Endothelial Hyperpolarization in Humans

This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2014 by Emory University
Sponsor:
Information provided by (Responsible Party):
Arshed A. Quyyumi, Emory University
ClinicalTrials.gov Identifier:
NCT00166166
First received: September 13, 2005
Last updated: August 28, 2014
Last verified: August 2014
  Purpose

The purpose of this study is to elucidate the role Endothelium-Derived Hyperpolarizing Factor (EDHF) plays in dilating blood vessels and whether it differs between healthy people and those with high cholesterol. A second purpose of the study is to determine the identity of EDHF.


Condition Intervention Phase
Hyperlipidemia
Drug: Tetraethylammonium (TEA)
Drug: L-NMMA
Drug: Bradykinin
Drug: Nitroprusside
Drug: S-methyl-L-thiocitrulline (SMTC)
Drug: Acetylcholine
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: Physiology and Pathologic Role of Endothelium-Derived Hyperpolarizing Factor in Humans

Resource links provided by NLM:


Further study details as provided by Emory University:

Primary Outcome Measures:
  • Forearm Blood Flow [ Time Frame: Immediate ] [ Designated as safety issue: No ]

Estimated Enrollment: 60
Study Start Date: July 2002
Estimated Primary Completion Date: June 2021 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Experimental Drug: Tetraethylammonium (TEA)
Short duration (minutes) intra-arterial infusion.
Drug: L-NMMA
Short duration (minutes) intra-arterial infusion.
Drug: Bradykinin
Short duration (minutes) intra-arterial infusion.
Drug: Nitroprusside
Short duration (minutes) intra-arterial infusion.
Drug: S-methyl-L-thiocitrulline (SMTC)
Short duration (minutes) intra-arterial infusion.
Drug: Acetylcholine
Short term (minutes) intra-arterial infusion.

Detailed Description:

The vascular endothelium synthesizes at least four potent vasodilator substances: nitric oxide (NO), prostacyclin, carbon monoxide and endothelium-derived hyperpolarizing factor (EDHF) that contribute to vasodilator tone, and to inhibition of platelet activation and inflammation. EDHF release is stimulated by receptor-dependent agonists such as acetylcholine and bradykinin (BK), and leads to hyperpolarization of the underlying smooth muscle cells presumably by opening Ca2+-activated K+ channels. Indirect pharmacological evidence suggests that EDHF is a cytochrome P450-derived arachidonic acid metabolite, presumably an epoxide. Although the pivotal role of NO to conduit vessel dilation in response to acute increases in shear stress is well known, its' contribution to dilation with sustained increases in flow are minimal, and may be due to EDHF release.

We have recently demonstrated that miconazole, an inhibitor of cytochrome P-450, antagonized BK-mediated, endothelium-dependent vasodilation after inhibition of NO synthase and cyclooxygenase in the forearm circulation of healthy subjects. Reduced bioavailability of endothelium-derived NO in subjects with hypertension, hypercholesterolemia, diabetes and smoking contribute to the pathogenesis of this condition, but whether EDHF activity is modified in hypercholesterolemia remains unknown and will be investigated in this protocol.

In Specific Aim 1, we will test the hypotheses that in hypercholesterolemia, CYP450-derived epoxide release in response to bradykinin is increased and compensates for the reduced NO activity. We propose to study two different antagonists of CYP450, a non-specific blocker, miconazole and a specific CYP450 2C9 antagonist, sulphaphenazole.

Activation of calcium-dependent potassium channels (K+CA) leading to membrane hyperpolarization and vasodilation is a cardinal feature of EDHF release. Experimentally, in human vasculature K+CA channels are inhibitable by charybdotoxin and apamin. Clinical studies have used tetraethylammonium chloride (TEA) that antagonizes K+CA channels.

In Specific Aim 2, we will test the hypothesis that bradykinin-mediated forearm microvascular vasodilation results from activation of K+CA channels in vivo in healthy humans, and that this is altered in hypercholesterolemic patients. We propose to study whether TEA alone or in combination with CYP450 blockade will inhibit bradykinin-mediated vasodilation, allowing us to investigate whether sources other than CYP450-derived epoxides hyperpolarize smooth muscle cells.

Conductance vessel dilation in response to short periods of hyperemia have long been recognized to be secondary to release of NO, however, vasodilation fter sustained hyperemia is largely independent of NO release. Similarly, physiologic metabolic vasodilation of the microcirculation during exercise has a minor contribution from endothelium-derived NO release and the contribution of EDHF to metabolic forearm vasodilation in vivo remains unknown.

In Specific Aim 4, we will test the hypothesis that flow-mediated vasodilation during sustained hyperemia or during exercise is partly mediated by EDHF and that this contribution varies between healthy and hypercholesterolemic subjects.

Thus, the aim of these studies is to comprehensively establish the activity and identity of EDHF in the human forearm circulation, investigate its physiologic role in vasodilation, and determine how its activity is modulated by hypercholesterolemia, a condition that is accompanied by dysfunction of several endothelium-dependent functions

  Eligibility

Ages Eligible for Study:   21 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Hyperlipidemic (LDL > 140)
  • Healthy Volunteer

Exclusion Criteria:

  • Pregnancy
  • Diabetes mellitus
  • Cardiovascular Disease
  • Hypertension
  • Use of any regular medications
  • Renal insufficiency
  • Smoking (current or within the past 5 years)
  • Bleeding disorder
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00166166

Contacts
Contact: Arshed A Quyyumi, MD 404-712-2741 aquyyum@emory.edu
Contact: Sherri Stearns 404-712-2741 smcdonald@emory.edu

Locations
United States, Georgia
Emory University School of Medicine Recruiting
Atlanta, Georgia, United States, 30322
Contact: Salim Hayek, MD    404-712-2741      
Principal Investigator: Arshed A Quyyumi, MD         
Sponsors and Collaborators
Emory University
Investigators
Principal Investigator: Arshed A Quyyumi, MD Emory University School of Medicine, Division of Cardiology
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Arshed A. Quyyumi, Professor, Emory University
ClinicalTrials.gov Identifier: NCT00166166     History of Changes
Other Study ID Numbers: IRB00021886, 1 RO1 HL079115-01, 0605-2002
Study First Received: September 13, 2005
Last Updated: August 28, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Emory University:
hyperlipidaemia
EDHF
FMD

Additional relevant MeSH terms:
Hyperlipidemias
Dyslipidemias
Lipid Metabolism Disorders
Metabolic Diseases
Acetylcholine
Bradykinin
Nitroprusside
Tetraethylammonium
Kininogens
Thiocitrulline
S-methylthiocitrulline
Vasodilator Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions
Cholinergic Agonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Cysteine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Antihypertensive Agents
Nitric Oxide Donors
Potassium Channel Blockers
Membrane Transport Modulators

ClinicalTrials.gov processed this record on August 28, 2014