Human Forearm Blood Flow Research Articles

Hyperbaric oxygenation reduces exercising forearm blood flow in humans

Hypoxia during exercise augments vasodilation and blood flow to ensure adequate delivery of O2 to active muscles. However, the impact of hyperoxia on skeletal muscle blood flow during exercise is poorly understood. Therefore, we tested the hypothesis that the hyperemic response to exercise with hyperbaric hyperoxia would be blunted compared to exercise during normoxia. Seven subjects (6M/1F; 26 ± 2 years) performed forearm exercise (20% of maximum) under normoxic and hyperoxic conditions. Forearm blood flow (FBF; ml/min) was measured using Doppler ultrasound. Forearm vascular conductance (FVC; ml/min/100mmHg) was calculated from FBF and blood pressure (mmHg; brachial arterial catheter). Studies were performed in a hyperbaric chamber with the subjects supine at 1 ATA (sea level) and 2.8 ATA while breathing normoxic (21% O2, 1 ATA; FIO2 ≈ 150 mmHg), hyperbaric normoxic (7% O2, 2.8 ATA, FIO2 ≈ 150 mmHg) and hyperoxic (7% O2, 2.8 ATA, FIO2 ≈ 2100 mmHg) gas. The change in FBF and FVC (Δ from rest) during exercise under normoxia and hyperbaric normoxia did not differ (P > 0.05). However, the ΔFBF and ΔFVC during exercise under hyperoxia were attenuated by ~18–29% compared to both normoxic conditions (P ≤ 0.01). Our data suggest that exercise hyperemia in skeletal muscle is highly dependent on oxygen availability during hyperoxia as well as hypoxia.NIH HL46493 (MJJ), AR55819 (DPC) and RR‐024150.

Hyperbaric hyperoxia reduces exercising forearm blood flow in humans

Hypoxia during exercise augments blood flow in active muscles to maintain the delivery of O(2) at normoxic levels. However, the impact of hyperoxia on skeletal muscle blood flow during exercise is not completely understood. Therefore, we tested the hypothesis that the hyperemic response to forearm exercise during hyperbaric hyperoxia would be blunted compared with exercise during normoxia. Seven subjects (6 men/1 woman; 25 ± 1 yr) performed forearm exercise (20% of maximum) under normoxic and hyperoxic conditions. Forearm blood flow (FBF; in ml/min) was measured using Doppler ultrasound. Forearm vascular conductance (FVC; in ml·min(-1)·100 mmHg(-1)) was calculated from FBF and blood pressure (in mmHg; brachial arterial catheter). Studies were performed in a hyperbaric chamber with the subjects supine at 1 atmospheres absolute (ATA) (sea level) while breathing normoxic gas [21% O(2), 1 ATA; inspired Po(2) (Pi(O(2))) ≈ 150 mmHg] and at 2.82 ATA while breathing hyperbaric normoxic (7.4% O(2), 2.82 ATA, Pi(O(2)) ≈ 150 mmHg) and hyperoxic (100% O(2), 2.82 ATA, Pi(O(2)) ≈ 2,100 mmHg) gas. Resting FBF and FVC were less during hyperbaric hyperoxia compared with hyperbaric normoxia (P < 0.05). The change in FBF and FVC (Δ from rest) during exercise under normoxia (204 ± 29 ml/min and 229 ± 37 ml·min(-1)·100 mmHg(-1), respectively) and hyperbaric normoxia (203 ± 28 ml/min and 217 ± 35 ml·min(-1)·100 mmHg(-1), respectively) did not differ (P = 0.66-0.99). However, the ΔFBF (166 ± 21 ml/min) and ΔFVC (163 ± 23 ml·min(-1)·100 mmHg(-1)) during hyperbaric hyperoxia were substantially attenuated compared with other conditions (P < 0.01). Our data suggest that exercise hyperemia in skeletal muscle is highly dependent on oxygen availability during hyperoxia.

