV dP/dt. beta-adrenergic receptor binding studies with [3H]-dihydroalprenolol ( [3H]DHA) indicated that the density of binding sites was significantly elevated, P less than 0.01, in the hypertrophied LV plasma membranes (111 +/- 8.8, n = 8), as compared with normal LV (61 +/- 5.6 fmol/mg protein, n = 11). The receptor affinity decreased, i.e., disassociation constant (KD) increased, selectively in the LV of the hypertrophy group; the KD in the normal LV was 6.8 +/- 0.7 nM compared with 10.7 +/- 1.8 nM in the hypertrophied LV. These effects were observed only in the LV of the LV hypertrophy group and not in the right ventricles from the same dogs. The plasma membrane marker, 5' -nucleotidase activity, was slightly lower per milligram protein in the LV hypertrophy group, indicating that the differences in beta-adrenergic receptor binding and affinity were not due to an increase in plasma membrane protein in the LV hypertrophy group. The EC50 for isoproterenol-stimulated adenylate cyclase activity was similar in both the right and left ventricles and in the two groups. However, maximal-stimulated adenylate cyclase was lower in the hypertrophied left ventricle. Plasma catecholamines were similar in the normal and hypertrophied groups, but myocardial norepinephrine was depressed in the dogs with LV hypertrophy (163 +/- 48 pg/mg) compared with normal dogs (835 +/- 166 pg/mg). Thus, severe, but compensated LV hypertrophy, induced by aortic banding in puppies, is characterized by essentially normal hemodynamics in adult dogs studied at rest and in response to catecholamines in the conscious state. At the cellular level, reduced affinity and increased beta-adrenergic receptor number characterized the LV hypertrophy group, while the EC50 for isoproterenol-stimulated adenylate cyclase activity was normal. By these mechanisms, adequate responsiveness to catecholamines is retained in conscious dogs with severe LV hypertrophy.

Responses of renal hemodynamics and function to acute volume expansion in the conscious dog.

The renal vascular and functional responses to acute volume expansion were determined in conscious dogs with all reflexes intact, sinoaortic arterial baroreceptor denervation, arterial baroreceptor denervation plus bilateral stellectomy, and arterial baroreceptor denervation plus bilateral vagotomy. In the intact dogs, when an isotonic saline infusion increased right atrial pressure by 6 mm Hg, arterial pressure increased by 15 +/- 3 from 95 +/- 3 mm Hg (P less than 0.01) and heart rate rose from 87 +/- 4 to 135 +/- 6 beats/min (P less than 0.01), while renal blood flow rose only slightly (4 +/- 2%), and calculated renal resistance was not altered significantly. After arterial baroreceptor denervation, volume expansion with saline induced a greater rise in blood flow (16 +/- 2%), but did not alter arterial pressure, and calculated resistance fell by 19 +/- 3% from 0.72 +/- 0.05 mm Hg/ml per min (P less than 0.01), while heart rate still increased. After arterial baroreceptor denervation and either bilateral stellectomy or vagotomy, volume expansion reduced renal vascular resistance by similar amounts. When intact animals were volume expanded by 20% of estimated blood volume with isooncotic, isotonic 3% dextran in saline solution, and with renal perfusion pressure held constant, central venous pressure increased by 4.5 +/- 0.6 from 1.8 +/- 0.4 mm Hg (P less than 0.01), renal blood flow increased significantly by 16 +/- 5 ml/min (P less than 0.05) from 191 +/- 30 ml/min, while calculated renal vascular resistance decreased significantly by 0.08 +/- 0.02 from 0.62 +/- 0.09 mm Hg/ml per min (P less than 0.05). Average urine flow rate and sodium excretion 10-60 minutes after expansion increased markedly by 1.85 +/- 0.27 ml/min and 9.84 +/- 1.13 muEq/min per kg, respectively (P less than 0.01). After arterial baroreceptor denervation, volume expansion induced a similar rise in central venous pressure and renal blood flow. The diuretic and natriuretic responses were not attenuated by arterial baroreceptor denervation. After arterial baroreceptor denervation plus bilateral vagotomy, there was a significant and similar rise in renal blood flow, whereas diuretic (urine flow rate rose by only 0.50 +/- 0.10 from 0.35 +/- 0.08 ml/min) and natriuretic (sodium excretion rose by only 4.83 +/- 0.95 from 1.50 +/- 0.48 muEq/min per kg) responses were significantly attenuated (P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of anesthesia on the canine carotid chemoreceptor reflex.

