GHB and heart

Journal of Cardiovascular Pharmacology

© 2004 Lippincott Williams & Wilkins, Inc.


Volume 44(6)             December 2004             pp 631-638


Mechanisms Underlying the Sympathomimetic Cardiovascular Responses Elicited by [gamma]-Hydroxybutyrate

[Original Article]

Hicks, Alissa R. BS; Kapusta, Daniel R. PhD; Varner, Kurt J. PhD

From the Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

Received for publication July 6, 2004; accepted August 31, 2004.

Supported in part by the American Heart Association Southeast Affiliate (0355155B) (K.J.V.) and a National Research Service Award (F31DA018035-01) (A.R.H.).

Reprints: Kurt J. Varner, Department of Pharmacology, LSUHSC, 1901 Perdido Street, New Orleans, LA 70112 (e-mail: KVarne@lsuhsc.edu).


 

 

 

 

 

Output…





320 K

Links…

Library Holdings


Help
Logoff

History…

Outline

·         Abstract:

·         METHODS

·         Animals

·         Radio Telemetry

·         Renal Sympathetic Nerve Recordings

·         Intracerebroventricular Injections

·         Experimental Protocols

·         Acute Cardiovascular Responses Elicited by Intravenous Administration of GHB

·         Role of GHB and GABAb Receptors in Mediating the Cardiovascular Responses Elicited by GHB

·         Role of Central GABAb Receptors in Mediating the Cardiovascular Responses Elicited by the Intravenous Administration of GHB

·         Effects of GHB on Renal Sympathetic Nerve Activity

·         Data Analysis

·         Drugs Used

·         RESULTS

·         Role of GHB and GABAb Receptors in Mediating the MAP and Heart Rate Responses Elicited by GHB

·         Role of the Sympathetic Nervous System

·         DISCUSSION

·         CONCLUSION

·         ACKNOWLEDGMENTS

·         REFERENCES

 

Graphics

·         Figure 1

·         Figure 2

·         Figure 3

·         Figure 4

·         Figure 5

·         Figure 6

·         Figure 7


Abstract:

[gamma]-Hydroxybutyrate (GHB) is generally thought to be a central nervous system depressant; however, GHB also has sympathomimetic cardiovascular actions. Radio telemetry was used to record the cardiovascular responses elicited by GHB (180-1000 mg/kg IV) in conscious rats. GHB elicited increases in mean arterial pressure (MAP) (24 ± 3 to 60 ± 5 mm Hg) lasting from 28 ± 8 to 227 ± 37 minutes. GHB (560 and 1000 mg/kg IV) also elicited a prolonged tachycardic response (85 ± 23 and 95 ± 22 bpm). The hypertension and tachycardia elicited by GHB (560 mg/kg) were reversed by the intravenous and intracerebroventricular administration of the GABAb receptor antagonist CGP 35348. CGP 35348 also reversed GHB-mediated increases in renal sympathetic nerve activity (RSNA). Administration of the purported GHB receptor antagonist NCS-382 reversed the increase in heart rate but not the pressor response elicited by GHB in telemetered rats. These data indicate that the intravenous administration of GHB markedly increases MAP, heart rate, and RSNA in conscious rats via activation of central GABAb receptors. In addition, GHB receptors appear to selectively mediate the increase in heart rate elicited by large doses of GHB.



The recreational use of [gamma]-hydroxybutyrate (GHB), known on the street as “G” or “liquid X,” has increased greatly over the past several years because of its ability to elicit euphoric intoxication with a loss of social inhibition.1,2 As a club drug, GHB is often used at large dance parties and has also been used in chemical submission “date rape” crimes.3 GHB is popular among weightlifters and body builders, who use the drug for its purported anabolic effects.3 As the recreational use of GHB has increased, so too has the incidence of drug-related toxicity, some of which involves the cardiovascular system.4,5

As an endogenous compound metabolically linked to [gamma]-aminobutyric acid (GABA), GHB is commonly thought to be a central nervous system depressant; however, experimental evidence suggests that in addition to its depressant actions, GHB also has significant sympathomimetic cardiovascular actions.6-9 Unfortunately, the experimental and clinical literature does not consistently define the cardiovascular effects of GHB. Clinical reports of acute GHB intoxication in humans typically report bradycardia, hypotension, and respiratory depression.2,4,5 However, a scattering of reports in the literature indicate that this drug elicits sympathomimetic cardiovascular effects in humans and animals. The use of GHB as a preanesthetic agent in humans is associated with increases in mean arterial pressure (MAP) and heart rate.6 In animal models of hemorrhagic shock, the administration of GHB returns arterial pressure, heart rate, and cardiac output to prehemorrhage levels without volume replacement.8 The most compelling evidence of the sympathomimetic actions of GHB is the observation that intraperitoneal administration of GHB elicits pronounced and prolonged increases in MAP and heart rate in conscious rats.7,9 These cardiovascular responses are prevented by pretreatment with [alpha]- and [beta]-adrenergic receptor antagonists. These responses can also be prevented by spinal cord transection or prehypothalamic lesions.7,9 The intracerebroventricular (ICV) administration of GHB also increases MAP and heart rate.9 Taken together, these data suggest that the cardiovascular responses elicited by GHB involve the activation of central sympathetic pathways; however, the mechanisms underlying the sympathoexcitatory cardiovascular responses have not been determined.

