Hemodynamic and biochemical effects of 100% oxygen breathing in humans.

High concentrations of inspired oxygen have been reported to have significant hemodynamic effects that may be related to increased free radical production. If oxygen therapy increases free radical production, it may also modify hemodynamic responses to a nitric oxide donor. Twenty-nine healthy male volunteers were studied using randomized, double-blind, placebo-controlled, crossover designs to determine whether oxygen therapy is associated with hemodynamic and forearm vascular effects. We measured hemodynamic parameters and forearm vascular responses before and 1 h after exposure to 100% oxygen versus medical air. Plasma 8-iso-PGF2alpha and plasma vitamin C were measured to assess the biochemical effects of oxygen administration. Hemodynamic measurements were also made following the acute administration of sublingual nitroglycerin. Oxygen therapy caused no significant change in blood pressure, plasma 8-iso-PGF2alpha, or vitamin C. Oxygen did cause a significant reduction in heart rate and forearm blood flow, and an increase in peripheral vascular resistance. Oxygen caused no change in the hemodynamic response to nitroglycerin. Therefore, in healthy young adults, therapy with 100% oxygen does not affect blood pressure, despite causing an increase in vascular resistance, is not associated with evidence of increased free radical injury, and does not affect the hemodynamic responses to nitroglycerin.     

Comparative haemodynamic studies of resting and active skeletal muscle in anaesthetised rats: role of nitric oxide.

Our previous studies have indicated that nitric oxide takes part in the basal regulation of vascular tone in skeletal muscle. The purpose of this study was to investigate whether nitric oxide has a role in the active hyperaemic response of a working muscle in a resting subject. Haemodynamic effects of nitric oxide synthase (NOS) inhibition (L-NAME, 10 mg/kg/30 min i.v. infusion) were determined simultaneously in the resting m. quadriceps femoris and in the working (breathing) m. rectus abdominis in anaesthetised rats (86Rb accumulation technique). L-NAME increased blood pressure and total peripheral resistance (TPR) while it decreased cardiac output. Blood flow (BF) decreased and vascular resistance (VR) increased both in resting (BF: 8.91+/-1.97-->5.92+/-2.59 ml/min/100 g, p<0.05: VR: 106+/-29.9-->212+/-113 R, p<0.01) and working (BF: 17.0+/-4.78-->6.93+/-2.15 ml/min/100 g, p<0.001; VR: 57.0+/-18.5-->160+/-56.7 R, p<0.01) muscle following NOS inhibition, but the percentile change of BF was higher in the working muscle (59%) than in the resting one (34%, p<0.001). There was a positive correlation between the cardiac output and the blood flow of the resting muscle with or without L-NAME administration, but blood flow of the working muscle failed to have any correlation with the cardiac output in control animals. However, L-NAME administration decreased both the cardiac output and the blood flow and similarly to the resting muscle a positive correlation was found. In conclusion, the haemodynamic effects of NOS inhibition are higher in working muscle than in the resting one: the nitric oxide may have important role in vasodilatation during muscle activity.     

Cardiovascular, metabolic and endocrine effects of chemical sympathectomy and of adrenal demedullation in fetal sheep

A procedure in fetal sheep for causing peripheral sympathectomy by regular intravascular guanethidine sulphate administration and for causing adrenal demedullation by intragland injection of acid formalin is reported. Demedullation substantially removed adrenaline from the fetal circulation, but has a small effect only on noradrenaline. Plasma noradrenaline levels were depressed by 50% when demedullated fetuses were also subject to peripheral sympathectomy by guanethidine sulphate treatment. This provides some evidence that the paraganglia in the sheep fetus contributes to resting plasma catecholamines. Furthermore the ability of adrenal demedullation to increase markedly this pool of extra-adrenal chromaffin tissue indicates that in the fetus adrenal activity regulates the growth of these para-aortic bodies. In response to sympathectomy plasma vasopressin concentrations rose substantially, whilst adrenal demedullation caused a small rise. Demedullation and sympathectomy depressed fetal plasma glucose and elevated plasma cortisol. In both sympathectomised and adrenal demedullated fetuses resting heart rate and blood pressure was not depressed. However in those with a depleted peripheral nervous system periods of cardiovascular instability were apparent after 2-3 days of treatment with guanethidine sulphate. Hence there were regular episodes where fetal blood pressure and heart rate fell sharply followed 60-90s later by very large increases in blood pressure sustained for up to 10 min and associated with substantial production of plasma vasopressin and catecholamines. These results show that fine cardiovascular control in the fetus requires an intact sympathetic system as the endocrine system is too slow responding to effectively maintain reflex vascular control.     

