Chan Yau Chi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 157-177). / Abstracts in English and Chinese. / Contents / Declaration --- p.i / Acknowledgement --- p.ii / Abbreviations --- p.iii-iv / Abstract in English --- p.v-viii / Abstract in Chinese --- p.ix-xi / Contents --- p.xii-xvi / Chapter CHAPTER I - --- Introduction / Chapter 1.1. --- Selective Estrogen Receptor Modulators (SERMs) --- p.1 / Chapter 1.1.1. --- Raloxifene --- p.6 / Chapter 1.2. --- Mechanisms of Action of SERMs in Vascular System --- p.7 / Chapter 1.2.1. --- Estrogen --- p.7 / Chapter 1.2.2. --- Estrogen Receptors (ERs) --- p.8 / Chapter 1.2.3. --- General Mechanisms of Action of SERMs --- p.13 / Chapter 1.2.4. --- Actions of Raloxifene --- p.14 / Chapter 1.3. --- Effects of SERMs in Cardiovascular System --- p.14 / Chapter 1.3.1. --- Effects of SERMs on Endothelial Function --- p.15 / Chapter 1.3.2. --- Effects of SERMs on Vascular Smooth Muscle --- p.17 / Chapter 1.4. --- Effects of Raloxifene on Vascular Circulations --- p.18 / Chapter 1.4.1. --- Effects of Raloxifene on Systemic Circulation --- p.18 / Chapter 1.4.1.1. --- Preclinical Data --- p.18 / Chapter 1.4.1.1.1. --- Effects on Serum Lipids --- p.18 / Chapter 1.4.1.1.2. --- Effects on Inflammation Markers and Blood Coagulation --- p.19 / Chapter 1.4.1.1.3. --- Antioxidative Effects --- p.19 / Chapter 1.4.1.1.4. --- Effects on Nitric Oxide and Endothelial Function --- p.19 / Chapter 1.4.1.1.5. --- Effects on Vascular Smooth Muscle --- p.20 / Chapter 1.4.1.1.6. --- "Vascular Injury, Atherosclerosis and Ischaemia-Reperfusion Injury" --- p.20 / Chapter 1.4.1.2. --- Clinical Studies - Effects in Post-Menopausal Women --- p.21 / Chapter 1.4.1.2.1. --- "Effects on Serum Lipids, Lipoproteins and Triglycerides" --- p.21 / Chapter 1.4.1.2.2. --- Effects on Inflammation Markers and Homocysteine --- p.22 / Chapter 1.4.1.2.3. --- Effects on Coagulation Markers --- p.23 / Chapter 1.4.1.2.4. --- Effects on Endothelial Function --- p.23 / Chapter 1.4.1.2.5. --- Cardiovascular Events --- p.23 / Chapter 1.5. --- Myogenic Response and Vascular System --- p.24 / Chapter 1.5.1. --- Initiation and Development of Myogenic Response --- p.25 / Chapter 1.5.2. --- Regulation of Myogenic Response --- p.26 / Chapter 1.5.2.1. --- 20-hydroxyeicosatetraenoic acid (20-HETE) --- p.26 / Chapter 1.5.2.2. --- "Protein Kinase C, Rho/Rho-Kinase, and Tyrosine Kinase" --- p.27 / Chapter 1.5.3. --- Myogenic Response and Endothelium --- p.31 / Chapter 1.5.4. --- Estrogen and Myogenic Tone --- p.31 / Chapter 1.6. --- Objectives of the Present Study --- p.32 / Chapter CHAPTER II - --- Methods and Materials / Chapter 2.1. --- Tissue and Cell Preparation --- p.34 / Chapter 2.1.1. --- Vessel Preparation --- p.34 / Chapter 2.1.2. --- Removal of a Functional Endothelium --- p.36 / Chapter 2.2. --- Myograph and Pressure Myograph Setups --- p.36 / Chapter 2.2.1. --- Myograph 一 Isometric Tension Measurement --- p.36 / Chapter 2.2.2. --- Pressure Myograph - Isobaric Diameter Measurement --- p.37 / Chapter 2.3. --- Intracellular [Ca2+] Measurement in Vascular Smooth Muscle --- p.42 / Chapter 2.4. --- Chronic Raloxifene Therapyin Spontaneously Hypertensive Rats (SHRs) and Wistar-Kyoto Rats (WKYs) --- p.42 / Chapter 2.4.1. --- Surgical Procedure - Raloxifene Tubing Insertion --- p.42 / Chapter 2.4.2. --- "Body Weight, Mean Arterial Blood Pressure and Uterine Weight" --- p.42 / Chapter 2.4.3. --- Measurement of Raloxifene Tubing Consumption --- p.43 / Chapter 2.4.4. --- Effect of Chronic Raloxifene Treatment on Artery Reactivity --- p.43 / Chapter 2.5. --- Ovariectomy and Chronic Raloxifene Therapyin Syrian Golden