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Ricciotti E, Haines PG, Chai W, FitzGerald GA. Prostanoids in Cardiac and Vascular Remodeling. Arterioscler Thromb Vasc Biol 2024; 44:558-583. [PMID: 38269585 PMCID: PMC10922399 DOI: 10.1161/atvbaha.123.320045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
Prostanoids are biologically active lipids generated from arachidonic acid by the action of the COX (cyclooxygenase) isozymes. NSAIDs, which reduce the biosynthesis of prostanoids by inhibiting COX activity, are effective anti-inflammatory, antipyretic, and analgesic drugs. However, their use is limited by cardiovascular adverse effects, including myocardial infarction, stroke, hypertension, and heart failure. While it is well established that NSAIDs increase the risk of atherothrombotic events and hypertension by suppressing vasoprotective prostanoids, less is known about the link between NSAIDs and heart failure risk. Current evidence indicates that NSAIDs may increase the risk for heart failure by promoting adverse myocardial and vascular remodeling. Indeed, prostanoids play an important role in modulating structural and functional changes occurring in the myocardium and in the vasculature in response to physiological and pathological stimuli. This review will summarize current knowledge of the role of the different prostanoids in myocardial and vascular remodeling and explore how maladaptive remodeling can be counteracted by targeting specific prostanoids.
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Affiliation(s)
- Emanuela Ricciotti
- Department of Systems Pharmacology and Translational Therapeutics (E.R., G.A.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Institute for Translational Medicine and Therapeutics (E.R., G.A.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Philip G Haines
- Rhode Island Hospital, Department of Medicine, Warren Alpert Medical School of Brown University, Providence (P.G.H.)
| | - William Chai
- Health and Human Biology, Division of Biology and Medicine, Brown University, Providence, RI (W.C.)
| | - Garret A FitzGerald
- Department of Systems Pharmacology and Translational Therapeutics (E.R., G.A.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Institute for Translational Medicine and Therapeutics (E.R., G.A.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Medicine (G.A.F.), University of Pennsylvania Perelman School of Medicine, Philadelphia
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Benedetto M, Piccone G, Gottin L, Castelli A, Baiocchi M. Inhaled Pulmonary Vasodilators for the Treatment of Right Ventricular Failure in Cardio-Thoracic Surgery: Is One Better than the Others? J Clin Med 2024; 13:564. [PMID: 38256697 PMCID: PMC10816998 DOI: 10.3390/jcm13020564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Right ventricular failure (RFV) is a potential complication following cardio-thoracic surgery, with an incidence ranging from 0.1% to 30%. The increase in pulmonary vascular resistance (PVR) is one of the main triggers of perioperative RVF. Inhaled pulmonary vasodilators (IPVs) can reduce PVR and improve right ventricular function with minimal systemic effects. This narrative review aims to assess the efficacy of inhaled nitric oxide and inhaled prostacyclins for the treatment of perioperative RVF. The literature, although statistically limited, supports the clinical similarity between them. However, it failed to demonstrate a clear benefit from the pre-emptive use of inhaled nitric oxide in patients undergoing left ventricular assist device implantation or early administration during heart-lung transplants. Additional concerns are related to cost safety and IPV use in pathologies associated with pulmonary venous congestion. The largest ongoing randomized controlled trial on adults (INSPIRE-FLO) is addressing whether inhaled Epoprostenol and inhaled nitric oxide are similar in preventing RVF after heart transplants and left ventricular assist device placement, and whether they are similar in preventing primary graft dysfunction after lung transplants. The preliminary analysis supports their equivalence. Several key points may be achieved by the present narrative review. When RVF occurs in the setting of elevated PVR, IPV should be the preferred initial treatment and they should be preventively used in patients at high risk of postoperative RVF. If severe refractory postoperative RVF occurs, IPVs should be combined with complementary pharmacology (inotropes and inodilators). If unsuccessful, right ventricular mechanical support should be established.
