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Departments of
¹ Physiology
² Medicine
³ Center for Heart, Hypertension and Kidney Disease, University of Maryland School of Medicine, Baltimore, MD, USA
⁴ Departments of Medicine and Physiology and the Institute for Molecular Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
⁵ Division of Nephrology, Dialysis and Hypertension, Hospital San Raffaele, Milan, Italy
⁶ Prassis Instituto Ricerche Sigma-Tau, Milan, Italy
⁷ Department of Pharmacology, Fukuoka University School of Medicine, Fukuoka, Japan
⁸ Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

	Abstract

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A key question in hypertension is: How is long-term blood pressure controlled? A clue is that chronic salt retention elevates an endogenous ouabain-like compound (EOLC) and induces salt-dependent hypertension mediated by Na⁺/Ca²⁺ exchange (NCX). The precise mechanism, however, is unresolved. Here we study blood pressure and isolated small arteries of mice with reduced expression of Na⁺ pump 1 (1^+/–) or 2 (2^+/–) catalytic subunits. Both low-dose ouabain (1–100 nM; inhibits only 2) and high-dose ouabain (1 µM; inhibits 1) elevate myocyte Ca²⁺ and constrict arteries from 1^+/–, as well as 2^+/– and wild-type mice. Nevertheless, only mice with reduced 2 Na⁺ pump activity (2^+/–), and not 1 (1^+/–), have elevated blood pressure. Also, isolated, pressurized arteries from 2^+/–, but not 1^+/–, have increased myogenic tone. Ouabain antagonists (PST 2238 and canrenone) and NCX blockers (SEA0400 and KB-R7943) normalize myogenic tone in ouabain-treated arteries. Only the NCX blockers normalize the elevated myogenic tone in 2^+/– arteries because this tone is ouabain independent. All four agents are known to lower blood pressure in salt-dependent and ouabain-induced hypertension. Thus, chronically reduced 2 activity (2^+/– or chronic ouabain) apparently regulates myogenic tone and long-term blood pressure whereas reduced 1 activity (1^+/–) plays no persistent role: the in vivo changes in blood pressure reflect the in vitro changes in myogenic tone. Accordingly, in salt-dependent hypertension, EOLC probably increases vascular resistance and blood pressure by reducing 2 Na⁺ pump activity and promoting Ca²⁺ entry via NCX in myocytes.

(Received 31 May 2005; accepted after revision 8 September 2005; first published online 15 September 2005)
Corresponding author M. P. Blaustein: Department of Physiology, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA. Email: mblauste{at}umaryland.edu

	Introduction

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Elevated blood pressure (BP), hypertension, is prevalent in developed societies, and is a major risk factor for disability and death (Kaplan, 2002; Chobanian et al. 2003). Salt (NaCl) retention by the kidneys typically leads to hypertension (Guyton, 1990; Kaplan, 2002; Johnson et al. 2005). Indeed, monogenic diseases of renal salt retention raise BP; in contrast, salt wasting syndromes lower BP (Lifton et al. 2001). Mutation, knockout or duplication of genes that affect BP induce either salt-dependent hypertension or unusual forms of salt-independent hypertension (Takahashi & Smithies, 1999). In essential hypertension, the primary defect may be an acquired renal injury rather than a genetic defect (Johnson et al. 2005). Nevertheless, none of those studies have addressed the question of precisely how salt retention leads to chronic hypertension (Kaplan, 2002; Johnson et al. 2005). In this paper we elucidate downstream molecular mechanisms and clarify the link between salt and hypertension.

Mean arterial BP depends primarily on cardiac output (CO) and total peripheral systemic vascular resistance (TPR) (Berne & Levy, 2001): at constant CO, mean BP CO x TPR. Acute plasma volume expansion elevates BP by increasing CO (Borst & Borst-de Geus, 1963; Guyton, 1990). With sustained volume expansion, however, TPR rises to maintain the elevated BP while CO declines (Borst & Borst-de Geus, 1963; Guyton, 1990). This condition of high TPR and near-normal CO is commonly observed in humans with essential hypertension (Cowley, 1992; Kaplan, 2002). Nevertheless, long-term control of BP is still poorly understood.

The shift from high CO to high TPR, called ‘whole-body autoregulation’, has been attributed to regulation of blood flow to meet metabolic demand (Guyton, 1990; Kaplan, 2002). This view is controversial (Julius, 1988), however, and the mechanisms are unresolved (Kaplan, 2002; Johnson et al. 2005). According to one hypothesis (Fig. 1) (Blaustein, 1977), salt retention promotes secretion of an endogenous cardiotonic (and vasotonic) steroid that inhibits Na⁺ pumps, including those in vascular smooth muscle. By raising the cytosolic Na⁺ concentration ([Na⁺]_cyt), this agent would be expected to promote Na⁺/Ca²⁺ exchanger (NCX)-mediated Ca²⁺ entry into the myocytes. This should elevate the cytosolic Ca²⁺ concentration ([Ca²⁺]_cyt), and thus increase TPR by enhancing myogenic tone, the intraluminal pressure-induced intrinsic arterial constriction that is prominent in small resistance arteries (Hill et al. 2001). Indeed, recent evidence reveals that NCX type-1 (NCX1) in arterial myocytes plays a central role in ouabain-induced hypertension and salt-dependent hypertension (Iwamoto et al. 2004b).

View larger version (30K): [in this window] [in a new window]   Figure 1.  Proposed mechanism for the pathogenesis of salt-dependent hypertension Interventions such as chronic administration of exogenous ouabain, use of heterozygous null mutant mice and treatment with agents that interfere with ouabain's action or the Na+/Ca2+ exchange (NCX) are indicated on the left.

Na⁺ pumps are expressed as ß dimers (Blanco & Mercer, 1998). Four isoforms of the catalytic () subunit, the only known ouabain receptor, have been identified (Blanco & Mercer, 1998), but mouse arteries only express Na⁺ pumps with the 1 and 2 isoforms (Shelly et al. 2004). Rodent 1 has unusually low ouabain affinity (EC₅₀ > 50 µM) (O'Brien et al. 1994; Blanco & Mercer, 1998) whereas, in mammals, Na⁺ pumps with 2 subunits have high ouabain affinity (EC₅₀ < 50 nM) (O'Brien et al. 1994; Blanco & Mercer, 1998).

