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Tacquard C, Iba T, Levy JH. Perioperative Anaphylaxis: Reply. Anesthesiology 2023; 139:362-364. [PMID: 37247346 DOI: 10.1097/aln.0000000000004598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
| | | | - Jerrold H Levy
- Duke University School of Medicine, Durham, North Carolina (J.H.L.).
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2
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Gouel-Chéron A, Dejoux A, Lamanna E, Bruhns P. Animal Models of IgE Anaphylaxis. BIOLOGY 2023; 12:931. [PMID: 37508362 PMCID: PMC10376466 DOI: 10.3390/biology12070931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Allergies and atopy have emerged as significant public health concerns, with a progressively increasing incidence over the last two decades. Anaphylaxis is the most severe form of allergic reactions, characterized by a rapid onset and potentially fatal outcome, even in healthy individuals. Due to the unpredictable nature and potential lethality of anaphylaxis and the wide range of allergens involved, clinical studies in human patients have proven to be challenging. Diagnosis is further complicated by the lack of reliable laboratory biomarkers to confirm clinical suspicion. Thus, animal models have been developed to replicate human anaphylaxis and explore its pathophysiology. Whereas results obtained from animal models may not always be directly translatable to humans, they serve as a foundation for understanding the underlying mechanisms. Animal models are an essential tool for investigating new biomarkers that could be incorporated into the allergy workup for patients, as well as for the development of novel treatments. Two primary pathways have been described in animals and humans: classic, predominantly involving IgE and histamine, and alternative, reliant on IgG and the platelet-activating factor. This review will focus essentially on the former and aims to describe the most utilized IgE-mediated anaphylaxis animal models, including their respective advantages and limitations.
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Affiliation(s)
- Aurélie Gouel-Chéron
- Université Paris Cité, 75010 Paris, France
- Anaesthesiology and Critical Care Medicine Department, DMU Parabol, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Antibodies in Therapy and Pathology, 75015 Paris, France
| | - Alice Dejoux
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Antibodies in Therapy and Pathology, 75015 Paris, France
- Sorbonne Université, Collège Doctoral, 75005 Paris, France
| | - Emma Lamanna
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Antibodies in Therapy and Pathology, 75015 Paris, France
- Neovacs SA, 92150 Suresnes, France
| | - Pierre Bruhns
- Institut Pasteur, Université de Paris Cité, INSERM UMR1222, Antibodies in Therapy and Pathology, 75015 Paris, France
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Combined Treatment with KV Channel Inhibitor 4-Aminopyridine and either γ-Cystathionine Lyase Inhibitor β-Cyanoalanine or Epinephrine Restores Blood Pressure, and Improves Survival in the Wistar Rat Model of Anaphylactic Shock. BIOLOGY 2022; 11:biology11101455. [PMID: 36290359 PMCID: PMC9598754 DOI: 10.3390/biology11101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Simple Summary Allergic diseases are presenting a constant increase all over the world and caused by such different substances as food, drugs, and pollens. Anaphylactic shock is the more severe complication of allergy which can induce death if the treatment is not administered immediately. Some patients do not respond to the recommended treatment, intra venous or intramuscular epinephrine. The pathophysiology of anaphylactic shock is still under investigation. The mediators released after the activation of mast cells and basophiles act on endothelial cells and smooth muscle cells, inducing the vasodilation responsible for hypotension and shock. Nitric oxide and hydrogen sulphide are both intracellular mediators that induce vasodilation. The role of potassium voltage dependent channels is suspected. We aimed to demonstrate the ability of a blocker of potassium voltage dependent channels, 4-aminopyridine, alone or in combination with inhibitors of cystathionine γ-lyase to restore blood pressure and improve survival in an ovalbumin rat anaphylactic shock model. The blockade of potassium voltage dependent channels alone or combined with inhibitors of cystathionine γ-lyase, dl-propargylglycine, or β-cyanoalanine restored blood pressure and improved survival. These findings suggest possible investigative treatment pathways for research concerning epinephrine-refractory anaphylactic shock in patients. Abstract The mechanism of anaphylactic shock (AS) remains incompletely understood. The potassium channel blocker 4-aminopyridine (4-AP), the inhibitors of cystathionine γ-lyase (ICSE), dl-propargylglycine (DPG) or β-cyanoalanine (BCA), and the nitric oxide (NO) synthase produce vasoconstriction and could be an alternative for the treatment of AS. The aim of this study was to demonstrate the ability of L-NAME, ICSE alone or in combination with 4-AP to restore blood pressure (BP) and improve survival in ovalbumin (OVA) rats AS. Experimental groups included non-sensitized Wistar rats (n = 6); AS (n = 6); AS (n = 10 per group) treated i.v. with 4-AP (AS+4-AP), epinephrine (AS+EPI), AS+DPG, AS+BCA, or with L-NAME (AS+L-NAME); or AS treated with drug combinations 4-AP+DPG, 4-AP+BCA, 4-AP+L-NAME, or 4-AP+EPI. AS was induced by i.v. OVA (1 mg). Treatments were administered i.v. one minute after AS induction. Mean arterial BP (MAP), heart rate (HR), and survival were monitored for 60 min. Plasma levels of histamine, prostaglandin E2 (PGE2) and F2 (PGF2α), leukotriene B4 and C4, angiotensin II, vasopressin, oxidative stress markers, pH, HCO3, PaO2, PaCO2, and K+ were measured. OVA induced severe hypotension and all AS rats died. Moreover, 4-AP, 4-AP+EPI, or 4-AP+BCA normalized both MAP and HR and increased survival. All sensitized rats treated with 4-AP alone or with 4-AP+BCA survived. The time-integrated MAP “area under the curve” was significantly higher after combined 4-AP treatment with ICSE. Metabolic acidosis was not rescued and NO, ICSE, and Kv inhibitors differentially alter oxidative stress and plasma levels of anaphylactic mediators. The AS-induced reduction of serum angiotensin II levels was prevented by 4-AP treatment alone or in combination with other drugs. Further, 4-AP treatment combined with EPI or with BCA also increased serum PGF2α, whereas only the 4-AP+EPI combination increased serum LTB4. Serum vasopressin and angiotensin II levels were increased by 4-AP treatment alone or in combination with other drugs. Moreover, 4-AP alone and in combination with inhibition of cystathionine γ-lyase or EPI normalizes BP, increases serum vasoconstrictor levels, and improves survival in the Wistar rat model of AS. These findings suggest possible investigative treatment pathways for research into epinephrine-refractory anaphylactic shock in patients.
