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The goal of the study is to examine the possible mechanisms of impaired cutaneous microvascular function through local heating along with administration of vasoconstrictors.
Cardiovascular disease (CVD) afflicts nearly one-third of the adult population with all races and ethnicities represented in CVD prevalence. Unfortunately, a disparity exists such that the black population (BL) is disproportionately affected compared to other groups, including the white population (WH). While the underlying cause of this disparity is multifactorial, vascular dysfunction (i.e., impaired vasodilation and/or augmented vasoconstriction) is a key contributor. Across a series of studies conducted in our laboratory we have consistently observed impaired microvascular function in the small blood vessels in the skin (the cutaneous microvasculature) in AA relative to age, sex, and body mass index Caucasian Americans (CA). From a research design perspective this offers the opportunity to conduct minimally invasive studies while investigating research questions in a systematic and mechanistic manner. Furthermore, the cutaneous circulation is recognized as surrogate vascular bed for assessment of mechanisms underlying systemic vascular disease and microvascular dysfunction is emerging as a critical step in the artherosclerotic process and a variety of conditions including hypertension, exercise intolerance, and insulin resistance. And, impaired cutaneous microvascular function mirrors impaired responses in other vascular beds. A primary advantage to utilizing the cutaneous circulation is that it provides an accessible vascular bed through which processes of endothelial function can be investigated, with virtually no risk, through thermal stimuli and local intra-dermal drug infusions.
In terms of the AA population our group and others have documented that impaired vascular function and elevated disease risk is related, in part, to reductions in bioavailability of the potent vasodilator Nitric oxide (NO). While, this has become fairly common knowledge what remains less well defined is the mechanisms of this reduced NO bioavailability. We have recently identified a role for oxidative stress in this process. However, oxidative stress is a complex process and likely does not explain all of the observed impairment. 2 other possibilities that are attractive candidate targets for mechanistic studies are the endothelin pathway as well as bioavailability of L-Arginine. Endothelin is a hormone that has been implicated in many populations with elevated CVD risk as it is a potent vasoconstrictor which also can reduce NO bioavailability. Interestingly, there are reports of elevated endothelin circulating concentration and/or increased sensitivity and thus vasoconstriction to endothelin in AA. L-Arginine is a naturally occurring amino acid that is required for the full endogenous production of NO. In other words reduced L-Arginine bioavailability is present in many disease conditions and contributes to vascular dysfunction. In regards to AA it is reported that they have reduced natural production of L-arginine and also respond more positively to intra coronary infusion of L-arginine relative to other populations. However, to our knowledge the role of the endothelin system as well as L-arginine in microvascular dysfunction in AA has never been investigated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | Active Comparator | This site will serve as the control site and will receive lactated Ringer's (saline solution) (2 µl/min) throughout the entire duration of the protocol. This site will additionally receive 20mM L-NAME and 28mM SNP to inhibit nitric oxide (NO) production and elicit vasodilation, respectively, to assess NO contribution and maximal vasodilation. |
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| Inhibitor of Endothelin Type B Receptor | Experimental | This site will receive 300 nM BQ-788, an inhibitor of the endothelin type B receptors. This site will additionally receive 20mM L-NAME and 28mM SNP to inhibit nitric oxide (NO) production and elicit vasodilation, respectively, to assess NO contribution and maximal vasodilation. |
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| Inhibition of Endothelin Type A Receptor | Experimental | This site will receive 500 nM aBQ-123, an inhibitor of endothelin type A receptors. This site will additionally receive 20mM L-NAME and 28mM SNP to inhibit nitric oxide (NO) production and elicit vasodilation, respectively, to assess NO contribution and maximal vasodilation. |
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| L-Arginine | Experimental | This site will receive 10 mM L-Arginine to supplement the substrate for endothelial nitric oxide synthase. This site will additionally receive 20mM L-NAME and 28mM SNP to inhibit nitric oxide (NO) production and elicit vasodilation, respectively, to assess NO contribution and maximal vasodilation. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BQ-788 | Drug | This intervention is aimed at blocking endothelin type B receptors to assess racial differences during vasoconstriction. The infusion rate will be 2 µl/min |
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| Measure | Description | Time Frame |
|---|---|---|
| Vasodilatory Response to Endothelin Receptor-A/B Blockers and L-Arginine following local heating as assessed by Intradermal Microdialysis and Laser Doppler Fluxmetry | Determine to what extent overactivation of Endothelin Receptor Type A/B or L-Arginine deficiencies have on vasodilatory capacity by delivering specific Endothelin receptor agonists or supplemental L-Arginine via intradermal microdialysis. Vasodilation will be elicited by local heating and changes in skin blood flux will be assessed via laser Doppler fluxmetry. All changes in skin blood flux will be normalized and reported as a percentage of maximal flux. | Through study completion, an average of 1 Year |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Science and Engineering Research and Innovation Building | Arlington | Texas | 76019 | United States |
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Each subject has one control site and three experimental sites concurrently tested within the same study using intradermal microdialysis on the dorsal forearm.
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| BQ-123 | Drug | This intervention is aimed at blocking endothelin type A receptors to assess racial differences during vasoconstriction. The infusion rate will be 2 µl/min |
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| L-Arginine | Drug | A substrate that is administered to increase endogenous nitric oxide production. The infusion rate will be 2 µl/min |
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| NG Nitro L Arginine Methyl Ester | Drug | L-Name is a NOS inhibitor that is administered to each site to allow for the quantification of NO contribution to vasodilation. The infusion rate will be 2 µl/min |
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| Sodium Nitroprusside | Drug | SNP will be perfused through each site to induce maximal vasodilation. The infusion rate will be 2 µl/min |
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| Lactated Ringer's | Drug | Lactated Ringer will serve as the control site. The infusion rate will be 2 µl/min |
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| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| C086539 | BQ 788 |
| C072247 | cyclo(Trp-Asp-Pro-Val-Leu) |
| D001120 | Arginine |
| D019331 | NG-Nitroarginine Methyl Ester |
| D009599 | Nitroprusside |
| D000077325 | Ringer's Lactate |
| ID | Term |
|---|---|
| D024361 | Amino Acids, Basic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000599 | Amino Acids, Diamino |
| D000601 | Amino Acids, Essential |
| D005292 | Ferricyanides |
| D003486 | Cyanides |
| D000838 | Anions |
| D007477 | Ions |
| D004573 | Electrolytes |
| D007287 | Inorganic Chemicals |
| D005290 | Ferric Compounds |
| D058085 | Iron Compounds |
| D006856 | Hydrogen Cyanide |
| D017672 | Nitrogen Compounds |
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
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