Carvedilol, a multiple-action neurohumoral antagonist, inhibits mitogen-activated protein kinase and cell cycle progression in vascular smooth muscle cells.

Recent findings that the multiple-action neurohumoral antagonist carvedilol inhibits the mitogenic effects of a broad variety of mitogens and produces marked protection against neointima formation after balloon angioplasty injury prompted further study into the molecular and biochemical mechanism of action. In the present study, the effects of carvedilol on mitogen-activated protein (MAP) kinase activity and cell cycle progression were evaluated. Carvedilol produced significant concentration-dependent inhibition of mitogen-induced MAP kinase activity in rat smooth muscle cells. Furthermore, when MAP kinase was purified from mitogen-stimulated cells by FPLC Mono Q chromatography, carvedilol produced direct enzyme inhibition. In the cell-free assay, carvedilol (10 microM) produced 50% inhibition of MAP kinase activity. Cell flow cytometry studies revealed that quiescent rat aortic smooth muscle cells showed 96% of the cell population in the G0/G1 phase of the cell cycle. The addition of serum (10%) increased the number of cells in S and G2/M phases 20% to 40%, respectively. Carvedilol (10 microM) significantly decreased (30-50%) the number of cells in S and G2/M phase. In addition, carvedilol significantly inhibited (>70%) serum-induced stimulation of the S phase-specific marker thymidine kinase. These data suggest that the antimitogenic actions of carvedilol on vascular smooth muscle may be in part due to the inhibition of MAP kinase activity and regulation of cell cycle progression.

Interferon-inducible protein-10 involves vascular smooth muscle cell migration, proliferation, and inflammatory response.

Interferon-inducible protein-10 (IP-10) is a member of the C-X-C chemokine family. Using mRNA differential display, we isolated a rat homologue to murine and human IP-10 from lipopolysaccharide-stimulated carotid arteries. Our studies demonstrated that IP-10 is a potent mitogenic and chemotactic factor for vascular smooth muscle cells, the critical features of smooth muscle cells for their contribution to the pathogenesis of atherosclerosis and restenosis. IP-10 induced a concentration-dependent stimulation of DNA synthesis, cell proliferation, and cell migration of rat aortic smooth muscle cells. A concentration- and time-dependent IP-10 mRNA induction was observed in lipopolysaccharide- or interferon-gamma-stimulated, but not interleukin-1beta- or tumor necrosis factor-alpha-stimulated smooth muscle cells. A marked synergistic effect on IP-10 mRNA expression was observed when smooth muscle cells were challenged with interferon-gamma together with interleukin-1beta or tumor necrosis factor-alpha. Furthermore, IP-10 mRNA expression was induced in the rat carotid artery after balloon angioplasty. The mitogenic and chemotactic features of IP-10 for smooth muscle cells, along with its discrete induction in cultured vascular smooth muscle cells and in carotid arteries after balloon angioplasty (neointima formation) suggest that IP-10 may play an active and distinct role in vascular remodeling processes.

Angiotensin type 1 receptors mediate smooth muscle proliferation and endothelin biosynthesis in rat vascular smooth muscle.

Angiotensin II (AII) has the potential to promote vascular smooth muscle (VSM) hypertrophy and hyperplasia; however, the mechanisms involved in AII stimulation of VSM growth are not fully understood. The AII receptor subtypes in VSM responsible for several biological events leading to cell proliferation have been evaluated. All-induced mitogenesis in explants of rat VSM cells was antagonized by the angiotensin type 1 (AT1)-selective receptor antagonists SK&F 108566 (IC50 = 5.3 +/- 0.96 nM) and DuP 753 (IC50 = 3.5 +/- 0.97 nM), but not by AT2 receptor antagonists. AII-stimulated endothelin (ET)-1 gene expression was antagonized by SK&F 108566 (50% at 1 microM), but not by selective AT2 receptor antagonists. Similarly, AII stimulated the release of immunoreactive ET (irET) from cultured VSM cells that was antagonized by 1 microM SK&F 108566 (72%) and DuP 753 (66%), but not by AT2 receptor antagonists. AII and growth factors that stimulated the release of irET down-regulated the number of ET receptor binding sites. AII (1-100 nM) markedly (6- to 10-fold) stimulated mitogen-activated protein kinase, an enzyme believed to be involved in the pathway for cell proliferation, and this stimulation was blocked (50-75%) by SK&F 108566 (1 nM-1 microM). Phosphoramidon (50 microM) inhibited (60%) both AII-induced irET release and cell proliferation. These data demonstrate that AII-mediated VSM growth is via AT1 receptors, and suggest that AII-induced ET production may contribute to the proliferative response in these cells.