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Affiliation(s)
- Maria Benedetto
- Cardio-Thoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (M.B.)
| | - Giulia Piccone
- Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy; (G.P.); (L.G.)
| | - Leonardo Gottin
- Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy; (G.P.); (L.G.)
| | - Andrea Castelli
- Cardio-Thoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (M.B.)
| | - Massimo Baiocchi
- Cardio-Thoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (M.B.)
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Lauro FV, Marcela RN, Maria LR, Francisco DC, Magdalena AR, Virginia MAM, Montserrat MG. Effect Produced by a Cyclooctyne Derivative on Both Infarct Area and Left Ventricular Pressure via Calcium Channel Activation. Drug Res (Stuttg) 2023; 73:105-112. [PMID: 36446591 DOI: 10.1055/a-1967-2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND There are reports which indicate that some cyclooctyne derivatives may exert changes in cardiovascular system; however, its molecular mechanism is not very clear. OBJECTIVE The aim of this study was to evaluate the biological activity of four cyclooctyne derivatives (compounds 1: to 4: ) produced on infarct area and left ventricular pressure. METHODS Biological activity produced by cyclooctyne derivatives on infarct area was determinate using an ischemia/reperfusion injury model. In addition, to characterize the molecular mechanism of this effect, the following strategies were carried out as follows; i) biological activity produced by cyclooctyne derivative (compound 4: ) on either perfusion pressure or left ventricular pressure was evaluated using an isolated rat heart; ii) theoretical interaction of cyclooctyne derivative with calcium channel (1t0j protein surface) using a docking model. RESULTS The results showed that cyclooctyne derivative (compound 4: ) decrease infarct area of in a dose-dependent manner compared with compound 1: to 3: . Besides, this cyclooctyne derivative increase both perfusion pressure and left ventricular pressure which was inhibited by nifedipine. Other theoretical data suggests that cyclooctyne derivative could interact with some aminoacid residues (Met83, Ile85, Ser86, Leu108, Glu114) involved in 1t0j protein surface. CONCLUSIONS All these data indicate that cyclooctyne derivative increase left ventricular pressure via calcium channel activation and this phenomenon could be translated as a decrease of infarct area.
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Affiliation(s)
- Figueroa-Valverde Lauro
- Laboratory of Pharmaco-Chemistry, Faculty of Chemical Biological Sciences, University Autonomous of Campeche, Av. Agustín Melgar s/n, Col Buenavista C.P. Campeche, Camp., México
| | - Rosas-Nexticapa Marcela
- Facultad de Nutrición, Universidad Veracruzana, Médicos y Odontologos s/n C.P. Unidad del Bosque Xalapa Veracruz, México
| | - López-Ramos Maria
- Laboratory of Pharmaco-Chemistry, Faculty of Chemical Biological Sciences, University Autonomous of Campeche, Av. Agustín Melgar s/n, Col Buenavista C.P. Campeche, Camp., México
| | - Díaz-Cedillo Francisco
- Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional. Prol. Carpio y Plan de Ayala s/n Col. Santo Tomas, México, D.F. C.P
| | - Alvarez-Ramirez Magdalena
- Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional. Prol. Carpio y Plan de Ayala s/n Col. Santo Tomas, México, D.F. C.P
| | - Mateu-Armad Maria Virginia
- Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional. Prol. Carpio y Plan de Ayala s/n Col. Santo Tomas, México, D.F. C.P
