Caffeine may exert vascular mechanisms of action through its direct or indirect effect on the VSMC.
5.1. Direct Effects
Caffeine, by acting on the VSMC, generates a minimal initial contraction and then a significant vasodilator effect. There are various mechanisms that explain these effects.
5.1.1. Caffeine and the Ryanodine Channels
The direct action of caffeine on the VSMC occurs initially through the ryanodine channels of the sarcoplasmic reticulum, stimulating the CICR mechanism, which generates an increase in iCa2+ and a slight transitory contraction [22]. This response is independent of the amount of extracellular Ca2+ and the presence of Ca2+ channel blockers [53].
As the intrareticular Ca2+ is used up, the entrance of extracellular Ca2+ to the cell through the slow (L-type) channels and the nonselective cation channel in the cell membrane begins. Caffeine directly activates the nonselective cation channel [30] to increase iCa2+. This increase in iCa2+ prolongs the contraction started by the CICR. It is interesting to note that in the experiments carried out with caffeine in our laboratory [54], in human arteries and animal models, this contraction was not seen, which leads us to believe that it is probably a very slight vasoconstrictor effect (Figure 2).
5.1.2. Caffeine and cAMP
In vitro experiments carried out with caffeine have demonstrated that in spite of an increase in the VSMC iCa2+, a vasodilator effect is seen [55, 56]. Caffeine is a nonselective competitive inhibitor of the phosphodiesterase enzymes [40]. These enzymes have the capacity to degrade the phosphodiesterase bond in some compounds such as cAMP and cyclic guanosine monophosphate (cGMP). One of the main enzymes inhibited by caffeine is - AMP phosphodiesterase [31, 32], whose function is to degrade cAMP, causing its local accumulation. The antiphosphodiesterase activity is concentration dependent, inhibiting the enzyme up to 5% at concentrations of 1× M and up to 80% at concentrations of 1× M [29]. In addition, it is time dependent, generating a greater accumulation of cAMP the longer the incubation time [28].
The accumulation of cAMP generates an increase in the phosphorylation of the kinase enzyme of the myosin light chain (MLC) in the cell’s contractile apparatus (actin-myosin). In this state, the enzyme is less sensitive to Ca2+, and therefore its activity is diminished. As the enzyme is inhibited, the MLC phosphorylation is diminished and the actin-myosin interaction is inhibited. This results in an increase of intracellular Ca2+ concentration without contraction32, which has been described as a loss of “sensitivity” to Ca2+ [28, 57]. As MLC phosphorylation decreases, the activity of MLC-phosphatase and relaxation predominate.
Up until now, the kinase enzyme of the myosin light chain in smooth muscle is the enzyme that activates the MLC through phosphorylation to a specific domain. The agonist stimulation increases the intracellular concentration of Ca2+ in smooth muscle, causing it to bind to calmodulin, which when bound to Ca2+ activates the kinase enzyme in the myosin light chain, thereby activating the form that interacts with actin to cause contraction. However, more recent studies have shown that this mechanism is not the only regulator of the myosin-actin interaction [58].
Rembold et al. [36] observed that upon adding 20 mM of caffeine to precontracted arteries, there was an increase in iCa2+ without a significant increase in tone, which could not be explained solely by the increase in phosphorylation of MLC kinase. They documented that the Ca2+ had a heterogeneous distribution. They concluded that caffeine increases iCa2+ but in a region distant from the contractile apparatus, which therefore did not result in a contraction. It is probable that this effect of caffeine is mediated by cAMP, since cAMP also increases the “non-contractile” Ca2+ [59].
However, the effects of caffeine described cannot be attributed solely to the increase in cAMP. In 1990, Ozaki et al. [56] carried out an observation of precontracted arteries, to which caffeine or forskolin (which also increases cAMP) were added. At similar levels of cAMP in the two preparations, caffeine inhibited contraction of the VSMC to a greater degree than forskolin.
5.1.3. Other Direct Mechanisms
Caffeine also inhibits inositol triphosphate (IP3) compound which stimulates the secretion of Ca2+ from the sarcoplasmic reticulum and is indispensable for contraction. This inhibitory effect of the IP3 pathway by caffeine is antagonized by the addition of ATP [34]. Given that the xanthenes contain an adenine ring identical to that of ATP, it has been postulated that they can interact competitively with the ATP binding site on the IP3 receptor [60]. In addition, caffeine acts directly on the voltage-dependent Ca2+ channels in the plasmatic membrane to inhibit the entrance of Ca2+ [37], an effect which is independent of its antiphosphodiesterase action