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Drăgan A, Drăgan AŞ. The Preventive Role of Glutamine Supplementation in Cardiac Surgery-Associated Kidney Injury from Experimental Research to Clinical Practice: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:761. [PMID: 38792944 PMCID: PMC11123382 DOI: 10.3390/medicina60050761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Acute kidney injury represents a significant threat in cardiac surgery regarding complications and costs. Novel preventive approaches are needed, as the therapeutic modalities are still limited. As experimental studies have demonstrated, glutamine, a conditionally essential amino acid, might have a protective role in this setting. Moreover, the levels of glutamine after the cardiopulmonary bypass are significantly lower. In clinical practice, various trials have investigated the effects of glutamine supplementation on cardiac surgery with encouraging results. However, these studies are heterogeneous regarding the selection criteria, timing, dose, outcomes studied, and way of glutamine administration. This narrative review aims to present the potential role of glutamine in cardiac surgery-associated acute kidney injury prevention, starting from the experimental studies and guidelines to the clinical practice and future directions.
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Affiliation(s)
- Anca Drăgan
- Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases “Prof Dr C C Iliescu”, 258 Fundeni Road, 022328 Bucharest, Romania
| | - Adrian Ştefan Drăgan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd, 050474 Bucharest, Romania;
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Benscoter AL, Alten JA, Atreya MR, Cooper DS, Byrnes JW, Nelson DP, Ollberding NJ, Wong HR. Biomarker-based risk model to predict persistent multiple organ dysfunctions after congenital heart surgery: a prospective observational cohort study. Crit Care 2023; 27:193. [PMID: 37210541 PMCID: PMC10199562 DOI: 10.1186/s13054-023-04494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is an important cause of post-operative morbidity and mortality for children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Dysregulated inflammation is widely regarded as a key contributor to bypass-related MODS pathobiology, with considerable overlap of pathways associated with septic shock. The pediatric sepsis biomarker risk model (PERSEVERE) is comprised of seven protein biomarkers of inflammation and reliably predicts baseline risk of mortality and organ dysfunction among critically ill children with septic shock. We aimed to determine if PERSEVERE biomarkers and clinical data could be combined to derive a new model to assess the risk of persistent CPB-related MODS in the early post-operative period. METHODS This study included 306 patients < 18 years old admitted to a pediatric cardiac ICU after surgery requiring cardiopulmonary bypass (CPB) for congenital heart disease. Persistent MODS, defined as dysfunction of two or more organ systems on postoperative day 5, was the primary outcome. PERSEVERE biomarkers were collected 4 and 12 h after CPB. Classification and regression tree methodology were used to derive a model to assess the risk of persistent MODS. RESULTS The optimal model containing interleukin-8 (IL-8), chemokine ligand 3 (CCL3), and age as predictor variables had an area under the receiver operating characteristic curve (AUROC) of 0.86 (0.81-0.91) for differentiating those with or without persistent MODS and a negative predictive value of 99% (95-100). Ten-fold cross-validation of the model yielded a corrected AUROC of 0.75 (0.68-0.84). CONCLUSIONS We present a novel risk prediction model to assess the risk for development of multiple organ dysfunction after pediatric cardiac surgery requiring CPB. Pending prospective validation, our model may facilitate identification of a high-risk cohort to direct interventions and studies aimed at improving outcomes via mitigation of post-operative organ dysfunction.
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Affiliation(s)
- Alexis L Benscoter
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
| | - Jeffrey A Alten
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA
| | - Mihir R Atreya
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - David S Cooper
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA
| | - Jonathan W Byrnes
- Division of Cardiology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David P Nelson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Hector R Wong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
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Wagner KD. Editorial (Preface) "Cells/Cells of the Cardiovascular System-Editorial Highlights 2020-2021: The Book Selection". Cells 2022; 11:cells11233898. [PMID: 36497157 PMCID: PMC9735509 DOI: 10.3390/cells11233898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This introduction provides a preface to the section on "Cells of the Cardiovascular System" in the book entitled "Editor's Choice Articles in 2020-2021" [...].
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The Editor’s Choice Articles—Section “Cells of the Cardiovascular System” 2020–2021. Cells 2022; 11:cells11142173. [PMID: 35883616 PMCID: PMC9323559 DOI: 10.3390/cells11142173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Cells is experiencing a rapid increase in attractiveness and impact [...]
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Parmana IMA, Boom CE, Rachmadi L, Hanafy DA, Widyastuti Y, Mansyur M, Siswanto BB. Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery. Vasc Health Risk Manag 2022; 18:219-231. [PMID: 35411147 PMCID: PMC8994629 DOI: 10.2147/vhrm.s361298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Myocardial injury due to on-pump coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is associated with poor outcomes. This study determines whether intravenous glutamine could protect the myocardium during on-pump CABG in patients with low EF. Materials and Methods This was a double-blind, randomized controlled trial to assess glutamine as a myocardial protector during on-pump CABG in patients with left ventricle EF of 31–50%, conducted from January to October 2021. Patients in the glutamine group (n = 30) received 0.5 g/kg of 20% glutamine solution diluted with 0.9% NaCl up to 500 mL in total volume over a period of 24 hours. Patients in the control group (n = 30) received 0.9% NaCl over the same period. The primary outcomes were plasma troponin I and plasma glutamine levels. Secondary outcomes included α-ketoglutarate (α-KG) levels and histopathology scoring of the right atrial appendage tissue, plasma lactate levels, hemodynamic measurement, and morbidity. Results Twenty-nine patients from each group (58 in total) were included in the analysis. Plasma troponin I levels at 6 and 24 hours after cardiopulmonary bypass (CPB) were significantly lower in the glutamine than the control group (mean 3.43 ± 1.51 ng/mL vs mean 4.41 ± 1.89 ng/mL; p = 0.034; median 3.08 ng/mL [min–max: 1.30–6.59] vs median 3.77 ng/mL [min–max: 0.00–36.53]; p = 0.038, respectively). Plasma glutamine levels at 24 hours after CPB were significantly higher in the glutamine than the control group (mean 935.42 ± 319.10 μmol/L vs mean 634.79 ± 243.89 μmol/L, p = 0.001). Plasma lactate levels at 6 and 24 hours after CPB were significantly lower in the glutamine than the control group (median 5.30 mmol/L [min-max: 1.20–9.50] vs median 5.70 mmol/L [min-max: 2.80–11.30], p = 0.042; mean 2.08 ± 0.67 mmol/L vs mean 2.46 ± 0.69 mmol/L, p = 0.044, respectively). Myocardial injury score was significantly lower in the glutamine than the control group (mean 1.30 ± 0.24 vs mean 1.48 ± 0.26, p = 0.011). Conclusion Perioperative administration of 0.5 g/kg intravenous glutamine solution over the period of 24 hours has myocardial protection effect in patients with low EF who undergo elective on-pump CABG.