Hamsters --- p.45 / Chapter 2.5.1. --- Surgical Procedure - Ovariectomy (OVX) --- p.45 / Chapter 2.5.2. --- Surgical Procedure - Raloxifene Tubing Insertion --- p.45 / Chapter 2.5.3. --- High-Cholesterol Food Preparation --- p.45 / Chapter 2.5.4. --- "Body Weight, Food Consumption and Uterine Weight" --- p.46 / Chapter 2.5.5. --- Measurement of Raloxifene Tubing Consumption --- p.46 / Chapter 2.5.6. --- Serum Lipid and Lipoprotein Determinations --- p.46 / Chapter 2.5.7. --- Effect of Chronic Raloxifene on Artery Reactivity --- p.46 / Chapter 2.6. --- Solutions and Drugs --- p.49 / Chapter 2.6.1. --- "Drugs, Chemicals and Enzymes" --- p.49 / Chapter 2.6.2. --- Solutions --- p.51 / Chapter 2.6.3. --- Diet Composition for Syrian Golden Hamsters --- p.51 / Chapter 2.7. --- Statistical Analysis --- p.52 / Chapter CHAPTER III - --- "Raloxifene Relaxes Rat Pulmonary Arteries and Veins: Roles of Gender, Endothelium, and Antagonism of Ca Influx" / Chapter 3.1. --- Abstract --- p.53 / Chapter 3.2. --- Introduction --- p.54 / Chapter 3.3. --- Methods and Materials --- p.55 / Chapter 3.3.1. --- Blood Vessel Preparation --- p.55 / Chapter 3.3.2. --- Protocols --- p.55 / Chapter 3.3.3. --- Measurement of Vascular Smooth Muscle [Ca2+]i --- p.56 / Chapter 3.3.4. --- Drugs --- p.57 / Chapter 3.3.5. --- Data Analysis --- p.53 / Chapter 3.4. --- Results --- p.58 / Chapter 3.4.1. --- Effects of Raloxifene on Pulmonary Arteries --- p.53 / Chapter 3.4.2. --- Effect of Raloxifene on CaCl2-induced Constrictionin Pulmonary Arteries --- p.59 / Chapter 3.4.3. --- Effects of Raloxifene on Pulmonary Veins --- p.59 / Chapter 3.4.4. --- Effect of Raloxifene on CaCl2-stimulated Increases in [Ca2+]i in Pulmonary Arteries --- p.60 / Chapter 3.5. --- Discussion --- p.67 / Chapter 3.6. --- Conclusion --- p.69 / Chapter CHAPTER IV - --- Raloxifene Modulates Pulmonary Vascular Reactivity in Spontaneously Hypertensive Rats / Chapter 4.1. --- Abstract --- p.70 / Chapter 4.2. --- Introduction --- p.71 / Chapter 4.3. --- Methods and Materials --- p.72 / Chapter 4.3.1. --- Raloxifene Treatment --- p.72 / Chapter 4.3.2. --- Blood Vessel Preparation --- p.72 / Chapter 4.3.3. --- Protocols --- p.73 / Chapter 4.3.4. --- Chemicals and Drugs --- p.73 / Chapter 4.3.5. --- Data Analysis --- p.74 / Chapter 4.4. --- Results --- p.74 / Chapter 4.4.1. --- Blood Pressure --- p.74 / Chapter 4.4.2. --- Vasocontraction in Spontaneously Hypertensive Rats --- p.75 / Chapter 4.4.3. --- Vasorelaxation in Spontaneously Hypertensive Rats --- p.75 / Chapter 4.4.4. --- Vasocontraction in Wistar-Kyoto rats --- p.76 / Chapter 4.4.5. --- Vasorelaxation in Wistar-Kyoto rats --- p.77 / Chapter 4.4.6. --- Comparison of contraction between WKY and SHR rats --- p.78 / Chapter 4.4.7. --- Comparison of relaxation between WKY and SHR rats --- p.78 / Chapter 4.5. --- Discussion --- p.93 / Chapter 4.6. --- Conclusion --- p.96 / Chapter CHAPTER V - --- Effects of Therapeutic Concentrations of Raloxifene in Pressurized Rat Small Mesenteric Artery / Chapter 5.1. --- Abstract --- p.98 / Chapter 5.2. --- Introduction --- p.99 / Chapter 5.3. --- Methods and Materials --- p.101 / Chapter 5.3.1. --- Blood Vessel Preparation --- p.101 / Chapter 5.3.2. --- Experimental Protocols --- p.102 / Chapter 5.3.2.1. --- Myogenic Tone Development --- p.102 / Chapter 5.3.2.2. --- Effects of Raloxifene and 17β-EstradioI on Myogenic Constriction --- p.102 / Chapter 5.3.2.3. --- Effects of Pharmacological Inhibitors on Raloxifene- or 17β-Estradiol-induced Myogenic Constriction --- p.103 / Chapter 5.3.3. --- Drugs and Solutions --- p.103 / Chapter 5.3.4. --- Expression of Results and Statistical