Efficacy and specificity of bFGF increased collateral flow in experimental peripheral arterial insufficiency

Angiogenic growth factors could prove to be useful in managing peripheral arterial insufficiency. The present study was designed to evaluate the dose response of basic fibroblast growth factor (bFGF), the efficacy of critical routes and dosing regimens, and the specificity of action in rats with peripheral arterial insufficiency. Bilateral ligation of femoral arteries greatly reduces blood flow capacity to the calf muscles but does not impair resting flow needs. Collateral blood flow to calf muscles was determined 16 days postocclusion, during treadmill running, with (85)Sr and (141)Ce microspheres, in blinded-randomized trials that included intra-arterial and intravenous infusions and subcutaneous injections of recombinant human bFGF. Peak blood flow of 75-80 ml. min(-1). 100 g(-1) for calf muscle was observed at a bFGF dose of 5 microg. kg(-1). day(-1) (ia for 14 days) compared with 50 ml. min(-1). 100 g(-1) for vehicle groups. Similar increases in collateral blood flow were observed with short-term or prolonged and continuous or intermittent delivery of bFGF by any route. Collateral blood flows were similar in corresponding muscles across both limbs. Vascular remodeling induced by bFGF required attendant vascular occlusion, inasmuch as vessels in the normal nonoccluded vascular tree were unresponsive to circulating bFGF. Improvement in collateral blood flow with exogenous bFGF is robust, amenable to short-term administration, and requires vascular occlusion to be effective.     

The influence of muscular contractions on acetylcholine effects on nutritive blood flow in the hindpaw of dog.

In the earlier investigations it was shown that muscular exercise augmented the dilator effects of ACh in the vascular bed of the hind leg of dog. To get a closer insight into this phenonenon the effects of acetylcholine on the nutritive blood flow in contracting skeletal muscle in the dog were studied. It was found that i.a. acetylcholine administration raises the nutritive blood flow in the investigated vascular bed within about 30--36 minutes after muscular contractions. The nutritive blood flow during and following muscular contractions induced by stimuli of varying frequency was also investigated.     

NEWER METHODS FOR SELECTION OF PATIENTS FOR LUMBAR SYMPATHECTOMY

The degree of vasodilatation achieved by various diagnostic methods (arterial occlusion, ganglionic block established by certain agents, lumbar sympathetic block, spinal anesthesia, and indirect heating) was studied by means of the pneumo-plethysmogram as well as through readings of skin temperature and skin resistance. The data obtained were interpreted as to their value in determining the type of patient with vascular disease for whom lumbar sympathectomy would be of noticeable benefit. Arterial occlusion proved itself a rapid and simple method which in most patients produced satisfactory results. As a rule, lumbar sympathectomy was effective in patients who preoperatively had shown a positive response upon release of arterial occlusion. A negative response, that is, absence of significant increase in blood flow, does not necessarily indicate organic disease, and cannot be taken to mean that lumbar sympathectomy would always be ineffective. Ganglionic block, using 2.6 dimethyl piperidinium bromide or tetraethylammonium ion, was generally less reliable in indicating the probable results of sympathectomy than lumbar sympathetic block or indirect heating. Lumbar sympathetic block with procaine was followed by a greater increase in skin temperature and blood flow than spinal anesthesia, and permitted far more accurate conclusions as to the probable outcome of sympathectomy. Subsequent to indirect heating the plethysmogram showed characteristic differences depending on the degree of vascular disease present. From the effect of this simple, safe and painless method upon the relative blood flow to the toe it becomes possible to arrive at a comparatively accurate estimate of the clinical benefit to be expected from lumbar sympathectomy.     

