The cardiovascular startle response: Anxiety and the benzodiazepine receptor complex

Benzodiazepine receptor (BZR) agonists are prototypic anxiolytic agents, whereas BZR inverse agonists exert anxio-genic effects. The effects of these compounds offer a potentially important pharmacological model system to examine the central mechanisms of anxiety. In accord with its putative anxiogenic properties, we previously found that the BZR partial inverse agonist, FG 7142, enhances the cardiovascular defensive response to a nonsignal acoustic stimulus in rats. In contrast, we found in the present study that this agent attenuates both the somatic and cardiovascular components of the acoustic startle response. BZR agonists and inverse agonists are known to modulate the basal forebrain cortical cholinergic system, and we consider the potential involvement of this system in the disparate psychophysiological actions of FG 7142 and in anxiety states in general.     

Electrophysiology of benzodiazepine receptor ligands: multiple mechanisms and sites of action

Electrophysiology of BZR ligands has been reviewed from different points of view. A great effort was made to critically discuss the arguments for and against the temporarily leading hypothesis of the mechanism of action of BZR ligands, the GABA hypothesis. As has been discussed at length in the present article, an impressive body of electrophysiological and biochemical evidence suggests an enhancement of GABAergic inhibition in CNS as a mechanism of action of BZR agonists. Biochemical data even indicate a physical coupling between GABA recognition sites and BZR which, together with the effector site build-up by Cl- channels, form a supramolecular GABAA/BZR complex. By binding to a specific site on this complex, BZR agonists allosterically increase and BZR inverse agonists decrease the gating of GABA-linked Cl- channels, whereas BZR antagonists bind to the same site without an appreciable intrinsic activity and block the binding and action of both agonists as well as inverse agonists. While this model is supported by many electrophysiological experiments performed with BZR ligands in higher nanomolar and lower micromolar concentrations, it does not explain much controversial data from animal behavior and, more importantly, is not in line with electrophysiological effects obtained with low nanomolar BZ concentrations. The latter actions of BZR ligands in brain slices occur within a concentration range compatible with concentrations of BZ observed in CSF fluid, which would be expected to be found in the biophase (receptor level) during anxiolytic therapy in man. Enhanced K+ conductance seems to be a suitable candidate for this effect of BZR ligands. This direct action on neuronal membrane properties may underlie the many electrophysiological observations with extremely low systemic doses of BZR ligands in vivo which demonstrated a depressant effect on spontaneous neuronal firing in various CNS regions. Skeletomuscular spasticity and epilepsy are two neurological disorders, where both the enhanced GABAergic inhibition and increased K+ conductance may contribute to the therapeutic effect of BZR agonists, since electrophysiological and behavioral studies strongly support GABA-dependent as well as GABA-independent action of BZR ligands elicited by low to intermediate doses of BZ necessary to evoke anticonvulsant and muscle relaxant effects. Somewhat higher doses of BZR ligands, inducing sedation and sleep, lead perhaps to the only pharmacologically relevant CNS concentrations (ca. 1 microM) which might be due entirely to increased GABAergic inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)     

Partial agonists acting at benzodiazepine receptors can be differentiated in tests of ingestional behaviour

Several categories of compounds active at benzodiazepine receptors (BZR) in the brain have been distinguished: agonists, antagonists and the novel category of inverse agonist. In terms of their effects on ingestional responses (e.g., food, saline and water consumption), agonists increase levels of intake, inverse agonists reduce intake in some, if not all, tests, while antagonists block the effects of both agonists and inverse agonists. Attention is currently focussed upon a range of compounds which fall between full agonists and antagonists. These partial agonists are of particular interest since they act more selectively than full agonists, retaining effects in animal models of anxiolytic and anticonvulsant activity, for example, while largely lacking behaviourally-depressant effects. Recent data indicate that tests of ingestional behaviour distinguish between various BZR partial agonists. The benzodiazepines Ro23-0364, Ro16-6028 and Ro17-1812, as well as the beta-carboline ZK 91296, enhanced ingestional responses. The pyrazoloquinolines, CGS 9895 and CGS 9896, did not, but antagonized agonist-induced increases in ingestion.     

