心肌缺血预处理与β-肾上腺素受体信号转导系统的研究进展

本文综述了心脏β-肾上腺素受体信号转导系统的生理功能及其各组成部分在心肌内缺血预处理中的作用,为心肌缺血预处理的保护机制提供科学依据。     

U50488H、哌唑嗪及心得安对去甲肾上腺素诱导心肌肥大的作用比较

目的：观测κ阿片受体激动对去甲肾上腺素诱导心肌肥大的抑制作用,并与哌唑嗪、心得安作用进行比较。方法：结晶紫染色法测心肌细胞增殖程度;Lowry法测心肌细胞蛋白含量;计算机图象分析系统测心肌细胞体积;[3H]-亮氨酸掺入法测心肌细胞蛋白合成。结果：①低血清环境下,NE明显诱导心肌细胞蛋白含量、蛋白合成及体积的增加,但对增殖无影响。②哌唑嗪和心得安单独作用部分抑制NE诱导的心肌肥大;联合作用则完全抑制。③U50488H明显抑制NE诱导的心肌肥大;其抑制程度与哌唑嗪和心得安联合作用类似,明显高于二者单独作用。结论：NE通过激动α1-和β-肾上腺受体途径诱导心肌肥大。κ阿片受体激动显著抑制NE诱导的心肌肥大,这可能与干预α1-AR和β-AR途径有关。     

mitoKATP通道参与心肌缺血预处理保护作用的机制

目的：探讨血管紧张素转换酶抑制剂（ACEI）和阈下缺血预处理联合预处理诱导的心肌保护作用中mi-toKatp通道激动后的作用机制：方法：采用离体大鼠心脏Langendorff灌流模型,观察心脏电脱耦联发生时间、细胞膜Na^＋／K^＋-ATPase和Ca^2＋/Mg^2＋-ATPase活性的改变：结果：单独使用卡托普利、或给予大鼠心脏2min缺血／10min复灌作为阈下缺血预处理,均不能改善长时间缺血／复灌引起的心脏收缩功能下降？而卡托普利和阂下缺血预处理联合使用可增高心脏收缩功能。mitoKatp通道特异性阻断剂5-HD可取消这一联合预处理的作用一联合预处理可引起缺血后电脱耦联发生时间延长,缺血心肌细胞膜Na^＋／K^＋-ATPase和Ca^2＋/Mg^2＋-ATPase活性增高;5-HD可取消此作用结论：mitoKatp通道参与了联合预处理延迟缺血引起的细胞间脱耦联和促进细胞膜离子通道稳定性维持的作用。     

雌激素的心脏保护作用——与β1-肾上腺素受体的相互作用及其信号通路

雌激素是女性体内主要的类固醇性激素。对于心肌缺血性伤害,切除卵巢的成年雌性大鼠在β-肾上腺素受体激动时,比正常雌性大鼠呈现更严重的心肌损伤：而去卵巢后的雌激素替补组大鼠对β-肾上腺素受体激动时心肌缺血性伤害的反应则又回复到正常雌性大鼠水平,这为雌激素对抗缺血性伤害的心脏保护作用提供了证据。雌激素的这种保护作用是通过下调β1-肾上腺素受体的表达来实现的。也有研究证明,雌激素能抑制蛋白激酶A（protein kinaseA,PKA）的表达和活性,PKA是Gs蛋白／腺苷酸环化酶（adenylyl cyclase,AC）／cAMP／PKA通路的第二信使,而该通路最终影响心肌的收缩功能。有初步证据表明雌激素还能抑制β1-肾上腺素受体通路下游的另一种第二信使钙调蛋白激酶Ⅱ．δc（Ca^2＋/calmodulin kinaseⅡ-δc,CaMKⅡ-δc）的活性,而CaMKII-δc参与PKA非依赖性的细胞凋亡。即时给予生理浓度雌激素可不通过雌激素受体而直接抑制心肌β1-肾上腺素受体并减弱Ca^2＋内流。此外,脑研究也显示雌激素能抑制负责调节动脉血压脑区的β1-肾上腺素受体活性。因此,雌激素和β1-肾上腺素受体之间的相互作用及其信号通路十分复杂。雌激素不仅主导性别决定,在机体其它功能例如心脏保护方面也具有重要作用。     

Toll受体-myd88通路与异氟烷预处理脑保护的研究新进展

研究表明,吸入麻醉药可作用于KATP通道、拮抗兴奋性氨基酸及抑制氧自由基生成等,从而诱导脑缺血耐受.但是,上述结果并未揭示与吸入麻醉药预处理脑保护效应相关的细胞内信号机制,目前,对Toll样受体(TLRs)家族的广泛研究揭示部分TLRs受体与全身重要器官的缺血再灌注损伤有关,本文就以异氨烷为代表的吸入麻醉药预处理与脑保护的研究进展及参与脑缺血再灌注损伤的TLRs受体信号通路综述如下.     

