RESUMO
BACKGROUND: In patients with ischemia and no obstructive coronary artery disease (INOCA), coronary microvascular dysfunction is associated with higher rate of major adverse cardiovascular events. OBJECTIVE: To demonstrate if microvascular dysfunction present in coronary microcirculation of patients with INOCA may be detected noninvasively in their peripheral circulation. METHODS: 25 patients with INOCA and 25 apparently healthy individuals (controls) were subjected to nailfold videocapillaroscopy (NVC) and venous occlusion plethysmography (VOP) to evaluate peripheral microvascular function and blood collection for biomarkers analysis, including soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1) and C-reactive protein (CRP). RESULTS: Red blood cell velocity (RBCV) before and after ischemia (RBCVmax) were significantly lower in patients with INOCA (pâ=â0.0001). Time to reach maximal red blood cell velocity (TRBCVmax) was significantly longer in INOCA group (pâ=â0.0004). Concerning VOP, maximal blood flow (pâ=â0.004) and its relative increment were significantly lower in patients with INOCA (pâ=â0.0004). RBCVmax showed significant correlations with sVCAM-1 (râ=â-0.38, pâ<â0.05), ET-1 (râ=â-0.73, pâ<â0.05) and CRP (râ=â-0.33, pâ<â0.05). Relative increment of maximal post-ischemic blood flow was significantly correlated with sVCAM-1 (râ=â-0.42, pâ<â0.05) and ET-1 (râ=â-0.48, pâ<â0.05). CONCLUSIONS: The impairment of microvascular function present in coronary microcirculation of patients with INOCA can be also detected in peripheral microcirculation.
Assuntos
Doença da Artéria Coronariana , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária , Vasos Coronários , Hemodinâmica , Humanos , Isquemia , Microcirculação , Angioscopia MicroscópicaRESUMO
This study compared macro- and microvascular endothelial function and redox status in active vs inactive HIV-infected patients (HIVP) under antiretroviral therapy. Using a cross-sectional design, macro- and microvascular reactivity, systemic microvascular density, and oxidative stress were compared between 19 HIVP (53.1 ± 6.1 year) enrolled in a multimodal training program (aerobic, strength and flexibility exercises) for at least 12 months (60-minutes sessions performed 3 times/wk with moderate intensity) vs 25 sedentary HIVP (51.2 ± 6.3 year). Forearm blood flow during reactive hyperemia (521.7 ± 241.9 vs 361.4% ± 125.0%; P = 0.04) and systemic microvascular density (120.8 ± 21.1 vs 105.6 ± 25.0 capillaries/mm2 ; P = 0.03) was greater in active than inactive patients. No significant difference between groups was detected for endothelium-dependent and independent skin microvascular vasodilation (P > 0.05). As for redox status, carbonyl groups (P = 0.22), lipid peroxidation (P = 0.86), catalase activity (P = 0.99), and nitric oxide levels (P = 0.72) were similar across groups. However, superoxide dismutase activity was greater in active vs inactive HIVP (0.118 ± 0.013 vs 0.111 ± 0.007 U/mL; P = 0.05). Immune function reflected by total T CD4 and T CD8 counts (cell/mm3 ) did not differ between active and inactive groups (P > 0.82). In conclusion, physically active HIVP exhibited similar immune function, but greater macrovascular reactivity, systemic microvascular density, and superoxide dismutase activity than inactive patients of similar age.
Assuntos
Exercício Físico/fisiologia , Infecções por HIV/fisiopatologia , Microvasos/fisiologia , Comportamento Sedentário , Superóxido Dismutase/fisiologia , Composição Corporal , Estudos Transversais , Feminino , Antebraço/irrigação sanguínea , Humanos , Hiperemia/fisiopatologia , Peroxidação de Lipídeos , Masculino , Microcirculação , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Estresse Oxidativo , PletismografiaRESUMO
Technological advances during the last years have enhanced the image quality of the microcirculation. Intravital microscopy (IM) has been considered the "gold standard" for many years, but it can be used mostly in anesthetized animals which is a disadvantage. The nailfold videocapillaroscopy, a non-invasive examination that includes a microscope with an epiillumination system, came afterward, but its major disadvantage is the restricted area available for investigation namely the nailfold capillary bed. The orthogonal polarization spectral (OPS) imaging technique, where reflected light allows the visualization of the microcirculation, was the next non-invasive exam, but it still presents some drawbacks such as suboptimal capillary visualization and image blurring due to red blood cell movements. Excessive probe pressure modifies red blood cell velocity. There is suboptimal imaging of capillaries due to motion-induced image blurring by movements of OPS device, tissue and/or flowing red blood cells. Sidestream dark field (SDF) imaging is the newest tool for microcirculatory research. Illumination is provided by concentrically placed light-emitting diodes to avoid image blurring and to enhance image contrast. It represents a simple and non-invasive imaging technique, with low cost, good portability and high sensitivity that provides fine, well-defined images. In addition, the microcirculation can be studied through laser Doppler flowmetry (LDF) or reflectance-mode confocal-laser-scanning microscopy (RCLM). However, LDF cannot show microcirculatory vessels and high cost of RCLM can be an inconvenience. New applications of SDF technique could include skin microcirculatory evaluation and allow dermatological studies on psoriasis, skin tumors and leprosy.
