Mechanisms of preserved baseline cardiac systolic function in rats with adrenergic inotropic downregulation

Despite reductions in beta-adrenoreceptor (beta-AR)-mediated inotropic effects induced by sustained sympathetic activation in cardiac disease, whether these changes necessarily result in reductions in systolic function under resting conditions (baseline function) is not clear. Moreover, possible compensatory mechanisms which might contribute to maintaining the baseline systolic function despite reductions in beta-AR-mediated inotropic effects have not been systematically sought. In the present study, 1 month of daily administration of the beta-AR agonist, isoproterenol (0.05 mg/kg/day, i.p.), to rats resulted in an attenuation of left ventricular inotropic responses to isoproterenol over a wide range of concentrations (10(-8)-10(-4) M), whereas a decline of inotropic responses to norepinephrine, an endogenous inotrope, occurred only at high concentrations (10(-5)-10(-4) M). However, chronic isoproterenol administration failed to modify baseline systolic chamber and myocardial function, as determined in vivo using echocardiography (endocardial and midwall fractional shortening), and in isolated, perfused heart preparations (end-systolic chamber and myocardial elastance) Sustained baseline chamber function despite profound beta-AR-mediated inotropic downregulation was not attributed to alterations in cardiac loading conditions, resting heart rate, chamber remodeling, increased myocardial norepinephrine release, or enhanced contractile responses to alternative receptor/signal transduction pathways mediating positive inotropy (as assessed from histamine, serotonin, forskolin, angiotensin II or phenylephrine responsiveness). These findings indicate that baseline cardiac contractile function might be unaltered despite a profound impairment of beta-AR-induced responsiveness, an effect related to a preserved stimulatory influence of low physiological concentrations of endogenous norepinephrine constituting adrenergic tone at rest.     

The coronary vasculature and the myocardium

The effect of bradykinin (BK) on myocardial inotropic state was tested on 5 isolated rat heart preparations, in which a proper ballon was placed to record left ventricular pressure, whose developed systolic value was taken as an index of contractility. A reduction of developed left ventricular pressure was observed when BK was added to the perfusion oxygenated Tyrode solution. However, when BK was given after 1-amino-benzotriazole, an inhibitor of Cytochrome P-450 (Cyt P-450), developed pressure did not change. Since Cyt P-450 is known to act on arachidonic acid inducing the production of epoxiecocistrienoic acids (EETs) which hyperpolarizes myocardial fibres, it was argued that the reduction in contractility by bradykinin was the result of the hyperpolarizing effect of EETs. The fact that the concentration of Cyt P-450 is higher in the vascular endothelial cells than in the sarcolemma of the myocytes and the observation that the coronary resistance decreases together with the contractility suggest that the endothelium plays a pivotal role in mediating the negative inotropic effect of BK.     

Spare alpha adrenoceptors in the peripheral circulation: excitation-contraction coupling

Postsynaptic alpha adrenoceptors in arteries and veins represent a mixed population of alpha 1 and alpha 2 adrenoceptors, with both subtypes mediating vasoconstriction. In the peripheral arterial circulation, postsynaptic vascular alpha 1 adrenoceptors are found in the adrenergic neuroeffector junction, whereas postsynaptic vascular alpha 2 adrenoceptors are located extrajunctionally. In the venous circulation, it appears that alpha 2 adrenoceptors may be predominantly junctional, whereas alpha 1 adrenoceptors may be predominantly extrajunctional. In general, alpha 1 adrenoceptors play a more important functional role in arteries than in veins, with the converse being true for postsynaptic vascular alpha 2 adrenoceptors. The relationship between alpha-adrenoceptor occupancy and vasoconstrictor response is more favorable for postsynaptic vascular alpha 1 adrenoceptors than for alpha 2 adrenoceptors in both arteries and veins, and there is evidence for a receptor reserve in alpha 1 adrenoceptors in both the arterial and venous circulation. No reserve in postsynaptic vascular alpha 2 adrenoceptors is seen in the arterial circulation, but in isolated venous preparations, a reserve in alpha 2 adrenoceptors has been observed. It has been suggested that spare alpha 2 adrenoceptors found in veins, but not arteries, may be responsible, at least in part, for the exaggerated alpha 2-adrenoceptor-mediated response of veins relative to arteries.     

Developmental changes in inotropic actions of neurotoxins observed in ventricular muscle of rat heart.