Here we show that exogenous ouabain, at low concentrations approaching circulating EOLC levels, elevates [Ca²⁺]_cyt and augments vasoconstriction of pressurized small arteries. Moreover, mice heterozygous for 2 Na⁺ pumps (James et al. 1999) (2^+/–, which mimic the effects of nanomolar ouabain), but not mice heterozygous for 1 (1^+/–), have altered artery function and elevated BP. These data demonstrate, for the first time, that modulation of 2 Na⁺ pump activity, and not 1, regulates small artery contractility and exerts long-term control over BP (Fig. 1).

	Methods

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Experimental animals

Wild-type (WT) C57/BL6 mice and mice with a null mutation in one Na⁺ pump 1 or 2 gene (1^+/– or 2^+/–) were studied; the homozygous knockouts do not survive (James et al. 1999). Genomic DNA was obtained from tail biopsies for genotyping by PCR.

In some experiments, normal male Sprague-Dawley rats (150–240 g) were used. All rat and mouse protocols were approved by the Institutional Animal Care and Use Committee of the University of Maryland School of Medicine.

Haemodynamic measurements

Mice (16 weeks old) were anaesthetized with isoflurane supplemented with 100% O₂; core temperature was maintained at 37.5–38°C. The right femoral artery was surgically isolated and cannulated with a 1.4 F Mikro-tip pressure catheter (Millar Instruments, Houston, TX, USA). Blood pressure was acquired under 1.5% isoflurane anaesthesia (Janssen et al. 2004); data were calculated off-line (BioPac System, Santa Barbara, CA, USA). After the experiment the animal was killed by cervical dislocation following an isofluorane overdose. The data collection was performed ‘double-blind’: the individual who instrumented and measured the BP did not know the genotype. Animal code numbers were matched with genotype and BP after the data on all the mice had been collected.

Diameter and [Ca²⁺]_cyt measurements

Mice and rats were killed by rapid cervical dislocation and decapitation. Mesenteric small arteries were isolated and pressurized to permit myogenic tone development (Zhang et al. 2002). Myogenic tone was generated at an intraluminal pressure of 70 mmHg unless otherwise noted. External diameter was monitored with a Nikon (Melville, NY, USA) TMS microscope (x10 objective) and a monochrome CCD camera operated by LabView software (National Instruments, Austin, TX, USA) (Zhang et al. 2002). Passive external diameter was measured in Ca²⁺-free solution (Zhang et al. 2002). Myogenic reactivity was determined by measuring the steady-state diameters following step changes in intraluminal pressure.

For [Ca²⁺]_cyt measurement, pressurized arteries were loaded (room temperature) with 10 µM fura-2 at 20 mmHg for 45 min or 10 µM fluo-4 at 70 mmHg for 2 h in albumin-free dissection solution containing 1.0% DMSO (vol/vol) and 0.03% cremaphor EL (vol/vol).

Fluo-4 imaging.  Arteries were imaged in one of two scanning planes (Mauban et al. 2001; Zhang et al. 2002) with a Nipkow-Yokogawa spinning disc confocal imaging system (CSU10, Solomere Technology, Salt Lake City, UT, USA) connected to a Stanford XR-Mega 10 camera (Stanford Photonics, Palo Alto, CA, USA). The spinning disc was mounted on a Nikon Eclipse TE2000-U inverted microscope (x60, numerical aperture (NA) 1.2 water immersion objective). The confocal images shown here were obtained from an optical plane at the centre of the artery, parallel to the long axis. In this plane, the myocyte cross-sections in the artery walls remain in the plane of focus while the artery walls move horizontally during vasoconstriction and vasodilatation (Mauban et al. 2001). This permits simultaneous diameter determination and Ca²⁺ imaging (e.g. Fig. 2A); the vasoconstriction of dye-loaded arteries, however, is often somewhat attenuated (see Results section).

View larger version (61K): [in this window] [in a new window]   Figure 2.  Influence of 100 nM ouabain on [Ca2+]cyt and myogenic tone in WT mouse arteries Aa, fluo-4 pseudocolor images from a representative artery wall cross-section captured at the times (i–iv) indicated in graph b when the artery was pressurized to 70 mmHg and warmed (at the arrow) to 35°C; L, lumen. Ab, simultaneous changes in diameter ( diameter = 2 x wall displacement) and [Ca2+]cyt (i.e. average fluorescence in arbitrary units, a.u.) in the artery in panel a (n= 13). B, effects of 100 nM ouabain (Ouab) on the diameter of a representative artery before and after development of myogenic tone (MT) in the absence of fluo-4 (n= 4). Ouabain was applied during the periods indicated by the bars at the bottom of the graph. An intraluminal pressure of 70 mmHg was used to generate myogenic tone in these and all subsequent experiments, unless otherwise noted. PD, passive diameter; MTCtrl, control myogenic tone; MT+Ouab, myogenic tone during exposure to ouabain. Ca and Da, fluo-4 pseudocolor images captured at the times (i–iii) indicated in graphs before (Ca) and after (Da) generation of myogenic tone. Cb and Db, [Ca2+]cyt and diameter changes in representative arteries during exposure to 100 nM ouabain before (C; n= 7) and after (D; n= 8) development of myogenic tone. Ea, tangential image of a representative fura-2-loaded artery wall at 70 mmHg showing individual fluorescent myocytes orientated horizontally (the long axis of the artery is orientated vertically). Eb, average [Ca2+]cyt in individual myocytes at 20 mmHg, and before, during and after treatment with 100 nM ouabain at 70 mmHg (n= 22 myocytes from three arteries). ***P < 0.001. Scale bars: 20 µm (A and E) or 10 µm (C and D).

with an apparent dissociation constant (K_d) of 282 (Knot & Nelson, 1998) after in situ calibration. R_min, R_max and ß were determined for each region where R is the fluorescent emission ratio with excitation at 340 and 380 nm, R_min and R_max are the emission ratios under Ca²⁺- free (5mM EGTA and saturating (24 mM) Ca²⁺ conditions respectively, and ß is the emission ratio with 380 nm excitation under Ca²⁺-free and saturating Ca²⁺ conditions.

Membrane potential measurements

Membrane potential was recorded in rat mesenteric small arteries (140–200 µm external diameter) using standard sharp microelectrodes. Pipettes were pulled on a Brown-Flaming electrode puller (Sutter Instruments) and filled with 3 M KCl (resistance, 70–100 M). The preamplifier (M-707A, World Precision Instruments, Sarasota, FL, USA) output was digitized using a Digidata 1322A (Axon Instruments, Union City, CA, USA); data were analysed using pCLAMP software (Axon Instruments).

