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Herajärvi J, Juvonen T. Preparing the spinal cord - priming or preconditioning? A systematic review of experimental studies. Scand Cardiovasc J Suppl 2023; 57:2166100. [PMID: 36660818 DOI: 10.1080/14017431.2023.2166100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives. Paraplegia is devastating complication associated with thoracic and thoracoabdominal aortic aneurysm repair. Vast evidence has been gathered on pre-, peri- and postoperative protective adjuncts aiming to minimize spinal cord ischemia. This review focuses on the pretreatment phase of open surgical or endovascular aortic procedures and gathers the experimental data on the interventional preconditioning and priming methods that increase the spinal cord ischemic tolerance. Design. By the start of March 2021, a systematic review was performed in PubMed, Scopus and Web of Science core collection to identify the articles that reported (i) either an ischemic preconditioning, remote ischemic preconditioning or priming method prior to (ii) experimental spinal cord ischemia performed in endovascular or open surgical fashion mimicking either thoracic, abdominal or thoracoabdominal aortic aneurysm procedures. (iii) The outcomes were reported via neurological, motor-evoked potential, somatosensory-evoked potential, histopathological, immunohistochemical, physiological analysis, or in different combinations of these measurements. Results. The search yielded 7802 articles, and 57 articles were included in the systematic review. The articles were assessed by the evaluated species, the utilized pretreatment, the measured protective effects, and the suggested underlying mechanisms. Conclusions. The reviewed articles showed several possible mechanisms in ischemic and remote ischemic preconditioning for prevention of spinal cord ischemia. The main suggested method for priming was arteriogenetic stimulus. Future studies should confirm these hints of arteriogenetic stimulus with more precise quantification of the protective recruitment process.
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Affiliation(s)
- Johanna Herajärvi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland
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Simon MV, Dong CC, Jacobs MJ, Mess WH. Neuromonitoring during descending aorta procedures. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:407-431. [PMID: 35772899 DOI: 10.1016/b978-0-12-819826-1.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thoraco-abdominal aneurysm (TAA) repair carries a significant risk of spinal cord infarction. The latter results from irreversible changes in the spinal cord arterial network, e.g., sacrifice of the segmental arteries. Intra-operative neurophysiology with somatosensory and especially motor evoked potential (SEP and MEP respectively) monitoring, has emerged as an effective tool to assess the efficiency of the collateral blood flow, detect reversible spinal cord ischemia and guide the peri-operative multidisciplinary management to prevent postoperative paraplegia. The main roles of such monitoring include diagnosis of spinal cord vs peripheral limb ischemia, titration of mean arterial pressure during aortic clamping, the guidance of selective re-implantation of critical segmental arteries, and management of hemodynamics in the immediate postoperative period. In addition, manipulation of the aortic arch and proximal descending aorta, adds the risk of cerebral infarction from both low flow state and/or thromboembolic events. As such, EEG monitoring may be a useful add-on for either assessment of the efficiency of cerebral cooling as a neuroprotective method and/or for detection and treatment of reversible cerebral ischemia. This chapter presents the multimodality approach to open TAA monitoring as a versatile tool for the prevention of devastating postoperative neurologic deficits.