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Affiliation(s)
- I Made Adi Parmana
- Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Correspondence: I Made Adi Parmana, Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, LetJen S. Parman St No. Kav. 87, West Jakarta, Jakarta, Indonesia, Tel +62 812-4601-212, Email
| | - Cindy Elfira Boom
- Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lisnawati Rachmadi
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dudy Arman Hanafy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yunita Widyastuti
- Department of Anesthesiology and Intensive Care, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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6
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van Wijk SW, Ramos KS, Brundel BJJM. Cardioprotective Role of Heat Shock Proteins in Atrial Fibrillation: From Mechanism of Action to Therapeutic and Diagnostic Target. Int J Mol Sci 2021; 22:ijms22010442. [PMID: 33466228 PMCID: PMC7795054 DOI: 10.3390/ijms22010442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia worldwide and is associated with ischemic stroke, heart failure, and substantial morbidity and mortality. Unfortunately, current AF therapy is only moderately effective and does not prevent AF progression from recurrent intermittent episodes (paroxysmal) to persistent and finally permanent AF. It has been recognized that AF persistence is related to the presence of electropathology. Electropathology is defined as structural damage, including degradation of sarcomere structures, in the atrial tissue which, in turn, impairs electrical conduction and subsequently the contractile function of atrial cardiomyocytes. Recent research findings indicate that derailed proteostasis underlies structural damage and, consequently, electrical conduction impairment. A healthy proteostasis is of vital importance for proper function of cells, including cardiomyocytes. Cells respond to a loss of proteostatic control by inducing a heat shock response (HSR), which results in heat shock protein (HSP) expression. Emerging clinical evidence indicates that AF-induced proteostasis derailment is rooted in exhaustion of HSPs. Cardiomyocytes lose defense against structural damage-inducing pathways, which drives progression of AF and induction of HSP expression. In particular, small HSPB1 conserves sarcomere structures by preventing their degradation by proteases, and overexpression of HSPB1 accelerates recovery from structural damage in experimental AF model systems. In this review, we provide an overview of the mechanisms of action of HSPs in preventing AF and discuss the therapeutic potential of HSP-inducing compounds in clinical AF, as well as the potential of HSPs as biomarkers to discriminate between the various stages of AF and recurrence of AF after treatment.
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Affiliation(s)
- Stan W. van Wijk
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; (K.S.R.); (B.J.J.M.B.)
- Correspondence:
| | - Kennedy S. Ramos
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; (K.S.R.); (B.J.J.M.B.)
- Erasmus Medical Center, Department of Cardiology, 3015 GD Rotterdam, The Netherlands
| | - Bianca J. J. M. Brundel
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; (K.S.R.); (B.J.J.M.B.)
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Papandreou C, Hernández-Alonso P, Bulló M, Ruiz-Canela M, Li J, Guasch-Ferré M, Toledo E, Clish C, Corella D, Estruch R, Cofán M, Fitó M, Razquin C, Arós F, Fiol M, Santos-Lozano JM, Serra-Majem L, Liang L, Martínez-González MA, Hu FB, Salas-Salvadó J. High Plasma Glutamate and a Low Glutamine-to-Glutamate Ratio Are Associated with Increased Risk of Heart Failure but Not Atrial Fibrillation in the Prevención con Dieta Mediterránea (PREDIMED) Study. J Nutr 2020; 150:2882-2889. [PMID: 32939552 PMCID: PMC7675032 DOI: 10.1093/jn/nxaa273] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the association between glutamate and glutamine in relation to cardiometabolic disorders has been evaluated, the role of these metabolites in the development of atrial fibrillation (AF) and heart failure (HF) remains unknown. OBJECTIVES We examined associations of glutamate, glutamine, and the glutamine-to-glutamate ratio with AF and HF incidence in a Mediterranean population at high cardiovascular disease (CVD) risk. METHODS The present study used 2 nested case-control studies within the PREDIMED (Prevención con Dieta Mediterránea) study. During ∼10 y of follow-up, there were 509 AF incident cases matched to 618 controls and 326 HF incident cases matched to 426 controls. Plasma concentrations of glutamate and glutamine were semiquantitatively profiled with LC-tandem MS. ORs were estimated with multivariable conditional logistic regression models. RESULTS In fully adjusted models, per 1-SD increment, glutamate was associated with a 29% (95% CI: 1.08, 1.54) increased risk of HF and glutamine-to-glutamate ratio with a 20% (95% CI: 0.67, 0.94) decreased risk. Glutamine-to-glutamate ratio was also inversely associated with HF risk (OR per 1-SD increment: 0.80; 95% CI: 0.67, 0.94) when comparing extreme quartiles. Higher glutamate concentrations were associated with a worse cardiometabolic risk profile, whereas a higher glutamine-to-glutamate ratio was associated with a better cardiometabolic risk profile. No associations between the concentrations of these metabolites and AF were observed. CONCLUSIONS Our findings suggest that high plasma glutamate concentrations possibly resulting from alterations in the glutamate-glutamine cycle may contribute to the development of HF in Mediterranean individuals at high CVD risk.This trial was registered at www.isrctn.com as ISRCTN35739639.
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Affiliation(s)
- Christopher Papandreou
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Pablo Hernández-Alonso
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Mònica Bulló
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Human Nutrition Unit, University Hospital of Sant Joan de Reus, Reus, Spain
| | - Miguel Ruiz-Canela
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jun Li
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marta Guasch-Ferré
- Biochemistry and Biotechnology Department, Human Nutrition Unit, Rovira i Virgili University, Reus, Spain,Pere i Virgili Health Research Institute (IISPV), Reus, Spain,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Clary Clish
- Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Dolores Corella
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Ramon Estruch
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Internal Medicine, Hospital Clinic, University of Barcelona,, Barcelona, Spain,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montserrat Cofán
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain,Lipid Clinic, Department of Endocrinology and Nutrition, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Montserrat Fitó
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Cardiovascular and Nutrition Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Cristina Razquin
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Fernando Arós
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Cardiology, University Hospital of Alava, Vitoria, Spain
| | - Miquel Fiol
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Institute of Health Sciences IUNICS, Health Research Institute of the Balearic Islands, Son Espases Hospital, Palma de Mallorca, Spain
| | - José M Santos-Lozano
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Family Medicine, Seville Primary Care Health District, San Pablo Health Center, Seville, Spain
| | - Lluís Serra-Majem
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Research Institute of Biomedical and Health Sciences IUIBS, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Liming Liang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA,Department of Statistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Miguel A Martínez-González
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA,Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Daily Supplementation of L-Glutamine in Atrial Fibrillation Patients: The Effect on Heat Shock Proteins and Metabolites. Cells 2020; 9:cells9071729. [PMID: 32698370 PMCID: PMC7408381 DOI: 10.3390/cells9071729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Pharmaco-therapeutic strategies of atrial fibrillation (AF) are moderately effective and do not prevent AF onset and progression. Therefore, there is an urgent need to develop novel therapies. Previous studies revealed heat shock protein (HSP)-inducing compounds to mitigate AF onset and progression. Such an HSP inducing compound is L-glutamine. In the current study we investigate the effect of L-glutamine supplementation on serum HSP27 and HSP70 levels and metabolite levels in patients with AF patients (n = 21). Hereto, HSP27 and HSP70 levels were determined by ELISAs and metabolites with LC-mass spectrometry. HSP27 levels significantly decreased after 3-months of L-glutamine supplementation [540.39 (250.97–1315.63) to 380.69 (185.68–915.03), p = 0.004] and normalized to baseline levels after 6-months of L-glutamine supplementation [634.96 (139.57–3103.61), p < 0.001]. For HSP70, levels decreased after 3-months of L-glutamine supplementation [548.86 (31.50–1564.51) to 353.65 (110.58–752.50), p = 0.045] and remained low after 6-months of L-glutamine supplementation [309.30 (118.29–1744.19), p = 0.517]. Patients with high HSP27 levels at baseline showed normalization of several metabolites related to the carbohydrates, nucleotides, amino acids, vitamins and cofactors metabolic pathways after 3-months L-glutamine supplementation. In conclusion, L-glutamine supplementation reduces the serum levels of HSP27 and HSP70 within 3-months and normalizes metabolite levels. This knowledge may fuel future clinical studies on L-glutamine to improve cardioprotective effects that may attenuate AF episodes.
