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Experimental Physiology 91.6 pp 1051-1058
DOI: 10.1113/expphysiol.2006.034694
© The Physiological Society 2006
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Frequency and pattern dependence of adrenergic and purinergic vasoconstriction in rat skeletal muscle arteries

Heidi A. Kluess1,2, John B. Buckwalter1,2, Jason J. Hamann1,2, Darren S. DeLorey1,2 and Philip S. Clifford1,2

Department of 1 Anesthesiology and Physiology, Medical College of Wisconsin2 Veterans Affairs Medical Center, Milwaukee, WI 53295, USA


    Abstract
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Sympathetic nerves fire in bursts followed by brief periods of quiescence. Periods of quiescence may be a valuable part of coding for different neurotransmitters. We compared adrenergic- and non-adrenergic-mediated vasoconstriction with repeating burst patterns versus constant frequency stimulation. Seventeen rats were killed, and the femoral arteries dissected out and mounted in organ tissue baths at 37°C and pH 7.4. Field stimulation was applied to artery rings from five rats at constant frequencies of 2–6 Hz for 144 impulses. In 12 rats, artery rings were stimulated with two burst pattern protocols consisting of repeating pairs, triplets, quadruplets or sextuplets performed using either 8 or 30 Hz as the instantaneous frequency for a total of 144 impulses. All protocols were repeated with the P2 purinergic antagonist pyridoxal-phosphate-6-azophenyl-2'4'-disulphonic acid (PPADs; 0.42 M) or the {alpha}1-antagonist prazosin (1.59 µM). Tension was decreased by the addition of the P2 antagonist PPADs (P < 0.05). Prazosin abolished tension at all constant frequencies (P < 0.05). P2 and {alpha}1-antagonism decreased tension with 8 and 30 Hz burst pattern field stimulation. However, the magnitude of decrease in tension with prazosin was less with burst patterns compared to the same average constant frequencies (P < 0.05). It appears that P2X receptors and {alpha}1-receptors in the femoral artery are sensitive to frequency and patterns of electrical stimulation.

(Received 12 June 2006; accepted after revision 7 September 2006; first published online 14 September 2006)
Corresponding author P. S. Clifford: Anesthesia Research 151, Veterans Affairs Medical Center, Milwaukee, WI 53295, USA. Email: pcliff{at}mcw.edu


    Introduction
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Vascular resistance in the skeletal muscle is, in part, controlled by sympathetic-mediated vasoconstriction via adrenergic and non-adrenergic receptors. The role of these receptors in mediating vasoconstriction depends on the neurotransmitters released from the sympathetic end terminal. Neurotransmitter release is evoked by sympathetic neurone firing, and there is considerable evidence that neurotransmitters are sensitive to the frequency and pattern of neurone firing (Flavahan & Vanhoutte, 1986a,b; Kennedy et al. 1986; Ren & Burnstock, 1997; Haniuda et al. 1997; Johnson et al. 2001; Bradley et al. 2003; Elam et al. 2003; Tanaka et al. 2003; Tarasova et al. 2003). In particular, high frequencies and long trains of neuronal or electrical impulses favour noradrenaline- and neuropeptide Y-mediated vasoconstriction, but low frequencies and short trains of impulses favour ATP-mediated vasoconstriction (Bao & Stjarne, 1993; Franco-Cereceda & Liska, 1998).

Our understanding of how the complex patterns of natural neural activity code for different neurotransmitters is incomplete. Previous research suggests that sympathetic neurones fire in series of bursts with periods of interburst quiescence (Habler et al. 1993; Macefield & Wallin, 1999). These periods of quiescence do not appear to result in a loss of vasoconstriction (Nilsson et al. 1985; Hardebo, 1992); therefore, they may be a valuable part of the coding for different neurotransmitters. We created a series of stimulation patterns to test the relative importance of firing patterns on neurotransmitter-mediated vasoconstriction in the femoral artery. Burst patterns were designed to mimic common sympathetic neurone firing patterns (Macefield et al. 1999; Macefield & Wallin, 1999; Elam et al. 2003) during periods of increased sympathetic activity. As a comparison, vessels were also exposed to constant frequency stimulation, in which there is a consistent interval between each electrical impulse. The purpose of this study was: (1) to compare adrenergic- or non-adrenergic-mediated vasoconstriction with repeating burst patterns versus constant frequency stimulation at the same average frequency; and (2) to compare the effect of the number of impulses within a burst and instantaneous frequency on adrenergic- or non-adrenergic-mediated vasoconstriction. We hypothesized that vasoconstrictor responses at lower frequencies and impulse numbers would be predominantly P2X receptor-mediated, whereas vasoconstriction in response to higher frequencies and impulse numbers would be {alpha}1-receptor-mediated in rat femoral artery rings.


