Microdialysis in the estimation of interstitial myocardial neuropeptide Y release

Assess the effect of ciliary neurotrophic factor on extracellular level of neuropeptide Y in paraventricular nucleus using microdialysis

In this study we investigated the effect of ciliary neurotrophic factor (CNTF) on dynamic changes in the release of hypothalamic neuropeptide Y (NPY) of freely moving rats using radioimmunoassay-microdialysis procedure. NPY concentrations in paraventricular nucleus (PVN) dialysate rapidly decreased to the lowest point, 47% of basal level (P&lt;0.01), in 30 minutes after intracerebroventricular injection 5&#956;g CNTF, and then increased slowly to 58%, 78% and 85% of basal level respectively at 60, 90 and 120 min (P<0.05). It became no significant difference with basal level at 150 and 180 min. These results suggested CNTF administration could directly down-regulate NPY release from hypothalamic PVN to reduce food intake and PVN was a target of CNTF's anorectic effect.

[Cardiac complications of acute brain injury]

The clinical importance of cardiovascular consequences resulting from cerebral injury has long been recognized. However, interactions between the brain and the cardiovascular system remain poorly defined and their importance for the management of patients suffering from acute brain injury is largely underestimated. This should have profound consequences on treatment strategies during anaesthesia and intensive cares of these patients, taking into account not only brain perfusion, but also cardiovascular optimisation. This report summarizes the main data available regarding the cardiovascular consequences of brain death, traumatic brain injury, stroke and epilepsy.

Neurogenic pulmonary edema

Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects. NPE seems to be under-diagnosed in acute neurologic injuries, partly because the prevention and detection of non-neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased P(a)o(2)/F(i)o(2) ratio. The associated mortality rate is high, but recovery is usually rapid with early and appropriate management. The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction. During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.

Polyaniline-coated nanoelectrospray emitters treated with hydrophobic polymers at the tip

In nanoelectrospray ionization (nanoESI) techniques, the hydrophilic character of the emitters generally produces large bases for the Taylor cones, thereby generating relatively large droplet sizes and consequently reduced sensitivity. In order to minimize this 'wetting' effect in nanoESI, a model hydrophobic polymer (an acrylic paint) was coated at the tip of commercial polyaniline (PANI)-coated emitters, and their performance was compared with that of unmodified PANI emitters using oxytocin and neuropeptide Y (NPY) solutions. In experiments with oxytocin, the hydrophobic emitter produced higher signal intensities (up to 3.6 times) as well as higher signal-to-noise ratios (33% increase) than those from the unmodified PANI emitter. In addition, the hydrophobic emitter showed reusability and a slightly wider linear dynamic range (10 nM to 50 microM, r2=0.9938) than that from the unmodified PANI emitter (10 nM to 10 microM, r2=0.9904). In the case of NPY, the hydrophobic emitter also enabled an approximately 350-fold overall increase in sensitivity than the unmodified PANI emitter (70 zmol vs. 25 amol). The enhanced performance of the hydrophobic emitter clearly indicates potential for further increases in nanoESI sensitivity using emitters with tailored hydrophobic overcoatings.

Effects of isometric contraction on intramuscular level of neuropeptide Y and local pain perception

OBJECTIVE

The release of neuropeptide Y (NPY) is reported to increase in ischemic conditions and may thus be involved in chronic myalgia. The purpose of this study was to investigate the effect of isometric contraction on intramuscular levels of NPY in relation to local pain development.

MATERIAL AND METHODS

Intramuscular microdialysis was performed in the masseter and trapezius muscles to determine NPY levels before, during, and after isometric contraction in 16 healthy females. Pain intensity was assessed simultaneously with VAS. Repeated measures ANOVA, t-test, and Pearson correlation analysis were used for statistical analyses.

RESULTS

The level of NPY in the trapezius muscle was increased during and after contraction, while there was no change in the masseter muscle. The level of NPY before contraction was higher in the masseter muscle than in the trapezius muscle, and the levels in the two muscles were correlated before and during contraction. Low-level pain in both muscles after probe insertion increased significantly during contraction, but the pain was not correlated to the NPY level.

CONCLUSIONS

Pain is developed in the trapezius and masseter muscles during repeated isometric contraction. The NPY level is increased in the trapezius muscle but is not associated with the pain development.

