Agonist-induced vasoactive responses in isolated perfused porcine dental pulpal arterioles

The Postural Autonomic Regulation of Pulpal Blood Flow

Evidence suggests that postural changes in systemic blood pressure may significantly affect blood flow in the dental pulp. This in vivo study examined the responses of pulpal perfusion, systemic blood pressure, and heart rate to postural changes in humans. The experiments were done on 21 premolars in 16 participants aged 20-31 yrs. Pulpal blood flow recordings were measured by means of a laser Doppler Flowmeter. A blood pressure monitor was used to record blood pressure and heart rate. All measurements were simultaneously recorded for 1 min, 5 min after participants made postural changes. Changing from supine to standing caused a significant reduction in pulpal perfusion, while heart rate and diastolic blood pressure increased significantly. A significant non-linear relationship was found between percentage changes in pulpal perfusion and heart rate resulting from standing up. We speculate that when patients arise from the supine position, the shift in venous blood to the legs transiently (2-10 sec) lowers venous return and cardiac output, causing less inhibition of the vasomotor center, which, in turn, results in increased heart rate and blood pressure, but a decrease in pulpal blood flow. These results suggest that pulpal blood flow is affected by postural change, presumably via the autonomic nervous system.

Current and prospective pharmacological targets in relation to antimigraine action

Migraine is a recurrent incapacitating neurovascular disorder characterized by unilateral and throbbing headaches associated with photophobia, phonophobia, nausea, and vomiting. Current specific drugs used in the acute treatment of migraine interact with vascular receptors, a fact that has raised concerns about their cardiovascular safety. In the past, alpha-adrenoceptor agonists (ergotamine, dihydroergotamine, isometheptene) were used. The last two decades have witnessed the advent of 5-HT(1B/1D) receptor agonists (sumatriptan and second-generation triptans), which have a well-established efficacy in the acute treatment of migraine. Moreover, current prophylactic treatments of migraine include 5-HT(2) receptor antagonists, Ca(2+) channel blockers, and beta-adrenoceptor antagonists. Despite the progress in migraine research and in view of its complex etiology, this disease still remains underdiagnosed, and available therapies are underused. In this review, we have discussed pharmacological targets in migraine, with special emphasis on compounds acting on 5-HT (5-HT(1-7)), adrenergic (alpha(1), alpha(2,) and beta), calcitonin gene-related peptide (CGRP(1) and CGRP(2)), adenosine (A(1), A(2), and A(3)), glutamate (NMDA, AMPA, kainate, and metabotropic), dopamine, endothelin, and female hormone (estrogen and progesterone) receptors. In addition, we have considered some other targets, including gamma-aminobutyric acid, angiotensin, bradykinin, histamine, and ionotropic receptors, in relation to antimigraine therapy. Finally, the cardiovascular safety of current and prospective antimigraine therapies is touched upon.

An overview of the dental pulp: its functions and responses to injury

The dental pulp is a unique tissue and its importance in the long-term prognosis of the tooth is often ignored by clinicians. It is unique in that it resides in a rigid chamber which provides strong mechanical support and protection from the microbial rich oral environment. If this rigid shell loses its structural integrity, the pulp is under the threat of the adverse stimuli from the mouth, such as caries, cracks, fractures and open restoration margins, all of which provide pathways for micro-organisms and their toxins to enter the pulp. The pulp initially responds to irritation by becoming inflamed and, if left untreated, this will progress to pulp necrosis and infection. The inflammation will also spread to the surrounding alveolar bone and cause periapical pathosis. The magnitude of pulp-related problems should not be underestimated since their most serious consequence is oral sepsis, which can be life threatening, and hence correct diagnosis and management are essential. Clinicians must have a thorough understanding of the physiological and pathological features of the dental pulp as well as the biological consequences of treatment interventions.

Pharmacological properties of serotonin receptor subtypes mediating contraction of bovine inferior alveolar arteries

OBJECTIVE

To characterise the 5-hydroxytryptamine (5-HT) receptor subtypes mediating contraction of the inferior alveolar artery. Additionally, to determine the role of cyclooxygenase products, nitric oxide, endothelium, monoamine oxidase and 5-HT uptake in modulating contraction of inferior alveolar arteries to 5-HT.

METHODS

Contractile responses to 5-HT were examined in vitro using ring segments of bovine inferior alveolar arteries. Affinity constants (K(B)'s) of subtype-selective 5-HT receptor antagonists were determined to characterise the 5-HT receptor-subtypes causing contraction of inferior alveolar arteries.