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The Hypertensive Effect of Amphotericin B-Containing Liposomes (Abelcet) in Mice: Dissecting the Roles of C3a and C5a Anaphylatoxins, Macrophages and Thromboxane. Biomedicines 2022; 10:biomedicines10071764. [PMID: 35885068 PMCID: PMC9313435 DOI: 10.3390/biomedicines10071764] [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: 05/20/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Liposomal amphotericin B (Abelcet) can cause infusion (anaphylactoid) reactions in patients whose mechanism is poorly understood. Here, we used mice to investigate the role of complement (C) receptors and the cellular sources of vasoactive mediators in these reactions. Anesthetized male NMRI and thromboxane prostanoid receptor (TP) or cyclooxygenase-1 (COX-1)-deficient and wild type C57Bl6/N mice were intravenously injected with Abelcet at 30 mg/kg. Mean arterial blood pressure (MABP) and heart rate (HR) were measured. In untreated mice, Abelcet caused a short (15 min) but large (30%) increase in MABP. C depletion with cobra venom factor (CVF) and inhibition of C5a receptors with DF2593A considerably prolonged, while C3aR inhibition with SB290157 significantly decreased the hypertensive effect. Likewise, the hypertensive response was abolished in COX-1- and TP-deficient mice. CVF caused a late hypertension in TP-deficient mice. Both macrophage depletion with liposomal clodronate and blockade of platelet GPIIb/IIIa receptors with eptifibatide prolonged the hypertensive effect. The early phase of the hypertensive effect is COX-1- and TP-receptor-dependent, partly mediated by C3aR. In contrast, the late phase is under the control of vasoactive mediators released from platelets and macrophages subsequent to complement activation and C5a binding to its receptor.
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Alfalasi M, Alzaabi S, Östlundh L, Al-Rifai RH, Al-Salam S, Mertes PM, Alper SL, Aburawi EH, Bellou A. Effect of Nitric Oxide Pathway Inhibition on the Evolution of Anaphylactic Shock in Animal Models: A Systematic Review. BIOLOGY 2022; 11:biology11060919. [PMID: 35741440 PMCID: PMC9228251 DOI: 10.3390/biology11060919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 12/09/2022]
Abstract
Simple Summary Anaphylactic shock (AS) is the most serious consequence of anaphylaxis, with life-threatening sequelae including hypovolemia, shock, and arrhythmias. The literature lacks evidence for the effectiveness of interventions other than epinephrine in the acute phase of anaphylaxis. Our objective was to assess, through a systematic review, how inhibition of nitric oxide (NO) pathways affects blood pressure, and whether such blockade improves survival in AS animal models. AS was induced in all included studies after or before drug administration that targeted blockade of the NO pathway. In all animal species studied, the induction of AS caused a reduction in arterial blood pressure. However, the results show different responses to the inhibition of nitric oxide pathways. Overall, seven of fourteen studies using inhibition of nitric oxide pathways as pre-treatment before induction of AS showed improvement of survival and/or blood pressure. Four post-treatment studies from eight also showed positive outcomes. This review did not find strong evidence to propose modulation of blockade of the NO/cGMP pathway as a definitive treatment for AS in humans. Well-designed in vivo AS animal pharmacological models are needed to explore the other pathways involved, supporting the concept of pharmacological modulation. Abstract Nitric oxide (NO) induces vasodilation in various types of shock. The effect of pharmacological modulation of the NO pathway in anaphylactic shock (AS) remains poorly understood. Our objective was to assess, through a systematic review, whether inhibition of NO pathways (INOP) was beneficial for the prevention and/or treatment of AS. A predesigned protocol for this systematic review was published in PROSPERO (CRD42019132273). A systematic literature search was conducted till March 2022 in the electronic databases PubMed, EMBASE, Scopus, Cochrane and Web of Science. Heterogeneity of the studies did not allow meta-analysis. Nine hundred ninety unique studies were identified. Of 135 studies screened in full text, 17 were included in the review. Among six inhibitors of NO pathways identified, four blocked NO synthase activity and two blocked guanylate cyclase downstream activity. Pre-treatment was used in nine studies and post-treatment in three studies. Five studies included both pre-treatment and post-treatment models. Overall, seven pre-treatment studies from fourteen showed improvement of survival and/or arterial blood pressure. Four post-treatment studies from eight showed positive outcomes. Overall, there was no strong evidence to conclude that isolated blockade of the NO/cGMP pathway is sufficient to prevent or restore anaphylactic hypotension. Further studies are needed to analyze the effect of drug combinations in the treatment of AS.
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Affiliation(s)
- Maryam Alfalasi
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; (M.A.); (S.A.)
| | - Sarah Alzaabi
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; (M.A.); (S.A.)
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates;
| | - Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates;
| | - Suhail Al-Salam
- Department of Pathology, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates;
| | - Paul Michel Mertes
- Department of Anesthesia and Intensive Care, University Hospital of Strasbourg, 67091 Strasbourg, France;
- Faculty of Medicine, EA 3072, Federation of Translational Medicine, University of Strasbourg, 67091 Strasbourg, France
| | - Seth L. Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Elhadi H. Aburawi
- Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates;
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Academy of Medical Sciences of Guangdong, Guangzhou 510060, China
- Department of Emergency Medicine, Academy of Medical Sciences of Guangdong, Guangzhou 510060, China
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Correspondence:
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Oulehri W, Collange O, Tacquard C, Bellou A, Graff J, Charles AL, Geny B, Mertes PM. Impaired Myocardial Mitochondrial Function in an Experimental Model of Anaphylactic Shock. BIOLOGY 2022; 11:730. [PMID: 35625458 PMCID: PMC9139016 DOI: 10.3390/biology11050730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 12/07/2022]
Abstract
Anaphylactic shock (AS) is associated with a profound vasodilation and cardiac dysfunction. The cellular mechanisms underlying AS-related cardiac dysfunction are unknown. We hypothesized that myocardial mitochondrial dysfunction may be associated with AS cardiac dysfunction. In controls and sensitized Brown Norway rats, shock was induced by ovalbumin i.v bolus, and abdominal aortic blood flow (ABF), systemic mean arterial pressure (MAP), and lactatemia were measured for 15 min. Myocardial mitochondrial function was assessed with the evaluation of mitochondrial respiration, oxidative stress production by reactive oxygen species (ROS), reactive nitrogen species (RNS), and the measurement of superoxide dismutases (SODs) activity. Oxidative damage was assessed by lipid peroxidation. The mitochondrial ultrastructure was assessed using transmission electronic microscopy. AS was associated with a dramatic drop in ABF and MAP combined with a severe hyperlactatemia 15 min after shock induction. CI-linked substrate state (197 ± 21 vs. 144 ± 21 pmol/s/mg, p < 0.05), OXPHOS activity by complexes I and II (411 ± 47 vs. 246 ± 33 pmol/s/mg, p < 0.05), and OXPHOS activity through complex II (316 ± 40 vs. 203 ± 28 pmol/s/mg, p < 0.05) were significantly impaired. ROS and RNS production was not significantly increased, but SODs activity was significantly higher in the AS group (11.15 ± 1.02 vs. 15.50 ± 1.40 U/mL/mg protein, p = 0.02). Finally, cardiac lipid peroxidation was significantly increased in the AS group (8.50 ± 0.67 vs. 12.17 ± 1.44 µM/mg protein, p < 0.05). No obvious changes were observed in the mitochondrial ultrastructure between CON and AS groups. Our experimental model of AS results in rapid and deleterious hemodynamic effects and was associated with a myocardial mitochondrial dysfunction with oxidative damage and without mitochondrial ultrastructural injury.
