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Geevarghese M, Patel K, Gulati A, Ranjan AK. Role of adrenergic receptors in shock. Front Physiol 2023; 14:1094591. [PMID: 36726848 PMCID: PMC9885157 DOI: 10.3389/fphys.2023.1094591] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Shock is a severe, life-threatening medical condition with a high mortality rate worldwide. All four major categories of shock (along with their various subtypes)-hypovolemic, distributive, cardiogenic, and obstructive, involve a dramatic mismatch between oxygen supply and demand, and share standard features of decreased cardiac output, reduced blood pressure, and overall hypoperfusion. Immediate and appropriate intervention is required regardless of shock type, as a delay can result in cellular dysfunction, irreversible multiple organ failure, and death. Studies have shown that dysfunction and downregulation of adrenergic receptors (ARs) are often implicated in these shock conditions; for example, their density is shown to be decreased in hypovolemic and cardiogenic shock, while their reduced signaling in the brain and vasculature decrease blood perfusion and oxygen supply. There are two main categories of ARs, α, and β, each with its subtypes and distributions. Our group has demonstrated that a dose of .02 mg/kg body wt of centhaquine (CQ) specifically activates α2B ARs on venous circulation along with the central α2A ARs after hypovolemic/hemorrhagic shock. Activating these receptors by CQ increases cardiac output (CO) and reduces systemic vascular resistance (SVR), with a net increase in blood pressure and tissue perfusion. The clinical trials of CQ conducted by Pharmazz Inc. in India have demonstrated significantly improved survival in shock patients. CQ improved blood pressure and shock index, indicating better blood circulation, and reduced lactate levels in the blood compared to in-use standard resuscitative agents. After successful clinical trials, CQ is being marketed as a drug (Lyfaquin®) for hypovolemic/hemorrhagic shock in India, and United States FDA has approved the phase III IND application. It is anticipated that the phase III trial in the United States will begin in 2023. Thus, we have demonstrated that α2 ARs could be suitable targets for treating or managing hypovolemic/hemorrhagic shock. Further understanding of ARs in shock would help find new potential pharmacological targets.
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Affiliation(s)
- Mathew Geevarghese
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, United States
| | - Krishna Patel
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, United States
| | - Anil Gulati
- Pharmazz Inc., Research and Development, Willowbrook, IL, United States,Department of Bioengineering, The University of Illinois at Chicago, Chicago, IL, United States,Midwestern University College of Pharmacy Downers Grove, Downers Grove, IL, United States,*Correspondence: Anil Gulati, ; Amaresh K. Ranjan,
| | - Amaresh K. Ranjan
- Midwestern University College of Pharmacy Downers Grove, Downers Grove, IL, United States,*Correspondence: Anil Gulati, ; Amaresh K. Ranjan,
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Sheen JC, Vella D, Hung L. Retrospective analysis of liver lobe torsion in pet rabbits: 40 cases (2016-2021). Vet Rec 2022; 191:e1971. [PMID: 35841624 DOI: 10.1002/vetr.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Liver lobe torsion (LLT) in rabbits can be under-recognised and potentially fatal. The clinical features of cases presented to an exotic animal veterinary service in Australia were retrospectively reviewed. METHOD Medical records of confirmed rabbit LLT cases between 2016 and 2021 were reviewed for signalment, clinical signs and findings, diagnostic imaging results, management strategies and outcomes. Variables of interest were analysed for statistical association with outcome. RESULTS A total of 40 rabbits were included. The mean presenting age was 56.2 months (SD 30.5). Neutered males (23/40, 57.5%) were over-represented. Common clinical signs and findings included reduced appetite (40/40, 100%), lethargy (32/40, 80.0%), reduced faecal production (16/40, 40.0%), a doughy distended stomach (20/40, 50.0%), pale mucous membranes (19/40, 47.5%) and hypothermia (17/40, 42.5%). Anaemia and elevated plasma alanine aminotransferase and blood urea nitrogen were common clinicopathologic findings. Computed tomography (CT) was performed in 34 of 40 rabbits, confirming the presence and position of LLT (34/34, 100%), stenosis of the caudal vena cava or portal system (28/34, 82.4%) and increased free peritoneal fluid (29/34, 85.3%). Fifteen (15/40, 37.5%) rabbits were medically managed, and surgical intervention was performed in 23 of 40 (57.5%) rabbits. Overall, 30 of 40 (75.0%) rabbits survived. Surgical intervention did not confer a significant difference in outcome compared to medical management (odds ratio 0.77, 95% confidence interval 0.15-4.10, p = 0.761). CONCLUSION CT can be an invaluable diagnostic modality for rabbit LLT. Favourable outcomes can be achieved in selected cases with medical management alone.
