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      Mechanisms for the control of local tissue blood flow during thermal interventions: influence of temperature‐dependent ATP release from human blood and endothelial cells

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          Abstract

          New Findings

          • What is the central question of this study?

            Skin and muscle blood flow increases with heating and decreases with cooling, but the temperature‐sensitive mechanisms underlying these responses are not fully elucidated.

          • What is the main finding and its importance?

            We found that local tissue hyperaemia was related to elevations in ATP release from erythrocytes. Increasing intravascular ATP augmented skin and tissue perfusion to levels equal or above thermal hyperaemia. ATP release from isolated erythrocytes was altered by heating and cooling. Our findings suggest that erythrocytes are involved in thermal regulation of blood flow via modulation of ATP release.

          Local tissue perfusion changes with alterations in temperature during heating and cooling, but the thermosensitivity of the vascular ATP signalling mechanisms for control of blood flow during thermal interventions remains unknown. Here, we tested the hypotheses that the release of the vasodilator mediator ATP from human erythrocytes, but not from endothelial cells or other blood constituents, is sensitive to both increases and reductions in temperature and that increasing intravascular ATP availability with ATP infusion would potentiate thermal hyperaemia in limb tissues. We first measured blood temperature, brachial artery blood flow and plasma [ATP] during passive arm heating and cooling in healthy men and found that they increased by 3.0 ± 1.2°C, 105 ± 25 ml min −1 °C −1 and twofold, respectively, (all P < 0.05) with heating, but decreased or remained unchanged with cooling. In additional men, infusion of ATP into the brachial artery increased skin and deep tissue perfusion to levels equal or above thermal hyperaemia. In isolated erythrocyte samples exposed to different temperatures, ATP release increased 1.9‐fold from 33 to 39°C ( P < 0.05) and declined by ∼50% at 20°C ( P < 0.05), but no changes were observed in cultured human endothelial cells, plasma or serum samples. In conclusion, increases in plasma [ATP] and skin and deep tissue perfusion with limb heating are associated with elevations in ATP release from erythrocytes, but not from endothelial cells or other blood constituents. Erythrocyte ATP release is also sensitive to temperature reductions, suggesting that erythrocytes may function as thermal sensors and ATP signalling generators for control of tissue perfusion during thermal interventions.

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          Most cited references56

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          Computation of aortic flow from pressure in humans using a nonlinear, three-element model.

          We computed aortic flow pulsations from arterial pressure by simulating a nonlinear, time-varying three-element model of aortic input impedance. The model elements represent aortic characteristic impedance, arterial compliance, and systemic vascular resistance. Parameter values for the first two elements were computed from a published, age-dependent, aortic pressure-area relationship (G. J. Langewouters et al. J. Biomech. 17:425-435, 1984). Peripheral resistance was predicted from mean pressure and model mean flow. Model flow pulsations from aortic pressure showed the visual aspects of an aortic flow curve. For evaluation we compared model mean flow from radial arterial pressure with thermodilution cardiac output estimations, 76 times, in eight open heart surgical patients. The pooled mean difference was +7%, the SD 22%. After using one comparison per patient to calibrate the model, however, we followed quantitative changes in cardiac output that occurred either during changes in the state of the patient or subsequent to vasoactive drugs. The mean deviation from thermodilution cardiac output was +2%, the SD 8%. Given these small errors the method could monitor cardiac output continuously.
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            Human plasma ATP concentration.