Interleukin-8. A mitogen and chemoattractant for vascular smooth muscle cells.

Interleukin-8 (IL-8) is a chemokine produced by a variety of cell types involved in atherogenesis and is chemotactic for neutrophils and lymphocytes. A recent study has shown that IL-8 is angiogenic and induces proliferation and chemotaxis of endothelial cells. The present study was undertaken to find out whether IL-8 is also mitogenic and chemotactic for vascular smooth muscle cells. IL-8 induced a concentration-dependent (0.1 to 10 nmol/L) stimulation of DNA synthesis and cell proliferation in both human and rat aortic smooth muscle cells. In addition, IL-8 stimulated smooth muscle cells to produce prostaglandin E2, which can inhibit IL-8-induced smooth muscle cell proliferation. In the presence of indomethacin (5 mumol/L), IL-8 (1 nmol/L) stimulated an increase in human and rat aortic smooth muscle cell number during a 3-day period of incubation by 61 +/- 16% and 59 +/- 7% (n = 4), respectively. IL-8 also increased DNA synthesis in human and rat aortic smooth muscle cells by 98 +/- 10% and 151 +/- 27% (n = 5), respectively. Moreover, IL-8 stimulated rat aortic smooth muscle cell migration by 20-fold over the control value, with an EC50 value of 0.83 nmol/L; this chemotactic activity of IL-8 was also potentiated by indomethacin. Exposure of smooth muscle cells to IL-8 caused rapid and transient expression of the immediate-early genes c-fos and zif268 mRNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for involvement of protein kinase C in expression of intracellular adhesion molecule-1 (ICAM-1) by human vascular endothelial cells.

Potent activators of protein kinase C (PKC), such as phorbol dibutyrate and octylindolactam V, stimulated expression of intercellular adhesion molecule 1 (ICAM-1) by human umbilical vein endothelial cells (HUVEC) in a concentration-dependent manner. Expression of PKC activator-induced ICAM-1 in HUVEC was inhibited by the PKC inhibitor, H-7. Furthermore, cytokine (TNF alpha, LPS)-induced ICAM-1 expression was inhibited by the potent PKC inhibitor, H-7, and not by the cAMP-dependent protein kinase (PKA) specific inhibitor, H-89. These data suggest that PKC is involved in cytokine- and inflammatory agent-induced upregulation of ICAM-1 expression in HUVEC.

Carvedilol, a novel cardiovascular agent, inhibits development of vascular and ventricular hypertrophy in spontaneously hypertensive rats.

The effects of carvedilol, a novel cardiovascular agent, were evaluated in developing spontaneously hypertensive rats (SHR) for effects on hemodynamics, and the ability to effect the development of left ventricular, and vascular hypertrophy associated with chronic hypertension. Chronic oral administration of low dose carvedilol (20 mg/kg/day) was initiated when rats were 5 weeks of age, and experiments progressed until 14 weeks of age. Carvedilol-treated SHR had significantly reduced systolic blood pressures and heart rates throughout the duration of the experiment, and had significantly reduced ventricle/body weights by approximately 9.0%. Morphologic analysis of tertiary branches of the mesenteric artery revealed that carvedilol-treated SHR had significant reductions in medial cross-sectional area. Carvedilol produced concentration-dependent inhibition of basal [3H]thymidine incorporation in cultured SHR vascular smooth muscle cells, as well as by stimulation produced by PDGF (1 nM), EDGF (1 nM), thrombin (0.5 U/ml), or endothelin-1 (1 nM), indicating that carvedilol had direct anti-mitogenic activity. The present studies demonstrate that low dose carvedilol produced sustained reductions in blood pressure and heart rate in developing SHR that were accompanied by significant inhibition in the development of vascular and myocardial hypertrophy. The morphological changes induced by carvedilol may be mediated by a combination of hemodynamic effects, as well as by direct anti-mitogenic effects on vascular smooth muscle.

