Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [114]-130).

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 81-91).

Hypertensive patients exhibit impaired exercise capacity, a strong independent risk factor for cardiovascular disease, and the mechanisms responsible for this are not fully determined. Potential candidates may include endothelial vasomotor dysfunction and arterial stiffness, both of which are associated with hypertension. Impairment of the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway plays a major role in the development of these abnormalities, suggesting that enhancement of NO-cGMP signalling through phosphodiesterase type 5 (PDE5) inhibition may offer therapeutic potential in arterial hypertension. This thesis investigated the effects of the PDE5 inhibitor sildenafil citrate on exercise-induced vasodilatation, maximal exercise capacity and arterial stiffness in hypertensive patients, using different studies involving local limb and whole body exercise. Preliminary dose-ranging studies were initially performed to investigate the intraarterial (brachial) effects of sildenafil on forearm blood flow (FBF), and to select an appropriate, cGMP-independent, vasodilator to use as a control. On the basis on these studies, it was established that sildenafil, infused at 50μg/min, and verapamil, infused at 5μg/min, had similar vasodilator effect on FBF. Ten untreated hypertensive patients and ten matched normotensive subjects were then studied in a three-way, randomised, single-blind and placebo-controlled FBF study. The aim was to investigate the effects of sildenafil on handgrip exercise-induced vasodilatation, and to compare this response with verapamil and saline (placebo). Preinfusion exercise-induced vasodilatation was significantly reduced in hypertensive compared with normotensive subjects (P<0.001). However, after the infusions, while verapamil did not affect the vasodilator response to exercise in either group, sildenafil substantially enhanced this response in hypertensive patients, but not in normotensive subjects (P<0.05). These results suggested that sildenafil, through an increase in cGMP levels in the vasculature, substantially and selectively improves the vasodilator response to handgrip exercise in hypertensive patients.

Background: Ethanol is a cardiotoxic substance that damages the heart by increasing apoptosis, free radical formation and calcium overloading. Consequently, there is an increase in cell death leaving fewer functioning myocytes leading to heart failure. Sildenafil is a phosphodiesterase type-5 (PDE-5) inhibitor approved for treatment of erectile dysfunction. Studies from our lab have demonstrated that PDE-5 inhibition reduces myocardial infarct size and attenuates post-ischemic cardiac dysfunction in both ischemia-reperfusion and permanent coronary artery ligation models. Therefore, in the present study, we hypothesized that treatment with sildenafil will prevent cardiotoxicity associated with acute alcohol exposure by reducing myocyte apoptosis and preserving cardiac function through PKG signaling. Methods and Results: Adult cardiomyocytes were isolated and treated with 100 mM of 100% ethanol ± 10 µM sildenafil. At 24 hours necrosis was assessed via trypan blue exclusion assay, JC-1 staining assessed mitochondrial membrane potential and ROS production was measured by DCF fluorescence. At 48 hours apoptosis was assessed by TUNEL assay. Ethanol increased the rate of necrotic and apoptotic cell death. This was attenuated by co-treatment with sildenafil. Ethanol disrupted the mitochondrial membrane potential and increased ROS production. Sildenafil preserved mitochondrial membrane potential and attenuated ROS production. Treatment of myocytes with 5-HD, a mitochondrial K+atp channel antagonist, blocked the protective effect of sildenafil. Knockdown of PKG using adenoviral siRNA blocked the protective effect of sildenafil, while overexpression of PKG1α conferred protection against ethanol cytotoxicity. To further demonstrate the effect of sildenafil ethanol-cardiotoxicity in vivo, mice were treated with ethanol (3 g/kg/day) with or without sildenafil (0.7 mg/kg) by i.p. injection for three consecutive days. After treatment, the animals were sacrificed and the hearts removed and perfused on a Langendorff system to measure function. After functional analysis, apoptosis and PKG activity was measured in the heart samples. Ethanol decreased the rate-force product and increased myocardial apoptosis. Sildenafil preserved cardiac function and significantly reduced apoptosis. Sildenafil treated myocardium also showed an increase in PKG activity. Conclusion: Sildenafil attenuates the toxic effect of ethanol by reducing apoptosis and maintaining the mitochondrial integrity in cardiomyocytes. Sildenafil also preserved cardiac function in ethanol-treated mice. Protein kinase G-dependent signaling plays a critical role in attenuating cardiotoxic effect of ethanol.

