title: Endogenous circulating sympatholytic factor in orthostatic intolerance.
abstract: Sympathotonic orthostatic hypotension (SOH) is an idiopathic syndrome characterized by tachycardia, hypotension, elevated plasma norepinephrine, and symptoms of orthostatic intolerance provoked by assumption of an upright posture. We studied a woman with severe progressive SOH with blood pressure unresponsive to the pressor effects of alpha(1)-adrenergic receptor (AR) agonists. We tested the hypothesis that a circulating factor in this patient interferes with vascular adrenergic neurotransmission. Preincubation of porcine pulmonary artery vessel rings with patient plasma produced a dose-dependent inhibition of vasoconstriction to phenylephrine in vitro, abolished vasoconstriction to direct electrical stimulation, and had no effect on nonadrenergic vasoconstrictive stimuli (endothelin-1), PGF-2alpha (or KCl). Preincubation of vessels with control plasma was devoid of these effects. SOH plasma inhibited the binding of an alpha(1)-selective antagonist radioligand ([(125)I]HEAT) to membrane fractions derived from porcine pulmonary artery vessel rings, rat liver, and cell lines selectively overexpressing human ARs of the alpha(1B) subtype but not other AR subtypes (alpha(1A) and alpha(1D)). We conclude that a factor in SOH plasma can selectively and irreversibly inhibit adrenergic ligand binding to alpha(1B) ARs. We propose that this factor contributes to a novel pathogenesis for SOH in this patient. This patient's syndrome represents a new disease entity, and her plasma may provide a unique tool for probing the selective functions of alpha(1)-ARs.
authors.affiliation: Department of Neurology, College of Medicine, University of Vermont, Burlington, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Shapiro
authors.forename: B
authors.initials: B
authors.lastname: Winters
authors.forename: M
authors.initials: M
authors.lastname: Hales
authors.forename: T
authors.initials: T
authors.lastname: Barnett
authors.forename: D A
authors.initials: DA
authors.lastname: Schwinn
authors.forename: N
authors.initials: N
authors.lastname: Flavahan
authors.forename: D E
authors.initials: DE
authors.lastname: Berkowitz
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists; D000818:Animals; D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D001667:Binding, Competitive / Q000187:drug effects; D001681:Biological Assay; D001798:Blood Proteins / Q000378:metabolism* / Q000494:pharmacology; D002460:Cell Line; D002462:Cell Membrane / Q000378:metabolism; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D066298:In Vitro Techniques; D007537:Isometric Contraction / Q000187:drug effects; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011187:Posture; D011651:Pulmonary Artery / Q000187:drug effects / Q000378:metabolism; D011869:Radioligand Assay; D051381:Rats; D018340:Receptors, Adrenergic, alpha-1 / Q000378:metabolism; D013552:Swine; D013610:Tachycardia / Q000209:etiology; D014661:Vasoconstriction / Q000187:drug effects
chemical_list: C547716:ADRA1B protein, human; C547718:Adra1b protein, rat; D058668:Adrenergic alpha-1 Receptor Antagonists; D001798:Blood Proteins; D018340:Receptors, Adrenergic, alpha-1; D009638:Norepinephrine