As a central nervous system depressant, GHB produces anesthesia and sedation similar to that produced by other classic sedative-hypnotics.3 In fact, GHB has recently been approved by the Food and Drug Administration for the treatment of cataplexy associated with narcolepsy based on its ability to induce sedation without disturbing natural sleep patterns.10 As a neuromodulator, GHB is thought to alter dopaminergic, serotonergic, and opioid transmission;3,11-14 however, most available evidence suggests that central serotonergic, dopaminergic, or acetylcholinergic mechanisms do not play significant roles in mediating GHB’s cardiovascular responses.9 Although the mechanisms underlying the depressant actions of GHB have not been clearly defined, they are thought to involve, at least in part, the activation of specific GHB receptors and GABAb receptors.15,16 What role, if any, these receptor systems play in mediating the sympathomimetic cardiovascular responses elicited by GHB is unknown.

In spite of the potential for GHB to elicit clinically significant cardiovascular responses, the mechanisms mediating the sympathomimetic actions of this central nervous system depressant have not been systematically studied. Therefore, the goals of this study were (1) to characterize the cardiovascular responses elicited by the acute intravenous administration of GHB; (2) to identify the role of the sympathetic nervous system in mediating the sympathomimetic cardiovascular responses elicited by GHB; and (3) to determine whether GABAb and/or GHB receptors are involved in mediating these responses.

METHODS

Animals

Experiments were performed using male Sprague-Dawley rats (249-346 g; Harlan, Indianapolis, IN). All procedures were in accordance with National Institutes of Health Guidelines for the Care and Use of Experimental Animals and were approved by the Institutional Animal Care and Use Committee at Louisiana State University Health Sciences Center. Before surgery, the rats were group housed in a temperature and humidity-controlled room with a 12-hour light/dark cycle. After surgery, the rats were individually housed with standard rat chow and tap water available ad libitum. During surgical procedures, the rats were anesthetized using pentobarbital (60 mg/kg, IP), a combination of methohexital sodium (Brevital, 20 mg/kg, IP) followed by propofol injectable emulsion (Propofol, 10 mg/kg, IV), or ketamine (90 mg/kg, IM) in combination with xylazine (3 mg/kg, IM). Supplemental anesthesia was administered in response to spontaneous changes in respiration or in response to tail or foot pinch.

Radio Telemetry

MAP and heart rate were recorded in conscious, unrestrained rats in their home cages using a radio telemetry system (Dataquest A.R.T. 2.2; Data Sciences International, St. Paul, MN) as described previously.17,18 Briefly, under pentobarbital anesthesia, the arterial pressure cannula of a battery-powered radio telemetry probe (TL11M2-C50-PXT, Data Sciences International, St Paul, MN) was inserted and secured in the descending abdominal aorta rostral to the femoral bifurcation. The probe was then placed in the abdominal cavity and secured to the abdominal musculature. In all rats, a polyurethane cannula (Micro-renathane, 0.33-inch OD × 0.014-inch ID; Braintree Scientific, Braintree, MA) was inserted into the femoral vein, and the free end tunneled subcutaneously to the nape of the neck and exteriorized. After surgery, fluids and penicillin (60,000 units, IM) were administered. Buprenorphine (2.5 mg/kg, IP, BID) was administered for 2 days. The rats were allowed to recover from the surgical procedures for 7-10 days before beginning any experimental protocol. In these experiments, the daily weight was measured, and baseline MAP and heart rate were recorded for a minimum of 20 minutes before the administration of any drugs.

Renal Sympathetic Nerve Recordings

Renal sympathetic nerve activity (RSNA) was recorded in conscious rats (n = 5) using a modification of the method of Kapusta and Obih.19 Briefly, anesthesia was induced with methohexital sodium and supplemented with propofol injectable emulsion. Anesthetized animals were instrumented with femoral venous cannulas. A polyurethane cannula was also inserted into the femoral artery to allow for recording of arterial pressure. The left kidney was exposed through an incision in the left flank. A branch of a renal nerve bundle was dissected free and placed on a bipolar platinum wire electrode. RSNA was amplified (×10,000-50,000) and filtered (low 30; high 10,000 Hz) using a Grass P511 amplifier. The recording electrode and nerve were then embedded in dental impression material. The electrode cable was secured to the abdominal muscles, and the flank incision was closed in layers. The amplified and filtered signal was collected and stored on a polygraph and a personal computer using BIOPAC acquisition and analysis software (BIOPAC Systems, Santa Barbara, CA). The rats were placed in rat holders to minimize movement and to protect the renal nerve recording preparation.