U50,488H对缺血期间心肌电耦联的影响及其机制研究

目的:研究κ-阿片受体特异性激动剂U50,488H对心肌缺血后电耦联特性的影响,并探讨其作用的可能机制。方法:采用雄性SD大鼠心脏Langendorff离体灌流模型和四电极法,观察U50,488H对全心停灌缺血期间心肌整体阻抗和电脱耦联参数(电脱耦联时间、平台时间、电脱耦联最大速率和阻抗倍数)的影响。采用免疫组化染色法检测U50,488H对左心室心肌细胞缝隙连接结构蛋白Cx43的影响,并同时观察U50,488H特异阻断剂nor-BNI(5×10-6mol/L)和PKC抑制剂chelerythrine(3×10-6mol/L)预处理对U50,488H作用的影响。结果:U50,488H可浓度依赖地延迟电脱耦联时间和平台时间,降低电脱耦联最大速率;nor-BNI或chelerythrine预处理均可明显减弱U50,488H对心肌缺血后电耦联特性的作用;与空白对照组比较,单纯缺血组心肌闰盘处Cx43蛋白显著减少,U50,488H处理可明显增加缺血心肌闰盘处Cx43蛋白含量;nor-BNI和chelerythrine预处理均可明显减弱U50,488H对心肌Cx43蛋白表达的作用。结论:κ-阿片受体激动剂U50,488H明显延迟缺血诱导的心肌电脱耦联,其作用涉及κ-阿片受体-PKC途径,其作用靶点可能为心肌细胞缝隙连接蛋白Cx43。     

κ-阿片受体激动对高糖诱导心肌肥大的影响

目的:研究κ-阿片受体(κ-OR)激动剂U50488H在高浓度葡萄糖(25.5mmol/L)诱导的心肌细胞肥大中的作用及可能的信号转导通路。方法:以原代培养的新生大鼠心肌细胞为模型,应用25.5mmol/L的高浓度葡萄糖诱导心肌肥大,用Lowry法检测心肌细胞蛋白含量;用消化分离法及计算机图像分析系统检测心肌细胞体积;用Western蛋白印迹法测定细胞外信号调节激酶(ERK)磷酸化水平。结果:25.5mmol/L的高浓度葡萄糖使心肌细胞蛋白含量和体积明显增加,1μmol/L的U50488H能抑制高糖诱导的心肌肥大,使ERK磷酸化水平降低,与10μmol/L的ERK抑制剂U0126对心肌肥大的抑制程度相近,统计结果没有显著性差异。结论:U50488H抑制高糖诱导的心肌肥大与ERK信号有关。     

阿片样物质与心脏缺血预处理

阿片肽和外源性阿片术物质如吗啡除了能缓解心肌梗塞造成的疼痛外,还具有减小梗塞范围和降低心律失常的发生等重要作用。心脏阿片受体参与了缺血预处理（IPC）对心脏的调节作用,阿片样物质激活心脏阿片受体还可模拟IPC对心脏的作用。心脏阿片受体的激活产生的急性即第一窗口期和延迟即第二窗口期的心脏保护作用的信号途径,与IPC相似,其信号通路涉及Gi/Go蛋白、蛋白激酶C、酪氨酸激酶和ATP敏感K^ 通道等途径。     

R-PIA保护心肌影响钾通道和一氧化氮的研究

就多种药物或措施改善心肌缺血/再灌注损伤的关键环节或信息通路进行了探讨.以大鼠心肌为材料,选取腺苷A1受体激动剂R-苯异丙基腺苷(R-PIA)为保护剂,分别或同时加入ATP敏感性钾通道阻滞剂格列苯脲、蛋白激酶C(PKC)抑制剂等,观察对氧自由基、一氧化氮、ATP酶和一氧化氮合酶基因等的影响,并与缺血预处理组比较,结果显示：R-PIA和缺血预处理后均有较好的保护作用,这些作用依赖钾通道的开放与蛋白激酶C(PKC)的激活;虽然钾通道的开放部分依赖PKC的激活,但ATP敏感性钾通道可能是居于下游的、比PKC更关键的因素.     