Western blotting

Mesenteric arteries, hearts and kidneys were minced and homogenized in NaCl/sucrose buffer and membrane fractions were prepared (Lencesova et al. 2004). Tissue extracts were analysed by Western blot with polyclonal -isoform-specific and non-selective antibodies (Pressley, 1992); the antibodies were gifts from Drs T. Pressley (Texas Tech University, Lubbock, TX, USA) and A. McDonough (University of Southern California, Los Angeles, CA, USA). Band densities were quantified (Golovina et al. 2003) using Kodak ID image analysis software (Eastman Kodak, Rochester, NY, USA). For these analyses, we confirmed that the amounts of protein in the bands were within the linear range of signal intensities. Band densities were normalized with ß-actin for arterial and renal membranes, and glyceraldehyde-3-phosphate dehydrogenase for cardiac membranes. The relative amounts of 1 and 2 in the tissue samples were calculated on the basis of evidence that 80–87% of the Na⁺ pumps in skeletal muscle have an 2 subunit, and the remainder is 1 (He et al. 2001; Golovina et al. 2003).

Reagents and solutions

Artery dissection solution (mM): NaCl, 145; KCl, 4.7; MgSO₄·7H₂O, 1.2; Mops, 2.0; EDTA, 0.02; NaH₂PO₄, 1.2; CaCl₂·2H₂O, 2.0; glucose, 5.0; pyruvate, 2.0; with 1% albumin (pH 7.4 at 5°C). Krebs perfusion solution (mM): NaCl, 112; NaHCO₃, 26; KCl, 4.9; CaCl₂, 2.5; MgSO₄·7H₂O, 1.2; KH₂PO₄, 1.2; glucose, 11.5; Hepes, 10 (pH adjusted to 7.3–7.4 with NaOH). Ca²⁺-free solution was made by omitting Ca²⁺ and adding 0.5 mM EGTA. Solutions were gassed with 5% O₂, 5% CO₂ and 90% N₂. Solution for membrane potential measurement (mM): NaCl, 140; KCl, 5; NaH₂PO₄, 1.2; MgCl₂, 1.4; Hepes, 10; NaHCO₃, 5; CaCl₂, 1.8; glucose, 11.5 (pH adjusted to 7.3 with NaOH).

Reagents and sources were as follows: ouabain, phenylepherine, phentolamine, acetylcholine and cremaphor EL (Sigma-Aldrich, St Louis, MO, USA); SEA0400 (Taisho, Tokyo, Japan); PST 2238 (Prassis/Sigma Tau, Milan, Italy); canrenone (Pharmacia Ltd, Morpeth, Northumberland, UK); KB-R7943 (Tocris, Ellisville, MO, USA); fluo-4 and fura-2 (Molecular Probes, Eugene, OR, USA). Other reagents were reagent grade or the highest grade available.

Data analysis and statistics

The data are expressed as means ±S.E.; n denotes the number of arteries studied (one per animal) unless otherwise stated. Comparisons of data were made using Student's paired or unpaired t test, as appropriate; one-way or two-way ANOVA was used where indicated (see figure legends). Differences were considered significant at P < 0.05. Images were analysed with customized Interactive Data Language software (IDL, Research Systems, Inc., Boulder, CO, USA).

	Results

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Nanomolar ouabain augments myogenic tone

WT mouse mesenteric small arteries were loaded with the Ca²⁺ indicators, fluo-4 (Fig. 2A, C and D) or fura-2 (Fig. 2E). Fluo-4 fluorescence, a measure of [Ca²⁺]_cyt, was relatively low in relaxed myocytes at 23°C (Fig. 2A). Cross-sections of individual myocytes are seen (arrows) in these confocal optical cross-sections of the artery wall (Zhang et al. 2002) that contains only a single layer of myocytes.

[Ca²⁺]_cyt rose (i.e. fluorescence increased) after a 40–50 min delay when the arteries were pressurized to 70 mmHg and temperature was increased from 23 to 35°C. This was followed (Fig. 2Ab) by vasoconstriction (i.e. myogenic tone) (Hill et al. 2001). Under these conditions, but in the absence of Ca²⁺ indicator, the arteries constricted from 129 ± 1 µm (passive external diameter) to 99 ± 2 µm (n= 91); thus, myogenic tone at 70 mmHg in WT arteries was a 23 ± 1% constriction from passive diameter. Vasoconstriction in Ca²⁺ indicator-loaded arteries was usually attenuated, perhaps because of Ca²⁺ buffering by the indicator.

In arteries with myogenic tone, 100 nM ouabain induced a further, reversible constriction (Fig. 2B). On average, ouabain decreased external diameter from 101 ± 1 to 93 ± 1 µm; i.e. myogenic tone increased from 23 ± 1% of passive diameter to 29 ± 1% of passive diameter, a 25 ± 2% increase (n= 64; P < 0.001). This constriction corresponds to a 10 µm decrease in internal diameter, from 85 to 75 µm.

The arteries were exposed to ouabain for periods of only 2–10 min in these and most other experiments. In experiments in which the myogenic response to step increases in pressure was examined (see below), however, the exposure to ouabain was prolonged. In these arteries, myogenic tone at 70 mmHg was 27 ± 3% of passive diameter after 10 min, and 32 ± 3% (n= 5) after 50–60 min of treatment with 100 nM ouabain. Thus, this effect of ouabain on myogenic tone was maintained (or even slightly increased), in contrast to the transient response described in noradrenaline-contracted small arteries (Aalkjaer & Mulvany, 1985).

Ouabain did not constrict pressurized arteries before the generation of myogenic tone (Fig. 2B). Thus, the ouabain-induced vasoconstriction apparently depended upon some of the same cellular mechanisms that produce myogenic tone: elevation of [Ca²⁺]_cyt (Fig. 2A) and/or enhanced Ca²⁺ sensitivity of the contractile apparatus (Hill et al. 2001). Ouabain (100 nM) elevated [Ca²⁺]_cyt in pressurized arteries before (Fig. 2C) as well as after (Fig. 2D) the generation of myogenic tone but, in the latter case, the ouabain-induced effect was superimposed on a significantly higher prior [Ca²⁺]_cyt (Fig. 2E). Even in two pressurized arteries treated with 0.3 µM nifedipine, which markedly reduces [Ca²⁺]_cyt and myogenic tone (Zhang et al. 2002), 100 nM ouabain still constricted the arteries by 6 and 20% of the diameter with nifedipine alone. Therefore, both an appropriately high [Ca²⁺]_cyt and a pressure-induced increase in Ca²⁺ sensitivity may contribute to the ouabain-induced constriction.

