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Kim JS, Ryoo SM, Kim YJ, Sohn CH, Ahn S, Seo DW, Hong SI, Kim SM, Chae B, Kim WY. Augmented-Medication CardioPulmonary Resuscitation Trials in out-of-hospital cardiac arrest: a pilot randomized controlled trial. Crit Care 2022; 26:378. [PMID: 36476543 PMCID: PMC9727995 DOI: 10.1186/s13054-022-04248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previously conducted physician-centered trials on the usefulness of vasopressin have yielded negative results; thus, patient-oriented trials have been warranted. We hypothesize that Augmented-Medication CardioPulmonary Resuscitation could be helpful for selected patients with out-of-hospital cardiac arrest (OHCA). METHODS This is a double-blind, single-center, randomized, placebo-controlled trial conducted in the emergency department in a tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adults with non-traumatic OHCA who had initial diastolic blood pressure (DBP) < 20 mm Hg via invasive arterial monitoring during the early cardiac compression period were randomly assigned to two groups. Patients received a dose of 40 IU of vasopressin or placebo with initial epinephrine. The primary endpoint was a sustained return of spontaneous circulation. Secondary endpoints were survival discharge, and neurologic outcomes at discharge. RESULTS Of the 180 included patients, 32 were excluded, and 148 were enrolled in the trial. A sustained return of spontaneous circulation was achieved by 27 patients (36.5%) in the vasopressin group and 24 patients (32.4%) in the control group (risk difference, 4.1%; P = .60). Survival discharge and good neurologic outcomes did not differ between groups. The trial group had significantly higher median DBPs during resuscitation than the control group (16.0 vs. 14.5 mm Hg, P < 0.01). There was no difference in end-tidal carbon dioxide, acidosis, and lactate levels at baseline, 10 min, and end-time. CONCLUSION Among patients with refractory vasodilatory shock in OHCA, administration of vasopressin, compared with placebo, did not significantly increase the likelihood of return of spontaneous circulation.
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Affiliation(s)
- June-sung Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Seung Mok Ryoo
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Youn-Jung Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Chang Hwan Sohn
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Shin Ahn
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Dong Woo Seo
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Seok In Hong
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Sang-Min Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Bora Chae
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
| | - Won Young Kim
- grid.413967.e0000 0001 0842 2126Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro-43-Gil, Songpa-gu, Seoul, 138-736 Republic of Korea
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Zhang Y, Zhang X, Cao Z, Huang Y, Zheng Y, Yang X. Endothelial cell-derived SSAO can increase MLC 20 phosphorylation in VSMCs. Open Life Sci 2021; 16:1141-1150. [PMID: 34722886 PMCID: PMC8542650 DOI: 10.1515/biol-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
Vascular hyporesponsiveness in the shock decompensation period is an important factor leading to death. Myosin light chain 20 (MLC20) is the main effector protein that regulates vascular reactivity. However, whether the change in semicarbazide-sensitive amine oxidase (SSAO) expression during hypoxia can change the MLC20 phosphorylation level, and its underlying mechanism were not clear. The amine oxidase copper containing 3 (AOC3) overexpressing adenovirus vector was constructed and transfected into rat intestinal microvascular endothelial cells (RIMECs) to overexpress SSAO, and the RIMECs were co-cultured with rat intestinal microvascular smooth muscle cells (RIMSCs). The changes in SSAO/inducible nitric oxide synthase (iNOS)/Rho associate coiled-coil containing protein kinase 1 (ROCK1) expression levels and MLC20 phosphorylation level were detected. Here we found that the increased SSAO by AOC3 overexpression can decrease the iNOS expression level and its activity after hypoxia. In addition, RIMSCs co-cultured with RIMECs overexpressed with AOC3 gene had significantly higher ROCK1 protein level and MLC20 phosphorylation level than RIMSCs co-cultured with normal RIMECs. Our study demonstrated that SSAO overexpression can significantly inhibit iNOS activity, promote RhoA/ROCK pathway activation, and increase the phosphorylation level of MLC20, which might be the potential mechanism in relieving the vascular hyporesponsiveness during shock decompensation.