Diazepam stimulates the binding of GABA and muscimol but not THIP to rat brain membranes

Diazepam (10-1000 nM) enhanced the binding of [3H]GABA and of the monocyclic GABA agonist [3H]muscimol, but failed to alter binding of the bicyclic GABA agonist [3H]THIP to fresh, well washed rat brain membranes incubated at 2 degrees C. Although stimulation of [3H]diazepam binding by THIP was observed at higher incubation temperatures and in the presence of chloride ions, these measures did not induce a corresponding enhancement of [3H]THIP binding by diazepam. These results extend earlier observations of the unusual behavior of THIP as a selective GABA agonist, and emphasize that enhancement of benzodiazepine binding by GABA agonists is not necessarily reflected in a complementary manner by any action of benzodiazepines on the binding of GABA agonists.     

Activation of α6-containing GABAA receptors by pentobarbital occurs through a different mechanism than activation by GABA

The GABA_A receptors are ligand-gated chloride channels which are the targets for many clinically used sedatives, including the barbiturates. The barbiturate pentobarbital acts through multiple sites on the GABA_A receptor. At low concentrations (μM), it acts as a positive allosteric modulator while at higher concentrations it can directly activate the receptor. This agonist action is influenced by the subunit composition of the receptor, and pentobarbital is a more effective agonist than GABA only at receptors containing an α6 subunit. The conformational change that translates GABA binding into channel opening is known to involve a lysine residue located in an extracellular domain between the 2nd and 3rd transmembrane domains. Mutations of this residue disrupt activation of the channel by GABA and have been linked to inherited epilepsy. Pentobarbital binds to the receptor at a different agonist site than GABA, but could use a common signal transduction mechanism to gate the channel. To address this question, we compared the effect of a mutating the homologous lysine residue in the α1 or α6 subunits (K278 or K277, respectively) to methionine on direct activation of recombinant GABA_A receptors by GABA or pentobarbital. We found that this mutation reduced GABA sensitivity for both α1 and α6 subunits, but affected pentobarbital sensitivity only for the α1 subunit. This suggests that pentobarbital acts through a distinct signal transduction pathway at the α6 subunit, which may account for its greater efficacy compared to GABA at receptors containing this subunit.     

High pH accelerates GABA deactivation on perch-rho1B receptors

The ionotropic GABA(C) receptor, formed by GABA rho subunits, is known to be modulated by a variety of endogenous compounds, as well as by changes in pH. In this study, we explore the proton sensitivity of the GABA rho subunits cloned from the perch retina, and report a novel action of high pH on the homomeric receptor formed by one of the GABA rho subunits, the perch-rho(1B) subunit. Raising extracellular pH to 9.5 significantly accelerated GABA deactivation responses elicited from oocytes expressing the perch-rho(1B) subunit, and reduced its sensitivity to GABA. The change in the kinetics of the GABA-offset response occurred without altering the maximum response amplitude, and the reduced GABA sensitivity was independent of membrane potential. Although acidification of the extracellular solution also accelerated GABA deactivation for all other GABA rho receptors examined in this study, the effects of high pH were unique to the homomeric receptor formed by the perch-rho(1B) subunit. In addition, we found that, unlike the effects on the response to the naturally occurring full agonist GABA, the responses elicited by partial agonists (imidazole-4-acetic acid (I4AA) and beta-alanine) in the presence of the high pH solution showed a significant reduction in the maximum response amplitude. When considered in terms of a model describing the activation of GABA(C) receptors, in which pH can potentially affect either the binding affinity or the rate of channel closure, the results were consistent with the view that external alkalization reduces the gating efficiency of the receptor. To identify the proton sensitive domain(s) of the perch-rho(1B) receptor, chimeras were constructed by domain swapping with other perch-rho subunits. Analysis of the pH sensitivities of the various chimeric receptors revealed that the alkaline-sensitive residues are located in the N-terminal region of the perch-rho(1B) subunit.     