Intracerebroventricular Injections

For experiments requiring the ICV administration of drugs, a stainless steel cannula was stereotaxically implanted into the right lateral cerebral ventricle of ketamine/xylazine-anesthetized rats at least 3-5 days before experimentation. The coordinates used to position the cannula were 0.3 mm posterior to the bregma, 1.3 mm lateral to midline, and 4.5 mm below skull surface.20 Verification of cannula position in the lateral ventricle was made by observation of cerebrospinal fluid flow from the implanted steel cannula after removal of the obturator and by observing injected dye in the lateral ventricle following completion of the study and subsequent postmortem brain section.21-23

Experimental Protocols

Acute Cardiovascular Responses Elicited by Intravenous Administration of GHB

Seven rats were instrumented with telemetry probes and femoral venous cannulas for intravenous administration of drugs. One week after surgery, the rats’ home cages were placed over telemetry receivers, where they remained for the duration of the experiment. On the first morning of the study, the rats received a single intravenous dose of saline or GHB (180, 320, 560, or 1000 mg/kg), and the cardiovascular responses were recorded continuously for at least 3 hours. GHB was injected (50 µL to 1 mL) over 1-2 minutes followed by a 0.5 to 0.7 mL saline flush. On subsequent days, doses of GHB or saline were administered in random order so that the order of doses was different for each animal and only 1 dose was administered per day. Each animal received all doses of GHB. The volumes of saline injected as controls corresponded with the volumes of the 180- (small volume control) and 1000-mg/kg (large volume control) doses of GHB.

Role of GHB and GABAb Receptors in Mediating the Cardiovascular Responses Elicited by GHB

To determine whether GHB and/or GABAb receptors were involved in mediating the MAP and heart rate responses elicited by GHB, a separate group of 9 rats was instrumented with telemetry probes and femoral venous cannulas. One week after surgery, baseline MAP and heart rate were recorded. The rats were then given a single intravenous dose of GHB (560 mg/kg), and the MAP response was continuously monitored. At or near the peak of the pressor response (35-45 minutes after GHB injection), either the GHB receptor antagonist NCS-382 (50 mg/kg, IV, n = 4) or the GABAb receptor antagonist CGP 35348 (50 mg/kg, IV, n = 5) was administered, and the cardiovascular parameters recorded. NCS-382 has been shown to block the discriminative stimulus effects of GHB.24,25 CGP 35348 has been shown to block the discriminative stimulus effects of GHB and baclofen (GABAb agonist) in rats.25 To determine the effects of both antagonists on baseline MAP and heart rate, a separate group of 5 rats were instrumented with telemetry probes and femoral venous cannulas. One week later, the animals received a single intravenous injection of CGP 35348 (50 mg/kg) or NCS-382 (50 mg/kg), and the cardiovascular responses were recorded. Seven days later the rats received the other antagonist. To evaluate the role of GABAb receptors in non-GHB-mediated hypertension, 5 rats were instrumented with telemetry probes and 2 femoral venous cannulas. On the day of the experiment, each rat received an intravenous infusion of the [alpha]1-adrenergic receptor agonist phenylephrine (1 µg/25 µL/min to 3.7 µg/90 µL/min) to achieve an average increase in MAP of 66 ± 5 mm Hg. Once the phenylephrine-induced hypertension was stable, CGP 35348 (50 mg/kg, IV) was administered, and the MAP response was recorded for 10 minutes. Afterward, the phenylephrine infusion was stopped, and the MAP was allowed to return to baseline.

Role of Central GABAb Receptors in Mediating the Cardiovascular Responses Elicited by the Intravenous Administration of GHB

Six rats were instrumented with telemetry probes, femoral venous cannulas, and ICV cannulas and allowed to recover. On the first day of the experiment, the animals received a single intravenous injection of GHB (560 mg/kg), and the MAP response was continuously monitored. At or near the peak of the MAP response, the GABAb antagonist CGP 35348 (50 µg/rat) was administered ICV, and the cardiovascular parameters were recorded.26 To determine the effect of CGP 35348 on baseline MAP and heart rate, the rats received a single ICV injection of CGP 35348 (50 µg/rat) in the absence of GHB, and their cardiovascular responses were recorded. All ICV injections were administered in a total volume of 5 µL. ICV cannulas were not removed for a minimum of 15 minutes after drug administration.

Effects of GHB on Renal Sympathetic Nerve Activity

Five rats were instrumented for renal sympathetic nerve recording and were allowed to awaken from anesthesia. MAP and heart rate were monitored until stable baselines were achieved. The minimum time from the end of surgery until stable baselines were achieved was 4 hours. Baseline arterial pressure, MAP, heart rate, and integrated RSNA were recorded for at least 10 minutes. GHB (560 mg/kg, IV) was administered, and the cardiovascular and neural responses monitored until the MAP and RSNA responses appeared to plateau. At this point, CGP 35348 (50 mg/kg, IV) was administered, and the cardiovascular and neural responses continuously recorded.