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Affiliation(s)
- Yuxing Zhang
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
| | - Xiliang Zhang
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
| | - Zhen Cao
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
| | - Yun Huang
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
| | - Yuexin Zheng
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
| | - Xiaodong Yang
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, People's Republic of China
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Wang C, Du HB, Zhao ZA, Zhai JY, Zhang LM, Niu CY, Zhao ZG. Autophagy Is Involved in Stellate Ganglion Block Reversing Posthemorrhagic Shock Mesenteric Lymph-Mediated Vascular Hyporeactivity. Front Physiol 2021; 12:728191. [PMID: 34621184 PMCID: PMC8491623 DOI: 10.3389/fphys.2021.728191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/23/2021] [Indexed: 12/05/2022] Open
Abstract
Objective: The aim of this study was to clarify the role of autophagy in stellate ganglion block (SGB) reversing posthemorrhagic shock mesenteric lymph (PHSML)-mediated vascular hyporeactivity. Methods: Hemorrhagic shock model in conscious rats was employed to observe the effects of SGB (0.2 ml of 0.25% ropivacaine hydrochloride hydrate) and autophagy inhibitor 3-methyladenine (3-MA; 30 mg/kg) on the vascular reactivity of second-order rat mesenteric arteries in vitro, while the effects of PHSML (1 ml/kg) and autophagy agonist rapamycin (Rapa, 10 mg/kg) on the beneficial effect of SGB were investigated. The cellular viability, contractility, and autophagy-related protein expressions in vascular smooth muscle cells (VSMCs) were detected following treatments of PHSML, PHSML obtained from the rats that underwent hemorrhagic shock plus SGB (PHSML-SGB), and PHSML plus 3-MA (5 mM), respectively. Results: Hemorrhagic shock significantly decreased the vascular reactivity to gradient norepinephrine (NE), which is reversed by the SGB treatment and 3-MA administration. On the contrary, PHSML intravenous infusion and Rapa administration inhibited the vascular contractile responses in rats that underwent hemorrhagic shock plus SGB treatment. PHSML treatment significantly inhibited the cellular viability and contractility in VSMCs, increased the expressions of LC3-II and Beclin 1, and decreased the expression of p62, along with opposite appearances in these indices following PHSML-SGB treatment. In addition, 3-MA counteracted the adverse roles of PHSML in these indices in VSMCs. Conclusion: SGB inhibits PHSML-mediated vascular hyporeactivity by reducing the excessive autophagy in VSMCs.
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Affiliation(s)
- Chen Wang
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China
| | - Hui-Bo Du
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China
| | - Zhen-Ao Zhao
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China.,Pathophysiology Experimental Teaching Center of Basic Medical College, Hebei North University, Zhangjiakou, China.,Key Laboratory of Critical Disease Mechanism and Intervention in Hebei, Hebei Medical University & Hebei North University, Shijiazhuang & Zhangjiakou, China
| | - Jia-Yi Zhai
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China
| | - Li-Min Zhang
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China.,Pathophysiology Experimental Teaching Center of Basic Medical College, Hebei North University, Zhangjiakou, China.,Key Laboratory of Critical Disease Mechanism and Intervention in Hebei, Hebei Medical University & Hebei North University, Shijiazhuang & Zhangjiakou, China
| | - Chun-Yu Niu
- Key Laboratory of Critical Disease Mechanism and Intervention in Hebei, Hebei Medical University & Hebei North University, Shijiazhuang & Zhangjiakou, China.,Basic Medical College, Hebei Medical University, Shijiazhuang, China
| | - Zi-Gang Zhao
- Institute of Microcirculation, Hebei North University, Zhangjiakou, China.,Pathophysiology Experimental Teaching Center of Basic Medical College, Hebei North University, Zhangjiakou, China.,Key Laboratory of Critical Disease Mechanism and Intervention in Hebei, Hebei Medical University & Hebei North University, Shijiazhuang & Zhangjiakou, China
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Estrogen Enhances The Microvascular Reactivity Through Rhoa-Rock Pathway In Female Mice During Hemorrhagic Shock. Shock 2021; 56:611-620. [PMID: 33756501 DOI: 10.1097/shk.0000000000001776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT Vascular hypo-reactivity plays a critical role inducing organ injury during hemorrhagic shock. 17β-estradiol (E2) can induce vasodilation to increase blood flow in various vascular beds. This study observed whether E2 can restore vascular hypo-reactivity induced by hemorrhagic shock, and whether E2 effects are associated with RhoA - Rho kinase (ROCK)- myosin light chain kinase phosphatase (MLCP) pathway. The hemorrhagic shock model (40 ± 2 mmHg for 1 h, resuscitation for 4 h) was established in ovary intact sham operation (OVI), ovariectomized (OVX) and OVX plus E2 supplement female mice. Intestinal microvascular loop was used to assess blood flow in vivo, mRNA expression and vascular reactivity in vitro. Hemorrhagic shock significantly reduced norepinephrine microvascular reactivity. Decreased microvascular reactivity was exacerbated by OVX and reversed by E2 supplement. U-46619 (RhoA agonist) increased microvascular reactivity, and C3 transferase (an ADP ribosyl transferase that selectively induces RhoA ribosylation) or Y-27632 (ROCK inhibitor) inhibited sham mice microvascular reactivity. Similarly, U-46619 increased microvascular reactivity in OVI and OVX mice following hemorrhagic shock, which was abolished by Y-27632 or concomitant incubation of okadaic acid (OA) (MLCP inhibitor) and Y-27632. In OVX plus E2 supplement mice with hemorrhagic shock, Y-27632 inhibited microvascular reactivity, which was abolished by concomitant U-46619 application. Lastly, hemorrhagic shock remarkably decreased intestinal loop blood flow, RhoA and ROCK mRNA expressions in vascular tissues in OVX females, but not in OVI females, which were reversed by E2 supplement. These results indicate that estrogen improves microvascular reactivity during hemorrhagic shock, and RhoA-ROCK signaling pathway may mediate E2 effects.
