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Jin T, He Q, Cheng C, Li H, Liang L, Zhang G, Su C, Xiao Y, Bradley J, Peberdy MA, Ornato JP, Tang W. UAMC-3203 or/and Deferoxamine Improve Post-Resuscitation Myocardial Dysfunction Through Suppressing Ferroptosis in a Rat Model of Cardiac Arrest. Shock 2022; 57:344-350. [PMID: 34618729 PMCID: PMC8868183 DOI: 10.1097/shk.0000000000001869] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Blocking ferroptosis reduces ischemia-reperfusion injury in some pathological contexts. However, there is no evidence that ferroptosis contributes to post-resuscitation myocardial dysfunction (PRMD). Here, we evaluated the therapeutic performance of ferroptosis inhibitors (UAMC-3203 or/and Deferoxamine) on the PRMD in a rat model of cardiac arrest and surveyed the changes of essential ferroptosis markers in the myocardium. Remarkably, all treatments reduce the severity of cardiac dysfunction and microcirculation hypoperfusion after resuscitation compared with control. Consistently, we observe that the ferroptosis marker Glutathione peroxidase 4, 4-hydroxynonenal and non-heme iron altered (1 ± 0.060 vs. 0.021 ± 0.016, 1 ± 0.145 vs. 3.338 ± 0.221, 52.010 ± 3.587 ug/g vs. 70.500 ± 3.158 ug/g, all P < 0.05) in the myocardium after resuscitation. These changes were significantly suppressed by UAMC-3203 [(0.187 ± 0.043, 2.848 ± 0.169, all P < 0.05), (72.43 ± 4.920 ug/g, P > 0.05)], or Deferoxamine (0.203 ± 0.025, 2.683 ± 0.273, 55.95 ± 2.497 ug/g, all P < 0.05). Briefly, UAMC-3203 or/and Deferoxamine improve post-resuscitation myocardial dysfunction and provide evidence of ferroptosis involvement, suggesting that ferroptosis inhibitors could potentially provide an innovative therapeutic approach for mitigating the myocardial damage caused by cardiopulmonary resuscitation.
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Affiliation(s)
- Tao Jin
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan Province, China
- School of Medicine, Anhui University of Science & Technology, Huainan, Anhui Province, China
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Qing He
- School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan Province, China
- Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan Province, China
| | - Cheng Cheng
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Hui Li
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lian Liang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Guozhen Zhang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Chenglei Su
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Yan Xiao
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
| | - Mary Ann Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
- Departments of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Joseph P. Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
- Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia
- Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
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The Effects of Pharmacological Hypothermia Induced by Neurotensin Receptor Agonist ABS 201 on Outcomes of CPR. Shock 2020; 51:667-673. [PMID: 30986796 DOI: 10.1097/shk.0000000000001178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurotensin is an endogenous tridecapeptide that binds to neurotensin receptors in the brain, which induce hypothermia. The aim of this study was to investigate whether the receptor agonist ABS 201 could induce therapeutic hypothermia and improve postresuscitation outcomes in a ventricular fibrillation cardiac arrest (VFCA) rat model. VF was electrically induced in 12 rats. Defibrillation was achieved after 6 min of cardiopulmonary resuscitation. After successful resuscitation, animals were randomized to receive ABS 201 (8 mg/kg/h) or placebo. Postresuscitation myocardial function and neurological deficit scores (NDS) were assessed, and postresuscitation survival duration was observed for up to 72 h. After administration of ABS 201, blood temperature decreased significantly from 37°C to 34°C, and was maintained for 2.5 h. There was a significant improvement of postresuscitation myocardial dysfunction, NDS, and survival duration in animals treated with ABS 201. These results demonstrated that ABS 201 induces therapeutic hypothermia in a VFCA rat model, ameliorates postresuscitation myocardial-neurological dysfunction, and prolongs survival duration. ABS 201 may therefore be an alternative method to induce therapeutic hypothermia with current cooling methods and improve postresuscitation outcomes.