Carvedilol, a cardiovascular drug, prevents vascular smooth muscle cell proliferation, migration, and neointimal formation following vascular injury.

Carvedilol is a cardiovascular drug currently used for the treatment of hypertension. Clinical studies have recently demonstrated efficacy in angina and congestive heart failure. Recently, carvedilol has been shown to attenuate oxygen free radical-initiated lipid peroxidation and to inhibit vascular smooth muscle mitogenesis induced by a wide variety of growth factors. These findings are of interest since smooth muscle proliferation and abnormal lipid metabolism are proposed to play an important role in the pathogenesis of atherosclerotic plaque formation and in development of stenotic lesions following vascular injury by balloon angioplasty and coronary artery bypass grafting. On the basis of these observations, the antiproliferative actions of carvedilol have been explored in detail. In human cultured pulmonary artery vascular smooth muscle cells, carvedilol (0.1-10 microM) produced a concentration-dependent inhibition of the mitogenesis stimulated by platelet-derived growth factor, epidermal growth factor, thrombin, and serum, with IC50 values ranging from 0.3 to 2.0 microM. Carvedilol also produced a concentration-dependent inhibition of vascular smooth muscle cell migration induced by platelet-derived growth factor, with an IC50 value of 3 microM. The extensive neointimal formation that occurs following balloon angioplasty of rat carotid arteries was markedly attenuated by carvedilol (1 mg/kg, i.p.; twice daily starting 3 days before angioplasty and continuing until 14 days after angioplasty). Quantitative image analysis demonstrated that carvedilol reduced the neointimal growth following angioplasty by 84% without altering either medial or adventitial cross-sectional areas. These observations indicate that carvedilol may also be effective in the treatment of pathological disorders principally associated with abnormal vascular smooth muscle growth, such as atherosclerosis and acute vascular wall injury induced by angioplasty or coronary artery bypass grafting.

Carvedilol inhibits vascular smooth muscle cell proliferation.

The antiproliferative properties of carvedilol, a newly developed multiple-action antihypertensive agent, were evaluated in early passage cultured rat aortic vascular smooth muscle cells. Carvedilol (10(-7)-10(-5) M) produced concentration-dependent decreases in basal and endothelin-1-stimulated mitogenesis of rat aortic vascular smooth muscle cells. The IC50 for inhibition of [3H]thymidine incorporation by carvedilol in both basal and endothelin-1-stimulated rat aortic vascular smooth muscle cells was approximately 1 microM. Carvedilol (10 microM) inhibited basal mitogenesis by approximately 65%, and endothelin-1-stimulated mitogenesis by approximately 95%. Carvedilol (1-10 microM) also produced significant concentration-dependent inhibition of the mitogenic response mediated by thrombin (0.5 U/ml), epidermal growth factor (1 nM), platelet-derived growth factor (1 nM), and angiotensin II (5 nM). Endothelin-1- or PDGF A/B-induced increases in cell number were also significantly inhibited by carvedilol (10 microM). The antimitogenic effect of carvedilol on cell growth was reversible. The inhibitory effect of carvedilol was not shared by other beta-adrenoceptor antagonists such as labetalol (10 microM), celiprolol (10 microM), or sotalol (10 microM), which did not significantly affect [3H]thymidine incorporation in rat vascular smooth muscle cells. Propranolol (10 microM) was the only beta-adrenoceptor antagonist tested that inhibited [3H]thymidine incorporation, with effects of approximately 50 and 75% on basal and endothelin-1-mediated stimulation, respectively. In contrast, celiprolol (10 microM) produced significant stimulation of DNA synthesis (125% over basal). The calcium channel antagonist nifedipine (10 microM) inhibited basal and endothelin-1-mediated mitogenesis by 58 and 72%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

CGRP stimulates the adhesion of leukocytes to vascular endothelial cells.

Calcitonin gene-related peptide (CGRP) stimulates the adhesiveness of human umbilical vein endothelial cells for U937 cells and human neutrophils in a dose- and time-dependent manner. The onset of CGRP-induced adhesives of HUVEC was rapid (30 min), independent of protein synthesis, and lasted over 24 h in the continuous presence of the peptide. The stimulatory effect of CGRP was completely blocked by the CGRP antagonist, CGRP(8-37). The present study provides evidence in support of the potential role of sensory nerve-derived neuropeptides in the modulation of leukocyte adhesion to vascular endothelial cells.