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Hariharan A, Weir N, Robertson C, He L, Betsholtz C, Longden TA. The Ion Channel and GPCR Toolkit of Brain Capillary Pericytes. Front Cell Neurosci 2020; 14:601324. [PMID: 33390906 PMCID: PMC7775489 DOI: 10.3389/fncel.2020.601324] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
Abstract
Brain pericytes reside on the abluminal surface of capillaries, and their processes cover ~90% of the length of the capillary bed. These cells were first described almost 150 years ago (Eberth, 1871; Rouget, 1873) and have been the subject of intense experimental scrutiny in recent years, but their physiological roles remain uncertain and little is known of the complement of signaling elements that they employ to carry out their functions. In this review, we synthesize functional data with single-cell RNAseq screens to explore the ion channel and G protein-coupled receptor (GPCR) toolkit of mesh and thin-strand pericytes of the brain, with the aim of providing a framework for deeper explorations of the molecular mechanisms that govern pericyte physiology. We argue that their complement of channels and receptors ideally positions capillary pericytes to play a central role in adapting blood flow to meet the challenge of satisfying neuronal energy requirements from deep within the capillary bed, by enabling dynamic regulation of their membrane potential to influence the electrical output of the cell. In particular, we outline how genetic and functional evidence suggest an important role for Gs-coupled GPCRs and ATP-sensitive potassium (KATP) channels in this context. We put forth a predictive model for long-range hyperpolarizing electrical signaling from pericytes to upstream arterioles, and detail the TRP and Ca2+ channels and Gq, Gi/o, and G12/13 signaling processes that counterbalance this. We underscore critical questions that need to be addressed to further advance our understanding of the signaling topology of capillary pericytes, and how this contributes to their physiological roles and their dysfunction in disease.
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Affiliation(s)
- Ashwini Hariharan
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Nick Weir
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Colin Robertson
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Liqun He
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Christer Betsholtz
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Medicine Huddinge (MedH), Karolinska Institutet & Integrated Cardio Metabolic Centre, Huddinge, Sweden
| | - Thomas A Longden
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, MD, United States
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Gao Q, Li H, Ding H, Fan X, Xu T, Tang J, Liu Y, Chen X, Zhou X, Tao J, Xu Z. Hyper-methylation of AVPR1A and PKCΒ gene associated with insensitivity to arginine vasopressin in human pre-eclamptic placental vasculature. EBioMedicine 2019; 44:574-581. [PMID: 31175056 PMCID: PMC6606951 DOI: 10.1016/j.ebiom.2019.05.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 01/12/2023] Open
Abstract
Background Pre-eclampsia is a leading cause of maternal mortality and morbidity. Although the exact mechanisms that cause pre-eclampsia remain unclear, it is undeniable that abnormal placental function and circulation are a center for initiation pre-eclampsia. As a potent vasoconstrictor, arginine vasopressin (AVP) has long been implicated in controlling placental vascular tone and circulation; its secretion is grossly elevated in pre-eclamptic circulation. However, little is known about the reactivity of AVP in pre-eclamptic placental vasculature. Methods To reveal the special features of placental vascular regulations with placental pathophysiological changes, as well as the corresponding molecular mechanisms under pre-eclamptic conditions, vascular function and molecular assays were conducted with placental vessel samples from normal and pre-eclamptic pregnancies. Findings The present study found that vasoconstriction responses of placental vessels to AVP were attenuated in pre-eclampsia as compared to in normal pregnancy. The insensitivity of AVP was correlated with the down-regulated AVP receptor 1a (AVPR1A, AVPR1A gene) and protein kinase C isoform β (PKCβ, PKCΒ gene), particularly the hyper-methylation-mediated AVPR1A and PKCΒ gene down-regulation, respectively. Interpretation The findings collectively revealed that aberrant DNA methylation-mediated gene expressions are correlated with vascular dysfunction in pre-eclamptic placental circulation. Fund This work was supported by National Nature & Science Foundation of China. “333 Project”, “Six one project”, “Shuang Chuang Tuan Dui” and Key Discipline “Fetal medicine” of Jiangsu Province, and the Suzhou city “Wei Sheng Ren Cai” program.