Assuntos
Dermatologia/métodos , Diagnóstico por Imagem/métodos , Microcirculação , Pele/irrigação sanguínea , Animais , Capilares , Dermatologia/instrumentação , Humanos , Fluxometria por Laser-Doppler/métodos , Microscopia Confocal , Microscopia de VídeoRESUMO
Previous experiments in our laboratory, using the hamster cheek pouch microcirculation, have shown that precapillary vessels exhibit spontaneous rhythmic luminal variations, termed vasomotion, a myogenic activity sustained by a balance between membrane currents among which polarizing K(+) currents play an important role. In these microvessels, endothelium-derived relaxing factors (EDRFs) seem to regulate arteriolar diameter [via nitric oxide (NO) and cyclic GMP] and vasomotion [probably via endothelium-derived hyperpolarizing factor (EDHF)]. Fish or fish oil diet can decrease the risk of cardiovascular diseases, probably by modifying the conductance of selective ion channels, such as K(+) and/or Ca(++), and/or increasing the production of vasodilators, such as NO. To investigate its effect on microvascular reactivity, using the same preparation and an intravital microscope coupled to a closed circuit TV system, male hamsters were treated for 14 days, twice a day, with 0.4 mL/100 g body weight with fish or olive oil. An attempt was also undertaken to record in arterioles, in vivo, the membrane potential of smooth muscle cells during their vasomotor activity combining conventional microelectrode and intravital microscopy techniques. The effects of topical application of two vasodilators, acetylcholine [endothelium-dependent one, NO release and membrane hyperpolarization via Ca(++)-activated K(+) channels (K(Ca))] and sodium nitroprusside (endothelium-independent, NO donor and no change on membrane potential) and two vasoconstrictors which elicited membrane depolarization via Ca(++) channels, phenylephrine (alpha(1)-adrenergic receptor agonist) and serotonin (5-hydroxi-tryptamine) on mean internal diameter of arterioles and venules, arteriolar blood flows, spontaneous arteriolar vasomotion frequency and amplitude and functional capillary density (FCD, number of capillaries with flowing red blood cells per unit area of tissue) were determined. Anesthesia was induced by sodium pentobarbital (i.p.) and maintained with alpha-chloralose through the femoral vein. In the presence of vasomotion, the membrane potentials are slowly oscillating by about 20 mV around values of approximately -50 mV in perfect synchrony with vasomotor movements and depolarizing phases coincide with vasoconstrictions while polarizing ones with vasodilatations. Comparing all parameters, in control conditions, only the spontaneous vasomotion frequency was significantly higher (2.37 times higher) on the group treated with fish oil and persisted as such throughout all experiments. With topical application of the drugs mentioned above, the group treated with fish oil showed, for each drug concentration, a balance towards vasodilatation with consequent increase on arteriolar blood flow and on FCD, compared with the olive oil treated one. No significant changes on mean arterial pressure, spontaneous arteriolar vasomotion amplitude or venular diameter could be detected in the two groups. Our results support the concept that, in the hamster cheek pouch microcirculation, fish oil supplementation activates K(+) channels which act as the EDHF and might also increase the production of vasodilators, probably NO.