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Wu C, Cheng J, Huang C, Chen Z, Chen S, Lin L. Iloprost and exercise haemodynamics in heart failure with preserved ejection fraction—the ILO‐HOPE randomised controlled trial. Br J Clin Pharmacol 2021. [DOI: 10.1111/bcp.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Cho‐Kai Wu
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan
| | - Jen‐Fang Cheng
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan
- Division of Cardiology, Department of Internal Medicine Pingtung Hospital, Ministry of Health and Welfare Pingtung Taiwan
- Graduate Institute of Clinical Medicine National Taiwan University College of Medicine and National Taiwan University Hospital Taipei Taiwan
| | - Chen‐Yu Huang
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan
- Division of Cardiology, Department of Internal Medicine Kinmen Hospital, Ministry of Health and Welfare Kinmen Taiwan
| | - Zheng‐Wei Chen
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital, Yun‐Lin Branch Dou‐Liu Taiwan
| | - Ssu‐Yuan Chen
- Department of Physical Medicine & Rehabilitation Fu Jen Catholic University Hospital and Fu Jen Catholic University School of Medicine New Taipei City Taiwan
- Department of Physical Medicine & Rehabilitation National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Lian‐Yu Lin
- Division of Cardiology, Department of Internal Medicine National Taiwan University College of Medicine and Hospital Taipei Taiwan
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Kim N, Lee SH, Joe Y, Kim T, Shin H, Oh YJ. Effects of Inhaled Iloprost on Lung Mechanics and Myocardial Function During One-Lung Ventilation in Chronic Obstructive Pulmonary Disease Patients Combined With Poor Lung Oxygenation. Anesth Analg 2020; 130:1407-1414. [PMID: 32167976 DOI: 10.1213/ane.0000000000004733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The ventilation/perfusion mismatch in chronic obstructive pulmonary disease (COPD) patients can exacerbate cardiac function as well as pulmonary oxygenation. We hypothesized that inhaled iloprost can ameliorate pulmonary oxygenation with lung mechanics and myocardial function during one-lung ventilation (OLV) in COPD patients combined with poor lung oxygenation. METHODS A total of 40 patients with moderate to severe COPD, who exhibited the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FIO2) <150 mm Hg 30 minutes after initiating OLV, were enrolled in this study. Patients were randomly allocated into either ILO group (n = 20) or Control group (n = 20), in which iloprost (20 μg) and saline were inhaled, respectively. The PaO2/FIO2 ratio, dead space, dynamic compliance, and tissue Doppler imaging with myocardial performance index (MPI) were assessed 30 minutes after initiating OLV (pre-Tx) and 30 minutes after completion of drug inhalation (post-Tx). Repeated variables were analyzed using a linear mixed-model between the groups. RESULTS At pre-Tx, no differences were observed in measured parameters between the groups. At post-Tx, PaO2/FIO2 ratio (P < .001) and dynamic compliance (P = .023) were significantly higher and dead space ventilation was significantly lower (P = .001) in iloprost group (ILO group) compared to Control group. Left (P = .003) and right ventricular MPIs (P < .001) significantly decreased in ILO group compared to Control group. CONCLUSIONS Inhaled iloprost improved pulmonary oxygenation, lung mechanics, and cardiac function simultaneously during OLV in COPD patients with poor lung oxygenation.