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Affiliation(s)
- Qinqin Gao
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China.
| | - Huan Li
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Hongmei Ding
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Xiaorong Fan
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Ting Xu
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Jiaqi Tang
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Yanping Liu
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Xueyi Chen
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Xiuwen Zhou
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China
| | - Jianying Tao
- Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Suzhou, China.
| | - Zhice Xu
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, China.
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Gao Q, Fan X, Xu T, Li H, He Y, Yang Y, Chen J, Ding H, Tao J, Xu Z. Promoter methylation changes and vascular dysfunction in pre-eclamptic umbilical vein. Clin Epigenetics 2019; 11:84. [PMID: 31138298 PMCID: PMC6537217 DOI: 10.1186/s13148-019-0685-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/15/2019] [Indexed: 01/03/2023] Open
Abstract
Background Hypertension is one of primary clinical presentations of pre-eclampsia. The occurrence and progress of hypertension are closely related to vascular dysfunction. However, information is limited regarding the pathological changes of vascular functions in pre-eclamptic fetuses. Human umbilical cord vein was used to investigate the influence of pre-eclampsia on fetal blood vessels in this study. Results The present study found that the vasoconstriction responses to arginine vasopressin (AVP) and oxytocin (OXT) were attenuated in the pre-eclamptic umbilical vein as compared to in normal pregnancy, which was related to the downregulated AVP receptor 1a (AVPR1a), OXT receptor (OXTR), and protein kinase C isoform β (PKCβ), owing to the deactivated gene transcription, respectively. The deactivated AVPR1a, OXTR, and PKCB gene transcription were respectively linked with an increased DNA methylation within the gene promoter. Conclusions To the best of our knowledge, this study first revealed that a hyper-methylation in gene promoter, leading to relatively reduced patterns of AVPR1a, OXTR, and PKCB expressions, which was responsible for the decreased sensitivity to AVP and OXT in the umbilical vein under conditions of pre-eclampsia. The data offered new and important information for further understanding the pathological features caused by pre-eclampsia in the fetal vascular system, as well as roles of epigenetic-mediated gene expression in umbilical vascular dysfunction.
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Affiliation(s)
- Qinqin Gao
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China.
| | - Xiaorong Fan
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Ting Xu
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Huan Li
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Yun He
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Yuxian Yang
- Department of Obstetrics and Gynecology, Affiliated Suzhou Hospital of Nanjing University of Chinese Medicine, Suzhou, China
| | - Jie Chen
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Hongmei Ding
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China
| | - Jianying Tao
- Department of Obstetrics and Gynecology, Suzhou Municipal Hospital, Suzhou, China
| | - Zhice Xu
- Institute for Fetology and Department of Obstetrics and Gynecology, First Hospital of Soochow University, Suzhou, 215006, China. .,Center for Perinatal Biology, Loma Linda University, California, USA.