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Affiliation(s)
- Walid Oulehri
- Pôle Anesthésie, Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (W.O.); (O.C.); (C.T.)
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
| | - Olivier Collange
- Pôle Anesthésie, Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (W.O.); (O.C.); (C.T.)
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
| | - Charles Tacquard
- Pôle Anesthésie, Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (W.O.); (O.C.); (C.T.)
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Academy of Medical Sciences, Guangdong General People Hospital, Guangzhou 510060, China;
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Global Healthcare Network & Research Innovation Institute LLC, Brookline, MA 02446, USA
| | - Julien Graff
- Faculté de Médecine de Strasbourg, Institut d’Histologie, Service Central de Microscopie Électronique, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France;
| | - Anne-Laure Charles
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
- Service de Physiologie et d’Explorations Fonctionnelles, Pôle de Pathologie Thoracique, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Bernard Geny
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
- Service de Physiologie et d’Explorations Fonctionnelles, Pôle de Pathologie Thoracique, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Paul-Michel Mertes
- Pôle Anesthésie, Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (W.O.); (O.C.); (C.T.)
- Faculté de Médecine de Strasbourg, UR 3072 Institut de Physiologie, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, 67091 Strasbourg, France; (A.-L.C.); (B.G.)
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Gouel-Cheron A, Neukirch C, Kantor E, Malinovsky JM, Tacquard C, Montravers P, Mertes PM, Longrois D. Clinical reasoning in anaphylactic shock: addressing the challenges faced by anaesthesiologists in real time: A clinical review and management algorithms. Eur J Anaesthesiol 2021; 38:1158-1167. [PMID: 33973926 DOI: 10.1097/eja.0000000000001536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute hypersensitivity reactions to drugs occur infrequently during anaesthesia and the peri-operative period. When clinical presentation includes the classical triad, erythema, cardiovascular abnormalities and increased airway pressure, the diagnosis is evident and the challenge is to prescribe a therapeutic regimen according to guidelines and to manage refractory signs in a timely manner. In many situations, however, the initial clinical signs are isolated, such as increased airway pressure or arterial hypotension. Rendering a differential diagnosis with causes and mechanisms other than acute hypersensitivity reactions (AHRs) is difficult, delaying treatment with possible worsening of the clinical signs, and even death, in previously healthy individuals. In these difficult diagnostic situations, clinical reasoning is mandatory, and guidelines do not explicitly explain the elements on which clinical reasoning can be built. In this article, based on clinical evidence whenever available, experimental data and pathophysiology, we propose algorithms that have been evaluated by experts. The goal of these algorithms is to provide explicit elements on which the differential diagnosis of AHRs can be made, accelerating the implementation of adequate therapy.
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Affiliation(s)
- Aurelie Gouel-Cheron
- From the Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP (AGC, EK, PM, DL), Antibody in Therapy and Pathology, Pasteur Institute, UMR 1222 INSERM, Paris, France (AGC), Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (AGC), Pulmonology Department, Bichat Hospital, AP-HP, Paris University (CN), INSERM UMR 1152, Paris University, DHU FIRE, Paris (CN, PM), Anaesthesiology and Critical Care Medicine Department, Maison Blanche Hospital, Centre Hospitalier Universitaire de Reims, Reims (JM-M), Anaesthesiology and Critical Care Medicine Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (CT, PM-M), Paris University (PM, DL), EA 3072, Institut de Physiologie, FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg (PM-M) and INSERM1148, Paris, France (DL)
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Tacquard C, Oulehri W, Collange O, Garvey LH, Nicoll S, Tuzin N, Geny B, Mertes PM. Treatment with a platelet‐activating factor receptor antagonist improves hemodynamics and reduces epinephrine requirements, in a lethal rodent model of anaphylactic shock. Clin Exp Allergy 2019; 50:383-390. [DOI: 10.1111/cea.13540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Charles Tacquard
- Department of anesthesia and intensive care Hôpitaux Universitaires de Strasbourg Nouvel Hôpital Civil Strasbourg France
- Groupe Méthode en Recherche Clinique Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil Strasbourg France
| | - Walid Oulehri
- Department of anesthesia and intensive care Hôpitaux Universitaires de Strasbourg Nouvel Hôpital Civil Strasbourg France
- EA 3072, Fédération de Médecine Translationnelle, Faculté de Médecine Université de Strasbourg Strasbourg France
| | - Olivier Collange
- Department of anesthesia and intensive care Hôpitaux Universitaires de Strasbourg Nouvel Hôpital Civil Strasbourg France
- EA 3072, Fédération de Médecine Translationnelle, Faculté de Médecine Université de Strasbourg Strasbourg France
| | - Lene H. Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy Copenhagen University Hospital Gentofte Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Susan Nicoll
- Department of Anaesthesia Christchurch Hospital Christchurch New Zealand
| | - Nicolas Tuzin
- Groupe Méthode en Recherche Clinique Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil Strasbourg France
| | - Bernard Geny
- EA 3072, Fédération de Médecine Translationnelle, Faculté de Médecine Université de Strasbourg Strasbourg France
| | - Paul M. Mertes
- Department of anesthesia and intensive care Hôpitaux Universitaires de Strasbourg Nouvel Hôpital Civil Strasbourg France
- EA 3072, Fédération de Médecine Translationnelle, Faculté de Médecine Université de Strasbourg Strasbourg France
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Al-Salam S, Aburawi EH, Al-Hammadi S, Dhanasekaran S, Shafiuallah M, Yasin J, Sudhadevi M, Awwad A, Alper SL, Kazzam EE, Bellou A. Cellular and Immunohistochemical Changes in Anaphylactic Shock Induced in the Ovalbumin-Sensitized Wistar Rat Model. Biomolecules 2019; 9:biom9030101. [PMID: 30871269 PMCID: PMC6468713 DOI: 10.3390/biom9030101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
Anaphylactic shock (AS) is a life-threatening, multisystem disorder arising from sudden release of mast cell- and basophil-derived mediators into the circulation. In this study, we have used a Wistar rat model to investigate AS-associated histopathologic changes in various organs. Rats were sensitized with ovalbumin (1 mg s.c), and AS was induced by intravenous injection of ovalbumin (1 mg). Experimental groups included nonallergic rats (n = 6) and allergic rats (n = 6). Heart rate and blood pressure were monitored during one hour. Organs were harvested at the end of the experiment and prepared for histologic and immunohistochemical studies. Lung, small bowel mucosa and spleen were found to undergo heavy infiltration by mast cells and eosinophils, with less prominent mast cell infiltration of cardiac tissue. The mast cells in lung, small bowel and spleen exhibited increased expression of tryptase, c-kit and induced nitric oxide synthase (iNOS). Increased expression of endothelial nitric oxide synthase (eNOS) by vascular endothelial cells was noted principally in lung, heart and small bowel wall. The Wistar rat model of AS exhibited accumulation of mast cells and eosinophils in the lung, small bowel, and spleen to a greater extent than in the heart. We conclude that lung and gut are principal inflammatory targets in AS, and likely contribute to the severe hypotension of AS. Targeting nitric oxide (NO) production may help reduce AS mortality.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Elhadi H Aburawi
- Department of Paediatrics, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Suleiman Al-Hammadi
- Department of Paediatrics, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | | | - Mohamed Shafiuallah
- Department of Pharmacology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Javed Yasin
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Manjusha Sudhadevi
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Aktham Awwad
- Department of Laboratory Medicine, Tawam Hospital, AlAin 15258, Abu Dhabi, UAE.