Data Analysis

The output from the telemetry probes was recorded (250 Hz) using receivers placed under the home cages. The data were sent to a consolidation matrix before being stored on a personal computer. Data acquisition was controlled using Data Sciences Dataquest acquisition software. The data were averaged into 2-second bins and displayed. The magnitude of the peak changes in MAP and heart rate elicited by the drugs were calculated off-line as the difference between the baselines and peak drug response using the Dataquest analysis program. Response durations were also calculated off-line using the Dataquest analysis program. The duration of the MAP response was calculated as the interval between drug administration and the point at which the MAP returned within 7 mm Hg of baseline. The duration of the heart rate response was calculated as the interval between the second increase in heart rate and the point at which the heart rate returned to within 7 bpm of baseline. In nerve recording studies, heart rate, MAP, and integrated RSNA were collected and analyzed using the computer-based BIOPAC system. The renal nerve activity was recorded (30 Hz to 10 kHz; Grass P511) and sampled at 2 KHz. RSNA measurements were performed using Labtech Notebook (version 6.1.1; Laboratory Technology, Wilmington, MA). Integrated RSNA was expressed as microvolt-seconds in 1-second intervals. The level background noise in the nerve signal was determined postmortem and subtracted from control and experimental periods. Peak RSNA responses were reported as changes (% control) from baseline. Baseline and peak MAP, heart rate, and RSNA responses recorded were compared using one-way repeated-measures analysis of variance (ANOVA). After the ANOVAs, the differences between the individual means were evaluated using the Tukey test. Statistical significance was assigned at P < 0.05.

Drugs Used

The drugs used in this study were [gamma]-hydroxybutyrate, NCS-382 ([5,7,8,9-tetrahydro-5-hydroxy-6H-benzocyclohepten-6-ylidene]-monosodium salt acetic acid), pentobarbital, phenylephrine (all from Sigma-Aldrich, St Louis, MO), methohexital sodium (Brevital sodium; Jones Pharma, St Lous, MO), propofol (Gensia Sicor Pharmaceuticals, Irvine, CA), ketamine (Phoenix Scientific, Inc, St Joseph, MO), and xylazine (Vedco, Inc, St Joseph, MO). CGP 35348 (3-aminopropyl diethoxymethyl phosphinic acid) was graciously supplied by Drs Charles France and Andy Coop, University of Texas, San Antonio.

RESULTS

Figure 1 shows a typical experimental recording of the MAP and heart rate responses elicited by the administration GHB (1000 mg/kg, IV) in a conscious telemetered rat. This dose of GHB elicited a large and prolonged increase in MAP. GHB also elicited an immediate but transient increase in heart rate followed by a prolonged tachycardia. The 560 mg/kg dose of GHB produced a similar pattern of MAP and heart rate responses. The magnitudes of the initial increases in heart rate ranged from 52 ± 16 to 74 ± 6 bpm and were not significantly different from the increase in heart rate elicited by corresponding control doses of saline (Fig. 2). Therefore, the initial increases in heart rate elicited by GHB were not considered a drug effect. Lower doses of GHB (180 and 320 mg/kg, IV) also increased arterial pressure but not heart rate. Figure 2 summarizes the peak MAP and heart rate responses elicited by GHB and saline in 7 rats. The increases in MAP elicited by GHB peaked within 7 ± 2 to 36 ± 7 minutes, and the durations of these pressor responses ranged from 28 ± 8 to 227 ± 37 minutes. The administration of 560 and 1000 mg/kg doses of GHB also elicited tachycardic responses that peaked 41 ± 6 and 53 ± 7 minutes after drug administration and lasted 77 ± 21 and 95 ± 13 minutes, respectively. The small volume control injections of saline significantly increased heart rate (P = 0.01) but did not significantly increase MAP (Fig. 2). The administration of large-volume control injections of saline significantly increased MAP (P < 0.001) and heart rate (P < 0.001); however, the durations (6 ± 2 and 6 ± minutes, respectively) of these responses were significantly shorter (P = 0.001 and P < 0.001, respectively) than those elicited by the 1000 mg/kg dose of GHB.

 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 1. Typical experimental record showing the heart rate (HR, top panel) and mean arterial pressure (MAP, bottom panel) responses elicited by the injection of GHB (1000 mg/kg, IV) in a conscious telemetered rat. Arrow, GHB injection.


 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 2. Summary of the peak mean arterial pressure (MAP) and heart rate (HR) responses elicited by the intravenous injection of GHB and saline in conscious rats (n = 7). Small (open squares) and large (open diamond) volumes of saline corresponded to the volumes of the 180- and 1000-mg/kg doses of GHB, respectively. (Top) Averages of the peak increases in HR elicited by GHB and large volumes of saline. (Bottom) Averages of the peak increases in MAP elicited by each dose of GHB and the small and large volumes of saline. Values are means ± SEM.