Improvement of Donor Myocardial Function after Treatment of Autonomic Storm During Brain Death

BACKGROUND

In experimental brain death models, autonomic storm (AS) triggers severe myocardial dysfunction, which can be attenuated by pharmacologic treatment. The aim of this study was to determine the incidence of AS in a cohort of human organ donors and to evaluate the potential interest of AS treatment on myocardial function, cardiac harvesting and transplantation.

METHODS

The cohort consisted of 152 patients. Among them, 46 patients were initially considered as potential cardiac donors (main criteria: age < 60 years, no history of cardiac disease). AS diagnosis included increased systolic arterial pressure > 200 mm Hg associated with tachycardia >140 beats/min. Heart acceptance criteria were associated creatine kinase (CK), troponin Ic, and left ventricle ejection fraction (LVEF) estimated by echocardiography and visual inspection.

RESULTS

AS was observed in 29 patients (63%). Hypertension was treated in 12 patients (esmolol n = 6, urapidil n = 5, nicardipine). Cardiac harvesting was performed in 28 donors (61%). LVEFs were significantly higher after AS treatment (no AS: 55.4 +/- 13.4%, untreated AS: 49.0 +/- 18.8%, treated AS: 63.9+ +/- 10.3%, P = 0.049). AS treatment was found to be independently associated with LVEF in > 50% of the cases (P = 0.034). Treatment of AS or the lack of AS were associated with an increased probability of successful cardiac transplantation (OR = 8.8; 95% CI 2.1-38.3, P = 0.002).

CONCLUSIONS

Treatment of hypertension during AS may attenuate brain death-induced myocardial dysfunction and increase the number of available cardiac grafts.

Microdialysis of neuropeptide Y in human muscle tissue

Microdialysis of neuropeptide Y (NPY) has been reported to be difficult, which partly may be due to the adhesive nature of the molecule. The aim of this study was to determine the optimal probe and perfusion medium for microdialysis of NPY and to investigate if microdialysis can be used to sample NPY from human muscle tissue. Three different probe types with a 10mm membrane were used for experiments in vitro. They were perfused with a modified Krebs-Henseleit buffer (KHB), with or without the addition of 0.5% human serum albumin (HSA). Dialysate samples were collected at different flow rates. Ten healthy subjects participated in the clinical microdialysis. Microdialysis samples were obtained by probes inserted intramuscularly in the right masseter and trapezius muscle and perfused with KHB+HSA at a flow-rate of 4 microl/min. The relative recovery of NPY was significantly higher in the dialysates with HSA added to the perfusion medium, while there was no difference between the three probe types. NPY was detectable in 90% of the dialysates from the masseter and in 40% of the dialysates from the trapezius muscle. In conclusion, this study shows that NPY can be detected in microdialysis samples from human skeletal muscle and that addition of HSA to the perfusion medium increases the relative recovery in vitro.

Consequences of inspired oxygen fraction manipulation on myocardial oxygen pressure, adenosine and lactate concentrations: a combined myocardial microdialysis and sensitive oxygen electrode study in pigs

Adenosine is a potent vasodilator whose concentration has been shown to increase in cardiac tissue in response to hypoxia. However, the time-dependent relationship between the levels of myocardial interstitial adenosine and tissue oxygenation has not yet been completely established. Therefore, the purpose of this study was to investigate the complex relationship between tissue myocardial oxygen tension (PtiO(2)) and interstitial myocardial adenosine and lactate concentrations by developing a new technique which combines a cardiac microdialysis probe and a Clark-type P O(2)electrode. The combined and the single microdialysis probes were implanted in the left ventricular myocardium of anesthetized pigs. The consequences of the combined use of microdialysis and P O(2)probes on myocardial PtiO(2)and microdialysis performances against glucose were evaluated. A moderate but significant reduction in the relative recovery against glucose of the combined probe was observed when compared to that of the single microdialysis probe (42+/-2 v 32+/-1%, mean+/-S.E. M.n=5 P<0.05), at 2microl/min microdialysis probe perfusion flow. Similarly, myocardial oxygen enrichment, measured by the P O(2)electrode, was negligible when microdialysis probe perfusion flow was 2microl/min. Systemic hypoxia (FiO(2)=0.08) resulted in a significant decrease in PtiO(2)from 30+/-4 to 11+/-2 mmHg, limited increase in coronary blood flow (CBF), and a significant increase in myocardial adenosine and lactate concentrations from 0.34+/-0.05 to 0.98+/-0.06micromol/l and from 0.45+/-0.05 to 0.97+/-0.06 mmol/l respectively (P<0.05). Increasing the FiO(2)to 0.3 restored the PtiO(2)and hemodynamic parameters to baseline values with no changes in interstitial adenosine and lactate concentrations. Nevertheless, myocardial interstitial adenosine remained significantly higher than baseline values. In conclusion, this study demonstrates the ability of a combined probe to measure simultaneously regional myocardial PtiO(2)and metabolite concentration during hypoxia. The hypoxia-induced increase in myocardial adenosine persists after correction of hypoxia. The physiological significance of this observation requires further studies.