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA 02215, USA.
| | - Elsadig E Kazzam
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, AlAin 17666, Abu Dhabi, UAE.
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
- Global HealthCare Network & Research Innovation Institute, Brookline, MA 02446, USA.
- International Board of Medicine and Surgery, Tampa, FL 34677, USA.
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Mukai K, Kuda Y, Shibamoto T, Tanida M, Kurata Y, Yokoyama H. Renal response to anaphylaxis in anesthetized rats and isolated perfused rat kidneys: roles of nitric oxide. J Physiol Sci 2018; 68:689-697. [PMID: 29209891 PMCID: PMC10717926 DOI: 10.1007/s12576-017-0583-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022]
Abstract
We determined the renal responses to anaphylaxis and the effects of a nitric oxide synthesis inhibitor, L-NAME, in anesthetized rats and isolated perfused rat kidneys. After the ovalbumin antigen injection, the sensitized rats showed transient and substantial decreases in mean blood pressure and renal blood flow and an increase in renal vascular resistance. Creatinine clearance, a measure of renal function, decreased to 53% baseline at 2 h after antigen. L-NAME pretreatment significantly enhanced the antigen-induced renal vasoconstriction and renal dysfunction. Moreover, plasma creatinine levels significantly increased only in the L-NAME pretreated rats. Separately, in isolated perfused kidneys, we observed the antigen-induced renal vasoconstriction and its augmentation by L-NAME. In conclusion, the renal vascular response to the antigen is vasoconstriction, which is enhanced by L-NAME in both isolated perfused rat kidneys and anesthetized rats; it is accompanied by renal dysfunction, which is also augmented by L-NAME.
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Affiliation(s)
- Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Yuhichi Kuda
- Department of Physiology II, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Toshishige Shibamoto
- Department of Physiology II, Kanazawa Medical University, Ishikawa, 920-0293, Japan.
| | - Mamoru Tanida
- Department of Physiology II, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Yasutaka Kurata
- Department of Physiology II, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
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4-Aminopyridine, A Blocker of Voltage-Dependent K+ Channels, Restores Blood Pressure and Improves Survival in the Wistar Rat Model of Anaphylactic Shock. Crit Care Med 2017; 44:e1082-e1089. [PMID: 27270180 DOI: 10.1097/ccm.0000000000001822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN Experimental study. SETTING Physiology laboratory. SUBJECTS Adult male Wistar rats. INTERVENTIONS Rats were sensitized with ovalbumin (1 mg SC), and anaphylactic shock was induced by IV injection of ovalbumin (1 mg). Experimental groups included non-allergic rats (NA) (n = 6); allergic rats (Controls) (n = 6); allergic rats treated with 4-aminopyridine (4-aminopyridine) (1 mg/kg) (n = 6); and allergic rats treated with epinephrine (EPI) (10 µg/kg) (n = 6). Treatments were administered 1 minute after induction of anaphylactic shock. MEASUREMENTS AND MAIN RESULTS Mean arterial blood pressure, heart rate, and survival were measured for 60 minutes. Plasma levels of histamine, leukotriene B4, prostaglandin E2, prostaglandin F2, pH, and HCO3 were measured. Mean arterial blood pressure was normal in the NA group; severe hypotension and high mortality were observed in controls; normalization of mean arterial blood pressure, heart rate, and increased survival were observed in 4-aminopyridine and EPI groups. All allergic 4-aminopyridine-treated rats survived after the induction of anaphylactic shock. Histamine level was higher in controls and the 4-aminopyridine group but reduced in the EPI group. Prostaglandin E2 increased in controls and EPI group and decreased in 4-aminopyridine group; prostaglandin F2 increased in controls but decreased in 4-aminopyridine and EPI groups. Leukotriene B4 decreased in 4-aminopyridine and EPI groups. Metabolic acidosis was prevented in the 4-aminopyridine group. CONCLUSIONS Our data suggest that voltage-dependent K+ channel inhibition with 4-aminopyridine treatment restores blood pressure and increases survival in the Wistar rat model of anaphylactic shock. 4-aminopyridine or related voltage-dependent K channel blockers could be a useful additional therapeutic approach to treatment of refractory anaphylactic shock.
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Zheng F, Copotoiu R, Tacquard C, Demoulin B, Malinovsky JM, Levy B, Longrois D, Barthel G, Mertes PM, Marchal F, Demoulin-Alexikova S, Collange O. Epinephrine but not vasopressin attenuates the airway response to anaphylactic shock in rats. Exp Lung Res 2017; 43:158-166. [DOI: 10.1080/01902148.2017.1323981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Feng Zheng
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ruxandra Copotoiu
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Charles Tacquard
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Bruno Demoulin
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Jean Marc Malinovsky
- Service d'Anesthésie-réanimation, Pôle URAD (Urgences – Réanimation- Anesthésie- Douleur), Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, CHU Nancy, Vandoeuvre les Nancy, France
- Inserm U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm U1148, Université Paris 7, Paris, France
| | - Grégoire Barthel
- Département d'Anesthésie-Réanimation, CHU Nancy, Vandoeuvre les Nancy, France
| | - Paul Michel Mertes
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - François Marchal
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450, Laboratoire de Physiologie, Université de Lorraine, Vandoeuvre les Nancy, France
- Explorations fonctionnelles pédiatriques, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Olivier Collange
- Service d'Anesthésie-Réanimation Chirurgicale, Pôle Anesthésie, Réanimations Chirurgicales, SAMU-SMUR, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
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Dhanasekaran S, Nemmar A, Aburawi EH, Kazzam EE, Abdulle A, Bellou M, Bellou A. Glyburide, a K+ATP channel blocker, improves hypotension and survival in anaphylactic shock induced in Wistar rats sensitized to ovalbumin. Eur J Pharmacol 2013. [DOI: 10.1016/j.ejphar.2013.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shmuel DL, Cortes Y. Anaphylaxis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2013; 23:377-94. [PMID: 23855441 DOI: 10.1111/vec.12066] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/27/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review and summarize current information regarding the pathophysiology and clinical manifestations associated with anaphylaxis in dogs and cats. The etiology, diagnosis, treatment, and prognosis is discussed. ETIOLOGY Anaphylaxis is a systemic, type I hypersensitivity reaction that often has fatal consequences. Many of the principal clinical manifestations involve organs where mast cell concentrations are highest: the skin, the lungs, and the gastrointestinal tract. Histamine and other deleterious inflammatory mediators promote vascular permeability and smooth muscle contraction; they are readily released from sensitized mast cells and basophils challenged with antigen. Anaphylaxis may be triggered by a variety of antigens including insect and reptile venom, a variety of drugs, vaccines, and food. DIAGNOSIS Anaphylaxis is a clinical diagnosis made from a collection of signs and symptoms. It is most commonly based on pattern recognition. Differential diagnoses include severe asthma, pheocromocytoma, and mastocytosis. THERAPY Epinephrine is considered the drug of choice for the treatment of anaphylaxis. It acts primarily as a vasopressor in improving hemodynamic recovery. Adjunctive treatments include fluid therapy, H1 and H2 antihistamines, corticosteroids, and bronchodilators; however, these do not substitute for epinephrine. PROGNOSIS Prognosis depends on the severity of the clinical signs. The clinical signs will vary among species and route of exposure. The most severe clinical reactions are associated when the antigen is administered parenterally.
