Name: A Pharmacodissection Approach to Uncover Mechanisms in Cardiovascular Disease Risk Populations (Video) | JoVE
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All procedures are approved by the Institutional Review Board of the Pennsylvania State University prior to participant recruitment.
1. Equipment setup
<ol>
	<li>Turn on the local heating unit and the laser Doppler flowmeter. 
	NOTE: Both should be calibrated prior to data collection according to the manufacturer&#39;s instructions. The laser Doppler flowmeter should be connected to data acquisition hardware with sampling at 100 Hz (100 samples/min) and continuous recording in a data ac...

Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

<ol>
	<li>Xu, J. Q., Murphy, S. L., Kochanek, K. D., Arias, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mortality+in+the+United+States,+2021.">Mortality in the United States, 2021.</a> NCHS Data Brief. 456, (2022).</li><li>Tsao, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+disease+and+stroke+statistics-2023+update:+A+report+from+the+American+heart+association.">Heart disease and stroke statistics-2023 update: A report from the American heart association.</a> Circulation. 147 (8), e93 (2023).</li><li>Cohuet, G., Struijker-Boudier, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+target+organ+damage+caused+by+hypertension:+Therapeutic+potential.">Mechanisms of target organ damage caused by hypertension: Therapeutic potential.</a> Pharmacology &amp; Therapeutics. 111 (1), 81-98 (2006).</li><li>Park, K. H., Park, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endothelial+dysfunction:+Clinical+implications+in+cardiovascular+disease+and+therapeutic+approaches.">Endothelial dysfunction: Clinical implications in cardiovascular disease and therapeutic approaches.</a> Journal of Korean Medical Science. 30 (9), 1213-1225 (2015).</li><li>Levy, B. I., Ambrosio, G., Pries, A. R., Struijker-Boudier, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microcirculation+in+hypertension:+a+new+target+for+treatment.">Microcirculation in hypertension: a new target for treatment.</a> Circulation. 104 (6), 735-740 (2001).</li><li>Sara, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+coronary+microvascular+dysfunction+among+patients+with+chest+pain+and+nonobstructive+coronary+artery+disease.">Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease.</a> Journal of the American College of Cardiology: Cardiovascular Interventions. 8 (11), 1445-1453 (2015).</li><li>Weis, M., Hartmann, A., Olbrich, H. G., H&#246;r, G., Zeiher, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prognostic+significance+of+coronary+flow+reserve+on+left+ventricular+ejection+fraction+in+cardiac+transplant+recipients.">Prognostic significance of coronary flow reserve on left ventricular ejection fraction in cardiac transplant recipients.</a> Transplantation. 65 (1), 103-108 (1998).</li><li>Rossi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Investigation+of+skin+vasoreactivity+and+blood+flow+oscillations+in+hypertensive+patients:+Effect+of+short-term+antihypertensive+treatment.">Investigation of skin vasoreactivity and blood flow oscillations in hypertensive patients: Effect of short-term antihypertensive treatment.</a> Journal of Hypertension. 29 (8), 1569-1576 (2011).</li><li>Pepine, C. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Coronary+microvascular+reactivity+to+adenosine+predicts+adverse+outcome+in+women+evaluated+for+suspected+ischemia+results+from+the+National+Heart,+Lung+and+Blood+Institute+WISE+(Women's+Ischemia+Syndrome+Evaluation)+study.">Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study.</a> Journal of the American College of Cardiology. 55 (25), 2825-2832 (2010).</li><li>Matsuda, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+and+clinical+significance+of+discordant+changes+in+fractional+and+coronary+flow+reserve+after+elective+percutaneous+coronary+intervention.">Prevalence and clinical significance of discordant changes in fractional and coronary flow reserve after elective percutaneous coronary intervention.</a> Journal of the American Heart Association. 5 (12), e004400 (2016).</li><li>Gupta, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integrated+noninvasive+physiological+assessment+of+coronary+circulatory+function+and+impact+on+cardiovascular+mortality+in+patients+with+stable+coronary+artery+disease.">Integrated noninvasive physiological assessment of coronary circulatory function and impact on cardiovascular mortality in patients with stable coronary artery disease.</a> Circulation. 136 (24), 2325-2336 (2017).</li><li>Roustit, M., Cracowski, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+endothelial+and+neurovascular+function+in+human+skin+microcirculation.">Assessment of endothelial and neurovascular function in human skin microcirculation.