Publications

The pulmonary artery pressure response to exercise has been used as an index of cardiac reserve and frequently mirrors diastolic conditions. To define this response after orthotopic heart transplantation, we exercised 27 subjects on supine bicycle ergonometers. Stroke volume and pulmonary artery pressure were monitored with contrast-enhanced Doppler imaging. Study patients had undergone orthotopic heart transplantation. Seventeen patients were screened, and eight were subsequently determined by endomyocardial biopsy to be histologically free of acute cardiac allograft rejection. A control population of nonconditioned normal volunteers was also evaluated (heart transplant patients: n = 8, age = 45.7 +/- 7.3 years, seven men; normals volunteers: n = 10, age = 49.4 +/- 12.8 years, nine men; P = NS). Total exercise time and peak heart rate were reduced in heart transplant patients: 7.6 +/- 2.5 minutes, 123 +/- 4 beats/min versus normal volunteers: 16.2 +/- 4.5 minutes, 134 +/- 4 beats/min (P < 0.05). Change in stroke volume from baseline to peak exercise was greater in heart transplant patients: 29.9 +/- 4.6 ml versus normal volunteers: 3.9 +/- 5.7 ml (P < 0.01). No difference was observed in the pulmonary artery pressure response to exercise. In patients with uncomplicated heart transplantation a reduction in exercise capacity is shown; however, the pulmonary artery pressure response to exercise is comparable to normal subjects. A blunted heart rate response is observed, which is partially compensated by increases in stroke volume. These findings suggest that cardiac diastolic function is preserved and that denervation of the heart accounts for impaired exercise tolerance.

Cyclosporine (CyA) metabolism was investigated in liver microsomes obtained from untreated male and female Sprague-Dawley rats, and rats pretreated with ethinyl estradiol (EE), dexamethasone (DX), and phenobarbital (PB). Total hepatic microsomal cytochrome P-450 content of DX- and PB-treated male and female rats was significantly higher than that of their respective control or EE-treated rats. However, CyA metabolism was significantly increased, by all drug pretreatments, both in male and female rats. EE increased (2-5 fold) the formation of AM9 (a hydroxylated metabolite) and AM1c (a cyclized-hydroxylated product) over the CyA concentration range tested (0.2-42 microM). DX and PB significantly increased (2- to 20-fold) all detected metabolites (AM1, another hydroxylated metabolite; AM9; AM4N, an N-demethylated product; and AM1c), especially at high substrate concentrations (above 1.25 microM). Immunoblot analyses revealed that the microsomal P-450 3A2 content was decreased in EE-treated male rats, but markedly induced in those treated with either DX or PB. P-450 3A1 was undetectable in untreated and EE-treated female rats, but greatly induced in DX-treated male and female rats. Examination of P-450 3A activity, using 6 beta-hydroxytestosterone formation as a probe, confirmed the immunoblot results. These studies suggest that enzyme(s), other than P-450s 3A1 and 3A2 also play a significant role in CyA metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)