The role of the GABA(B) receptor and calcium channels in a Drosophila model of Parkinson's Disease

Transgenic Drosophila melanogaster carrying the human gene for alpha synuclein is an animal model for the study of Parkinson's Disease. Climbing activity in these flies is reduced as a result of the effect of this protein on the locomotor activity of the transgenic fly. L-DOPA and gamma amino butyric acid (GABA) reverse the loss of this activity when placed in the food fed to these flies. While muscimol, a GABA(A) receptor agonist has no effect in this system, baclofen and the allosteric agonists CG 7930 and GS 39783 which affect the GABA(B) receptor reverse this activity. This latter effect is eliminated when these compounds are fed in conjunction with the GABA(B) receptor antagonist 2-hydroxysaclofen. In addition, fendiline which is a Ca(++) receptor blocker also reverses the loss of climbing ability. Because there is a calcium channel close to the GABA(B) receptor on the cell surface, these data are indicative of a relationship between the roles of the GABA(B) receptor, the calcium channel and the effect of alpha-synuclein on the motor activity of the transgenic fly.     

Interaction between nociceptin/orphanin FQ (N/OFQ) and GABA in response to feeding

Nociceptin/orphanin FQ (N/OFQ) and gamma aminobutyric acid (GABA) agonists have been shown to increase feed intake in mammals and birds. In this study, the effect of intracerebroventricular (icv) injection of the potent NOP receptor agonists Nociceptin (1-13) NH(2), the GABA(A) receptor antagonist bicuculline, and the GABA(A) receptor agonist muscimol on feed intake in cockerels was investigated. The icv injection of N/OFQ and muscimol increases feed intake. The effect of N/OFQ on feed intake was strongly blocked by the injection of bicuculline whereas the effect of muscimol was stimulated by N/OFQ. These results suggest that N/OFQ may act at GABA(A) receptors or increases overflow of GABA in the brain of chickens to stimulate feeding.     

Distinct GABA and glutamate receptors may share a common channel in Aplysia neurons

Using a microperfusion technique for rapid application of agonists to single identified voltage-clamped neurons of the marine mollusc Aplysia, chloride conductances elicited by gamma-aminobutyric acid (GABA) and L-glutamate were found to differ in rates of activation and desensitization, voltage dependence and dose-response relations. In spite of these marked differences, the two responses showed strong interaction: previous application of GABA could completely block the responses to glutamate while previous application of glutamate decreased the response to GABA. This interaction was not due to transmembrane chloride redistribution, and is probably not cross receptor blockade. Cross-desensitization of GABA and glutamate responses suggest that distinct receptors activate a common ion channel.     

Unusual functional properties of homo- and heteromultimeric histamine-gated chloride channels of Drosophila melanogaster: spontaneous currents and dual gating by GABA and histamine

Histamine acts as a neurotransmitter of photoreceptors in insects and other arthropods, where it directly activates a chloride channel and mediates rapid inhibitory responses. Homo- and heteromultimeric histamine-gated ion channels formed by HisCl-alpha2 or HisCl-alpha1 + alpha2 subunits from Drosophila melanogaster were characterized by two-electrode voltage-clamp measurements of functionally expressed ion channels in Xenopus laevis oocytes. The sensitivity of heteromultimeric histamine receptors with an EC(50) of 2.3 microM is lower than that of either homomultimeric receptor. They can be further distinguished from the homomultimeric channels by their reduced sensitivity to d-tubocurarine. Heteromultimeric channels generate a spontaneous current in the absence of any agonist. This spontaneous current can be blocked in the absence of an agonist by d-tubocurarine and the histamine antagonists cimetidine, thioperamide and pyrilamine. Homomultimeric HisCl-alpha2 channels are dually gated by histamine (IC(50)=9.4 microM) and GABA (IC(50)=1.0mM), both of which are full agonists. The action of both agonists can be blocked with comparable IC(50) values by the histamine antagonists cimetidine, thioperamide and pyrilamine but not by the GABA antagonist bicuculline. Picrotoxin blocked with an IC(50) of 403 microM. Our data show that histamine and GABA act on the same ion channel, which thus might function as a site of integration of the action of different neurotransmitters.     

GABA enhances acetylcholine release from hippocampal nerve endings through a mechanism blocked by a GABA uptake inhibitor

The effect of γ-aminobutyric acid (GABA) on the release of [³H]acetylcholine ([³H]ACh) was investigated using superfused rat hippocampal synaptosomes. GABA enhanced the basal efflux of [³H]ACh. The effect of GABA was bicuculline-insensitive. Muscimol, (±)-baclofen or (−)-baclofen did not increase [³H]ACh release. The effect of GABA was counteracted by SK&F 89976 A (N-(4,4-diphenyl-3-butenyl)-nipecotic acid), a GABA uptake inhibitor. One possible interpretation of the results is that a GABA transport system is present on cholinergic terminals, suggesting that GABA and ACh may coexist in some rat hippocampus nerve endings. Another possibility is that the effect of GABA is mediated by a novel subtype of GABA receptor sensitive to SK&F 89976 A.     