The selective endothelin ETA receptor antagonist BQ123 antagonizes endothelin-1-mediated mitogenesis.

The mitogenic effects of endothelin isopeptides and the selective ETA receptor antagonist BQ123 were evaluated in rat aortic vascular smooth muscle cells. Endothelin-1 (ET-1) and endothelin-3 (ET-3) produced concentration-dependent increases in [3H]thymidine incorporation (EC50 = 0.1 and 25 nM, respectively). The ETB-selective agonist sarafotoxin 6c did not produce significant effects on [3H]thymidine incorporation. BQ123 produced selective and concentration-dependent inhibition of ET-1-mediated [3H]thymidine incorporation. These data demonstrate that ET-1-mediated mitogenesis in vascular smooth muscle is mediated by ETA receptors.

Evidence for the involvement of carbohydrate moieties in the adhesion of U937 cells to tumor necrosis factor-alpha (TNFalpha)-stimulated vascular endothelium in vitro.

Treatment of U937 cells with fructose 1-phosphate (P) and fucoidan dose-dependently inhibited the adhesion of these monocytic cells to TNF alpha-stimulated human umbilical vein endothelial cells (HUVEC) (IC50 = 1 mM and 10 micrograms/ml respectively). These carbohydrates (CHO) failed to inhibit U937 adhesion to unstimulated (basal) HUVEC or phorbol 12, 13 dibutyrate (PdBu)-stimulated HUVEC. At 10 mM concentration, both fucose 1-P and lactose 1-P inhibited TNF alpha-stimulated adhesion while the latter also inhibited basal adhesion. Fructose 6-P, fucose, galactose 1-P, glucose 1-P, glucose 6-P, glucuronic acid, beta-glycerol 1-P, mannose 1-P, mannose 6-P, ribose 1-P and ribose 5-P tested at 10 mM did not inhibit U937 cells adhesion to basal or TNF alpha-stimulated HUVEC. These data suggest that CHO may play an important role in modulating monocytes adhesion to cytokine-induced adhesion molecule(s) on the surface of HUVEC.

Neuropeptide Y upregulates the adhesiveness of human endothelial cells for leukocytes.

The nervous system and the autonomic system in particular have been associated with stress-induced changes in host resistance to infections and inflammatory reactions. Since a key step in initiation of inflammation is adhesion of leukocytes to the endothelium, we hypothesized that neuron-derived factors might be involved in this process. Neuropeptide Y (NPY), a 36-amino acid neuropeptide that is colocalized and released with norepinephrine from sympathetic nerves, has already been implicated in inflammatory reactions via modulation of histamine release from mast cells. This study was undertaken to examine the potential role of NPY in proinflammatory processes via modulation of endothelium-leukocyte interaction. NPY (0.01-10 microM) increased the adhesion of 51Cr-labeled human neutrophils or the human monocytic U937 cell line to human umbilical vein endothelial cells in a dose- and time-dependent manner. The stimulation of human umbilical vein endothelial cell adhesiveness occurred as early as 30 minutes and lasted over 48 hours. The increase of leukocyte adhesion to human umbilical vein endothelial cells by NPY was not inhibited by protein synthesis inhibitor cycloheximide, nor was it associated with expression of intercellular adhesion molecule-1 on human umbilical vein endothelial cells; in contrast, strong expression of intercellular adhesion molecule-1 was induced by tumor necrosis factor alpha and lipopolysaccharide endotoxin. These data suggest that neuron-derived factors such as NPY may serve as modulators of not only the neuromuscular unit but also the interaction of endothelial cells with leukocytes. In this capacity, the sympathetic nervous system might play an important role in the regulation of proaggregatory and hemostatic activity of microvessels.

Modulation of U937 cell adhesion to vascular endothelial cells by cyclic AMP.