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Affiliation(s)
- Mirela V Simon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
| | - Charles C Dong
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Michael J Jacobs
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Fu D, Liu H, Liu H, Yao J. Effects of D‑Ala2, D‑Leu5‑Enkephalin pre‑ and post‑conditioning in a rabbit model of spinal cord ischemia and reperfusion injury. Mol Med Rep 2019; 20:4811-4820. [PMID: 31638217 PMCID: PMC6854538 DOI: 10.3892/mmr.2019.10729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 06/20/2019] [Indexed: 11/15/2022] Open
Abstract
It has recently been revealed that during the aorta-clamped period, D-Ala2, D-Leu5-Enkephalin (DADLE) infusion can protect the spinal cord against ischemia and reperfusion (I/R) injury. However, the protective effects of DADLE administration prior to ischemia or at the time of early reperfusion have not yet been investigated. Drug pre- or post-conditioning can serve as a more valuable clinical strategy. Therefore, the present study was designed to investigate the neuroprotective effect of DADLE infusion at different time intervals in order to determine the optimum time point for ischemic spinal cord protection. A total of 40 New Zealand white rabbits were randomly divided into 5 groups: Sham-operated (Sham), normal saline pre-conditioning (NS), DADLE per-conditioning (Dper), DADLE pre-conditioning (Dpre) and DADLE post-conditioning (Dpost). All animals were subjected to spinal cord ischemia for 30 min followed by 48 h reperfusion. Hind limb motor functions were assessed according to the Tarlov criterion when the animals regained consciousness, 6, 24 and 48 h after reperfusion. Histological analysis and the number of viable α-motor neurons were also used to assess the extent of spinal cord injury. Compared with the NS group, the Tarlov scores and the number of normal neurons were significantly higher in the Dper group (P<0.05), which were consistent with the results of a previous study. In addition, the paraplegia rate and loss of normal motor neurons were lower in the DADLE per- and post-conditioning groups compared with the DADLE pre-conditioning; however, these were not statistically significant. DADLE 0.05 mg/kg administration at three time points all mitigated normal motor neuron injury in the anterior horn and decreased the paraplegia rates in rabbits. The therapeutic benefits appeared best in the post-conditioning group with DADLE, and worst in the pre-conditioning group.
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Affiliation(s)
- Danyun Fu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Haitong Liu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Hua Liu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai 200080, P.R. China
| | - Junyan Yao
- Department of Anesthesiology, Shanghai General Hospital, Shanghai 200080, P.R. China
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Perlikos F, Lagiou M, Papalois A, Rizou T, Kroupis C, Toumpoulis IK. Lazaroid (U-74389G) ameliorates lung injury due to lipid peroxidation and nitric oxide synthase-dependent reactive oxygen species generation caused by remote systematic ischemia-reperfusion following thoracoabdominal aortic occlusion. Int J Surg 2018; 55:156-161. [PMID: 29860124 DOI: 10.1016/j.ijsu.2018.05.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lung ischemia-reperfusion injury after thoracoabdominal aortic occlusion represents a major complication, which increases morbidity and mortality. In the present study we hypothesized that lazaroid U-74389G intravenous administration protects from lung ischemia-reperfusion injury through lipid peroxidation inhibition. MATERIALS AND METHODS A total of 24 pigs were randomized in three groups. Group I (n = 8) underwent sham operation, group II (n = 8) underwent thoracoabdominal aortic occlusion for 45min and received placebo and group III (n = 8) received 3 doses of lazaroid (3 mg/kg) 60 and 30min before thoracoabdominal aortic occlusion and at 30min during thoracoabdominal aortic occlusion (duration 45min). Aortic occlusion was performed with aortic balloon-catheters under fluoroscopic guidance. All animals were sacrificed at the 7 t h postoperative day and lung specimens were harvested for molecular analysis. RESULTS mRNA levels of leukotrienes LB4 (LTB4R2), LC4 (LTC4S) and nitric oxide synthase (NOS) isoforms including iNOS, nNOS and eNOS were determined with real-time RT-qPCR. Nitric oxide can either induce (iNOS) or inhibit (nNOS and eNOS) lipid peroxidation based on its specific isoform origin. Group III showed significantly reduced mRNA levels of LTB4R2 (-63.7%), LTC4S (-35.9%) and iNOS (-60.2%) when compared with group II (P < 0.05, for all). The mRNA levels of nNOS was significantly increased (+37.4%), while eNOS was slightly increased (+2.1%) in group III when compared with group II (P < 0.05 and P = 0.467 respectively). CONCLUSION Lazaroid U-74389G may represent an effective pharmacologic intervention in reducing lung ischemia-reperfusion injury following thoracoabdominal aortic occlusion.