In vivo microdialysis sampling: theory and applications

During the last two decades, a number of methods have been developed for in vivo collection, separation and characterization of biological samples and analytes. The capability and reliability of the microdialysis technique for measuring endogenous substances (such as neurotransmitters and their metabolites) as well as exogenous therapeutic agents in various tissue systems have brought it to the forefront of the in vivo tissue sampling methods. The usability of this technique is demonstrated by its application as reported in almost 3600 scientific papers (as of January 1998). This paper describes the general aspects and various applications of this fast growing technique. Emphasis has been given to analytical considerations with regards to microdialysis probe recovery and newer HPLC techniques.

Consequences of static and pulsatile pressure on transmembrane exchanges during in vitro microdialysis: implication for studies in cardiac physiology

Microdialysis is an established technique for measuring the kinetics of various neurotransmitters within the extracellular space in the field of neurochemistry. Recently, its use has been extended to sampling in other tissues, including liver, kidney and the heart. A persistent problem in cardiac microdialysis concerns two parameters related to myocardial function: pressure and frequency (heart rate). The aim of the study is to evaluate the consequences of pressure and frequency on transmembrane exchanges. Linear flexible microdialysis probes (membrane length: 12 mm, outside diameter: 390 microns, MWCO 50,000 Daltons) were designed in our laboratory. The probes, perfused at 2 microL/min with sterile water, were placed in a system filled with a glucose solution (2 g/L) and able to generate either static: 0 to 400 mmHg (0 to 53.31 kPa) or pulsatile pressure: 0-100; 0-200; 0-300 mmHg (0-13.32; 0-26.65; 0-39.98 kPa) at different frequencies: 1, 2 and 3 Hz. At 2 mu litre min-1 perfusion rate, the pressure inside the probe is estimated to be 80 mmHg (10.66 kPa). Under static pressure conditions, the glucose recovery rate can be expressed as an exponential function, and the outflow rate can be expressed as a linear function of the external pressure level. Under dynamic conditions, the external mean pressure must be accounted for. When external mean pressure exceeds 80 mmHg (10.66 kPa) (pressure generated by the flow rate of perfusion inside the probe), the recovery rate increases with frequency. Conversely, if the outer mean pressure is lower than 80 mmHg (10.66 kPa), the recovery rate decreases with frequency. Theoretical and experimental modelling results in a nomogram that can be used to estimate in vivo recovery. In conclusion, mass transfer across a microdialysis membrane is dependent on the direction of the transmembrane pressure gradient and increases with heart rate. These findings must be taken into account when in vivo recovery rates during cardiac microdialysis are determined.

Increase in myocardial interstitial adenosine and net lactate production in brain-dead pigs: an in vivo microdialysis study

BACKGROUND

Brain death-related cardiovascular dysfunction has been documented; however, its mechanisms remain poorly understood. We investigated changes in myocardial function and metabolism in brain-dead and control pigs.

METHODS

Heart rate, systolic (SAP) and mean (MAP) arterial pressure, left ventricular (LV) dP/dtmax, rate-pressure product, cardiac output (CO), left anterior descending coronary artery blood flow, lactate metabolism, and interstitial myocardial purine metabolite concentrations, monitored by cardiac microdialysis, were studied. A volume expansion protocol was performed at the end of the study.

