Cyclooxygenase inhibition attenuates peripheral venous distension reflex in healthy humans

Abstract

Background: Venous distension in limbs evokes a pressor reflex (venous distension reflex, VDR). Group III and IV nerves, innervating peripheral veins, are suggested as the afferent arm of the VDR. Prostaglandins stimulate/sensitize group III/IV nerves. The purpose of this study was to evaluate the effect of cyclooxygenase (COX) blockade on muscle sympathetic nerve activity (MSNA) and blood pressure (BP) responses to venous distension. Hypothesis: We hypothesized that inhibition of prostaglandin synthesis by local COX blockade would attenuate the MSNA and BP responses to peripheral venous distension. Methods: Nineteen healthy volunteers (age, 27 ± 5 years) participated in the study with a randomized, double-blind, placebo-controlled, and crossover study design with two separate visits. To induce venous distension, a volume of solution (saline alone or 9 mg ketorolac tromethamine in saline) was infused into the vein in the antecubital fossa of an arterially occluded forearm. During the procedure, beat-by-beat heart rate (HR), BP, and MSNA were recorded simultaneously. The vein size at the site with the catheter for the infusion was measured with ultrasound. This study is associated with a registered clinical trial (NCT03513770). Data and a summary of the results: In both visits, the venous distension procedure significantly increased the vein size, and the increase in vein size was not different between the visits (P > 0.05). A significant decrease (P < 0.001) in TXB2 level (an index for prostaglandin synthesis) by the procedure was observed only in the ketorolac visit. In both visits, the venous distension procedure significantly increased BP, HR, and MSNA (all, P < 0.05). The increase in mean arterial pressure (MAP) and MSNA in the ketorolac visit was significantly lower than in the control visit (ΔMAP, 7.0 ± 6.2 vs. 13.8 ± 7.7 mmHg; ΔMSNA, 6.0 ± 7.1 vs. 14.8 ± 7.7 bursts/minute; both, P < 0.05). Discussion and conclusion: The presented data show that COX blockade attenuates the responses in MSNA and BP to peripheral venous distension. The results suggest that COX products play a key role in evoking afferent activation responsible for the VDR. Vein size was measured with ultrasonography only at the catheter site. Some members of COX products have vasoactive effects. Future studies evaluating the effect of COX blockade on vein size in more detail using other approaches (e.g., magnetic resonance imaging) are warranted to verify the detailed mechanism of the attenuated VDR by the COX blockade. This study was supported by National Institutes of Health Grants R01 HL144781 (to J.C. and L.I.S). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.