Role of GHB and GABAb Receptors in Mediating the MAP and Heart Rate Responses Elicited by GHB

The experimental record in Figure 3 demonstrates the ability of CGP 35348 to reverse the hypertension elicited by GHB (560 mg/kg, IV) in a telemetered rat when administered at the peak of the GHB-mediated increase in MAP. CGP 35348 also reversed the secondary tachycardia, lowering heart rate below baseline (Fig. 3). The decrease in MAP and/or heart rate elicited by the intravenous administration of NCS-382 or CGP 35348 was measured at the lowest point within 10 minutes. The effects of CGP 35348 on the GHB-mediated increases in MAP and the secondary tachycardic response in 5 rats are summarized in Figure 4A. In a separate group of 5 rats, the intravenous administration of CGP 35348 (50 mg/kg) alone significantly increased MAP (18 ± 3 mm Hg) and heart rate (56 ± 9 bpm), and these increases were significantly greater than those elicited by saline.

 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 3. Typical experimental record showing reversal of the GHB-mediated increases in heart rate (HR, top panel) and mean arterial pressure (MAP, bottom panel) elicited by administration of the GABAb receptor antagonist CGP 35348 in a conscious telemetered rat. Single arrow, injection of GHB (560 mg/kg, IV). Double arrow, injection of CGP 35348 (50 mg/kg, IV).


 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 4. Effect of CGP 35348 (A) and the GHB receptor antagonist NCS-382 (B) on the mean arterial pressure (MAP) and heart rate (HR) responses elicited by GHB (560 mg/kg, IV). Values are means ± SEM. *Significantly different from baseline. #Significantly different from peak GHB-mediated response.


In 5 rats, the intravenous infusion of phenylephrine increased MAP 66 ± 5 mm Hg. Five and 10 minutes after the subsequent intravenous administration of CGP 35348, MAP was unchanged at 66 ± 4 and 66 ± 3 mm Hg, respectively.

In a separate group of rats, the ICV administration of CGP 35348 (50 µg/rat) at the peak of the GHB-mediated pressor response returned MAP and the secondary increase in heart rate to baseline within 18 ± 4 (n = 6) and 13 ± 6 minutes (n = 4), respectively (Fig. 5). In control animals, the average time interval from the peak of the GHB-mediated pressor response to the return to baseline was significantly greater (91 ± 15 minutes, n = 7). Similarly, the time from the peak of the secondary tachycardia to the return to baseline in control animals was also significantly longer (87 ± 41 minutes, n = 7) than in treated rats. The central administration of CGP 35348 alone did not significantly alter baseline MAP (102 ± 4 versus 102 ± 7 mm Hg) or heart rate (333 ± 8 versus 332 ± 20 bpm) when measured approximately 18 minutes after drug administration.

 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 5. Summary of the effect of CGP 35348 (50 µg/rat, ICV) on the increases in mean arterial pressure (MAP, n = 6) and heart rate (HR, n = 4) elicited by GHB (560 mg/kg, IV) in conscious, telemetered rats. Values are means ± SEM. *Significantly different from baseline. #Significantly different from the peak GHB-mediated response.


In a separate group of 4 rats, the intravenous administration of NCS-382 completely reversed the GHB-mediated increase in heart rate but not the pressor response (Fig. 4B). The administration of NCS-382 (50 mg/kg, IV, n = 4) alone increased MAP (22 ± 2 mm Hg) and heart rate (56 ± 13 bpm). Although the increase in MAP elicited by NCS-382 alone was significantly greater than that elicited by saline, the increases in heart rate elicited by the antagonist alone and saline were not significantly different.

Role of the Sympathetic Nervous System

Figure 6 shows a typical experimental record of the cardiovascular and renal sympathetic nerve responses elicited by GHB (560 mg/kg, IV) alone and after the subsequent administration of CGP 35348 in a conscious rat. In this rat, the injection of GHB (560 mg/kg, IV) increased RSNA and MAP (Fig. 6). At the plateau of the renal sympathetic nerve response, the administration of CGP 35348 reversed the increase in RSNA, reduced the hypertension, and lowered heart rate (Fig. 6). The decreases in MAP and heart rate after injection of CGP 35348 were preceded by a brief (<1 min) increase in MAP (14 ± 1 mm Hg, n = 5), which coincided with the injection. Figure 7 summarizes the RSNA, MAP, and heart rate responses elicited by GHB (560 mg/kg, IV) alone and after the subsequent administration of CGP 35348 in 5 rats. In these experiments, GHB elicited significant increases in RSNA (P < 0.01) and MAP (P < 0.001), both of which were reversed by administration of CGP 35348 (Fig. 7). Unlike the tachycardia observed in the telemetered rats, GHB tended to decrease heart rate in rats used for nerve recording studies (Fig. 7). The administration of CGP 35348 significantly reduced heart rate (Fig. 7).

 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 6. Typical experimental record showing the heart rate (HR), arterial pressure (AP), mean arterial pressure (MAP), and integrated renal sympathetic nerve activity (RSNA) responses elicited by GHB in a conscious rat. Also shown is the effect of CGP 35348 on the GHB-mediated cardiovascular and sympathetic nerve responses. Single arrow, 16 minutes after injection of GHB (560 mg/kg, IV). Double arrow, injection of CGP 35348 (50 mg/kg, IV). Horizontal calibration is 1 minute.