            Human plasma ATP concentration is reported in many studies as roughly 1000 nmol/L. The present study tested the hypothesis that the measured plasma ATP concentration is lower if ATP release from formed blood elements is inhibited during blood sample processing. A second hypothesis was that pretreatment with aspirin to inhibit platelets would reduce the measured plasma concentration of ATP. Blood was sampled from the antecubital vein in 20 healthy individuals 30 and 60 min after ingestion of aspirin (325 mg) or placebo. Aliquots of each blood sample were added to the usual EDTA/saline solution to inhibit ATP catabolism, or to a new stabilizing solution designed to both stop ATP catabolism and inhibit ATP release from blood elements. The stabilizing solution contained NaCl, EDTA, tricine buffer, KCl, nitrobenzylthioinosine, forskolin, and isobutylmethylxanthine. Plasma ATP was measured with the luciferin-luciferase assay with standard additions in each sample to determine ATP content. Hemoglobin concentration was used as an index of sample hemolysis, and the plasma ATP concentration was corrected for the hemolysis component. Aspirin pretreatment had no effect on plasma ATP concentrations. However, use of the stabilizing solution resulted in mean (SD) ATP concentrations 8-fold lower than the use of EDTA alone [28 (16) vs 236 (201) nmol/L; P <0.001]. When precautions are taken to inhibit ATP release from blood elements during sample preparation, human venous plasma ATP concentration is much lower than previously reported.
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              Erythrocyte and the regulation of human skeletal muscle blood flow and oxygen delivery: role of circulating ATP.

              Blood flow to contracting skeletal muscle is tightly coupled to the oxygenation state of hemoglobin. To investigate if ATP could be a signal by which the erythrocyte contributes to the regulation of skeletal muscle blood flow and oxygen (O2) delivery, we measured circulating ATP in 8 young subjects during incremental one-legged knee-extensor exercise under conditions of normoxia, hypoxia, hyperoxia, and CO+normoxia, which produced reciprocal alterations in arterial O2 content and thigh blood flow (TBF), but equal thigh O2 delivery and thigh O2 uptake. With increasing exercise intensity, TBF, thigh vascular conductance (TVC), and femoral venous plasma [ATP] augmented significantly (P<0.05) in all conditions. However, with hypoxia, TBF, TVC, and femoral venous plasma [ATP] were (P<0.05) or tended (P=0.14) to be elevated compared with normoxia, whereas with hyperoxia they tended to be reduced. In CO+normoxia, where femoral venous O2Hb and (O2+CO)Hb were augmented compared with hypoxia despite equal arterial deoxygenation, TBF and TVC were elevated, whereas venous [ATP] was markedly reduced. At peak exercise, venous [ATP] in exercising and nonexercising limbs was tightly correlated to alterations in venous (O2+CO)Hb (r2=0.93 to 0.96; P<0.01). Intrafemoral artery infusion of ATP at rest in normoxia (n=5) evoked similar increases in TBF and TVC than those observed during exercise. Our results in humans support the hypothesis that the erythrocyte functions as an O2 sensor, contributing to the regulation of skeletal muscle blood flow and O2 delivery, by releasing ATP depending on the number of unoccupied O2 binding sites in the hemoglobin molecule.
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                Author and article information

                Contributors
                kkalsi@sgul.ac.uk , kkalsihl@gmail.com
                Journal
                Exp Physiol
                Exp. Physiol
                10.1111/(ISSN)1469-445X
                EPH
                expphysiol
                Experimental Physiology
                John Wiley and Sons Inc. (Hoboken )
                0958-0670
                1469-445X
                01 February 2017
                01 February 2017
                : 102
                : 2 ( doiID: 10.1113/eph.2017.102.issue-2 )
                : 228-244
                Affiliations
                [ 1 ] Centre for Human Performance, Exercise and RehabilitationBrunel University London UxbridgeUK
                [ 2 ] Department of AnaestheticsEaling Hospital NHS Trust SouthallUK
                Author notes
                [*] [* ] Corresponding author K. K. Kalsi: Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Kingston Lane, Uxbridge, London UB8 3PH, UK.   Email: kkalsi@ 123456sgul.ac.uk and kkalsihl@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-2386-7251
                http://orcid.org/0000-0002-8205-3311
                Article
                EPH12037
                10.1113/EP085910
                5363389
                27859767
                acc69bcf-669b-4da6-bcd7-686262408f89
                © 2016 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 June 2016
                : 14 November 2016
                Page count
                Figures: 5, Tables: 4, Pages: 17, Words: 11497
                Categories
                Thermoregulation
                Endurance and Performance
                Circulation
                Research Paper
                Research Papers
                Human, Environmental & Exercise
                Custom metadata
                2.0
                eph12037
                1 February 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.9 mode:remove_FC converted:23.03.2017

                Anatomy & Physiology
                Anatomy & Physiology

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