</a> Trends in Pharmacological Sciences. 34 (7), 373-384 (2013).</li><li>Low, D. A., Jones, H., Cable, N. T., Alexander, L. M., Kenney, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Historical+reviews+of+the+assessment+of+human+cardiovascular+function:+interrogation+and+understanding+of+the+control+of+skin+blood+flow.">Historical reviews of the assessment of human cardiovascular function: interrogation and understanding of the control of skin blood flow.</a> European Journal of Applied Physiology. 120 (1), 1-16 (2020).</li><li>Kenney, W. L., Cannon, J. G., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cutaneous+microvascular+dysfunction+correlates+with+serum+LDL+and+sLOX-1+receptor+concentrations.">Cutaneous microvascular dysfunction correlates with serum LDL and sLOX-1 receptor concentrations.</a> Microvascular Research. 85, 112-117 (2013).</li><li>Holowatz, L. A., Thompson, C. S., Minson, C. T., Kenney, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+acetylcholine-mediated+vasodilatation+in+young+and+aged+human+skin.">Mechanisms of acetylcholine-mediated vasodilatation in young and aged human skin.</a> Journal of Physiology. 563, 965-973 (2005).</li><li>Sokolnicki, L. A., Roberts, S. K., Wilkins, B. W., Basu, A., Charkoudian, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Contribution+of+nitric+oxide+to+cutaneous+microvascular+dilation+in+individuals+with+type+2+diabetes+mellitus.">Contribution of nitric oxide to cutaneous microvascular dilation in individuals with type 2 diabetes mellitus.</a> American Journal of Physiology - Endocrinology and Metabolism. 292 (1), E314-E318 (2007).</li><li>DuPont, J. J., Ramick, M. G., Farquhar, W. B., Townsend, R. R., Edwards, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=NADPH+oxidase-derived+reactive+oxygen+species+contribute+to+impaired+cutaneous+microvascular+function+in+chronic+kidney+disease.">NADPH oxidase-derived reactive oxygen species contribute to impaired cutaneous microvascular function in chronic kidney disease.</a> American Journal of Physiology - Renal Physiology. 306 (12), F1499-F1506 (2014).</li><li>Sprung, V. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nitric+oxide-mediated+cutaneous+microvascular+function+is+impaired+in+polycystic+ovary+syndrome+but+can+be+improved+by+exercise+training.">Nitric oxide-mediated cutaneous microvascular function is impaired in polycystic ovary syndrome but can be improved by exercise training.</a> Journal of Physiology. 591 (6), 1475-1487 (2013).</li><li>Greaney, J. L., Saunders, E. F. H., Santhanam, L., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oxidative+stress+contributes+to+microvascular+endothelial+dysfunction+in+men+and+women+with+major+depressive+disorder.">Oxidative stress contributes to microvascular endothelial dysfunction in men and women with major depressive disorder.</a> Circulatory Research. 124 (4), 564-574 (2019).</li><li>Stanhewicz, A. E., Jandu, S., Santhanam, L., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+angiotensin+II+sensitivity+contributes+to+microvascular+dysfunction+in+women+who+have+had+preeclampsia.">Increased angiotensin II sensitivity contributes to microvascular dysfunction in women who have had preeclampsia.</a> Hypertension. 70 (2), 382-389 (2017).</li><li>Greaney, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+hydrogen+sulfide-mediated+vasodilation+contributes+to+microvascular+endothelial+dysfunction+in+hypertensive+adults.">Impaired hydrogen sulfide-mediated vasodilation contributes to microvascular endothelial dysfunction in hypertensive adults.</a> Hypertension. 69 (5), 902-909 (2017).</li><li>Dillon, G. A., Stanhewicz, A. E., Serviente, C., Greaney, J. L., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hydrogen+sulfide-dependent+microvascular+vasodilation+is+improved+following+chronic+sulfhydryl-donating+antihypertensive+pharmacotherapy+in+adults+with+hypertension.">Hydrogen sulfide-dependent microvascular vasodilation is improved following chronic sulfhydryl-donating antihypertensive pharmacotherapy in adults with hypertension.</a> Journal of Physiology. 321 (4), H728-H734 (2021).</li><li>Wong, B. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensory+nerve-mediated+and+nitric+oxide-dependent+cutaneous+vasodilation+in+normotensive+and+prehypertensive+non-Hispanic+blacks+and+whites.">Sensory nerve-mediated and nitric oxide-dependent cutaneous vasodilation in normotensive and prehypertensive non-Hispanic blacks and whites.</a> American Journal of Physiology - Heart and Circulatory Physiology. 319 (2), H271-H281 (2020).</li><li>Dillon, G. A., Greaney, J. L., Shank, S., Leuenberger, U. A., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=AHA/ACC-defined+stage+1+hypertensive+adults+do+not+display+cutaneous+microvascular+endothelial+dysfunction.">AHA/ACC-defined stage 1 hypertensive adults do not display cutaneous microvascular endothelial dysfunction.