The current recommendations by the American Heart Association for health promotion are that all persons should partake in regular physical activity in order to reduce the risk of cardiovascular disease. Regular physical exercise reduces blood pressure and is an important component of the management of hypertension. It is therefore important that patients with hypertension participate in habitual physical exercise. Many hypertensive patients who exercise will require anti-hypertensive medication. However, some antihypertensive agents cause fatigue during exercise. In order for patients to gain the full benefits of an active lifestyle, it is important that the prescribed antihypertensive agent does not prevent them performing and enjoying sustained exercise. It has been well documented that β-blockers cause premature fatigue during physical exercise. The effects on exercise performance of other first line antihypertensive medications, such as calcium channel antagonists have not been extensively investigated. In particular, the effects of these agents on prolonged submaximal exercise endurance have not been well studied. The object of this thesis was to compare the effects of isradipine, a dihydropyridine calcium channel antagonist, to those of atenolol, a β₁-selective antagonist, on maximal and submaximal exercise performance and on short duration high-intensity exercise in physically active hypertensive patients. The study design was a crossover trial where drug treatments were double blinded and randomised. Physically active volunteers with mild to moderate hypertension were recruited. 11 subjects performed i) progressive exercise to exhaustion for determination of maximal oxygen consumption (VO₂max), maximal work load and cardiorespiratory responses to maximal exercise, ii) prolonged submaximal exercise for determination of exercise endurance, cardiorespiratory responses and ratings of perceived exertion (APE), and iii) short duration, high intensity exercise consisting of a 30 second maximal exercise test (Wingate test) to determine skeletal muscle power output, following 4 weeks ingestion of isradipine (2.5mg bd), atenolol (50mg bd) or placebo. Diastolic blood pressure at rest was reduced by both atenolol and isradipine, but was lowered to a greater extent by atenolol (83.3 vs 89.0 vs 96.1 mmHg, atenolol vs isradipine vs placebo, p<.0005). Systolic blood pressure at rest tended to be similarly reduced by both agents, but was significantly reduced during maximal and submaximal exercise by atenolol only (p<.001, atenolol vs isradipine, placebo). Heart rate at rest and during maximal and submaximal exercise was decreased by atenolol only (p<.0005, atenolol vs isradipine, placebo). Maximal exercise performance was reduced after atenolol ingestion compared to placebo but not after isradipine ingestion. Peak workload achieved during the maximal exercise test was decreased after atenolol but unchanged after isradipine ingestion (214 vs 243 W, atenolol vs placebo, p<.01). Similarly, VO₂max was reduced after atenolol compared to placebo but was unchanged after isradipine ingestion (33.6 vs 36.4, 33.6 vs 36.1 mlO₂/kg/min, atenolol vs placebo, atenolol vs isradipine, p<.05). Both atenolol and isradipine ingestion reduced submaximal endurance time compared to placebo (27.8 vs 46.4, 34.4 vs 46.4 min, atenolol vs placebo, isradipine vs placebo, p<.005), and increased rating of perceived exertion (APE) after 30 min of submaximal exercise (p<.05). Submaximal oxygen consumption (VO₂), ventilation, respiratory exchange ratio (REA) and blood lactate, glucose and free fatty acid concentrations were not altered after the ingestion of either agent. Neither agent influenced peak skeletal muscle power, total work done, or rate of fatigue during the Wingate test compared to placebo. The results of these studies indicate that impaired performance and increased RPE during submaximal exercise after ingestion of either atenolol or isradipine is not due to alterations of ventilation, VO₂, RER, or blood lactate, glucose and free fatty acid concentrations during prolonged submaximal exercise. Similarly, reduced submaximal exercise performance after atenolol or isradipine ingestion is not due to factors which would also limit the ability of skeletal muscle to perform short duration, high intensity exercise before a bout of prolonged exercise. This study demonstrates that prolonged submaximal exercise testing can reveal an impairment in exercise performance after ingestion of antihypertensive medication which is not evident during maximal exercise testing. This finding is important as prolonged submaximal exercise is the form of exercise which most hypertensive patients actually perform. Further research is required on the effects of anti-hypertensive medications on submaximal exercise performance before firm recommendations can be made regarding medications most suitable for the physically active hypertensive patient. The results of these and other studies indicate that it is not yet possible to make claims that the calcium channel antagonist agents are without effect on physical exercise performance in physically active hypertensive patients.