Introdução e objetivos: A ejaculação precoce é uma forma de disfunção sexual presente em 25,8% dos homens brasileiros. O objetivo do presente estudo é avaliar se a associação de tadalafila, um inibidor da fosfodiesterase-5 e fluoxetina, um inibidor da recaptação da serotonina em uma apresentação de liberação lenta, ambos tomados uma vez por semana, pode prolongar o tempo de latência da ejaculação em homens com ejaculação precoce. Pacientes e Métodos: Sessenta pacientes com ejaculação precoce e sem disfunção erétil foram avaliados. A idade média foi 45,5 anos de idade (desvio padrão +/- 9,6). O tempo médio de ejaculação antes do início do tratamento era 51,3 segundos (desvio padrão +/- 23 segundos) e não foi estatisticamente significativo entre os grupos (p=0,805). Foram distribuídos de forma aleatória e duplo-cega em 4 grupos, conforme a medicação recebida: (1) fluoxetina 90 mg e placebo, (2) tadalafila 20 mg e fluoxetina 90 mg, (3) tadalafila 20 mg e placebo, e (4) placebo com placebo. Antes de iniciar qualquer medicamento, os pacientes anotaram o tempo de latência para ejaculação com um mesmo cronômetro uma vez por semana, durante 3 semanas. À partir do início do uso dos medicamentos, os pacientes cronometraram o tempo em nove ocasiões, uma vez por semana. Foi usado fluoxetina 90 mg ou placebo semanalmente e tadalafila 20 mg ou placebo em um intervalo de até 36 horas da presumida relação sexual com parceira heterossexual regular. Os pacientes foram prospectivamente seguidos a cada 3 semanas durante 12 semanas. Resultados: A comparação dos grupos com análise de variância (ANOVA) unidirecional demonstrou diferença estatisticamente significativa no tempo de ejaculação após tratamento (p<0,001). O maior aumento em relação ao tempo basal foi observado no grupo que associou tadalafila 20 mg com fluoxetina 90 mg semanalmente (p<0,001). Reações adversas foram observadas, tendo sido toleradas e equivalentes entre os grupos usando princípio ativo. Conclusão: Tadalafila 20 mg utilizada em um período de 36 horas de atividade sexual associado com fluoxetina 90 mg de liberação lenta usada semanalmente, significativamente aumentou o tempo de latência de ejaculação em homens com ejaculação precoce, quando comparados com cada droga usada isoladamente, beneficiando esses pacientes sem a necessidade do uso diário de medicamentos. / Introduction and Objectives: Premature ejaculation is a sexual disorder present in 25.8% of brazilian men. The aim of the present study is to evaluate if the association of tadalafil, a phosphodiesterase-5 inhibitor and fluoxetine, a selective serotonin reuptake inhibitor in a slow release presentation, both taken once a week, can prolong the intravaginal ejaculatory latency time (IELT) in men with premature ejaculation. Methods: Sixty patients with premature ejaculation and no erectile dysfunction were enrolled in the protocol. Mean age was 45.5 years (range 24 - 64 years, standard deviation +/- 9.6). They were randomly assigned in a double-blind manner into 4 groups to use the medications: (1) fluoxetine 90 mg and placebo, (2) tadalafil 20 mg and fluoxetine 90 mg, (3) tadalafil 20 mg and placebo, and (4) two different placebo capsules. Before starting any medication, each individual timed the IELT with a given stopwatch in 3 different days, and likewise weekly during the treatment period. Mean IELT before starting treatment was 51.3 seconds (sd: +/- 23 seconds), and was not different between groups (p=0.805). They took fluoxetine 90 mg or placebo once a week, and tadalafil 20 mg or placebo in a 36-hour frame of intended sexual intercourse with a regular heterosexual partner. Patients were prospectively followed every 3 weeks during a 12-week interval. Results: Comparison between groups with oneway ANOVA demonstrated a statistically significant difference in post-treatment IELT (p<0.001). The greatest increase in time from baseline IELT was observed in patients in the tadalafil plus fluoxetine group (p<0.001). Side effects were observed and tolerated, being equivalent in groups using active drugs. Conclusion: Tadalafil 20 mg taken in a 36-hour window for sexual intercourse associated with fluoxetine 90 mg in a slow release form taken weekly, significantly increased the intravaginal ejaculatory latency time from baseline in men with premature ejaculation, when compared to either drug taken solely, benefiting patients without the need to be medicated on a daily basis.