ATP敏感性钾通道、酪氨酸激酶和NF-κB参与高铁血红素诱导的大鼠心肌保护作用

通过诱导血红素氧化酶1(Hemeoxygenase1,HO1)可增强大鼠对抗心肌缺血复灌损伤。本文探讨线粒体ATP敏感性钾通道(MitochondrialATPsensitivepotassiumchannel,mitoKATP)、酪氨酸激酶(Proteintyrosinekinases,PTK)和核因子κB(NuclearfactorkappaB,NFκB)是否参与其中。SD大鼠腹腔注射HO1的诱导剂高铁血红素(hemin)50mg/kg,24h后取离体心脏给予30min缺血和120min复灌。结果发现,hemin可改善缺血-复灌(Ischemiareperfusion,IS)心脏的收缩功能,缩小心肌梗死面积;而HO1的抑制剂ZnPP可抑制hemin引起的HO1活性增加,并抵消hemin诱导的心肌保护作用。在腹腔注射hemin前给予mitoKATP通道阻断剂5HD(5mg/kg),与hemin IS组相比,心脏的收缩功能明显下降,心肌梗死面积增大,LDH和CK释放增加。而在hemin预处理后24h,30min缺血前给予5HD灌流(100μmol/L)同样可阻断hemin诱导的心肌保护作用。hemin诱导的心肌保护作用亦可被PTK抑制剂genistein(10μmol/L)或NFκB抑制剂PDTC(100μmol/L)所取消。结果提示:hemin可诱导心肌HO1增加,保护心肌缺血-复灌性损伤,其作用可能与PTK和NFκB的激活有关,而mitoKATP通道在hemin诱导的心肌保护作用中可能扮演了启动因子和终末效应器双重角色。     

Kappa- but not delta-opioid receptors mediate effects of ischemic preconditioning on both infarct and arrhythmia in rats

Two series of experiments were performed in the isolated perfused rat heart to determine the role of kappa- and delta-opioid receptors (OR) in cardioprotection of ischemic preconditioning (IP). In the first series of experiments, it was found that IP with two cycles of 5-min regional ischemia followed by 5-min reperfusion each reduced infarct size induced by 30-min ischemia, and the ameliorating effect of IP on infarct was attenuated with blockade of either 5 x 10(-6) mol/l nor-binaltorphimine (nor-BNI), a selective kappa-OR antagonist, or 5 x 10(-6) mol/l naltrindole (NTD), a selective delta-OR antagonist. The second series showed that U50,488H, a selective kappa-OR agonist, or D-Ala(2)-D-leu(5)-enkephalin (DADLE), a selective delta-OR agonist, dose dependently reduced the infarct size induced by ischemia, which mimicked the effects of IP. The effect of 10(-5) mol/l U50,488H on infarct was significantly attenuated by blockade of protein kinase C (PKC) with specific PKC inhibitors, 5 x 10(-6) mol/l chelerythrine or 8 x 10(-7) mol/l calphostin C, as well as by blockade of ATP-sensitive K(+) (K(ATP)) channels with blockers of the channel, 10(-5) mol/l glibenclamide or 10(-4) mol/l 5-hydroxydecanoate. IP also reduced arrhythmia induced by ischemia. Nor-BNI, but not NTD, attenuated, while U50,488H, but not DADLE, mimicked the antiarrhythmic action of IP. In conclusion, the present study has provided first evidence that kappa-OR mediates the ameliorating effects of IP on infarct and arrhythmia induced by ischemia, whereas delta-OR mediates the effects only on infarct. Both PKC and K(ATP) channels mediate the effect of activation of kappa-OR on infarct.     

Dual roles of mitochondrial K(ATP) channels in diazoxide-mediated protection in isolated rabbit hearts