Effect of opioid peptides on regional hemodynamics in waking rats

The hemodynamic effects of intravenously administered relatively selective mu-(DAGO) and delta-(DADL) opioid agonists were investigated in conscious rats. The radioactive microsphere technique was used to measure regional blood flow in 10 zones before and 5 min after bolus injection of each peptide. Both opioid agonists in a dose of 1 mumol/kg produced transient hypotension, bradycardia and apnoea. DADL injection increased blood flow in the adrenals and decreased it in the muscles; vascular resistance spleen. DAGO administration increased blood flow in the adrenals and decreased it in the pancreas and skin, whereas vascular resistance increased in the pancreas and skin and decreased in the adrenals. Naloxone pretreatment diminished regional blood flow responses to DAGO. Regional hemodynamic changes after peptide administration are suggested to be connected with the activation of peripheral opiate receptors. High differentiation of regional vascular responses may be related to heterogeneous distribution of mu- and delta-opiate receptors in the body.     

Contributions of hemodynamic monitoring to the treatment of chronic congestive heart failure.

Optimal therapy for congestive cardiac failure requires identification of correctable factors that aggravate it as well as an understanding of its etiology. Increased sympathetic nervous system activity, reduced renal blood flow, and cardiac hypertrophy and dilation are the main compensatory processes that occur in response to cardiac failure. Although they may be of initial benefit in supporting a reduced stroke volume, they may ultimately prove self-defeating. New drugs for the treatment of severe congestive heart failure include dopamine, which has a selective nonadrenergic dilator effect on the renal vascular bed, and dobutamine, which has potent inotropic effects, lowers the left ventricular filling pressure and does not increase the heart rate or the systemic vascular resistance. By reducing both the resistance to left ventricular ejection and the venous return to the right heart, vasodilators result in improved peripheral perfusion and reduced pulmonary congestion. Optimal therapy for refractory cardiac failure can be rationally determined by characterizing the hemodynamic profile through measurement of the mean arterial pressure, the left ventricular filling pressure, the cardiac output and the systemic vascular resistance. The specific therapy can then be effectively and safely delivered by a careful analysis of the dose-response relation as identified by hemodynamic monitoring.     

Stimulation of NTS A1 adenosine receptors evokes counteracting effects on hindlimb vasculature

Our previous studies concluded that stimulation of the nucleus of the solitary tract (NTS) A2a receptors evokes preferential hindlimb vasodilation mainly via inducing increases in preganglionic sympathetic nerve activity (pre-ASNA) directed to the adrenal medulla. This increase in pre-ASNA causes the release of epinephrine and subsequent activation of beta-adrenergic receptors that are preferentially located in the skeletal muscle vasculature. Selective activation of NTS A1 adenosine receptors evokes variable, mostly pressor effects and increases pre-ASNA, as well as lumbar sympathetic activity, which is directed to the hindlimb. These counteracting factors may have opposite effects on the hindlimb vasculature resulting in mixed vascular responses. Therefore, in chloralose-urethane-anesthetized rats, we evaluated the contribution of vasodilator versus vasoconstrictor effects of stimulation of NTS A1 receptors on the hindlimb vasculature. We compared the changes in iliac vascular conductance evoked by microinejctions into the NTS of the selective A1 receptor agonist N6-cyclopentyladenosine (330 pmol in 50 nl volume) in intact animals with the responses evoked after beta-adrenergic blockade, bilateral adrenalectomy, bilateral lumbar sympathectomy, and combined adrenalectomy + lumbar sympathectomy. In intact animals, stimulation of NTS A1 receptors evoked variable effects: increases and decreases in mean arterial pressure and iliac conductance with prevailing pressor and vasoconstrictor effects. Peripheral beta-adrenergic receptor blockade and bilateral adrenalectomy eliminated the depressor component of the responses, markedly potentiated iliac vasoconstriction, and tended to increase the pressor responses. Lumbar sympathectomy tended to decrease the pressor and vasoconstrictor responses. After bilateral adrenalectomy plus lumbar sympathectomy, a marked vasoconstriction in iliac vascular bed still persisted, suggesting that the vasoconstrictor component of the response to stimulation of NTS A1 receptors is mediated mostly via circulating factors (e.g., vasopressin, angiotensin II, or circulating catecholamines released from other sympathetic terminals). These data strongly suggest that stimulation of NTS A1 receptors exerts counteracting effects on the iliac vascular bed: activation of the adrenal medulla and beta-adrenergic vasodilation versus vasoconstriction mediated by neural and humoral factors.     

Duration of the hemodynamic effects of N(G)-nitro-L-arginine methyl ester in vivo.