    Methods
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Animals

Experimental procedures described below were approved by the Institutional Animal Care and Use Committees of the Medical College of Wisconsin and Veterans Affairs Medical Center. The femoral arteries were taken from male Sprague–Dawley rats (body weight, 339.6 ± 10.5 g) after induction of general anaesthesia with pentobarbitone (40 mg kg–1 I.P., killed via pneumothorax). The vessels were placed in a Krebs–Henseleit buffer solution (Sigma, St Louis, MO, USA) with Hepes (10 mM; Sigma), sodium bicarbonate (25 mM; ICN, Aurora, OH, USA), and calcium chloride (0.95 mM; ICN) added. They were dissected free of connective tissue and cut into ring segments (2 mm in length). Three to four vessel segments per rat were mounted on tungsten triangular holders, connected to force transducers and positioned in 15 ml tissue baths containing modified Krebs–Henseleit buffer solution. Baths were continuously bubbled with a mixture of 5% CO2–95% O2. The tension of the vessel segments was set to 0.5 g and allowed to stabilize for 30 min at pH 7.4 and 37°C (Zhou et al. 1993).

Field stimulation was delivered via two parallel platinum electrodes placed on either side of the vessel. The electrical current was supplied using a custom-made constant voltage stimulator set to deliver 15 V using a 2 ms pulse width. The data were collected using a Powerlab 16/30 with Chart software (version 5.2; ADI Instruments, Colorado Springs, CO, USA). The frequency and pattern of stimulation were controlled through the stimulator function in Chart.

A length–tension curve was contructed to determine the optimal baseline tension using 60 Hz field stimulation for a total time of 10 s. Baseline tension was increased by 0.5 g until the developed tension failed to increase by 10% in response to stimulation (Spier et al. 1999). Viability of the smooth muscle was assessed by contraction in response to phenylephrine (10–5 M; Baxter Healthcare Corp., Irvine, CA, USA), and the viability of the endothelium was assessed by at least 20% relaxation in response to acetylcholine (10–5 M, Sigma; Schneider et al. 1994).

Protocols

Series 1.  Vessels from six rats were stimulated with two burst pattern protocols consisting of pairs, triplets, quadruplets and sextuplets for 144 impulses per pattern with 5 min rest between each pattern (see Fig. 1). The burst patterns were performed using 8 and 30 Hz as the instantaneous frequency. The order of the stimulation sets was randomized and the vessels repeatedly rinsed for 15 min in between sets. The specific {alpha}1-antagonist prazosin (1.59 µM) was added 5 min before field stimulation to one organ bath, and the purinergic-2 (P2) antagonist pyridoxal-phosphate-6-azophenyl-2'4'-disulphonic acid (0.42 M; PPADs; Sigma) was added to one tissue bath per rat. This concentration of PPADs abolishes the response to the agonist {alpha},ß-methylene ATP (Kluess et al. 2005). During four of the 8 Hz pattern experiments, both prazosin and PPADs were added to one tissue bath.


Figure 1
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Figure 1.  Diagram of burst patterns for pairs, triplets, quadruplets and sextuplets

 
Series 2.  Vessels from five rats were stimulated at constant frequencies of 2, 3, 4 and 6 Hz for 144 impulses per frequency with 5 min rest between each frequency. The frequencies 2, 3, 4 and 6 Hz were chosen for comparison with the burst patterns because they represent the same net frequencies (e.g. pairs = 2 Hz).

Five minutes before beginning the stimulation protocols, prazosin (1.59 µM) was added to one tissue bath per rat and PPADs (0.42 M) was added to one tissue bath per rat. The remaining untreated vessel segments were used as controls.