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Affiliation(s)
- Daniella L Shmuel
- Oradell Animal Hospital, Emergency and Critical Care, 580 Winters Avenue, Paramus, NJ 07652, USA.
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15
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Barthel G, Zheng F, Demoulin B, Davidson J, Montémont C, Gaburro J, Mertes PM, Marchal F. Biphasic airway-lung response to anaphylactic shock in Brown Norway rats. Respir Physiol Neurobiol 2013; 189:47-51. [PMID: 23835280 DOI: 10.1016/j.resp.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
Bronchospasm may be part of the response to systemic anaphylaxis in humans. The anaphylactic shock has been characterized in allergic rats, but little data are available on the concurrent changes in airway-lung mechanics. The aim was to describe the respiratory resistance (Rrs) and reactance (Xrs) response to ovalbumin (OVA) induced systemic anaphylaxis in allergic rats. Thirty five anesthetized and mechanically ventilated Brown Norway rats were randomly allocated to OVA (n=20) or vehicle (n=15) sensitization and provocation. Rrs and Xrs were obtained by the forced oscillation technique at 20 Hz. Allergic rats showed dramatic and reproducible concurrent Rrs peak and Xrs through within 4 min of OVA injection (p<0.0001). Thereafter, Rrs returned to baseline while Xrs remained significantly more negative (p<0.0001). It is concluded that systemic anaphylaxis in allergic rats is associated with severe early acute inhomogeneous bronchoconstriction followed by pulmonary interstitial/small airspace edema. The model may be of interest to assess treatments targeting the associated bronchoconstriction and/or airway vascular leakage.
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Affiliation(s)
- G Barthel
- Groupe Choc, Contrat Avenir INSERM U961, Faculté de Médecine, Université de Lorraine, Nancy, France; Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Central, CHU de Nancy, Nancy, France
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17
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Abstract
PURPOSE OF REVIEW This article aims to make a review of the up-to-date knowledge on anaphylaxis and outline the recent advances on pathophysiology, diagnosis, and management of anaphylaxis. RECENT FINDINGS New data confirm the increase in prevalence of anaphylaxis and emphasize immunopathologic mechanisms. However, anaphylaxis is often underdiagnosed and guidelines are poorly applied, particularly in emergency departments. SUMMARY An improvement of rapid diagnosis and treatment combined with education of population will decrease mortality and morbidity of anaphylaxis.
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Anaphylactic Shock Decreases Cerebral Blood Flow More Than What Would Be Expected From Severe Arterial Hypotension. Shock 2012; 38:429-35. [DOI: 10.1097/shk.0b013e3182690897] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Menardi AC, Capellini VK, Celotto AC, Albuquerque AAS, Viaro F, Vicente WVA, Rodrigues AJ, Evora PRB. Methylene blue administration in the compound 48/80-induced anaphylactic shock: hemodynamic study in pigs. Acta Cir Bras 2012; 26:481-9. [PMID: 22042112 DOI: 10.1590/s0102-86502011000600013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 07/27/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify if the methylene blue (MB) administration prevents and/or reverses the compound 48/80 (C48/80)-induced anaphylactic shock in pigs. METHODS Female Dalland pigs were anesthetized and had the hemodynamic parameters recorded during the necessary time to administer some drugs and observe their effect. The animals were randomly assigned to one of the five groups: 1) control; 2) MB: the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 3) C48/80: the animals received a bolus injection of C48/80 (4 mg/kg); 4) C48/80+MB: the animals received a bolus injection of C48/80 (4 mg/kg) and 10 minutes after the C48/80 administration the animals received a bolus injection of MB (2 mg/kg) followed by continuous infusion of MB (2.66 mg/Kg/h delivered by syringe infusion pump); 5) MB+C48/80: the animals received a bolus injection of MB (2 mg/kg) and 3 minutes later they received a bolus injection of C48/80 (4 mg/kg). RESULTS The intravenous infusion of MB alone caused no changes in the mean arterial pressure (MAP) showing that the administered MB dose was safe in this experimental model. The C48/80 was effective in producing experimental anaphylactic shock since it was observed a decrease in both MAP and cardiac output (CO) after its administration. The MB did not prevent or reverse the C48/80-induced anaphylactic shock in this model. In fact, the MAP of the animals with anaphylactic shock treated with MB decreased even more than the MAP of the animals from the C48/80 group. On the other hand, the C48/80-induced epidermal alterations disappeared after the MB infusion. CONCLUSION Despite our data, the clinical manifestations improvement brings some optimism and does not allow excluding the MB as a possible therapeutic option in the anaphylactic shock.