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Sabbatinelli J, Prattichizzo F, Olivieri F, Procopio AD, Rippo MR, Giuliani A. Where Metabolism Meets Senescence: Focus on Endothelial Cells. Front Physiol 2019; 10:1523. [PMID: 31920721 PMCID: PMC6930181 DOI: 10.3389/fphys.2019.01523] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022] Open
Abstract
Despite the decline in their proliferative potential, senescent cells display a high metabolic activity. Senescent cells have been shown to acquire a more glycolytic state even in presence of high oxygen levels, in a way similar to cancer cells. The diversion of pyruvate, the final product of glycolysis, away from oxidative phosphorylation results in an altered bioenergetic state and may occur as a response to the enhanced oxidative stress caused by the accumulation of dysfunctional mitochondria. This metabolic shift leads to increased AMP/ATP and ADP/ATP ratios, to the subsequent AMPK activation, and ultimately to p53-mediated growth arrest. Mounting evidences suggest that metabolic reprogramming is critical to direct considerable amounts of energy toward specific activities related to the senescent state, including the senescence-associated secretory phenotype (SASP) and the modulation of immune responses within senescent cell tissue microenvironment. Interestingly, despite the relative abundance of oxygen in the vascular compartment, healthy endothelial cells (ECs) produce most of their ATP content from the anaerobic conversion of glucose to lactate. Their high glycolytic rate further increases during senescence. Alterations in EC metabolism have been identified in age-related diseases (ARDs) associated with a dysfunctional vasculature, including atherosclerosis, type 2 diabetes and cardiovascular diseases. In particular, higher production of reactive oxygen species deriving from a variety of enzymatic sources, including uncoupled endothelial nitric oxide synthase and the electron transport chain, causes DNA damage and activates the NAD+-consuming enzymes polyADP-ribose polymerase 1 (PARP1). These non-physiological mechanisms drive the impairment of the glycolytic flux and the diversion of glycolytic intermediates into many pathological pathways. Of note, accumulation of senescent ECs has been reported in the context of ARDs. Through their pro-oxidant, pro-inflammatory, vasoconstrictor, and prothrombotic activities, they negatively impact on vascular physiology, promoting both the onset and development of ARDs. Here, we review the current knowledge on the cellular senescence-related metabolic changes and their contribution to the mechanisms underlying the pathogenesis of ARDs, with a particular focus on ECs. Moreover, current and potential interventions aimed at modulating EC metabolism, in order to prevent or delay ARD onset, will be discussed.
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Affiliation(s)
- Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
| | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
- Center of Clinical Pathology and Innovative Therapy, IRCCS INRCA, Ancona, Italy
| | - Antonio Domenico Procopio
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
- Center of Clinical Pathology and Innovative Therapy, IRCCS INRCA, Ancona, Italy
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
| | - Angelica Giuliani
- Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, Ancona, Italy
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10
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Wang X, Huang L, Qu Y, Lv H, He X. Effects of glutamine on cytokines 1L-1 and TNF-α in rehabilitation and prognosis of patients with lobectomy. Exp Ther Med 2018; 16:2303-2308. [PMID: 30186471 PMCID: PMC6122503 DOI: 10.3892/etm.2018.6443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/18/2018] [Indexed: 11/24/2022] Open
Abstract
This study was designed to investigate the effects of glutamine on cytokines 1L-1, TNF-α and prognosis of patients with lobectomy in the process of postoperative rehabilitation. A total of 78 patients with lung cancer who underwent lobectomy from January 2015 to January 2017 were selected in Daqing Oilfield General Hospital (Daqing, China). Patients were randomly divided into two groups, 39 patients in each group. Patients in the control group were treated with conventional treatment, while patients in the observation group were treated with both conventional and glutamine treatment. The levels of TNF-α, endotoxin, serum IL-1, IL-10, IL-15, IL-18 and intercellular adhesion molecule-1 (ICAM-1), myeloperoxidase (MPO) activity, incidence of nausea and vomiting, pulmonary histopathological changes, prognosis, and rehabilitation (time in bed, hospital stay and lung function) were compared between the two groups. Within 1 year after treatment, most patients survived, except 2 patients in the observation group and 3 patients in the control group who died. The rate of postoperation infection in the observation group was slightly lower than that in the control group. After treatment, the levels of endotoxin and TNF-α in the observation group were significantly lower than those in the control group (p<0.05). After treatment, the serum levels of IL-1 and IL-10 were significantly higher and the serum levels of IL-15 and IL-18 were significantly lower in the observation group than those in the control group (p<0.05). The expression levels of ICAM-1 and MPO activity were significantly higher in the observation group than those in the control group (p<0.05). No significant difference in the incidence of nausea and vomiting was found between the two groups (p>0.05). The average postoperative bed rest and hospital stay in the observation group were significantly shorter than those in the control group (p<0.05). The levels of forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) in the observation group were significantly higher than those in the control group (p<0.05). The results indicated that glutamine treatment is effective in the postoperative rehabilitation of patients undergoing lobectomy. Glutamine can regulate the levels of IL-1 and TNF-α, improve lung function, shorten bed rest and hospitalization days, promote patients postoperative rehabilitation process, and improve patients quality of life.
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Affiliation(s)
- Xuefeng Wang
- Department of Rehabilitation, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163001, P.R. China
| | - Lei Huang
- Department of Rehabilitation, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163001, P.R. China
| | - Yanxia Qu
- Department of Rehabilitation, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163001, P.R. China
| | - Hongmei Lv
- Department of Rehabilitation, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163001, P.R. China
| | - Xiaohua He
- Department of Rehabilitation, Daqing Oilfield General Hospital, Daqing, Heilongjiang 163001, P.R. China
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Golbidi S, Li H, Laher I. Oxidative Stress: A Unifying Mechanism for Cell Damage Induced by Noise, (Water-Pipe) Smoking, and Emotional Stress-Therapeutic Strategies Targeting Redox Imbalance. Antioxid Redox Signal 2018; 28:741-759. [PMID: 29212347 DOI: 10.1089/ars.2017.7257] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SIGNIFICANCE Modern technologies have eased our lives but these conveniences can impact our lifestyles in destructive ways. Noise pollution, mental stresses, and smoking (as a stress-relieving solution) are some environmental hazards that affect our well-being and healthcare budgets. Scrutinizing their pathophysiology could lead to solutions to reduce their harmful effects. Recent Advances: Oxidative stress plays an important role in initiating local and systemic inflammation after noise pollution, mental stress, and smoking. Lipid peroxidation and release of lysolipid by-products, disturbance in activation and function of nuclear factor erythroid 2-related factor 2 (Nrf2), induction of stress hormones and their secondary effects on intracellular kinases, and dysregulation of intracellular Ca2+ can all potentially trigger other vicious cycles. Recent clinical data suggest that boosting the antioxidant system through nonpharmacological measures, for example, lifestyle changes that include exercise have benefits that cannot easily be achieved with pharmacological interventions alone. CRITICAL ISSUES Indiscriminate manipulation of the cellular redox network could lead to a new series of ailments. An ideal approach requires meticulous scrutiny of redox balance mechanisms for individual pathologies so as to create new treatment strategies that target key pathways while minimizing side effects. FUTURE DIRECTIONS Extrapolating our understanding of redox balance to other debilitating conditions such as diabetes and the metabolic syndrome could potentially lead to devising a unifying therapeutic strategy. Antioxid. Redox Signal. 28, 741-759.