Analysis --- p.104 / Chapter 5.4. --- Results --- p.104 / Chapter 5.4.1. --- Effects of Raloxifene and 17β-Estradiol on Rat Resistance Mesenteric Arteries1 --- p.104 / Chapter 5.4.2. --- Effects of Inhibitors of NOS --- p.105 / Chapter 5.4.3. --- Effect of CTX plus Apamin --- p.106 / Chapter 5.4.4. --- "Effect of ICI 182,780" --- p.106 / Chapter 5.4.5. --- "Effects of Wortmannin, LY 294002 and Cycloheximide" --- p.106 / Chapter 5.5. --- Discussion --- p.122 / Chapter 5.6. --- Conclusion --- p.125 / Chapter CHAPTER VI - --- Effects of Chronic Raloxifene Treatment on Vascular Reactivity in Pressurized Septal Coronary Arteries from Hamsters Fed with High-Cholesterol Diet / Chapter 6.1. --- Abstract --- p.127 / Chapter 6.2. --- Introduction --- p.128 / Chapter 6.3. --- Methods and Materials --- p.129 / Chapter 6.3.1. --- Preparatory Work --- p.129 / Chapter 6.3.1.1. --- Animals and Diets --- p.129 / Chapter 6.3.1.2. --- Preparation of High-Cholesterol (HC) Food --- p.129 / Chapter 6.3.1.3. --- Surgical Procedure - Ovariectomy (OVX) --- p.129 / Chapter 6.3.1.4. --- Surgical Procedure - Raloxifene Tubing Insertion --- p.130 / Chapter 6.3.1.5. --- Blood Vessel Preparation --- p.130 / Chapter 6.3.1.6. --- "Body Weight, Food Consumption and Uterine Weight" --- p.131 / Chapter 6.3.1.7. --- Measurement of Raloxifene Tubing Consumption --- p.131 / Chapter 6.3.1.8. --- Serum Lipid and Lipoprotein Determinations --- p.132 / Chapter 6.3.2. --- Experimental Protocols --- p.132 / Chapter 6.3.2.1. --- Development of Myogenic Tone --- p.132 / Chapter 6.3.2.2. --- Pressure-Diameter Relationships --- p.132 / Chapter 6.3.2.3. --- The Effect of Acetylcholine --- p.133 / Chapter 6.3.2.4. --- The Effect of U46619 --- p.133 / Chapter 6.3.2.5. --- The Effect of L-NAME --- p.133 / Chapter 6.3.3. --- Drugs and Solutions --- p.133 / Chapter 6.3.4. --- Expression of Results and Statistical Analysis --- p.134 / Chapter 6.4. --- Results --- p.135 / Chapter 6.4.1. --- Effects on Myogenic Response --- p.135 / Chapter 6.4.2. --- "Effects of Acetylcholine, U46619 and L-NAME" --- p.135 / Chapter 6.4.2.1. --- Comparison between OHHCD and OvxOHHCD --- p.135 / Chapter 6.4.2.2. --- Comparison between OvxOHHCD and OvxOHHCDRf --- p.135 / Chapter 6.4.2.3. --- Comparison between OHHCDRf and OvxOHHCDRf --- p.136 / Chapter 6.4.2.4. --- Comparison between OHHCD and OHHCDRf --- p.136 / Chapter 6.5. --- Discussion --- p.155 / Chapter 6.6. --- Conclusion --- p.156 / References --- p.157 / Publications --- p.176

INTRODUÇÃO: A rigidez arterial é fator de risco cardiovascular pouco estudado e importante determinante de sobrecarga cardiovascular, estando associada ao envelhecimento. Analisou-se a ação das terapêuticas com estrogênios eqüinos conjugados (EEC) ou raloxifeno sobre os índices de rigidez, com o intuito de se observar a influência destas medicações na rigidez arterial, bem como se as mesmas são capazes de influenciar o envelhecimento vascular bem sucedido. MÉTODOS: Realizou-se estudo duplo cego, randomizado, placebo-controlado, que envolveu sessenta e sete mulheres saudáveis, normotensas e com 1 a 10 anos de menopausa, divididas em três grupos de 24, 25 e 18 mulheres. Estas receberam placebo, 0,625 mg EEC ou 60 mg de raloxifeno, respectivamente, 1 comprimido por dia, por 4 meses consecutivos. Analisou-se a rigidez arterial, através da avaliação das velocidades de onda de pulso carótida-femoral (VOP CF), fêmoro-pediosa (VOP FP), e do índice de amplificação (IA) da pressão sistólica na artéria carótida. RESULTADOS: Não se observou qualquer alteração dos índices de rigidez arterial associada às intervenções farmacológicas no grupo placebo (VOP CF