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Vadas P, Perelman B. Effect of epinephrine on platelet-activating factor-stimulated human vascular smooth muscle cells. J Allergy Clin Immunol 2012; 129:1329-33. [PMID: 22460068 DOI: 10.1016/j.jaci.2012.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 02/19/2012] [Accepted: 02/22/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Animal and human data show that platelet-activating factor (PAF) mediates the life-threatening manifestations of anaphylaxis. Although administration of epinephrine is the mainstay of therapy of acute anaphylaxis, the interaction between epinephrine and PAF has not been studied. In particular, the effect of the timing of epinephrine administration on the action of PAF has not been examined. OBJECTIVE Using human vascular smooth muscle cells (HVSMCs), we examined the effect of timing of epinephrine addition on the action of PAF. METHODS The effect of epinephrine on PAF-mediated prostaglandin E(2) (PGE(2)) release from human aortic smooth muscle cells was examined. Epinephrine was added at various times before and after PAF stimulation. RESULTS HVSMCs stimulated with PAF released PGE(2) in a concentration- and time-dependent manner. Whereas preincubation of HVSMCs with epinephrine before the addition of PAF suppressed PGE(2) release, treatment with epinephrine after PAF stimulation was less effective with time after PAF stimulation. PGE(2) release was suppressed by means of preincubation with 8-bromo-cyclic AMP and forskolin. CONCLUSIONS PAF induced PGE(2) release from HVSMCs in a concentration- and time-dependent manner, and early addition of epinephrine was essential for the control of PAF-induced PGE(2) release. Epinephrine was most effective when administered before stimulation with PAF but was progressively less effective with time after PAF stimulation.
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Affiliation(s)
- Peter Vadas
- Department of Medicine, Division of Allergy and Clinical Immunology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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21
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Watts SW, Morrison SF, Davis RP, Barman SM. Serotonin and blood pressure regulation. Pharmacol Rev 2012; 64:359-88. [PMID: 22407614 DOI: 10.1124/pr.111.004697] [Citation(s) in RCA: 255] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
5-Hydroxytryptamine (5-HT; serotonin) was discovered more than 60 years ago as a substance isolated from blood. The neural effects of 5-HT have been well investigated and understood, thanks in part to the pharmacological tools available to dissect the serotonergic system and the development of the frequently prescribed selective serotonin-reuptake inhibitors. By contrast, our understanding of the role of 5-HT in the control and modification of blood pressure pales in comparison. Here we focus on the role of 5-HT in systemic blood pressure control. This review provides an in-depth study of the function and pharmacology of 5-HT in those tissues that can modify blood pressure (blood, vasculature, heart, adrenal gland, kidney, brain), with a focus on the autonomic nervous system that includes mechanisms of action and pharmacology of 5-HT within each system. We compare the change in blood pressure produced in different species by short- and long-term administration of 5-HT or selective serotonin receptor agonists. To further our understanding of the mechanisms through which 5-HT modifies blood pressure, we also describe the blood pressure effects of commonly used drugs that modify the actions of 5-HT. The pharmacology and physiological actions of 5-HT in modifying blood pressure are important, given its involvement in circulatory shock, orthostatic hypotension, serotonin syndrome and hypertension.
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Affiliation(s)
- Stephanie W Watts
- Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI 48824-1317, USA.
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Longrois D, Lejus C, Constant I, Bruyère M, Mertes PM. [Treatment of hypersensitivity reactions and anaphylactic shock occurring during anaesthesia]. ACTA ACUST UNITED AC 2011; 30:312-22. [PMID: 21377314 DOI: 10.1016/j.annfar.2010.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Longrois
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, Paris cedex 18, France
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Kamikado C, Shibamoto T, Zhang W, Kuda Y, Ohmukai C, Kurata Y. Portacaval shunting attenuates portal hypertension and systemic hypotension in rat anaphylactic shock. J Physiol Sci 2011; 61:161-6. [PMID: 21181324 PMCID: PMC10717408 DOI: 10.1007/s12576-010-0123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/18/2010] [Indexed: 11/30/2022]
Abstract
Anaphylactic shock in rats is characterized by antigen-induced hepatic venoconstriction and the resultant portal hypertension. We determined the role of portal hypertension in anaphylactic hypotension by using the side-to-side portacaval shunt- and sham-operated rats sensitized with ovalbumin (1 mg). We measured the mean arterial blood pressure (MAP), portal venous pressure (PVP), and central venous pressure (CVP) under pentobarbital anesthesia and spontaneous breathing. Anaphylactic hypotension was induced by an intravenous injection of ovalbumin (0.6 mg). In sham rats, the antigen caused not only an increase in PVP from 11.3 cmH(2)O to the peak of 27.9 cmH(2)O but also a decrease in MAP from 103 mmHg to the lowest value of 41 mmHg. CVP also decreased significantly after the antigen. In the portacaval shunt rats, in response to the antigen, PVP increased slightly, but significantly, to the peak of 17.5 cmH(2)O, CVP did not decrease, and MAP decreased to a lesser degree with the lowest value being 60 mmHg. These results suggest that the portacaval shunt attenuated anaphylactic portal hypertension and venous return decrease, partially preventing anaphylactic hypotension. In conclusion, portal hypertension is involved in rat anaphylactic hypotension presumably via splanchnic congestion resulting in decreased venous return and thus systemic arterial hypotension.
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Affiliation(s)
- Chiaki Kamikado
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
| | - Toshishige Shibamoto
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
| | - Wei Zhang
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
- Department of Pathophysiology, Medical College of Qinghai University, Xining, 810001 China
| | - Yuhichi Kuda
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
| | - Chieko Ohmukai
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
| | - Yasutaka Kurata
- Department of Physiology II, Kanazawa Medical University, Uchinada Ishikawa, 920-0293 Japan
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7-NITROINDAZOLE, BUT NOT L-NAME OR AMINOGUANIDINE, ATTENUATES ANAPHYLACTIC HYPOTENSION IN CONSCIOUS RATS. Shock 2009; 31:201-6. [DOI: 10.1097/shk.0b013e31817c05bc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schummer C, Wirsing M, Schummer W. The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock. Anesth Analg 2008; 107:620-4. [DOI: 10.1213/ane.0b013e3181770b42] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shibamoto T, Shimo T, Cui S, Zhang W, Takano H, Kurata Y, Tsuchida H. The roles of mast cells and Kupffer cells in rat systemic anaphylaxis. Am J Physiol Regul Integr Comp Physiol 2007; 293:R2202-9. [DOI: 10.1152/ajpregu.00613.2007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mast cells and other cells such as macrophages have been shown to mediate systemic anaphylaxis. We determined the roles of mast cells and Kupffer cells in hepatic and systemic anaphylaxis of rats. Roles of mast cells were examined by using the mast cell-deficient white spotting (Ws/Ws) rat; the Ws/Ws and wild type (+/+) rats were sensitized with ovalbumin (1 mg). Roles of Kupffer cells were examined by depleting Kupffer cells using gadolinium chloride or liposome-encapsulated dichloromethylene diphosphonate in the Ws/Ws and Sprague-Dawley rats. An intravenous injection of 0.6 mg ovalbumin caused substantial anaphylactic hypotension in both the Ws/Ws and +/+ rats; however, the occurrence was delayed in the Ws/Ws rats. After antigen, portal venous pressure increased by 13.1 cmH2O in the +/+ rats, while it increased only by 5.7 cmH2O in the Ws/Ws rats. In response to antigen, the isolated perfused liver of the Ws/Ws rats also showed weak venoconstriction, the magnitude of which was one tenth as large as that of the +/+ rats, indicating that hepatic anaphylaxis was primarily due to mast cells. In contrast, Kupffer cell depletion did not attenuate anaphylactic hepatic venoconstriction in isolated perfused livers. In conclusion, mast cells are involved mainly in anaphylactic hepatic presinusoidal portal venoconstriction but only in the early stage of anaphylactic systemic hypotension in rats. Macrophages, including Kupffer cells, do not participate in rat hepatic anaphylactic venoconstriction.