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Affiliation(s)
- Saeid Golbidi
- 1 Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia , Vancouver, Canada
| | - Huige Li
- 2 Department of Pharmacology, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Ismail Laher
- 1 Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia , Vancouver, Canada
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Wang H, Dong Y, Cai Y. Alanyl-glutamine prophylactically protects against lipopolysaccharide-induced acute lung injury by enhancing the expression of HSP70. Mol Med Rep 2017; 16:2807-2813. [DOI: 10.3892/mmr.2017.6896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/02/2017] [Indexed: 11/06/2022] Open
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Liguori GR, Kanas AF, Moreira LFP. Managing the inflammatory response after cardiopulmonary bypass: review of the studies in animal models. Braz J Cardiovasc Surg 2014; 29:93-102. [PMID: 24896169 PMCID: PMC4389477 DOI: 10.5935/1678-9741.20140017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022] Open
Abstract
Objective To review studies performed in animal models that evaluated therapeutic
interventions to inflammatory response and microcirculatory changes after
cardiopulmonary bypass. Methods It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and
("Microcirculation" (MeSH) or "Inflammation" (MeSH) or
"Inflammation Mediators" (MeSH)). Repeated results, human studies,
non-English language articles, reviews and studies without control were
excluded. Results Blood filters, system miniaturization, specific primers regional perfusion,
adequate flow and temperature and pharmacological therapies with anticoagulants,
vasoactive drugs and anti-inflammatories reduced changes in microcirculation and
inflammatory response. Conclusion Demonstrated efficacy in animal models establishes a perspective for evaluating
these interventions in clinical practice.
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Affiliation(s)
- Gabriel Romero Liguori
- Correspondence address: Gabriel Romero Liguori, Instituto do Coração
(InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,
Av. Dr. Enéas de Carvalho Aguiar, 44 - 2º andar - bloco II - sala 13 - Cerqueira
César, São Paulo, SP, Brazil - Zip code: 05403-000. E-mail:
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Ni HB, Zhang Z, Qin HD. Protective effect of glutamine in critical patients with acute liver injury. World J Emerg Med 2014; 2:210-5. [PMID: 25215012 DOI: 10.5847/wjem.j.1920-8642.2011.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 08/03/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Glutamine (Gln) supplementation is known to decrease oxidative stress and inflammatory response, enhance resistance to infectious pathogens, shorten hospital stay, and decrease medical costs of patients. This study was undertaken to evaluate the relationship between the effect of early parenteral glutamine (Gln) supplement on acute liver injury (ALI) and heat shock protein 70 (HSP-70) expression in critical patients. METHODS Forty-four patients who had been admitted to the emergency intensive care unit (EICU) of Nanjing First Hospital Affiliated to Nanjing Medical University were randomly divided into a control group (n=22) and a Gln group (n=22). The patients of the two groups received enteral and parenteral nutrition. In addition, parenteral Gln 0.4 g/kg per day was given for 7 days in the Gln group. Serum HSP-70 and Gln were measured at admission and at 7 days after admission. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBiL), serum levels of HSP-70 and Gln, mechanical ventilation (MV) time, ICU stay, peripheral blood of TNF-α, IL-6, CD3, CD4 and CD4/CD8 levels were also measured in the two groups. RESULTS In the Gln group, the levels of serum HSP-70 and Gln were significantly higher after Gln treatment than those before the treatment (P<0.01). HSP-70 level was positively correlated with the Gln level in the Gln group after administration of parenteral Gln (P<0.01). The levels of serum ALT, AST, TBiL and TNF-α, IL-6 were lower in the Gln group than in the non-Gln group (P<0.01). MV time and ICU stay were significantly different between the two groups (P<0.05). The levels of CD3, CD4 and CD4/CD8 were significantly higher in the Gln group than in the control group after treatment (P<0.05). CONCLUSION Parenteral Gln significantly increases the level of serum HSP70 in critically ill patients. The enhanced expression of HSP70 is correlated with improved outcomes of Gln-treated patients with acute liver injury.
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Affiliation(s)
- Hai-Bin Ni
- Department of Emergency, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
| | - Zheng Zhang
- Department of Emergency, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
| | - Hai-Dong Qin
- Department of Emergency, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
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Addabbo F, Chen Q, Patel DP, Rabadi M, Ratliff B, Zhang F, Jasmin JF, Wolin M, Lisanti M, Gross SS, Goligorsky MS. Glutamine supplementation alleviates vasculopathy and corrects metabolic profile in an in vivo model of endothelial cell dysfunction. PLoS One 2013; 8:e65458. [PMID: 23776484 PMCID: PMC3679132 DOI: 10.1371/journal.pone.0065458] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/25/2013] [Indexed: 02/07/2023] Open
Abstract
Endothelial Cell Dysfunction (ECD) is a recognized harbinger of a host of chronic cardiovascular diseases. Using a mouse model of ECD triggered by treatment with L-Nω-methylarginine (L-NMMA), we previously demonstrated that renal microvasculature displays a perturbed protein profile, including diminished expression of two key enzymes of the Krebs cycle associated with a Warburg-type suppression of mitochondrial metabolism. We hypothesized that supplementation with L-glutamine (GLN), that can enter the Krebs cycle downstream this enzymatic bottleneck, would normalize vascular function and alleviate mitochondrial dysfunction. To test this hypothesis, mice with chronic L-NMMA-induced ECD were co-treated with GLN at different concentrations for 2 months. Results confirmed that L-NMMA led to a defect in acetylcholine-induced relaxation of aortic rings that was dose-dependently prevented by GLN. In caveolin-1 transgenic mice characterized by eNOS inactivation, L-NMMA further impaired vasorelaxation which was partially rescued by GLN co-treatment. Pro-inflammatory profile induced by L-NMMA was blunted in mice co-treated with GLN. Using an LC/MS platform for metabolite profiling, we sought to identify metabolic perturbations associated with ECD and offset by GLN supplementation. 3453 plasma molecules could be detected with 100% frequency in mice from at least one treatment group. Among these, 37 were found to be differentially expressed in a 4-way comparison of control vs. LNMMA both with and without GLN. One of such molecules, hippuric acid, an “uremic toxin” was found to be elevated in our non-uremic mice receiving L-NMMA, but normalized by treatment with GLN. Ex vivo analysis of hippuric acid effects on vasomotion demonstrated that it significantly reduced acetylcholine-induced vasorelaxation of vascular rings. In conclusion, functional and metabolic profiling of animals with early ECD revealed macrovasculopathy and that supplementation GLN is capable of improving vascular function. Metabolomic analyses reveal elevation of hippuric acid, which may further exacerbate vasculopathy even before the development of uremia.
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Affiliation(s)
- Francesco Addabbo
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
- Department of Experimental Immunopathology, National Institute of Gastroenterology, IRCCS “S. De Bellis” Castellana Grotte, Italy
- * E-mail: (FA); (MSG)
| | - Qiuying Chen
- Department of Pharmacology, Weill Cornell Medical College, New York, New York, United States of America
| | - Dhara P. Patel
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
| | - May Rabadi
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Brian Ratliff
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Frank Zhang
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Jean-Francois Jasmin
- Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Michael Wolin
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
| | - Michael Lisanti
- Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Breakthrough Breast Cancer Research Unit, University of Manchester, United Kingdom
| | - Steven S. Gross
- Department of Pharmacology, Weill Cornell Medical College, New York, New York, United States of America
| | - Michael S. Goligorsky
- Departments of Medicine, Pharmacology and Physiology, New York Medical College, Valhalla, New York, United States of America
- * E-mail: (FA); (MSG)
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Malyshev I. The Role of HSP70 in the Protection of: (A) The Brain in Alzheimer’s Disease and (B) The Heart in Cardiac Surgery. IMMUNITY, TUMORS AND AGING: THE ROLE OF HSP70 2013. [DOI: 10.1007/978-94-007-5943-5_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Chronic unpredictable mild stress affects myocardial metabolic profiling of SD rats. J Pharm Biomed Anal 2012; 70:534-8. [DOI: 10.1016/j.jpba.2012.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/24/2012] [Accepted: 04/24/2012] [Indexed: 11/23/2022]
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Le Guillou V, Tamion F, Jouet I, Richard V, Mulder P, Bessou JP, Doguet F. Mesenteric endothelial dysfunction in a cardiopulmonary bypass rat model: the effect of diabetes. Diab Vasc Dis Res 2012; 9:270-9. [PMID: 22278737 DOI: 10.1177/1479164111434432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes is a risk factor for perioperative complications after cardiac surgery. We studied its effects on mesenteric endothelial function in a cardiopulmonary bypass (CPB) model. METHODS Forty Wistar rats were divided into four groups: sham (D-CPB-), cardiopulmonary bypass (D-CPB+), diabetic (D+CPB-) and diabetic that have undergone CPB (D+CPB+). Two samples of mesenteric artery were used for nitric oxide synthase (NOS) Western blot analysis, and two others for assessing contractile response and endothelium relaxations. Nitrite products and tumour necrosis factor-alpha (TNF-α) were assessed as markers of inflammatory response. RESULTS We observed an enhanced contractile response to the α-adrenergic agonist associated with impairment of mesenteric vasorelaxation in D+CPB+ rats. Western immunoblot analysis of D+CPB+ highlighted an additive effect of hyper-expression of inducible NOS. A significantly increased inflammatory response was observed after CPB in diabetic animals. CONCLUSIONS This work confirms the potential deleterious impact of diabetes on the mesenteric endothelium during CPB in cardiac surgery.