Mechanistic electronic model to simulate and predict the effect of heat stress on the functional genomics of HO-1 system: Vasodilation

The present work is concerned to model the molecular signalling pathway for vasodilation and to predict the resting young human forearm blood flow under heat stress. The mechanistic electronic modelling technique has been designed and implemented using MULTISIM 8.0 and an assumption of 1 V/°C for prediction of forearm blood flow and the digital logic has been used to design the molecular signalling pathway for vasodilation. The minimum forearm blood flow has been observed at 35 °C (0 ml 100 ml −1 min −1) and the maximum at 42 °C (18.7 ml 100 ml −1 min −1) environmental temperature with respect to the base value of 2 ml 100 ml −1 min −1. This model may also enable to identify many therapeutic targets that can be used in the treatment of inflammations and disorders due to heat-related illnesses.

Prolonged pharmacodynamic effects of S-0139, an intravenously administered endothelin A (ETA) antagonist, in the human forearm blood flow model

To estimate the pharmacologically active dose range of a new investigational compound S-0139, a selective endothelin A (ET(A)) receptor antagonist, in man, and to examine the duration of its pharmacodynamic effect. Venous occlusion plethysmography was performed to assess changes in forearm blood flow following intra-brachial administration of endothelin-1 (ET-1). ET(A) antagonists have been shown to block ET-1-induced vasoconstriction in this model. The study was conducted in three parts: (1) a pilot study to explore dose-response (dose range 0.08-13.33 microg kg(-1) min(-1)), (2) a randomized study to confirm dose-response (placebo, 2.5, 6.67 and 15 microg kg(-1) min(-1)), and (3) a delayed administration study (15.7 microg kg(-1) min(-1)) to explore the duration of the pharmacodynamic effect. In all studies a 3-h infusion of S-0139 was given and during the last 90 min of the infusion, ET-1 was infused concurrently for 90 min. In study (3) a second ET-1 infusion was given starting 3 h after completion of the first. Intravenously administered S-0139 resulted in significant inhibition of ET-1-induced vasoconstriction in the forearm (plasma concentration 800-2000 ng ml(-1)). In the delayed administration study, the same extent of inhibition was still present when ET-1 was administered 3 h after the end of infusion of S-0139, even though the S-0139 plasma concentrations (mean 17 ng ml(-1)) were well below pharmacologically active concentrations as determined in studies 1 and 2. S-0139 dose-dependently blocks ET-1-mediated vasoconstriction in the forearm and has a prolonged duration of effect beyond that expected from its pharmacokinetic profile.

Abstract 3628: Neuronal Nitric Oxide Synthase (nNOS) Regulates Basal Flow in the Human Coronary Circulation I n Vivo

Endothelial NO synthase (eNOS) is thought to be the major source of nitric oxide (NO) involved in the local regulation of human vascular tone. However, in studies using a selective neuronal NOS (nNOS) inhibitor S-methyl-L-thiocitrulline (SMTC), we recently reported that basal human forearm blood flow is regulated by nNOS. SMTC had no effect on acetylcholine-induced vasodilatation which however was inhibited by the non-selective NOS inhibitor N G monomethyl-L-arginine (L-NMMA). This study investigated the effects of nNOS in the human coronary circulation in vivo . We studied patients undergoing diagnostic cardiac catheterisation who had angiographically normal coronary arteries. Coronary flow velocity was measured by an intracoronary Doppler wire and epicardial artery diameter by QCA. We compared the effects of intracoronary SMTC or L-NMMA infusion on basal flow and the responses to substance P and isosorbide dinitrate (endothelium-dependent and -independent dilators, respectively). L-NMMA (25 μmol/min) reduced basal coronary flow by 22.3±5.3% and inhibited dilation to substance P (20 pmol/min) by 57±5.7% (n=8; both P&lt;0.01). SMTC (0.625 μmol/min) also reduced basal flow (−34.8±6.3%; n=8; P&lt;0.01), but had no effect on the response to substance P (inhibited by −2±14%; P=NS). The effects of SMTC were abolished by L-arginine (240μmol/ min; n=3). Both L-NMMA and SMTC reduced epicardial artery diameter (−2.5±0.6% and −2.8±0.9% respectively; P&lt;0.05) but only L-NMMA reduced dilatation to substance P (5.6±1.3% before versus 3.0±0.8% after L-NMMA; P&lt;0.05). These data indicate that local nNOS-derived NO regulates basal coronary blood flow in humans in vivo , whereas substance P-stimulated vasodilatation is eNOS-mediated. Our results indicate that nNOS and eNOS have distinct local roles in the physiological regulation of human coronary vascular tone in vivo .