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Abstract
Refractory hypotension with end-organ hypoperfusion and failure is an ominous feature of shock. Distributive shock is caused by severe infections (septic shock) or severe systemic allergic reactions (anaphylactic shock). In 1986, it was concluded that nitric oxide (NO) is the endothelium-derived relaxing factor that had been discovered 6 years earlier. Since then, NO has been shown to be important for the physiological and pathological control of vascular tone. Nevertheless, although inhibition of NO synthesis restores blood pressure, NO synthase (NOS) inhibition cannot improve outcome, on the contrary. This implies that NO acts as a double-edged sword during septic shock. Consequently, the focus has shifted towards selective inducible NOS (iNOS) inhibitors. The contribution of NO to anaphylactic shock seems to be more straightforward, as NOS inhibition abrogates shock in conscious mice. Surprisingly, however, this shock-inducing NO is not produced by the inducible iNOS, but by the so-called constitutive enzyme endothelial NOS. This review summarizes the contribution of NO to septic and anaphylactic shock. Although NOS inhibition may be promising for the treatment of anaphylactic shock, the failure of a phase III trial indicates that other approaches are required for the successful treatment of septic shock. Amongst these, high hopes are set for selective iNOS inhibitors. But it might also be necessary to shift gears and focus on downstream cardiovascular targets of NO or on other vasodilating phenomena.
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Affiliation(s)
- A Cauwels
- Department for Molecular Biomedical Research, VIB, Technologiepark 927, B-9052 Ghent, Belgium.
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Abstract
Anaphylaxis is a severe immediate-type hypersensitivity reaction characterized by life-threatening upper airway obstruction bronchospasm and hypotension. Although many episodes are easy to diagnose by the combination of characteristic skin features with other organ effects, this is not always the case and a workable clinical definition of anaphylaxis and useful biomarkers of the condition have been elusive. A recently proposed consensus definition is ready for prospective validation. The cornerstones of management are the supine position, adrenaline and volume resuscitation. An intramuscular dose of adrenaline is generally recommended to initiate treatment. If additional adrenaline is required, then a controlled intravenous infusion might be more efficacious and safer than intravenous bolus administration. Additional bronchodilator treatment with continuous salbutamol and corticosteroids are used for severe and/or refractory bronchospasm. Aggressive volume resuscitation, selective vasopressors, atropine (for bradycardia), inotropes that bypass the beta-adrenoreceptor and bedside echocardiographic assessment should be considered for hypotension that is refractory to treatment. Management guidelines continue to be opinion- and consensus-based, with retrospective studies accounting for the vast majority of clinical research papers on the topic. The clinical spectrum of anaphylaxis including major disease subgroups requires clarification, and validated scoring systems and outcome measures are needed to enable good-quality prospective observational studies and randomized controlled trials. A systematic approach with multicentre collaboration is required to improve our understanding and management of this disease.
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Affiliation(s)
- Simon G A Brown
- Discipline of Emergency Medicine, The University of Western Australia and Fremantle Hospital, Fremantle, Western Australia, Australia.
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Cauwels A, Janssen B, Buys E, Sips P, Brouckaert P. Anaphylactic shock depends on PI3K and eNOS-derived NO. J Clin Invest 2006; 116:2244-51. [PMID: 16886062 PMCID: PMC1523420 DOI: 10.1172/jci25426] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 05/02/2006] [Indexed: 11/17/2022] Open
Abstract
Anaphylactic shock is a sudden, life-threatening allergic reaction associated with severe hypotension. Platelet-activating factor (PAF) is implicated in the cardiovascular dysfunctions occurring in various shock syndromes, including anaphylaxis. Excessive production of the vasodilator NO causes inflammatory hypotension and shock, and it is generally accepted that transcriptionally regulated inducible iNOS is responsible for this. Nevertheless, the contribution of NO to PAF-induced shock or anaphylactic shock is still ambiguous. We studied PAF and anaphylactic shock in conscious mice. Surprisingly, hyperacute PAF shock depended entirely on NO, produced not by inducible iNOS, but by constitutive eNOS, rapidly activated via the PI3K pathway. Soluble guanylate cyclase (sGC) is generally regarded as the principal vasorelaxing mediator of NO. Nevertheless, although methylene blue partially prevented PAF shock, neither 1H-[1,2,4]oxadiazole[4,3-a]quinoxalin-1-one (ODQ) nor sGCalpha1 deficiency did. Also, in 2 different models of active systemic anaphylaxis, inhibition of NOS, PI3K, or Akt or eNOS deficiency provided complete protection. In contrast to the unsubstantiated paradigm that only excessive iNOS-derived NO underlies cardiovascular collapse in shock, our data strongly support the unexpected concept that eNOS-derived NO is the principal vasodilator in anaphylactic shock and define eNOS and/or PI3K or Akt as new potential targets for treating anaphylaxis.
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Affiliation(s)
- Anje Cauwels
- Molecular Pathophysiology and Experimental Therapy Unit, Department for Molecular Biomedical Research, Ghent University, Belgium, and Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, USA.
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Shibamoto T, Cui S, Ruan Z, Liu W, Takano H, Kurata Y. Hepatic venoconstriction is involved in anaphylactic hypotension in rats. Am J Physiol Heart Circ Physiol 2005; 289:H1436-41. [PMID: 15923315 DOI: 10.1152/ajpheart.00368.2005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We determined the roles of liver and splanchnic vascular bed in anaphylactic hypotension in anesthetized rats and the effects of anaphylaxis on hepatic vascular resistances and liver weight in isolated perfused rat livers. In anesthetized rats sensitized with ovalbumin (1 mg), an intravenous injection of 0.6 mg ovalbumin caused not only a decrease in systemic arterial pressure from 120 ± 9 to 43 ± 10 mmHg but also an increase in portal venous pressure that persisted for 20 min after the antigen injection (the portal hypertension phase). The elimination of the splanchnic vascular beds, by the occlusions of the celiac and mesenteric arteries, combined with total hepatectomy attenuated anaphylactic hypotension during the portal hypertension phase. For the isolated perfused rat liver experiment, the livers derived from sensitized rats were hemoperfused via the portal vein at a constant flow. Using the double-occlusion technique to estimate the hepatic sinusoidal pressure, presinusoidal ( Rpre) and postsinusoidal ( Rpost) resistances were calculated. An injection of antigen (0.015 mg) caused venoconstriction characterized by an almost selective increase in Rpre rather than Rpost and liver weight loss. Taken together, these results suggest that liver and splanchnic vascular beds are involved in anaphylactic hypotension presumably because of anaphylactic presinusoidal contraction-induced portal hypertension, which induced splanchnic congestion resulting in a decrease in circulating blood volume and thus systemic arterial hypotension.