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Affiliation(s)
- Namo Kim
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Hyun Lee
- Department of Anesthesiology and Pain Medicine, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Youngeun Joe
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taelim Kim
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heesoo Shin
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jun Oh
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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HUANG CHENYU, LEE JENKUANG, CHEN ZHENGWEI, CHENG JENFANG, CHEN SSUYUAN, LIN LIANYU, WU CHOKAI. Inhaled Prostacyclin on Exercise Echocardiographic Cardiac Function in Preserved Ejection Fraction Heart Failure. Med Sci Sports Exerc 2020; 52:269-277. [DOI: 10.1249/mss.0000000000002145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Karaman S, Ozkan B, Yazir Y, Yardimoglu M, Gok M, Kara O, Vural C, Rencber S, Emek SK. Comparison of hyperbaric oxygen versus iloprost treatment in an experimental rat central retinal artery occlusion model. Graefes Arch Clin Exp Ophthalmol 2016; 254:2209-2215. [PMID: 27480178 DOI: 10.1007/s00417-016-3444-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Central retinal artery occlusion (CRAO) is one of the serious ophthalmological emergencies with poor visual prognosis. Iloprost is a stable prostacyclin analogue and has prominent anti-edema, anti-inflammatory, vasodilatory, and antiagregant effects. The main objective of this work was to investigate iloprost as an alternative agent versus hyperbaric oxygen (HBO) in the treatment of CRAO. METHODS Twenty-eight healthy Wistar albino male rats were randomly assigned into control (n = 7, sham operation), HBO (n = 7), iloprost (n = 7), and sham groups (n = 7). CRAO model was created through optic nerve exploration and ligation. Full-thickness retina (FTR), outer nuclear layer (ONL), inner nuclear layer (INL) and ganglion cell layer (GCL) thickness were measured on Hematoxylin/Eosin (H&E) stained retinal sections and immunohistochemical analysis including terminal deoxynucleotidyl transferase-mediated biotindeoxyuridine triphosphate nick-end labeling (TUNEL) assay was performed to determine the apoptotic index (AI). RESULTS AI values of HBO (0.204 ± 0.067) and iloprost (0.197 ± 0.052) groups were significantly lower than sham (0.487 ± 0.046) group (p < 0.001). Any significant difference was found between the HBO and iloprost groups in terms of AI (p = 0.514). A statistically significant increase in thickness of FTR, ONL, INL and GCL was detected in HBO, iloprost and sham groups compared to the control group (p = 0.002). FTR, ONL, INL and GCL thickness were significantly thinner in HBO and iloprost groups than in the sham group (p = 0.002). A significant lesser increase was observed in all the retinal layers thickness in iloprost group versus HBO group (p = 0.002) except for INL (p = 0.665). CONCLUSIONS The study results demonstrated anti-edema, neuroprotective, and anti-apoptotic effects of iloprost quantitatively; thus, iloprost may be a beneficial alternative agent in the treatment of CRAO.
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Affiliation(s)
| | - Berna Ozkan
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Yusufhan Yazir
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Melda Yardimoglu
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Gok
- Department of Ophthalmology, Ministry of Health, Ordu University Research and Training Hospital, Ordu, 52200, Turkey.
| | - Ozgur Kara
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Cigdem Vural
- Department of Pathology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Selenay Rencber
- Department of Histology and Embryology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Salih K Emek
- Oksimed Hyperbaric Oxygen Clinic, Kocaeli, Turkey
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The use of a prostacyclin analog, iloprost, as an adjunct to uterus preservation with histidine-tryptophan-ketoglutarate solution. Transplant Proc 2011; 43:1998-2003. [PMID: 21693315 DOI: 10.1016/j.transproceed.2011.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/21/2011] [Accepted: 04/07/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although assisted reproductive techniques have made most causes of both male and female infertility treatable, uterine factor infertility is not able to therapy. Therefore, transplantation of the uterus has been suggested as a future possible cure. Organ preservation solutions seek to reduce reperfusion injury. Since iloprost is an antioxidant with cytoprotective properties, we investigated its potential positive effects in histidine-tryptophan-ketoglutarate (HTK) solution after 4 or 24 h cold storage period of the rat uterus. METHODS We divided 24 female Wistar-albino rats into four groups: Group 1 had the uterus tissue stored in HTK solution at 4 °C for 4h. Group 2, the tissue was stored in HTK solution combined with iloprost (10(-8) M) for 4h at 4 °C. The same procedures were repeated for 24 h for Groups 3 and 4 respectively. Tissue levels of malondialdehyde (MDA) and nitric oxide (NO), as indicators of oxidative stress were determined with histopathological evaluations. RESULTS MDA and NO levels were compared between the group 1 vs 3; and 2 vs 4. No significant difference was observed between the groups. Cold storage for 24 h produced alterations in histological appearances that were mitigated by the addition of iloprost to HTK solution. CONCLUSION In conclusion, addition of iloprost to HTK solution reversed the histological alterations after 24h-cold storage of the rat uterus.