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Xiao Y, Contaifer D, Huang W, Yang J, Hu Z, Guo Q, Bradley J, Peberdy MA, Ornato JP, Wijesinghe DS, Tang W. Cannabinoid Receptor Agonist WIN55, 212-2 Adjusts Lipid Metabolism in a Rat Model of Cardiac Arrest. Ther Hypothermia Temp Manag 2020; 10:192-203. [PMID: 31990631 DOI: 10.1089/ther.2019.0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to investigate the effects of pharmacologically induced hypothermia with WIN55, 212-2 (WIN)on postresuscitation myocardial function, microcirculation, and metabolism-specific lipids in a rat cardiac arrest (CA) model. Ventricular fibrillation was electrically induced and untreated for 6 minutes in 24 Sprague-Dawley rats weighing 450-550 g. Cardiopulmonary resuscitation including chest compression and mechanical ventilation was then initiated and continued for 8 minutes, followed by defibrillation. At 5 minutes after restoration of spontaneous circulation (ROSC), animals were randomized into four groups: (1) normothermia with vehicle (NT); (2) physical hypothermia with vehicle (PH); (3) WIN55, 212-2 with normothermia (WN); and (4) WIN55, 212-2 with hypothermia (WH). For groups of WN and WH, WIN was administered by continuous intravenous infusion with a syringe pump for 4 hours. PH started at 5 minutes after resuscitation. NT maintained core temperature at 37°C ± 0.2°C with the aid of a heating blanket. Hypothermia groups maintained temperature at 33°C ± 0.5°C for 4 hours after ROSC. There was a significant improvement in myocardial function as measured by ejection fraction, cardiac output, and myocardial performance index in animals treated with WH and PH beginning at 1 hour after start of infusion. In the WH and PH groups, buccal microcirculation was significantly improved compared with NT and WN. Plasma at pre-CA and ROSC 4 hours was harvested for lipid metabolism. The WH group appeared to be closer to baseline than the other groups in lipid metabolism. lysophosphatidylcholine (LPC) 18:2, free fatty acid (FFA) 22:6, and ceramide (CER) (24:0) changed significantly among the lipidomic data compared with NT (p < 0.05). Postresuscitation hypothermia improved myocardial function and microcirculation. WH-mediated lipid metabolism had the best metabolic outcome to bring back the animals to normal metabolism, which may be protective to improve outcomes of CA. LPC 18:2, FFA 22:6, and CER (24:0) may be important predictors of outcomes of CA.
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Affiliation(s)
- Yan Xiao
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Soochow, China.,Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daniel Contaifer
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Weiping Huang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jin Yang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zhangle Hu
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Qinyue Guo
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mary Ann Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dayanjan S Wijesinghe
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia, USA.,Da Vinci Center, School of Pharmacy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Monoacylglycerol Lipase Inactivation by Using URB602 Mitigates Myocardial Damage in a Rat Model of Cardiac Arrest. Crit Care Med 2019; 47:e144-e151. [PMID: 30431495 DOI: 10.1097/ccm.0000000000003552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Monoacylglycerol lipase participates in organ protection by regulating the hydrolysis of the endocannabinoid 2-arachidonoylglycerol. This study investigated whether blocking monoacylglycerol lipase protects against postresuscitation myocardial injury and improves survival in a rat model of cardiac arrest and cardiopulmonary resuscitation. DESIGN Prospective randomized laboratory study. SETTING University research laboratory. SUBJECTS Male Sprague-Dawley rat (n = 96). INTERVENTIONS Rats underwent 8-minute asphyxia-based cardiac arrest and resuscitation. Surviving rats were randomly divided into cardiopulmonary resuscitation + URB602 group, cardiopulmonary resuscitation group, and sham group. One minute after successful resuscitation, rats in the cardiopulmonary resuscitation + URB602 group received a single dose of URB602 (5 mg/kg), a small-molecule monoacylglycerol lipase inhibitor, whereas rats in the cardiopulmonary resuscitation group received an equivalent volume of vehicle solution. The sham rats underwent all of the procedures performed on rats in the cardiopulmonary resuscitation and cardiopulmonary resuscitation + URB602 groups minus cardiac arrest and asphyxia. MEASUREMENTS AND MAIN RESULTS Survival was recorded 168 hours after the return of spontaneous circulation (n = 22 in each group). Compared with vehicle treatment (31.8%), URB602 treatment markedly improved survival (63.6%) 168 hours after cardiopulmonary resuscitation. Next, we used additional surviving rats to evaluate myocardial and mitochondrial injury 6 hours after return of spontaneous circulation, and we found that URB602 significantly reduced myocardial injury and prevented myocardial mitochondrial damage. In addition, URB602 attenuated the dysregulation of endocannabinoid and eicosanoid metabolism 6 hours after return of spontaneous circulation and prevented the acceleration of mitochondrial permeability transition 15 minutes after return of spontaneous circulation. CONCLUSIONS Monoacylglycerol lipase blockade may reduce myocardial and mitochondrial injury and significantly improve the resuscitation effect after cardiac arrest and cardiopulmonary resuscitation.