Developmental changes in functions of myocardial sodium channels were examined from inotropic effects of several neurotoxins in ventricular muscle preparations obtained from prenatal (20-22 day gestation) or adult (3-4 months old) rat hearts. Tetrodotoxin caused a negative inotropic effect in low concentrations and a loss of muscle responsiveness to electrical stimulation in high concentrations in preparations obtained from either prenatal or adult rat heart. The tetrodotoxin concentration that caused a 50% decrease in developed tension was higher in prenatal rats. Anemonia sulcata toxin, Androctonus australis toxin, veratridine, and Centruroides sculpturatus toxin all produced positive inotropic effects in adult rat heart. The effects were largest with A. sulcata and A. australis toxins, intermediate with veratridine, and smallest with C. sculpturatus toxin. Prenatal heart required higher concentrations of either veratridine, or A. sulcata or A. australis toxins to produce comparable positive inotropic effects. With C. sculpturatus toxin, no significant positive inotropic effect was observed in prenatal heart muscle preparations. These results indicate that cardiac sodium channels undergo significant functional changes during development and that negative and positive inotropic effects of neurotoxins resulting from inhibition and enhancement of fast Na+ channels reflect developmental changes in the cardiac sodium channels.     

Augmentation of the inotropic response to insulin in diabetic rat hearts.

Insulin participates in the modulation of myocardial function, but its inotropic action in diabetes mellitus is not fully clear. In the present study, we examined contractile responses to insulin in left-ventricular papillary muscles and ventricular myocytes isolated from hearts of normal or short-term (5-7 days) streptozotocin-induced (65 mg/kg) diabetic rats. Mechanical properties of papillary muscles and ventricular myocytes were evaluated using a force transducer and an edge-detector, respectively. Contractile properties of papillary muscles or cardiac myocytes, electrically stimulated at 0.5 Hz, were analyzed in terms of peak tension development (PTD) or peak twitch amplitude (PTA), time-to-peak contraction (TPT) and time-to-90% relaxation (RT90). Intracellular Ca2+ transients were measured as fura-2 fluorescence intensity change (deltaFFI). Insulin (1-500 nM) had no effect on PTD in normal myocardium, whereas it produced a positive inotropic response in preparations from diabetic animals, with a maximal increase of 11%. Insulin did not modify TPT or RT90 in either group. Further studies revealed that insulin enhanced cell shortening in diabetic but not normal myocytes, with a maximal increase of 21%. Consistent with its action on the mechanical properties of papillary muscles and cardiac myocytes, insulin also induced a dose-dependent increase in the intracellular Ca2+ transient in diabetic but not normal myocytes. Collectively, these data suggest that the myocardial contractile response to insulin may be altered in diabetes.     

Association of the positive inotropic action of ouabain with a second species of digitalis receptors

Studies were conducted to determine whether Na-K ATPase or a second species of digitalis receptors in canine cardiac sarcolemma membrane preparations is associated with the positive inotropic action of nontoxic concentrations of ouabain. [3H]ouabain association and dissociation experiments using highly enriched sarcolemma preparations from canine ventricle indicate the presence of two species of ouabain binding receptors. Ouabain binding to Na-K ATPase of the sarcolemma preparation requires supporting ligands and is characterized by fast association and very slow dissociation in vitro. The second species of digitalis receptor does not require supporting ligands for ouabain binding and is characterized by slow association and fast dissociation. To determine which species of digitalis receptor is associated with the positive inotropic action of digitalis, ouabain washout experiments were conducted using various isolated canine myocardial preparations. Washout of the positive inotropic effects of 1.2-2.4 X 10(-7) M ouabain gave half-life values of 1.5-2.0 h for the various myocardial preparations. [3H]ouabain dissociation from the second species of digitalis receptors gave half-life values of 1.7-1.8 h, whereas dissociation from the sarcolemma Na-K ATPase gave half-life values of 8.9-9.3 h for the various sarcolemma preparations utilized. Therefore, based on similarities in half-life values between ouabain inotropy and [3H]ouabain dissociation from the second class of digitalis receptors, it is postulated that the positive inotropic action of digitalis glycosides is associated with the second species of digitalis receptors in the sarcolemma and not with the digitalis inhibitory receptor of Na-K ATPase for nontoxic concentrations of digitalis.     

Dissociation of Na+,K+-ATPase inhibition from digitalis inotropy.