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A major physiological risk factor of temporomandibular disorders (TMD) is sensitization of peripheral and central nervous system pain processing pathways. Calcium channel, voltage-dependent, alpha-2/delta subunit-1 (CACNA2D1) has a crucial role in relaying nociceptive information in the spinal dorsal horn. Up-regulation of CACNA2D1 results in abnormal excitatory synapse formation and enhanced presynaptic excitatory neurotransmitter release. Blocking CACNA2D1 with gabapentinoid-class drugs relieves orofacial hypersensitivity. Drs. Foley, Horton, and Sciote previously reported that in a small sample group (n=12), CACNA2D1 expression was greater in males than females, but increased in women with TMD. The objectives of this study are to corroborate these data and investigate expression patterns of other ion channel and conducting system genes. Additionally, since the null polymorphism ACTN3-577XX associates with muscle fiber microdamage during eccentric contraction, we tested for possible gene associations with ACTN3-R577XX genotypes. Masseter muscle samples came from human subjects (n=23 male; 48 female) with malocclusions undergoing orthognathic surgery. This population had skeletal disharmony of the jaws and thus was prone to eccentric contraction. Three males and eighteen females were diagnosed with localized masticatory myalgia. Muscle total RNA was isolated and CACNA2D1, CACNA1S, GABARAP, and TRPM7 expression was quantified using RT-PCR. Expression of these genes were compared based on TMD status and various characteristics that may influence TMD including: sex, age, facial symmetry, sagittal dimension, vertical dimension, ACTN3-577 genotype and fiber type. CACNA2D1 expression differed significantly between sexes, overall (p&lt;0.02), and without TMD (p=0.001). Women with (n=13) and without (n=23) TMD differed significantly (p&lt;0.03). CACNA2D1 expression was also significantly higher (p=0.031) in subjects below age 25. Similarly, GABARAP expression was significantly higher (p=0.001) for patients younger than 25 and for patients less than or equal to age 18 (p=0.013). Otherwise, CACNA1S, TRPM7 and GABARAP differences were not significant. GABARAP expression differed, but not significantly by sex and for the ACTN3-577XX-null genotype. In a population of malocclusion patients, masseter muscle CACNA2D1 expression is significantly higher than CACNA1S, TRPM7, and GABARAP. CACNA2D1 expression is greater in males than females without TMD. However, CACNA2D1 expression increases significantly in females with TMD-associated myalgia. This may support evidence for calcium channel regulation of nociception differences seen between sexes in TMD. It was also found that expression of CACNA2D1 and GABARAP is significantly higher in younger subjects. Additionally, observations presented here suggest potential influence of ACTN3-null condition on function of GABARAP. / Oral Biology

Phosphorylation-dependent relief of Rad inhibition of cardiac Caᵥ1.2 channels underlies β-adrenergic increase in heart contraction essential for the fight-or-flight response. Prevailing evidence outline 4 steps involved in PKA-dependent relief of Caᵥ1.2 inhibition by Rad: basally, Rad inhibits Caᵥ1.2 by binding Caᵥβ and the plasma membrane using the G-domain and C-terminus, respectively (step 0), PKA-dependent phosphorylation of Ser residues in Rad C-terminus disengages Rad from the plasma membrane (step 1) and decreases affinity for Caᵥβ (step 2), potentially