Abstract-Endothelin (ET)-1 causes vasoconstriction via ET A and ET B receptors located on vascular smooth muscle cells and vasodilatation via ET B receptors on endothelial cells. Studies in vitro indicate an upregulation of ET B receptors in atherosclerosis. The present study investigated the vascular effects evoked by endogenous ET-1 in atherosclerotic patients. Forearm blood flow (FBF) was measured with venous occlusion plethysmography in 10 patients with atherosclerosis and in 10 healthy control subjects during intra-arterial infusion of selective ET receptor antagonists. The ET B receptor antagonist BQ788 evoked a significant increase in FBF (31Ϯ13%) in the patients, whereas a 20Ϯ9% reduction was observed in the control subjects. The ET A receptor antagonist BQ123 combined with BQ788 evoked a marked increase in FBF (102Ϯ25%) in the patients compared with no effect in the control subjects (Ϫ3Ϯ9%, PϽ0.001 versus patients). The ET A receptor antagonist BQ123 increased FBF to a similar degree in patients (39Ϯ11%) as in control subjects (41Ϯ11% Key Words: endothelin Ⅲ receptors Ⅲ regional blood flow Ⅲ atherosclerosis T he endothelins (ETs) are a family of peptides with potent and characteristically long-lasting vasoconstrictor and vasopressor actions. 1 ET-1 is the major isoform in the cardiovascular system and is produced in endothelial cells. 2 The functional effects of ET-1 are mediated by 2 distinct receptor subtypes, the ET A and the ET B receptors. 3,4 The ET A receptor is expressed on vascular smooth muscle cells (VSMCs), and its activation by ET-1 leads to vasoconstriction. ET B receptors are present on VSMCs and on endothelial cells. Activation of VSMC ET B receptors results in vasoconstriction, whereas activation of the ET B receptor results in vasodilatation via the release of NO. Thus, the net result depends on the receptor localization that predominates. Local administration of the selective ET A receptor antagonist BQ123 resulted in forearm vasodilatation in healthy subjects. 5,6 The selective ET B receptor antagonist BQ788, on the other hand, induced reduction in forearm blood flow (FBF). 6 Combined administration of the 2 antagonists resulted in vasodilatation, a response indicating that ET-1 contributes to vascular tone via the ET A receptor and that this constrictor tone, to a minor degree, is counteracted by the ET B receptor.It has been speculated that ET-1 plays a part in the pathophysiology of several cardiovascular disorders, including atherosclerosis. 7 There is enhanced expression of ET-1 in VSMCs and macrophages of human atherosclerotic plaques. 8,9 Although the ET A receptor seems to be the major receptor mediating vasoconstriction in healthy humans, the situation may be different in atherosclerosis. Binding studies in vitro suggest that ET B receptors are upregulated in the atherosclerotic human coronary artery. 10 Furthermore, accumulation of foamy macrophages and T lymphocytes in human atherosclerotic lesions may modulate a switch of ET receptor subtypes from ET A to ET B in VSMCs, 1...