The extent of damage in animal models of spinal cord injury (SCI) can be reduced by various neuroprotective regimens that include maintaining levels of the second messenger, cyclic adenosine monophosphate (cAMP), via administration of the phosphodiesterase 4 inhibitor, Rolipram. The current study sought to determine the optimal neuroprotective dose, route and therapeutic window for Rolipram following thoracic contusive SCI injury in rat. Rolipram or vehicle control (10% ethanol) was given daily for 2 weeks post-injury (PI) after which the preservation of oligodendrocytes, neurons and central myelinated axons (CMAs) was stereologically assessed. Doses of 0.1 mg/kg to 1.0 mg/kg (2 h PI) increased neuronal survival; 0.5 mg- 1.0 mg/kg protected oligodendrocytes, 1.0 mg/kg produced optimal preservation of CMAs. Administration of 1.0 mg/kg Rolipram via different routes (intravenous [i.v.], subcutaneous [s.c.] or oral, 2 h PI) demonstrated that all routes allowed for significant protection following SCI; the i.v. route provided the best clinical translation. Examination of delayed treatment, initiated 1-48 h after SCI, revealed protective efficacy of Rolipram even when administered up to 48 h PI. With the optimal therapeutic protocol (1.0 mg/kg, i.v.), Rolipram reduced the levels of the chemokine, monocyte chemoattractant protein acutely post-injury and elevated the levels of the anti-inflammatory cytokine, interleukin-10, based on Enzyme-Linked ImmunoSorbent Assay (ELISA) results. Rolipram, when delivered within 48 h PI, was also able to significantly reduce the number of ED1-positive mononuclear phagocytes compared to vehicle-treated controls. This work supports the use of Rolipram as an acute neuroprotectant following SCI, defines an administration protocol, and investigates a potential mechanism for Rolipram-mediated protection.

Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) act as second messengers in intracellular signaling cascades to influence neuronal responses. Hippocampal cAMP signaling is thought to underlie the pathophysiology of major depressive disorder (MDD) and antidepressant action; however, little is known about the possible role of cGMP signaling. Furthermore, circadian rhythm disturbances can occur as part of the clinical symptoms of MDD and resolve with antidepressant therapy. The pineal gland is relevant to circadian rhythms as it secretes the hormone melatonin following activation of cAMP signaling and the rate-limiting enzyme for its synthesis, arylalkylamine N-acetyltransferase (AA-NAT). Little is known about the contribution of the phosphodiesterase (PDE) system to antidepressant-induced alterations in pineal cAMP signaling and melatonin synthesis. There is a need to clarify the trajectory of cAMP and cGMP concentrations, their synthesis by cyclases, and degradation by PDEs to understand the role of cyclic mononucleotide signaling in the effect of chronic antidepressant therapy. Using quantitative real-time PCR and enzyme immunoassay, we systematically studied elements of intracellular signaling in the hippocampus of rats chronically treated with imipramine, fluoxetine, and amitriptyline and in the pineal gland of rats treated chronically with fluoxetine. In the hippocampus, we found chronic imipramine downregulated cAMP signaling with decreased cAMP, increased PDEs and decreased adenylate cyclase mRNA. In contrast, repeated fluoxetine and amitriptyline increased hippocampal cGMP signaling, with increased cGMP and decreased PDE mRNA. We conclude that in contrast to the assumption of antidepressant-mediated increases in cAMP levels, increased hippocampal cGMP signaling might underlie the efficacy of chronic antidepressant treatment. A follow up study using cultured embryonic rat hippocampal cells in vitro treated with the PDE type 5 inhibitor, sildenafil, demonstrated increased cAMP content following acute and chronic treatment, indicating either crosstalk between cAMP and cGMP pathways or a non-specific inhibitory effect of sildenafil on other PDEs. In the pineal gland, we found elevated melatonin synthesis with increased pineal AA-NAT mRNA and daytime plasma melatonin and downregulated cAMP signaling with increased PDE and unchanged AC pineal mRNA, and decreased pineal cAMP. We conclude that chronic fluoxetine increases daytime plasma melatonin and pineal AA-NAT mRNA despite downregulated pineal cAMP signaling.