On a separate day, femoral rings from four rats were stimulated at constant frequencies of 2, 3, 4 and 6 Hz. This protocol was repeated after adding both prazosin and PPADs to the bath. Double blocking was performed on a separate day because in our experience, femoral artery rings begin to lose tension when they are subjected to more than two sets of stimulation.

Series 3.  We have previously established that the femoral artery of the rat contains P2X and {alpha}1-adrenergic receptors in sufficient quantities to allow a dose–response curve to be contructed (Kluess et al. 2005). However, it is less clear whether there are neuropeptide Y1 and {alpha}2-adrenergic receptors on the femoral artery. The neuropeptide Y1 specific agonist [Leu31,Pro34]neuropeptide Y (10–4 M) was added to the organ baths. This dose of [Leu31,Pro34]neuropeptide Y was chosen because it was higher than the highest dose used in several studies looking at neuropeptide Y1-mediated vasoconstriction (Pernow et al. 1987; Cressier et al. 1995; Gradin et al. 2003). Since the role of neuropeptide Y1 postjunctional receptors may include potentiation of {alpha}1-mediated vasoconstriction (Grassi et al. 1996; Pernow et al. 1986), [Leu31,Pro34]neuropeptide Y (10–4 M) was added 1 min before the addition of noradrenaline (10–6 M). The experiments were performed consecutively in the same vessel segments.

We also wished to establish whether {alpha}2-adrenergic receptors are present on the femoral artery of the rat. The {alpha}2-receptor specific agonist 5-bromo-N-(2-imidazolin-2-yl)-6-quinoxalinamine (UK-14,304; 10–5 M) was added to the organ baths. This dose of UK-14 304 was higher than that used in studies by Flavahan & Vanhoutte (1986b) and Chotani et al. (2000).

Data analysis

Results are expressed as means ± S.E.M. unless stated otherwise. Data are presented as developed tension (peak tension minus baseline tension) and as a percentage change from control [(developed tension with antagonist minus developed tension control)/developed tension control) x 100].

Differences between control and antagonist in series 1 and 2 were assessed using two-way-repeated measures ANOVA followed by Tukey's post hoc test when appropriate. Differences between series 1 and series 2 were assessed using a two-way ANOVA followed by Tukey's post hoc test when appropriate. Differences were considered significant when P < 0.05.

To determine whether different stimulation patterns or receptor blockade resulted in a change in the time to half-maximal tension (t1/2;) or the slope, tension data from 6 Hz constant stimulation, 30 Hz sextuplets and 8 Hz sextuplets were fitted with non-linear regression analysis. A curve fit was considered adequate if the correlation coefficient (r) was greater than 0.90. The t1/2; and the slope of the curve were calculated. Data for t1/2; or slope were compared using a one-way ANOVA followed by Tukey's post hoc test when appropriate.


    Results
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Series 1

Raw data traces from individual femoral artery rings during 8 Hz sextuplet and 30 Hz sextuplet burst pattern stimulation and during 6 Hz constant frequency stimulation are shown in Fig. 2. At the onset of all patterns of field stimulation, there was a brief delay and then tension in the rings increased exponentially.


Figure 2
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Figure 2.  Raw data traces of individual femoral artery rings showing the tension development during 8 Hz sextuplets, 30 Hz sextuplets and 6 Hz constant frequency field stimulation

 
Figure 3 summarizes the results from stimulation with the 8 Hz burst (Fig. 3A), the 30 Hz burst (Fig. 3B) and the constant frequency pattern (Fig. 3C). The burst pattern with 8 Hz instantaneous frequency (Fig. 3A) produced an increase in tension (control conditions), but developed tension was not dependent on impulse numbers per burst (n = 6). Addition of PPADs, a purinergic antagonist, produced a –51 ± 10% decrease in tension (P < 0.05 versus control values; n = 6). On average, prazosin, a specific {alpha}1-antagonist, resulted in a –68 ± 12% change from control values (P < 0.05; n = 6). When PPADs and prazosin were added together, tension was abolished (P < 0.05 versus control values; n = 4).