We studied the effects of alpha-chloralose (100 mg/kg, iv), Na pentobarbital (25 mg/kg, iv) and halothane (1 vol% and 2 vol%) on the response to carotid chemoreceptor stimulation (CCRS) in eight chronically instrumented dogs. CCRS was accomplished by means of intracarotid injections of nicotine while ventilation was held constant in the unanesthetized state and following administration of one of three different anesthetics. In the conscious state, CCRS elicited intense bradycardia and peripheral vasoconstriction as reflected by a 173 +/- 14% increase in initial cardiac cycle length and a 216 /+- 22% increase in mean iliac vascular resistance. Each anaesthetic, studied on separate days, attenuated these responses to CCRS strikingly (P less than 0.01). For instance, after alpha-chloralose, CCRS increased iliac resistance by only 55 +/- 14% and cardiac cycle length by only 27 +/- 13%. After Na pentobarbital, CCRS increased iliac resistance by 12 +/- 4% and cardiac cycle length by 8 +/- 5%. After inhalation of halothane (1 vol%), CCRS increased iliac resistance by 28 +/- 7% and cardiac cycle length by 11 +/- 5%, whereas halothane (2 vol%) abolished these responses to CCRS. Thus, general anesthesia interferes severely with carotid chemoreceptor control of the circulation. Whereas halothane and Na pentobarbital altered responses to CCRS the most, we found that even alpha-chloralose, which has been thought to maintain or augment reflex responses, was able to depress the response to CCRS strikingly.

Regional blood flow during digestion in the conscious dog.

Blood flows to the major organs of the resting conscious dog were measured prior to and 30 and 90 min after feeding using the radioactive microsphere technique. Mean systemic arterial pressure, heart rate, and arterial PO2, PCO2, and pH, as well as blood flow to the brain, heart, adrenals, skeletal muscle, hepatic artery, and gastric antrum were not significantly changed following the meal. Pancreatic and duodenal and jejunal blood flows increased at both 30 and 90 min, whereas ileal blood flow increased only at 90 min after feeding. Flow to the gastric body increased in only half of the fed animals, but it increased in all of the animals treated with histamine. In all cases where there was an increase in total wall flow the increase was confined to the mucosa-submucosal layer. Blood flow to the colon was unchanged except for a decrease in the distal colon at 30 min. Thus, the cardiovascular response to feeding appears to be limited to those organs and tissues actively involved in digestion.

Constituents of chyme responsible for postprandial intestinal hyperemia.

While local venous outflow was measured in anesthetized dogs, various constituents of intestinal chyme were placed in the jejunal lumen to identify those responsible for postprandial intestinal hyperemia. Digested food and its supernatant increased local blood flow, whereas its precipitate, undigested food, and pancreatic enzymes did not. In the jejunum bile alone had no effect, but it markedly enhanced the hyperemic effect of digested food. Bile in the ileal lumen, however, increased local blood flow. At physiological postprandial concentrations in the jejunum, glucose, and micellar solutions of oleic acid and monoolein increased flow, but taurocholate and 16 common dietary amino acids did not. The hyperemic effect of lipids required the presence of taurocholate. Of the 16 amino acids, only Glu and Asp increased flow at 10 times the physiological concentrations (28 and 20 mM, respectively). The study indicates that the constituents of chyme responsible for postprandial intestinal hyperemia are the hydrolytic products of food, especially those of carbohydrates and fats and that bile plays an important role in the hyperemia.