</a> American Journal of Physiology - Heart and Circulatory Physiology. 319 (3), H539-H546 (2020).</li><li>Gagge, A. P., Stolwijk, J. A., Hardy, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comfort+and+thermal+sensations+and+associated+physiological+responses+at+various+ambient+temperatures.">Comfort and thermal sensations and associated physiological responses at various ambient temperatures.</a> Environmental Research. 1 (1), 1-20 (1967).</li><li>Greaney, J. L., Stanhewicz, A. E., Kenney, W. L., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lack+of+limb+or+sex+differences+in+the+cutaneous+vascular+responses+to+exogenous+norepinephrine.">Lack of limb or sex differences in the cutaneous vascular responses to exogenous norepinephrine.</a> Journal of Applied Physiology. 117 (12), 1417-1423 (2014).</li><li>Greaney, J. L., Stanhewicz, A. E., Kenney, W. L., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+increases+in+skin+sympathetic+nerve+activity+contribute+to+age-related+decrements+in+reflex+cutaneous+vasoconstriction.">Impaired increases in skin sympathetic nerve activity contribute to age-related decrements in reflex cutaneous vasoconstriction.</a> Journal of Physiology. 593 (9), 2199-2211 (2015).</li><li>Alba, B. K., Greaney, J. L., Ferguson, S. B., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endothelial+function+is+impaired+in+the+cutaneous+microcirculation+of+adults+with+psoriasis+through+reductions+in+nitric+oxide-dependent+vasodilation.">Endothelial function is impaired in the cutaneous microcirculation of adults with psoriasis through reductions in nitric oxide-dependent vasodilation.</a> American Journal of Physiology - Heart and Circulatory Physiology. 314 (2), H343-H349 (2018).</li><li>Greaney, J. L., Surachman, A., Saunders, E. F. H., Alexander, L. M., Almeida, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Greater+daily+psychosocial+stress+exposure+is+associated+with+increased+norepinephrine-induced+vasoconstriction+in+young+adults.">Greater daily psychosocial stress exposure is associated with increased norepinephrine-induced vasoconstriction in young adults.</a> Journal of the American Heart Association. 9 (9), e015697 (2020).</li><li>Nakata, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantification+of+catecholamine+neurotransmitters+released+from+cutaneous+vasoconstrictor+nerve+endings+in+men+with+cervical+spinal+cord+injury.">Quantification of catecholamine neurotransmitters released from cutaneous vasoconstrictor nerve endings in men with cervical spinal cord injury.</a> American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. 324 (3), R345-R352 (2023).</li><li>Tucker, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postsynaptic+cutaneous+vasodilation+and+sweating:+Influence+of+adiposity+and+hydration+status.">Postsynaptic cutaneous vasodilation and sweating: Influence of adiposity and hydration status.</a> European Journal of Applied Physiology. 118 (8), 1703-1713 (2018).</li><li>Craighead, D. H., Alexander, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Menthol-induced+cutaneous+vasodilation+is+preserved+in+essential+hypertensive+men+and+women.">Menthol-induced cutaneous vasodilation is preserved in essential hypertensive men and women.</a> American Journal of Hypertension. 30 (12), 1156-1162 (2017).</li><li>Brunt, V. E., Minson, C. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=KCa+channels+and+epoxyeicosatrienoic+acids:+Major+contributors+to+thermal+hyperaemia+in+human+skin.">KCa channels and epoxyeicosatrienoic acids: Major contributors to thermal hyperaemia in human skin.</a> Journal of Physiology. 590 (15), 3523-3534 (2012).</li><li>Choi, P. J., Brunt, V. E., Fujii, N., Minson, C. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+approach+to+measure+cutaneous+microvascular+function:+An+improved+test+of+NO-mediated+vasodilation+by+thermal+hyperemia.">New approach to measure cutaneous microvascular function: An improved test of NO-mediated vasodilation by thermal hyperemia.</a> Journal of Applied Physiology. 117 (3), 277-283 (2014).</li><li>Johnson, J. M., Kellogg, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Local+thermal+control+of+the+human+cutaneous+circulation.">Local thermal control of the human cutaneous circulation.</a> Journal of Applied Physiology. 109 (4), 1229-1238 (2010).</li><li>Jung, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+Doppler+flux+measurement+for+the+assessment+of+cutaneous+microcirculation-Critical+remarks.">Laser Doppler flux measurement for the assessment of cutaneous microcirculation-Critical remarks.</a> Clinical Hemorheology and Microcirculation. 55 (4), 411-416 (2013).</li></ol>