Figure 3
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Figure 3.  Developed tension with 8 Hz burst stimulation pattern (A), 30 Hz burst stimulation pattern (B) and constant frequency stimulation (C)
P2 receptor antagonism (using PPADs) resulted in an attenuation of developed tension with all patterns of stimulation. {alpha}1-Adrenergic receptor antagonism (using prazosin) attenuated tension with the 8 and 30 Hz burst patterns, but abolished tension with constant frequency stimulation. Double blocking with prazosin and PPADs abolished tension with the 8 Hz burst patterns and constant frequency stimulation. Double blocking was not performed for the 30 Hz burst pattern because developed tensions for 8 and 30 Hz burst patterns were not different during the control, PPADs or prazosin conditions. *P < 0.05 versus control; +P < 0.05 versus PPADs; #P < 0.05 versus pairs, triplets and quadruplets; +P < 0.05 versus 2, 3 and 4 Hz.

 
For 30 Hz instantaneous frequency (Fig. 3B), the tension was greater with 30 Hz sextuplets (P < 0.05) than that elicited by pairs, triplets or quadruplets (n = 6). However, the tension produced with the 30 Hz burst pattern was not significantly different from that produced by the 8 Hz burst pattern. On average, PPADs produced a –62 ± 14% change from control values (P < 0.05; n = 6), whereas prazosin caused a –77 ± 10% change from control values (P < 0.05; n = 6). There were no significant differences between the percentage change from control values with PPADs or prazosin with the burst pattern protocols.

Series 2

During 2–6 Hz constant frequency stimulation (Fig. 3C), PPADs (n = 5) attenuated tension on average by –67 ± 7% (P < 0.05 from control values). Prazosin (n = 5) abolished tension at all constant frequencies (on average, –100 ± 4%; P < 0.05 from control and PPADs values). Double blocking with both prazosin and PPADs (n = 4) also abolished tension (P < 0.05 from control and PPADs values).

Comparison of constant with burst pattern protocols

In order to compare changes in tension as a result of receptor antagonism more easily, data were expressed as a percentage change from control values. A summary of the percentage change with PPADs for 8 Hz burst pattern, 30 Hz burst pattern and constant frequency is presented in Fig. 4A and for prazosin in Fig. 4B. The percentage change in tension with PPADs was not significantly different between the burst pattern and constant frequency stimulation, indicating that the effect of PPADs was similar for the two stimulation protocols. However, the percentage decrease in tension with prazosin was significantly greater for constant frequency stimulation compared with the burst patterns (P < 0.05).


Figure 4
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Figure 4.  Relative effects of purinergic and adrenergic antagonism
A, percentage change from control values with P2 receptor antagonism (using PPADs). The percentage decrease in tension from control values was not different with constant frequency or burst pattern stimulation. B, percentage change from control values with {alpha}1-adrenergic receptor antagonism (using prazosin). Prazosin attenuated the percentage change with 8 and 30 Hz burst pattern stimulation, but abolished tension with constant frequency stimulation (+P < 0.05 versus 8 and 30 Hz burst pattern).

 
Non-linear regession curves were fitted to control, PPADs and prazosin data from 8 Hz sextuplets, 30 Hz sextuplets and 6 Hz constant stimulation. Data for prazosin resulted in a large number of poor fits; therefore, only the PPADs data and matching control data were used for further comparison. In the 8 Hz sextuplets data set, data from two rats resulted in a poor fit because of vasomotion during the experiment and were removed from the set. Table 1 presents a summary of the data for the control and PPADs conditions. There was no difference in t1/2; or the slope among 8 Hz sextuplets (n = 4), 30 Hz sextuplets (n = 6) and 6 Hz constant frequency (n = 5) field stimulation patterns. There was also no difference in the t1/2; or slope with PPADs.


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Table 1.  Tension development kinetics for sextuplet burst patterns and 6 Hz constant frequency
 
Series 3

Tension was not increased above baseline values with the addition of [Leu31,Pro34]neuropeptide Y (from 0.50 ± 0.01 to 0.54 ± 0.17 g; n = 5). The {alpha}-adrenergic agonist noradrenaline caused a significant increase in tension ({alpha}-adrenergic agonist, 1.47 ± 0.13 g), but prior addition of [Leu31,Pro34]neuropeptide Y did not potentiate this response (1.53 ± 0.03 g; n = 5). The addition of UK-14,304, a specific {alpha}2-agonist, did not cause an increase in tension above baseline (from 0.36 ± 0.02 to 0.38 ± 0.03 g; n = 4).


