Insulin modulation of an endothelial nitric oxide component present in the alpha(2)- and beta-adrenergic responses in human forearm

We explored in 51 normal subjects, distributed in various series of experiments, whether endothelium nitric oxide may play a role in insulin modulation of alpha(2)- beta-adrenergic-evoked vascular responses. In particular, we examined the forearm blood flow response (FBF, ml.min(-1).dl(-1)) to intrabrachial infusion of BHT-933 (0.5, 1, and 2 mu g.min(-1).dl(-1)) or isoproterenol (1, 3, and 6 ng.min(-1).dl(-1)) in control conditions, during intrabrachial infusion of insulin alone (0.05 mU.kg(-1).min(-1)) and associated with L-N-monomethylarginine (L-NMMA) (0.05 mu g.min(-1).dl(-1)), a nitric oxide synthase inhibitor. In control conditions both BHT-933 and isoproterenol induced a dose-dependent vascular response. Local hyperinsulinemia (deep venous plasma insulin 68.5+/-4 mu U/ml) did not change basal FBF whereas attenuated BHT-933 vasoconstriction and enhanced isoproterenol vasodilation. L-NMMA reduced basal FBF and abolished the insulin effect on BHT-933 and isoproterenol response, To clarify whether a nitric oxide component is included in alpha(2)- and beta-adrenergic response and may be responsible for insulin vascular effect, we further examined BHT-933 and isoproterenol responses during nitric oxide inhibition. Interestingly, L-NMMA potentiated the BHT-933 vasoconstriction and attenuated the isoproterenol vasodilation and, in these conditions, insulin was no more able to exhibit its vascular effects. Finally, to rule out the possibility that the conteracting effect of L-NMMA may not be specifically related to insulin action, dose-response curves to phenylephrine (0.5, 1, and 2 mu g.min(-1).dl(-1)) or sodium nitroprusside (1, 2, and 4 mu g.min(-1).dl(-1)) were also performed. Both insulin and L-NMMA were unable to alter the phenylephrine-induced vasoconstriction and the sodium nitroprusside vasodilation. In conclusion, our data demonstrate an endothelial nitric oxide component in the alpha(2)- and beta-adrenergic vascular responses which is the target of the insulin vascular action.