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Dynamic palmitoylation regulates trafficking of K channel interacting protein 2 (KChIP2) across multiple subcellular compartments in cardiac myocytes. J Mol Cell Cardiol 2019; 135:1-9. [PMID: 31362018 DOI: 10.1016/j.yjmcc.2019.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/26/2019] [Accepted: 07/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND K channel interacting protein 2 (KChIP2), initially cloned as Kv4 channel modulator, is a multi-tasking protein. In addition to modulating several cardiac ion channels at the plasma membrane, it can also modulate microRNA transcription inside nuclei, and interact with presenilins to modulate Ca release through RyR2 in the cytoplasm. However, the mechanism regulating its subcellular distribution is not clear. OBJECTIVE We tested whether palmitoylation drives KChIP2 trafficking and distribution in cells, and whether the distribution pattern of KChIP2 in cardiac myocytes is sensitive to cellular milieu. METHOD We conducted imaging and biochemical experiments on palmitoylatable and unpalmitoylatable KChIP2 variants expressed in COS-7 cells and in cardiomyocytes, and on native KChIP2 in myocytes. RESULTS In COS-7 cells, palmitoylatable KChIP2 clustered to plasma membrane, while unpalmitoylatable KChIP2 exhibited higher cytoplasmic mobility and faster nuclear entry. The same differences in distribution and mobility were observed when these KChIP2 variants were expressed in cardiac myocytes, indicating that the palmitoylation-dependent distribution and trafficking are intrinsic properties of KChIP2. Importantly, acute stress in a rat model of cardiac arrest/resuscitation induced changes in native KChIP2 resembling those of KChIP2 depalmitoylation, promoting KChIP2 nuclear entry. CONCLUSION The palmitoylation status of KChIP2 determines its subcellular distribution in cardiac myocytes. Stress promotes nuclear entry of KChIP2, diverting it from ion channel modulation at the plasma membrane to other functions in the nuclear compartment.
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Kochanek PM, Jackson TC. Therapeutic Hypothermia and Targeted Temperature Management With or Without the "Cold Stress" Response. Ther Hypothermia Temp Manag 2017; 7:134-136. [PMID: 28800291 PMCID: PMC5610381 DOI: 10.1089/ther.2017.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Patrick M Kochanek
- Department of Critical Care Medicine/Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Travis C Jackson
- Department of Critical Care Medicine/Safar Center for Resuscitation Research, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Wu MJ, Zhang YJ, Yu H, Liu B. Emulsified isoflurane combined with therapeutic hypothermia improves survival and neurological outcomes in a rat model of cardiac arrest. Exp Ther Med 2017; 13:891-898. [PMID: 28450915 PMCID: PMC5403392 DOI: 10.3892/etm.2017.4044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/28/2016] [Indexed: 02/05/2023] Open
Abstract
Emulsified isoflurane (EIso), when introduced following cardiopulmonary resuscitation (CPR), significantly improves survival and neurological outcomes in a rat model of cardiac arrest (CA). The present study aimed to examine whether EIso combined with therapeutic hypothermia (TH) confers an additive neuroprotective effect. Adult male Sprague-Dawley rats that were subjected to return of spontaneous circulation (ROSC) after a 6-min asphyxia-induced CA were randomized to five groups: Sham group, control group under normothermic conditions, EIso group (4 ml/kg for 30 min under normothermic conditions), TH group (33°C for 2 h), and EIso plus TH group. Survival conditions and neurological outcomes were evaluated at 1 day and 7 days after ROSC. Animal survival rate at 7 days after ROSC was 30.7% in the CPR group, 60% in the EIso group, 63.6% in the TH group and 72.7% in the EIso plus TH group. EIso, TH and EIso plus TH yielded significant improvements in survival rates, neural deficit score and cognitive function, and ameliorated hippocampal CA1 region cell injury and apoptosis at 1 day and 7 days after ROSC compared with the CPR group. Combined therapy of EIso and TH was superior to EIso or TH alone, suggesting that combined EIso and TH treatment results in significant improvements in survival and neurological outcomes, and was more effective than independent EIso or TH treatment.
