Background-The evaluation of new therapeutic modalities to induce collateral growth in coronary artery disease require improved methods of angiographic characterization of collaterals, which should be validated by quantitative assessment of collateral function. Methods and Results-In 100 patients with total chronic occlusion of a major coronary artery (duration Ͼ2 weeks) collaterals were assessed angiographically by the Rentrop grading, by their anatomic location, and by a new grading of collateral connections (CC grade 0: no continuous connection, CC1: threadlike continuous connection, CC2: side branch-like connection). The interobserver variability was 10%. Collateral function was assessed by Doppler flow (average peak velocity) and pressure recordings distal to the occlusion before recanalization. A collateral resistance index (R Coll ) was calculated. Recruitable collateral flow was measured during a final balloon inflation Ͼ30 minutes after the baseline measurement. The comparison of the anatomic location, the Rentrop, and the collateral connection grade showed only for the latter an independent and significant relation with R Coll . CC2 collaterals preserved regional left ventricular function better than did CC1 collaterals and provided a higher collateral flow reserve during adenosine infusion. CC0 collaterals were predominantly observed in recent occlusions of 2 to 4 weeks' duration, with the highest R Coll . During balloon reocclusion, recruitable collateral function was best preserved with CC2 and least with CC0. Conclusions-The angiographic grading of collateral connections in total chronic occlusions could differentiate collaterals according to their functional capacity to preserve regional left ventricular function and was closely associated with invasively determined parameters of collateral hemodynamics.

The membrane-associated, microfilament-binding protein annexin II is abundantly expressed in endothelial cells from calf pulmonary artery (CPAE cells). We have analyzed its role in the regulation of volume-activated chloride currents (I Cl, vol ) by loading the cells via the patch pipette with a peptide comprising the N-terminal 14 residues of annexin II. This sequence harbors the binding site for the intracellular annexin II ligand, p11, and the peptide interferes with the annexin II-p11 complex formation. Loading of a CPAE cell with this peptide caused a gradual decrease in the amplitude of I Cl, vol during repetitive stimulations with a 28% hypotonic extracellular solution. This run down of the current was virtually absent in untreated cells and in cells that were loaded with a mutated 14-amino acid peptide, which has a single amino acid replacement known to result in a more than 1000 times reduced affinity for binding to p11. We conclude that annexin II-p11 complex formation is either directly or indirectly involved in the activation of I Cl, vol in endothelial cells.

Diabetic patients with TCOs have similarly developed collaterals as nondiabetic patients. However, in TCOs <3 months duration the acute recruitment of collaterals in case of reocclusion is impaired. This could explain some of the higher complication rate and mortality after coronary interventions in diabetic patients.

Combined patch clamp and Ca2+-measurements (Fura-2) were used to study the dependence of volume-activated Cl--currents (ICl,vol) of endothelial cells from bovine pulmonary artery on the intracellular Ca2+-concentration [Ca2+]i. Loading the cells with high concentrations of EGTA or BAPTA via ruptured membrane patches or by preincubating them with 50 microM BAPTA-AM caused a substantial decrease of ICl,vol. This reduction was independent of the activation state of the current: the current amplitude was not only diminished if [Ca2+]i was lowered at the peak of the volume-activated current, but this low Ca2+-concentration also prevented activation of the current by a second hypotonic challenge.ICl,vol is already maximally activated at intracellular Ca2+-concentrations between 50 and 100 nmol/l, a further increase of [Ca2+]i does not affect the size of ICl,vol.These results indicate that a sustained full activation of ICl,vol in endothelial cells requires submicromolar concentrations of Ca2+, and that changes in [Ca2+]i do not modulate the current.

We have measured ionic currents and changes in intracellular Ca2+ concentration ([Ca2+]i) induced by extracellular ATP in single epithelial cells of the distal nephron from toad (A6 cells). ATP increased [Ca2+]i and concomitantly activated ionic currents. The ATP concentration for half-maximal increase in [Ca2+]i was approximately 10 microM. Current activation and elevation of [Ca2+]i also occurred in Ca(2+)-free bath solutions but were abolished by loading the cells via the patch pipette with 10 mM 1,2-bis(2-aminophenoxy)ethane N,N,N',N'-tetraacetic acid (BAPTA) or by preincubating the cells with 10 microM BAPTA-acetoxymethyl ester for 120 min. ATP-activated currents reversed at -53.9 +/- 1.9 mV (n = 22). Tetraethylammonium (TEA, 25 mM), a K+ channel blocker, partially blocked this current but did not affect the Ca2+ transients. The TEA-insensitive component of the current reversed close to Cl- equilibrium potential. 5-Nitro-2-(3-phenylpropylamino) benzoic acid, a putative Cl- channel blocker (100 microM), abolished nearly completely the ATP-activated current. Suramin (100 microM), a P2-purinergic receptor antagonist, strongly attenuated both Ca2+ transients and currents. In cell-attached patches, single channel currents activated by ATP could be observed, i.e., an inwardly rectifying K+ channel with a slope conductance for inward currents of approximately 32 pS and an ohmic Cl- channel with a conductance of 34 pS. It is concluded that ATP activates both Cl- and K+ channels in distal nephron epithelial cells by a Ca(2+)-dependent mechanism.