Recent findings from our laboratory as well as those of other laboratories do not support the postulation that the mechanism of the positive inotropic action of digitalis is due to inhibition of NA,K-ATPase. Using short-acting digitalis steroids and drug washout experiments, in isolated myocardial preparations, it has been demonstrated that Na,K-ATPase isolated from such preparations is still significantly inhibited, whereas the positive inotropic effect is no longer present. Also, based on kinetic measurements the two exponential rate constants observed for drug half-life, a rapid and slow phase, were found to be associated, respectively, with the very short inotropic half-life and the very long enzyme inhibition half-life. In addition, a dissociation of the transient inotropic effects of digitalis was observed from the long lasting cardiotoxic effects of digitalis during drug washout. Moreover, a temporal correlation was noted between the persistent inhibitory effects of digitalis on Na,K-ATPase and the persistent cardiotoxic effects of digitalis. Therefore, it is concluded that inhibition of Na,K-ATPase is not responsible for the positive inotropic action of digitalis, but may be the mechanism, at least in part, for certain cardiotoxic effects of digitalis.     

Dependence on extracellular potassium of the positive inotropic response to St 587, a selective alpha-1 adrenoceptor agonist, in Zucker rat heart ventricle

The effects of St 587, a selective alpha-1 adrenoceptor agonist, were investigated in non obese and obese Zucker rat heart ventricles. In both groups, the numbers and affinity constants for alpha-1 adrenoceptors were found to be similar. At 4 or 10 mM [K]o, St 587 failed to increase the developed tension whereas at 14 mM [K]o, St 587 significantly increased it in both groups of rats. This effect was reversed by prazosin; St 587 also increased action potential duration at 14 mM [K]o. [K]o is thus important for the occurrence of the inotropic effect of St 587 in 12 week-old Zucker rats, either non obese or obese with reduced beta-adrenoceptor responsiveness. This suggests the participation of phosphoinositide metabolism in the mechanism of St 587 inotropic effect in the rat.     

Cardiac dilatation and pump dysfunction without intrinsic myocardial systolic failure following chronic beta-adrenoreceptor activation

There is no direct evidence to indicate that pump dysfunction in a dilated chamber reflects the impact of chamber dilatation rather than the degree of intrinsic systolic failure resulting from myocardial damage. In the present study, we explored the relative roles of intrinsic myocardial systolic dysfunction and chamber dilatation as mediators of left ventricular (LV) pump dysfunction. Administration of isoproterenol, a beta-adrenoreceptor agonist, for 3 mo to rats (0.1 mg.kg(-1).day(-1)) resulted in LV pump dysfunction as evidenced by a reduced LV endocardial fractional shortening (echocardiography) and a decrease in the slope of the LV systolic pressure-volume relation (isolated heart preparations). Although chronic beta-adrenoreceptor activation induced cardiomyocyte damage (deoxynucleotidyl transferase-mediated dUTP nick-end labeling) as well as beta(1)- and beta(2)-adrenoreceptor inotropic downregulation (attenuated contractile responses to dobutamine and salbutamol), these changes failed to translate into alterations in intrinsic myocardial contractility. Indeed, LV midwall fractional shortening (echocardiography) and the slope of the LV systolic stress-strain relation (isolated heart preparations) were unchanged. A normal intrinsic myocardial systolic function, despite the presence of cardiomyocyte damage and beta-adrenoreceptor inotropic downregulation, was ascribed to marked increases in myocardial norepinephrine release, to upregulation of alpha-adrenoreceptor-mediated contractile effects as determined by phenylephrine responsiveness, and to compensatory LV hypertrophy. LV pump failure was attributed to LV dilatation, as evidenced by increased LV internal dimensions (echocardiography), and a right shift and increased volume intercept of the LV diastolic pressure-volume relation. In conclusion, chronic sympathetic stimulation, despite reducing beta-adrenoreceptor-mediated inotropic responses and promoting myocyte apoptosis, may nevertheless induce pump dysfunction primarily through LV dilatation, rather than intrinsic myocardial systolic failure.     

The relationship between prostaglandin release and lung c-AMP levels during anaphylaxis in the guinea-pig.

A four-fold transient rise in c-AMP levels was seen when sensitized guinea-pig lungs were challenged with antigen in vitro. This rise in c-AMP also occurred in vivo and was shown to be due to release of Prostaglandin E2. This conclusion is supported by the finding that inhibitors of prostaglandin synthesis (Indomethacin and Poly phloretin phosphate) prevent the rise in c-AMP while neither ICI 74, 917, an inhibitor of histamine release, nor antihistamines had any effect on the c-AMP levels.     