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Affiliation(s)
- Fotis Perlikos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece.
| | - Maria Lagiou
- Department of Clinical Biochemistry, Attikon Hospital, National and Kapodistrian University of Athens, Greece
| | | | - Tatiana Rizou
- Department of Clinical Biochemistry, Attikon Hospital, National and Kapodistrian University of Athens, Greece
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis K Toumpoulis
- Department of Cardiac Surgery, Attikon Hospital, National and Kapodistrian University of Athens, Greece
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Sapmaz A, Ulus AT, Turan NN, Kaymaz FF, Yazıcıoğlu H, Ersöz S, Simsek E, Köksoy C. Which type of conditioning method protects the spinal cord from the ischemia–reperfusion injury in 24 hours? Vascular 2015; 23:614-21. [DOI: 10.1177/1708538114568702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This study was designed to test the effects of different types of preconditioning and postconditioning methods on spinal cord protection following aortic clamping. Methods The animals (rabbits) were divided into sham-operated, ischemic preconditioning, remote ischemic preconditioning, simultaneous aortic and ischemic remote preconditioning, and ischemic postconditioning groups. After neurological evaluations, ultrastructural analysis and immunohistochemical staining for caspase-3 were evaluated after 24 h following ischemia. Results The neurological outcomes of the remote ischemic preconditioning (4.2 ± 0.4) and ischemic postconditioning (4.6 ± 0.8) groups were significantly improved when compared with the ischemia group (2.2 ± 04). The immunohistochemical analysis revealed that the lowest percentage of apoptosis was in-group ischemic preconditioning at 12.5 ± 30.6%. In the comparison of intracellular edema in an ultrastructural analysis, the ischemic preconditioning and ischemic postconditioning groups had significantly lower values than the ischemia group. Conclusion The conditioning methods attenuate ischemia–reperfusion injury for spinal cord injury. Ischemic and remote preconditioning and also postconditioning methods are simple to perform and inexpensive.
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Affiliation(s)
- Ali Sapmaz
- Department of General Surgery, University of Ankara, Ankara, Turkey
| | - A Tulga Ulus
- Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
- Cardiovascular Surgery Department, Hacettepe University, Ankara, Turkey
| | - Nilüfer N Turan
- Pharmacology Department, Faculty of Pharmacy, University of Gazi, Ankara, Turkey
| | - F Figen Kaymaz
- Histology Department, University of Hacettepe, Ankara, Turkey
| | - Hija Yazıcıoğlu
- Anesthesiology and Reanimation Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Siyar Ersöz
- Department of General Surgery, University of Ankara, Ankara, Turkey
| | - Erdal Simsek
- Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
| | - Cüneyt Köksoy
- Department of General Surgery, University of Ankara, Ankara, Turkey
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Spinal Cord Early Ischemic Preconditioning Activates the Stabilized Fraction of β-Catenin After Thoracoabdominal Aortic Occlusion in Pigs. Ann Vasc Surg 2013; 27:480-6. [DOI: 10.1016/j.avsg.2012.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/20/2012] [Accepted: 08/16/2012] [Indexed: 12/20/2022]
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Lozos VA, Toumpoulis IK, Agrogiannis G, Giamarellos-Bourboulis EJ, Chamogeorgakis TP, Rizos IK, Patsouris ES, Anagnostopoulos CE, Rokkas CK. Aprikalim a potassium adenosine triphosphate channel opener reduces neurologic injury in a rabbit model of spinal cord ischemia. Int J Surg 2013; 11:354-9. [PMID: 23473993 DOI: 10.1016/j.ijsu.2013.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 01/30/2013] [Accepted: 02/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Potassium adenosine triphosphate (KATP) channel openers have been involved in the enhancement of ischemic tolerance in various tissues. The purpose of the present study is to evaluate the effects of aprikalim, a specific KATP channel opener, on spinal cord ischemic injury. METHODS Fifty-four rabbits were randomly assigned to three groups: group 1 (n = 18, sham operation), group 2 (n = 18, 30 min of normothermic aortic cross-clamping) and group 3 (n = 18, aprikalim 100 μg/kg was administered 15 min before 30 min of normothermic aortic cross-clamping). Neurologic evaluation was performed according to the modified Tarlov scale. Six animals from each group were sacrificed at 24, 48 and 168 h postoperatively. The lumbar spinal cords were harvested and examined histologically. The motor neurons were counted and the histologic lesions were scored (0-3, 3: normal). RESULTS Group 3 (aprikalim group) had better Tarlov scores compared to group 2 at all-time points (P < 0.025). The histologic changes were proportional to the Tarlov scores and group 3 had better functional outcome as compared to group 2 at 168 h (number of neurons: 21.2 ± 4.9 vs. 8.0 ± 2.7, P < 0.001 and histologic score: 1.67 ± 1.03 vs. 0.50 ± 0.55, P = 0.03). Although aprikalim exhibited improved effect on clinical and histologic neurologic outcome when compared to normothermic spinal cord ischemia, animals in group 3 had worse Tarlov score, reduced number of motor neurons and worse histologic score when compared to group 1 (sham operation) at 168 h (P = 0.003, P = 0.001 and P = 0.019 respectively). CONCLUSION Aprikalim reduces the severity of spinal cord ischemic injury in a rabbit model of spinal cord ischemia.