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Affiliation(s)
- Joanne C Sheen
- Sydney Exotics & Rabbit Vets, North Shore Veterinary Specialist Centre, Artarmon, New South Wales, Australia
| | - David Vella
- Sydney Exotics & Rabbit Vets, North Shore Veterinary Specialist Centre, Artarmon, New South Wales, Australia
| | - Lily Hung
- Animalius, Bayswater, Western Australia, Australia
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Guo J, Hong Y, Wang Z, Li Y. Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors. Front Endocrinol (Lausanne) 2021; 12:656641. [PMID: 34177801 PMCID: PMC8220065 DOI: 10.3389/fendo.2021.656641] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A low concentration of plasma triiodothyronine (T3) indicates euthyroid sick syndrome (ESS), which could be associated with a poor outcome in patients in intensive care units (ICUs). This study evaluated the relationship between ESS and prognostic indicators in patients admitted to an ICU and examined the free T3 (FT3) cut-off points that could be associated with 28-day mortality. METHODS This prospective observational study included patients admitted to the ICU of The Third Hospital of Hebei Medical University between February and November 2018. Baseline variables and data on the occurrence of low FT3 were collected. The patients were divided into ESS (FT3 < 3.28 pmol/L) and non-ESS groups. The relationship between ESS and prognostic indicators in patients admitted to the ICU was evaluated, and the FT3 cut-off points that could be associated with 28-day mortality were examined. RESULTS Out of a total of 305 patients, 118 (38.7%) were in the ESS group. Levels of FT3 (P < 0.001) and FT4 (P = 0.001) were lower, while the 28-day mortality rate (P < 0.001) and hospitalization expenses in the ICU (P = 0.001) were higher in the ESS group. A univariable analysis identified ESS, FT3, free thyroxine (FT4)/FT3, the APACHE II score, the sequential organ failure (SOFA) score, the duration of mechanical ventilation, creatinine (CREA) levels, the oxygenation index (HGB), white blood cells, albumin (ALB) levels, age, and brain natriuretic peptide (BNP) levels as factors associated with 28-day mortality (all P < 0.05). The cut-off value of FT3 for 28-day mortality was 2.88 pmol/L, and the 28-day mortality rate and hospitalization expenses in the ICU were higher in patients with ESS. The syndrome was confirmed to be independently associated with 28-day mortality. CONCLUSION This study determined the incidence of ESS in the comprehensive ICU to be 38.7%. APACHE II, SOFA, BNP, APTT, HGB, PLT, CREA, ALB, FT4, SBP, and DBP are closely related to ESS, while BNP, PLT, and ALB are independent risk factors for the syndrome.
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Affiliation(s)
- Jianying Guo
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Critical Care Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Yukun Li, ; Jianying Guo,
| | - Yanyan Hong
- Department of School Infirmary, Infirmary of Shijiazhuang Institute of Technology, Shijiazhuang, China
| | - Zhiyong Wang
- Department of Critical Care Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yukun Li
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Yukun Li, ; Jianying Guo,
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Mota CMD, Borges GS, Amorim MR, Carolino ROG, Batalhão ME, Anselmo-Franci JA, Carnio EC, Branco LGS. Central serotonin prevents hypotension and hypothermia and reduces plasma and spleen cytokine levels during systemic inflammation. Brain Behav Immun 2019; 80:255-265. [PMID: 30885841 DOI: 10.1016/j.bbi.2019.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023] Open
Abstract
An exceptionally high mortality rate is observed in sepsis and septic shock. Systemic administration of lipopolysaccharide (LPS) has been used as an experimental model for sepsis resulting in an exacerbated immune response, brain neurochemistry adjustments, hypotension, and hypothermia followed by fever. Central serotonergic pathways not only modulate systemic inflammation (SI) but also are affected by SI, including in the anteroventral region of the hypothalamus (AVPO), which is the hierarchically most important region for body temperature (Tb) control. In this study, we sought to determine if central serotonin (5-HT) plays a role in SI induced by intravenous administration of LPS (1.5 mg/kg) in male Wistar rats (280-350 g) by assessing 5-HT levels in the AVPO, mean arterial pressure, heart rate, and Tb up to 300 min after LPS administration, as well as assessing plasma and spleen cytokine levels, nitric oxide (NO) plasma levels, and prostaglandin (PG) E2 levels in the AVPO at 75 min and 300 min after LPS administration. We observed reduced AVPO 5-HT levels, hypotension, tachycardia, hypothermia followed by fever, as well as observing increased plasma NO, plasma and spleen cytokines and AVPO PGE2 levels in SI. Intracerebroventricular (icv) administration of 5-HT 30 min before LPS administration prevented hypotension and hypothermia, which were accompanied by reduced plasma NO, as well as plasma TNF-α, IL-1β, IL-6, and IL-10 and spleen TNF-α and IL-10 levels. We suggest that SI reduced 5-HT levels in the AVPO favor an increased pro-inflammatory status both centrally and peripherally that converge to hypotension and hypothermia. Moreover, our results are consistent with the notion that exogenous 5-HT given icv prevents hypotension and hypothermia probably activating the splenic anti-inflammatory pathway.