Fluo-4 is a non-ratiometric Ca²⁺ indicator and does not report absolute [Ca²⁺]_cyt. The ratiometric Ca²⁺ sensor, fura-2, was therefore used to determine [Ca²⁺]_cyt in individual myocytes imaged in a plane tangential to the surface of the artery (Fig. 2E). [Ca²⁺]_cyt was 185 nM at 70 mmHg. Ouabain (100 nM) reversibly elevated [Ca²⁺]_cyt by 22 ± 4 nM (n= 22 cells; P < 0.001); thus, the ouabain-induced constriction of internal diameter is 0.45 µm per 1 nM rise in [Ca²⁺]_cyt. Therefore, when Ca²⁺ sensitivity is high and [Ca²⁺]_cyt is already above contraction threshold in small arteries with myogenic tone, small changes in [Ca²⁺]_cyt should significantly affect vessel diameter.

These findings are comparable with published data from somewhat larger (200 µm passive diameter) pressurized rat cerebral arteries with myogenic tone (Knot & Nelson, 1998): [Ca²⁺]_cyt was 200 nM at 60 mmHg and 37°C, and K⁺ depolarization constricted the arteries by 1.05 µm per 1 nM increase in [Ca²⁺]_cyt. Such small, but highly significant ouabain-induced increases in [Ca²⁺]_cyt and myogenic tone (Figs 2B–E and 3A) have profound physiological implications. Blood flow through small arteries is governed by Poiseuille's law (Berne & Levy, 2001), and resistance to flow, R, is inversely proportional to the fourth power of the internal radius, r (i.e. R 1/r⁴). For example, an ouabain-induced constriction from 85 to 75 µm internal diameter would be expected to increase R by 68% and markedly elevate BP.

View larger version (39K): [in this window] [in a new window]   Figure 3.  Effects of ouabain concentration on myogenic tone in WT arteries; roles of the Na+ pump 1 and 2 isoforms Aa, fluo-4 pseudocolor images from a representative artery captured at the times (i–iii) indicated in graph b. Ab, simultaneous [Ca2+]cyt and diameter changes during exposure to 10 nM ouabain in an artery (Aa) with myogenic tone (n= 6). Scale bar, 10 µm. B, effect of 10 nM ouabain on myogenic tone in a representative artery in the absence of fluo-4. Ouabain (10 nM) increased myogenic tone (MT) from 21 ± 2% to 25 ± 2% of passive diameter (PD) (n= 7; P < 0.01). C, effect of 10 µM ouabain on myogenic tone in a representative artery in the absence of fluo-4. Ouabain (10 µM) increased myogenic tone (MT) from 23 ± 3% to 33 ± 4% of passive diameter (PD) (n= 5; P < 0.01). D, change in myogenic tone (MT, as a percentage of control MT) graphed as a function of ouabain concentration (n= 7). Brackets at the right indicate the components of MT that correspond to inhibition of the Na+ pump high ouabain affinity 2 and low ouabain affinity 1 isoforms, respectively. *P < 0.05; **P < 0.01 versus control (before ouabain); the value at 10 µM was significantly greater than at 100 nM or 1 µM (P < 0.01). E, immunoblots of Na+ pump subunit isoform (1, 2 and 3) distribution in mouse mesenteric artery and other tissues. Numbers are micrograms of protein per lane. Since the skeletal muscle (SkM) 1:2 ratio is 1:4 (He et al. 2001; Golovina et al. 2003), the normalized band densities (see Methods) indicate that mesenteric artery 1:2 4:1 and heart 1:2 6.3:1.

Na⁺ pump 2 subunits are the low-dose ouabain receptor

To elucidate the mechanism of action of low-dose ouabain on myogenic tone, it is important to identify the high affinity ouabain receptor. A dose of 10 nM ouabain also raised [Ca²⁺]_cyt (Fig. 3Aa), and the accompanying increase in myogenic tone (Fig. 3Ab and B) approached the maximal effect of 100 nM ouabain (Figs 2B and 3D). The relationship between the ouabain dose and the increase in myogenic tone was biphasic, with a plateau between 10 and 1000 nM (Fig. 3D). The apparent EC₅₀ was 1.3 nM at the high affinity ouabain site. This effect must be mediated by Na⁺ pumps with high ouabain affinity 2 subunits. Even though the 1:2 ratio is 4:1 in mesenteric arteries (Fig. 3E; the ratio is 2.3:1 in the aorta (Shelly et al. 2004; Staton et al. 2005)), in rodents, Na⁺ pumps with 1 subunits have 1000-fold lower affinity for ouabain (O'Brien et al. 1994; Blanco & Mercer, 1998).

The artery wall contains endothelial cells and neurones as well as myocytes, and all the cells have Na⁺ pumps/ouabain receptors. To determine whether endothelial cells play a major role in the response to ouabain, the endothelium was denuded. This is indicated by the loss of ACh-induced vasodilatation in arteries constricted with 5 µM phenylephrine (PE; Fig. 4A, red). Then, following development of myogenic tone, 100 nM ouabain still augmented myogenic tone by 21 ± 4% (n= 3; Fig. 4A, green). Thus, the endothelium had little influence on the response to nanomolar concentrations of ouabain.

View larger version (18K): [in this window] [in a new window]   Figure 4.  The effect of nanomolar concentrations of ouabain on myogenic tone is not mediated by the endothelium, catecholamine release or myocyte depolarization A, effect of endothelium removal on ouabain's action in a representative artery. ACh-evoked endothelium-dependent relaxation of phenylephrine (PE) vasoconstriction (E(+); blue) is absent (red) after removing endothelium. Endothelium removal (E(–)) with an intraluminal air bubble (25–30 min) did not prevent the generation of myogenic tone (MT) or the effect of 100 nM ouabain on myogenic tone (green) (n= 3). B, effect of 100 nM ouabain on myogenic tone in a representative artery in the absence (before and after, blue and green, respectively) and presence (red) of 1 µM phentolamine (n= 3). C, effects of 100 nM ouabain and 10 mM K+ on myocyte resting membrane potential (Vm) in a representative rat intact mesenteric small artery (n= 6). The electrode was withdrawn from the myocyte at the red arrow.