Neuronal Nitric Oxide Synthase Regulates Basal Microvascular Tone in Humans In Vivo

Nitric oxide (NO) has a pivotal role in the regulation of vascular tone and blood flow, with dysfunctional release contributing to disease pathophysiology. These effects have been attributed to NO production by the endothelial NO synthase (eNOS); however, recent evidence suggests that a neuronal NO synthase (nNOS) may also be expressed in arterial vessels. We undertook a first-in-humans investigation of the role of nNOS in the local regulation of vascular blood flow in healthy subjects. Brachial artery infusion of the nNOS-specific inhibitor S-methyl-L-thiocitrulline (SMTC, 0.025 micromol/min to 0.2 micromol/min) caused a dose-dependent reduction in basal flow, with a 30.1+/-3.8% decrease at the highest dose (n=10; mean+/-SE; P<0.01). The effect of SMTC was abolished by coinfusion of the NO synthase substrate L-arginine but was unaffected by D-arginine. A similar reduction in basal flow with the nonselective NO synthase inhibitor N(G)-monomethyl-L-arginine (L-NMMA; 37.4+/-3.1%, n=10) required a 20-fold higher dose of 4 micromol/min. At doses that produced comparable reductions in basal flow, only L-NMMA (4 micromol/min) and not SMTC (0.2 micromol/min) inhibited acetylcholine-induced vasodilation; however, both SMTC and L-NMMA inhibited the forearm vasodilator response to mental stress. Basal forearm blood flow in humans is regulated by nNOS-derived NO, in contrast to the acetylcholine-stimulated increase in blood flow, which, as shown previously, is mediated primarily by eNOS. These data indicate that vascular nNOS has a distinct local role in the physiological regulation of human microvascular tone in vivo.

A quantitative assessment of skin blood flow in humans

Various aspects of skin blood flow (SkBF) in human beings have been studied experimentally for more than seven decades. While reasonably complete phenomenological descriptions of individual factors have emerged from those investigations, little effort has been devoted to assembling the component parts into a coherent description of the entire system. This paper describes an effort to do that. Although the result is essentially a mathematical model of human SkBF, the model is firmly based on empirical data and not merely an abstract theoretical construct. We found that experimental data for human forearm blood flow (FBF) from many sources are well represented by an equation in which the rate of cutaneous blood flow (q (s)) is defined by the equation q (s) = q (s,r) AVD x CVCM x CVCL x CVCE. The coefficient q (s,r) is the perfusion rate at a reference state, and the four component factors are defined as follows: AVD defines centrally mediated active vasodilation as a function of central temperature (T (c)), mean skin temperature (T(s))d intensity of exercise (V(o)(2)) CVCM defines reflexly mediated cutaneous vasoconstriction as a function of (T(s)) CVCL defines locally mediated cutaneous vasoconstriction as a function of local skin temperature (T (s)); and CVCE defines the effect of exercise on cutaneous vasoconstriction and mean arterial pressure. The definition of each component function is based on experimental data. Two conclusions are particularly significant. One is that the study provides a rational explanation, based on the role of (T(s)), for previously disparate opinions about the non-thermal effect of exercise on active cutaneous vasodilation. The other is that it establishes that the four factors combine multiplicatively, and not additively, as previous investigators have suggested.

