Vasopressin: Mechanisms of action on the vasculature in health and in septic shock
- 1 January 2007
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 35 (1), 33-40
- https://doi.org/10.1097/01.ccm.0000251127.45385.cd
Abstract
Vasopressin is essential for cardiovascular homeostasis, acting via the kidney to regulate water resorption, on the vasculature to regulate smooth muscle tone, and as a central neurotransmitter, modulating brainstem autonomic function. Although it is released in response to stress or shock states, a relative deficiency of vasopressin has been found in prolonged vasodilatory shock, such as is seen in severe sepsis. In this circumstance, exogenous vasopressin has marked vasopressor effects, even at doses that would not affect blood pressure in healthy individuals. These two findings provide the rationale for the use of vasopressin in the treatment of septic shock. However, despite considerable research attention, the mechanisms for vasopressin deficiency and hypersensitivity in vasodilatory shock remain unclear. To summarize vasopressin's synthesis, physiologic roles, and regulation and then review the literature describing its vascular receptors and downstream signaling pathways. A discussion of potential mechanisms underlying vasopressin hypersensitivity in septic shock follows, with reference to relevant clinical, in vivo, and in vitro experimental evidence. Search of the PubMed database (keywords: vasopressin and receptors and/or sepsis or septic shock) for articles published in English before May 2006 and manual review of article bibliographies. The pathophysiologic mechanism underlying vasopressin hypersensitivity in septic shock is probably multifactorial. It is doubtful that this phenomenon is merely the consequence of replacing a deficiency. Changes in vascular receptors or their signaling and/or interactions between vasopressin, nitric oxide, and adenosine triphosphate-dependent potassium channels are likely to be relevant. Further translational research is required to improve our understanding and direct appropriate educated clinical use of vasopressin.Keywords
This publication has 93 references indexed in Scilit:
- Science Review: Vasopressin and the cardiovascular system part 1 – receptor physiologyCritical Care, 2003
- Physiology of Vasopressin Relevant to Management of Septic ShockChest, 2001
- Vasopressin-induced contraction in the rat basilar artery in vitroEuropean Journal of Pharmacology, 2001
- Vasopressin ReceptorsTrends in Endocrinology & Metabolism, 2000
- A non‐capacitative pathway activated by arachidonic acid is the major Ca2+ entry mechanism in rat A7r5 smooth muscle cells stimulated with low concentrations of vasopressinThe Journal of Physiology, 1999
- Physiological pathways regulating the activity of magnocellular neurosecretory cellsProgress in Neurobiology, 1999
- Endothelin-1 and Vasopressin Activate Ca2+-permeable Non-selective Cation Channels in Aortic Smooth Muscle Cells: Mechanism of Receptor-mediated Ca2+InfluxJournal of Molecular and Cellular Cardiology, 1996
- Role of Nitric Oxide in the Regulation of Renin and Vasopressin SecretionFrontiers in Neuroendocrinology, 1994
- Receptor-Operated Calcium-Permeable Channels in Vascular Smooth MuscleJournal of Cardiovascular Pharmacology, 1989
- Opposing α- and β-adrenergic mechanisms mediate dose-dependent actions of noradrenaline on supraoptic vasopressin neurones in vivoBrain Research, 1985