Inhibition of Na⁺ pumps, which are electrogenic, might be expected to depolarize the myocytes and thereby trigger vasoconstriction (Haddy & Overbeck, 1976; but see Blaustein, 1981). However, 100 nM ouabain, which should block only about 20% of total Na⁺ pumps (i.e. only those with 2 subunits), had negligible effect on the membrane potential of myocytes within intact mesenteric arteries (Fig. 4C). On average, 100 nM ouabain depolarized the myocytes by only 0.1 ± 0.5 mV (n= 6). As these experiments were performed on rat arteries, it is important to note that 100 nM ouabain increased myogenic tone from a 21 ± 3% to a 27 ± 3% constriction relative to passive diameter in rat mesenteric small arteries (n= 5; P < 0.01).

The influence of the external K⁺ concentration ([K⁺]_o) was tested in order to demonstrate that small, reversible changes in membrane potential could be detected. Unlike ouabain, elevating [K⁺]_o from 4.9 to 10 mM depolarized the arteries by about 4–5 mV (Fig. 4C). Indeed, a hyperpolarization might have been expected (Weston et al. 2002) because such small increases in [K⁺]_o often dilate small arteries (Emanuel et al. 1959), perhaps as a result of Na⁺ pump activation (Weston et al. 2002). Nevertheless, the subject is controversial because some other investigators also have observed that a 5 mM rise in [K⁺]_o depolarizes small arteries (Quinn et al. 2000; Bratz et al. 2002).

Myogenic tone is increased in 2^+/– mice

Figures 2–4 suggest that 10–100 nM ouabain raises [Ca²⁺]_cyt and increases myogenic tone by inhibiting myocyte Na⁺ pumps with 2 subunits. Therefore we also studied myogenic tone in mesenteric small arteries from mice with a single null mutation in the gene that encodes either the 1 or 2 isoform of the Na⁺ pump subunit (1 or 2 heterozygotes: 1^+/– or 2^+/–; James et al. 1999). Arteries from the heterozygous mice expressed 50% of normal 1 or 2, respectively (Fig. 5A and B) (James et al. 1999; Shelly et al. 2004). Thus, despite up-regulation of 2, total Na⁺ pump expression was reduced by 40% in 1^+/– arteries (Fig. 5A and B). Nevertheless, 1^+/– arteries generated the same amount of myogenic tone at 70 mmHg pressure, and the same response to 100 nM ouabain as did WT mouse arteries (Fig. 6A).

View larger version (22K): [in this window] [in a new window]   Figure 5.  Na+ pump 1 and 2 isoform expression in mesenteric arteries and other tissues from WT, 1+/– and 2+/– mice A, representative immunoblots showing Na+ pump 1, 2 and total subunit expression levels in mesenteric arteries from WT, 1+/– and 2+/– mice. B, comparison of relative 1 expression (normalized data; see Methods) in mesenteric arteries, kidneys and hearts from WT, 1+/– and 2+/– mice (n= 3 for all bars). **P < 0.01 versus WT and 2+/–.

View larger version (17K): [in this window] [in a new window]   Figure 6.  Effects of reduced Na+ pump 1 and 2 isoform expression and ouabain on myogenic tone and myogenic reactivity A, effects of ouabain on myogenic tone in WT, 1+/– and 2+/– mouse arteries. Myogenic tone (MT) is shown as a percentage of passive diameter (PD). P < 0.05 versus WT control; *P < 0.05, **P < 0.01, ***P < 0.001 versus genotype control (numbers of arteries in parentheses). B, effects of 100 nM ouabain (Ouab; red) and reduced Na+ pump 2 expression (2+/–; green) on passive diameter (PD, dashed lines) and myogenic reactivity to step changes in intraluminal pressure (MR, continuous lines). Blue lines, control (Ctrl) passive diameter and myogenic reactivity. Ordinate shows diameter as a percentage of passive diameter at 120 mmHg (PD120). n= 7 (WT), 6 (WT + ouabain) and 5 (2+/–) arteries. *P < 0.05, **P < 0.01 versus WT MR; P values were determined by two-way ANOVA.

2^+/– mice have high blood pressure

Maintained low nanomolar plasma ouabain induces a sustained hypertension in rodents that requires 2 Na⁺ pumps with high affinity for ouabain (Dostanic et al. 2005). As reduced Na⁺ pump 2 subunit expression mimics the effects of nanomolar ouabain on small arteries (Fig. 6A and B), we reasoned that 2^+/– mice might have elevated BP. Indeed, averaged mean BP (MBP) was significantly higher in 2^+/– mice than in WT mice under isofluorane anaesthesia (Fig. 7).

View larger version (13K): [in this window] [in a new window]   Figure 7.  Effects of genetically reduced Na+ pump 1 or 2 isoform expression on arterial blood pressure Mean femoral artery blood pressure (MBP) in WT, 1+/– and 2+/– mice under 1.5% isofluorane anaesthesia. , individual measurements for n= 12 mice in each group; , mean values. Mice were age-matched: WT = 113 ± 2, 1+/–= 109 ± 4 and 2+/–= 110 ± 4 days. P values were determined by one-way ANOVA.

Alternatively, 1^+/– mice might be normotensive because they lose salt due to reduced expression of 1 in the kidneys. This is not the case, however, because renal 1 expression is not reduced in the 1^+/– mice, whereas cardiac and arterial 1 are reduced by 50% (Fig. 5B). As cardiac contractility is reduced in these mice (James et al. 1999), the BP might be normal because of a reduced CO. There is, however, no reason to expect a hypercontracted vasculature and an augmented TPR in 1^+/– mice, as myogenic tone is normal in isolated 1^+/– arteries (Fig. 6A).

Ouabain antagonists block ouabain's effect on tone

If the proposed sequence of events leading from ouabain to increased vascular tone (Fig. 1) is correct, it should be possible to interrupt this sequence with appropriate pharmacological tools. For example, PST 2238 and canrenone, known ouabain antagonists (Finotti & Palatini, 1981; Ferrari et al. 1998), should reduce ouabain's inhibition of Na⁺ pump 2 subunits and augmentation of myogenic tone. Indeed, 5 µM PST 2238, an antihypertensive agent (Ferrari et al. 1998) derived from digitoxigenin (Quadri et al. 1997), abolished the effect of 100 nM ouabain on myogenic tone (Fig. 8A and B); prior application of PST prevented ouabain from augmenting myogenic tone (not shown). Canrenone (5 µM), a spironolactone metabolite with antihypertensive activity (Semplicini et al. 1995; Mantero & Lucarelli, 2000), was a partial antagonist (Fig. 8B). Neither agent affected control myogenic tone. Also, neither agent affected the increase in myogenic tone in 2^+/– arteries as, in this case, the reduced 2 activity was genetic and was not induced by ouabain.

