Local skin heating is used to assess microvascular function in clinical populations because NO is required for full expression of the response; however, controversy exists as to the precise NO synthase (NOS) isoform producing NO. Human aging is associated with attenuated cutaneous vasodilation but little is known about the middle aged, an age cohort used for comparison with clinical populations. We hypothesized that endothelial NOS (eNOS) is the primary isoform mediating NO production during local heating, and eNOS-dependent vasodilation would be reduced in middle-aged skin. Vasodilation was induced by local heating (42°C) and during acetylcholine dose-response (ACh-DR: 0.01, 0.1, 1.0, 5.0, 10.0, 50.0, 100.0 mmol/l) protocols. Four microdialysis fibers were placed in the skin of 24 men and women; age cohorts were 12 middle-aged (53 ± 1 yr) and 12 young (23 ± 1 yr). Sites served as control, nonselective NOS inhibited [N(G)-nitro-l-arginine methyl ester (l-NAME)], inducible NOS (iNOS) inhibited (1400W), and neuronal NOS (nNOS) inhibited (N(ω)-propyl-l-arginine). After full expression of the local heating response, l-NAME was perfused at all sites. Cutaneous vascular conductance was measured and normalized to maximum (%CVC(max): Nitropress). l-NAME reduced %CVCmax at baseline, all phases of the local heating response, and at all ACh concentrations compared with all other sites. iNOS inhibition reduced the initial peak (53 ± 2 vs. 60 ± 2%CVC(max); P < 0.001); however, there were no other differences between control, nNOS-, and iNOS-inhibited sites during the phases of local heating or ACh-DR. When age cohorts were compared, NO-dependent vasodilation during local heating (52 ± 6 vs. 68 ± 4%CVC(max); P = 0.013) and ACh perfusion (50 mmol/l: 83 ± 3 vs. 93 ± 2%CVC(max); 100 mmol/l: 83 ± 4 vs. 92 ± 3%CVC(max); both P = 0.03) were reduced in middle-aged skin. There were no differences in NOS isoform expression obtained from skin biopsy samples between groups (all P > 0.05). These data suggest that eNOS mediates the production of NO during local heating and that cutaneous vasodilation is attenuated in middle-aged skin.

Essential hypertension is a pro-inflammatory, pro-constrictor disease coinciding with endothelial dysfunction and inward vessel remodeling. Using the skin circulation our aim was to determine if iNOS upregulation attenuates NO-dependent cutaneous vasodilation in hypertensive humans. We hypothesized that with hypertension (1) localized iNOS inhibition would restore vasodilation in response to NO-dependent stimuli and (2) iNOS expression would be increased and phosphorylated vasodilator-stimulated phosphoprotein (pVASP) would be decreased. In vivo protocols: four intradermal microdialysis (MD) fibers were placed in 9 hypertensive and 10 normotensive (SBP: 146 ± 4 vs.113 ± 2 mmHg, p<0.001) men and women. MD fibers served as control, iNOS-inhibited (1400W), nNOS-inhibited (NPLA), and non-selective NOS-inhibited (L-NAME). Cutaneous vascular conductance was calculated (%CVCmax; sodium nitroprusside) during standardized local heating (42°C) and acetylcholine (ach) dose-response protocols (0.01, 0.1, 1, 5, 10, 50, 100 mmol/L). The NO-dependent local heating response was attenuated at control (95 ± 2 vs. 76 ± 2 %CVCmax, p<0.05) and nNOS-inhibited sites (94 ± 4 vs. 77 ± 3 %CVCmax, p<0.01) in hypertensives. iNOS inhibition augmented the NO-dependent local heating response (93 ± 2 vs. 89 ± 10 %CVCmax). Ach-induced vasodilation was attenuated in control sites at doses ≥ 0.1mM Ach in hypertensives, and was restored with iNOS inhibition (0.1 mM p<0.05; 1, 5, 10 mM p<0.001; 50, 100 mM p<0.01). In vitro iNOS expression was increased (p=0.006) and pVASP/VASP was decreased in skin from hypertensive humans (p=0.04). These data suggest that iNOS is upregulated in essential hypertensive humans and contributes to reduced NO-dependent cutaneous vasodilation.