Vascular effects of anandamide and N‐acylvanillylamines in the human forearm and skin microcirculation

The endocannabinoid anandamide is an emerging potential signalling molecule in the cardiovascular system. Anandamide causes vasodilatation, bradycardia and hypotension in animals and has been implicated in the pathophysiology of endotoxic, haemorrhagic and cardiogenic shock, but its vascular effects have not been studied in man. Human forearm blood flow and skin microcirculatory flow were recorded using venous occlusion plethysmography and laser-Doppler perfusion imaging (LDPI), respectively. Each test drug was infused into the brachial artery or applied topically on the skin followed by a standardized pin-prick to disrupt the epidermal barrier. Anandamide failed to affect forearm blood flow when administered intra-arterially at infusion rates of 0.3-300 nmol min(-1). The highest infusion rate led to an anandamide concentration of approximately 1 microM in venous blood as measured by mass spectrometry. Dermal application of anandamide significantly increased skin microcirculatory flow and coapplication of the transient receptor potential vanilloid 1 (TRPV1) antagonist capsazepine inhibited this effect. The TRPV1 agonists capsaicin, olvanil and arvanil all induced concentration-dependent increases in skin blood flow and burning pain when administered dermally. Coapplication of capsazepine inhibited blood flow and pain responses to all three TRPV1 agonists. This study shows that locally applied anandamide is a vasodilator in the human skin microcirculation. The results are consistent with this lipid being an activator of TRPV1 on primary sensory nerves, but do not support a role for anandamide as a circulating vasoactive hormone in the human forearm vascular bed.

Troglitazone, an insulin sensitizer, increases forearm blood flow in humans

To test whether troglitazone, a thiazolidinedione insulin sensitizer, increases the peripheral blood flow, the changes in forearm blood flow (FBF) were evaluated by venous occlusion plethysmography in 11 lean healthy male volunteers (age range, 24 to 39 years) after a single oral dose of 200 mg of troglitazone. Forearm vascular resistance (FVR) was calculated from FBF and blood pressure. Two hours after the dose, FBF increased from 3.66 ± 0.31 to 4.81 ± 0.57 mL/100 mL/min ( P < .01), and FVR decreased from 24.7 ± 2.2 to 20.2 ± 2.2 units ( P < .01), whereas both these values did not change during the control recordings obtained without troglitazone. Blood pressure, blood glucose levels, and serum immunoreactive insulin levels did not change significantly during the observation period. Serum concentrations of nitrate ions decreased from 27.0 ± 3.5 mmol/L to 23.1 ± 2.7 mmol/L ( P < .01) after the administration. These results suggest that troglitazone increases muscular blood flow through vasodilation induced by a mechanism other than the correction of hyperinsulinemia or the increase in nitric oxide. The present study provides the first evidence that troglitazone dilates the vasculature in humans.

Continuous release of vasodilator prostanoids contributes to regulation of resting forearm blood flow in humans.

Continuous release of nitric oxide contributes to the maintenance of resting tone in the human forearm and coronary circulations; however, evidence for a similar role of vasodilator prostanoids such as prostacyclin is lacking. We examined whether continuous release of prostacyclin contributes to basal forearm blood flow. Flow was measured using venous occlusion plethysmography in 38 healthy volunteers [mean age 21.3 +/- 2.5 yr (+/- SD); 13 female, 25 male] at rest, after administration of three incremental intra-arterial infusions of either the cyclooxygenase inhibitor aspirin or placebo, and before and after administration of the endothelium-dependent and -independent dilators acetylcholine (30 micrograms/min) and nitroprusside (1 microgram/min). To assess the effect of aspirin on the production of prostacyclin, plasma 6-keto prostaglandin F1 alpha (6-keto-PGF1 alpha; the stable metabolite of prostacyclin) was measured by simultaneous arterial and venous sampling. Aspirin produced a time- and dose-dependent reduction in forearm blood flow, resulting in a 32% decrease at the highest dose. The effect was maximal after 10 min. Flow at rest and after aspirin doses of 1, 3, and 10 mg/min was 2.6 +/- 0.2, 2.3 +/- 0.2, 2.1 +/- 0.2, and 1.8 +/- 0.2 ml.100 ml forearm tissue-1.min-1, respectively (means +/- SE, P < 0.001). Commensurate with these data, the net forearm production of 6-keto-PGF1 alpha was 52.9 +/- 16.4, 11.7 +/- 8.6, 18.7 +/- 8.5, and 12.0 +/- 12.5 pg.100 ml forearm tissue-1.min-1 for the respective doses (P = 0.04). No time-dependent reduction in flow was seen in subjects with vehicle infusion. Aspirin did not affect the responses to acetylcholine or nitroprusside. These data suggest that continuous release of prostacyclin plays a role in the maintenance of resting forearm blood flow. There appears to be a direct link between the reduction in flow with aspirin and inhibition of prostacyclin production.