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Harding P, Murray DB. The contribution of prostaglandins versus prostacyclin in ventricular remodeling during heart failure. Life Sci 2011; 89:671-6. [PMID: 21855554 DOI: 10.1016/j.lfs.2011.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 12/20/2022]
Abstract
Although the role of Cox-2 in the heart's response to physiologic stress remains controversial (i.e. expression in myocytes versus other resident myocardial cells) the ever expanding role of prostanoids in multiple models of heart failure cannot be denied. Due to the fact that prostanoids are metabolized rather quickly (half life of seconds to minutes) it is believed these signaling mediators act in a paracrine fashion at the site of production. Evidence to date is quite convincing that these bioactive lipid derivatives are involved in physiologic homeostatic regulation as well as beneficial and maladaptive ventricular remodeling in heart failure. Thus, this review will assess the direct contribution of each PG on remodeling in the left ventricle (e.g. hypertrophy, functional effects, and fibrosis).
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Affiliation(s)
- Pamela Harding
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
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The effects of iloprost, a prostacyclin analogue, in experimental ischaemia/reperfusion injury in rat ovaries. ACTA ACUST UNITED AC 2009; 61:519-27. [DOI: 10.1016/j.etp.2009.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/08/2009] [Accepted: 06/22/2009] [Indexed: 11/18/2022]
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Dedeoglu BD, Aytac E, Suzer O, Balci H, Uzun H, Seymen P, Seymen HO. Donor heart preservation with iloprost supplemented St. Thomas Hospital cardioplegic solution in isolated rat hearts. Prostaglandins Leukot Essent Fatty Acids 2008; 78:415-21. [PMID: 18583122 DOI: 10.1016/j.plefa.2008.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 09/04/2007] [Accepted: 05/15/2008] [Indexed: 11/23/2022]
Abstract
This study was designed to assess the influence of St. Thomas Hospital cardioplegic solution (St. Th.) on heart preservation in rat hearts subjected to 6h ischemia when supplemented with iloprost. In the control group (n=8), nothing was added to St. Th., whereas 10 or 1000 nmol L(-1) iloprost was added in the second (n=7) and third (n=8) groups, respectively. Mechanical contraction parameters, cardiac tissue damage and oxidative stress markers were evaluated. The 10 nmol/L iloprost group peak systolic pressure (71.0+/-30.9 versus 41.0+/-9.4 mm Hg) and -dp/dtmax (1103.8+/-94.3 versus 678.6+/-156.8 mm Hg s(-1)) were significantly higher than control group at 30 min of reperfusion (p<0.05). Iloprost supplemented groups had higher GSH and catalase levels of coronary perfusate at reperfusion, in comparison with initial values (p<0.05). AST, CK, CK-MB values increased at 0 min of reperfusion and cTnI values at 45 min of reperfusion (p<0.05) in all groups with no difference between groups. According to our results, iloprost supplementation had mild but significant improvement in postischemic values in mechanical and oxidative stress parameters, resulting in better heart preservation.