leading to Rad loss from Caᵥ1.2 nanodomain (step 3). It is unclear which steps and Rad structural determinants are necessary and sufficient for PKA regulation of CaV channels and the mechanism linking steps 1 and 2 is not entirely understood. Moreover, there is an apparent Rad-concentration-dependence to Caᵥ1.2 regulation wherein PKA activation is unable to overcome over-expressed Rad inhibition of the channel. The basis of this effect is unknown and constitutes a significant gap in our complete understanding of convergent regulation of Caᵥ channels, by Rad and PKA. We developed a systematic protein engineering-based approach to dissect the distinct steps and determinants involved in PKA modulation of Rad-inhibited Caᵥ channels. Fusing Rad C-terminus to Caᵥβ₃ generated β3-CT which was tethered to the plasma membrane when expressed alone in HEK293 cells and yielded constitutively inhibited channels when co-expressed with CaV2.2. Unexpectedly, PKA activation with forskolin further deepened inhibition of Caᵥ2.2 currents despite being sufficient to release β₃-CT from the plasma membrane. Phosphomimetic mutations in β₃-CT 6SD yielded deeply inhibited Caᵥ2.2 currents that were not further affected by forskolin. Two CaVβ-binding nanobodies fused to Rad C-terminus, F3-CT and B11-CT, were membrane-targeted yet yielded Caᵥ2.2 currents that were not basally inhibited and decreased by forskolin. Over-expressing wildtype Rad C-terminus (WTCT) by itself with Caᵥ1.2 produced basally inhibited channels that were further reduced by forskolin and co-expression of Caᵥ1.2 with a phosphomimetic Rad C-terminus (CTD) also produced constitutively inhibited channels. Truncated Rad lacking the C-terminus (Rad[1-276]) displayed low affinity to Caᵥβ, discounting a direct role for phosphorylated Rad C-terminus in linking steps 1 and 2. Fusing the protein kinase C C1 domain to Rad[1-276] yielded Rad₂₇₆-C1 which was cytosolic and displayed low affinity to Caᵥβ. Exposure to PdBu recruited Rad₂₇₆-C1 to the plasma membrane, increased affinity for Caᵥβ, and concomitantly inhibited Caᵥ1.2 currents. These results reveal that all 4 steps are necessary for PKA regulation of Caᵥ channels, membrane association regulates Rad affinity for CaVβ, and the Rad G-domain and C-terminus are replaceable with modular units that mimic their function. Our findings deepen understanding of PKA modulation of Caᵥ channels and provide new insights for developing chemo-genetic Caᵥ channel regulators.

Kattaya-Annappa-Seema. / Thesis submitted in: December 2006. / "2+" and "+" in the title are superscripts. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 162-188). / Abstracts in English and Chinese. / Abstract --- p.i / Acknowledgements --- p.viii / Abstracts published based on work in this thesis --- p.ix / Table of contents --- p.x / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Pulmonary hypertension / Chapter 1.1.1 --- Pulmonary circulation and its functions --- p.1 / Chapter 1.1.2 --- Pulmonary vascular diseases and symptoms --- p.3 / Chapter 1.2 --- Muscarinic Receptor functions --- p.5 / Chapter 1.3 --- Acetylcholine (ACh) and its function --- p.7 / Chapter 1.4 --- ACh receptors in pulmonary vascular bed --- p.11 / Chapter 1.5 --- Potassium channel classification and functions --- p.12 / Chapter 1.5.1 --- "Importance of High-conductance, Ca2+ activated potassium channel (BKca) in vascular smooth muscle functions" --- p.15 / Chapter 1.5.2 --- Modulation of BKca channel by various cations --- p.18 / Chapter 