Pathophysiology of coronary artery disease.

CAD reflects an alteration in the dynamic nature of coronary conduits. This alteration in function can be precipitated by a constellation of pathologic processes and combination of risk behaviors. Nursing intervention based on knowledge of pathophysiology of CAD and its interaction with risk factors and behaviors can play an important role in prevention of sequelae and development of effective therapeutic strategies.

Blocker-related changes of channel density. Analysis of a three-state model for apical Na channels of frog skin.

Blocker-induced noise analysis of apical membrane Na channels of epithelia of frog skin was carried out with the electroneutral blocker (CDPC, 6-chloro-3,5-diamino-pyrazine-2-carboxamide) that permitted determination of the changes of single-channel Na currents and channel densities with minimal inhibition of the macroscopic rates of Na transport (Baxendale, L. M., and S. I. Helman. 1986. Biophys. J. 49:160a). Experiments were designed to resolve changes of channel densities due to mass law action (and hence the kinetic scheme of blocker interaction with the Na channel) and to autoregulation of Na channel densities that occur as a consequence of inhibition of Na transport. Mass law action changes of channel densities conformed to a kinetic scheme of closed, open, and blocked states where blocker interacts predominantly if not solely with open channels. Such behavior was best observed in "pulse" protocol experiments that minimized the time of exposure to blocker and thus minimized the contribution of much longer time constant autoregulatory influences on channel densities. Analysis of data derived from pulse, staircase, and other experimental protocols using both CDPC and amiloride as noise-inducing blockers and interpreted within the context of a three-state model revealed that Na channel open probability in the absence of blocker averaged near 0.5 with a wide range among tissues between 0.1 and 0.9.

Cell sodium activity and sodium pump function in frog skin.

Cell Na activity, acNa, was measured in the short-circuited frog skin by simultaneous cell punctures from the apical surface with open-tip and Na-selective microelectrodes. Skins were bathed on the serosal surface with NaCl Ringer and, to reduce paracellular conductance, with NaNO3, Ringer on the apical surface. Under control conditions acNa averaged 8 +/- 2 mM (n = 9, SD). Apical addition of amiloride (20 microM) or Na replacement reduced acNa to 3 mM in 6-15 min. Sequential decreases in apical [Na] induced parallel reductions in acNa and cell current, Ic. On restoring Na after several minutes of exposure to apical Na-free solution Ic rose rapidly (approximately less than 30 sec) to a stable value while acNa increased exponentially, with a time constant of 1.8 +/- 0.7 min (n = 8). Analysis of the time course of acNa indicates that the pump Na flux is linearly related to acNa in the range 2-12 mM. These results indicate that acNa plays an important role in relating apical Na entry to basolateral active Na flux.

Patch clamp studies of apical membranes of renal cortical collecting ducts.

Patch clamp techniques were used in study of the apical membrane of isolated renal cortical collecting ducts. Whereas on-the-cell patches (reported previously) gave channel activity due primarily to K+, isolated inside-out patches of the same membranes bathed with 150 mM Na+, 5 mM K+, and 1 mM Ca2+ gave channel activity due primarily to Na+. Na+ channels could remain either open or closed for periods of milliseconds to minutes. Although unitary currents of tenths of a pA were observed routinely, patch activity could change spontaneously between quiescent and violent with 'apparent' unitary currents of several pA. It was not possible to rule out the idea that the complex activity of the patches was due to synchronous or near synchronous openings/closings of several channels of identical unitary current. The unpredictable spontaneous changes of patch activity make difficult the design of experiments to test for the influence of agents expected or suspected to alter channel behavior.

Cell K activity in frog skin in the presence and absence of cell current.

Cell K activity, acK, was measured in the short-circuited frog skin by simultaneous cell punctures from the apical surface with open-tip and K-selective microelectrodes. Strict criteria for acceptance of impalements included constancy of the open-tip microelectrode resistance, agreement within 3% of the fractional apical voltage measured with open-tip and K-selective microelectrodes, and constancy of the differential voltage recorded between the open-tip and the K microelectrodes 30-60 sec after application of amiloride or substitution of apical Na. Skins were bathed on the serosal surface with NaCl Ringer and, to reduce paracellular Cl conductance and effects of amiloride on paracellular conductance, with NaNO3 Ringer on the apical surface. Under control conditions acK was nearly constant among skins (mean +/- SD = 92 +/- 8 mM, 14 skins) in spite of a wide range of cellular currents (5 to 70 microA/cm2). Cell current (and transcellular Na transport) was inhibited by either apical addition of amiloride or substitution of Na by other cations. Although in some experiments the expected small increase in acK after inhibition of cell current was observed, on the average the change was not significant (98 +/- 11 mM after amiloride, 101 +/- 12 mM after Na substitution), even 30 min after the inhibition of cell current. The membrane potential, which in the control state ranged from -42 to -77 mV, hyperpolarized after inhibition of cell current, initially to -109 +/- 5 mV, then depolarizing to a stable value (-88 +/- 5 mV) after 15-25 min. At this time K was above equilibrium (EK = 98 +/- 2 mV), indicating that the active pump mechanism is still operating after inhibition of transcellular Na transport. The measurement of acK permitted the calculation of the passive K current and pump current under control conditions, assuming a "constant current source" with almost all of the basolateral conductance attributable to K. We found a significant correlation between pump current and cell current with a slope of 0.31, indicating that about one-third of the cell current is carried by the pump, i.e., a pump stoichiometry of 3Na/2K.

Cytochalasin B does not stimulate sugar uptake into small intestine of necturus or chick.

3-O-Methylglucose accumulation by Necturus intestine was studied in the presence and absence of cytochalasin B. The effect of this agent on 3-O-methylglucose-induced changes in transepithelial potential difference was also investigated. Cytochalasin B (50 microM) blocked the rise in potential difference induced by 4 mM 3-O-methyglucose. 3-O-Methyglucose accumulation by Necturus intestine was measured; it was inhibited by cytochalasin B at concentrations of 50 and 100 microM. These results indicate that, in Necturus intestine, sodium-dependent sugar transport across the apical cell membrane is blocked by cytochalasin B.