Every 34 seconds an American experiences a myocardial infarction or cardiac death. Approximately 80% of these coronary artery disease (CAD)-related deaths are attributable to modifiable behaviors, such as a lack of physical exercise training (ET). Regular ET decreases CAD morbidity and mortality through systemic and cardiac-specific adaptations. ET increases myocardial oxygen demand acting as a stimulus to increase coronary blood flow and thus myocardial oxygen supply, which reduces myocardial infarction and angina. ET augments coronary blood flow through direct actions on the vasculature that improve endothelial and coronary smooth muscle function, enhancing coronary vasodilation. Additionally, ET promotes collateralization, thereby, increasing blood flow to ischemic myocardium and also treats macrovascular CAD by attenuating the progression of coronary atherosclerosis and restenosis, potentially through stabilization of atherosclerotic lesions. In summary, ET can be used as a relatively safe and inexpensive way to prevent and treat CAD.

Functional constitutive nitric oxide synthase (NOS) is required for full expression of reflex cutaneous vasodilation that is attenuated in aged skin. Both the essential cofactor tetrahydrobiopterin (BH(4)) and adequate substrate concentrations are necessary for the functional synthesis of nitric oxide (NO) through NOS, both of which are reduced in aged vasculature through increased oxidant stress and upregulated arginase, respectively. We hypothesized that acute local BH(4) administration or arginase inhibition would similarly augment reflex vasodilation in aged skin during passive whole body heat stress. Four intradermal microdialysis fibers were placed in the forearm skin of 11 young (22 ± 1 yr) and 11 older (73 ± 2 yr) men and women for local infusion of 1) lactated Ringer, 2) 10 mM BH(4), 3) 5 mM (S)-(2-boronoethyl)-l-cysteine + 5 mM N(ω)-hydroxy-nor-l-arginine to inhibit arginase, and 4) 20 mM N(G)-nitro-l-arginine methyl ester (l-NAME) to inhibit NOS. Red cell flux was measured at each site by laser-Doppler flowmetry (LDF) as reflex vasodilation was induced. After a 1.0°C rise in oral temperature (T(or)), mean body temperature was clamped and 20 mM l-NAME was perfused at each site. Cutaneous vascular conductance was calculated (CVC = LDF/mean arterial pressure) and expressed as a percentage of maximum (%CVC(max); 28 mM sodium nitroprusside and local heat, 43°C). Vasodilation was attenuated at the control site of the older subjects compared with young beginning at a 0.3°C rise in T(or). BH(4) and arginase inhibition both increased vasodilation in older (BH(4): 55 ± 5%; arginase-inhibited: 47 ± 5% vs. control: 37 ± 3%, both P < 0.01) but not young subjects compared with control (BH(4): 51 ± 4%CVC(max); arginase-inhibited: 55 ± 4%CVC(max) vs. control: 56 ± 6%CVC(max), both P > 0.05) at a 1°C rise in T(or). With a 1°C rise in T(or), local BH(4) increased NO-dependent vasodilation in the older (BH(4): 31.8 ± 2.4%CVC(max) vs. control: 11.7 ± 2.0%CVC(max), P < 0.001) but not the young (BH(4): 23 ± 4%CVC(max) vs. control: 21 ± 4%CVC(max), P = 0.718) subject group. Together these data suggest that reduced BH(4) contributes to attenuated vasodilation in aged human skin and that BH(4) NOS coupling mechanisms may be a potential therapeutic target for increasing skin blood flow during hyperthermia in older humans.

Antithrombotic therapy with oral aspirin or clopidogrel (PlavixR) is associated with an attenuated skin vasodilator response and a greater rate of rise in core temperature in healthy, middle-aged individuals during passive heating in a water perfused suit. Purpose The present double-blind, crossover study examined the functional consequences of 7 days of low-dose aspirin (ASA, 81 mg/day) vs. clopidogrel (CLO, 75 mg/day) treatment in 14 healthy, middle-aged (50–65 yrs) men and women during passive heating in air (40 min at 30°C, 40% rh) followed by exercise (60% V̇O2peak). Methods Oral temperature (Tor) was measured in the antechamber (23.0 ± 0.1°C) before entering a warm environmental chamber. After 40 minutes of rest subjects cycled on a recumbent cycle ergometer for up to 120 minutes. Esophageal temperature (Tes) and laser Doppler flux were measured continuously, and the latter was normalized to maximal cutaneous vascular conductance (%CVCmax). Results Prior to entry into the environmental chamber there were no differences in Tor among treatments; however, after 40 minutes of rest in the heat, Tes was significantly higher for ASA and CLO vs. placebo (37.2±0.1°C, 37.3±0.1°C, vs. 37.0±0.1°C, both P<0.001), a difference that persisted throughout exercise (P<0.001 vs. placebo). The mean body temperature thresholds for the onset of cutaneous vasodilation were shifted to the right for both ASA and CLO during exercise (P<0.05). Conclusion ASA and CLO resulted in elevated core temperatures during passive heat stress and shifted the onset of peripheral thermoeffector mechanisms toward higher body temperatures during exercise heat stress.