    Discussion
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
In the rat femoral artery, the {alpha}1-adrenergic receptors contribute to vasoconstriction during field stimulation with all frequencies and patterns. With constant frequency stimulation, P2X receptors did not produce vasoconstriction themselves, but potentiated {alpha}1-mediated vasoconstriction. In contrast, with burst patterns, P2X receptors caused vasoconstriction and potentiated {alpha}1-mediated vasoconstriction. Therefore, it appears that P2X and {alpha}1-adrenergic receptor-mediated vasoconstriction are sensitive to different electrical stimulation frequencies and patterns.

Burst pattern stimulation

Based on previous research and sympathetic neurone recordings, the burst patterns used in this study were repeating pairs, triplets, quadruplets or sextuplets with a quiescent period between bursts (Hardebo, 1992; Macefield et al. 1999; Macefield & Wallin, 1999). The length of time in quiescence depended on the instantaneous frequency (frequency within a burst) and the number of impulses in a burst (duration of each epoch was 1000 ms). A low (8 Hz) and a high instantaneous frequency (30 Hz) were used with the expectation that a higher instantaneous frequency would cause greater tension. With the 8 Hz burst patterns, there were no differences in tension development among the patterns of pairs, triplets, quadruplets and sextuplets. However, with the 30 Hz burst pattern, developed tension with the sextuplets pattern was significantly greater than that with the pairs, triplets or quadruplets pattern. Overall, there was no difference in the developed tension with 8 Hz patterns compared with 30 Hz patterns.

P2X antagonism resulted in a decrease in tension with 8 and 30 Hz burst patterns. There was no significant difference in P2X antagonism with the pairs, triplets, quadruplets or sextuplets patterns. It is particularly difficult to compare our results to those of others, since most researchers have used a single burst, rather than a repeating pattern. However, Johnson et al. (2001) saw a non-significant increase in vascular resistance with couplets, but the increase in vascular resistance with a train of 20 impulses was attenuated by purinergic blockade. In contrast, Hardebo (1992) used the protocol most similar to our 30 Hz sextuplets pattern and did not see an effect of P2X antagonism in the rabbit ear artery. Differences between species and vessels used may explain the differences in results.

Antagonism of {alpha}1 receptors resulted on average in a 68 and 77% decrease from control values with 8 and 30 Hz burst pattern stimulation, respectively. The residual tension was abolished with the addition of PPADs. This suggests that the residual tension is the proportion of tension mediated by the P2X receptors (on average 32% for 8 Hz burst pattern and 23% for 30 Hz burst pattern). In agreement with this finding, previous studies have shown that as much as half of the tension developed by natural nerve patterns is resistant to {alpha}1-antagonism (Sjoblom-Widfeldt & Nilsson, 1990; Johnson et al. 2001).

Furthermore, we tested for the presence of {alpha}2-receptors and neuropeptide Y1 receptors on the femoral artery. In agreement with others, we found that the femoral artery did not contain {alpha}2-receptors and neuropeptide Y1 receptors in sufficient quantities to result in vasoconstriction in response to receptor-specific agonists (Thom et al. 1985; Flavahan et al. 1987; Guimaraes & Moura, 2001). Addition of a neuropeptide Y1 agonist did not cause potentiation of {alpha}1-mediated vasoconstriction. These data highlight the fact that {alpha}2-receptors and neuropeptide Y1 receptors contribute little to vasoconstriction in the femoral artery and explain the focus of the present study on {alpha}1-receptors and P2X receptors.

Constant frequency stimulation

As expected (Nilsson et al. 1985; Flavahan & Vanhoutte, 1986b; Sjoblom-Widfeldt & Nilsson, 1990; Hardebo, 1992; Haniuda et al. 1997; Ren & Burnstock, 1997; Morris, 1999; Zhang & Ren, 2001), tension produced by field stimulation was greater at 6 Hz compared with lower frequencies. P2X antagonism attenuated developed tension at all frequencies, a finding that is consistent with previous investigations employing constant frequency stimulation (Evans & Cunnane, 1992; Haniuda et al. 1997; Ren & Burnstock, 1997).

