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These results suggest that α(1)-adrenoceptor and muscarinic receptor-mediated contractility is upregulated in the proximal urethra 4 weeks after PNT.
alpha-adrenoceptor antagonists have traditionally been used in the treatment of hypertension but in recent years they have become increasingly common in the treatment of benign prostatic enlargement (BPE), where they reduce the 'dynamic' component of bladder outlet obstruction and appear to have additional actions to reduce irritative symptoms of the disease. Prazosin (Hypovase), Alza), doxazosin (Cardura), Pfizer), indoramin (Doralese), Wyeth-Ayerst Pharmaceuticals Inc.) and terazosin (Hytrin), Abbott Laboratories) are currently available in the UK for BPE but these agents have cardiovascular actions in a significant number of patients, inducing effects which must be considered adverse unless the patient also requires treatment for mild-to-moderate hypertension. The uroselective alpha-adrenoceptor antagonists tamsulosin (Flomax), Yamanouchi Pharmaceutical Co. Ltd.) and alfuzosin (Xatral), Sanofi-Synthelabo) have recently been introduced. These agents exert their selectivity via different mechanisms; selective tissue distribution for alfuzosin and alpha-adrenoceptor subtype selectivity for tamsulosin. The incidence of cardiovascular side effects for both drugs is similar to placebo. Several lines of evidence suggest that the alpha-adrenoceptor antagonists may relieve lower urinary tract (LUT) symptoms by other mechanisms additional to those which account for the reduction in bladder outlet obstruction. If correct, these agents may be of use in the treatment of other bladder conditions.
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Catecholamines may be one of the molecular signals linking increased circulatory demand to myocardial hypertrophy, and I have found previously that norepinephrine stimulates hypertrophy of cultured neonatal rat heart muscle cells through an alpha 1-adrenergic receptor. Since catecholamine stimulation of contractility is believed to be under beta-adrenergic control, I asked whether these cultured heart cells had dual pathways regulating growth and contractility through alpha- and beta-adrenergic receptors, respectively. I examined the effect of adrenergic agents on hypertrophy and beating of myocytes in serum-free cultures. Hypertrophy was defined as an increase in myocyte surface area and in cell protein content, measured by a radioisotopic method, and chronotropic activity was examined visually. Norepinephrine and epinephrine were equipotent stimulants of hypertrophy and beating, increasing cell protein and area 1.5- to 2-fold, and the proportion of beating cells from 5% or less to 95%. Response maxima occurred 24-48 hours after exposure, and EC50 were 20-200 nM. Studies with other agonists (phenylephrine, methoxamine, clonidine, isoproterenol, dopamine) and antagonists (prazosin, terazosin, yohimbine, propranolol, betaxolol, ICI 118,551) indicated that hypertrophy was mediated through an alpha 1-adrenergic receptor, whereas the induction of beating required both alpha 1- and beta 1-receptor activation. Hypertrophied cells with minimal beating were produced by alpha-stimulation, alone. In contrast, alpha-plus beta-stimulation in the presence of cycloheximide to inhibit protein synthesis resulted in maximum beating but no hypertrophy. These findings imply that growth and beating can be regulated independently through separate cellular pathways.