Adhesion of leukocytes to the endothelium is an essential event in inflammatory cell emigration from intravascular to extravascular compartment. While many mediators (e.g. cytokines) enhance cell adhesion through expression of adhesion molecules on endothelial cells the mechanism of this phenomenon is not known. In this study we examined the role of cAMP in mediation of the adhesion of monocytic cell line, U937 to human umbilical vein endothelial cells (HUVEC). Incubation of HUVEC with cholera toxin (10-500 ng/ml) for 4 hrs greatly enhanced the adhesiveness of HUVEC for U937 cells. The magnitude of adhesion stimulation produced by cholera toxin was comparable to that produced by the cytokines TNF alpha or IL-1 (2-3 folds). Upregulation of U937 cells adhesion to HUVEC was also achieved by short incubation (less than 1 hr) of HUVEC with cAMP elevating agents such as forskolin (10 microM), isoproterenol (0.3-30 microM), epinephrine (10-100 microM), norepinephrine (100 microM) as well as by endogenously added dibutyryl cAMP (0.05-2.0 mM). Dibutyryl cyclic GMP (0.05-2.0 mM) was ineffective in promoting adhesion. These data suggest that cAMP might be an important intracellular modulator of leukocyte adhesion to endothelium and therefore promoter of pro-inflammatory processes.

Biosynthesis and modulation of endothelin from bovine pulmonary arterial endothelial cells.

The biosynthesis and modulation of the vasoconstrictor peptide endothelin was studied in the conditioned medium from cultured bovine pulmonary artery endothelial (BPAE) cells. Conditioned medium from cultured BPAE cells produced contraction of isolated rabbit aortic rings. Incubation of BPAE cells with the protease inhibitors TPCK or isatoic anhydride attenuated the extent of conditioned medium-induced contractions. Incubation of BPAE cells with thrombin produced an enhancement of conditioned medium-induced contraction by approximately 25%. Endothelin levels in conditioned medium were measured by RIA and incubation of BPAE cells with TPCK or isatoic anhydride significantly reduced endothelin levels, whereas incubation with thrombin or transforming growth factor beta-1 stimulated the levels of endothelin in the conditioned medium. These data indicate that endothelin may be modulated by certain protease inhibitors and by platelet and immune cell mediators and suggest a potential new mode of vascular tone regulation.

Pharmacological activities of spirogermanium and other structurally related azaspiranes: effects on tumor cell and macrophage functions.

Spirogermanium is a germanium containing azaspirane which has been shown to have activity in experimental models of cancer and immune dysfunction. A series of analogs of the parent compound were synthesized and evaluated in a number of in vitro and in vivo biological assays to define the structure-activity relationships of this class of compounds relative to their potential therapeutic activities. In a colony-forming assay using HT-29 human colon carcinoma cells various analogs in which carbon replaced germanium (e.g. carbon) retained the potent cytotoxic activity in vitro seen with spirogermanium. Increased cytotoxic potency within the group of carbon containing analogs was directly related to increase in the length of the alkyl group(s) attached to the carbon atom opposite the azaspirane ring structure. DNA and protein synthesis by HT-29 cells was inhibited by these compounds. However, inhibition occurred only at supralethal concentrations or after long exposure times with the drug. None of the azaspiranes demonstrated in vivo anti-tumor activity against P388 leukemia or ADJ-PC6 plasmacytoma. The effect of these compounds on macrophage cell function was evaluated in vitro by their ability to modulate superoxide (O2-) production by macrophages. Spirogermanium inhibited the production of O2- by activated macrophages with an IC50 of 5 microM. Although macrophage viability did not appear to be decreased at the respective IC50 concentrations, the rank order potency for the analogs in the O2- production assay was directly proportional to that measured for their cytotoxic potency in the HT-29 colony formation assay. The results demonstrate that, within this class of compounds, (1) potent biological activity does not require the presence of germanium in the structure; (2) in vitro cytotoxic activity does not appear to be a direct result of the inhibition of macromolecular synthesis, and (3) macrophage function can be modulated in vitro at non-cytotoxic concentrations. These results are discussed in context with the reported anti-tumor activity of spirogermanium and the potential anti-arthritic and immunomodulatory activity of this class of compounds.

Endothelial thromboxane receptors: biochemical characterization and functional implications.

We have identified thromboxane specific receptors in membrane preparations of bovine pulmonary artery endothelial cells using a potent thromboxane specific antagonist, [125I]-PTA-OH in a binding assay. The binding was specific and saturable. Neither thromboxane B2, prostaglandin D2 nor prostaglandin F2 alpha displaced the ligand (0.1 nM) at concentrations up to 10 microM. However, binding was displaced by IPTA-OH greater than SQ29548 greater than U46619. In addition, we observed that thromboxane mimetic U46619 significantly lowered the basal production of prostacyclin and also markedly suppressed bradykinin-stimulated prostacyclin released by endothelial cells. We propose that an important biological effect of thromboxane on vascular endothelial cells may be the suppression of prostacyclin production.