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Affiliation(s)
- Vasileios A Lozos
- Department of Cardiothoracic Surgery, National and Kapodistrian University of Athens Medical School, Attikon University Hospital Center, Rimini 1, Chaidari, Athens, Greece
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Early Ischaemic Preconditioning of Spinal Cord Enhanced the Binding Profile of Heat Shock Protein 70 with Neurofilaments and Promoted its Nuclear Translocation after Thoraco-abdominal Aortic Occlusion in Pigs. Eur J Vasc Endovasc Surg 2012; 43:408-14. [DOI: 10.1016/j.ejvs.2011.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 12/28/2011] [Indexed: 11/21/2022]
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Fansa I, Altug ME, Melek I, Ucar E, Kontas T, Akcora B, Atik E, Duman T. The Neuroprotective and Anti-inflammatory Effects of Diltiazem in Spinal Cord Ischaemia–Reperfusion Injury. J Int Med Res 2009; 37:520-33. [DOI: 10.1177/147323000903700228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The protective effects of diltiazem were examined in a rabbit model of spinal cord ischaemia–reperfusion induced by infrarenal aortic occlusion for 30 min. In the diltiazem group ( n = 6), an intravenous infusion (2 μg/kg per min) was started 10 min before ischaemia induction; normal saline solution was infused in the control group ( n = 6). Neurological function was assessed using modified Tarlov criteria 24 h after surgery. Plasma samples were analysed for interleukin (IL)-6 and IL-10. Spinal tissue was analysed for malondialdehyde, nitric oxide and reduced glutathione activities. Tarlov scores of the diltiazem-treated rabbits indicated significantly improved hind-limb motor function compared with the control group. The diltiazem group also had better quantitative and qualitative histopathological findings. Diltiazem infusion significantly reduced IL-6 levels 3 and 24 h after reperfusion compared with the control group. The mean IL-10 level in the diltiazem group was significantly higher than in the control group 24 h after reperfusion. It is concluded that diltiazem has cytoprotective and anti-inflammatory properties, leading to reduced spinal cord injury.
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Affiliation(s)
- I Fansa
- Department of Cardiovascular Surgery, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - ME Altug
- Department of Surgery, Faculty of Veterinary Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - I Melek
- Department of Neurology, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - E Ucar
- Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - T Kontas
- Department of Biochemistry, Faculty of Veterinary Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - B Akcora
- Department of Paediatric Surgery, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey; and
| | - E Atik
- Department of Pathology, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
| | - T Duman
- Department of Neurology, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay, Turkey
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Erythropoietin during porcine aortic balloon occlusion-induced ischemia/reperfusion injury. Crit Care Med 2008; 36:2143-50. [PMID: 18552697 DOI: 10.1097/ccm.0b013e31817d7912] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aortic occlusion causes ischemia/reperfusion injury, kidney and spinal cord being the most vulnerable organs. Erythropoietin improved ischemia/reperfusion injury in rodents, which, however, better tolerate ischemia/reperfusion than larger species. Therefore, we investigated whether erythropoietin attenuates porcine aortic occlusion ischemia/reperfusion injury. MATERIALS AND METHODS Before occluding the aorta for 45 mins by inflating intravascular balloons, we randomly infused either erythropoietin (n = 8; 300 IU/kg each over 30 mins before and during the first 4 hrs of reperfusion) or vehicle (n = 6). During aortic occlusion, mean arterial pressure was maintained at 80% to 120% of baseline by esmolol, nitroglycerine, and adenosine 5'-triphosphate. During reperfusion, noradrenaline was titrated to keep mean arterial pressure >80% of baseline. Kidney perfusion and function were assessed by fractional Na-excretion, p-aminohippuric acid and creatinine clearance, spinal cord function by lower extremity reflexes and motor evoked potentials. Blood isoprostane levels as well as blood and tissue catalase and superoxide dismutase activities allowed evaluation of oxidative stress. After 8 hrs of reperfusion, kidney and spinal cord specimens were taken for histology (hematoxylin-eosin, Nissl staining) and immunohistochemistry (TUNEL assay for apoptosis). RESULTS Parameters of oxidative stress and antioxidative activity were comparable. Erythropoietin reduced the noradrenaline requirements to achieve the hemodynamic targets and may improve kidney function despite similar organ blood flow, histology, and TUNEL staining. Neuronal damage and apoptosis was attenuated in the thoracic spinal cord segments without improvement of its function. CONCLUSION During porcine aortic occlusion-induced ischemia/reperfusion erythropoietin improved kidney function and spinal cord integrity. The lacking effect on spinal cord function was most likely the result of the pronounced neuronal damage associated with the longlasting ischemia.
