Wackenfors Angelica, Ingemansson Richard, Malmsjö Malin
Department of Internal Medicine, Lund University Hospital, Lund, Sweden.
Ann Thorac Surg. 2003 Mar;75(3):874-81. doi: 10.1016/s0003-4975(02)04637-4.
Coronary artery bypass graft (CABG) surgery is hampered by deleterious vasospasm in the vessel wall, especially in vein grafts. Endothelin (ET) is a strong vasoconstrictor that can be observed in increasing concentrations during CABG surgery.
Endothelin-induced vasoconstriction was evaluated in isolated, endothelium-denuded vessel segments of the human saphenous vein (SV), left internal mammary artery (LIMA), and coronary arteries. The ET(A) and ET(B) receptor mRNA levels were quantified by real-time polymerase chain reaction (PCR) analysis.
The ET(A) and ET(B) receptor mRNA levels were significantly higher in the SV than in the LIMA and the coronary arteries. ET-1 induced a more efficacious contraction in the SV and LIMA as compared with in the coronary arteries. The ET(B) receptor agonist, Sarafotoxin 6c (S6c) stimulated constriction of the LIMA and SV, while inactive in the coronary arteries. The concentration-response curve for S6c was biphasic, suggesting activation of ET(A) receptors at high concentrations as this response could be inhibited by FR139317 (10 micromol/L), and ET(B) at low concentrations as this response could be inhibited by BQ788 (0.1 micromol/L).
Endothelin-induced vasoconstriction is mediated by ET(A) receptors alone in coronary arteries, while a combination of ET(A) and ET(B) receptors are of importance in SV and LIMA. Expression of contractile ET(B) receptors may be a pharmacologic disadvantage that contributes to the vasospasm during CABG surgery. The lower levels of ET(A) and ET(B) receptor mRNA in the LIMA and coronary arteries as compared with in the SV may provide one explanation for the better long- and short-term patency of LIMA as compared with SV grafts.
冠状动脉旁路移植术(CABG)手术受到血管壁有害血管痉挛的阻碍,尤其是在静脉移植物中。内皮素(ET)是一种强烈的血管收缩剂,在CABG手术期间其浓度会不断升高。
在人隐静脉(SV)、左乳内动脉(LIMA)和冠状动脉的离体、内皮剥脱血管段中评估内皮素诱导的血管收缩。通过实时聚合酶链反应(PCR)分析对ET(A)和ET(B)受体mRNA水平进行定量。
SV中ET(A)和ET(B)受体mRNA水平显著高于LIMA和冠状动脉。与冠状动脉相比,ET-1在SV和LIMA中诱导的收缩更有效。ET(B)受体激动剂,蛙皮素6c(S6c)刺激LIMA和SV收缩,而在冠状动脉中无活性。S6c的浓度-反应曲线是双相的,表明在高浓度时激活ET(A)受体,因为这种反应可被FR139317(10微摩尔/升)抑制,而在低浓度时激活ET(B)受体,因为这种反应可被BQ788(0.1微摩尔/升)抑制。
在冠状动脉中,内皮素诱导的血管收缩仅由ET(A)受体介导,而在SV和LIMA中,ET(A)和ET(B)受体共同发挥作用。收缩性ET(B)受体的表达可能是一种药理学上的不利因素,导致CABG手术期间的血管痉挛。与SV相比,LIMA和冠状动脉中ET(A)和ET(B)受体mRNA水平较低,这可能是LIMA与SV移植物相比具有更好的长期和短期通畅率的一个原因。