Cardiac adrenoceptors at low temperature: what is the experimental evidence for the adrenoceptor interconversion hypothesis?

Isolated heart preparations of frog and rat were used to test the validity of the adrenoceptor interconversion hypothesis. This hypothesis claims that low temperature converts the inotropic beta-adrenoceptors in isolated frog and rat heart to alpha-adrenoceptors. The present results do not support the adrenoceptor interconversion hypothesis. In the isolated frog ventricle, lowering the temperature from 24 C to 14 C did not significantly alter the inotropic potency of the sympathomimetic drugs isoprenaline, epinephrine, and phenylephrine and did not reduce the potency of the beta-adrenoceptor blocking drug propranolol as an epinephrine antagonist. In the isolated rat left atrium, lowering the temperature from 31 C to 17-19 C did not significantly change the inotropic potency of isoprenaline, norepinephrine and phenylephrine, did not diminish the potency of propranolol, and did not increase the potency of the alpha-adrenoceptor blocking drug phentolamine.--Benfey, B. G. Cardiac adrenoceptors at low temperature; what is the experimental evidence for the adrenoceptor interconversion hypothesis?     

Altered inotropic reactivity in diabetic rabbit right ventricular myocardium

Alloxan monohydrate was used to induce diabetes in rabbits, which were maintained for a 3-month period with or without daily insulin replacement along with age-matched controls. Isolated right ventricular myocardial strips were used to generate dose-response curves to isoproterenol, forskolin, and Bay K 8644. Basal developed force was significantly elevated in diabetic ventricular strips. While isoproterenol acted as a full inotropic agonist, diabetic preparations revealed a consistent but insignificant decrease in the maximum developed force. While both sensitivity to isoproterenol and beta-adrenoceptor density were decreased in preparations from diabetic rabbits, there was no associated increase in circulating plasma catecholamines. In contrast, forskolin and Bay K 8644 were partial agonists in control preparations but full inotropic agonists in diabetic preparations, demonstrating significant increases in maximum developed force. This hyperresponsiveness was not associated with altered calcium channel density. Finally, insulin replacement reduced or prevented all diabetic-related changes. These data indicate that the hyperresponsiveness to forskolin and Bay K 8644 represents an altered utilization of intracellular calcium in the diabetic rabbit, converting them into full agonists similar to isoproterenol. The decrease in sensitivity to isoproterenol correlated with a decrease in beta-adrenoceptor density but not elevated circulating catecholamines as previously observed in diabetic rats.     

The action of ultrasound on the contraction strength and action potential of the papillary muscle of the rat heart

In experiments on isolated rat papillary muscles the effects of therapeutic doses of ultrasound (US) (intensity, less than 2 W/cm2) with frequency of 0.88 MHz on contraction force and action potential (AP) were studied. 12 muscles (from 14) responded to 3-min exposition of the US with a rise both in contraction force and in resting tension. Sensitivity to US and a value of inotropic effect changed significantly between the preparation, and the threshold intensities of US varied from 0.3 to 2 W/cm2. In 3 experiments the inotropic effect of US was more than 100%, but in others it was about 50%. Two preparations were not sensitive to the US. The positive inotropic effect of US was accompanied by membrane depolarization (up to 20 mV) and by prolongation of AP duration measured at 10% of its amplitude (APD10). The correlation between the increase in contraction force and APD10 was demonstrated. Some preparations responded to US with high depolarization (up to 50 mV) and were inexcitable. The US induced an increase in temperature less than 1 degree C, therefore all the effects of US could not be explained as a result of temperature rise.     

Effect of lysosomal enzymes on myocardial electrical and contractile activity in burn shock

Marked depression of the amplitude of isometric contractions of myocardial preparations, which was induced by lysosomal enzymes from the liver of control animals, was demonstrated in isolated rabbit papillary muscles. The decrease of contractility was not accompanied by remarkable changes in the amplitude or in the duration of intracellular action potentials. The negative inotropic action of lysosomal enzymes was similar to that of blood plasma of the burnt animals. Based on the appearance and subsequent activation of lysosomal enzymes in blood of the animals by the 20th to 60th min after thermal injury it is suggested that lysosomal enzymes might be one of factors that depress myocardial contractility in burn shock.     