The objective of this study was to quantify the duration of the hemodynamic activity of N(G)-nitro-l-arginine methyl ester (l-NAME) in a variety of different tissues following a single bolus injection of this nitric oxide synthase inhibitor to healthy rats. l-NAME (15 micromol x kg(-1)) was injected (ip) into rats to produce maximal inhibition of endothelial cell NOS. Animals were subsequently anesthetized and blood flow was quantified using the radioactive microsphere/reference organ technique. At 1 h following a single bolus injection of l-NAME blood flow was reduced to the entire gastrointestinal tract, pancreas, and liver. Three hours following l-NAME administration, blood flow to the stomach and upper small intestine had returned to pretreatment levels; however, blood flow to the jejunum, ileal-jejunal junction, and colon remained significantly reduced. Splenic blood flow was significantly reduced and hepatic arterial blood flow was further reduced at this time as well. After 6 h following l-NAME administration, blood flow in all organs had completely recovered to control levels. Although cardiac index and total peripheral resistance had also returned to preinjection values at this time, mean arterial pressure remained elevated at 6 h posttreatment. Blood flow to the brain, lungs, and psoas muscle were unaffected by l-NAME administration at any time point. Taken together, these data demonstrate a differential regulation of vascular tone by NO in different vascular beds and, depending upon the organ system in question, the vasoactive activity of l-NAME may last from 3 to 6 h following a single bolus injection of this NOS inhibitor.     

Muscle flaps' triphasic microcirculatory response to sympathectomy and denervation.

Whether sympathectomy and somatic denervation in muscle flaps increased microcirculatory flow in the short or long term, thus producing an effect similar to the delay phenomenon, which increases survival in transferred skin flaps, was determined. The rat cremaster muscle flap model was used for in vivo microscopy. In the left cremasters of 30 Sprague-Dawley rats, the genitofemoral nerve was divided and the proximal vessels were stripped of their adventitia. The muscle was not elevated. In each rat, the contralateral cremaster served as the control. The rats were assigned to one of five groups: no delay before observation, a 24-hour delay, a 48-hour delay, a 7-day delay, or a 14-day delay. After the delay, red blood cell velocity, vessel diameters, number of functional capillaries, and leukocyte-endothelial interactions were measured. Microvessel response to topical vasoactive substances was measured. Immediately after denervation, red blood cell velocity increased transiently (71 percent; p = 0.006). Main arterioles dilated (20 percent; p = 0.02) at 24 hours, and capillary perfusion increased 36 percent (p = 0.001) at 2 weeks. The microvessels had hyperactive responses to all vasoactive agents 2 weeks after denervation. These findings indicate that proximal sympathectomy with somatic denervation leads to a triphasic, dynamic response in the peripheral microcirculation of the cremaster muscle flap. An initial acute hyperadrenergic phase was followed by a nonadrenergic phase, with significant vasodilatation, and a sensitized phase, with increased capillary perfusion and hyperresponsiveness to vasoactive substances. This study shows that with minimal access to the cremaster muscle flap neurovascular pedicle and without changing the blood supply to the flap, significant hemodynamic improvements can be made in the peripheral microcirculation.     

Effects of propranolol and metoprolol on the peripheral circulation.

The effects of single doses of propranolol and metoprolol on skin temperature and skin and muscle blood flow were compared in 10 normal subjects and four patients with essential hypertension. In normal subjects the mean skin temperature fell by 1.30 +/- 0.62 degrees C 90 minutes after 80 mg propranolol and 0.15 +/- 0.05 degrees C after 100 mg metoprolol. Skin blood flow and resting muscle blood flow were not affected by metoprolol but fell significantly after propranolol. Both drugs reduced post-exercise muscle hyperaemia, propranolol by more than metoprolol. Similar changes were seen in the hypertensive patients. Propranolol should be used with care in patients with known vascular disease.     

Control of the Splanchnic Circulation

The major regulatory factors in the mesenteric circulation include general hemodynamic forces, the autonomic nervous system, circulating vasoactive substances, tissue metabolites and intrinsic characteristics of vascular smooth muscle. During mesenteric ischemic states smooth muscle spasm elevates resistance to blood flow and aggravates intestinal tissue hypoxia leading to mucosal necrosis. Close intraarterial infusion of potent vasodilator drugs holds the promise of reversing intestinal ischemia and preserving viability of the gut.     