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Affiliation(s)
- Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, France
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Stachowicz-Stencel T, Synakiewicz A. Glutamine as a supplemental treatment in pediatric and adult oncology patients. Expert Opin Investig Drugs 2012; 21:1861-71. [DOI: 10.1517/13543784.2012.717929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lomivorotov VV, Efremov SM, Shmirev VA, Ponomarev DN, Lomivorotov VN, Karaskov AM. Glutamine is cardioprotective in patients with ischemic heart disease following cardiopulmonary bypass. Heart Surg Forum 2012; 14:E384-8. [PMID: 22167767 DOI: 10.1532/hsf98.20111074] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the cardioprotective effects of the perioperative use of N(2)-L-alanyl-L-glutamine (GLN) in patients with ischemic heart disease (IHD) who undergo their operations under cardiopulmonary bypass (CPB). METHODS This double-blind, placebo-controlled, randomized study included 50 patients who underwent cardiac surgery with CPB. Exclusion criteria were a left ventricular ejection fraction <50%, diabetes mellitus, <3 months since the onset of myocardial infarction, and emergency surgery. Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven, 20% solution) per day. Patients in the control group (n = 25) were administered a placebo (0.9% NaCl). The primary end point was the dynamics of troponin I at the following stages: (1) prior to anesthesia, (2) 30 minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and (5) 48 hours after surgery. Secondary end points included measurements of hemodynamics with a Swan-Ganz catheter. RESULTS On the first postoperative day after the surgery, the median troponin I level was significantly lower in the study group than in the placebo group: 1.280 ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL (IQR, 1.060-6.600 ng/mL) (P = .035). At 4 hours after cardiopulmonary bypass (CPB), the median cardiac index was higher in the patients in the study group: 2.58 L/min per m2 (IQR, 2.34-2.91 L/min per m2) versus 2.03 L/min per m2 (IQR, 1.76-2.32 L/min per m2) (P = .002). The median stroke index also was higher in the patients who received GLN: 32.8 mL/m2 (IQR, 27.8-36.0 mL/m2) versus 26.1 mL/m2 (IQR, 22.6-31.8 mL/m2) (P = .023). The median systemic vascular resistance index was significantly lower in the study group than in the placebo group: 1942 dyn·s/cm5 per m2 (IQR, 1828-2209 dyn·s/cm5 per m2) versus 2456 dyn·s/cm5 per m2 (IQR, 2400-3265 dyn·s/cm5 per m2) (P = .001). CONCLUSION Perioperative administration of GLN during the first 24 hours has cardioprotective effects in IHD patients following CPB. This technique enhances the troponin concentration at 24 hours after surgery and is associated with improved myocardial function.
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Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anaesthesiology and Intensive Care, Academician E. N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
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Murphy CG, Stapelton R, Chen GC, Winter DC, Bouchier-Hayes DJ. Glutamine preconditioning protects against local and systemic injury induced by orthopaedic surgery. J Nutr Health Aging 2012; 16:365-9. [PMID: 22499460 DOI: 10.1007/s12603-011-0084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Long bone surgery represents a significant surgical insults, and may cause severe local and systemic sequalae following both planned and emergent surgery. Glutamine offers pharmacological modulation of injury through clinically acceptable preconditioning. This effect has not been previously demonstrated in an orthopaedic model. AIMS The aim of the study was to test the hypothesis that glutamine preconditioning protects against the local and systemic effects of long bone trauma in a rodent model. METHODS Thirty two adult male Sprague-Dawley rats were randomised into four groups: Control group which received trauma without preconditioning; Normal Saline preconditioning 1 hour before trauma; Glutamine preconditioning 1 hour before trauma; Glutamine preconditioning 24 hours prior to trauma. Trauma consisted of bilateral femoral fracture following intramedullary instrumentation. Blood samples were taken before the insult, and at an interval four hours following this. Bronchioalveolar lavage (BAL) was performed, with skeletal muscle and lung harvested for evaluation. RESULTS Glutamine pre-treated rats had lower Creatine Kinase levels, less creatinine elevation, and a significant reduction in neutrophil infiltration into BAL fluid. Glutamine pre-treated rats showed less muscle and lung oedema. This effect was more pronounced for the group which received glutamine 24 hours before trauma. CONCLUSION Preconditioning with a single bolus of intravenous glutamine prior to planned orthopaedic intervention affords loco-regional and distal organ protection. We believe these finding have significant implications for elective orthopaedic surgery where significant soft tissue and long bone manipulation is anticipated.
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Affiliation(s)
- C G Murphy
- RCSI Surgical Research Unit, Dublin, Ireland.
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Lehmann C, Pavlovic D, Zhou J, Wuttke U, Saeger D, Spassov A, Hung O, Cerny V, Witter T, Whynot S, Suchner U, Alteheld B, Stehle P, Gründling M. Intravenous free and dipeptide-bound glutamine maintains intestinal microcirculation in experimental endotoxemia. Nutrition 2012; 28:588-93. [PMID: 22222295 DOI: 10.1016/j.nut.2011.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The administration of glutamine (Gln), which is depleted in critical illness, is associated with an improvement of gut metabolism, structure, and function. The aim of the present study was to evaluate the effects of intravenous Gln and its galenic formulation, l-alanyl-l-glutamine dipeptide (AlaGln), on the intestinal microcirculation during experimental endotoxemia using intravital fluorescence microscopy. Gln or AlaGln administration was performed as pretreatment or post-treatment, respectively. To identify further the underlying mechanisms, amino acid levels were studied. METHODS Sixty male Lewis rats were randomly divided into six groups (n = 10/group): control, LPS (lipopolysaccharide 5 mg/kg intravenously), Gln/LPS (LPS animals pretreated with Gln 0.75 g/kg Gln intravenously), AlaGln/LPS (LPS animals pretreated with AlaGln intravenously, 0.75 g/kg Gln content), LPS/Gln (LPS animals post-treated with Gln 0.75 g/kg intravenously), and LPS/AlaGln (LPS animals post-treated with AlaGln intravenously, 0.75 g/kg Gln content). Two hours after the endotoxin challenge, the microcirculation of the terminal ileum was studied using intravital fluorescence microscopy. Blood samples were drawn at the beginning, during, and the end of the experiment to determine the amino acid levels. RESULTS The Gln and AlaGln pre- and post-treatment, respectively, prevented the LPS-induced decrease in the functional capillary density of the intestinal muscular and mucosal layers (P < 0.05). The number of adherent leukocytes in the submucosal venules was significantly attenuated after the Gln and AlaGln pre- and post-treatment (P < 0.05). CONCLUSION The Gln and AlaGln administrations improved the intestinal microcirculation by increasing the functional capillary density of the intestinal wall and decreasing the submucosal leukocyte activation.