 

Graphic
[Help with image viewing]
[Email Jumpstart To Image]


FIGURE 7. Effects of CGP 35348 on the peak cardiovascular and sympathetic nerve responses elicited by GHB in conscious rats (n = 5). Values are means ± SEM. *Significantly different from GHB-mediated response.


DISCUSSION

Previous studies have shown that the intraperitoneal injection of GHB elicits marked and prolonged increases in MAP and heart rate in conscious rats.7,9 The present study showed for the first time that the intravenous administration of GHB consistently increases MAP in conscious rats. The 560- and 1000-mg/kg doses of GHB elicited a large increase in heart rate that coincided with the sustained hypertension. There is great variability in the dose of GHB used by humans. Therapeutic doses of GHB used to treat narcolepsy are approximately 64 mg/kg, which is below the lowest cardiovascular effective dose used in the current study (180 mg/kg). However, the doses used by individuals who misuse GHB are more difficult to document. There are reports in the literature of individuals using as much as 570 mg/kg of GHB per day.27 When GHB was used as an anesthetic in humans, IV doses ranged from 69 to 210 mg/kg.6 The dose-response relationships for GHB’s cardiovascular effects in rats are in good agreement with those used for the drug’s behavioral effects in rats.16,25

In the present study, GHB also significantly increased RSNA in conscious rats, providing the first direct demonstration that GHB increases sympathetic nerve activity. The fact that central and peripheral administration of CGP 35348 attenuated or reversed the cardiovascular and neural effects of GHB indicates that central GABAb receptors mediate the sympathoexcitatory cardiovascular responses elicited by GHB. The inability of CGP 35348 to reverse a non-GHB-mediated hypertension reflects its ability to block GABAb receptors rather than a nonspecific vasodilatory action.

Further supporting the involvement of GABAb receptor mechanisms are reports that the systemic or central administration of the selective GABAb agonist baclofen increases arterial pressure and heart rate in rats, presumably by increasing central sympathetic outflow.28-30 More specifically, evidence suggests that GABAb receptors in the nucleus of the tractus solitarius (NTS) play important roles in regulating cardiovascular function and may be an important site of action for GABAb agonists.31-33 Altered GABAb receptor function in the NTS has been implicated in the pathogenesis of several forms of experimental hypertension.34,35 The activation of GABAb receptors in the NTS also attenuates baroreceptor reflex function, leading some investigators to suggest that the decrease in reflex function is responsible for the increase in arterial pressure and heart rate elicited by GABA agonists.32,33,36 Whether GHB, like baclofen, alters baroreceptor reflex function to increase sympathetic outflow via activation of GABAb receptors is unknown. The conclusion that the increases in arterial pressure, heart rate, and RSNA elicited by GHB involve the activation of central GABAb receptors raises the possibility that the NTS may be an important locus for the cardiovascular actions of this drug. However, previous studies have shown that increases in arterial pressure and heart rate elicited by intraperitoneal GHB could be prevented by prehypothalamic lesions, lesions that spared the NTS.7,9 Conversely, similar lesions did not prevent the cardiovascular response elicited by systemically administered baclofen.30

Surprisingly, activation of GHB receptors appears to mediate the increase in heart rate elicited by GHB. The mechanism by which GHB receptor activation increases heart rate is unknown. The ability of NCS-382 to completely reverse the tachycardia without reducing the hypertension raises the possibility that GHB receptors may contribute to baroreceptor heart rate reflex function. Whether the GHB receptors in question are located in the NTS, on vagal preganglionic neurons in the nucleus ambiguus, or some other pathway is unknown.

Although the cardiovascular and neural responses elicited by GHB appear to be mediated by the activation of GABAb receptors, it is not clear whether this reflects a direct or indirect action of GHB. GHB has been shown to have agonist activity at recombinant GABAb receptor complexes in oocytes 37 and to have low affinity for GABAb receptors in vitro.3,15 However, GHB may also indirectly activate GABAb receptors following its metabolism to GABA in vivo.38

The heart rate responses elicited by GHB in the telemetry and sympathetic nerve recording studies were not consistent in that GHB elicited tachycardia in the telemetry studies but decreased heart rate in the sympathetic nerve-recording studies. It is possible that these differences reflect a residual cardiac effect of the barbiturate anesthesia used during instrumentation of the rats.

CONCLUSION

In conclusion, the acute intravenous administration of GHB elicits large and prolonged increases in MAP and heart rate in conscious rats. These increases appear to be mediated by an increase in central sympathetic outflow via activation of central GABAb receptors. Whether the GABAb receptors in question are located in forebrain sympathetic pathways, the NTS, or some other brain region is unknown. GHB receptors appear to selectively mediate the increase in heart rate elicited by GHB. The magnitude and duration of the sympathomimetic cardiovascular responses elicited by GHB are cause for concern because they are, in many ways, similar to those elicited by sympathomimetic stimulants (eg, cocaine and methamphetamine), which are known to produce cardiac and cardiovascular toxicity.17,18,39 Whether the administration of GHB also produces cardiac and cardiovascular toxicity is unknown; however, given the widespread recreational use of GHB and its use as a therapeutic agent, further investigation of the cardiovascular actions of this drug is warranted.