Prolactin interacts with gonadotropin through a suppression of c-AMP production probably as a LH-sensitive adenylate cyclase inhibitor

The interaction between gonadotropin and prolactin (PRL) on ovarian steroidogenesis as well as c-AMP production was studied in rat ovaries. Ovaries obtained from adult female Wistar rats in a morning of proestrus were chopped into 30-40 pieces and subjected to short term incubation studies using various buffers. HCG-stimulated c-AMP, estradiol (E2), progesterone (P) secretions were suppressed in a dose-dependent manner by ovine (o) PRL in a plain Gey-Gey (G-G) buffer. Addition of 3-isobutyl-1-methyl-xanthine (IBMX) increased c-AMP accumulation as well as E2 and P secretions. Deletion of Ca++ from the IBMX buffer stimulated c-AMP production, but suppressed steroid secretion. The inhibitory effect of PRL on E2 and P was not demonstrated in IBMX buffer at any Ca++ concentration examined despite suppression of c-AMP production. In conclusion, it was demonstrated that PRL inhibited gonadotropin-stimulated production of E2 and P by inhibiting c-AMP production. IBMX stimulated accumulation of c-AMP, E2 and P and counteracted with the antigonadal effect of PRL. Ca++ inhibited c-AMP accumulation but stimulated E2 and P secretions. The data suggested that PRL exerts its antigonadal effect through an inhibition of adenylate cyclase action in a manner similar to that of Ca++.     

Mesenteric lymph from rats with trauma-hemorrhagic shock causes abnormal cardiac myocyte function and induces myocardial contractile dysfunction

Myocardial contractile dysfunction develops following trauma-hemorrhagic shock (T/HS). We have previously shown that, in a rat fixed pressure model of T/HS (mean arterial pressure of 30-35 mmHg for 90 min), mesenteric lymph duct ligation before T/HS prevented T/HS-induced myocardial contractile depression. To determine whether T/HS lymph directly alters myocardial contractility, we examined the functional effects of physiologically relevant concentrations of mesenteric lymph collected from rats undergoing trauma-sham shock (T/SS) or T/HS on both isolated cardiac myocytes and Langendorff-perfused whole hearts. Acute application of T/HS lymph (0.1-2%), but not T/SS lymph, induced dual inotropic effects on myocytes with an immediate increase in the amplitude of cell shortening (1.4 ± 0.1-fold) followed by a complete block of contraction. Similarly, T/HS lymph caused dual, positive and negative effects on cellular Ca2? transients. These effects were associated with changes in the electrophysiological properties of cardiac myocytes; T/HS lymph initially prolonged the action potential duration (action potential duration at 90% repolarization, 3.3 ± 0.4-fold), and this was followed by a decrease in the plateau potential and membrane depolarization. Furthermore, intravenous infusion of T/HS lymph, but not T/SS lymph, caused myocardial contractile dysfunction at 24 h after injection, which mimicked actual T/HS-induced changes; left ventricular developed pressure (LVDP) and the maximal rate of LVDP rise and fall (±dP/dt(max)) were decreased and inotropic response to Ca2? was blunted. However, the contractile responsiveness to β-adrenergic receptor stimulation in the T/HS lymph-infused hearts remained unchanged. These results suggest that T/HS lymph directly causes negative inotropic effects on the myocardium and that T/HS lymph-induced changes in myocyte function are likely to contribute to the development of T/HS-induced myocardial dysfunction.     

Influence of arachidonic acid metabolites on cardiac alpha 1-adrenoceptor responses in diabetic rats.

There is evidence that one or more metabolites of arachidonic acid can produce positive inotropic effects and may also be implicated in the enhanced alpha 1-adrenoceptor responses in hearts from diabetic rats. We therefore carried out a study to investigate the possibility that arachidonic acid metabolites could be involved in the altered cardiac alpha 1-effect of norepinephrine (in the presence of propranolol) in chronic streptozotocin-diabetic rats. Our results have shown that in the presence of the cyclooxygenase inhibitor indomethacin or the thromboxane synthetase inhibitor imidazole, the norepinephrine-stimulated positive inotropic effect and the formation of inositol 1,4,5-trisphosphate were significantly increased in control hearts but were unaltered in hearts from diabetic rats. The addition of the prostacyclin synthetase inhibitor tranylcypromine reduced the norepinephrine-stimulated positive inotropic effect and inositol 1,4,5-trisphosphate formation only in diabetic hearts and had no effect in the controls. The nature and physiological significance of the enhanced positive inotropic effect and inositol 1,4,5-trisphosphate formation in the control heart with the addition of indomethacin and imidazole are still unclear. The effect of tranylcypromine may indicate the participation of prostacyclin in mediating the enhanced alpha 1-inotropic effect of norepinephrine in the chronic diabetic heart.     

