title: Reduction in vascular responsiveness to adrenomedullin during sepsis.
abstract: BACKGROUND
  Although sepsis is characterized by an early, hyperdynamic phase followed by a late, hypodynamic phase, the mechanism responsible for the transition from the hyperdynamic to the hypodynamic state remains unknown. Since recent studies have shown that adrenomedullin (ADM), a novel potent vasodilatory peptide, is upregulated during sepsis, the aim of this study was to determine whether the reduced vascular responsiveness to ADM is associated with the transition from the hyperdynamic phase to the hypodynamic phase of sepsis.
  
  
  METHODS
  Adult male Sprague-Dawley rats were subjected to sepsis by cecal ligation and puncture (CLP). At 5 and 10 h (i.e., the hyperdynamic phase of sepsis) or 20 h (the hypodynamic phase) after CLP, the thoracic aorta or small intestine was harvested and preconstricted with norepinephrine. Adrenomedullin (10(-7) M) was applied and the percentage of ADM-induced vascular relaxation in the aortic ring and isolated small intestine was determined.
  
  
  RESULTS
  The responsiveness to ADM in the thoracic aorta was not altered at 5-10 h, but decreased significantly at 20 h after CLP. Although ADM-induced relaxation in resistance blood vessels of the small intestine did not change at 5 h, it decreased markedly at 10 and 20 h after the onset of sepsis.
  
  
  CONCLUSIONS
  Since the transition from hyperdynamic to hypodynamic sepsis takes place between 10 and 20 h after CLP, it is likely that reduced vascular responsiveness to ADM may be responsible for such an event during the course of polymicrobial sepsis. In view of this, maintenance of vascular ADM responsiveness by pharmacologic agents appears to be a novel approach for preventing or delaying the occurrence of hypodynamic sepsis and septic shock.
authors.affiliation: Center for Surgical Research and Department of Surgery, Brown University School of Medicine and Rhode Island Hospital, Providence, Rhode Island, 02903, USA. pwang@lifespan.org
authors.forename: P
authors.initials: P
authors.lastname: Wang
authors.forename: P
authors.initials: P
authors.lastname: Yoo
authors.forename: M
authors.initials: M
authors.lastname: Zhou
authors.forename: W G
authors.initials: WG
authors.lastname: Cioffi
authors.forename: Z F
authors.initials: ZF
authors.lastname: Ba
authors.forename: I H
authors.initials: IH
authors.lastname: Chaudry
mesh_terms: D053607:Adrenomedullin; D000818:Animals; D001013:Aorta, Thoracic / Q000187:drug effects / Q000502:physiology; D001424:Bacterial Infections / Q000503:physiopathology*; D001808:Blood Vessels / Q000187:drug effects* / Q000503:physiopathology; D066298:In Vitro Techniques; D007422:Intestines / Q000098:blood supply; D008297:Male; D010455:Peptides / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D014664:Vasodilation / Q000502:physiology; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D010455:Peptides; D014665:Vasodilator Agents; D053607:Adrenomedullin