pré x pós: 644 x 626 cm/s, p= 0,09; VOP FP pré x pós: 1006 x 1012 cm/s, p= 0,77; IA pré x pós = 30 x 29%, p= 0,55), no grupo EEC (VOP CF pré x pós: 642 x 600 cm/s, p= 0,11; VOP FP pré x pós: 952 x 971 cm/s, p= 0,66; IA pré x pós: 25 x 32%, p= 0,82) e no grupo raloxifeno (VOP CF pré x pós: 636 x 601 cm/s, p= 0,12; VOP FP pré x pós: 964 x 941 cm/s, p= 0,62; IA pré x pós:25 x 25%, p= 0,65). Apesar da ausência de ação das drogas sobre a rigidez arterial, houve uma correlação significativa entre o grau de rigidez arterial basal e a resposta à intervenção farmacológica, particularmente no grupo EEC, de tal maneira que a redução dos índices de rigidez neste grupo foi proporcional ao nível de rigidez basal, apresentando as seguintes relações: VOP CF (r= -0,602, p= 0,001); VOP FP (r= -0,455, p= 0,022); IA (r= -0,410, p= 0,042). CONCLUSÃO: EEC e raloxifeno não parecem afetar a rigidez arterial de mulheres sadias e normotensas com menos de 10 anos de menopausa / INTRODUCTION: Arterial stiffness has been recognized as a cardiovascular risk factor, an important determinant of the left ventricular overload and a marker of cardiovascular aging. However, the clinical impact of arterial stiffness and how it is affected by hormone therapy has not been fully investigated. This study analyzed the influence of conjugated equine estrogens (CEE) or raloxifene on arterial stiffness and how the may influence successful cardiovascular aging. METHODS: Sixty-seven healthy and normotensive women with 1 to 10 years of menopause were randomly assigned to one of three groups, with 24, 25, and 18 participants. They were given oral placebo, 0,625 mg of conjugated equine estrogen, or 60 mg of raloxifene, respectively, for 4 consecutive months. Arterial stiffness was evaluated by measurement of the carotid-femoral pulse wave velocity (PWV CF) and femoral-dorsalis pedis pulse wave velocity (PWV FP), and the systolic pressure augmentation index (AI) at the carotid artery obtained by applanation tonometry. RESULTS: None of the treatment regimens affected arterial stiffness: placebo (PWV CF before x after: 644 x 626 cm/s, p= 0.09; PWV FP before x after : 1006 x 1012 cm/s, p= 0.77; AI before x after = 30 x 29%, p= 0.55), CEE (PWV CF before x after: 642 x 600 cm/s, p= 0.11; PWV FP before x after: 952 x 971 cm/s, p= 0.66; AI before x after: 25 x 32%, p= 0.82) and raloxifene (PWV CF before x after: 636 x 601 cm/s, p= 0.12; PWV FP before x after: 964 x 941 cm/s, p= 0.62; AI before x afer:25 x 25%, p= 0.65). Despite the absence of statistically significant reduction in arterial stiffness with treatment, there was a significant correlation between basal stiffness and the degree of reduction in the indexes measured, indicating that the higher the basal stiffness, the greater the degree of reduction, particularly in the CEE group: PWV CF (r= -0.602, p= 0.001); PWV FP (r= -0.455, p= 0.022); AI (r= -0.410, p= 0.042). CONCLUSIONS: Conjugated equine estrogen and raloxifene do not seem to affect arterial stiffness of healthy normotensive women with less than 10 years of menopause

INTRODUÇÃO: A rigidez arterial é fator de risco cardiovascular pouco estudado e importante determinante de sobrecarga cardiovascular, estando associada ao envelhecimento. Analisou-se a ação das terapêuticas com estrogênios eqüinos conjugados (EEC) ou raloxifeno sobre os índices de rigidez, com o intuito de se observar a influência destas medicações na rigidez arterial, bem como se as mesmas são capazes de influenciar o envelhecimento vascular bem sucedido. MÉTODOS: Realizou-se estudo duplo cego, randomizado, placebo-controlado, que envolveu sessenta e sete mulheres