Improvement of the microcirculation in the acute ischemic rat limb during intravenous infusion of drag-reducing polymers

Drag-reducing polymers (DRPs) are blood-soluble macromolecules that can increase blood flow and reduce vascular resistance. The purpose of the present study is to examine the effects of DRPs on microcirculation in rat hind limb during acute femoral artery occlusion. Two groups of 20 male Wistar rats were subjected to either hemodynamic measurement or contrast enhanced ultrasound (CEU) imaging during peripheral ischemia. Both groups were further subdivided into a DRP-treated group or a saline-treated group. Polyethylene oxide (PEO) was chosen as the test DRP, and rats were injected with either 10 ppm PEO solution or saline through the caudal vein at a constant rate of 5 ml/h for 20 min. Abdominal aortic flow, iliac artery pressure, iliac vein pressure, heart rate, carotid artery pressure and central venous pressure (CVP) were monitored, and vascular resistance was calculated by (iliac artery pressure-iliac vein pressure)/abdominal aortic blood flow. Flow perfusion and capillary volume of skeletal muscle were measured by CEU. During PEO infusion, abdominal aortic blood flow increased (p<0.001) and vascular resistance decreased (p<0.001) compared to rats that received saline during peripheral ischemia. There was no significant change in ischemic skeletal capillary volume (A) with DRP treatment (p>0.05), but red blood cell velocity (β) and capillary blood flow (A×β) increased significantly (p<0.05) during PEO infusion. In addition, A, β and A×β all increased (p<0.05) in the contralateral hind limb muscle. In contrast, PEO had no significant influence on heart rate, mean carotid artery blood pressure or CVP. Intravenous infusion of drag reducing polymers may offer a novel hydrodynamic approach for improving microcirculation during acute peripheral ischemia.     

Foetal circulatory responses to arrest of uterine blood flow in sheep: effects of chemical sympathectomy.

Acute foetal asphyxia, caused by arrest of uterine blood flow, increases both sympathetic activity and peripheral vascular resistance and decreases blood flow to peripheral organs (Jensen et al., J. Dev. Physiol., 9, 543-559). The rapidity and uniformity of this peripheral vasoconstriction suggest that the sympatho-neuronal system may reflexly cause these initial blood flow changes during acute asphyxia. To test this hypothesis, we studied 5 intact and 6 chemically sympathectomized (6-hydroxy-dopamine, 46.1 +/- 6 mg/kg foetal weight) chronically prepared normoxaemic foetal sheep in utero at 0.9 of gestation. Organ blood flows (microsphere method), plasma concentrations of catecholamines, vasopressin, and angiotensin II, acid-base balance and blood gases were measured before, during and after arrest of uterine blood flow for 2 min, i.e., at 0, 1, 2, 3, 4 & 30 min. In intact foetuses there was a progressive increase in arterial blood pressure and a rapid circulatory centralization in favour of the brain stem and heart and at the expense of most of the peripheral organs. The changes in peripheral blood flow during and after asphyxia were well reflected by those in the skin and scalp. In chemically sympathectomized foetuses, arterial blood pressure fell transiently at 1 min of asphyxia and cardiac output was redistributed towards the carcass and intestinal organs at the expense of the heart, spinal medulla, and placenta. We conclude that in foetal sheep at 0.9 of gestation, the short-term adaptation to arrest of uterine blood flow is a rapid and profound peripheral vasoconstriction to effect an increase in arterial blood pressure. This initial response during circulatory centralization, which is necessary to increase or maintain blood flow to the heart, brain stem, and placenta, is blunted by sympathectomy. Thus, the foetal sympatho-neuronal system is important for short-term adaptation to and intact survival of asphyxia.     

The physiologic reserve in oxygen carrying capacity: studies in experimental hemodilution

The mechanisms by which the body attempts to avoid tissue hypoxia when total body oxygen delivery is compromised during acute anemia are reviewed. When the hematocrit is reduced by isovolemic hemodilution the compensatory adjustments include an increase in cardiac output, redistribution of blood flow to some tissues, and an increase in the whole body oxygen extraction ratio. These responses permit whole body oxygen uptake to be maintained until the hematocrit has been lowered to about 10%. Several factors are discussed which contribute to the increase in cardiac output during acute anemia including the reduction in blood viscosity, sympathetic innervation of the heart, and increased venomotor tone. The latter has been shown to be dependent on intact aortic chemoreceptors. With respect to peripheral vascular responses, the rise in coronary and cerebral blood flows which occur following hemodilution is proportionally greater than the increase in cardiac output while the opposite is true for kidney, liver, spleen, and intestine. Skeletal muscle does not contribute to a redistribution of blood flow to more vital areas during acute anemia despite its relatively large anaerobic capacity. Overall, peripheral compensatory adjustments result in an increased oxygen extraction ratio during acute anemia which reflects a better matching of the limited oxygen supply to tissue oxygen demands. However, some areas such as muscle are relatively overperfused which limits an even more efficient utilization of the reduced oxygen supply. Studies of the response of the microcirculation and the extent to which sympathetic vascular controls are involved in peripheral blood flow regulation are necessary to further appreciate the complex pattern of physiological responses which help ensure survival of the organism during acute anemia.     