Contributions of acetylcholine and nitric oxide to forearm blood flow at exercise onset and recovery.

The contributions of acetylcholine and/or nitric oxide (NO) to the rapid changes in human forearm blood flow (FBF) at the onset and recovery from mild exercise were studied in eight subjects. Rhythmic handgrip contractions were performed during brachial artery infusions of saline (2 ml/min; control), atropine (0.2 mg over 3 min), to block acetylcholine binding to muscarinic receptors, or atropine + NG-monomethyl-L-arginine (L-NMMA; 4 mg/min for 4 min), to additionally inhibit NO synthase. Brachial artery mean blood velocity (MBV; pulsed Doppler ultrasound) and diameter (echo Doppler) were measured continuously, and FBF was calculated. Atropine reduced acetylcholine-induced increases in FBF by approximately 71% (P < 0.05). FBF at rest was reduced by atropine and further reduced with atropine + L-NMMA. Both drug conditions reduced FBF during exercise by approximately 10% compared with control, with no difference between drug treatments. Brachial artery diameter was unchanged from rest by exercise, recovery, and drug treatments. Neither drug treatment altered the rate or magnitude of the increase in FBF above rest. Peak FBF after exercise was reduced by atropine and atropine + L-NMMA. Total FBF during 5 min of recovery was reduced with atropine + L-NMMA compared with control and atropine. The results suggest that 1) acetylcholine and NO mechanisms additively contribute to FBF levels at rest, 2) a cholinergic mechanism adjusts the absolute FBF levels during exercise, 3) neither acetylcholine nor NO is essential to observe the normal time course or magnitude of the exercise response, and 4) NO contributes to the FBF response during recovery from exercise.

Vasodilation and muscle pump contribution to immediate exercise hyperemia

A rapid (within 0-5 s) increase in skeletal muscle blood flow has been demonstrated following muscle contraction, yet the mechanism remains unresolved. Recently, it was suggested that the entire rapid exercise hyperemia could be attributed to the mechanical muscle pump effect. Other evidence indicates that the muscle pump cannot increase arterial flow. We measured human forearm blood flow with the arm positioned above or below heart level during 1) simulation of rhythmic muscle pump function via repeated inflation/deflation of a forearm cuff to 100 mmHg to achieve mechanical emptying of forearm veins, and 2) 1-s single-cuff inflations, 1-s voluntary forearm contractions, and 1-s contractions performed within a cuff inflation. Rhythmic cuff inflation increased blood flow with the arm below heart level (P < 0.05) but not above. Flow following single contractions was higher than flow following cuff inflation within 2 s (P < 0.05). Peak flow increases due to a single mechanical venous emptying (7.7 +/- 0.7 ml.100 ml(-1) min(-1)) could account for 60% of the peak flow increase due to muscle contraction (12.8 +/- 1.0 ml.100 ml(-1).min(-1)) with the arm below heart level, whereas above heart level mechanical venous emptying accounted for 46% of the flow increase due to contraction (3.0 +/- 0.4 vs. 6.5 +/- 0.6 ml.100 ml(-1).min(-1)). We conclude that a functional muscle pump does exist in the human forearm in vivo, but that a rapid vasodilation detectable within 2 s also contributes to the early exercise hyperemia.