Whether the mitochondrial ATP-dependent potassium (mK(ATP)) channel is the trigger or the mediator of cardioprotection is controversial. We investigated the critical time sequences of mK(ATP) channel opening for cardioprotection in isolated rabbit hearts. Pretreatment with diazoxide (100 microM), a selective mK(ATP) channel opener, for 5 min followed by 10 min washout before the 30-min ischemia and 2-h reperfusion significantly reduced infarct size (9 +/- 3 vs. 35 +/- 3% in control), indicating a role of mK(ATP) channels as a trigger of protection. The protection was blocked by coadministration of the L-type Ca(2+) channel blockers nifedipine (100 nM) or 5-hydroxydecanoic acid (5-HD; 50 microM) or by the protein kinase C (PKC) inhibitor chelerythrine (5 microM). The protection of diazoxide was not blocked by 50 microM 5-HD but was blocked by 200 microM 5-HD or 10 microM glybenclamide administrated 5 min before and throughout the 30 min of ischemia, indicating a role of mK(ATP) opening as a mediator of protection. Giving diazoxide throughout the 30 min of ischemia also protected the heart, and the protection was not blocked by chelerythrine. Nifedipine did not affect the ability of diazoxide to open mK(ATP) channels assessed by mitochondrial redox state. In electrically stimulated rabbit ventricular myocytes, diazoxide significantly increased Ca(2+) transient but had no effect on L-type Ca(2+) currents. Our results suggest that opening of mK(ATP) channels can trigger cardioprotection. The trigger phase may be induced by elevation of intracellular Ca(2+) and activation of PKC. During the lethal ischemia, mK(ATP) channel opening mediates the protection, independent of PKC, by yet unknown mechanisms.     

Ketamine abolishes ischemic preconditioning through inhibition of K(ATP) channels in rabbit hearts

Although ketamine inhibits ATP-sensitive K (K(ATP)) channels in rat ventricular myocytes and abolishes the cardioprotective effect of ischemic preconditioning in isolated rat hearts and in rabbits in in vivo, no studies to date specifically address the precise mechanism of this prevention of ischemic preconditioning by ketamine. This study investigated the mechanism of the blockade of ischemic preconditioning by ketamine in rabbit ventricular myocytes using patch-clamp techniques and in rabbit heart slices model for simulated ischemia and preconditioning. In cell-attached and inside-out patches, ketamine inhibited sarcolemmal K(ATP) channel activities in a concentration-dependent manner. Ketamine decreased the burst duration and increased the interburst duration without a change in the single-channel conductance. In the heart slice model of preconditioning, heart slices preconditioned with a single 5-min anoxia, pinacidil, or diazoxide, followed by 15-min reoxygenation, were protected against subsequent 30-min anoxia and 1-h reoxygenation, and the cardioprotection was blocked by the concomitant presence of ketamine. These data are consistent with the notion that inhibition of sarcolemmal or mitochondrial K(ATP) channels may contribute, at least in part, to the mechanism of the blockade of ischemic preconditioning by ketamine.     

Preconditioning limits mitochondrial Ca(2+) during ischemia in rat hearts: role of K(ATP) channels

Prolonged myocardial ischemia results in an increase in intracellular calcium concentration ([Ca(2+)]i), which is thought to play a critical role in ischemia-reperfusion injury. Ischemic preconditioning (PC) improves myocardial function during ischemia-reperfusion, a process that may involve opening mitochondrial ATP-sensitive potassium (K(ATP)) channels. Because pharmacological limitation of mitochondrial calcium concentration ([Ca(2+)]m) overload during ischemia-reperfusion has been shown to improve myocardial function, we hypothesized that PC would reduce [Ca(2+)]m during ischemia-reperfusion and that this effect was mediated by opening mitochondrial K(ATP) channels. Isolated rat hearts were subjected to 25 min of global ischemia and 30 min of reperfusion with or without PC in the presence of mitochondrial K(ATP) channel opening (diazoxide, 100 microM) and blockade [5-hydroxydecanoic acid (5-HD), 100 microM]. Contracture during ischemia (end-diastolic pressure) and functional recovery on reperfusion (developed pressure) were assessed. Total [Ca(2+)]i and [Ca(2+)]m were measured using indo 1 fluorescence. Both PC and diazoxide limited the increase in end-diastolic pressure and resulted in greater functional recovery after 30 min of reperfusion, functional effects that were partially or completely abolished by 5-HD. PC and diazoxide also significantly limited the increase in [Ca(2+)]m during ischemia-reperfusion. In addition, PC lowered [Ca(2+)]i during reperfusion, whereas diazoxide paradoxically resulted in increased [Ca(2+)]i during reperfusion. There was an inverse linear relationship between [Ca(2+)]m and developed pressure during reperfusion. PC limits the ischemia-induced increase in mitochondrial, but not total, [Ca(2+)]i, an effect mediated by opening mitochondrial K(ATP) channels. These data suggest that the lowering of mitochondrial calcium overload is a mechanism of cardioprotection in PC.     