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Co-application of ischemic preconditioning and postconditioning provides additive neuroprotection against spinal cord ischemia in rabbits. Life Sci 2008; 82:608-14. [DOI: 10.1016/j.lfs.2007.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 11/19/2007] [Accepted: 12/09/2007] [Indexed: 11/30/2022]
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Kim KO, Choe G, Chung SH, Kim CS. Delayed pharmacological pre-conditioning effect of mitochondrial ATP-sensitive potassium channel opener on neurologic injury in a rabbit model of spinal cord ischemia. Acta Anaesthesiol Scand 2008; 52:236-42. [PMID: 18005376 DOI: 10.1111/j.1399-6576.2007.01534.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Diazoxide, pharmacological openers of mitochondrial ATP-sensitive potassium channels have been shown to induce early pre-conditioning in the spinal cord. Here, the authors investigated whether diazoxide also induce delayed pre-conditioning and thereby reduce neurologic complications using a rabbit model of spinal cord ischemia. METHODS Infrarenal blood flow was interrupted for 20 min in 21 rabbits. Non-treated control animals received no pre-treatment. Diazoxide (5 mg/kg) were given 48 h before 20 min ischemia in the 48-h DZ group, whereas 15-min DZ group received diazoxide (5 mg/kg) 15 min before 20-min ischemia. Neurological functions were evaluated using Johnson scores for 3 days after reperfusion, after which, spinal cords were procured for hematoxylin and eosin staining for cell counting. RESULTS Johnson scores revealed a marked improvement in both the diazoxide-treated groups vs. the non-treated control group at 3, 24, 48, and 72 h after reperfusion (P<0.01). The histologic changes were proportional to the Johnson scores, with better preservation of motor neuron numbers in the animals of the 48-h DZ and 15-min DZ group relative to the non-treated controls (81+/-12, 90+/-10, 50+/-23 motor neurons, respectively, P<0.01). No difference was found between the 48-h DZ group and 15-min DZ group with respect to the Johnson scores or neuron numbers. CONCLUSIONS The study demonstrates that pre-treatment with diazoxide 48 h before ischemia, induce delayed pharmacological pre-conditioning, thereby significantly improving clinical neurologic scores and histologic findings in this animal model.
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Affiliation(s)
- K O Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
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Anagnostopoulos PV, Toumpoulis IK, Shepard AD, Drossos GE, Tsatsoulis A, Anagnostopoulos CE. Temporary adrenal dysfunction with descending thoracic aortic occlusion. SCAND CARDIOVASC J 2007; 41:248-54. [PMID: 17680513 DOI: 10.1080/14017430701227754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We sought to determine whether descending thoracic aortic occlusion (DTAOC) induced ischemia results in adrenal dysfunction. METHODS Eight pigs underwent DTAOC for 45 min. Six control pigs underwent a sham procedure. Serum cortisol and adrenocorticotropic hormone (ACTH) were measured at baseline, at the end of DTAOC, 30 and 60 min after restoration of flow, and 24 hours later. Statistical analysis was performed using repeated measures ANOVA and t-test. RESULTS In the study group, cortisol levels decreased during DTAOC (p=0.048) and 30 min after flow restoration (p=0.004). In the control group there was no change in serum cortisol levels. In the study group the drop in serum cortisol was associated with an increase in ACTH levels during DTAOC (p=0.040) and 30 minutes after flow restoration (p=0.070). The increase in ACTH was also significant when compared to the controls during DTAOC (p=0.030) and 30 min after blood flow restoration (p=0.040). CONCLUSIONS There is a transient period of adrenal dysfunction associated with DTAOC that results in stimulation of the pituitary-adrenal axis.