saudáveis, normotensas e com 1 a 10 anos de menopausa, divididas em três grupos de 24, 25 e 18 mulheres. Estas receberam placebo, 0,625 mg EEC ou 60 mg de raloxifeno, respectivamente, 1 comprimido por dia, por 4 meses consecutivos. Analisou-se a rigidez arterial, através da avaliação das velocidades de onda de pulso carótida-femoral (VOP CF), fêmoro-pediosa (VOP FP), e do índice de amplificação (IA) da pressão sistólica na artéria carótida. RESULTADOS: Não se observou qualquer alteração dos índices de rigidez arterial associada às intervenções farmacológicas no grupo placebo (VOP CF pré x pós: 644 x 626 cm/s, p= 0,09; VOP FP pré x pós: 1006 x 1012 cm/s, p= 0,77; IA pré x pós = 30 x 29%, p= 0,55), no grupo EEC (VOP CF pré x pós: 642 x 600 cm/s, p= 0,11; VOP FP pré x pós: 952 x 971 cm/s, p= 0,66; IA pré x pós: 25 x 32%, p= 0,82) e no grupo raloxifeno (VOP CF pré x pós: 636 x 601 cm/s, p= 0,12; VOP FP pré x pós: 964 x 941 cm/s, p= 0,62; IA pré x pós:25 x 25%, p= 0,65). Apesar da ausência de ação das drogas sobre a rigidez arterial, houve uma correlação significativa entre o grau de rigidez arterial basal e a resposta à intervenção farmacológica, particularmente no grupo EEC, de tal maneira que a redução dos índices de rigidez neste grupo foi proporcional ao nível de rigidez basal, apresentando as seguintes relações: VOP CF (r= -0,602, p= 0,001); VOP FP (r= -0,455, p= 0,022); IA (r= -0,410, p= 0,042). CONCLUSÃO: EEC e raloxifeno não parecem afetar a rigidez arterial de mulheres sadias e normotensas com menos de 10 anos de menopausa / INTRODUCTION: Arterial stiffness has been recognized as a cardiovascular risk factor, an important determinant of the left ventricular overload and a marker of cardiovascular aging. However, the clinical impact of arterial stiffness and how it is affected by hormone therapy has not been fully investigated. This study analyzed the influence of conjugated equine estrogens (CEE) or raloxifene on arterial stiffness and how the may influence successful cardiovascular aging. METHODS: Sixty-seven healthy and normotensive women with 1 to 10 years of menopause were randomly assigned to one of three groups, with 24, 25, and 18 participants. They were given oral placebo, 0,625 mg of conjugated equine estrogen, or 60 mg of raloxifene, respectively, for 4 consecutive months. Arterial stiffness was evaluated by measurement of the carotid-femoral pulse wave velocity (PWV CF) and femoral-dorsalis pedis pulse wave velocity (PWV FP), and the systolic pressure augmentation index (AI) at the carotid artery obtained by applanation tonometry. RESULTS: None of the treatment regimens affected arterial stiffness: placebo (PWV CF before x after: 644 x 626 cm/s, p= 0.09; PWV FP before x after : 1006 x 1012 cm/s, p= 0.77; AI before x after = 30 x 29%, p= 0.55), CEE (PWV CF before x after: 642 x 600 cm/s, p= 0.11; PWV FP before x after: 952 x 971 cm/s, p= 0.66; AI before x after: 25 x 32%, p= 0.82) and raloxifene (PWV CF before x after: 636 x 601 cm/s, p= 0.12; PWV FP before x after: 964 x 941 cm/s, p= 0.62; AI before x afer:25 x 25%, p= 0.65). Despite the absence of statistically significant reduction in arterial stiffness with treatment, there was a significant correlation between basal stiffness and the degree of reduction in the indexes measured, indicating that the higher the basal stiffness, the greater the degree of reduction, particularly in the CEE group: PWV CF (r= -0.602, p= 0.001); PWV FP (r= -0.455, p= 0.022); AI (r= -0.410, p= 0.042). CONCLUSIONS: Conjugated equine estrogen and raloxifene do not seem to affect arterial stiffness of healthy normotensive women with less than 10 years of menopause