1.6 --- Calcium signaling and homeostasis --- p.20 / Chapter 1.7 --- Role of sodium in hypertension --- p.22 / Chapter 1.8 --- Na+-H+ exchanger (NHE) functions --- p.25 / Chapter 1.9 --- Na+-Ca2+ exchanger (NCX) in vascular smooth muscle cells --- p.29 / Chapter 1.10 --- Spontaneously hypertensive rat (SHR) / Chapter 1.10.1 --- Hypertension in SHR --- p.32 / Chapter 1.10.2 --- BKca in smooth muscle vasculature of SHR --- p.33 / OBJECTIVES OF THE STUDY --- p.34 / Chapter Chapter 2: --- Material and methods / Chapter 2.1 --- Material / Chapter 2.1.1 --- Solutions and Drugs --- p.35 / Chapter 2.1.2 --- Chemicals and Enzymes --- p.39 / Chapter 2.2 --- Methods / Chapter 2.2.1 --- Isolation of single pulmonary arterial smooth muscle cells --- p.40 / Chapter 2.2.2 --- Electrophysiological measurement --- p.42 / Chapter 2.2.3 --- Data analysis --- p.44 / Chapter Chapter 3: --- Receptor-mediated activation of BKca Channel / Chapter 3.1 --- BKCa activation by ACh/ Carbachol (CCh) --- p.45 / Chapter 3.2 --- Role of extracellular sodium ([Na+]o）on BKca activation --- p.49 / Chapter 3.3 --- Receptor-mediated activation of BKca in a [Na+]o-containing solution --- p.51 / Chapter 3.4 --- Receptor-mediated activation of BKca in a [Na+]o-free solution --- p.55 / Chapter Chapter 4: --- Non-receptor mediated activation of BKCa Channel / Chapter 4.1 --- Effect of different concentrations of sodium nitroprusside (SNP) on BKCa activation --- p.60 / Chapter 4.2 --- Effect of SNP on BKca activation in a [Na+]o-containing and [Na+]o-free solutions --- p.62 / Chapter Chapter 5: --- Role of NHE in modulating activation of BKCa Channel / Chapter 5.1 --- Effect of Monensin on BKca activation / Chapter 5.1.1 --- Effect of monensin on CCh-mediated activation of BKca in a [Na+]o-containing solution --- p.70 / Chapter 5.1.2 --- Effect of monensin on CCh-mediated activation of BKca in a [Na+]o-free solution --- p.74 / Chapter 5.1.3 --- Effect of monensin on SNP- mediated activation of BKca in [Na+]o-containing and [Na+]o-free solutions --- p.78 / Chapter 5.2 --- Effect of 5-(N-ethyl-N-isopropyI) amiloride (EIPA) on BKCa activation / Chapter 5.2.1 --- Effect of EIPA on CCh-mediated activation of BKca in a [Na+]o-containing solution --- p.85 / Chapter 5.2.2 --- Effect of EIPA on CCh-mediated activation of BKca in a [Na+]。-free solution --- p.89 / Chapter 5.2.3 --- Effect of EIPA on SNP-mediated activation of BKCa in [Na+]o-containing and [Na+]o-free solutions --- p.93 / Chapter Chapter 6: --- Role of NCX in modulating activation of BKCa Channel / Chapter 6.1 --- Effect of KB-R7943 on CCh-mediated activation of BKCa in a [Na+]o-containing solution --- p.100 / Chapter 6.2 --- Effect of KB-R7943 on CCh-mediated activation of BKCa in a [Na+]o-free solution --- p.104 / Chapter 6.3 --- Effect of KB-R7943 on SNP-mediated activation of BKca in [Na+]o-containing and [Na+]o-free solutions --- p.109 / Chapter Chapter 7: --- Effect of intracellular sodium ([Na+]i) on BKCa channel activation / Chapter 7.1 --- Effect of CCh on BKCa channel activation with elevated [Na+]i pipette solution --- p.117 / Chapter 7.2 --- Effect of SNP on BKca channel activation with elevated [Na+]j pipette solution --- p.130 / Chapter Chapter 8: --- Discussion / Chapter 8.1 --- Modulatory effect of ACh and SNP --- p.138 / Chapter 8.2 --- Role of ion exchangers: NHE and NCX in modulating BKca channel function --- p.144 / Chapter 8.3 --- Modulatory effect of elevated [Na+]i on BKca activation --- p.153 / CONCLUSION --- p.161 / References --- p.162