H2S preconditioning-induced PKC activation regulates intracellular calcium handling in rat cardiomyocytes

The present study was aimed to investigate the regulatory effect of protein kinase C (PKC) on intracellular Ca(2+) handling in hydrogen sulfide (H(2)S)-preconditioned cardiomyocytes and its consequent effects on ischemia challenge. Immunoblot analysis was used to assess PKC isoform translocation in the rat cardiomyocytes 20 h after NaHS (an H(2)S donor, 10(-4) M) preconditioning (SP, 30 min). Intracellular Ca(2+) was measured with a spectrofluorometric method using fura-2 ratio as an indicator. Cell length was compared before and after ischemia-reperfusion insults to indicate the extent of hypercontracture. SP motivated translocation of PKCalpha, PKCepsilon, and PKCdelta to membrane fraction but only translocation of PKCepsilon and PKCdelta was abolished by an ATP-sensitive potassium channel blocker glibenclamide. It was also found that SP significantly accelerated the decay of both electrically and caffeine-induced intracellular [Ca(2+)] transients, which were reversed by a selective PKC inhibitor chelerythrine. These data suggest that SP facilitated Ca(2+) removal via both accelerating uptake of Ca(2+) into sarcoplasmic reticulum and enhancing Ca(2+) extrusion through Na(+)/Ca(2+) exchanger in a PKC-dependent manner. Furthermore, blockade of PKC also attenuated the protective effects of SP against Ca(2+) overload during ischemia and against myocyte hypercontracture at the onset of reperfusion. We demonstrate for the first time that SP activates PKCalpha, PKCepsilon, and PKCdelta in cardiomyocytes via different signaling mechanisms. Such PKC activation, in turn, protects the heart against ischemia-reperfusion insults at least partly by ameliorating intracellular Ca(2+) handling.     

Cardioprotection with kappa-opioid receptor stimulation is associated with a slowing of cross-bridge cycling

Opioid and alpha-adrenergic receptor activation protect the heart from ischemic damage. One possible intracellular mechanism to explain this is that an improvement in ATP availability contributes to cardioprotection. We tested this hypothesis by correlating postischemic left ventricular developed pressure (LVDP) and myofibrillar Ca(2+)-dependent actomyosin Mg(2+)-ATPase from isolated rat hearts treated with the kappa-opioid receptor agonist U-50488H (1 microM) or the alpha-adrenergic receptor agonist phenylephrine (10 microM) + propranolol (3 microM). Preischemic treatment with U-50488H or phenylephrine + propranolol improved postischemic LVDP recovery by 25-30% over control hearts. Ca(2+)-dependent actomyosin Mg(2+)-ATPase was found to be 20% lower in both U-50488H- and phenylephrine + propranolol-treated hearts compared with control hearts. The kappa-opioid receptor antagonist nor-binaltorphimine (1 microM) abolished the effects of U-50488H on postischemic LVDP and actomyosin Mg(2+)-ATPase activity. Reduced actomyosin ATP utilization was also suggested in single ventricular myocytes treated with either U-50488H or the protein kinase C activator, phorbol 12-myristate 13-acetate (PMA), because U-50488H and PMA lowered maximum velocity of unloaded shortening by 15-25% in myocytes. U-50488H and phenylephrine + propranolol treatment both resulted in increased phosphorylation of troponin I and C protein. These findings are consistent with the hypothesis that kappa-opioid and alpha-adrenergic receptors decrease actin-myosin cycling rate, leading to a conservation of ATP and cardioprotection during ischemia.     

Mitochondrial Ca2+-activated K+ channels more efficiently reduce mitochondrial Ca2+ overload in rat ventricular myocytes