Lipid deposition inside the arterial wall is a hallmark of plaque vulnerability. Based on overtone absorption of C-H bonds, intravascular photoacoustic (IVPA) catheter is a promising technology for quantifying the amount of lipid and its spatial distribution inside the arterial wall. Thus far, the clinical translation of IVPA technology is limited by its slow imaging speed due to lack of a high-pulse-energy high-repetition-rate laser source for lipid-specific first overtone excitation at 1.7 μm. Here, we demonstrate a potassium titanyl phosphate (KTP)-based optical parametric oscillator with output pulse energy up to 2 mJ at a wavelength of 1724 nm and with a repetition rate of 500 Hz. Using this laser and a ring-shape transducer, IVPA imaging at speed of 1 frame per sec was demonstrated. Performance of the IVPA imaging system's resolution, sensitivity, and specificity were characterized by carbon fiber and a lipid-mimicking phantom. The clinical utility of this technology was further evaluated ex vivo in an excised atherosclerotic human femoral artery with comparison to histology. 503-505 (1994). 2. P. Libby, "Inflammation in atherosclerosis," Nature 420(6917), 868-874 (2002 385-390 (2014). 25. Y. Li, X. Gong, C. Liu, R. Lin, W. Hau, X. Bai, and L. Song, "High-speed intravascular spectroscopic photoacoustic imaging at 1000 A-lines per second with a 0.9-mm diameter catheter," J.

Background Peri-coronary epicardial adipose tissue (cEAT) serves as a metabolic and paracrine organ that contributes to inflammation and is associated with macrovascular coronary artery disease (CAD) development. While there is a strong correlation in humans between cEAT volume and CAD severity, there remains a paucity of experimental data demonstrating a causal link of cEAT to CAD. The current study tested the hypothesis that surgical resection of cEAT attenuates inflammation and CAD progression. Methods Female Ossabaw miniature swine (n=12) were fed an atherogenic diet for 8 months and randomized into sham (n=5) or adipectomy (n=7) groups. Both groups underwent a thoracotomy, opening of the pericardial sac, and placement of radio-opaque clips to mark the proximal left anterior descending artery. Adipectomy swine underwent removal of 1–1.5 cm2 of cEAT from the proximal artery. Following sham or adipectomy, CAD severity was assessed with intravascular ultrasound. Swine recovered for an additional 3 months on atherogenic diet and CAD was assessed immediately prior to euthanasia. Artery sections were processed for histological and immunohistochemical analysis. Results CAD severity, as assessed by percent stenosis, was reduced in the adipectomy cohort compared to shams; however, plaque size remained unaltered, while sham-operated swine developed greater plaque sizes. Adipectomy resulted in an expanded arterial diameter, similar to the Glagov phenomenon of positive outward remodeling. No differences in inflammatory marker expression were observed. Conclusions These data indicate that cEAT resection did not alter inflammatory marker expression, but arrested CAD progression through increased positive outward remodeling and arrest of atherogenesis.

When prolonged intense exercise is performed at high ambient temperatures, cardiac output must meet dual demands for increased blood flow to contracting muscle and to the skin. The literature has commonly painted this scenario as a fierce competition, wherein one circulation preserves perfusion at the expense of the other, with the regulated maintenance of blood pressure as the ultimate goal. This review redefines this scenario as commensalism, an integrated balance of regulatory control where one circulation benefits with little functional effect on the other. In young, healthy subjects, arterial pressure rarely falls to any great extent during either extreme passive heating or prolonged dynamic exercise in the heat. Nor does body temperature rise disproportionately due to a compromised skin blood flow. Rather, it often takes the superimposition of additional stressors – e.g., dehydration or simulated hemorrhage – upon heat stress to substantially impact blood pressure regulation.