The effect of calcitonin gene‐related peptide (CGRP) on human forearm blood flow

The effect of intravenous and intra-arterially administered calcitonin gene-related peptide (CGRP) on the human forearm blood flow and cutaneous blood flow were investigated by means of venous occlusion plethysmography and laser-Doppler flowmetry, respectively. Infusion of CGRP (11-216 pmol min-1) into the brachial artery resulted in a dose-dependent increase in forearm blood flow and cutaneous blood flow which persisted for up to 90 min after the infusion was stopped. Repeated infusions resulted in an identical response. Systemic intravenous infusion of CGRP (104-520 pmol min-1) resulted in a dose-dependent flush in the face, neck, upper trunck and upper arms, and an increase in the forearm blood flow. The cutaneous blood flow was dramatically increased on the forehead, whereas on the hand only a slight increase was noted. By intravenous infusions a significant drop in blood pressure and increase in heart rate were seen at 520 pmol min-1. Thus, it is possible to give CGRP in doses that increase the blood flow in muscle and skin without resulting in a fall in systemic arterial blood pressure and tachycardia, suggesting that CGRP may be used as a tool for the treatment of various conditions in man with compromised blood flow.

In Vivo and In Vitro Studies of α2-Adrenoceptor Responses in Human Vascular Smooth Muscle

To assess the role of alpha 2-receptor mechanisms in the control of vascular tone in humans, the pharmacological activities of RX 781094, an alpha 2-antagonist, and UK 14304, an alpha 2-agonist, have been investigated with the additional use of an alpha 1-antagonist, doxazosin. The effects of these agents on human forearm blood flow have been studied. In addition, some preliminary observations on the effects of these alpha 2-selective agents on isolated human arterial segments have been made. The alpha 2 agonist, UK 14304, produced a dose-dependent reduction in forearm blood flow, but the antagonism of this response by both doxazosin and RX 781094 at a dose which must be regarded as nonselective casts doubt on the hypothesis that alpha 2-receptors may be located postsynaptically in human vascular smooth muscle. These observations may be explained by UK 14304 having partial alpha 1-agonist activity. RX 781094 infused at low doses produced a dose-dependent reduction in forearm blood flow, which is interpreted as evidence for a presynaptic alpha 2 autoregulatory mechanism in the vasculature. Observations on isolated arterial segments (mesenteric, renal, splenic, gastric, and brachial) obtained during surgical procedures and mounted under tension in tissue baths did not provide evidence for a postsynaptic alpha 2-receptor mediating vasoconstriction. In contrast, the potentiation of the adrenaline response in the presence of the alpha 2 antagonist, RX 781094, supports the possibility that, in humans, an extrajunctional alpha 2-receptor may serve as the adrenergic mechanism for the release of an endothelial derived relaxing factor.

Effect of different prostaglandin synthesis inhibitors on post-occlusive blood flow in human forearm

The vascular relaxation response in the human forearm that follows a short period of arterial occlusion (reactive hyperemia) was investigated with respect to its dependance on an intact PG synthesis. In 10 healthy subjects, five men and five women, forearm blood flow was measured, using venous occlusion plethysmography, in the basal state and during the recovery phase following 5 min of obstructed arterial flow. The subjects were studied at nine different occasions. At six of these they were pre-treated with the highest recommended doses of either of the PG synthesis inhibitors acetyl-salicylic acid, diclofenac, ibuprofen, indomethacin, naproxen or piroxicam; the remaining occasions were controls, performed in the absence of drugs in the beginning, middle, and end of the series. All the drugs significantly decreased the total reactive hyperemia following 5 min of arterial occlusion. Ibuprofen was the most efficient agent, inhibiting the total reactive hyperemia by more than 70%, and naproxen was least active, producing about 35% inhibition. The rest of the drugs diminished the total reactive hyperemia by 55–65%. Basal forearm blood flow was not affected by either of the agents. From these data we conclude that drugs which inhibit PG synthesis in man have in common the capacity to decrease post-occlusive reactive hyperemia. This indicates that an activation of the local release of arachidonic acid, leading to formation of vasodilator PG, is one of the main factors behind the vascular smooth muscle relaxation response to arterial occlusion.