ACKNOWLEDGMENTS

The authors would like to thank Ms Lisa Badon and Mr Brian Ogden for their expert technical assistance and Ms Velga Kenigs for her assistance in the nerve-recording studies. The authors would also like to thank Drs Charles France and Andy Coop for providing CPG 35348 (DA14986 awarded to C. P. France). We also thank Drs Lisa Gerak and Peter Winsauer for their discussions and editorial comments.

REFERENCES

1. Friedman J, Westlake R, Furman M. “Grievous bodily harm”: gamma hydroxybutyrate abuse leading to a Wernicke-Korsakoff syndrome. Neurology. 1996;46:469-471. Ovid Full Text Bibliographic Links Library Holdings [Context Link]

2. Chin RL, Sporer KA, Cullison B, et al. Clinical course of gamma-hydroxybutyrate overdose. Ann Emerg Med. 1998;31:716-722. [Context Link]

3. Nicholson KL, Blaster RL. GHB: a new and novel drug of abuse. Drug Alcohol Depend. 2001;63:1-22. Bibliographic Links Library Holdings [Context Link]

4. Li J, Stokes SA, Woeckener A. A tale of novel intoxication: seven cases of gamma-hydroxybutyric acid overdose. Ann Emerg Med. 1998;31:723-728. Bibliographic Links Library Holdings [Context Link]

5. Suner S, Szlatenyi CS, Wang RY. Pediatric gamma hydroxybutyrate intoxication. Acad Emerg Med. 1997;4:1041-1045. Bibliographic Links Library Holdings [Context Link]

6. Blumenfeld M, Suntay RG, Harmel MH. Sodium gamma-hydroxybutyric acid: a new anesthetic adjuvant. Anesth Analg. 1962;41:721-726. [Context Link]

7. Gomes C, Flygt C, Henning M, et al. Gammahydroxy butyric acid: cardiovascular effects in the rat. J Neural Transm. 1976;38:123-129. [Context Link]

8. Boyd AJ, Sherman IA, Saibil FG. The cardiovascular effects of gamma-hydroxybutyrate following hemorrhage. Circ Shock. 1992;38:115-121. Bibliographic Links Library Holdings [Context Link]

9. Persson B, Henning M. Central cardiovascular effects of gamma-hydroxybutyric acid: interactions with noradrenaline, serotonin, dopamine and acetylcholine transmission. Acta Pharmacol Toxicol. 1980;47:335-346. [Context Link]

10. Abramowicz M. Gamma hydroxybutyrate (Xyrem) for narcolepsy. Med Lett. 2002;44:103-105. [Context Link]

11. Poldrugo F, Addolorato G. The role of gamma-hydroxybutyric acid in the treatment of alcoholism: from animal to clinical studies. Alcohol Alcohol. 1999;34:15-24. Bibliographic Links Library Holdings [Context Link]

12. Mamelak M. Gammahydroxybutyrate: an endogenous regulator of energy metabolism. Neurosci Biobehav. 1989;13:187-198. [Context Link]

13. Howard SG, Feigenbaum JJ. Effect of gamma-hydroxybutyrate on central dopamine release in vivo. Biochem Pharmacol. 1997;53:103-110. Bibliographic Links Library Holdings [Context Link]

14. Martellotta MC, Balducci C, Fattore L, et al. Gamma-hydroxybutyric acid decreases intravenous cocaine self-administration in rats. Pharmacol Biochem Behav. 1998;59:697-702. [Context Link]

15. Cash CD. Gammahydroxybutyrate: an overview of the pros and cons for it being a neurotransmitter and/or a useful therapeutic agent. Neurosci Behav Rev. 1994;18:291-304. Bibliographic Links Library Holdings [Context Link]

16. Carter LP, Wu H, Chen W, et al. Effects of GHB on schedule-controlled responding in rats: role of GHB and GABAb receptors. J Pharmacol Exp Ther. 2004;308:182-188. [Context Link]

17. Varner KJ, Ogden BA, Delcarpio J, et al. Cardiovascular responses elicited by the “binge” administration of methamphetamine. J Pharmacol Exp Ther. 2002;301:152-159. [Context Link]

18. Badon LA, Hicks A, Lord K, et al. Changes in cardiovascular responsiveness and cardiotoxicity elicited during binge administration of ecstasy. J Pharmacol Exp Ther. 2002;302:898-907. Bibliographic Links Library Holdings [Context Link]

19. Kapusta DR, Obih JC. Central kappa opioids blunt the renal excretory responses to volume expansion by a renal nerve-dependent mechanism. J Pharmacol Exp Ther. 1995;273:199-205. Bibliographic Links Library Holdings [Context Link]

