Alterations of myocardial and vascular adrenergic receptor-mediated responses in Escherichia coli-induced septic shock in the rat

Objectives: To investigate responsiveness to exogenous catecholamines in rat bacteremic shock by studying both myocardial and vascular functional parameters; to determine in the same study the relationship of these parameters with other relevant biological parameters of the adrenergic pathway, such as myocardial beta-adrenergic receptors and cyclic adenosine monophosphate (cAMP); and to indirectly approach the roles of tumor necrosis factor-alpha (TNF-alpha) and nitric oxide. Design: Experimental, comparative study. Setting: Laboratory in a university hospital, Subjects: Male Sprague-Dawley rats, weighing 270 to 320 g. Interventions: Intravenous injection of live Escherichia coli DH5 alpha (2 x 10(10) organisms/kg) or saline (0.6 mL) and comparison of the two groups. Measurements and Main Results: Mean arterial pressure and heart rate (HR) were recorded, and circulating TNF-alpha concentrations were measured, during the first 3 hrs after E. coli administration. Myocardial and vascular functional parameters were obtained, respectively, from Langendorff-perfused hearts and isolated aortic rings, Adrenergic biochemical parameters (catecholamines, den sity and affinity of beta-receptors, and isoproterenol-stimulated myocardial cAMP) were determined 3 hrs after E. coli injection, Mean arterial pressure decreased within 5 to 60 mins after bacteria injection and returned to basal levels in the last 2 hrs; HR was unchanged. Serum TNF-alpha concentrations peaked at 120 mins (7333 +/- 672 pg/mL) and were still increased at 3 hrs. Plasma concentrations of epinephrine and norepinephrine were significantly (p < .05) increased, Baseline values for differential left ventricular pressure and coronary flow were significantly (p < .0001, p<.001, respectively) reduced; HR remained unchanged, Isoproterenol induced a similar increase in differential left ventricular pressure and in HR. There was no decrease in the functional myocardial response to adrenergic stimulation. beta-adrenergic receptors were similar in density and in affinity in the two groups, Isoproterenol-stimulated myocardial cAMP was significantly (p < .01) reduced compared with the control group, In aortic rings, bacteria administration significantly (p <.01) shifted the dose-response curve to norepinephrine to the right, both in the presence and absence of endothelium, N-G-monomethyl-L-arginine significantly increased the contractions to attain the control level: p< .001 in presence of endothelium; p<.05 in absence of endothelium. Conclusions: In ex vivo experiments, 3 hrs after E. coli injection, vascular responsiveness was sharply decreased, This im paired response was improved by inhibition of nitric oxide. The heart, nevertheless, was still able to modulate its inotropic and chronotropic response to isoproterenol, even though an impaired beta-adrenergic-receptor stimulation of cAMP was already present.