We investigated the role of the mitochondrial ATP-sensitive K(+) (K(ATP)) channel, the mitochondrial big-conductance Ca(2+)-activated K(+) (BK(Ca)) channel, and the mitochondrial permeability transition pore (MPTP) in the ouabain-induced increase of mitochondrial Ca(2+) in native rat ventricular myocytes by loading cells with rhod 2-AM. To overload mitochondrial Ca(2+), we pretreated cells with ouabain before applying mitochondrial K(ATP) or BK(Ca) channel and/or MPTP opener. Ouabain (1 mM) increased the rhod 2-sensitive fluorescence intensity (160 +/- 5.0% of control), which was dramatically decreased to the control level on application of diazoxide and NS-1619 in a dose-dependent manner (half-inhibition concentrations of 78.3 and 7.78 muM for diazoxide and NS-1619, respectively). This effect was reversed by selective inhibition of the mitochondrial K(ATP) channel by 5-hydroxydecanoate, the mitochondrial BK(Ca) channel by paxilline, and the MPTP by cyclosporin A. Although diazoxide did not efficiently reduce mitochondrial Ca(2+) during prolonged exposure to ouabain, NS-1619 reduced mitochondrial Ca(2+). These results suggest that although mitochondrial BK(Ca) and K(ATP) channels contribute to reduction of ouabain-induced mitochondrial Ca(2+) overload, activation of the mitochondrial BK(Ca) channel more efficiently reduces ouabain-induced mitochondrial Ca(2+) overload in our experimental model.     

Preconditioning blocks cardiocyte apoptosis: role of K(ATP) channels and PKC-epsilon

The aims of this study were to determine whether preconditioning blocks cardiocyte apoptosis and to determine the role of mitochondrial ATP-sensitive K(+) (K(ATP)) channels and the protein kinase C epsilon-isoform (PKC-epsilon) in this effect. Ventricular myocytes from 10-day-old chick embryos were used. In the control series, 10 h of simulated ischemia followed by 12 h of reoxygenation resulted in 42 +/- 3% apoptosis (n = 8). These results were consistent with DNA laddering and TdT-mediated dUTP nick-end labeling (TUNEL) assay. Preconditioning, elicited with three cycles of 1 min of ischemia separated by 5 min of reoxygenation before subjection to prolonged simulated ischemia, markedly attenuated the apoptotic process (28 +/- 4%, n = 8). The selective mitochondrial K(ATP) channel opener diazoxide (400 micromol/l), given before ischemia, mimicked preconditioning effects to prevent apoptosis (22 +/- 4%, n = 6). Pretreatment with 5-hydroxydecanoate (100 micromol/l), a selective mitochondrial K(ATP) channel blocker, abolished preconditioning (42 +/- 2%, n = 6). In addition, the effects of preconditioning and diazoxide were blocked with the specific PKC inhibitors G?-6976 (0.1 micromol/l) or chelerythrine (4 micromol/l), given at simulated ischemia and reoxygenation. Furthermore, preconditioning and diazoxide selectively activated PKC-epsilon in the particulate fraction before simulated ischemia without effect on the total fraction, cytosolic fraction, and PKC delta-isoform. The specific PKC activator phorbol 12-myristate 13-acetate (0.2 micromol/l), added during simulated ischemia and reoxygenation, mimicked preconditioning to block apoptosis. Opening mitochondrial K(ATP) channels blocks cardiocyte apoptosis via activating PKC-epsilon in cultured ventricular myocytes. Through this signal transduction, preconditioning blocks apoptosis and preserves cardiac function in ischemia-reperfusion.     

Modulation of sympathetic actions on the heart by opioid receptor stimulation

The sympathetic nervous system, the most important extrinsic regulatory mechanism of the heart, is inhibited postsynaptically and presynaptically by opioid peptides produced in the heart via their respective receptors. The cardiac actions of beta-adrenergic receptor (beta-AR) stimulation are attenuated by activation of the opioid receptor (OR) with OR agonist at ineffective concentrations, implying cross-talk between the OR and beta-AR. This cross-talk results from inhibition of the Gs protein and adenylyl cyclase of the beta-AR pathway by the pertussis toxin-sensitive G protein of the opioid pathway. Alterations in cross-talk between these two receptors occur in pathological situations to meet bodily needs. In myocardial ischemia, when the sympathetic activity is increased, the inhibition of beta-AR stimulation by kappa-opioid stimulation is also enhanced, thus reducing the workload, oxygen consumption and cardiac injury. Whereas cardiac responsiveness to sympathetic discharges is also reduced after chronic hypoxia, the cross-talk between kappa-OR and beta-AR is reduced to prevent undue suppression of the sympathetic influence on the heart. On the other hand, impairment of the cross-talk may result in abnormality. A lack or a significant reduction in the inhibition of beta-AR stimulation by kappa-OR stimulation may lead to an excessive increase in cardiac activities, which contribute to the maintenance of high arterial blood pressure in spontaneously hypertensive rats. Other than opioid peptides, female sex hormone and adenosine also inhibit the sympathetic actions on the heart. In addition, sympathetic action is also inhibited presynaptically by kappa-opioid peptides via their receptor.