Study of the association of adrenomedullin and basic-fibroblast growth factors with the peripheral arterial blood flow and endothelial dysfunction biomarkers in type 2 diabetic patients with peripheral vascular insufficiency

Background

Progressive micro-vascular vaso-degeneration is the major factor in progression of diabetic complications. Adrenomedullin (AM) and basic-Fibroblast growth factor (b-FGF) are strongly correlated with angiogenesis in vascular diseases. This study aims to provide base line data regarding the vascular effects and correlation of AM, and b-FGF with the peripheral blood flow in diabetic patients with peripheral vascular disease (PVD), and their effect on endothelial dysfunction markers. Ninety age- and sex matched females were enrolled in the study: 30 were controls, 30 had diabetes without complications (group II) and 30 had diabetes with PVD (group III) diagnosed by ankle/ brachial index (A/BI). Plasma levels of AM, b-FGF, intercellular adhesion molecule −1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were measured by indirect enzyme immunoassay (ELISA).

Results

There was a significant increase in plasma AM, VCAM-1and ICAM-1, while a significant decrease in plasma b-FGF in diabetic patients with PVD (p < 0.05). A positive correlation was observed between plasma AM, b-FGF and A/BI and a negative correlation with VCAM −1 and ICAM in diabetic PVD. AM was not a predictor, while b-FG, VCAM-1 and ICAM-1 could be predictors for peripheral blood flow in diabetic PVD.

Conclusion

This study elucidates for the first time that AM and b-FGF are correlated and have a direct impact on the peripheral blood flow, the rise of AM in diabetic PVD may be a consecutive and compensatory vasculo-protective effect as its angiogenic and anti-inflammatory properties act to relief the endothelial insult. Down expression of b-FGF may be a predisposing factor for micro-vascular derangement. It is not clear if the rise of AM and the decline of b- FGF levels may be consequences or predisposing factors for VCAM-1 and ICAM-1 elevation as these endothelial dysfunction biomarkers could reduce peripheral blood flow and vascular integrity. It is optimistic to believe that drug intervention through AM and b-FGF administration together with reversing the endothelial inflammatory process by targeting VCAM and ICAM could reduce the prevalence of diabetic vascular complications, reduce the risk of cerebrovascular and cardiovascular morbidity in diabetes through normalizing vascular endothelium function and peripheral blood flow.     

Dehydrogenated alkaloids of ergot in treatment of peripheral vascular diseases

The dihydrogenated alkaloids of ergot, dihydroergocornine (DHO 180) and an equal mixture of dihydroergocornine, dihydroergocristine and dihydroergokryptine known as CCK 179 have been found to be therapeutic adjuncts in the medical treatment of peripheral vascular diseases. Their action is primarily that of adrenergic blockage, although depression of the brain stem is to be considered. The mixture of alkaloids (CCK 179) was found to be more effective than a single alkaloid, dihydroergocornine (DHO 180). A greater number of patients were benefited, relief of symptoms was greater and the dosage easier to establish. A favorable therapeutic response of clinical significance with the mixture was obtained in approximately 60 per cent of all cases investigated. It was of greater benefit in the organic occlusive diseases, where a larger percentage of favorable responses was obtained than in the purely vasospastic disorders. Orally and subcutaneously, CCK 179 exhibited vasodilating properties which compared favorably with paravertebral and peripheral nerve block, reflex heat, alcohol and sympathectomy. Surface temperatures were elevated, oscillometric readings increased and tolerance to cold increased in a statistically significant number of cases. Effects of sympathectomies were frequently enhanced. Following subcutaneous administration, increased surface temperatures of the extremities of one to two hours' duration were obtained in 90 per cent of all cases.Paresthesias, nocturnal cramps and intermittent claudication were improved. A sense of well-being was occasionally exhibited. Blood pressure and pulse rates were rarely affected. Blood pressure was lowered in normotensive patients, but was rarely changed in hypertensive patients. Symptoms of overdosage appeared after two to three months of continuous therapy. These were manifested by lowered surface temperatures, decreased tolerance to cold, return of intermittent claudication and occasionally by vague general discomfort. These symptoms disappeared on cessation of therapy. Improvement frequently followed. In only one case was there an immediate reaction. Following subcutaneous administration of CCK, blood pressure and pulse rate increased and oscillometric readings and surface temperatures decreased. Frequent courses of therapy with interruptions were necessary for maintenance of improvement.     