The intradermal microdialysis technique is a versatile tool in human vascular research. Investigators may alter the protocol to further diversify its applications. For example, we describe an ACh dose-response protocol, but other investigations into the mechanisms of vasoconstriction or vasomotor tone, rather than vasodilation alone, have utilized norepinephrine or sodium nitroprusside dose-response approaches26,27,28,</sup...

Cardiovascular disease (CVD) is the leading cause of death in the United States1. Hypertension (HTN) is an independent risk factor for stroke, coronary heart disease, and heart failure and is estimated to affect upward of ~50% of the United States population2. HTN can develop as an independent CVD (primary HTN) or as a result of another condition, such as polycystic kidney disease and/or endocrine disorders (secondary HTN). The breadth of etiologies of HTN complicates investigations into the underlying mechanisms and end-organ damage observed with HTN. Diverse and novel research approaches into the pathophysiology of the end-organ damage associated with HTN are needed.
One of the earliest pathological signs of CVD is endothelial dysfunction, as characterized by impaired nitric oxide (NO)-mediated vasodilation3,4,5. Flow-mediated dilation is a common approach used to quantify the endothelial dysfunction associated with CVD, but endothelial dysfunction in microvascular beds can be both independent of and precursory to that of large conduit arteries6,7,8. Furthermore, resistance arterioles are more directly acted on by local tissue than conduit arteries and have more immediate control over the delivery of oxygen-rich blood. Microvascular function is predictive of adverse cardiovascular event-free survival9,10,11. The cutaneous microvasculature is an accessible vascular bed that can be used to examine responses to physiological and pharmacological vasoconstrictive or vasodilatory stimuli. Intradermal microdialysis is a minimally invasive technique, the goal of which is to investigate the mechanisms of both vascular smooth muscle and endothelial function in the cutaneous microvasculature with targeted pharmacological dissection. This method contrasts with other techniques, such as post-occlusive reactive hyperemia, which does not allow for pharmacological dissection, and iontophoresis, which allows for pharmacological delivery but is less precise in its mechanism of action (reviewed thoroughly elsewhere12).
The rationale behind the development and use of this technique is extensively reviewed elsewhere13. This approach was originally developed for use in neurological research in rodents and then was first applied to humans to investigate the mechanisms underlying active vasodilation from a thermoregulatory standpoint. In the late 1990s, this method was used to examine both neural and endothelial mechanisms with regard to local heating of the skin. Since that time, the technique has been utilized to investigate a number of neurovascular signaling mechanisms in the skin.
Using this technique, our group and others have interrogated the mechanisms of endothelial dysfunction in the microvasculature of several clinical populations, including, but not limited to, dyslipidemia, primary aging, diabetes, chronic kidney disease, polycystic ovary syndrome, preeclampsia, major depressive disorder14,15,16,17,18,19, and hypertension20,21,22,23,24. For example, a previous study found that normotensive women with a history of preeclampsia, who are at an increased risk for CVD, had reduced NO-mediated vasodilation in the cutaneous circulation compared with women with a history of normotensive pregnancy20. In another study, adults diagnosed with primary HTN demonstrated increased angiotensin II sensitivity in the microvasculature compared with healthy controls21, and chronic sulfhydryl-donating antihypertensive pharmacotherapy in primary HTN patients has been shown to decrease blood pressure and improve both hydrogen sulfide- and NO-mediated vasodilation22. Wong et al.23 found impaired sensory-mediated and NO-mediated vasodilation in prehypertensive adults, coinciding with our finding of a progression of endothelial dysfunction with increasing HTN stages, as categorized by the 2017 American Heart Association and American College of Cardiology guidelines24.
