Contractile, metabolic and arrhythmogenic effects of ionic and nonionic contrast agents in the isolated rat heart

An in vivo and in vitro model on the protective effect of cilnidipine on contrast-induced nephropathy via regulation of apoptosis and CaMKⅡ/mPTP pathway

Contrast-induced nephropathy (CIN) is an acute kidney injury (AKI) observed after the administration of contrast media. Calcium channel blockers (CCBs) have been reported to exert a renal protective effect. This study aims to investigate the role of cilnidipine, a novel CCBs, on CIN by regulating the calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)/mitochondrial permeability transition pore (mPTP) pathway. Here, iohexol, a representative contrast media, was used to establish CIN model. KN-93 (CaMKⅡ inhibitor) and atractyloside (mPTP opener) were administered in rats, and CaMKⅡ overexpression was used in Human proximal tubular epithelial cells. Markers of renal injury (serum creatinine, blood urea nitrogen, and urinary NAGL), hematoxylin-eosin stain, oxidative stress (ROS, superoxide dismutase [SOD], and malondialdehyde [MDA] levels), cell death (MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling [TUNEL]), mitochondrial function (mPTP, mitochondrial membrane potential [MMP], and ATP) were assessed. Western blots were used to measure the expression levels of Bax/Bcl-2, caspase-3, CaMKⅡ/mPTP signaling pathways. Results showed that cilnidipine markedly improved kidney function, and alleviated tubular cell apoptosis, oxidative stress and mitochondrial damage induced by iohexol in vitro and in vivo. The underlying mechanism may be that cilnidipine relieved CaMKⅡ activation and mPTP opening induced by iohexol. All of these protective effects of cilnidipine were attenuated by CaMKⅡ overexpression and atractyloside (mPTP opener) pretreatment. Moreover, KN-93 (CaMKⅡ inhibitor) treatment showed a similar renal protective effect with cilnidipine, while the protective effect of cilnidipine on kidney in CIN rats was not further suppressed by KN-93 cotreatment. These in vitro and in vivo results point toward the fact that cilnidipine might be a novel therapeutic drug against contrast-induced nephrotoxicity in a CaMKⅡ-dependent manner.

Effects of Different Contrast Media on Glutathione Peroxidase and Superoxide Dismutase Activities in the Heart and Kidneys of Normal and Streptozotocin-induced Diabetic Rats

BACKGROUND/PURPOSE

Hemodynamic changes and contrast nephropathy are well known complications of contrast media injection. However, the mechanisms of toxicity leading to these complications remain unclear. We hypothesized that contrast media toxicity would manifest as a change in antioxidant enzyme activity, thus leading to tissue damage.

METHODS

This study investigated the effects of injection of ionic high-osmolar diatrizoate, ionic low-osmolar ioxaglate, and nonionic low-osmolar iopromide on the activities of two antioxidant enzymes, glutathione peroxidase (GPX) and superoxide dismutase (SOD), in the heart and kidney tissue of normal male Wistar rats (n = 51) and streptozotocin (STZ)-induced diabetic rats (n = 54). Activities of GPX and SOD were assayed spectrophotometrically.

RESULTS

Renal GPX activities were significantly decreased in both normal (458.3 +/- 64.6 to 385.5 +/- 63.4 mU/mg, p = 0.005) and diabetic rats (669.0 +/- 98.1 vs. 564.0 +/- 153.3 mU/mg, p = 0.035) at 1 hour after diatrizoate injection. Renal SOD activities were not affected after contrast injection. Ioxaglate and iopromide injection did not cause any change in renal antioxidant enzyme activity. In contrast to kidney tissue, there was no significant change in GPX and SOD activities in heart tissue at 1 hour after injection of different contrast media.

CONCLUSION

Intravenous injection of ionic high-osmolar diatrizoate reduced renal GPX activity during the first hour in both normal and STZ-induced diabetic rats. Heart tissue was not prone to antioxidant enzyme activity changes after intravenous contrast media injection. GPX activity reduction can be an important mechanism of nephrotoxicity after contrast media injection.

Contrast-medium-induced ventricular fibrillation: arrhythmogenic mechanisms and the role of antiarrhythmic drugs in dogs

RATIONALE AND OBJECTIVES

Small electrolyte additions to a nonionic contrast medium reduce the risk of ventricular fibrillation (VF) during wedged catheter injection of a contrast medium. The current study was designed to further investigate contrast-medium-induced VF by studying the effect of pretreatment with different antiarrhythmic drugs.

METHODS

During a simulated wedged catheter situation, iohexol was injected into the anterior descending branch of the left coronary artery in five open-chest, anesthetized dogs pretreated with lidocaine, propranolol, amiodarone, almokalant, or verapamil.

RESULTS

Wedging the catheter for 60 sec did not induce VF. However, all 15 wedged catheter injections with iohexol induced VF within 28 sec (19 +/- 1 [mean +/- standard error of the mean]) despite pretreatment with antiarrhythmic drugs. Prior to VF, conduction was slowed and monophasic action potential duration lengthened in the contrast-medium-perfused myocardium, although no significant changes occurred in the control area.

CONCLUSION

The combination of catheter wedging and long-lasting contrast medium injection has a high risk of causing VF. Although adding a small amount of electrolytes to nonionic contrast media can reduce the risk of VF, antiarrhythmic drug therapy may not have a protective effect.

Acute hemodynamic effects of intravenous bolus injection of ionic and nonionic magnetic resonance contrast media

RATIONALE AND OBJECTIVES

With the development of fast magnetic resonance (MR) imaging, bolus injection of contrast media is often required. We evaluated the acute hemodynamic effects of intravenous (i.v.) bolus injection of two MR contrast media: ionic gadopentetate dimeglumine and nonionic gadoteridol.

METHODS

Twenty normal rats were anesthetized, and the left ventricular pressure (LVP), right atrial pressure (RAP), peripheral arterial pressure (PAP), positive rate pressure development (dP/dt) of the left ventricle, and heart rate were continuously monitored up to 10 min after bolus injections of 0.1, 0.3, and 0.5 mmol/kg of either media.

RESULTS

Bolus injections of gadopentetate dimeglumine induced temporal reduction of the blood pressure (the peak LVP was -25.0% at 0.5 mmol/kg and -13.2% at 0.3 mmol/kg). At the injected doses of 0.5 and 0.3 mmol/kg, the systolic PAP, mean PAP, and dP/dt were reduced. The lowest peak systolic LVP was observed at around 20 sec after injection. Those suppressed values returned to the control values within 120 sec. Injection of high doses of gadoteridol caused a temporal increase in the peak systolic LVP (9.2% at 0.5 mmol/kg and 7.4% at 0.3 mmol/kg), systolic PAP, and dP/dt. Approximately 15 sec after injection, the highest peak systolic LVP was observed, and within 30 sec the value normalized. With both ionic and nonionic contrast media, a dose of 0.1 mmol/kg did not cause significant changes in hemodynamics.

CONCLUSION

In normal rats, bolus i.v. injection of high-dose gadopentetate dimeglumine has negative hemodynamic effects; gadoteridol produces mild positive effects.