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Affiliation(s)
- Clarissa M D Mota
- Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Gabriela S Borges
- Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Mateus R Amorim
- Department of Morphology, Physiology and Basic Pathology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ruither O G Carolino
- Department of Morphology, Physiology and Basic Pathology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcelo E Batalhão
- Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Janete A Anselmo-Franci
- Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Morphology, Physiology and Basic Pathology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Evelin C Carnio
- Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz G S Branco
- Department of Physiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Morphology, Physiology and Basic Pathology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Saramago EA, Borges GS, Singolani-Jr CG, Nogueira JE, Soriano RN, Cárnio EC, Branco LGS. Molecular hydrogen potentiates hypothermia and prevents hypotension and fever in LPS-induced systemic inflammation. Brain Behav Immun 2019; 75:119-128. [PMID: 30261305 DOI: 10.1016/j.bbi.2018.09.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022] Open
Abstract
Molecular hydrogen (H2) exerts anti-oxidative, anti-apoptotic, and anti-inflammatory effects. Here we tested the hypothesis that H2 modulates cardiovascular, inflammatory, and thermoregulatory changes in systemic inflammation (SI) induced by lipopolysaccharide (LPS) at different doses (0.1 or 1.5 mg/kg, intravenously, to induce mild or severe SI) in male Wistar rats (250-300 g). LPS or saline was injected immediately before the beginning of 360-minute inhalation of H2 (2% H2, 21% O2, balanced with nitrogen) or room air (21% O2, balanced with nitrogen). Deep body temperature (Tb) was measured by dataloggers pre-implanted in the peritoneal cavity. H2 caused no change in cardiovascular, inflammatory parameters, and Tb of control rats (treated with saline). During mild SI, H2 reduced plasma surges of proinflammatory cytokines (TNF-α and IL-6) while caused an increase in plasma IL-10 (anti-inflammatory cytokine) and prevented fever. During severe SI, H2 potentiated hypothermia, and prevented fever and hypotension, which coincided with reduced plasma nitric oxide (NO) production. Moreover, H2 caused a reduction in surges of proinflammatory cytokines (plasma TNF-α and IL-1β) and prostaglandin E2 [(PGE2), in plasma and hypothalamus], and an increase in plasma IL-10. These data are consistent with the notion that H2 blunts fever in mild SI, and during severe SI potentiates hypothermia, prevents hypotension reducing plasma NO production, and exerts anti-inflammatory effects strong enough to prevent fever by altering febrigenic signaling and ultimately down-modulating hypothalamic PGE2 production.
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Affiliation(s)
- Eduardo A Saramago
- Medical School of Ribeirão Preto, 14049-900, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela S Borges
- Medical School of Ribeirão Preto, 14049-900, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlitos G Singolani-Jr
- Medical School of Ribeirão Preto, 14049-900, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jonatas E Nogueira
- Medical School of Ribeirão Preto, 14049-900, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; School of Physical Education and Sports of Ribeirao Preto, 14030-680, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato N Soriano
- Division of Physiology and Biophysics, Department of Basic Life Sciences, 35010-177, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Evelin C Cárnio
- Nursing School of Ribeirão Preto, 14040-902, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz G S Branco
- Dental School of Ribeirão Preto, 14040-904, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Savo APH, Zheng Y, Zheng Y, Lewbart GA. Health status assessment of traumatic injury freshwater turtles. PLoS One 2018; 13:e0202194. [PMID: 30153271 PMCID: PMC6112633 DOI: 10.1371/journal.pone.0202194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/30/2018] [Indexed: 11/18/2022] Open
Abstract
A group of injured yellow-bellied sliders (Trachemys scripta) and river cooters (Pseudemys concinna) were evaluated for a variety of health values at presentation to the NC State Turtle Rescue Team and prior to release. An i-STAT Portable Clinical Analyzer and CG8+ cartridges were used to determine venous blood gas and biochemical values, the packed cell volume (PCV) and total protein were evaluated using hematocrit tubes and high speed centrifugation, and a differential WBC percentage was determined manually with Diff-Quick stained blood smear slides. Forty-six turtles were sampled on presentation and twenty-three of those were sampled again prior to release. Blood values were analyzed for significant differences between samples collected at presentation and prior to release, as well as differences between surviving and non-surviving turtles. Five variables were identified as significantly different between presenting and recuperated samples: pH, pCO2, Glu, % heterophils, and % eosinophils. When comparing samples between turtles that survived versus those that did not, two variables were identified as being significant prognostic indicators; lactate and PCV. Identification of these significant variables can aid in determining patient prognosis and triage therapy for injured aquatic turtles.
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Affiliation(s)
- Alison P. H. Savo
- North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, United States of America
| | - Yaxin Zheng
- North Carolina State University, Department of Statistics, Raleigh, North Carolina, United States of America
| | - Yuting Zheng
- North Carolina State University, Department of Statistics, Raleigh, North Carolina, United States of America
| | - Gregory A. Lewbart
- North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, United States of America
- * E-mail:
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