Assuntos
Bochecha/irrigação sanguínea , Óleos de Peixe/farmacologia , Óleos de Plantas/farmacologia , Vasoconstrição/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Acetilcolina/farmacologia , Animais , Arteríolas/efeitos dos fármacos , Arteríolas/metabolismo , Fatores Biológicos/metabolismo , Cricetinae , Relação Dose-Resposta a Droga , Masculino , Potenciais da Membrana/efeitos dos fármacos , Microcirculação/efeitos dos fármacos , Microcirculação/metabolismo , Microeletrodos , Microscopia de Vídeo , Óxido Nítrico/metabolismo , Nitroprussiato/farmacologia , Azeite de Oliva , Fenilefrina/farmacologia , Canais de Potássio/agonistas , Canais de Potássio/metabolismo , Serotonina/farmacologia , Vasoconstritores/farmacologia , Vasodilatadores/farmacologia , Vênulas/efeitos dos fármacos , Vênulas/metabolismoRESUMO
1. The present study was designed to evaluate the effect of micronization on the protective effect of the purified flavonoid fraction (MPFF) on increases in macromolecular permeability induced by ischaemia-reperfusion in the hamster cheek pouch microcirculation. 2. Male hamsters (Mesocricetus auratus) were treated orally, twice a day, with vehicle (lactose), MPFF and non-micronized purified flavonoid fraction (PFF) at 5, 20, 80 and 320 mg/kg per day for 10 consecutive days. On the 11th day, cheek pouches of anaesthetized animals were prepared for intravital microscopy. 3. Local ischaemia was obtained by clamping the neck of the everted pouch and the increase in microvascular permeability was quantified as leakage (leaks) of intravenously injected fluorescein isothiocyanate-labelled dextran (FITC-dextran 150; MW = 150 000). 4. Reperfusion, after 30 min ischaemia, resulted in an immediate but reversible increase in post-capillary leakage. The MPFF induced a significant dose-related reduction in the increased permeability, with 83.4% inhibition compared with control at 320 mg/kg per day (19.2 +/- 1.9 vs 115.7 +/- 4.1 leaks/cm2; P < 0.0001). Non-micronized PFF was significantly less effective: only 47.9% inhibition compared with control was observed at 320 mg/kg per day (60.3 +/- 1.0 vs 115.7 +/- 4.1 leaks/cm2; P < 0.0001) and there was no dose-effect relationship. 5. In conclusion, micronization significantly enhances the protective effects of the purified flavonoid fraction on reperfusion injury in the hamster cheek pouch. This improvement is likely to be related to the better absorption of the micronized formulation, which could explain the superior clinical efficacy shown in previous studies.
Assuntos
Bochecha/irrigação sanguínea , Diosmina/farmacologia , Hesperidina/farmacologia , Substâncias Protetoras/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Administração Oral , Animais , Permeabilidade Capilar/efeitos dos fármacos , Cricetinae , Diosmina/administração & dosagem , Combinação de Medicamentos , Hesperidina/administração & dosagem , Isquemia/complicações , Isquemia/fisiopatologia , Masculino , Mesocricetus , Microcirculação/efeitos dos fármacos , Tamanho da Partícula , Substâncias Protetoras/administração & dosagem , Fluxo Sanguíneo Regional/efeitos dos fármacos , ReperfusãoRESUMO
INTRODUCTION: Sulfonylureas are widely prescribed for the treatment of type 2 diabetes. Their therapeutic efficacy resides in the ability to bind to sulfonylurea receptors (SURs) present on the beta-cell plasma membrane, to close the ATP-regulated potassium (K(ATP)) channel, and thereby to enhance glucose-stimulated insulin secretion. These receptors are also found in a wide variety of extra-pancreatic tissues such as brain, peripheral nerves, heart, and vascular smooth muscle where they contribute to the regulation of the vascular tone. OBJECTIVE: The objective of the present study was to determine the potency of three sulfonylureas, glibenclamide, gliclazide, and glimepiride, in antagonizing the vasorelaxant action of diazoxide, an ATP-regulated K(+) channel (K(ATP)) opener, in vivo, using the hamster cheek pouch preparation and evaluating the changes in mean internal diameter and blood flow of arterioles and venules. MATERIAL AND METHODS: Cheek pouches of anesthetized male hamsters superfused with a HEPES-supported HCO(3)(-)-buffered saline solution were placed under an intravital microscope coupled to a closed-circuit TV system. All substances were applied topically. MEASUREMENTS: Mean arteriolar and venular internal diameters using an image shearing device, red blood cell (RBC) velocity by the dual-slit photometric technique and microvessel volume flow was calculated from diameters and RBC velocities. RESULTS: The numbers are given in order, first diameter and then flow, always for the highest concentration of diazoxide tested, by itself or in combination with a given sulfonylurea: (1) diazoxide, used in doses of 0.01, 1, and 100 microM, elicited a dose-dependent dilation and flow increase in arterioles [increase of 52.1% (P<.01) and 41.2% (P<.01)] and venules [37.9% (P<.05) and 57.6% (P<.01)]; (2) glibenclamide (0.81 microM)+diazoxide 29.3% (P=.172) and 25.0% (P=.064) for arterioles and 8% (P=.654) and 3.7% (P=.769) for venules; (3) gliclazide (12 microM)+diazoxide 51.0% (P<.01) and 46.7% (P<.01) for arterioles and 59.0% (P<.01) and 45.2% (P<.01) for venules; (4) glimepiride (0.82 microM)+diazoxide 22.8% (P=.228) and 12.5% (P=.305) for arterioles and 15.6% (P=.415) and 16.0% (P=.291) for venules. CONCLUSION: These results suggest that, in contrast to glibenclamide and glimepiride, therapeutic concentrations of gliclazide produce no cross-reactivity with smooth muscle cell K(ATP) channels in the microvessels of the hamster cheek pouch. Previous studies have confirmed these results in isolated aortic rings of rats and guinea pigs.