Blockade of nucleoside transport is required for delivery of intraarterial adenosine into the interstitium - Relevance to therapeutic preconditioning in humans

Background - Adenosine, a known mediator of preconditioning, has been infused into the coronary circulation to induce therapeutic preconditioning, eg, in preparation for angioplasty. However, results have been disappointing. We tested the hypothesis that endothelial nucleoside transporter acts as a barrier impeding the delivery of intravascular adenosine into the underlying myocardium and that this can be overcome with dipyridamole, a nucleoside transporter blocker. Methods and Results - We infused saline or adenosine (0.125 and 0.5 mg/min) into the brachial artery while monitoring forearm blood flow (FBF) and interstitial adenosine levels with microdialysis probes implanted in the flexor digitorum superficialis of the forearm in 7 healthy volunteers during intravenous administration of saline or dipyridamole ( loading dose, 0.142 mg/kg per min for 5 minutes followed by 0.004 mg/kg per min). Adenosine produced near maximal forearm vasodilation, increasing FBF from 4.0 +/- 0.7 to 10.4 +/- 1.9 and 13.1 +/- 1.6 mL/100 mL per min for the low and high doses, respectively, but did not increase muscle dialysate adenosine concentration (from 88 +/- 21 to 65 +/- 23 and 85 +/- 26 nmol/L). Intravenous dipyridamole enhanced resting muscle dialysate adenosine (from 77 +/- 25 to 147 +/- 50 nmol/L), adenosine-induced increase in FBF (from 4.1 +/- 0.8 to 12.6 +/- 3 and 15.1 +/- 3 mL/100 mL per min for the low and high dose, respectively), and the delivery of adenosine into the interstitium (to 290 +/- 80 and 299 +/- 143 nmol/L for the low and high dose, respectively, P = 0.04). Conclusions - Intravascular adenosine is likely ineffective in inducing myocardial preconditioning because of poor interstitial delivery. This can be overcome by blocking the nucleoside transporter with dipyridamole.