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Affiliation(s)
- Meng-Jun Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ya-Jie Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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The cannabinoid receptor agonist WIN55.212 reduces consequences of status epilepticus in rats. Neuroscience 2016; 334:191-200. [PMID: 27520083 DOI: 10.1016/j.neuroscience.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 12/29/2022]
Abstract
An acute brain insult can cause a spectrum of primary and secondary pathologies including increased risk for epilepsy, mortality and neurodegeneration. The endocannabinoid system, involved in protecting the brain against network hyperexcitability and excitotoxicity, is profoundly dysregulated by acute brain insults. We hypothesize that post-insult dysregulation of the endocannabinoid signaling may contribute to deleterious effects of an acute brain injury and potentiation of endocannabinoid transmission soon after an insult may reduce its pathological outcomes. Effects of an acute post-insult administration of the endocannabinoid receptor agonist WIN55,212-2 on early seizure occurrence, animal mortality and hippocampal cell loss were studied in the lithium-pilocarpine status model. A single dose of WIN55,212-2 (5mg/kg) administered four hours after the end of status epilepticus (SE) reduced the incidence of early seizures during the first two post-SE days though did not change their duration and latency. Brief 4-6-Hz spike-wave discharges appeared de novo in the latent post-SE period and the acute administration of WIN55,212-2 also reduced the incidence of the epileptiform events. A single dose of WIN55,212-2 administered soon after SE improved survival of animals and reduced cell loss in the dentate hilus but did not prevent appearance of spontaneous recurrent seizures in the chronic period. Thus, a brief pharmacological stimulation of the endocannabinoid system soon after a brain insult exerts beneficial effects on its pathological outcome though does not prevent epileptogenesis.
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Latorre JGS, Schmidt EB. Cannabis, Cannabinoids, and Cerebral Metabolism: Potential Applications in Stroke and Disorders of the Central Nervous System. Curr Cardiol Rep 2016; 17:627. [PMID: 26238742 DOI: 10.1007/s11886-015-0627-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
No compound has generated more attention in both the scientific and recently in the political arena as much as cannabinoids. These diverse groups of compounds referred collectively as cannabinoids have both been vilified due to its dramatic and potentially harmful psychotropic effects and glorified due to its equally dramatic and potential application in a number of acute and chronic neurological conditions. Previously illegal to possess, cannabis, the plant where natural form of cannabinoids are derived, is now accepted in a growing number of states for medicinal purpose, and some even for recreational use, increasing opportunities for more scientific experimentation. The purpose of this review is to summarize the growing body of literature on cannabinoids and to present an overview of our current state of knowledge of the human endocannabinoid system in the hope of defining the future of cannabinoids and its potential applications in disorders of the central nervous system, focusing on stroke.