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Winterhalter M, Simon A, Fischer S, Rahe-Meyer N, Chamtzidou N, Hecker H, Zuk J, Piepenbrock S, Strüber M. Comparison of Inhaled Iloprost and Nitric Oxide in Patients With Pulmonary Hypertension During Weaning From Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial. J Cardiothorac Vasc Anesth 2008; 22:406-13. [PMID: 18503929 DOI: 10.1053/j.jvca.2007.10.015] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Indexed: 02/02/2023]
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Rex S, Missant C, Segers P, Rossaint R, Wouters PF. Epoprostenol treatment of acute pulmonary hypertension is associated with a paradoxical decrease in right ventricular contractility. Intensive Care Med 2007; 34:179-89. [PMID: 17710383 DOI: 10.1007/s00134-007-0831-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Prostacyclins have been suggested to exert positive inotropic effects which would render them particularly suitable for the treatment of right ventricular (RV) dysfunction due to acute pulmonary hypertension (PHT). Data on this subject are controversial, however, and vary with the experimental conditions. We studied the inotropic effects of epoprostenol at clinically recommended doses in an experimental model of acute PHT. DESIGN AND SETTING Prospective laboratory investigation in a university hospital laboratory. SUBJECTS Six pigs (36 +/- 7kg). INTERVENTIONS Pigs were instrumented with biventricular conductance catheters, a pulmonary artery (PA) flow probe, and a high-fidelity pulmonary pressure catheter. Incremental doses of epoprostenol (10, 15, 20, 30, 40ng kg(-1) min(-1)) were administered in undiseased animals and after induction of acute hypoxia-induced PHT. MEASUREMENTS AND RESULTS In acute PHT epoprostenol markedly reduced RV afterload (slopes of pressure-flow relationship in the PA from 7.0 +/- 0.6 to 4.2 +/- 0.7mmHg minl(-1)). This was associated with a paradoxical and dose-dependent decrease in RV contractility (slope of preload-recruitable stroke-work relationship from 3.0 +/- 0.4 to 1.6 +/- 0.2 mW s ml(-1); slope of endsystolic pressure-volume relationship from 1.5 +/- 0.3 to 0.7 +/- 0.3mmHg ml(-1)). Left ventricular contractility was reduced only at the highest dose. In undiseased animals epoprostenol did not affect vascular tone and produced a mild biventricular decrease in contractility. CONCLUSIONS Epoprostenol has no positive inotropic effects in vivo. In contrast, epoprostenol-induced pulmonary vasodilation in animals with acute PHT was associated with a paradoxical decrease in RV contractility. This effect is probably caused indirectly by the close coupling of RV contractility to RV afterload. However, data from normal animals suggest that mechanisms unrelated to vasodilation are also involved in the observed negative inotropic response to epoprostenol.
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Affiliation(s)
- Steffen Rex
- Section Centre for Experimental Anesthesiology, Emergency and Intensive Care Medicine, Department of Acute Medical Sciences, Katholieke Universiteit Leuven, Minderbroederstraat 19 - bus 7003, 3000 Leuven, Belgium
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Boga M, Discigil B, Ozkisacik EA, Gurcun U, Badak MI, Dikicioglu E, Yenisey C, Meteoglu I. The combined effect of iloprost and N-acetylcysteine in preventing spinal cord ischemia in rabbits. Eur J Vasc Endovasc Surg 2005; 31:366-72. [PMID: 16359890 DOI: 10.1016/j.ejvs.2005.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 10/14/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study investigated the cytoprotective effects of N-acetylcysteine (NAC) and iloprost on spinal cord ischemia in an experimental model. MATERIALS AND METHODS Thirty-five (male) New Zealand white rabbits were included in five study groups (n=7, each group). One group served as Sham. Rabbits in other groups had their abdominal aorta cross-clamped just above the iliac bifurcation for 40 min. During aortic cross clamping, iloprost, NAC, both iloprost and NAC or saline (control) were infused. RESULTS In NAC, iloprost, and iloprost+NAC groups, neurological status of rabbits (Tarlov score) 24 and 48 h after the operation was better than the control group (p<0.01), but worse than the Sham group (p<0.01). There was minimal neuronal damage in the iloprost treated groups compared to the NAC group (p<0.05). Mean viability index values in NAC, iloprost and iloprost+NAC groups were higher than the control group (p<0.01). Viability index in the NAC group was lower than the iloprost and iloprost+NAC groups. CONCLUSIONS The use of iloprost and NAC may provide better protection from spinal cord ischemia.
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Affiliation(s)
- M Boga
- Department of Cardiovascular Surgery, Medical Faculty, Adnan Menderes University, 09100 Aydin, Turkey.
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