Use of a Novel Mouse Genotype to Model Acute Benzodiazepine Withdrawal

Withdrawal from benzodiazepines in physically dependent rodents often requires that the drug be dislodged from its receptor with a competitive antagonist. Withdrawal Seizure-Prone (WSP) mice were selectively bred for their susceptibility to handling-induced withdrawal convulsions following chronic treatment with ethanol. Reflecting pleiotropic genetic influences, they also experience more severe withdrawal from other sedative-hypnotics including the benzodiazepine, diazepam. We used this susceptible genotype to test whether other benzodiazepine receptor (BZR) agonists also produce physical dependence following acute administration, comparing studies of spontaneous withdrawal with those where convulsions were precipitated by a BZR antagonist (flumazenil). Separate groups of mice were tested following a single injection of one of eight BZR agonists. Several doses of each drug were tested for spontaneous withdrawal, and a single dose of each drug was tested for precipitated withdrawal. Withdrawal convulsions were seen after all of the drugs by at least one method, suggesting that BZR agonists as a class elicit acute physical dependence in this susceptible genotype. Edited by Andrew Holmes     

In vivo benzodiazepine receptor occupancy by CL 218,872 visualized by positron emission tomography in the brain of the living baboon: modulation by GABAergic transmission and relation with anticonvulsant activity

Summary In vivo benzodiazepine receptor occupancy by increasing doses of CL 218,872 has been evaluated in the baboon Papio papio, using (¹¹C) RO 15-1788 as specific radioligand and positron emission tomography as external detection system. Although BZR heterogeneity has been previously demonstrated in the brain of the living baboon using PET, we did not observe in our studies that CL 218,872 interacts preferentially with one of the BZR subtypes. The monophasic pattern of the dose dependent CL 218,872 displacement curve and the corresponding in vivo Hill coefficient near unity suggest that CL 218,872 binds in cerebral baboon cortex with a similar affinity with BZ1 as well as BZ2 subtypes. The anticon-vulsant properties of CL 218,872 against bicuculline and allylglycine-induced seizures were correlated with benzodiazepine receptor occupancy by assessment of electroencephalographic activity during positron emission tomography studies. Our data confirmed in vivo the hypothesis of a partial agonist anticonvulsant activity of CL 218,872. At the same time, the use of a GABAantagonist (bicuculline) or an inhibitor of the GABA synthesis (allylglycine) suggested the existence of an allosteric interaction between benzodiazepine receptors and GABA receptors.     

The chloride channel blocking agent, t-butyl bicyclophosphorothionate, binds to the gamma-aminobutyric acid-benzodiazepine, but not to the glycine receptor in rodents

The inhibitory neurotransmitters glycine and gamma-aminobutyric acid (GABA) both activate transmembrane chloride channels of similar physical characteristics. A common ion channel component has therefore been postulated for both the glycine and GABA receptor proteins. Different convulsant drugs as picrotoxin and t-butyl bicyclophosphorothionate (TBPS) have been reported as channel-blocking ligands of the GABA receptor. Here, we show that the distribution of [35S]TBPS binding sites parallels the binding of the GABA receptor ligand [3H]flunitrazepam, but not that of the glycine receptor antagonist [3H]strychnine. Binding was examined in membrane fractions from different regions of the rat CNS and of the mutant mouse spastic, an animal deficient in glycine receptors. Also, affinity purification of the glycine receptor on aminostrychnine-agarose resulted in almost complete removal of [35S]TPBS binding sites from the receptor preparation. It is concluded that TBPS selectively binds to the GABA, but not glycine, receptor chloride channel complex.     