D- and L-isoprenaline have different effects on adrenoceptors in the systemic vasculature of the cod, Gadus morhua

The effects of D- and L-isoprenaline on systemic vascular adrenoceptors of the cod was studied using blood pressure recording from conscious cod in vivo and isolated coeliac artery strip preparations in vitro. Experiments with isolated artery preparations demonstrated that the D-, but not the L-isomer of isoprenaline acts as an alpha-adrenoceptor antagonist. A dose-dependent reduction of ventral and dorsal aortic blood pressures together with a dose-dependent increase in the heart rate could be produced by injection of L-isoprenaline. D-Isoprenaline, on the other hand, had no effect on the blood pressures or heart rate except in the highest dose injected. The results show an alpha-adrenoceptor blocking capacity of D-isoprenaline in the cod. The effect of L-isoprenaline on the blood pressure supports the idea that the hypotensive effect of DL-isoprenaline seen in previous studies of the cod may be attributed to an effect of the L-isomer on beta-adrenoceptors mediating vasodilation of the cod systemic vasculature.     

Pharmacological characterization of an Endogenous Negative Inotrophic Factor (ENIF) from porcine heart

Recently we have been successful in isolating an endogenous negative inotropic factor (ENIF) from porcine left ventricular tissue. In this study, we have characterized its pharmacological properties. The results of the study demonstrated that ENIF produces a concentration-dependent negative inotropic response on both guinea pig left atria and right ventricular trabeculae. The maximal reduction in contractile force produced by 300 ul of ENIF (5 ml bath) on atria and trabeculae were 90.0 ± 0.8% and 77.5 ± 6%. Atria, however, was significantly more sensitive to ENIF than trabeculae. The ED 50 of ENIF for atria was found to be 38 ul as opposed to ED 50 of 100 ul of ENIF for trabeculae.Acetylcholine (ACh), a muscarinic receptor agonist, decreased the contractile force of guinea pig atria in a dose-dependent manner with a maximal decline in the contractile force of 90%. However, none of the concentration of ACh used affected the contractile function of the trabeculae. Atropine (1 uM) completely blocked the negative inotropic response on atria of all the doses of ACh used. The same dose of atropine, however, was unable to influence the negative inotropic effect of any of the doses of ENIF used on either the atria or trabeculae preparations in our study. The maximal decline in the contractile force of atria was e.g. 94 and 95% in the presence and absence of atropine respectively. These data demonstrate that the myocardial negative inotropic effect of ENIF is not mediated via the cholinegic receptor mechanism.     

Interactions of agonists with peripheral alpha-adrenergic receptors

The alpha adrenoceptors may be subdivided based on their anatomical distribution within the synapse. Presynaptic alpha adrenoceptors are generally of the alpha 2 subtype and modulate neurotransmitter liberation via a negative feedback mechanism. Postsynaptic alpha adrenoceptors are usually of the alpha 1 subtype and mediate the response of the effector organ. Although this anatomical subclassification is generally applicable, many exceptions are now known. A more useful classification of alpha-adrenoceptor subtypes is based on a pharmacological characterization in which selective agonists and antagonists are used. Two major classes of alpha-adrenoceptor agonists are known: the phenethylamines, which are structurally related to norepinephrine, and the imidazolines, which are structurally related to clonidine. A number of important differences between these two classes of agonists have been observed and have led to the conclusion that the phenethylamines and imidazolines interact differently with alpha adrenoceptors. Many developments have recently been made in regard to peripheral alpha adrenoceptors in the cardiovascular system. Postsynaptic alpha adrenoceptors in the vasculature represent a mixed population of alpha 1 and alpha 2 adrenoceptors. Both alpha-adrenoceptor subtypes mediate vasoconstriction, but appear to do so through different mechanisms. alpha 1 adrenoceptors also exist in the heart and mediate a positive inotropic response. Renal alpha 1 and alpha 2 adrenoceptors have been identified and subserve a variety of functions such as regulation of renal blood flow, gluconeogenesis, renin release, and sodium and water reabsorption.