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Xu J, Yang G, Li T, Liu L. Myoendothelial gap junctions mediate regulation of angiopoietin-2-induced vascular hyporeactivity after hypoxia through connexin 43-gated cAMP transfer. Am J Physiol Cell Physiol 2017. [PMID: 28637680 DOI: 10.1152/ajpcell.00369.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Angiopoietin-2 (Ang-2) contributes to vascular hyporeactivity after hemorrhagic shock and hypoxia through upregulation of inducible nitric oxide synthase (iNOS) in a vascular endothelial cell (VEC)-specific and Ang-2/Tie2 receptor-dependent manner. While iNOS is primarily expressed in vascular smooth muscle cells (VSMCs), the mechanisms of signal transfer from VECs to VSMCs are unknown. A double-sided coculture model with VECs and VSMCs from Sprague-Dawley rats was used to investigate the role of myoendothelial gap junctions (MEGJs), the connexin (Cx) isoforms involved, and other relevant mechanisms. After hypoxia, VSMCs treated with exogenous Ang-2 showed increased iNOS expression and hyporeactivity, as well as MEGJ formation and communication. These Ang-2 effects were suppressed by the MEGJ inhibitor 18α-glycyrrhetic acid (18-GA), Tie2 siRNA, or Cx43 siRNA. Reagents antagonizing cAMP or protein kinase A (PKA) in VECs inhibited Cx43 expression in MEGJs, decreasing MEGJ formation and associated communication, after hypoxia following Ang-2 treatment. The increased cAMP levels in VSMCs and transfer of Alexa Fluor 488-labeled cAMP from VECs to VSMCs, after hypoxia following Ang-2 treatment, was antagonized by Cx43 siRNA. A cAMP antagonist added to VECs or VSMCs inhibited both increased iNOS expression and hyporeactivity in VSMCs subjected to hypoxia following Ang-2 treatment. Based on these findings, we propose that Cx43 was the Cx isoform involved in MEGJ-mediated VEC-dependent regulation of Ang-2, which induces iNOS protein expression and vascular hyporeactivity after hypoxia. Cx43 was upregulated by cAMP and PKA, permitting cAMP transfer between cells.
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Affiliation(s)
- Jing Xu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Guangming Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Liangming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
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Xiao X, Zhang J, Wang Y, Zhou J, Zhu Y, Jiang D, Liu L, Li T. Effects of terlipressin on patients with sepsis via improving tissue blood flow. J Surg Res 2016; 200:274-82. [DOI: 10.1016/j.jss.2015.07.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/24/2015] [Accepted: 07/08/2015] [Indexed: 12/14/2022]
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10
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Wasilewski MA, Myers VD, Recchia FA, Feldman AM, Tilley DG. Arginine vasopressin receptor signaling and functional outcomes in heart failure. Cell Signal 2015; 28:224-233. [PMID: 26232615 DOI: 10.1016/j.cellsig.2015.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/27/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Melissa A Wasilewski
- Center for Translational Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Valerie D Myers
- Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, PA, USA
| | - Fabio A Recchia
- Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, PA, USA
| | - Arthur M Feldman
- Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, PA, USA
| | - Douglas G Tilley
- Center for Translational Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
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11
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Liu S, Li T, Yang G, Hu Y, Xiao X, Xu J, Zhang J, Liu L. Protein markers related to vascular responsiveness after hemorrhagic shock in rats. J Surg Res 2015; 196:149-58. [PMID: 25801977 DOI: 10.1016/j.jss.2015.02.019] [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: 11/03/2014] [Revised: 01/27/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vascular hyporesponsiveness is an important pathophysiological feature of some critical conditions such as hemorrhagic shock. Many proteins and molecules are involved in the regulation of the pathologic process, however the mechanism has still remained unclear. Our study was intended to look for the related protein markers involved in the regulation of vascular reactivity after hemorrhagic shock. METHODS Differential in-gel electrophoresis and tandem mass spectrometry were applied to quantify the differences of protein expression in the superior mesenteric arteries from hemorrhagic shock and normal rats. RESULTS A total of 2317 differentially expressed protein spots in the superior mesenteric arteries of rats before and after hemorrhagic shock were found, and 146 protein spots were selected for tandem mass spectrometry identification. Thirty-seven differentially expressed proteins were obtained, including 3 uncharacterized proteins and 34 known proteins. Among them, heat shock protein beta-1 and calmodulin were the known proteins involved in the occurrence of vascular hyporesponsiveness. Bioinformatics analysis results showed that 18 proteins were related to vasoconstriction, 11 proteins may be involved in other vascular functions such as regulation of angiogenesis and endothelial cell proliferation. CONCLUSIONS The changes of vascular responsiveness after hemorrhagic shock in rats may be associated with the upregulation or downregulation of previously mentioned protein expressions. These findings may provide the basis for understanding and further study of the mechanism and treatment targets of vascular hyporeactivity after shock.
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Affiliation(s)
- Shangqing Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China; Experimental Teaching Centre of Human Anatomy, School of Basic Medical Sciences, North Sichuan Medical College, Nangchong, Sichuan, P. R. China
| | - Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Guangming Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Yi Hu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Xudong Xiao
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jin Xu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jie Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Liangming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of the Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P. R. China.