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Maier C, Scheuerle A, Hauser B, Schelzig H, Szabó C, Radermacher P, Kick J. The selective poly(ADP)ribose-polymerase 1 inhibitor INO1001 reduces spinal cord injury during porcine aortic cross-clamping-induced ischemia/reperfusion injury. Intensive Care Med 2007; 33:845-850. [PMID: 17361386 DOI: 10.1007/s00134-007-0585-3] [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: 12/07/2006] [Accepted: 02/12/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE It is well-established that poly(ADP)ribose-polymerase (PARP) assumes major importance during ischemic brain damage, and the selective PARP-1 inhibitor PJ34 reduced spinal cord damage in murine aortic occlusion-induced ischemia/reperfusion injury. We investigated the effect of the PARP-1 inhibitor INO1001 on aortic-occlusion-related porcine spinal cord injury. DESIGN AND SETTING Prospective, randomized, controlled experimental study in an animal laboratory. PATIENTS AND PARTICIPANTS Ten anesthetized, mechanically ventilated, and instrumented pigs. INTERVENTIONS Animals underwent 45 min of thoracic aortic cross-clamping after receiving vehicle (n=5) or intravenous INO1001 (n=5, total dose 4 mg/kg administered both before clamping and during reperfusion). During reperfusion continuous intravenous norepinephrine was incrementally adjusted to maintain blood pressure at or above 80% of the preclamping level. Plasma INO1001 levels were analyzed by HPLC. After 4[Symbol: see text]h of reperfusion spinal cord biopsy samples were analyzed for neuronal damage (hematoxyline-eosine and Nissl staining), expression of the cyclin-dependent kinase inhibitor genes p21 and p27 (immunohistochemistry), and apoptosis (terminal deoxynucleotidyl transferase mediated nick end labeling assay). MEASUREMENTS AND RESULTS Plasma INO1001 levels were 0.8-2.3 and 0.30-0.76 mM before and after clamping, respectively. While 3-5% of the spinal cord neurons were irreversibly damaged in the INO1001 animals, the neuronal cell injury was three times higher in the control group. Neither p21 and p27 expression nor apoptosis showed any intergroup difference. CONCLUSIONS The selective PARP-1 inhibitor INO1001 markedly reduced aortic occlusion-induced spinal cord injury. Given the close correlation reported in the literature between morphological damage and impaired spinal cord function, INO1001 may improve spinal cord recovery after thoracic aortic cross-clamping.
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Affiliation(s)
- Christian Maier
- Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, 89073, Ulm, Germany
- Abteilung Thorax- und Gefäßchirurgie, Universitätsklinikum, 89070, Ulm, Germany
| | | | - Balázs Hauser
- Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, 89073, Ulm, Germany
- Aneszteziológiai és Intenzív Terápiás Klinika, Semmelweis Egyetem, 1125, Budapest, Hungary
| | - Hubert Schelzig
- Abteilung Thorax- und Gefäßchirurgie, Universitätsklinikum, 89070, Ulm, Germany
| | - Csaba Szabó
- Department of Surgery, University of Medicine and Dentistry, Newark, N.J., USA
| | - Peter Radermacher
- Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, 89073, Ulm, Germany.