The intradermal microdialysis technique allows for tightly controlled mechanistic investigations into microvascular function in health and disease states. Therefore, this paper aims to describe the intradermal microdialysis technique as applied by our group and others. We detail the procedures for both pharmacological stimulation of the endothelium with acetylcholine (ACh) to examine the dose-response relationship and physiological stimulation of endogenous NO production with either a 39 &#176;C or 42 &#176;C local heating stimulus protocol. We present representative results for each approach and discuss the clinical implications of the findings that have arisen from this technique.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1 mL syringes</td>
			<td>BD Syringes</td>
			<td>302100</td>
			<td></td>
		</tr>
		<tr>
			<td>Acetlycholine</td>
			<td>United States Pharmacopeia</td>
			<td>1424511</td>
			<td>Pilot data collected in our lab indicate drying acetylcholine increases variability of CVC response; do not dry, store in desiccator</td>
		</tr>
		<tr>
			<td>Alcohol swabs</td>
			<td>Mckesson</td>
			<td>191089</td>
			<td></td>
		</tr>
		<tr>
			<td>Baby Bee Syringe Drive</td>
			<td>Bioanalytical Systems, Incorporated</td>
			<td>MD-1001</td>
			<td>In this study the optional 3-syringe bracket (catalg number MD-1002) was utilized</td>
		</tr>
		<tr>
			<td>CMA 30 Linear Microdialysis Probes</td>
			<td>Harvard Apparatus</td>
			<td>CMA8010460</td>
			<td></td>
		</tr>
		<tr>
			<td>Connex Spot Monitor</td>
			<td>WelchAllyn</td>
			<td>74CT-B</td>
			<td>automated blood pressure monitor</td>
		</tr>
		<tr>
			<td>Hive Syringe Pump Controller</td>
			<td>Bioanalytical Systems, Incorporated</td>
			<td>MD-1020</td>
			<td>Controls up to 4 Baby Bee Syringe Drives</td>
		</tr>
		<tr>
			<td>LabChart 8</td>
			<td>AD Instruments</td>
			<td></td>
			<td>**PowerLab hardware and LabChart software must be compatible versions</td>
		</tr>
		<tr>
			<td>Lactated Ringer&#39;s Solution</td>
			<td>Avantor (VWR)</td>
			<td>76313-478</td>
			<td></td>
		</tr>
		<tr>
			<td>Laser Doppler Blood FlowMeter</td>
			<td>Moor Instruments</td>
			<td>MoorVMS-LDF</td>
			<td></td>
		</tr>
		<tr>
			<td>Laser Doppler probe calibration kit</td>
			<td>Moor Instruments</td>
			<td>CAL</td>
			<td></td>
		</tr>
		<tr>
			<td>Laser Doppler VP12 probe</td>
			<td>Moor Instruments</td>
			<td>VP12</td>
			<td></td>
		</tr>
		<tr>
			<td>Linear Microdialysis Probes</td>
			<td>Bioanalytical Systems, Inc.</td>
			<td>MD-2000</td>
			<td></td>
		</tr>
		<tr>
			<td>NG-nitro-l-arginine methyl ester</td>
			<td>Sigma Aldrich</td>
			<td>483125-M</td>
			<td>L-NAME</td>
		</tr>
		<tr>
			<td>Povidone-iodine / betadine</td>
			<td>Dynarex</td>
			<td>1202</td>
			<td></td>
		</tr>
		<tr>
			<td>PowerLab C Data Acquisition Device</td>
			<td>AD Instruments</td>
			<td>PLC01</td>
			<td>**</td>
		</tr>
		<tr>
			<td>PowerLab C Instrument Interface</td>
			<td>AD Instruments</td>
			<td>PLCI1</td>
			<td>**</td>
		</tr>
		<tr>
			<td>Probe adhesive discs</td>
			<td>Moor Instruments</td>
			<td></td>
			<td>attach local heating unit to skin</td>
		</tr>
		<tr>
			<td>Skin Heater Controller</td>
			<td>Moor Instruments</td>
			<td>moorVMS-HEAT 1.3</td>
			<td></td>
		</tr>
		<tr>
			<td>Small heating probe</td>
			<td>Moor Instruments</td>
			<td>VHP2</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile drapes</td>
			<td>Halyard</td>
			<td>89731</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile gauze</td>
			<td>Dukal Corporation</td>
			<td>2085</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile surgical gloves</td>
			<td>Esteem Cardinal Health</td>
			<td>8856N</td>
			<td>catalogue number followed by the initials of the glove size, then the letter &#34;B&#34; (e.g., 8856NMB for medium)</td>
		</tr>
		<tr>
			<td>Surgical scissors</td>
			<td>Cole-Parmer</td>
			<td>UX-06287-26</td>
			<td></td>
		</tr>
	</tbody>
</table>