Structural basis for partial agonist action at ionotropic glutamate receptors

An unresolved problem in understanding neurotransmitter receptor function concerns the mechanism(s) by which full and partial agonists elicit different amplitude responses at equal receptor occupancy. The widely held view of 'partial agonism' posits that resting and active states of the receptor are in equilibrium, and partial agonists simply do not shift the equilibrium toward the active state as efficaciously as full agonists. Here we report findings from crystallographic and electrophysiological studies of the mechanism of activation of an AMPA-subtype glutamate receptor ion channel. In these experiments, we used 5-substituted willardiines, a series of partial agonists that differ by only a single atom. Our results show that the GluR2 ligand-binding core can adopt a range of ligand-dependent conformational states, which in turn control the open probability of discrete subconductance states of the intact ion channel. Our findings thus provide a structure-based model of partial agonism.     

大鼠GAD样阳性终末与三叉神经中脑核内GABA_B受体和PAG共存神经元的联系

本研究应用免疫荧光组织化学双重和三重反应技术 ,在激光共聚焦显微镜下观察了大鼠三叉神经中脑核神经元内GABAB受体和磷酸激活的谷氨酰胺酶 (PAG)的共存关系 ,以及谷氨酸脱羧酶 (GAD)样阳性终末与此二者共存的神经元之间的联系。结果证明 :在三叉神经中脑核内可见大量 GABAB受体样和谷氨酰胺酶样免疫阳性神经元 ,在吻尾方向上几乎亘其全长出现 ,多为大的假单极神经元。许多谷氨酰胺酶样阳性神经元同时呈 GABAB受体样免疫阳性 ,这种双重阳性的细胞约占磷酸激活的谷氨酰胺酶样阳性细胞的 85 %。在激光共聚焦显微镜下观察到密集分布的谷氨酸脱羧酶样阳性终末聚集于 GABAB受体样和磷酸激活的谷氨酰胺酶样双重阳性的三叉神经中脑核神经元胞体周围 ,并与之形成密切接触。以上结果提示 ,GABA能投射至三叉神经中脑核的神经终末可能通过 GABAB受体对谷氨酸介导的口面部本体觉信息的传递发挥抑制性调控作用     

Cell-type specific distribution of chloride transporters in the rat suprachiasmatic nucleus

The suprachiasmatic nucleus (SCN) is a circadian oscillator and biological clock. Cell-to-cell communication is important for synchronization among SCN neuronal oscillators and the great majority of SCN neurons use GABA as a neurotransmitter, the principal inhibitory neurotransmitter in the adult CNS. Acting via the ionotropic GABA_A receptor, a chloride ion channel, GABA typically evokes inhibitory responses in neurons via Cl⁻ influx. Within the SCN GABA evokes both inhibitory and excitatory responses although the mechanism underlying GABA-evoked excitation in the SCN is unknown. GABA-evoked depolarization in immature neurons in several regions of the brain is a function of intracellular chloride concentration, regulated largely by the cation-chloride cotransporters NKCC1 (sodium/potassium/chloride cotransporter for chloride entry) and KCC1-4 (potassium/chloride cotransporters for chloride egress). It is well established that changes in the expression of the cation-chloride cotransporters through development determines the polarity of the response to GABA. To understand the mechanisms underlying GABA-evoked excitation in the SCN, we examined the SCN expression of cation-chloride cotransporters. Previously we reported that the K⁺/Cl⁻ cotransporter KCC2, a neuron-specific chloride extruder conferring GABA's more typical inhibitory effects, is expressed exclusively in vasoactive intestinal peptide (VIP) and gastrin-releasing peptide (GRP) neurons in the SCN. Here we report that the K⁺/Cl⁻ cotransporter isoforms KCC4 and KCC3 are expressed solely in vasopressin (VP) neurons in the rat SCN whereas KCC1 is expressed in VIP neurons, similar to KCC2. NKCC1 is expressed in VIP, GRP and VP neurons in the SCN as is WNK3, a chloride-sensitive neuron-specific with no serine–threonine kinase which modulates intracellular chloride concentration via opposing actions on NKCC and KCC cotransporters. The heterogeneous distribution of cation-chloride cotransporters in the SCN suggests that Cl⁻ levels are differentially regulated within VIP/GRP and VP neurons. We suggest that GABA's excitatory action is more likely to be evoked in VP neurons that express KCC4.     