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Affiliation(s)
- Julius Gene S Latorre
- Neurocritical Care Division, Department of Neurology and Neurosurgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA,
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Neuroprotective hypothermia - Why keep your head cool during ischemia and reperfusion. Biochim Biophys Acta Gen Subj 2016; 1860:2521-2528. [PMID: 27475000 DOI: 10.1016/j.bbagen.2016.07.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/28/2016] [Accepted: 07/25/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Targeted temperature management (TTM) is the induced cooling of the entire body or specific organs to help prevent ischemia and reperfusion (I/R) injury, as may occur during major surgery, cardiac resuscitation, traumatic brain injury and stroke. Ischemia and reperfusion induce neuronal damage by mitochondrial dysfunction and oxidative injury, ER stress, neuronal excitotoxicity, and a neuroinflammatory response, which may lead to activation of apoptosis pathways. SCOPE OF REVIEW The aim of the current review is to discuss TTM targets that convey neuroprotection and to identify potential novel pharmacological intervention strategies for the prevention of cerebral ischemia and reperfusion injury. MAJOR CONCLUSIONS TTM precludes I/R injury by reducing glutamate release and oxidative stress and inhibiting release of pro-inflammatory factors and thereby counteracts mitochondrial induced apoptosis, neuronal excitotoxicity, and neuroinflammation. Moreover, TTM promotes regulation of the unfolded protein response and induces SUMOylation and the production of cold shock proteins. These advantageous effects of TTM seem to depend on the clinical setting, as well as type and extent of the injury. Therefore, future aims should be to refine hypothermia management in order to optimize TTM utilization and to search for pharmacological agents mimicking the cellular effects of TTM. GENERAL SIGNIFICANCE Bundling knowledge about TTM in the experimental, translational and clinical setting may result in better approaches for diminishing I/R damage. While application of TTM in the clinical setting has some disadvantages, targeting its putative protective pathways may be useful to prevent I/R injury and reduce neurological complications.
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Lamoureux L, Radhakrishnan J, Gazmuri RJ. A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique. J Vis Exp 2015:52413. [PMID: 25938619 PMCID: PMC4541594 DOI: 10.3791/52413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A rat model of electrically-induced ventricular fibrillation followed by cardiac resuscitation using a closed chest technique that incorporates the basic components of cardiopulmonary resuscitation in humans is herein described. The model was developed in 1988 and has been used in approximately 70 peer-reviewed publications examining a myriad of resuscitation aspects including its physiology and pathophysiology, determinants of resuscitability, pharmacologic interventions, and even the effects of cell therapies. The model featured in this presentation includes: (1) vascular catheterization to measure aortic and right atrial pressures, to measure cardiac output by thermodilution, and to electrically induce ventricular fibrillation; and (2) tracheal intubation for positive pressure ventilation with oxygen enriched gas and assessment of the end-tidal CO2. A typical sequence of intervention entails: (1) electrical induction of ventricular fibrillation, (2) chest compression using a mechanical piston device concomitantly with positive pressure ventilation delivering oxygen-enriched gas, (3) electrical shocks to terminate ventricular fibrillation and reestablish cardiac activity, (4) assessment of post-resuscitation hemodynamic and metabolic function, and (5) assessment of survival and recovery of organ function. A robust inventory of measurements is available that includes - but is not limited to - hemodynamic, metabolic, and tissue measurements. The model has been highly effective in developing new resuscitation concepts and examining novel therapeutic interventions before their testing in larger and translationally more relevant animal models of cardiac arrest and resuscitation.
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Affiliation(s)
- Lorissa Lamoureux
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science
| | | | - Raúl J Gazmuri
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science;
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Hayashida K, Sano M, Kamimura N, Yokota T, Suzuki M, Ohta S, Fukuda K, Hori S. Hydrogen inhalation during normoxic resuscitation improves neurological outcome in a rat model of cardiac arrest independently of targeted temperature management. Circulation 2014; 130:2173-80. [PMID: 25366995 DOI: 10.1161/circulationaha.114.011848] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have previously shown that hydrogen (H2) inhalation, begun at the start of hyperoxic cardiopulmonary resuscitation, significantly improves brain and cardiac function in a rat model of cardiac arrest. Here, we examine the effectiveness of this therapeutic approach when H2 inhalation is begun on the return of spontaneous circulation (ROSC) under normoxic conditions, either alone or in combination with targeted temperature management (TTM). METHODS AND RESULTS Rats were subjected to 6 minutes of ventricular fibrillation cardiac arrest followed by cardiopulmonary resuscitation. Five minutes after achieving ROSC, post-cardiac arrest rats were randomized into 4 groups: mechanically ventilated with 26% O2 and normothermia (control); mechanically ventilated with 26% O2, 1.3% H2, and normothermia (H2); mechanically ventilated with 26% O2 and TTM (TTM); and mechanically ventilated with 26% O2, 1.3% H2, and TTM (TTM+H2). Animal survival rate at 7 days after ROSC was 38.4% in the control group, 71.4% in the H2 and TTM groups, and 85.7% in the TTM+H2 group. Combined therapy of TTM and H2 inhalation was superior to TTM alone in terms of neurological deficit scores at 24, 48, and 72 hours after ROSC, and motor activity at 7 days after ROSC. Neuronal degeneration and microglial activation in a vulnerable brain region was suppressed by both TTM alone and H2 inhalation alone, with the combined therapy of TTM and H2 inhalation being most effective. CONCLUSIONS H2 inhalation was beneficial when begun after ROSC, even when delivered in the absence of hyperoxia. Combined TTM and H2 inhalation was more effective than TTM alone.
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Affiliation(s)
- Kei Hayashida
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Motoaki Sano
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.).
| | - Naomi Kamimura
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Takashi Yokota
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Masaru Suzuki
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Shigeo Ohta
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Keiichi Fukuda
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
| | - Shingo Hori
- From the Department of Emergency and Critical Care Medicine (K.H., M.S., S.H.) and Department of Cardiology (M.S., K.F.), School of Medicine, Keio University, Tokyo, Japan; and Department of Biochemistry and Cell Biology, Institute of Development and Aging Science, Graduate School of Medicine, Nippon Medical School, Kanagawa, Japan (N.K., T.Y., S.O.)
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Uray T, Kochanek PM. Finding a faster and safer way to "catch a cold" after cardiac arrest: we may be getting closer. Resuscitation 2014; 85:1131-3. [PMID: 24992871 DOI: 10.1016/j.resuscitation.2014.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Uray
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Knapp J, Schneider A, Nees C, Bruckner T, Böttiger BW, Popp E. Effects of adenosine monophosphate on induction of therapeutic hypothermia and neuronal damage after cardiopulmonary resuscitation in rats. Resuscitation 2014; 85:1291-7. [PMID: 24978110 DOI: 10.1016/j.resuscitation.2014.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/16/2014] [Accepted: 05/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Animal studies and pathophysiological considerations suggest that therapeutic hypothermia after cardiopulmonary resuscitation is the more effective the earlier it is induced. Therefore this study is sought to examine whether pharmacological facilitated hypothermia by administration of 5'-adenosine monophosphate (AMP) is neuroprotective in a rat model of cardiac arrest (CA) and resuscitation. METHODS Sixty-one rats were subjected to CA. After 6 min of ventricular fibrillation advanced cardiac life support was started. After successful return of spontaneous circulation (ROSC, n=40), animals were randomized either to placebo group (n=14) or AMP group (800 mg/kg body weight, n=14). Animals were kept at an ambient temperature of 18°C for 12 h after ROSC and core body temperature was measured using a telemetry temperature probe. Neuronal damage was analyzed by counting Nissl-positive (i.e. viable) neurons and TUNEL-positive (i.e. apoptotic) cells in coronal brain sections 7 days after ROSC. Functional status evaluated on days 1, 3 and 7 after ROSC by a tape removal test. RESULTS Time until core body temperature dropped to <34.0°C was 31 min [28; 45] in AMP-treated animals and 125 min [90; 180] in the control group (p=0.003). Survival until 7 days after ROSC was comparable in both groups. Also number of Nissl-positive cells (AMP: 1 [1; 7] vs. placebo: 2 [1; 3] per 100 pixel; p=0.66) and TUNEL-positive cells (AMP: 56 [44; 72] vs. placebo: 53 [41; 67] per 100 pixel; p=0.70) did not differ. Neither did AMP affect functional neurological outcome up to 7 days after ROSC. Mean arterial pressure 20 min after ROSC was 49 [45; 55] mmHg in the AMP group in comparison to 91 [83; 95] mmHg in the control group (p<0.001). CONCLUSION Although application of AMP reduced the time to reach a core body temperature of <34°C neither survival was improved nor neuronal damage attenuated. Reason for this is probably induction of marked hypotension as an adverse reaction to AMP treatment.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
| | - Andreas Schneider
- Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Kerpener Str. 62, D-50937 Köln, Germany
| | - Corinna Nees
- Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany
| | - Bernd W Böttiger
- Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Kerpener Str. 62, D-50937 Köln, Germany
| | - Erik Popp
- Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
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