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12
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Lei Y, Peng X, Liu L, Dong Z, Li T. Beneficial effect of cyclosporine A on traumatic hemorrhagic shock. J Surg Res 2015; 195:529-40. [DOI: 10.1016/j.jss.2015.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/18/2022]
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13
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Xiao X, Zhu Y, Zhen D, Chen XM, Yue W, Liu L, Li T. Beneficial and side effects of arginine vasopressin and terlipressin for septic shock. J Surg Res 2015; 195:568-79. [DOI: 10.1016/j.jss.2015.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/22/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
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14
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Li T, Xiao X, Zhang J, Zhu Y, Hu Y, Zang J, Lu K, Yang T, Ge H, Peng X, Lan D, Liu L. Age and sex differences in vascular responsiveness in healthy and trauma patients: contribution of estrogen receptor-mediated Rho kinase and PKC pathways. Am J Physiol Heart Circ Physiol 2014; 306:H1105-15. [PMID: 24531808 DOI: 10.1152/ajpheart.00645.2013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several medical conditions exhibit age- and sex-based differences. Whether or not traumatic shock exhibits such differences with regard to vascular responsiveness is not clear. In a cohort of 177 healthy subjects and 842 trauma patients (21–82 years) as well as different ages (4, 8, 10, 14, 18, and 24 wk; 1 and 1.5 years) and sexes of Sprague-Dawley normal and traumatic shock rats, the age- and sex-based differences of vascular responsiveness and the underlying mechanisms were investigated. Middle-aged and young women as well as female rats of reproductive age had higher vascular responsiveness in the normal condition and a lower decrease in vascular responsiveness after traumatic shock than older men and male rats of identical age. Exogenous supplementation of 17β-estrdiol increased vascular reactivity in both male and femal rats of 8–24 wk and preserved vascular responsiveness in rats following traumatic shock. No effect was observed in rats 1 to 1.5 years. These protective effects of estrogen were closely related to G protein-coupled receptor (GPR)30, estrogen receptor-mediated Rho kinase, and PKC pathway activation. Vascular responsiveness exhibits age- and sex-based differences in healthy subjects and trauma patients. Estrogen and its receptor (GPR30) mediated activation of Rho kinase and PKC using genomic and nongenomic mechanisms to elicit protective effects in vascular responsiveness. This finding is important for the personalized treatment for several age- and sex-related diseases involving estrogen.
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Affiliation(s)
- Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Xudong Xiao
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Jie Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Yu Zhu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Yi Hu
- Department of Anesthesiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Jiatao Zang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Kaizhi Lu
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Tiande Yang
- Department of Anesthesiology, South Western Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Hengjiang Ge
- Department of Anesthesiology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Xiaoyong Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Dan Lan
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Liangming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
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15
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Layek A, Maitra S, Pal S, Bhattacharjee S, Baidya DK. Efficacy of vasopressin during cardio-pulmonary resuscitation in adult patients: a meta-analysis. Resuscitation 2014; 85:855-63. [PMID: 24704138 DOI: 10.1016/j.resuscitation.2014.03.303] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/03/2014] [Accepted: 03/07/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Experimental and animal studies suggested that vasopressin may have a favorable survival profile during CPR. This meta-analysis aimed to determine the efficacy of vasopressin in adult cardiac patients. METHODOLOGY Meta-analysis of randomized control trials (RCTs) comparing the efficacy of vasopressin containing regimen during CPR in adult cardiac arrest population with an epinephrine only regimen. RESULTS A total of 6120 patients from 10 RCTs were included in this meta-analysis. Vasopressin use during CPR has no beneficial impact in an unselected population in ROSC [OR 1.19, 95% CI 0.93, 1.52], survival to hospital discharge [OR 1.13, 95% CI 0.89, 1.43], survival to hospital admission [OR 1.12, 95% CI 0.99, 1.27] and favorable neurological outcome [OR 1.02, 95% CI 0.75, 1.38]. ROSC in "in-hospital" cardiac arrest setting [OR 2.20, 95% CI 1.08, 4.47] is higher patients receiving vasopressin. Subgroup analyses revealed equal or higher chance of ROSC [OR 2.15, 95% CI 1.00, 4.61], higher possibility of survival to hospital discharge [OR 2.39, 95% CI 1.34, 4.27] and favorable neurological outcome [OR 2.58, 95% CI 1.39, 4.79] when vasopressin was used as repeated boluses of 4-5 times titrating desired effects during CPR. CONCLUSION ROSC in "in-hospital" cardiac arrest patients is significantly better when vasopressin was used. A subgroup analysis of this meta-analysis found that ROSC, survival to hospital admission and discharge and favorable neurological outcome may be better when vasopressin was used as repeated boluses of 4-5 times titrated to desired effects; however, overall no beneficial effect was noted in unselected cardiac arrest population.