Activation of GABA receptors attenuates neuronal apoptosis through inhibiting the tyrosine phosphorylation of NR2A by Src after cerebral ischemia and reperfusion

Cerebral ischemia can induce both the increase of excitation and the decrease of inhibition, which leads to neuronal excitotoxicity. Since glutamatergic and GABAergic transmissions work by each counterbalancing the function of the other, enhancing GABAergic activity should balance excessive glutamatergic excitation. But the potential mechanisms underlying these effects are obscure. Here, we used two GABA agonists, muscimol and baclofen, and performed immunoblotting, immunoprecipitation and histology analysis to evaluate the neuroprotective effects by stimulating GABA receptors in rat four-vessel occlusion (4-VO) ischemic model, and to investigate the potential mechanism. Our results indicate that whether in global cerebral ischemia in vivo, or in oxygen glucose deprivation (OGD) in vitro, coapplication of muscimol with baclofen can protect neurons from neuronal death through down-regulating the function of N-methyl-d-aspartic acid (NMDA) receptors via attenuating the tyrosine phosphorylation of NR2A subunit. We further elucidate that the phosphorylation level of Src kinase and the interaction among Src, post-synaptic density protein 95 and NR2A were also suppressed by coapplication of muscimol with baclofen. Both MK-801, a specific antagonist of NMDA receptors, and chelerythrine, an inhibitor of protein kinase C (PKC), could down-regulate the phosphorylation of NR2A via inhibiting the activation of Src and PKC respectively. These results suggest that the modified pattern of dynamic balance between excitation and inhibition by coactivation of the GABA receptors in cerebral ischemia can attenuate the excitatory NMDAR via inhibiting a novel postsynaptic NMDAR/Src-mediated signal amplification, the ‘NMDAR-Ca²⁺ → PKC → Src → NMDAR-Ca²⁺’ cycle.     

Bicuculline-resistant, Cl- dependent GABA response in the rat spinal dorsal horn.

Receptors for gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the mammalian central nervous system (CNS), have been divided into three subtypes. GABA(A) receptor is a ligand-gated chloride channel that is competitively antagonized by bicuculline, whereas GABA(B) receptor regulate Ca2+ or K+ channels through G proteins. Recently, GABA(C) receptor has been identified in mammalian and fish retina. Unlike GABA(A) receptors, the GABA(C) receptor is a bicuculline-resistant chloride channel that is selectively activated by cis-4-aminocrotonic acid (CACA), and antagonized by imidazole-4-acetic acid (I4AA) and to some extent by picrotoxin. We report here that bicuculline-resistant GABA responses mediated by chloride channels are also expressed in substantia gelatinosa (SG) neurons in the dorsal horn, which receive predominantly nociceptive inputs from periphery. The GABA responses are, however, not mimicked by CACA nor affected by I4AA, but abolished by picrotoxin. Moreover, these responses are modulated by benzodiazepines (flunitrazepam) and barbiturates (thiopental), although GABA(C) responses are not affected. Thus, the pharmacological characteristics of the GABA responses observed in SG neurons are distinct from those responses mediated by the known GABA receptors. These differences may reflect the presence of receptor subunits unique to SG neurons.     

Enhanced activity of GABA receptors inhibits glutamate release induced by focal cerebral ischemia in rat striatum

Cerebral ischemia causes an excess release of glutamate, which can injure neurons. The striatum is one of the important regions vulnerable to hypoxia and ischemia. Using push–pull perfusion technique, we investigated the regulatory role of γ-aminobutyric acid (GABA) and its receptors in modifying the amount of glutamate in rat striatum with ischemia. Perfusion with exogenous GABA (1 mM) inhibited cerebral ischemia-induced glutamate release by as much as 47%. We further characterized relative roles of subtype receptors of GABA on glutamate release by using pharmacological tools. While baclofen (500 μM), a GABA_B receptor agonist, suppressed ischemia-induced glutamate release by 52%, GABA_B receptor antagonist saclofen (500 μM) failed to produce a significant increase of glutamate release. The GABA_A receptor agonist muscimol (500 μM) also reduced by 38% the release of glutamate induced by cerebral ischemia but the GABA_A receptor antagonist bicuculline (500 μM) had very little effect. The present study demonstrates that the excessive release of glutamate or the overly activated glutamate receptor, triggered by cerebral ischemia, can be down-regulated by exogenous GABA or by increased activity of GABA receptors, especially the presynaptic GABA_B receptors, which might be one of the important mechanisms to protect against striatum neuronal damage from over stimulation by excessive glutamate during ischemia.