View larger version (18K): [in this window] [in a new window]   Figure 8.  Effects of ouabain antagonists on myogenic tone augmented by 100 nM ouabain or by reduced 2 Na+ pump expression A, the action of 5 µM PST 2238 on 100 nM ouabain-augmented myogenic tone (MT) in a representative WT artery. B, summary of effects of 5 µM PST 2238 and 5 µM canrenone on control myogenic tone (WT Ctrl MT), and on myogenic tone augmented by 100 nM ouabain and by reduced 2 expression (2+/–). *P < 0.05, ***P < 0.001 versus MTCtrl in WT arteries (MTCtrl is myogenic tone in the absence of ouabain). P < 0.01, P < 0.001 versus MT+Ouab in WT arteries or MTCtrl in 2+/– arteries (numbers of arteries in parentheses).

NCX blockers inhibit effects of reduced 2 activity

One proposed mechanism by which ouabain increases myogenic tone is by reducing the Na⁺ electrochemical gradient across the plasma membrane (PM) at PM– sarcoplasmic/endoplasmic reticulum (S/ER) junctions (Arnon et al. 2000; Golovina et al. 2003) where high ouabain affinity Na⁺ pumps (Juhaszova & Blaustein, 1997; Shelly et al. 2004) and NCX1 (Juhaszova & Blaustein, 1997; Lencesova et al. 2004) are located. As in the heart (Hilgemann, 2004), the reduced Na⁺ gradient should have a profound effect: it should, via NCX1, raise [Ca²⁺]_cyt not only locally, but in the S/ER and bulk cytosol as well (Arnon et al. 2000; Golovina et al. 2003).

In the present study, 1 µM SEA0400 reduced control myogenic tone by 10%, abolished the ouabain-induced increase in myogenic tone (Fig. 9A and C), and significantly attenuated the enhanced myogenic tone in arteries from 2^+/– mice (Fig. 9B and C). The latter effect contrasts with the absence of responses to PST 2238 and canrenone in 2^+/– mouse arteries (Fig. 8B). KB-R7943 (1 µM), another, less selective NCX inhibitor (Matsuda et al. 2001; Iwamoto et al. 2004a), had similar but less marked effects (Fig. 9C). These data cannot be explained by inhibition of L-type voltage-gated Ca²⁺ channels: Ca²⁺ entry through these channels accounts for most of control myogenic tone (Hill et al. 2001), but neither 1 µM SEA0400 nor KB-R7943 blocked the 75 mM K⁺-induced, nifedipine-sensitive vasoconstriction in these arteries (not shown). Rather, the in vitro data (Fig. 9C) indicate that 10% of control myogenic tone depends upon Ca²⁺ entry through NCX (presumably NCX1). Operation of a 3 Na⁺:1 Ca²⁺ exchanger in the Ca²⁺ entry mode is not surprising because the myocyte membrane potential in pressurized arteries (about –45 to –55 mV; Knot & Nelson, 1998) may be positive to the NCX reversal potential (Blaustein & Lederer, 1999). Reduction of myogenic tone by SEA0400 and KB-R7943, rather than augmentation, when myogenic tone was amplified by reduced 2 activity (Fig. 9A, B and C) also indicates that increased Ca²⁺ entry via NCX was responsible for the increased myogenic tone in ouabain-treated and 2^+/– arteries. Thus, arterial myocyte NCX1 mediates the rise in myogenic tone and elevation of BP induced by nanomolar ouabain and by reduced Na⁺ pump 2 subunit expression.

View larger version (29K): [in this window] [in a new window]   Figure 9.  Effects of NCX blockers on myogenic tone augmented by 100 nM ouabain or by reduced 2 Na+ pump expression A and B, representative experiments illustrating the actions of 1 µM SEA0400 on ouabain-augmented myogenic tone in a WT artery (A) and on myogenic tone in an 2+/– artery (B). C, summary of effects of 1 µM SEA0400 and 1 µM KB-R7943 on control myogenic tone (WT Ctrl MT) and on myogenic tone augmented by 100 nM ouabain or by reduced 2 expression (2+/–). *P < 0.05, **P < 0.01, ***P < 0.001 versus MTCtrl in WT arteries. P < 0.05, P < 0.01, P < 0.001 versus MT+Ouab in WT arteries or MTCtrl in 2+/– arteries (numbers of arteries in parentheses).

	Discussion

Top Abstract Introduction Methods Results Discussion References

2 Na⁺pumps: long-term regulators of blood pressure in mice

This report reveals that low nanomolar ouabain augments myogenic reactivity and myogenic tone in small arteries by interacting specifically with arterial myocyte 2 Na⁺ pumps. These data are consistent with the recent report (Dostanic et al. 2005) that ouabain does not induce hypertension in mice with mutated, ouabain-resistant 2 Na⁺ pumps. The latter result demonstrates that interaction between ouabain and 2 is necessary for the induction of hypertension by ouabain, but this does not elucidate the mechanism.

Here, we employed ouabain concentrations approaching the EOLC levels in the circulation (0.1–3.0 nM; e.g. Rossi et al. 1995), and we addressed the mechanism of ouabain's action in intact, small arteries. The data demonstrate that low-dose ouabain-induced vasoconstriction is a result of its direct action on the arterial myocytes; it is not due to effects on the endo-thelium, catecholamine release from the sympathetic neuroeffector cells, or myocyte depolarization. In the isolated arteries, brief (e.g. 5–15 min) treatment with low-dose ouabain mimics the effects of genetically reduced 2 expression on myogenic reactivity and myogenic tone. Clearly, there is little adaptation or compensation for reduction of 2 activity even over the lifetime of the mice. Also, BP is elevated in 2^+/– mice, as it is in ouabain-treated rodents (Yuan et al. 1993; Manunta et al. 1994; Iwamoto et al. 2004b; Dostanic et al. 2005). Thus, the ouabain-induced increase in myogenic reactivity and myogenic tone, as well as the elevated BP, are primarily due to reduction of arterial myocyte 2 activity, per se, and not to other reported actions of ouabain (Santana et al. 1998; Aizman et al. 2001; Gao et al. 2002; Xie & Askari, 2002; Saunders & Scheiner-Bobis, 2004). Moreover, a preliminary report that overexpression of 2, but not 1, in mouse smooth muscle induces hypotension (Staton et al. 2005) is consistent with this view of the central role of arterial myocyte 2 Na⁺ pump activity in regulating BP.