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Affiliation(s)
- Christian Lehmann
- Department of Anesthesia, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
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Gullotta F, di Masi A, Coletta M, Ascenzi P. CO metabolism, sensing, and signaling. Biofactors 2012; 38:1-13. [PMID: 22213392 DOI: 10.1002/biof.192] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/19/2011] [Indexed: 12/16/2022]
Abstract
CO is a colorless and odorless gas produced by the incomplete combustion of hydrocarbons, both of natural and anthropogenic origin. Several microorganisms, including aerobic and anaerobic bacteria and anaerobic archaea, use exogenous CO as a source of carbon and energy for growth. On the other hand, eukaryotic organisms use endogenous CO, produced during heme degradation, as a neurotransmitter and as a signal molecule. CO sensors act as signal transducers by coupling a "regulatory" heme-binding domain to a "functional" signal transmitter. Although high CO concentrations inhibit generally heme-protein actions, low CO levels can influence several signaling pathways, including those regulated by soluble guanylate cyclase and/or mitogen-activated protein kinases. This review summarizes recent insights into CO metabolism, sensing, and signaling.
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Affiliation(s)
- Francesca Gullotta
- Department of Experimental Medicine and Biochemical Sciences, University of Roma Tor Vergata, Via Montpellier 1, I-00133 Roma, Italy
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Mok E, Hankard R. Glutamine supplementation in sick children: is it beneficial? J Nutr Metab 2011; 2011:617597. [PMID: 22175008 PMCID: PMC3228321 DOI: 10.1155/2011/617597] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/28/2011] [Indexed: 12/14/2022] Open
Abstract
The purpose of this review is to provide a critical appraisal of the literature on Glutamine (Gln) supplementation in various conditions or illnesses that affect children, from neonates to adolescents. First, a general overview of the proposed mechanisms for the beneficial effects of Gln is provided, and subsequently clinical studies are discussed. Despite safety, studies are conflicting, partly due to different effects of enteral and parenteral Gln supplementation. Further insufficient evidence is available on the benefits of Gln supplementation in pediatric patients. This includes premature infants, infants with gastrointestinal disease, children with Crohn's disease, short bowel syndrome, malnutrition/diarrhea, cancer, severe burns/trauma, Duchenne muscular dystrophy, sickle cell anemia, cystic fibrosis, and type 1 diabetes. Moreover, methodological issues have been noted in some studies. Further mechanistic data is needed along with large randomized controlled trials in select populations of sick children, who may eventually benefit from supplemental Gln.
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Affiliation(s)
- Elise Mok
- INSERM Centre D'Investigation Clinique 802, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers Cedex, France
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Antioxidant and anti-inflammatory effects of exercise in diabetic patients. EXPERIMENTAL DIABETES RESEARCH 2011; 2012:941868. [PMID: 22007193 PMCID: PMC3191828 DOI: 10.1155/2012/941868] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 07/15/2011] [Accepted: 07/17/2011] [Indexed: 02/06/2023]
Abstract
Diabetes is a chronic metabolic disease which is characterized by absolute or relative deficiencies in insulin secretion and/or insulin action. The key roles of oxidative stress and inflammation in the progression of vascular complications of this disease are well recognized. Accumulating epidemiologic evidence confirms that physical inactivity is an independent risk factor for insulin resistance and type II diabetes. This paper briefly reviews the pathophysiological pathways associated with oxidative stress and inflammation in diabetes mellitus and then discusses the impact of exercise on these systems. In this regard, we discuss exercise induced activation of cellular antioxidant systems through “nuclear factor erythroid 2-related factor.” We also discuss anti-inflammatory myokines, which are produced and released by contracting muscle fibers. Antiapoptotic, anti-inflammatory and chaperon effects of exercise-induced heat shock proteins are also reviewed.
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Cao H, Xue L, Xu X, Wu Y, Zhu J, Chen L, Chen D, Chen Y. Heat shock proteins in stabilization of spontaneously restored sinus rhythm in permanent atrial fibrillation patients after mitral valve surgery. Cell Stress Chaperones 2011; 16:517-28. [PMID: 21455828 PMCID: PMC3156265 DOI: 10.1007/s12192-011-0263-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 03/10/2011] [Accepted: 03/11/2011] [Indexed: 01/24/2023] Open
Abstract
A spontaneously restored sinus rhythm in permanent atrial fibrillation patients has been often observed after mitral valve (MV) surgery, but persisting duration in sinus rhythm varies from patient to patient. Heat shock proteins (Hsps) may be involved in pathogenesis of atrial fibrillation. We hypothesized that stabilization of restored sinus rhythm is associated with expression of Hsps in the atria. To test this hypothesis, clinical data, biopsies of right atrial appendage, and blood samples were collected from 135 atrial fibrillation patients who spontaneously restored sinus rhythm after conventional isolated MV replacement. Comparison was made between patients who had recurrence of atrial fibrillation within 7 days (AF) vs. patients with persisted sinus rhythm for more than 7 days (SR). Results showed that SR patients had higher activity of heat shock transcription factor 1 (HSF1) as well as upregulated expressions of heat shock cognate 70, Hsp70, and Hsp27 in the tissues. The activation of HSF1-Hsps pathway was associated with less-aggressive pathogenesis as reflected by lower rates of myolysis, apoptosis, interstitial fibrosis, and inflammation in SR patients. However, Hsp60 was lower in both tissue and plasma in SR patients, and was positively correlated with apoptosis, interstitial fibrosis, and inflammation. These findings suggest that the Hsps play important roles in stabilization of restored sinus rhythm after MV surgery by inhibiting AF-related atrial remodeling and arrhythmogenic substrates in atrial fibrillation patients. Low circulating Hsp60 levels preoperatively might predict a stable spontaneously restored sinus rhythm postoperatively.
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Affiliation(s)
- Hailong Cao
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lei Xue
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
| | - Xiaohan Xu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
| | - Yanhu Wu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
| | - Jinfu Zhu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
| | - Liang Chen
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
| | - Duan Chen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yijiang Chen
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou RD, Nanjing, 210029 China
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Mochida S, Matsura T, Yamashita A, Horie S, Ohata S, Kusumoto C, Nishida T, Minami Y, Inagaki Y, Ishibe Y, Nakada J, Ohta Y, Yamada K. Geranylgeranylacetone ameliorates inflammatory response to lipopolysaccharide (LPS) in murine macrophages: inhibition of LPS binding to the cell surface. J Clin Biochem Nutr 2011; 41:115-23. [PMID: 18193105 PMCID: PMC2170953 DOI: 10.3164/jcbn.2007016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 01/19/2007] [Indexed: 11/22/2022] Open
Abstract
We investigated whether pretreatment with geranylgeranylacetone (GGA), a potent heat shock protein (HSP) inducer, could inhibit proinflammatory cytokine liberation and nitric oxide (NO) production in lipopolysaccharide (LPS)-treated murine macrophages. The levels of NO and tumor necrosis factor-α (TNF-α) released from murine macrophage RAW 264 cells were increased dose- and time-dependently following treatment with LPS (1 µg/ml). GGA (80 µM) treatment 2 h before LPS addition significantly suppressed TNF-α and NO productions at 12 h and 24 h after LPS, respectively, indicating that GGA inhibits activation of macrophages. However, replacement by fresh culture medium before LPS treatment abolished the inhibitory effect of GGA on NO production in LPS-treated cells. Furthermore, GGA inhibited both HSP70 and inducible NO synthase expressions induced by LPS treatment despite an HSP inducer. When it was examined whether GGA interacts with LPS and/or affects expression of Toll-like receptor 4 (TLR4) and CD14 on the cell surface, GGA inhibited the binding of LPS to the cell surface, while GGA did not affect TLR4 and CD14 expressions. These results indicate that GGA suppresses the binding of LPS to the cell surface of macrophages, resulting in inhibiting signal transduction downstream of TLR4.