| | - Jochen Kick
- Abteilung Thorax- und Gefäßchirurgie, Universitätsklinikum, 89070, Ulm, Germany
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Toumpoulis IK. Resveratrol or Higher Arterial Blood Pressure Protects the Spinal Cord From Ischemia-Reperfusion Injury? Ann Thorac Surg 2006; 82:1572-3. [PMID: 16996993 DOI: 10.1016/j.athoracsur.2006.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Revised: 02/19/2006] [Accepted: 04/03/2006] [Indexed: 11/25/2022]
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Jiang X, Shi E, Nakajima Y, Sato S. Postconditioning, a series of brief interruptions of early reperfusion, prevents neurologic injury after spinal cord ischemia. Ann Surg 2006; 244:148-53. [PMID: 16794400 PMCID: PMC1570597 DOI: 10.1097/01.sla.0000217608.08582.35] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We sought to test whether postconditioning, a series of brief mechanical interruptions of reperfusion applied during the onset of reperfusion, can prevent neurologic injury of the spinal cord after transient ischemia. SUMMARY BACKGROUND DATA Ischemia-reperfusion injury of the spinal cord is the principal mechanism leading to the paraplegia after surgery for descending and thoracoabdominal aortic aneurysms. Postconditioning has recently been demonstrated to confer cardioprotection by attenuating reperfusion injury. METHODS Spinal cord ischemia was induced in rabbits by infrarenal aorta occlusion for 25 minutes. Control animals underwent no additional intervention. Two groups of animals underwent postconditioning consisting of 4 or 6 cycles of 1-minute occlusion/1-minute reperfusion, respectively, which were applied 1 minute after the start of reperfusion. In 2 additional groups, 6 cycles of postconditioning started 5 or 10 minutes after the onset of reperfusion, respectively. Hind-limb motor function was assessed during a 10-day recovery period using the modified Tarlov criteria. Histologic examination of the spinal cord was performed, and the number of intact motor neurons was counted. RESULTS Compared with controls, 4 cycles of postconditioning significantly increased the Tarlov score and the number of intact motor neurons. Six cycles of postconditioning did not further improve the neuroprotection. Postconditioning starting 5 minutes after reperfusion still resulted in powerful neuroprotection, but the neuroprotection disappeared completely when postconditioning was delayed for 10 minutes. CONCLUSIONS Postconditioning prevents neurologic injury of the spinal cord after ischemia, and the first few minutes of reperfusion are crucial to neuroprotection by postconditioning.
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Affiliation(s)
- Xiaojing Jiang
- Department of Anesthesiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Papakostas JC, Matsagas MI, Toumpoulis IK, Malamou-Mitsi VD, Pappa LS, Gkrepi C, Anagnostopoulos CE, Kappas AM. Evolution of Spinal Cord Injury in a Porcine Model of Prolonged Aortic Occlusion. J Surg Res 2006; 133:159-66. [PMID: 16337967 DOI: 10.1016/j.jss.2005.10.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 10/06/2005] [Accepted: 10/11/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spinal cord injury and subsequent paraplegia remains an unpredictable and devastating complication of thoracoabdominal aortic surgery. The aim of this study was to investigate spinal cord injury due to prolonged thoracoabdominal aortic occlusion. MATERIALS AND METHODS We used a highly reproducible porcine model of 45-min thoracoabdominal aortic occlusion, which was accomplished by two balloon occlusion catheters. Neurological evaluation after the end of experiment was performed by an independent observer according to the Tarlov scale. The lower thoracic and lumbar spinal cords were harvested at 10, 48, and 120 h (n = 6 animals per time point) and examined histologically with hematoxylin and eosin (H&E) stain and TUNEL method. Tarlov scores, number of neurons, and the grade of inflammation were analyzed. RESULTS H&E staining revealed reduction in the number of motor neurons which occurred in two phases (between 0 and 10 h and between 48 and 120 h of reperfusion), as well as development of inflammation in spinal cord sections during the reperfusion period, reaching a peak at 48 h. TUNEL reaction was negative for apoptotic neurons at any time point. CONCLUSIONS In this porcine model, we demonstrated that, after 45 min of thoracoabdominal aortic occlusion, motor neuron death seems to occur in two phases (immediate and delayed). Inflammation was a subsequent event of transient prolonged spinal cord ischemia and possibly a major contributor of delayed neuronal death. Using TUNEL straining we found no evidence of neuronal apoptosis at any time point of reperfusion.
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Affiliation(s)
- John C Papakostas
- Department of Surgery, Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
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Basaran M. Early ischemic preconditioning provides transient protection. J Thorac Cardiovasc Surg 2005; 129:1204. [PMID: 15867821 DOI: 10.1016/j.jtcvs.2004.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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