Role of Noradrenergic Brain Nuclei in the Regulation of Carotid Artery Blood Flow: Pharmacological Evidence From Anesthetized Pigs With Alpha-2 Adrenergic Receptor Modulator Drugs

J Alzheimers Dis. 2018;66(1):407-419. doi: 10.3233/JAD-180340.


Background: Cerebral hypoperfusion and degeneration of the noradrenergic locus coeruleus (LC) occur early in Alzheimer's disease (AD). Cerebral blood vessels are densely innervated by noradrenergic projections from the LC suggesting a functional role for the regulation of cerebral blood flow (CBF). Experimental LC stimulation, however, has provided no clarity as decreases or increases in CBF were reported from different experimental settings and investigators.

Objective: To find out with pharmacological methods whether endogenously released norepinephrine (NE) increases or decreases carotid artery blood flow (CABF) in anesthetized pigs by investigating the effect of centrally acting alpha-2 adrenergic drugs, which increase (atipamezole) or decrease (xylazine) NE in the brain.

Methods: CABF was measured by a Doppler-flow probe placed around the left carotid artery in pentobarbital anesthetized young pigs.

Results: Neither current antihypertensive drugs nor pharmacological stimulation of dopamine, histamine, serotonin or acetylcholine receptors changed CABF. The alpha-2 adrenergic-receptor agonist xylazine decreased, while the antagonist atipamezole raised CABF. This rise was abolished by a combined treatment with endothelial NO-synthase inhibitor Nω-Nitro-L-arginine methyl ester (L-NAME) and the non-selective β-receptor antagonist propranolol. Propranolol alone did not decrease CABF in contrast to L-NAME but decreased CABF after L-NAME, surprisingly.

Conclusion: Pharmacological evidence suggests that NE released in the brain of anesthetized pigs raises CABF involving β-adrenergic mechanisms and nitric oxide. If in awake humans NE released from the LC had vasodilator effects early LC degeneration could be involved in early cerebral hypoperfusion of AD. Moreover, a cerebral adrenergic vascular innervation deficit, possibly resulting from LC degeneration, and systemic endothelial dysfunction together may act synergistically to reduce CBF.

Keywords: Alpha-2 adrenergic drugs; Alzheimer’s disease; atipamezole; carotid artery blood flow; cerebral blood flow; cerebral hypoperfusion; degeneration; locus coeruleus; pigs; propranolol; xylazine.

MeSH terms

  • Adrenergic Neurons / drug effects
  • Adrenergic Neurons / physiology*
  • Adrenergic alpha-2 Receptor Agonists / pharmacology*
  • Adrenergic beta-Antagonists / pharmacology*
  • Animals
  • Carotid Arteries / drug effects
  • Carotid Arteries / physiology*
  • Cerebrovascular Circulation / drug effects
  • Cerebrovascular Circulation / physiology*
  • Locus Coeruleus / drug effects
  • Locus Coeruleus / physiology*
  • Norepinephrine / metabolism
  • Receptors, Adrenergic, alpha-2 / physiology*
  • Swine


  • Adrenergic alpha-2 Receptor Agonists
  • Adrenergic beta-Antagonists
  • Receptors, Adrenergic, alpha-2
  • Norepinephrine