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Affiliation(s)
- Shinsuke Mochida
- Division of Medical Biochemistry, Department of Pathophysiological and Therapeutic Science, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago 683-8503, Japan
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Guiqi G. Pre-treatment with glutamine attenuates lung injury in rats subjected to intestinal ischaemia-reperfusion. Injury 2011; 42:72-7. [PMID: 19837405 DOI: 10.1016/j.injury.2009.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/09/2009] [Accepted: 09/17/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Glutamine (Gln) is the most abundant amino acid in blood and tissue fluids and is considered to be essential in certain catabolic conditions. A series of studies has shown that glutamine can attenuate cytokine release, reduce organ damage and improve survival in a rat model of endotoxaemia. The hypothesis for this rat model study is that pre-treatment with Gln reduces the expression of ICAM-1 and attenuates lung injury induced by intestinal ischaemia-reperfusion (I/R). METHODS Sprague-Dawley rats were randomised into five groups, namely sham group (sham surgery), Gln groups (three different doses) and control group. Lung injury caused by intestinal I/R was evaluated using Evans blue dye concentration and histopathologic examination. The level of myeloperoxidase (MPO) was measured using biochemistry method. The expression of heat shock protein 70 (HSP 70) and ICAM-1 were detected using Western blot and real-time polymerase chain reaction (PCR) methods, respectively. RESULTS Compared with the control group, rats pre-treated with Gln before intestinal I/R demonstrated decreased Evans Blue content and MPO activities in lung tissue, reduced the expression of ICAM-1, attenuated lung injury evidenced by pathological change compared with lactated Ringer pre-treated rats. Gln administration increased HSP 70 mRNA and protein expression in lung tissue compared with control group. CONCLUSION Ischaemia-reperfusion injury increases the expression of ICAM-1 in the lung. This may contribute to the migration, accumulation and activation of neutrophils. Pre-treatment with Gln attenuates rat lung injury and reduces ICAM-1 expression.
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Affiliation(s)
- Geng Guiqi
- Department of Anesthesiology, The Ninth Hospital, School of Medicine, JiaoTong University, Shanghai, PR China.
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Adachi H, Kondo T, Ogawa R, Sasaki K, Morino-Koga S, Sakakida M, Kawashima J, Motoshima H, Furukawa N, Tsuruzoe K, Miyamura N, Kai H, Araki E. An acylic polyisoprenoid derivative, geranylgeranylacetone protects against visceral adiposity and insulin resistance in high-fat-fed mice. Am J Physiol Endocrinol Metab 2010; 299:E764-71. [PMID: 20716696 DOI: 10.1152/ajpendo.00075.2010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Induction of heat shock protein (HSP)72 improves insulin resistance and obesity in diabetic animal models. Geranylgeranylacetone (GGA), known as an antiulcer drug, induces HSP72 and protects organs against several cellular stresses. This study investigated whether GGA administration would induce HSP72 in liver and render physiological protection against high-fat feeding in mice. A single and 4-wk oral administration of 200 mg/kg GGA was performed in high-fat diet (HFD)-fed mice. Metabolic parameters, cytokines, and gene expressions related to insulin signaling were evaluated. A single administration of GGA induced HSP72 in liver of normal chow-fed and HFD-fed mice. Insulin resistance after HFD was slightly ameliorated. Four weeks of GGA administration also increased HSP72 in liver and significantly improved insulin resistance and glucose homeostasis upon glucose challenge. Activation of c-jun NH₂-terminal kinase (JNK) was attenuated, and insulin signaling was improved in the liver of HFD mice. Visceral adiposity was decreased in GGA-treated mice, accompanied by reduced leptin and increased adiponectin levels. GGA can be a novel therapeutic approach to treat metabolic syndrome as well as type 2 diabetes by improving insulin signaling and reducing adiposity. These beneficial effects of GGA could be mediated through HSP72 induction and JNK inactivation in the liver.
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Affiliation(s)
- Hironori Adachi
- Dept. of Metabolic Medicine, Kumamoto University, Honjo, Japan
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Ugurlucan M, Erer D, Karatepe O, Ziyade S, Haholu A, Gungor Ugurlucan F, Filizcan U, Tireli E, Dayioglu E, Alpagut U. Glutamine enhances the heat shock protein 70 expression as a cardioprotective mechanism in left heart tissues in the presence of diabetes mellitus. Expert Opin Ther Targets 2010; 14:1143-56. [DOI: 10.1517/14728222.2010.521500] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ohata S, Moriyama C, Yamashita A, Nishida T, Kusumoto C, Mochida S, Minami Y, Nakada J, Shomori K, Inagaki Y, Ohta Y, Matsura T. Polaprezinc Protects Mice against Endotoxin Shock. J Clin Biochem Nutr 2010; 46:234-43. [PMID: 20490319 PMCID: PMC2872229 DOI: 10.3164/jcbn.09-125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 01/02/2010] [Indexed: 12/20/2022] Open
Abstract
Polaprezinc (PZ), a chelate compound consisting of zinc and l-carnosine (Car), is an anti-ulcer drug developed in Japan. In the present study, we investigated whether PZ suppresses mortality, pulmonary inflammation, and plasma nitric oxide (NO) and tumor necrosis factor (TNF)-α levels in endotoxin shock mice after peritoneal injection of lipopolysaccharide (LPS), and how PZ protects against LPS-induced endotoxin shock. PZ pretreatment inhibited the decrease in the survival rate of mice after LPS injection. PZ inhibited the increases in plasma NO as well as TNF-α after LPS. Compatibly, PZ suppressed LPS-induced inducible NO synthase mRNA transcription in the mouse lungs. PZ also improved LPS-induced lung injury. However, PZ did not enhance the induction of heat shock protein (HSP) 70 in the mouse lungs after LPS. Pretreatment of RAW264 cells with PZ suppressed the production of NO and TNF-α after LPS addition. This inhibition likely resulted from the inhibitory effect of PZ on LPS-mediated nuclear factor-κB (NF-κB) activation. Zinc sulfate, but not Car, suppressed NO production after LPS. These results indicate that PZ, in particular its zinc subcomponent, inhibits LPS-induced endotoxin shock via the inhibition of NF-κB activation and subsequent induction of proinflammatory products such as NO and TNF-α, but not HSP induction.