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Affiliation(s)
- Amitava Layek
- Department of Anaesthesiology, CNBC, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sugata Pal
- Department of Anaesthesiology & Intensive Care, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Dalim K Baidya
- Department of Anaesthesiology & Intensive Care, CDER, All India Institute of Medical Sciences, New Delhi, India
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Liu L, Yang G, Zhu Y, Xu J, Zang J, Zhang J, Peng X, Lan D, Li T. Role of non-MLC20 phosphorylation pathway in the regulation of vascular reactivity during shock. J Surg Res 2014; 187:571-80. [DOI: 10.1016/j.jss.2013.10.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
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Postshock mesenteric lymph drainage ameliorates vascular reactivity and calcium sensitivity through RhoA. J Surg Res 2014; 186:304-9. [DOI: 10.1016/j.jss.2013.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/14/2013] [Accepted: 08/16/2013] [Indexed: 01/27/2023]
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Small Doses of Arginine Vasopressin in Combination With Norepinephrine “Buy” Time for Definitive Treatment for Uncontrolled Hemorrhagic Shock in Rats. Shock 2013; 40:398-406. [DOI: 10.1097/shk.0000000000000036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang Y, Niu C, Zhao Z, Zhang L, Si Y. Myosin light chain kinase is necessary for post-shock mesenteric lymph drainage enhancement of vascular reactivity and calcium sensitivity in hemorrhagic-shocked rats. Braz J Med Biol Res 2013; 46:574-9. [PMID: 23903684 PMCID: PMC3859335 DOI: 10.1590/1414-431x20132900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/28/2013] [Indexed: 11/22/2022] Open
Abstract
Vascular hyporeactivity is an important factor in irreversible shock, and
post-shock mesenteric lymph (PSML) blockade improves vascular reactivity after
hemorrhagic shock. This study explored the possible involvement of myosin light
chain kinase (MLCK) in PSML-mediated vascular hyporeactivity and calcium
desensitization. Rats were divided into sham (n=12), shock (n=18), and
shock+drainage (n=18) groups. A hemorrhagic shock model (40±2 mmHg, 3 h) was
established in the shock and shock+drainage groups. PSML drainage was performed
from 1 to 3 h from start of hypotension in shock+drainage rats. Levels of
phospho-MLCK (p-MLCK) were determined in superior mesenteric artery (SMA)
tissue, and the vascular reactivity to norepinephrine (NE) and sensitivity to
Ca2+ were observed in SMA rings in an isolated organ perfusion
system. p-MLCK was significantly decreased in the shock group compared with the
sham group, but increased in the shock+drainage group compared with the shock
group. Substance P (1 nM), an agonist of MLCK, significantly elevated the
decreased contractile response of SMA rings to both NE and Ca2+ at
various concentrations. Maximum contractility (Emax) in the shock
group increased with NE (from 0.179±0.038 to 0.440±0.177 g/mg, P<0.05) and
Ca2+ (from 0.515±0.043 to 0.646±0.096 g/mg, P<0.05). ML-7 (0.1
nM), an inhibitor of MLCK, reduced the increased vascular response to NE and
Ca2+ at various concentrations in the shock+drainage group (from
0.744±0.187 to 0.570±0.143 g/mg in Emax for NE and from 0.729±0.037
to 0.645±0.056 g/mg in Emax for Ca2+, P<0.05). We
conclude that MLCK is an important contributor to PSML drainage, enhancing
vascular reactivity and calcium sensitivity in rats with hemorrhagic shock.