During the development of atherosclerosis, contractile vascular smooth muscle cells (VSMCs) change to cells capable of migrating and proliferating to mediate repair, where the responses may be adaptive or mal-adaptive in effect. Cyclic adenosine monophosphate (cAMP)-elevating agents have been shown to inhibit migration of VSMC. cAMP activity within the cell is known to be ubiquitous and dynamic, requiring control through signal termination mechanisms for cellular homeostasis. Phosphodiesterase (PDE) enzymes are central to this critical regulatory process catalyzing the hydrolysis of cAMP. A great deal of insight into the role of PDEs in defining compartmentalization of cAMP signaling has arisen predominately from recent studies on the cAMP-specific PDE4 family. Compartmentalization of PDE4 is mediated by their unique N-terminal domains, which have been proposed to provide the “postcodes/zipcodes” for cellular localization. PDE4D isoforms vary widely, yet their conservation over evolutionary time suggests important non-redundant roles in distinct cellular processes. To study the potential role of individual PDE4D isoforms we seek to utilize the unique N-terminal targeting domains that are proposed to be responsible for their protein-protein interactions and site-directed localization. Herein, we report on the expression, targeting and localization of five “long” PDE4D isoforms and the impact on cell morphology of certain amino-terminal domains of individual PDE4D constructs expressing green fluorescent protein (NT-PDE4D/GFP) in human aortic smooth muscle cells (HASMCs). Through the development of engineered NT-PDE4D/GFP expression plasmids, we were able to study the cell biological impacts associated with the overexpression of individual PDE4D amino-terminal variants in HASMCs. We show that NT-PDE4D5/GFP and NT-PDE4D7/GFP expressing cells exhibited an elongated cell morphology, where this effect was much more marked in NT-PDE4D7/GFP expressing cells, exhibiting multiple leading edge structures and highly elongated “tails”. We identify a potential role for PDE4D7 targeting in the regulation of cell polarity and migration. Our results suggest the novel idea that PDE4D7, rather than the four other long PDE4D isoforms (PDE4D3, PDE4D5, PDE4D8, or PDE4D9), represents the dominant PDE4D variant involved in controlling cAMP-mediated effects on cell tail retraction dynamics. / Thesis (Master, Pathology & Molecular Medicine) -- Queen's University, 2014-03-13 13:00:31.684 / Video I: Time-lapse video of GFP-expressing cell migration in HASMC. GFP expressing cells did not differ in cell migration or morphology compared to non-injected control cells. HASMCs were microinjected with GFP construct. Representative images of micoinjected GFP cells were taken 24 h post-injection overnight at 30min intervals using a Zeiss Axiovert S100 microscope and processed as described in Materials & Methods. (10X) / Video II: Time-lapse video of NT-PDE4D7/GFP-expressing cell migration in HASMC. NT-PDE4D7/GFP expressing cells exhibit elongated tail and decrease in cell migration compared to non-injected control cells. HASMCs were microinjected with NT-PDE4D7/GFP construct. Particle tracking of NT-PDE4D7 cells showed cleaving and full detachment of elongated tail. Representative images of micoinjected NT-PDE4D7 cells were taken 24 h post-injection overnight at 30min intervals using a Zeiss Axiovert S100 microscope and processed as described in Materials & Methods. (10X)

Natriuretic peptides are a group of hormones, including atrial-, brain-, and C-type- natriuretic peptides (ANP, BNP, CNP). BNP can bind to two NP receptors (NPRs) denoted NPR-A (activates guanylyl cyclase) and NPR-C (activates inhibitory G- proteins). This study investigated the electrophysiological effects of BNP on isolated mouse atrial myocytes. Current-clamp experiments show that BNP had no effect on action potential (AP) parameters in basal conditions; however, when pre-stimulated with the ?-adrenergic receptor agonist isoproterenol (ISO), BNP prolonged AP duration. Voltage-clamp experiments demonstrate that BNP increased L-type calcium current (ICa,L) in the presence of ISO without altering cardiac potassium currents. The BNP effect on ICa,L was blocked by A71915 (a selective NPR-A antagonist), maintained in myocytes lacking NPR-C receptors and blocked by the phosphodiesterase-3 (PDE-3) inhibitor milrinone. These data demonstrate that BNP prolongs AP duration and increases ICa,L in atrial myocytes by activating NPR-A, increasing intracellular cGMP, and inhibiting PDE- 3.

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