20. Paxinos G, Watson C. The Rat Brain in Stereotaxic Coordinates, 2nd ed. Sydney: Academic Press, 1986. [Context Link]

21. Kapusta DR, Sezen SF, Chang JK, et al. Diuretic and antinatriuretic responses produced by the endogenous opioid-like peptide, nociceptin (orphanin FQ). Life Sci. 1997;60:PL15-PL21. [Context Link]

22. Kapusta DR, Chang JK, Kenigs VA. Central administration of [Phe1psi(CH2-NH)Gly2]nociceptin(1-13)-NH2 and orphanin FQ/nociceptin (OFQ/N) produce similar cardiovascular and renal responses in conscious rats. J Pharmacol Exp Ther. 1999;289:173-180. Bibliographic Links Library Holdings [Context Link]

23. Kapusta DR, Dayan LA, Kenigs VA. Nociceptin/orphanin FQ modulates the cardiovascular, but not renal, responses to stress in spontaneously hypertensive rats. Clin Exp Pharmacol Physiol. 2002;3:254-259. [Context Link]

24. Colombo G, Agabio R, Balaklievskaia N, et al. Oral self-administration of gamma-hydroxybutyric acid in the rat. Eur J Pharmacol. 1995;285:103-107. [Context Link]

25. Carter LP, Flores LR, Wu H, et al. The role of GABAb receptors in the discriminative stimulus effects of gamma-hydroxybutyrate in rats: time course and antagonism studies. J Pharmacol Exp Ther. 2003a;305:668-674. [Context Link]

26. Zarrindast MR, Bakhsha A, Rostami P, et al. Effects of intrahippocampal injection of GABAergic drugs on memory retention of passive avoidance learning in rats. J Psychopharmacol. 2002;16:313-319. [Context Link]

27. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med. 2001;37:147-153. Bibliographic Links Library Holdings [Context Link]

28. Chahl LA, Walker SB. The effect of baclofen on the cardiovascular system of the rat. Br J Pharmacol. 1980;69:631-637. [Context Link]

29. Persson B, Henning M. Central cardiovascular and biochemical effects of baclofen in the conscious rat. J Pharm Pharmacol. 1980b;32:417-422. [Context Link]

30. Persson B. A hypertensive response to baclofen in the nucleus tractus solitarii in rats. J Pharm Pharmacol. 1981;33:226-231. [Context Link]

31. Sved AF, Sved JC. Endogenous GABA acts on GABAB receptors in nucleus tractus solitarius to increase blood pressure. Brain Res. 1990;526:235-240. [Context Link]

32. Florentino A, Varga K, Kunos G. Mechanism of the cardiovascular effects of GABAB receptor activation in the nucleus tractus solitarii of the rat. Brain Res. 1990;535:264-270. Bibliographic Links Library Holdings [Context Link]

33. Sved AF, Tsukamoto K. Tonic stimulation of GABAB receptors in the nucleus tractus solitarius modulates the baroreceptor reflex. Brain Res. 1992;592:37-43. Bibliographic Links Library Holdings [Context Link]

34. Tsukamoto K, Sved AF. Enhanced gamma-aminobutyric acid-mediated responses in nucleus tractus solitarius of hypertensive rats. Hypertens. 1993;22:819-825. Bibliographic Links Library Holdings [Context Link]

35. Hayakawa K, Kimura M, Kamata K. Mechanism underlying gamma-aminobutyric acid-induced antihypertensive effect in spontaneously hypertensive rats. Eur J Pharmacol. 2002;438:107-113. [Context Link]

36. Callera JC, Bonagamba LG, Nosjean A, et al. Activation of GABA receptors in the NTS of awake rats reduces the gain of baroreflex bradycardia. Autonom Neurosci Basic Clin. 2000;84:58-67. [Context Link]

37. Lingenhoehl K, Brom R, Heid J, et al. A specific gamma-hydroxybutyrate receptor ligand possesses both antagonistic and anticonvulsant properties. J Pharmacol Exp Ther. 1999;255:657-663. [Context Link]

38. Maitre M. The gamma-hydroxybutyrate signaling system in brain: organization and functional implications. Prog Neurobiol. 1997;51:337-361. Bibliographic Links Library Holdings [Context Link]

39. Knuepfer MM. Cardiovascular disorders associated with cocaine use: myths and truths. J Pharmacol Exp Ther. 2003;97:181-222. [Context Link]

Key Words: [gamma]-hydroxybutyrate; sympathomimetic effects; GABAb receptors

 

Share This Post

© 2004 Lippincott Williams & Wilkins, Inc. Volume 44(6)             December 2004             pp 631-638 Mechanisms Underlying the Sympathomimetic Cardiovascular Responses Elicited by [gamma]-Hydroxybutyrate [Original Article] Hicks, Alissa R. BS; Kapusta, Daniel R. PhD; Varner, Kurt J. PhD From the Department of Pharmacology and Experimental Therapeutics, Louisiana…
&source=WeeksMD">