RESULTS

In 100 nM ketanserin or 30 nM spiperone, 5-HT caused a biphasic contraction best-fit by a two-site curve model, where one site was antagonist-sensitive and the other site antagonist-insensitive. 5-HT(2A) receptor-subtype selective antagonists, ketanserin and spiperone, blocked 5-HT induced contraction with K(B)'s of 1.0 and 0.16 nM, respectively. RS102221 (5-HT(2C) selective) and (S)-WAY100135 (5-HT(1A) selective) blocked 5-HT stimulated contraction with low affinities (K(B)'s=100 nM and 330 nM, respectively). GR55562, a 5-HT(1) receptor subtype antagonist with a reported affinity of 500 nM at the 5-HT(1D) receptor subtype, blocked 5-HT induced contraction with a K(B) of 470 nM. Cylooxygenase inhibition with 50 microM ibuprofen caused a 44% increase in maximal contraction to 5-HT; whereas, nitric oxide inhibition with N(G)-nitro-L-arginine, endothelium removal or inhibition of 5-HT uptake and monoamine oxidase with imipramine and iproniazid, respectively, did not affect 5-HT contraction.

CONCLUSIONS

Both 5-HT(2A) and 5-HT(1D/1B) receptor subtypes mediate 5-HT induced contraction of the bovine inferior alveolar artery. 5-HT stimulated contraction of the inferior alveolar artery is modulated by a vasodilator prostaglandin.

Uptake and release of [3H]adenosine in human dental pulp

The purpose of this study was to examine the uptake and release of adenosine in human dental pulp. Pulp was removed from extracted teeth and incubated in [3H]adenosine (0.02-3.2 micromol/l) for 30-90 min, washed for 30 min and the residual [3H]adenosine extracted and assayed. At 0.02 and 0.4 micromol/l the uptake was saturated after 30 min, whereas at 3.2 micromol/l it was not, even after 90 min. Destruction of the sympathetic nerves by 6-hydroxydopamine prior to incubation in [3H]adenosine (0.4 micromol/l) decreased the uptake of [3H] by 40%. Addition of S(4-nitrobenzyl)-6-thioguanosine (NBTG; 0.1 micromol/l), an inhibitor of adenosine uptake, blocked 90% of the uptake. Electrical stimulation of sympathetic nerves following incubation of pulp in [3H]adenosine (0.4 micromol/l) increased the overflow of [3H] into the medium superfusing the tissue segments. NBTG (0.1 micromol/l) had no effect on this overflow, whereas denervation with 6-hydroxydopamine prior to incubation decreased the overflow by 85%. Although the contribution of post-junctional elements, such as smooth muscle, to this release was not determined it is proposed that most of the purine released was derived from sympathetic nerves.

An in vivo and in vitro comparison of the effects of vasoactive mediators on pulpal blood vessels in rat incisors

The effects of endogenous vasoactive substances were evaluated in anaesthetized rats using a laser Doppler flowmeter to monitor changes in pulpal blood flow, as well as directly in isolated pulpal arteriole preparations utilising a microperfusion and monitoring system to observe changes in vessel diameter. In anaesthetized rats, while systemic arterial blood pressure remained relatively stable, intra-arterial delivery of adrenaline (epinephrine) (A), noradrenaline (norepinephrine) (NA), phenylephrine (PHE), dopamine (DOPA), 5-hydroxytryptamine (5-HT), or endothelin-1 (ET-1) produced a dose-dependent reduction in pulpal blood flow (order of potency: ET-1>>A=NA>PHE=DOPA=5-HT); acetylcholine induced a dose-dependent increase in pulpal blood flow; histamine, isoproterenol and adenosine produced no significant changes. In isolated arteriole preparations, intraluminal delivery of A, NA, PHE, DOPA or 5-HT produced dose-dependent vasoconstriction (A=NA>PHE=DOPA=5-HT). Acetylcholine relaxed NA-precontracted vessels dose-dependently. Histamine and isoproterenol produced a small vasodilatation. Intraluminal ET-1 produced a small vasoconstriction at 10(-8)M, whereas extraluminal ET-1 produced a dose-dependent vasoconstriction from 10(-10)M and above. Intraluminal adenosine failed to dilate vessels precontracted with ET-1, whereas extraluminal adenosine caused a complete relaxation. These combined in vivo and in vitro data suggest that, in the rat incisor, the pulpal microcirculation is capable of functional regulation and that pulpal blood flow may be modulated by endothelium-related factors, metabolic (tissue-related) factors, as well as humoral (blood-borne) factors.