RESULTS

After brain death, a transient increase in heart rate (from 90 [67-120] to 158 [120-200] beats/min) (median, with range in brackets), MAP (82 [74-103] to 117 [85-142] mmHg), LV dP/dtmax (1750 [1100-2100] to 5150 [4000-62,000] mmHg x sec(-1), rate-pressure product (9100 [7700-9700] beats mmHg/min to 22,750 [20,000-26,000] beats mmHg/min), CO (2.2 [2.0-4.0] to 3.3 [3.0-6.0] L/min), and a limited increase in left anterior descending coronary artery blood flow (40 [30-60] to 72 [50-85] ml/min) were observed. Net myocardial lactate production occurred (27 [4-40] to -22 [-28, -11] mg/L, P<0.05) and persisted for 2 hr. A 6-7-fold increase in adenosine dialysate concentration was observed after brain death induction (2.9 [1.0-5.8] to 15.8 [7.0-50.7] micromol/L), followed by a slow decline. Volume expansion significantly increased MAP, CO, and LV dP/dtmax in control animals, but decreased LV dP/dtmax and slightly increased CO in brain-dead animals. A significant increase in adenosine concentration was observed in both groups, with higher levels (P<0.05) in brain-dead animals.

CONCLUSIONS

Brain death increased oxygen demand in the presence of a limited increase in coronary blood flow, resulting in net myocardial lactate production and increased interstitial adenosine concentration consistent with an imbalance between myocardial oxygen demand and supply. This may have contributed to the early impairment of cardiac function in brain-dead animals revealed by rapid volume infusion.

[Protective effect of labetalol on cardiovascular consequences of brain death in the swine]

OBJECTIVE

Assessment of the preventive effect on cardiovascular changes following experimental brain death (BD) in the pig by pretreatment with labetalol, an alpha and beta adrenoreceptor blocking agent.

STUDY DESIGN

Experimental study.

ANIMALS

Ten 25-35 kg domestic pigs allocated either in the control group (n = 5) or the labetalol group (n = 5).

METHODS

BD was achieved in anaesthetized animals by the rapid inflation of a Foley catheter inserted into the sub-dural space. In the labetalol group, the agent (total: 10 +/- 3 mg.kg-1) was administered immediately before BD and thereafter over a 20-min period, in order to maintain haemodynamic parameters at control values. The following haemodynamic data were recorded over a 3 hour period after BD: heart rate (HR), dP/dtmax, mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO) and left anterior descending coronary artery blood flow (CBF). Afterwards, a dynamic loading test with 500 mL of dextran over 20 min was performed.

RESULTS

In the control group, BD elicited a significant increase in HR (from de 96 +/- 9 to 176 +/- 11 b.min-1), dP/dtmax (from 1,960 +/- 123 to 4,904 +/- 930 mmHg.s-1), MAP (from 88 +/- 5 to 119 +/- 11 mmHg), CO (from 2.4 +/- 0.2 to 3.6 +/- 0.7 L.min-1) and CBF (from 45 +/- 6 to 73 +/- 7 mL.min-1) respectively. Apart from a slight increase in HR and a significant increase in CBF (from 34 +/- 4 to 55 +/- 6 mL.min-1), no other modifications occurred in the labetalol group. Following volume expansion, the labetalol group animals experienced a significant increase in CO (from 2.3 +/- 0.3 to 3.7 +/- 0.2 L.min-1), dP/dtmax (from 1,400 +/- 91 to 2,100 +/- 212 mmHg.s-1) and MAP (from 55 +/- 5 to 70 +/- 5 mmHg). In the opposite, a significant decrease in dP/dtmax (from 1,645 +/- 450 to 628 +/- 152 mmHg.s-1) occurred in the control group.

CONCLUSION

The protective effect of labetalol confirms the role played by the activation of the cardiac sympathetic nervous system in the cardiocirculatory changes following BD.

Application of microdialysis in pharmacokinetic studies

The objective of this review is to survey the recent literature regarding the various applications of microdialysis in pharmacokinetics. Microdialysis is a relatively new technique for sampling tissue extracellular fluid that is gaining popularity in pharmacokinetic and pharmacodynamic studies, both in experimental animals and humans. The first part of this review discusses various aspects of the technique with regard to its use in pharmacokinetic studies, such as: quantitation of the microdialysis probe relative recovery, interfacing the sampling technique with analytical instrumentation, and consideration of repeated procedures using the microdialysis probe. The remainder of the review is devoted to a survey of the recent literature concerning pharmacokinetic studies that apply the microdialysis sampling technique. While the majority of the pharmacokinetic studies that have utilized microdialysis have been done in the central nervous system, a growing number of applications are being found in a variety of peripheral tissue types, e.g. skin, muscle, adipose, eye, lung, liver, and blood, and these are considered as well. Given the rising interest in this technique, and the ongoing attempts to adapt it to pharmacokinetic studies, it is clear that microdialysis sampling will have an important place in studying drug disposition and metabolism.