The evidence that BP is elevated in 2^+/–, but not 1^+/– mice implies that reduced 2 activity is both necessary and sufficient to induce hypertension, even without ouabain. Thus, arterial myocyte 2 Na⁺ pumps are a newly identified and long-sought long-term regulator of BP. The hypertension (and presumed increase in TPR) in the 2^+/– mice are probably the consequence of the augmented myogenic reactivity and myogenic tone observed in the isolated 2^+/– arteries. It is important to note, however, that these results do not preclude other, additional effects of EOLC in the pathogenesis of salt-dependent hypertension. For example, effects in the kidneys (in addition to vasoconstriction) may influence salt retention (Ferrandi et al. 2004), and in the kidneys and other tissues may contribute to target organ damage, possibly by promoting cell growth and proliferation (Aizman et al. 2001; Xie & Askari, 2002; Saunders & Scheiner-Bobis, 2004).

How does 2 activity influence blood pressure?

The increase in myogenic tone that results from reduced 2 Na⁺ pump activity can be explained by a rise in [Ca²⁺]_cyt mediated by NCX1 (Iwamoto et al. 2004b), with which 2 Na⁺ pumps are coupled both geographically (Juhaszova & Blaustein, 1997; Lencesova et al. 2004) and functionally (Arnon et al. 2000; Golovina et al. 2003). This view is supported by the pharmacological evidence that the augmented myogenic tone in arteries from 2^+/– mice as well as the increased myogenic tone induced by nanomolar ouabain are blocked by SEA0400 and KB-R7943.

Salt-dependent hypertension was not explored in the present study. Indeed, the observation that the ouabain antagonists, PST 2238 and canrenone, did not influence the augmented myogenic tone in arteries from 2^+/– mice implies that the 2^+/– hypertension model is ouabain (and salt) independent, presumably because salt and ouabain act upstream (Fig. 1). Nevertheless, a preliminary report indicates that the development of deoxycorticosterone acetate (DOCA)-salt hypertension is accelerated in 2^+/– (versus WT) mice (Staton et al. 2005). This is expected if, when there are already a reduced number of 2 Na⁺ pumps, the DOCA and salt elevate plasma EOLC (Hamlyn et al. 1991; Rossi et al. 1995; Goto & Yamada, 2000).

In summary, these data are consistent with the recent report (Iwamoto et al. 2004b) that salt-dependent and ouabain-induced hypertension share the same downstream mechanism; namely, enhanced NCX1-mediated Ca²⁺ entry into arterial myocytes via NCX1 (Fig. 1). This is, presumably, the consequence of a reduced Na⁺ concentration gradient across the plasma membrane in the vicinity of the 2 Na⁺ pump and NCX1 clusters (Juhaszova & Blaustein, 1997; Arnon et al. 2000; Golovina et al. 2003; Lencesova et al. 2004).

Implications for human hypertension

The essential link between reduced 2 activity and ouabain-induced hypertension in rodents (Yuan et al. 1993; Manunta et al. 1994; Iwamoto et al. 2004b; Dostanic et al. 2005) has important implications for human hypertension. EOLC is elevated in rodents with salt-dependent hypertension (Hamlyn et al. 1991; Ferrandi et al. 1998; Takada et al. 1998). EOLC is also elevated in humans with mineralocorticoid hypertension (Rossi et al. 1995; Goto & Yamada, 2000) and in a large fraction of patients with essential hypertension (Rossi et al. 1995; Manunta et al. 1999; Pierdomenico et al. 2001; Goto & Yamada, 2000). It would be surprising if the mechanisms responsible for raising BP in salt-dependent hypertension are fundamentally different in rodents and humans. Nevertheless, the markedly different affinities of human and rodent 1 for ouabain seem puzzling. Human 1 has high affinity for ouabain, and nanomolar EOLC should inhibit human 1 as well as 2; thus, very different effects of EOLC might be expected in humans and rodents.

We observed, however, both normal myogenic tone in isolated 1^+/– arteries, and normal BP in 1^+/– mice, despite the markedly reduced 1 activity in the arteries. Nevertheless, brief exposure to high-dose (1 µM) ouabain, which should inhibit rodent 1 Na⁺ pumps (O'Brien et al. 1994; Blanco & Mercer, 1998), induced profound vasoconstriction of the isolated, small arteries from 1^+/– mice as well as those from WT and 2^+/– mice. The implication is that the 1^+/– mice compensate for the chronically (genetically) reduced 1 activity, and thereby avoid a rise in BP. This contrasts with the apparent absence of compensation for genetically reduced 2 activity, mentioned above.

Perhaps in humans, too, if there is compensation for chronically EOLC-inhibited 1 activity, functionally comparable with the reduced 1 expression in 1^+/– mice, the dominant long-term effect of EOLC in humans may still be on arterial myocyte 2. This would reconcile the dilemma about the proposed role of EOLC in human hypertension (Fig. 1). Indeed, such compensation for 1 inhibition seems likely because this isoform is the ‘housekeeper’ that maintains the low global [Na⁺]_cyt (Golovina et al. 2003). Complete inhibition or knockout of rodent 2 Na⁺ pumps (only 20% of total arterial Na⁺ pumps) has minimal effect on global [Na⁺]_cyt (Golovina et al. 2003) and membrane potential (Fig. 4C). In contrast, acute inhibition of a significant fraction of the predominant 1 Na⁺ pumps (e.g. by micromolar ouabain concentrations) can be expected to elevate global [Na⁺]_cyt substantially (Golovina et al. 2003) and markedly depolarize the myocytes (Aalkjaer & Mulvany, 1985); this should induce profound vasoconstriction.

