Editorial
Most organs are able to modulate both blood flow and oxygen extraction to meet oxygen demand during increases in metabolism. However, the heart extracts oxygen near maximally (60%-80%) at rest and, therefore, relies almost exclusively on changes in perfusion to meet this demand.1 This requires moment-to-moment changes in arteriolar (resistance artery) tone to match changes in oxygen demand with flow. It is generally thought that a metabolic dilator substance released from the myocardium serves as the signal for vasodilation. However, despite several decades of investigation, the chemical mediator of cardiac metabolic dilation remains elusive. Recently, Chilian laboratory has proposed hydrogen peroxide (H 2 O 2 ) as the link between cardiac metabolism and coronary dilation.2 Although H 2 O 2 had been studied extensively as an endothelium-derived vasodilator, its role in metabolic dilation had not been well-defined. H 2 O 2 has several characteristics that support a role in metabolic dilation. It is a product of cardiac metabolism, is produced in large quantities proportional to mitochondrial respiration, is cell membrane permeable, and has a sufficiently long half-life to serve as an intercellular signaling molecule. H 2 O 2 elicits a dose-dependent dilation in coronary arterioles.
Article, see p 612On the basis of these characteristics, H 2 O 2 has been studied as a mediator of metabolic dilation. Chilian laboratory used a bioassay where effluent from freshly isolated cardiomyocytes was dripped onto rat coronary arterioles. The resulting dilation was shown to be catalase-sensitive and related to the metabolic rate of the cultured myocytes.2 A variation of that preparation was used by Shimokawa laboratory, where pressurized coronary arterioles from a rabbit were placed on a canine beating heart. 4 Pacing the dog heart induced a catalaseinhibitable dilation in the overlying rabbit arteriole, suggesting a role for H 2 O 2 in metabolic dilation. Similar support for a role for H 2 O 2 was observed in an in vivo dog model, where pacing-induced epicardial coronary arteriolar dilation was observed during increases in metabolism. 4,5 Over the past 5 years, a role for H 2 O 2 in metabolic dilation has emerged, but the mechanism by which H 2 O 2 elicits this dilation remains unclear. Numerous candidate pathways exist, including activation of Kca channels, 6 Katp channels, endothelial nitric oxide synthase, Akt, and protein kinase G. Paradoxically, in some cases, H 2 O 2 can inhibit these same pathways.7 H 2 O 2 can also mediate mitochondrial Katp-induced dilation by stimulating calcium sparks on vascular smooth muscle cell membranes.
8Rogers et al 9 expanded on these mechanisms by which H 2 O 2 can elicit dilation by demonstrating a role for Kv channels. Saitoh et al 2 in the same laboratory extended that observation to metabolic dilation in the heart. Using the same bioassay described above, cardiomyocyte effluent elicited a 4-aminopyridine-sensitive vasodilation suggesting a role for Kv channels. Unfortunately...