Simultaneous brain and blood microdialysis study with a new removable venous probe. Serotonin and 5-hydroxyindolacetic acid changes after D-norfenfluramine or fluoxetine

A removable intravenous microdialysis probe was developed and simultaneously used with a removable microdialysis probe placed in the lateral hypothalamus (LH). Serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) changes in blood and brain dialysates were measured by HPLC-EC after an i.p. injection of 5 mg/kg d-norfenfluramine (dNF) or 10 mg/kg fluoxetine (FLU) in freely moving rats. 5-HT in the LH significantly increased after both drugs, but the rise was larger and faster with dNF [F(7,28)=4.0 p<0.05] than with FLU [F(5,20)=5.0 p<0.01]. By contrast, in venous blood 5-HT increased after FLU [F(5,20)=2.96 p<0.05] but not after dNF. 5-HIAA after both drugs continued decreasing significantly in the LH [dNF F(7,28)=11.4 p<0.01; FLU F(5,20)=22.8 p<0.01], but it did not change in blood. Simultaneous dialysis in brain and blood allowed evaluation of the differential effects of dNF and FLU on 5-HT and 5-HIAA in the two places. Removable venous probes prevented the inflammatory reaction that may occur around permanently implanted probes, and the dialysis could be more efficient and with less risk of clogging.

Myocardial effects of experimental acute brain death: evaluation by hemodynamic and biological studies

BACKGROUND

Because of problems concerning the functional quality of heart transplants, more and more interest has been focused on the physiologic changes occurring during brain death, one of the major possible contributing factors to the myocardial alterations.

METHODS

The aim of this study was to describe the link between acute experimental brain death and myocardial metabolism. This was achieved by in vivo 3-hour hemodynamic and biological (myocardial lactate production) studies and then in vitro 6-hour phosphorus-31 nuclear magnetic resonance spectroscopy. Two groups of pigs were involved in the study: group I (n = 10) as control and group II (n = 10) as brain-dead animals.

RESULTS

Within the first hour, we observed a strong increase in myocardial activity associated with the onset of myocardial lactate production, lasting 2 hours and corresponding to a myocardial anaerobic metabolism period. Despite the apparent normalization before excision of the hearts, phosphorus-31 nuclear magnetic resonance spectroscopy revealed a significant decrease in adenosine triphosphate levels in group II when compared with group I.

CONCLUSIONS

We conclude that, in our study, acute experimental brain death is associated with an early and transient period of myocardial anaerobic metabolism and adenosine triphosphate consumption. These myocardial consequences of brain death could partially explain some observations of heart graft dysfunction.

Quantitative microdialysis of neuropeptide Y

The feasibility of using the difference method of quantitative microdialysis to measure neuropeptide Y (NPY) was evaluated in vitro and in vivo. The accuracy of this method was tested in vitro under steady-state conditions for 3 test solutions containing known concentrations of NPY. The estimated concentrations of NPY were 1.2 +/- 0.6, 3.7 +/- 0.9, and 15.1 +/- 0.7 pg/microliter (mean +/- SEM) in agreement with the actual concentrations of NPY in the test solutions which were 1.1 +/- 0.8, 4.6 +/- 0.6, and 14.6 +/- 0.5 pg/microliter (mean +/- SEM of solution samples), respectively. The responsiveness of the estimated NPYext measure to changes in the external concentration of NPY was also evaluated in vitro. An accurate estimate of NPYext was obtained within the first sampling period (within 15 min) after a 2-3-fold increase in the test solution concentration of NPY and within 2-3 sampling periods (15-45 min) in response to a 2-3-fold decrease in the test solution concentration of NPY. In vivo, the estimated basal concentration of NPY in dialysis samples from probes in the medial basal hypothalamus of anesthetized female rats (n = 4) was 4.0 +/- 1.6 pg/microliters and increased to 9.5 +/- 0.3 pg/microliter during K+ stimulation. Relative recovery was 22% in vivo under steady-state conditions and ranged from 14% to 30% during dynamic conditions. These results demonstrate that the difference method of quantitative microdialysis accurately estimates picomolar concentrations of NPY in vitro, and is sufficiently sensitive to detect basal and increasing concentrations of NPY in vivo.