Antagonism of {alpha}1-adrenergic receptors abolished tension with constant frequency stimulation. This finding is in agreement with others and suggests that P2X receptors produce little to no vasoconstriction themselves during constant frequency stimulation (Flavahan & Vanhoutte, 1986b; Johnson et al. 2001; Tanaka et al. 2003; Tarasova et al. 2003). However, this finding is in contrast to the results of Evans & Cunnane (1992), Haniuda et al. (1997) and Ren & Burnstock (1997), who saw no effect of {alpha}-adrenergic blockade at frequencies below 5 Hz. It is difficult to resolve the differences among these studies considering differences in vessels, species and stimulation protocols, but a predominance of the papers that support our findings are studies in the rat, while the dissenters are mostly studies in the rabbit.

Comparison of burst and constant frequency stimulation

It is clear from the data above that constant frequency field stimulation favours {alpha}1-mediated vasoconstriction, while both {alpha}1-receptors and P2X receptors contribute to vasoconstriction with burst pattern stimulation. However, the increased contribution to vasoconstriction from the P2X receptor with burst patterns does not result in an additive increase in tension development. There are two possible explanations for this finding, including neurotransmitter release and postjunctional receptor interactions. Although we did not measure noradrenaline or ATP release from the nerve end terminals, our findings are consistent with the idea that more ATP and less noradrenaline is released with burst patterns. However, Hardebo (1992) has previously shown that more noradrenaline is released with burst pattern compared with constant stimulation. Release of ATP was not measured in that study.

An alternative explanation was presented by Bao & Stjarne (1993), who found evidence to suggest that P2X receptors may inhibit {alpha}1-receptors, perhaps through an intracellular mechanism. Further support for this idea comes from Johnson et al. (2001), who also found evidence that ATP has a dual role of potentiating and inhibiting the effect of noradrenaline. It is hypothesized that the potentiating role is mediated by prejunctional P2X receptors (Boehm, 1999; Papp et al. 2004), but the inhibiting role is mediated by postjunctional P2X receptors (Bao & Stjarne, 1993). This issue could be resolved by simultaneous measurement of ATP and noradrenaline at the synapse.

Significance

The femoral artery, although a conduit vessel, is unique in that sympathetic vasoconstriction is mediated only by P2X receptors and {alpha}1-receptors, which makes it an excellent model for investigating the interactions between {alpha}1-receptors and P2X receptors. One of the potential limitations of this study is the use of field stimulation rather than naturally occurring sympathetic nerve activity to induce endogenous release of neurotransmitters. It is unknown whether endogenous release of sympathetic neurotransmitters is similar with field stimulation and natural nerve activity, although Johnson et al. (2001) found that the vascular response of the tail artery to field stimulation and natural nerve activity were comparable.

Sympathetic nerve activity increases during application of stressors such as heat, exercise, cardiovascular disease and ageing. The pattern of firing from a single sympathetic neurone changes by increasing the number of impulses within a burst and the number of bursts within a period of time. This has been demonstrated in people with chronic heart failure, but we know little about specific pattern changes with thermal stress, exercise and ageing. Our data add to the literature by showing that repeated patterns of bursts have an influence on the relative contributions of different neurotransmitters on vascular tone. The higher average frequency of our burst patterns suggests that P2X receptors can play an important role in producing vasoconstriction even with high levels of sympathetic activity. However, these data also suggest that as the pattern of sympathetic activity tends towards shorter quiescent periods (constant frequency), the ability of P2X receptors to directly mediate vascular tone declines. The overall impact of a loss of P2X-mediated vasoconstriction in skeletal muscle is unknown, but Thompson & Kenney (2004) have shown that a loss of non-adrenergic-mediated vasoconstriction in the skin impairs the ability to respond to thermal stress.

In conclusion, using a stimulation pattern modelled after that found in vivo, vasoconstriction in the femoral artery is mediated by {alpha}1-receptors and P2X receptors. We found that P2X receptors are active at all stimulation frequencies and play a dual role of vasoconstriction and potentiation of {alpha}1-receptor-mediated vasoconstriction. This study underscores the importance of the pattern of stimulation in better understanding the interaction among adrenergic and purinergic receptors.


    References
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
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    Acknowledgements
 
The authors acknowledge the technical assistance of Kelly Allbee. We also wish to thank Andrew Williams and Richard Rys for engineering and maintenance of our laboratory equipment. This project was supported by the National Heart, Lung, and Blood Institute and the Medical Research Service of the Department of Veterans Affairs.





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