intradermal microdialysis: an approach to investigating novel mechanisms of microvascular dysfunction in humans

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally invasive technique used to investigate mechanisms of vascular smooth muscle and endothelial function in the cutaneous circulation. This technique allows for the pharmacological dissection of the pathophysiology of microvascular endothelial dysfunction as indexed by decreased nitric oxide-mediated vasodilation, an indicator of cardiovascular disease development risk. In this technique, a microdialysis probe is placed in the dermal layer of the skin, and a local heating unit with a laser Doppler flowmetry probe is placed over the probe to measure the red blood cell flux. The local skin temperature is clamped or stimulated with direct heat application, and pharmacological agents are perfused through the probe to stimulate or inhibit intracellular signaling pathways in order to induce vasodilation or vasoconstriction or to interrogate mechanisms of interest (co-factors, antioxidants, etc.). The cutaneous vascular conductance is quantified, and mechanisms of endothelial dysfunction in disease states can be delineated.

Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

Acetylcholine dose-response protocol
Figure 1A depicts a schematic detailing the ACh dose-response protocol. Figure 1B illustrates representative tracings of the RBC flux values (perfusion units, PU; 30 s averages) from the standardized ACh dose-response protocol for one subject over time. Figure 1C illustrates a raw data file of an ACh dose-response protocol. Additional baseline measurem...

Watch this Scientific Journal Video about A Pharmacodissection Approach to Uncover Mechanisms in Cardiovascular Disease Risk Populations at JoVE.com

A Pharmacodissection Approach to Uncover Mechanisms in Cardiovascular Disease Risk Populations (Video) | JoVE

Intradermal microdialysis is a minimally invasive technique used to investigate microvascular function in health and disease. Both dose-response and local heating protocols can be utilized for this technique to explore mechanisms of vasodilation and vasoconstriction in the cutaneous circulation.

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally ...