Neuroprotective Effect of Ulinastatin on Spinal Cord Ischemia-Reperfusion Injury in Rabbits

Effect of captopril on paraplegia caused by spinal cord ischemia-reperfusion injury in rats

This study investigated the effect of captopril (Cap) on spinal cord ischemia-reperfusion injury (SCII) in rats. Twenty-four adults male Wistar rats were randomly divided into four groups of six animals each: spinal cord ischemia-reperfusion (SCI-R) with Cap (SCI-R + Cap), SCI-R, sham-operated with Cap (SHAM + Cap), and SHAM. The 24 hr and 90 min before ischemia induction, Cap was administered intragastrically (100 mg kg-1) to the SHAM + Cap and SCI-R + Cap groups. Abdominal aortic clamping was performed in the SCI-R and SCI-R + Cap groups for 40 min. Hindlimb motor function was evaluated using the Tarlov Scale at 4, 6, 12, 24, 48, and 60 hr after SCII. The malondialdehyde (MDA), the ferric-reducing ability of plasma (FRAP) and prooxidant-antioxidant balance (PAB) values were also measured. Throughout the study period, the SCI-R group had significantly lower motor function scores compared to the other groups. The MDA and PAB levels were higher and the FRAP value was lower in the SCI-R group compared to in the SHAM group. The SCI-R + Cap had higher motor function scores compared to the SCI-R group at all time points. There were no significant differences in MDA concentration, FRAP and PAB values between the SCI-R + Cap and SCI-R groups. Captopril may act as a protective agent against SCII in rats based on hind limb motor function assessment.

Ulinastatin ameliorates preeclampsia induced by N(gamma)-nitro-l-arginine methyl ester in a rat model via inhibition of the systemic and placental inflammatory response

BACKGROUND

The pathogenesis of preeclampsia (PE) is associated with inflammation and endothelial damage. Ulinastatin (UTI) mainly inhibits proteolytic activity and significantly reduces the release of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) from macrophages. It also ameliorates vascular endothelial damage in pathological conditions. Hence, we investigated the effects of UTI in a rat model of PE induced using N(gamma)-nitro-l-arginine methyl ester (L-NAME).

METHODS

Although inducing PE in a rat model, 5000 U/kg of UTI were injected daily. Systolic blood pressure (SBP) and protein levels in the urine were measured. Renal function, and serum concentrations of TNF-α, IL-6, placental growth factor (PLGF), and von Willebrand factor (vWF) were evaluated. The number and weight of live fetuses as well as the weight of placentas were measured. Placentas were collected for western blot and pathological analysis.

RESULTS

UTI slightly ameliorated proteinuria and the increases in SBP, blood urea nitrogen (BUN), and serum creatinine. Furthermore, UTI improved serum and placental protein expression levels of TNF-α, IL-6, vWF, and PLGF. Pathological analysis revealed that vascular density and blood flow perfusion was enhanced, vessel wall thickening and neutrophil infiltration were diminished, and the weight and number of live fetuses as well as the weight of the placentas were improved with UTI.

CONCLUSION

Preventive use of UTI in the PE rat model induced by L-NAME partially alleviated hypertension, proteinuria, and impaired renal function; improved fetal growth restriction; diminished vascular endothelial injury; and ameliorated placental vasculogenesis abnormality and malperfusion by inhibiting the systemic and placental inflammatory response, suggesting that UTI is a potential drug for PE prevention or treatment.

Ulinastatin attenuates spinal cord injury by targeting AMPK/NLRP3 signaling pathway

The AMPK and NLRP3 inflammasome signaling pathways are reported to participant in the inflammatory responses following spinal cord injury (SCI). Ulinastatin (ULI) is a urinary trypsin inhibitor with excellent anti-inflammatory effects, but the functions of ULI on SCI are rarely reported. Hence, this study was designed to investigate whether ULI could modulate SCI through regulating the AMPK/NLRP3 signaling pathway. Cell Counting Kit-8 (CCK-8) assays were used to investigate whether ULI had cytotoxic effects on BV-2 cells. Basso-Beattie-Bresnahan (BBB) scale, spinal cord water content detection, hematoxylin-eosin (HE) and Nissl stainings were used to investigate the protective effects of ULI on rat SCI. The expressions of inflammatory cytokines were detected by ELISA and RT-qPCR. The expressions of key proteins of AMPK and NLRP3 inflammasome were analyzed by western blot. The CCK-8 assays indicated that ULI did not significantly influence the viability of BV-2 cells at various concentrations below 10,000 U/ml. It was witnessed that ULI could dramatically inhibit the activation of NLRP3 inflammasome via activating the AMPK signaling pathway, thus relieving inflammatory responses. Besides, the in vivo experiment suggested that treatment with ULI remarkably relieve spinal cord edema, ameliorated spinal cord tissue architecture, and improved neurological function following SCI. The findings indicate that ULI significantly ameliorates neurological function following SCI by regulating the AMPK/NLRP3 inflammasome signaling pathway.

Salubrious effects of ulinastatin and quercetin alone or in combination in endothelial dysfunction and vascular dementia

BACKGROUND

Vascular dementia is the second most prevalent form of dementia. Hypertension is the leading risk factor for endothelial dysfunction and the progression of dementia that is of vascular origin. This study investigates the role of ulinastatin (UTI) and quercetin alone as well as in combination in hypertension-induced endothelial dysfunction and vascular dementia (VaD).

METHOD

Two-kidney one-clip (2K1C) renovascular model was set up to induce hypertension in the Albino Wistar rats (males). Rats were assessed for mean arterial blood pressure, behavioral function (Morris water maze, attention set-shifting tests), vascular endothelial function, and biochemical levels (aortic superoxide anion and serum nitrite/nitrate), as well as brains' thiobarbituric acid reactive species-TBARS, reduced glutathione-GSH, interleukin-6, 10, tumor necrosis factor-TNF-α and acetylcholinesterase-AChE). UTI (10,000 U/kg, ip) and quercetin (60 mg/kg) were used alone and in combination for treatment. Donepezil (0.5 mg/kg) was used as a positive control.

RESULTS

2K1C rats showed impairment in learning, memory, executive functioning, and reversal learning. These rats further showed endothelial dysfunction as well as an increase in mean arterial blood pressure, brains' oxidative stress, inflammation, and AChE-activity. Treatment with UTI and quercetin alone as well in combination significantly attenuated the 2K1C model induced impairments in the behavioural, biochemical, and endothelial parameters.

CONCLUSION

2K1C renovascular hypertension-induced impairment in behavioural, biochemical, and endothelial parameters were attenuated by the treatment with UTI and quercetin alone as well as in combination. Therefore, the utility of these agents might be studied further to understand their full potential in hypertension-induced VaD.

Effects of Ulinastatin on Myocardial Ischemia-Reperfusion Injury, Cardiac Function, and Serum TNF-α and IL-10 Levels in Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass

Background

Myocardial ischemia-reperfusion injury (MIRI) is a very common adverse reaction after cardiac valve replacement (CVR) under cardiopulmonary bypass, which seriously affects the rehabilitation and prognosis of patients.

Objective

The prevention and treatment of MIRI are a hotspot of modern medical research, and this study is aimed at providing reliable reference and guidance for future clinical prevention and treatment of MIRI by analyzing the effects of ulinastatin (UL) on cardiac function and MIRI of patients after CVR.

Methods

A total of 104 patients undergoing CVR under cardiopulmonary bypass in our hospital were selected as research participants. Among them, 52 patients treated with UL were assigned to the observation group, and the rest 52 patients given the same amount of normal saline were assigned to the control group. The cardiopulmonary bypass status, postoperative status, cardiac function, inflammatory response, oxidative stress response, and hemodynamics were observed and compared between the two groups. In addition, clinical efficacy and safety and patient prognosis were compared.

Results

Through experimental analysis, we found that UL had no significant effect on the clinical efficacy, safety, and prognosis of patients after surgery (P > 0.05) but had obvious protective effects on cardiopulmonary bypass status, cardiac function, inflammation, oxidative stress, and hemodynamics (P < 0.05).

Conclusion

UL can effectively prevent the occurrence of MIRI after CVR under cardiopulmonary bypass, which is worthy of clinical application.

Efficacy of Ulinastatin and Sulforaphane Alone or in Combination in Rat Model of Streptozotocin Diabetes Induced Vascular Dementia

Objective

Vascular Dementia (VaD), is associated with metabolic conditions. Diabetes is a major risk factor for the development of VaD. This study investigates the efficacy of ulinastatin (UTI) and sulforaphane (SUL) in streptozotocin (STZ)-diabetes induced vascular endothelium dysfunction and related dementia.

Methods

Single dose STZ (50 mg/kg i.p.) was administered to Albino Wistar rats (male, 200−250 g). Morris water maze and attentional set shifting tests were used to assess the spatial learning, memory, reversal learning, and executive functioning in animals. Body weight, serum glucose, serum nitrite/nitrate, vascular endothelial function, aortic superoxide anion, brains’ oxidative markers (thiobarbituric acid reactive species-TBARS, reduced glutathione-GSH, superoxide dismutase-SOD, and catalase-CAT), inflammatory markers (IL-6, IL-10, TNF-a, and myeloperoxidase-MPO), acetylcholinesterase activity-AChE, blood brain barrier (BBB) permeability and histopathological changes were also assessed. UTI (10,000 U/kg) and SUL (25 mg/kg) were used alone as well as in combination, as the treatment drugs. Donepezil (0.5 mg/kg) was used as a positive control.

Results

STZ-administered rats showed reduction in body weight, learning, memory, reversal learning, executive functioning, impairment in endothelial function, BBB permeability, increase in serum glucose, brains’ oxidative stress, inflammation, AChE-activity, BBB permeability and histopathological changes. Administration of UTI and SUL alone as well as in combination, significantly and dose dependently attenuated the STZ-diabetes-induced impairments in the behavioral, endothelial, and biochemical parameters.

Conclusion

STZ administration caused diabetes and VaD which was attenuated by the administration of UTI and SUL. Therefore, these agents may be studied further for the assessment of their full potential in diabetes induced VaD.

Early diagnosis of serum sICAM-1 and sRAGE in severe acute pancreatitis, and efficacy and prognosis prediction of glutamine combined with ulinastatin

Acute pancreatitis (AP) is a common gastrointestinal disease that can become severe, so that intensive care may be required. This study was to examine serum soluble intercellular adhesion molecule-1 (sICAM-1), and soluble receptor for advanced glycation end products (sRAGE) for efficacy and prognosis prediction of glutamine (Glu) combined with ulinastatin (UTI) on severe acute pancreatitis (SAP). Fifty-four mild acute pancreatitis (MAP) patients admitted to Yidu Central Hospital of Weifang were selected as the MAP group (MAPG), 80 with SAP were divided as the SAP group (SAPG), and 60 healthy individuals who came to Yidu Central Hospital of Weifang for physical examination during the same period were included to the normal group (NG). Serum sICAM-1 and sRAGE were measured and their predictive value of efficacy and prognosis were analyzed. In view of the treatment effectiveness and prognosis, the patients were divided into effective group (EG) and ineffective group (IG), good prognosis group (GPG) and poor prognosis group (PPG). The levels of D-lactate, diamine oxidase (DAO), endotoxin and T-lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺) were measured and the changes before and after treatment were analyzed. The AUC values of NG and MAPG, NG and SAPG, MAPG and SAPG were 0.857, 0.939 and 0.856, respectively, those of predicting efficacy were 0.920 and 0.874, respectively, and those of poor prognosis in the SAPG were 0.914 and 0.879, respectively. In the SAPG, D-lactate, DAO, endotoxin and CD8⁺ decreased markedly after treatment, but CD3⁺, CD4⁺, and CD4⁺/CD8⁺ were opposite. SICAM-1 and sRAGE were also independent risk factors for poor prognosis in the SAPG. Serum sICAM-1 and sRAGE have high predictive value for early diagnosis, efficacy and prognosis of Glu combined with UTI.

Ulinastatin alleviates mitochondrial damage and cell apoptosis induced by isoflurane in human neuroglioma H4 cells

Isoflurane has been demonstrated to induce mitochondrial damage and cell apoptosis. The isoflurane-induced inflammation may be an important reason for this phenomenon. Studies have shown that ulinastatin (UTI) has an anti-inflammatory effect. Our aim was to investigate whether UTI could attenuate isoflurane-induced mitochondrial damage and cell apoptosis by inhibiting inflammation. Human neuroglioma H4 cells were exposed to isoflurane with or without UTI. The ratio of cell apoptosis was evaluated by flow cytometry. β-Amyloid (Aβ) peptide and cleaved caspase 3 expression were evaluated by Western blot analysis. The concentrations of tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) were detected by sandwich enzyme-linked immunosorbent assays. Mitochondrial structural changes were detected by transmission electron microscopy. Mitochondrial membrane potential (Δψm) was determined by 5,5',6,6'-Tetrachloro-1,1',3,3'-tetraethyl-imidacarbocyanine iodide (JC-1). The activity of the mitochondrial electron transport chain (ETC) complexes I, II, III, and IV was determined by assay kits. UTI attenuated the TNF-α and IL-1β release induced by isoflurane. UTI could also reduce mitochondrial structure damage, mitigate the decrease in Δψm, and improve ETC complexes dysfunction. Furthermore, it decreased cell apoptosis induced by isoflurane in H4 cells. UTI had no effect on isoflurane-induced Aβ expression. UTI may mitigate isoflurane-induced mitochondrial damage and cytotoxicity by inhibiting inflammation.

PRSS contributes to cetuximab resistance in colorectal cancer

Cetuximab improves the survival of patients with metastatic colorectal cancer. The main limitation is primary and secondary resistance, the underlying mechanism of which requires extensive investigation. We proved that PRSS expression levels are significantly negatively associated with the sensitivity of cancer cells to cetuximab. Detailed mechanistic analysis indicated that PRSS can cleave cetuximab, leading to resistance. Cetuximab or bevacizumab combined with SPINK1, a PRSS inhibitor, inhibited cell growth more efficiently than cetuximab or bevacizumab alone in xenograft models. PRSS levels in the serum of 156 patients with mCRC were analyzed, and poor efficacy of cetuximab therapy was observed in patients with aberrant PRSS expression. PRSS expression in monoclonal antibody (mAb)-treated patients with cancer from The Cancer Genome Atlas database was also evaluated to determine whether patients with higher PRSS expression have significantly reduced progression-free survival. Our work provides a strong scientific rationale for targeting PRSS in combination with cetuximab therapy.

Ulinastatin attenuates isoflurane-induced cognitive dysfunction in aged rats by inhibiting neuroinflammation and β-amyloid peptide expression in the brain

Objective: Postoperative neurocognitive disease (PNCD) in the aged is a major clinical problem with unclear mechanisms. This study was designed to explore the mechanisms for ulinastatin (UTI) to attenuate isoflurane-induced cognitive decline in Fischer-344 rats. Methods: The rats were divided into four groups: Control (0.9% saline only), Isoflurane (exposure to 1.2% isoflurane), Isoflurane-plus-UTI (exposure to 1.2% isoflurane followed by 100,000 U/kg UTI injection i.v.) and UTI-plus-isoflurane (i.v. of 100,000 U/kg UTI followed by 1.2% isoflurane exposure). After respective tests, the concentrations of tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the brain were determined by ELISA the expression of β-amyloid peptide (Aβ) and cleaved caspase-3 were measured by Western blot. Ratio of apoptotic cells after Barnes maze challenge was assessed by TUNEL assay. Results: In both Barnes Maze training and challenge, results indicated isoflurane-impaired learning capacity, while pre-and post-treatment with UTI could attenuate this phenomenon. The ratio of apoptotic cells and the expression of cleaved caspase-3 were increased after isoflurane exposure, indicating that isoflurane could induce neuronal apoptosis, while both pre- and post-treatment with UTI could diminish these effects. Moreover, UTI inhibited the expression of TNF-α, IL-1β and Aβ induced by isoflurane in rat brain harvested at 16 h after isoflurane exposure. Conclusion: These results suggest that UTI inhibits neuronal apoptosis in rat brain by attenuating increased expression of Aβ₄₂ and inflammatory cytokines, which may contribute to its alleviation of isoflurane-induced cognitive dysfunction in rats. Moreover, UTI pre-treatment before isoflurane exposure showed more effective than post-treatment.

Tat-HSP70 protects neurons from oxidative damage in the NSC34 cells and ischemic damage in the ventral horn of rabbit spinal cord

Heat shock protein 70 (HSP70) is an ATP-dependent molecular chaperone, and it has been shown that its levels increase after exposure to various types of stress, including ischemia. In the present study, we investigated the effects of HSP70 against H₂O₂-induced neuronal stress in NSC34 cells and against spinal cord ischemia in rabbits. Tat-HSP70 proteins facilitated the intracellular delivery of HSP70 into the NSC34 cells and enabled them to cross the blood-brain barrier in the rabbit spinal cord. Tat-HSP70 was effectively transduced into NSC34 cells in a concentration- and time-dependent manner, while control-HSP70 protein could not be delivered intracellularly at any concentration or time after treatment. Treatment with Tat-HSP70 reduced the generation of reactive oxygen species and cell death induced by H₂O₂, while the control-HSP70 did not show any significant effect on the NSC34 cells exposed to H₂O₂. In rabbit spinal cord, the administration of Tat-HSP70 showed significant amelioration of neurological defects and neuronal death in the ventral horn of spinal cord. In addition, Tat-HSP70 treatment significantly reduced lipid peroxidation and increased Cu, Zn-superoxide dismutase activities in the spinal cord, but glutathione peroxidase and Mn-superoxide dismutase activities remained unchanged. These results suggest that Tat-HSP70, not control-HSP70, decreases cell damage by reducing oxidative stress in NSC34 cells and rabbit spinal cord, and it can be employed for the reduction of neuronal damage caused after spinal cord ischemia.

Anti-Inflammatory Effect of Lycopene on Experimental Spinal Cord Ischemia Injury via Cyclooxygenase-2 Suppression

OBJECTIVE

Spinal cord ischemia/reperfusion injury (SCII) is a devastating complication following thoracoabdominal aortic surgeries, often leading to severe neurological deficits. We sought to examine the effects of lycopene, a naturally existing carotenoid with anti-inflammatory properties, in the treatment against SCII.

METHODS

Rats were assigned into four treatment groups: Sham (sham operation), SCII (SCII-induction), LY25, and LY50 (lycopene treatment at 25 or 50 mg/kg following SCII induction, respectively).

RESULTS

Lycopene treatment improved the recovery of neurological functions following SCII and suppressed the neuronal cell death and neuroinflammation at 14 days after SCII. Furthermore, Western blot assay revealed that lycopene treatment attenuated the SCII-induced increase in the protein levels of cyclooxygenase-2 (COX-2), nuclear factor-κB, and activate protein-1, as well as the reduction of heme oxygenase-1.

CONCLUSION

Lycopene exerted neuroprotective functions in SCII and inhibited SCII-elicited neuroinflammation via COX-2 suppression.

Ulinastatin mediates suppression of regulatory T cells through TLR4/NF-κB signaling pathway in murine sepsis

CD4⁺CD25⁺ regulatory T cells (Tregs) play an essential role in the suppression of the immune response and prevention of autoimmune reactions. The activation of TLR4, which provides a critical link between the innate and adaptive immune systems, has been implicated in regulating the function of Tregs. Ulinastatin (UTI) is a broad-spectrum protease inhibitor that has been shown to modulate innate immunity and pro-inflammatory signaling in sepsis. In addition, there are reports that UTI may modulate the functional activity of Tregs to influence the inflammatory response in infectious disease. In the present study, we investigated the effect of UTI on the activity of Tregs, which was assessed by measuring the survival and inflammatory responses of mice with cecal ligation and puncture (CLP)-induced sepsis. In addition, we further explored the cellular and molecular mechanisms involved in these effects. The results showed that UTI could enhance survival and attenuate inflammatory responses during CLP-induced sepsis. Moreover, sepsis-induced increases in the quantity and activity of Tregs were attenuated under UTI treatment, but not in TLR4^-/- mice. We also found that the functional changes in Tregs could be attributed to the TLR4/NF-κB signaling pathway. Collectively, our results indicated that UTI could ameliorate inflammatory damage by modulating the quantity and function of Tregs via the TLR4/NF-κB signaling pathway. Our study provides theoretical and experimental evidence for the administration of UTI in the treatment of sepsis and other acute critical illnesses.

Tat-protein disulfide-isomerase A3: a possible candidate for preventing ischemic damage in the spinal cord

In the present study, we searched for possible candidates that can prevent ischemic damage in the rabbit spinal cord. For this study, we used two-dimensional gel electrophoresis followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, in sham- and ischemia-operated animals. As the level of protein disulfide-isomerase A3 (PDIA3) significantly decreased 3 h after ischemia/reperfusion, we further investigated its possible role against ischemic damage using an in vitro spinal cord cell line and in vivo spinal cord ischemic model. The administration of Tat-PDIA3 significantly reduced the hydrogen peroxide-induced formation of reactive oxygen species and cell death, based on terminal deoxynucleotidyl transferase-mediated biotinylated dUTP nick end labeling and a colorimetric WST-1 assay. Further, Tat-PDIA3 significantly ameliorated the ischemia-induced deficits in motor function, based on Tarlov's criteria, 24-72 h after ischemia/reperfusion, as well as the degeneration of motor neurons in the ventral horn 72 h after ischemia/reperfusion. Tat-PDIA3 administration also reduced the ischemia-induced activation of microglia and lipid peroxidation in the motor neurons 72 h after ischemia/reperfusion. PDIA3 also potentially ameliorated the ischemia-induced increase in oxidative markers in serum and decreased the activity of Cu,Zn-superoxide dismutase, Mn-superoxide dismutase, and glutathione peroxidase in spinal cord homogenates, 24 h and 72 h after ischemia/reperfusion. These results suggest that Tat-PDIA3 could be used to protect spinal cord neurons from ischemic damage, due to its modulatory action on the oxidative/anti-oxidative balance. Tat-PDIA3 could be applicable to protects neurons from the ischemic damage induced by thoracoabdominal aorta obstruction.

Diffusion Kurtosis Imaging and Pathology in Spinal Cord Ischemia/Reperfusion Injury in Rabbits: A Case-Control Study

Background

The aim of this study was to evaluate the application of diffusion kurtosis imaging (DKI) in spinal cord ischemia/reperfusion (SCI/R) injury and to explore its association with pathology.

Material/Methods

Japanese male long-eared rabbits were chosen and divided into 7 groups (8 rabbits in each group): control group (C group), sham-operation control group (S group), and 5 experimental groups (E-2 h group, E-24 h group, E-48 h group, E-7 d group, and E-14 d group). Tarlov scoring and immunohistochemical staining were used to assess hindlimb motor function and observe the expression of glial fiber acidic protein (GFAP), respectively. The correlation between DKI and pathology after SCI/R injury was compared by 3.0TMR scanning DKI.

Result

Neuroethology in each time point of E groups was significantly different from that in C and S groups (P<0.05). The E-24 h group had the lowest value (P<0.05), and the hindlimb motor function began to recover after 24 h. The expression of GFAP was gradually increased after SCI/R injury, and the maximum value was in the E-7 d group (P<0.05). MK (mean kurtosis) had a linear negative correlation with average optical density (OD) (r=−0.115, P<0.05) and was positively correlated with integral OD (IOD) (r=0.204, P<0.05), in which MD (mean dispersion) was positively correlated with OD and IOD, but without a significant difference (r=0.618, r=251, P>0.05).

Conclusions

DKI can be used to monitor the changes in SCI/R injury, and fractional anisotropy (FA) can reflect change in white matter structure. The changes in expression of MK and GFAP were related to the myelin sheath injury repair process.

Effect of ulinastatin on postoperative renal function in patients undergoing robot-assisted laparoscopic partial nephrectomy: a randomized trial

BACKGROUND

Robot-assisted laparoscopic partial nephrectomy (RLPN) is an emerging technique for treating small renal masses. Although RLPN has many advantages, ischemic kidney injury is inevitable during renal artery clamping. The overall incidence of acute kidney injury (AKI) after partial nephrectomy has been reported to be up to 39%. Moreover, effective pharmacological protection against AKI after partial nephrectomy has not yet been demonstrated. Ulinastatin has been shown to protect the kidney from ischemia/reperfusion injury via its anti-inflammatory and anti-oxidant activities. Therefore, this study aimed to evaluate the effect of ulinastatin on postoperative kidney function in patients undergoing RLPN.

METHODS

In this randomized, double-blinded, placebo-controlled study, patients undergoing RLPN received either intravenous ulinastatin (100,000 units/10 kg; ulinastatin group, n = 35) or the same volume of normal saline (control group, n = 35) for 1 h starting 10 min before renal artery clamping. The primary outcome was incidence of postoperative AKI. Secondary outcomes were levels of serum creatinine, estimated glomerular filtration rate (eGFR), cystatin C, and inflammatory markers and were measured before operation and at 1, 24, 48, and 72 h postoperatively.

RESULTS

The incidence of postoperative AKI was 18% in the ulinastatin group, whereas it was 30% in the control group (p = 0.251). No significant differences in postoperative changes of serum creatinine, eGFR, or cystatin C were observed between the two groups. Postoperative inflammatory markers including C-reactive protein, white blood cell count, and neutrophil percentage were significantly increased until 72 h after operation compared to the preoperative values in both groups, with no significant differences between the groups.

CONCLUSIONS

Administration of ulinastatin (100,000 units/10 kg) during the warm ischemia and reperfusion periods did not show any beneficial effects on postoperative kidney function or inflammatory responses in patients undergoing RLPN.

Inhibition of Intracellular Type 10 Adenylyl Cyclase Protects Cortical Neurons Against Reperfusion-Induced Mitochondrial Injury and Apoptosis

Mitochondrial injury significantly contributes to the neuronal death under cerebral ischemia and reperfusion. Within several signaling pathways, cyclic adenosine monophosphate (cAMP) signaling plays a substantial role in mitochondrial injury and cell death. Traditionally, the source of cellular cAMP has been attributed to the membrane-bound adenylyl cyclase, whereas the role of the intracellular localized type 10 soluble adenylyl cyclase (sAC) in neuronal pathology has not been considered. Since neurons express an active form of sAC, we aimed to investigate the role of sAC in reperfusion-induced neuronal apoptosis. For this purpose, the in vitro model of oxygen/glucose deprivation (simulated ischemia, 1 h), followed by recovery (simulated reperfusion, 12 h) in rat embryonic neurons, was applied. Although ischemia alone had no significant effect on apoptosis, reperfusion led to an activation of the mitochondrial pathway of apoptosis, hallmarked by mitochondrial depolarization, cytochrome c release, and mitochondrial ROS formation. These effects were accompanied by significantly augmented sAC expression and increased cellular cAMP content during reperfusion. Pharmacological suppression of sAC during reperfusion reduced cellular cAMP and ameliorated reperfusion-induced mitochondrial apoptosis and ROS formation. Similarly, sAC knockdown prevented neuronal death. Further analysis revealed a role of protein kinase A (PKA), a major downstream target of sAC, in reperfusion-induced neuronal apoptosis and ROS formation. In conclusion, the results show a causal role of intracellular, sAC-dependent cAMP signaling in reperfusion-induced mitochondrial injury and apoptosis in neurons. The protective effect of sAC inhibition during the reperfusion phase provides a basis for the development of new strategies to prevent the reperfusion-induced neuronal injury.

Ulinastatin attenuates LPS-induced human endothelial cells oxidative damage through suppressing JNK/c-Jun signaling pathway

Lipopolysaccharide (LPS)-induced oxidative stress is a main feature observed in the sepsis by increasing endothelial oxidative damage. Many studies have demonstrated that Ulinastatin (UTI) can inhibit pro-inflammatory proteases, decrease inflammatory cytokine levels and suppress oxidative stress. However, the potential molecular mechanism underlying UTI which exerts its antioxidant effect is not well understood. In this study, we aimed to investigate the effects of UTI on the LPS-induced oxidative stress and the underlying mechanisms using human umbilical vein endothelial cells (HUVECs). After oxidative stress induced By LPS in HUVECs, the cell viability and reactive oxygen species (ROS) in cytoplasm were measured. In addition, superoxide dismutase (SOD) and malondialdehyde (MDA) were examined. We found that LPS resulted in a profound elevation of ROS production and MDA levels. The decrease in Cu/Zn-SOD protein and increased in Mn-SOD protein were observed in a time- and dose-dependent manner. These responses were suppressed by an addition of UTI. The increase in c-Jun N-terminal kinases (JNK) phosphorylation by LPS in HUVECs was markedly blocked by UTI or JNK inhibitor SP600125. Our results suggest that UTI exerts its anti-oxidant effects by decreasing overproduction of ROS induced by LPS via suppressing JNK/c-Jun phosphorylation. Therefore UTI may play a protective role in vascular endothelial injury induced by oxidative stress such as sepsis. This study may provide insight into a possible molecular mechanism by which Ulinastatin inhibits LPS-induced oxidative stress.

Diabetes blocks the cardioprotective effects of sevoflurane postconditioning by impairing Nrf2/Brg1/HO-1 signaling

Sevofluane postconditioning (SPostC) protects heart against ischemia/reperfusion injury. However, SPostC cardioprotection is lost in diabetes whose cardiac heme oxygenase-1 (HO-1) is reduced. Brahma-related gene 1 (Brg1) facilitates nuclear factor-erythroid-2-related factor-2 (Nrf2) to activate HO-1 to increase myocardial antioxidant capacity in response to oxidative stress. However, cardiac Brg1 is reduced in diabetes. We hypothesized that SPostC confers cardioprotection by activating HO-1 through Nrf2/Brg1 and that impaired Nrf2/Brg1/HO-1 in diabetes is responsible for the loss of SPostC. Control and streptozotocin-induced diabetic mice were subjected to 45min coronary artery occlusion followed by 2h reperfusion with or without SPostC achieved by exposing the mice to 2% sevoflurane for 15min at the onset of reperfusion. In invitro study, H9c2 cells were exposed to normal or high glucose and subjected to 3h hypoxia followed by 6h reoxygenation. Diabetic mice displayed larger post-ischemic infarct size, severer cardiomyocytes apoptosis, and increased oxidative stress concomitant with reduced HO-1, nuclear Nrf2 and Brg1 protein expression. These changes were prevented/reversed by SPostC in control but not in diabetic mice, and these beneficial effects of SPostC were abolished by HO-1 inhibition. In H9c2 cells exposed to normal glucose but not high glucose, SPostC significantly attenuated hypoxia/reoxygenation-induced cellular injury and oxidative stress with increased HO-1 and nuclear Nrf2. These SPostC beneficial effects were canceled by HO-1 inhibition. In conclusion, SPostC protects against myocardial ischemia/reperfusion injury through activation of Nrf2/Brg1/HO-1 signaling and impairment of this signaling may be responsible for the loss of SPostC cardioprotection in diabetes.