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Affiliation(s)
- Toshishige Shibamoto
- Department of Physiology, Kanazawa Medical University, Uchinada Ishikawa 920-0293, Japan.
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Brown SGA. Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis. Curr Opin Allergy Clin Immunol 2005; 5:359-64. [PMID: 15985820 DOI: 10.1097/01.all.0000174158.78626.35] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Anaphylactic cardiovascular collapse can be resistant to treatment with epinephrine (adrenaline) and, in some cases, diagnostic uncertainty compromises follow-up care. The purpose of this review is to examine recent studies relevant to the management and diagnosis of this condition. RECENT FINDINGS Nausea, vomiting, incontinence, diaphoresis, dyspnoea, hypoxia, dizziness and collapse are associated with hypotension. Relative bradycardia (falling heart rate despite hypotension) is a consistent feature of hypotensive insect sting anaphylaxis and may represent a non-specific physiological response to severe hypovolaemia in conscious individuals. Upright posture has been found to be associated with death from anaphylaxis. Animal studies have found the intramuscular route for epinephrine is ineffective, intravenous boluses temporarily effective, but intravenous infusions of epinephrine are able to reverse anaphylactic shock. In one animal model, antihistamines were found to be harmful. A prospective human study provides evidence for the efficacy of treatment with intravenous epinephrine infusion and fluid (volume) resuscitation. Case reports support the use of the vasoconstrictors metaraminol, methoxamine and vasopressin if adrenaline is ineffective. Repeated measurements of mast cell tryptase are more sensitive and specific than a single measurement for the diagnosis of anaphylaxis. SUMMARY Current evidence supports use of the supine/Trendelenburg position, epinephrine by intravenous infusion and aggressive volume resuscitation. If these fail, atropine should be considered for severe bradycardia and potent vasoconstrictors may be useful. To confirm the diagnosis of anaphylaxis, serial measurements of mast cell tryptase may be preferable to a single measurement.
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Affiliation(s)
- Simon G A Brown
- Discipline of Emergency Medicine, The University of Western Australia at Fremantle Hospital, Fremantle, Western Australia, Australia.
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Costanzo MJ, Almond HR, Hecker LR, Schott MR, Yabut SC, Zhang HC, Andrade-Gordon P, Corcoran TW, Giardino EC, Kauffman JA, Lewis JM, de Garavilla L, Haertlein BJ, Maryanoff BE. In-depth study of tripeptide-based alpha-ketoheterocycles as inhibitors of thrombin. Effective utilization of the S1' subsite and its implications to structure-based drug design. J Med Chem 2005; 48:1984-2008. [PMID: 15771442 DOI: 10.1021/jm0303857] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thrombin inhibitors are potentially useful in medicine for their anticoagulant and antithrombotic effects. We synthesized and evaluated diverse heterocycle-activated ketones based on the d-Phe-Pro-Arg, and related thrombin active-site recognition motifs, as candidate inhibitors. The peptide-based alpha-ketoheterocycles were typically prepared by either an imidate or a Weinreb amide route (Schemes 1 and 2), the latter of which proved to be more general. Test compounds were generally assayed for inhibition of human alpha-thrombin and bovine trypsin. From a structure-based design standpoint, the heterocycle allows one to explore and adjust interactions within the S1' subsite of thrombin. The preferred alpha-ketoheterocycle is a pi-rich 2-substituted azole with at least two heteroatoms proximal to the carbon bearing the keto group, and a preferred thrombin inhibitor is 2-ketobenzothiazole 3, with a potent K(i) value of 0.2 nM and ca. 15-fold selectivity over trypsin. 2-Ketobenzothiazole 13 exhibited exceedingly potent thrombin inhibition (K(i) = 0.000 65 nM; slow tight binding). Several alpha-ketoheterocycles had thrombin K(i) values in the range 0.1-400 nM. The "Arg" unit in the alpha-ketoheterocycles can be sensitive to stereomutation under mildy basic conditions. For example, 2-ketothiazoles 4 and 59 readily epimerize at pH 7.4, although they are fairly stable stereochemically at pH 3-4; thus, suitable conditions had to be selected for the enzymatic assays. Lead d-Phe-Pro-Arg 2-benzothiazoles 3, 4, and 68 displayed good selectivity for thrombin over other key coagulation enzymes (e.g., factor Xa, plasmin, protein Ca, uPA, tPA, and streptokinase); however, their selectivity for thrombin over trypsin was modest (<25-fold). Compounds 3, 4, and 68 exhibited potent in vitro antithrombotic activity as measured by inhibition of gel-filtered platelet aggregation induced by alpha-thrombin (IC(50) = 30-40 nM). They also proved to be potent anticoagulant/antithrombotic agents in vivo on intravenous administration, as determined in the canine arteriovenous shunt (ED(50) = 0.45-0.65 mg/kg) and the rabbit deep vein thrombosis (ED(50) = 0.1-0.4 mg/kg) models. Intravenous administration of 3, and several analogues, to guinea pigs caused hypotension and electrocardiogram abnormalities. Such cardiovascular side effects were also observed with some nonguanidine inhibitors and inhibitors having recognition motifs other than d-Phe-Pro-Arg. 2-Benzothiazolecarboxylates 4 and 68 exhibited significantly diminished cardiovascular side effects, and benzothiazolecarboxylic acid 4 had the best profile with respect to therapeutic index. The X-ray crystal structures of the ternary complexes 3-thrombin-hirugen and 4-thrombin-hirugen depict novel interactions in the S(1)' region, with the benzothiazole ring forming a hydrogen bond with His-57 and an aromatic stacking interaction with Trp-60D of thrombin's insertion loop. The benzothiazole ring of 3 displaces the Lys-60F side chain into a U-shaped gauche conformation, whereas the benzothiazole carboxylate of 4 forms a salt bridge with the side chain of Lys-60F such that it adopts an extended anti conformation. Since 3 has a 10-fold greater affinity for thrombin than does 4, any increase in binding energy resulting from this salt bridge is apparently offset by perturbations across the enzyme (viz. Figure 4). The increased affinity and selectivity of 2-ketobenzothiazole inhibitors, such as 3, may be primarily due to the aromatic stacking interaction with Trp-60D. However, energy contour calculations with the computer program GRID also indicate a favorable interaction between the benzothiazole sulfur atom and a hydrophobic patch on the surface of thrombin.
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Affiliation(s)
- Michael J Costanzo
- Drug Discovery, Johnson & Johnson Pharmaceutical Research & Development, Spring House, Pennsylvania 19477-0776, USA
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