Smooth muscle progenitor cells from peripheral blood promote the neovascularization of endothelial colony-forming cells

Proangiogenic cell therapy using autologous progenitors is a promising strategy for treating ischemic disease. Considering that neovascularization is a harmonized cellular process that involves both endothelial cells and vascular smooth muscle cells, peripheral blood-originating endothelial colony-forming cells (ECFCs) and smooth muscle progenitor cells (SMPCs), which are similar to mature endothelial cells and vascular smooth muscle cells, could be attractive cellular candidates to achieve therapeutic neovascularization. We successfully induced populations of two different vascular progenitor cells (ECFCs and SMPCs) from adult peripheral blood. Both progenitor cell types expressed endothelial-specific or smooth muscle-specific genes and markers, respectively. In a protein array focused on angiogenic cytokines, SMPCs demonstrated significantly higher expression of bFGF, EGF, TIMP2, ENA78, and TIMP1 compared to ECFCs. Conditioned medium from SMPCs and co-culture with SMPCs revealed that SMPCs promoted cell proliferation, migration, and the in vitro angiogenesis of ECFCs. Finally, co-transplantation of ECFCs and SMPCs induced robust in vivo neovascularization, as well as improved blood perfusion and tissue repair, in a mouse ischemic hindlimb model. Taken together, we have provided the first evidence of a cell therapy strategy for therapeutic neovascularization using two different types of autologous progenitors (ECFCs and SMPCs) derived from adult peripheral blood.     

DIHYDROGENATED ALKALOIDS OF ERGOT IN TREATMENT OF PERIPHERAL VASCULAR DISEASES

The dihydrogenated alkaloids of ergot, dihydroergocornine (DHO 180) and an equal mixture of dihydroergocornine, dihydroergocristine and dihydroergokryptine known as CCK 179 have been found to be therapeutic adjuncts in the medical treatment of peripheral vascular diseases. Their action is primarily that of adrenergic blockage, although depression of the brain stem is to be considered.The mixture of alkaloids (CCK 179) was found to be more effective than a single alkaloid, dihydroergocornine (DHO 180). A greater number of patients were benefited, relief of symptoms was greater and the dosage easier to establish. A favorable therapeutic response of clinical significance with the mixture was obtained in approximately 60 per cent of all cases investigated. It was of greater benefit in the organic occlusive diseases, where a larger percentage of favorable responses was obtained than in the purely vasospastic disorders.Orally and subcutaneously, CCK 179 exhibited vasodilating properties which compared favorably with paravertebral and peripheral nerve block, reflex heat, alcohol and sympathectomy. Surface temperatures were elevated, oscillometric readings increased and tolerance to cold increased in a statistically significant number of cases. Effects of sympathectomies were frequently enhanced. Following subcutaneous administration, increased surface temperatures of the extremities of one to two hours'' duration were obtained in 90 per cent of all cases.Paresthesias, nocturnal cramps and intermittent claudication were improved. A sense of well-being was occasionally exhibited.Blood pressure and pulse rates were rarely affected. Blood pressure was lowered in normotensive patients, but was rarely changed in hypertensive patients.Symptoms of overdosage appeared after two to three months of continuous therapy. These were manifested by lowered surface temperatures, decreased tolerance to cold, return of intermittent claudication and occasionally by vague general discomfort. These symptoms disappeared on cessation of therapy. Improvement frequently followed. In only one case was there an immediate reaction. Following subcutaneous administration of CCK, blood pressure and pulse rate increased and oscillometric readings and surface temperatures decreased.Frequent courses of therapy with interruptions were necessary for maintenance of improvement.