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Affiliation(s)
- Y.P. Zhang
- Institute of Microcirculation, Hebei North University, China
| | - C.Y. Niu
- Institute of Microcirculation, Hebei North University, China
| | - Z.G. Zhao
- Institute of Microcirculation, Hebei North University, China
| | - L.M. Zhang
- Institute of Microcirculation, Hebei North University, China
| | - Y.H. Si
- Institute of Microcirculation, Hebei North University, China
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Mitogen-activated protein kinases regulate vascular reactivity after hemorrhagic shock through myosin light chain phosphorylation pathway. J Trauma Acute Care Surg 2013; 74:1033-43. [PMID: 23511142 DOI: 10.1097/ta.0b013e31828586a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vascular hyporeactivity played an important role in many critical illness including shock or sepsis, but the mechanisms are incompletely understood. The objective of the present study was to investigate the roles of major mitogen-activated protein kinases (MAPKs extracellular signal-regulated kinase [ERK], p38 MAPK, and jun NH2-terminal kinase [JNK]) on vascular reactivity and the mechanisms. METHODS With superior mesenteric arteries from hemorrhagic shock rats, the role of p38 MAPK, ERK, and JNK in the regulation of vascular reactivity following shock and their relationship to myosin light chain (MLC20) phosphorylation-dependent pathway was observed. RESULTS ERK, p38 MAPK, and JNK activities in superior mesenteric arteries were increased at early shock and decreased at late shock. Stimulation of MAPKs with angiotensin II (AngII) increased the vascular reactivity, calcium sensitivity, and MLC20 phosphorylation. The increasing effect of AngII on vascular reactivity was antagonized by ERK, p38 MAPK, and JNK inhibitors, while the effect of AngII on calcium sensitivity was only blocked by ERK and p38 MAPK inhibitor, but not by JNK inhibitor. AngII increased the activity of protein kinase C-dependent phosphatase inhibitor of 17-kD (CPI17), integrin-linked kinase (ILK), and zipper-interacting protein kinase (ZIPK), The effect of AngII on CPI17 was blocked by ERK and p38 MAPK inhibitor, while the effect of AngII on ILK and ZIPK was only blocked by ERK inhibitor. CONCLUSION MAPKs participated in the regulation of vascular reactivity during shock. ERK and p38 MAPK is mainly through ILK, ZIPK, and CPI17-mediated MLC20 phosphorylation-dependent pathway, while JNK may be involved in the regulation of vascular reactivity by other mechanisms.
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Xu J, Lan D, Li T, Yang G, Liu L. Angiopoietins regulate vascular reactivity after haemorrhagic shock in rats through the Tie2-nitric oxide pathway. Cardiovasc Res 2012; 96:308-19. [DOI: 10.1093/cvr/cvs254] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Mentzelopoulos SD, Zakynthinos SG, Siempos I, Malachias S, Ulmer H, Wenzel V. Vasopressin for cardiac arrest: meta-analysis of randomized controlled trials. Resuscitation 2011; 83:32-9. [PMID: 21787738 DOI: 10.1016/j.resuscitation.2011.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/25/2011] [Accepted: 07/14/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Prior meta-analyses-reported results of randomised controlled trials (RCTs) published between 1997 and 2004 failed to show any vasopressin-related benefit in cardiac arrest. Based on new RCT-data and a hypothesis of a potentially increased vasoconstricting efficacy of vasopressin, we sought to determine whether the cumulative, current evidence supports or refutes an overall and/or selective benefit for vasopressin regarding sustained restoration of spontaneous circulation (ROSC), long-term survival, and neurological outcome. METHODS Two reviewers independently searched PubMed, EMBASE, and Cochrane Database for RCTs assigning adults with cardiac arrest to treatment with a vasopressin-containing regimen (vasopressin-group) vs adrenaline (epinephrine) alone (control-group) and reporting on long-term outcomes. Data from 4475 patients in 6 high-methodological quality RCTs were analyzed. Subgroup analyses were conducted according to initial cardiac rhythm and time from collapse to drug administration (T(DRUG))<20 min. RESULTS Vasopressin vs. control did not improve overall rates of sustained ROSC, long-term survival, or favourable neurological outcome. However, in asystole, vasopressin vs. control was associated with higher long-term survival {odds ratio (OR)=1.80, 95% confidence interval (CI)=1.04-3.12, P=0.04}. In asystolic patients of RCTs with average T(DRUG)<20 min, vasopressin vs. control increased the rates of sustained ROSC (data available from 2 RCTs; OR=1.70, 95% CI=1.17-2.47, P=0.005) and long-term survival (data available from 3 RCTs; OR=2.84, 95% CI=1.19-6.79, P=0.02). CONCLUSIONS Vasopressin use in the resuscitation of cardiac arrest patients is not associated with any overall benefit or harm. However, vasopressin may improve the long-term survival of asystolic patients, especially when average T(DRUG) is <20 min.
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Affiliation(s)
- Spyros D Mentzelopoulos
- First Department of Pulmonary and Critical Care Medicine, University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, GR-10675 Athens, Greece.
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