Antagonism of ouabain's effect

An intriguing feature of cardiotonic steroid action is the fact that Strophanthus steroids such as ouabain and dihydro-ouabain induce hypertension in rodents, whereas Digitalis steroids such as digoxin and digitoxin do not (Kimura et al. 2000; Manunta et al. 2001). This seems surprising because both classes of steroids inhibit the Na⁺ pump and, as emphasized here, reduced 2 Na⁺ pump activity is necessary and sufficient for induction of hypertension in rodents. However, the fact that digoxin and digitoxin not only do not induce hypertension, but lower blood pressure in ouabain-hypertensive rats (Manunta et al. 2000) and even in human hypertensives (Abarquez, 1967), provides an important clue. This observation implies that the Digitalis steroids are partial Na⁺ pump agonists (i.e. they are pump inhibitors) and partial antagonists (i.e. they block ouabain's inhibition of the Na⁺ pump). Indeed, the digitoxigenin derivative, PST 2238, is a particularly interesting synthetic furane analogue of a Digitalis steroid because it has negligible agonist activity and strong ouabain-antagonist activity (Fig. 8) (Ferrari et al. 1998). The observation that PST 2238 antagonizes the low-dose ouabain-induced increase in myogenic tone, but has no effect on the augmented myogenic tone in arteries from 2^+/– mice, is consistent with this mechanism of action.

We conclude that there is now compelling evidence for the sequence of events illustrated in Fig. 1. EOLC, Na⁺ pumps with 2 subunits and NCX1 are key downstream components in the regulation of myocyte [Ca²⁺]_cyt and contractility, and long-term control of BP. This pathway (Fig. 1) provides several novel targets for antihypertensive therapy. These include the biosynthetic and secretory pathways of EOLC as well as Na⁺ pumps with 2 subunits and NCX1. Finally, by clarifying the mechanisms involved in salt-dependent hypertension, it should now be easier to elucidate the mechanisms that underlie the pathogenesis of other forms of essential hypertension.

	References

Top Abstract Introduction Methods Results Discussion References

 
Aalkjaer C & Mulvany MJ (1985). Effect of ouabain on tone, membrane potential and sodium efflux compared with [³H]ouabain binding in rat resistance vessels. J Physiol 362, 215–231.[Abstract/Free Full Text]

Abarquez RF Jr (1967). Digitalis in the treatment of hypertension. A preliminary report. Acta Med Philipp 3, 161–170.[Medline]

Aizman O, Uhlen P, Lal M, Brismar H & Aperia A (2001). Ouabain, a steroid hormone that signals with slow calcium oscillations. Proc Natl Acad Sci U S A 98, 13420–13424.[Abstract/Free Full Text]

Arnon A, Hamlyn JM & Blaustein MP (2000). Ouabain augments Ca²⁺ transients in arterial smooth muscle without raising cytosolic Na⁺. Am J Physiol Heart Circ Physiol 279, H679–H691.[Abstract/Free Full Text]

Bagrov AY, Roukoyatkina NI, Pinaev AG, Dmitrieva RI & Fedorova OV (1995). Effects of two endogenous Na⁺,K⁺-ATPase inhibitors, marinobufagenin and ouabain, on isolated rat aorta. Eur J Pharmacol 274, 151–158.[CrossRef][Medline]

Berne RM & Levy MN (2001). Cardiovascular Physiology, 8th edn, pp. 115–153. Mosby, St. Louis.

Blanco G & Mercer RW (1998). Isozymes of the Na-K-ATPase: heterogeneity in structure, diversity in function. Am J Physiol Renal Physiol 275, F633–F650.[Abstract/Free Full Text]

Blaustein MP (1977). Sodium ions, calcium ions, blood pressure regulation, and hypertension: a reassessment and a hypothesis. Am J Physiol Cell Physiol 232, C165–C173.[Abstract/Free Full Text]

Blaustein MP (1981). Commentary: What is the link between vascular smooth muscle sodium pumps and hypertension. Clin Exp Hypertens 3, 173–178.[CrossRef][Medline]

Blaustein MP & Lederer WJ (1999). Sodium/calcium exchange: its physiological implications. Physiol Rev 79, 763–854.[Abstract/Free Full Text]

Borst JGG & Borst-de Geus A (1963). Hypertension explained by Starling's theory of circulatory homoeostasis. Lancet 1, 677–682.[CrossRef][Medline]

Bratz IN, Falcon R, Partridge LD & Kanagy NL (2002). Vascular smooth muscle cell membrane depolarization after NOS inhibition hypertension. Am J Physiol Heart Circ Physiol 282, H1648–H655.[Abstract/Free Full Text]

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 42, 1206–1252.[Abstract/Free Full Text]

Cowley AW (1992). Long-term regulation of arterial blood pressure. Physiol Rev 72, 231–300.[Abstract/Free Full Text]

Dostanic I, Paul RJ, Lorenz JN, Theriault S, Van Huysse JW & Lingrel JB (2005). The 2 isoform of Na,K-ATPase mediates ouabain-induced hypertension in mice and increased vascular contractility invitro. Am J Physiol Heart Circ Physiol 288, H477–H485.[Abstract/Free Full Text]

Emanuel DA, Scott JB & Haddy FJ (1959). Effect of potassium on small and large blood vessels of the dog forelimb. Am J Physiol 197, 637–642.[Abstract/Free Full Text]

Ferrandi M, Manunta P, Rivera R, Bianchi G & Ferrari P (1998). Role of the ouabain-like factor and Na-K pump in rat and human genetic hypertension. Clin Exp Hypertens 20, 629–639.[Medline]

Ferrandi M, Molinari I, Barassi P, Minotti E, Bianchi G & Ferrari P (2004). Organ hypertrophic signaling within caveolae membrane subdomains triggered by ouabain and antagonized by PST 2238. J Biol Chem 279, 33306–33314.[Abstract/Free Full Text]

Ferrari P, Torielli L, Ferrandi M, Padoani G, Duzzi L, Florio M et al. (1998). PST2238: a new antihypertensive compound that antagonizes the long-term pressor effect of ouabain. J Pharmacol Exp Ther 285, 83–94.[Abstract/Free Full Text]

Finotti P & Palatini P (1981). Canrenone as a partial agonist at the digitalis receptor site of sodium-potassium-activated adenosine triphosphatase. J Pharmacol Exp Ther 217, 784–790.[Abstract/Free Full Text]

Gao J, Wymore RS, Wang Y, Gaudette GR, Krukenkamp IB, Cohen IS et al. (2002). Isoform-specific stimulation of cardiac Na/K pumps by nanomolar concentrations of glycosides. J General Physiol 119, 297–312.[Abstract/Free Full Text]

Golovina VA, Song H, James PF, Lingrel JB & Blaustein MP (2003). Na