Characterization and function of bradykinin receptors in vascular endothelial cells.

One of many important roles of the naturally occurring nonapeptide bradykinin (BK) is the modulation of vascular tone. As endothelial cells may play vital roles in the physiology of vascular tissues, it is important to understand the interaction of this peptide with endothelial cells. By using radiolabeled BK we have demonstrated for the first time BK specific binding sites in membranes of bovine pulmonary artery endothelial cells. There are two types of receptors shown in binding assay: one with a saturable, high-affinity binding (Kd = 1.28 +/- 0.21 nM, maximum binding = 111.4 +/- 12.0 fmol/mg) and the other with not readily saturable, low-affinity binding. The activation of BK receptors on bovine pulmonary artery endothelial cells is assessed by two functional assays, namely, the release of endothelium-derived relaxing factor and the elevation of cytosolic calcium. The characteristics of the BK receptors in both binding and functional assays indicate that the high-affinity binding is to B2 receptors and the low-affinity binding is to B1 receptors on the cells. Thus, high-affinity binding is blocked by B2 antagonists, D-Arg[Hyp3, thienylalanine5,8,D-Phe7]-BK and [thienylalanine5,8, D-Phe7]-BK and low-affinity binding is blocked by B1 antagonist des-Arg9[Leu8]-BK. The elevation of intracellular calcium and the release of endothelium-derived relaxing factor in response to BK in endothelial cells is predominately through B2 receptor activation. The ability to subtype BK receptors in endothelial cells may facilitate the understanding of the vascular functions of BK and the potential design of drugs to regulate these functions.

Effect of metal containing compounds on superoxide release from phorbol myristate acetate stimulated murine peritoneal macrophages: inhibition by auranofin and spirogermanium.

A variety of metal containing compounds were examined for their ability to inhibit the respiratory burst of murine peritoneal macrophages. Auranofin (AF), a gold containing complex used in the treatment of rheumatoid arthritis, is a potent inhibitor of the macrophage respiratory burst. Ten rhodium, iridium, osmium and ruthenium containing complexes were inactive in inhibiting superoxide production. The only active nongold organometallic complex was spirogermanium which had an equivalent IC50 for activity as AF. The inhibitory activity of AF, but not spirogermanium, was reduced in the presence of the sulfhydryl reducing agent dithiothreitol. This suggests that interactions other than those with sulfhydryl groups may be involved in the action of spirogermanium.

Effects of the novel dopamine beta-hydroxylase inhibitor SK&F 102698 on catecholamines and blood pressure in spontaneously hypertensive rats.

The novel dopamine beta-hydroxylase (D beta H) inhibitor SK&F 102698 was characterized in vitro with soluble enzyme from bovine adrenal medulla and in vivo by measuring the dopamine/norepinephrine (DA/NE) ratio in the mesenteric artery, heart and brains of spontaneously hypertensive rats (SHR). SK&F 102698 was a potent D beta H inhibitor with an IC50 of 1.2 microM on crude enzyme and had a Ki value of 40 nM on purified enzyme. SK&F 102698 produced a dose-dependent fall in NE and a dose-dependent increase in DA in the vasculature of SHR after p.o. administration. Elevation of the vascular DA/NE ratio was observed within 0.5 hr after administration. Peak effects were observed at 12 hr and values were still significantly increased at 18 hr. The rise in the DA/NE ratio of the blood vessels correlated with the fall in blood pressure following the first 4 hr after SK&F 102698. SK&F 102698 inhibited SHR heart D beta H and elevated the myocardial DA/NE ratio approximately 2.4-fold. SK&F 102698 also caused a dose-dependent increase in the whole brain DA/NE ratio of SHR. Catecholamine levels were also studied in six discrete brain regions and SK&F 102698 produced the greatest increase in the DA/NE ratio in the cerebellum, brain stem and midbrain regions, whereas the striatum was the region least affected. No overt sedation was observed in the rats. Further study with SK&F 102698 is warranted to better explore the role of DA and D beta H in pathophysiology, and to determine whether this drug or a congener D beta H inhibitor will be a useful therapeutic agent in humans.