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Affiliation(s)
- Shuzo Ohata
- Division of Medical Biochemistry, Department of Pathophysiological and Therapeutic Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Lin CY, Yang TL, Hong GJ, Li CY, Lin FY, Tsai CS. Enhanced Intracellular Heat Shock Protein 70 Expression of Leukocytes and Serum Interleukins Release: Comparison of On-pump and Off-pump Coronary Artery Surgery. World J Surg 2010; 34:675-81. [DOI: 10.1007/s00268-010-0419-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Perng WC, Huang KL, Li MH, Hsu CW, Tsai SH, Chu SJ, Chang DM. Glutamine attenuates hyperoxia-induced acute lung injury in mice. Clin Exp Pharmacol Physiol 2010; 37:56-61. [DOI: 10.1111/j.1440-1681.2009.05239.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen G, Neilan TG, Chen H, Condron C, Kelly C, Hill ADK, Bouchier-Hayes DJ. Attenuation of lipopolysaccharide-mediated left ventricular dysfunction by glutamine preconditioning. J Surg Res 2009; 160:282-7. [PMID: 19628228 DOI: 10.1016/j.jss.2009.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 04/03/2009] [Accepted: 04/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Myocardial dysfunction is often seen during the inflammatory response to major surgery at 4 to 6h postoperatively. The aim of this study was to investigate the effect of glutamine pretreatment, as a means of preconditioning, on lipopolysaccharide-induced myocardial dysfunction. METHODS C57BL/6 mice were randomized into four groups: Control; lipopolysaccharide; glutamine plus lipopolysaccharide; and Quercetin, an inhibitor of heat shock protein synthesis plus glutamine and lipopolysaccharide. Left ventricular function was assessed at 6h following lipopolysaccharide (LPS) insult by invasive hemodynamics. Heat shock protein (HSP)72 in heart tissue was determined by Western immunoblot at 12h after glutamine administration. RESULTS Administration of lipopolysaccharide resulted in significant decrease in left ventricular end systolic pressure (LVESP) (69.1 +/- 2.52 mm Hg versus 106.3 +/- 3.36 mm Hg in controls), reduced dP/dtmax (4704.1 +/- 425.31 mm Hg/s versus 9389.8 +/- 999.4 mm Hg/s in controls), and the increase in left ventricular end diastolic pressure (LVEDP) (5.10 +/- 0.28 mm Hg versus 2.16 +/- 0.27 mm Hg in controls) (P < 0.05). Peritoneal injection of 25 g/kg of glutamine 12 h prior to lipopolysaccharide exposure induced HSP72 expression in heart tissues and attenuated lipopolysaccharide-induced left ventricular dysfunction: LVESP 85.94 +/- 3.8 mm Hg (P < 0.05), dP/dtmax 8331 +/- 425 mm Hg (P < 0.05), LVEDP 2.32 +/- 0.23 mm Hg (P < 0.01). Quercetin partially attenuated glutamine induced HSP72 expression and blocked the protective response of glutamine. CONCLUSION These data demonstrate that cardioprotection with glutamine is associated with induction of HSP72 and may be an approach to activating the preconditioning response in the heart in clinical practise.
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Affiliation(s)
- Gang Chen
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research CentreBeaumont Hospital, Dublin 9, Ireland.
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Bielecka-Dabrowa A, Barylski M, Mikhailidis DP, Rysz J, Banach M. HSP 70 and atherosclerosis--protector or activator? Expert Opin Ther Targets 2009; 13:307-17. [PMID: 19236153 DOI: 10.1517/14728220902725149] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atherosclerosis and its complications represent the leading cause of morbidity and mortality. Heat shock protein 70 (HSP70) protects cellular elements from injury by reducing oxidation, inflammation and apoptosis and by refolding damaged proteins. HSP70 improves viability of stressed vascular smooth muscle cells, possibly via its chaperone functions. It has been proposed that the response mounted against bacterial HSPs results in an autoimmune reaction, which has the potential to cause complement-mediated endothelial injury, and hence accelerate atherogenesis. OBJECTIVE to examine the roles of HSPs in atherosclerosis. METHODS A literature review. RESULTS/CONCLUSIONS The role of HSPs in atherosclerosis is controversial. HSP60 probably acts as an autoantigen, and may trigger both cell- and antibody-mediated immune responses, while HSP70 is likely to be involved in cytoprotection. The significance of this inverse relation between HSP70 and atherosclerosis has not yet been elucidated. Whether HSPs will become therapeutic targets remains to be established.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Molecular Cardionephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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Ugurlucan M, Erer D, Kalko Y, Gungor F, Haholu A, Basaran M, Banach M, Rysz J, Mikhailidis DP, Tireli E, Dayioglu E, Alpagut U. Aortic stiffness in diabetes mellitus – association with glutamine and heat shock protein 70 expression: a pilot study based on an experimental rodent model. Expert Opin Ther Targets 2009; 13:267-74. [DOI: 10.1517/14728220902735833] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Jong PR, Schadenberg AWL, Jansen NJG, Prakken BJ. Hsp70 and cardiac surgery: molecular chaperone and inflammatory regulator with compartmentalized effects. Cell Stress Chaperones 2009; 14:117-31. [PMID: 18668350 PMCID: PMC2727984 DOI: 10.1007/s12192-008-0066-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 07/04/2008] [Indexed: 12/15/2022] Open
Abstract
Open heart surgery is a unique model to study the interplay between cellular injury, regulation of inflammatory responses and tissue repair. Stress-inducible heat shock protein 70-kDa (Hsp70) provides a molecular link between these events. In addition to molecular chaperoning, Hsp70 exerts modulatory effects on endothelial cells and leukocytes involved in inflammatory networks. Hsp70 residing in the intracellular compartment is part of an inhibitory feedback loop that acts on nuclear factor kappaB (NF-kappaB). In contrast, extracellular Hsp70 is recognized by multiple germline-encoded immune receptors, e.g., Toll-like receptor (TLR) 2, TLR4, LOX-1, CD91, CD94, CCR5 and CD40. Hsp70 is thereby able to enhance chemotaxis, phagocytosis and cytolytic activity of innate immune cells and stimulate antigen-specific responses. These apparent contradictory pro- and anti-inflammatory effects of endogenous Hsp70 in the context of cardiac surgery are still not fully understood. An all-embracing model of the compartmentalized effects of endogenous Hsp70 in the orchestration of inflammatory responses in cardiac surgery is proposed.
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Affiliation(s)
- Petrus R. de Jong
- Department of Pediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Home mailbox KC.03.063.0, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Alvin W. L. Schadenberg
- Department of Pediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Home mailbox KC.03.063.0, PO Box 85090, 3508 AB Utrecht, The Netherlands
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Nicolaas J. G. Jansen
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Berent J. Prakken
- Department of Pediatric Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Home mailbox KC.03.063.0, PO Box 85090, 3508 AB Utrecht, The Netherlands
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Intravenous Glutamine Enhances COX-2 Activity Giving Cardioprotection. J Surg Res 2009; 152:140-7. [DOI: 10.1016/j.jss.2008.03.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 03/17/2008] [Accepted: 03/28/2008] [Indexed: 11/18/2022]
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Abstract
Controversy continues to surround the appropriate form and timing of nutrition support for the patient with circulatory shock. Clinical studies have demonstrated improvements in outcome with the administration of enteral nutrition to critically ill patients; however, the provision of enteral nutrition to critically ill patients with ongoing shock remains controversial. This article reviews gut perfusion during normal states and during circulatory shock as well as alterations in perfusion when enteral feeding is provided. Pharmaconutrients studied during ischemia and reperfusion are discussed.
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Affiliation(s)
- Gail Cresci
- Medical College of Georgia, Department of Surgery, Room 4072, 1120 15th Street, Augusta, GA 30912, USA.
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YENARI MIDORIA, LIU JIALING, ZHENG ZHEN, VEXLER ZINAIDAS, LEE JONGEUN, GIFFARD RONAG. Antiapoptotic and Anti-inflammatory Mechanisms of Heat-Shock Protein Protection. Ann N Y Acad Sci 2008. [DOI: 10.1111/j.1749-6632.2005.tb00012.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hoetzel A, Dolinay T, Vallbracht S, Zhang Y, Kim HP, Ifedigbo E, Alber S, Kaynar AM, Schmidt R, Ryter SW, Choi AMK. Carbon monoxide protects against ventilator-induced lung injury via PPAR-gamma and inhibition of Egr-1. Am J Respir Crit Care Med 2008; 177:1223-32. [PMID: 18356564 PMCID: PMC2408440 DOI: 10.1164/rccm.200708-1265oc] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 03/17/2008] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Ventilator-induced lung injury (VILI) leads to an unacceptably high mortality. In this regard, the antiinflammatory properties of inhaled carbon monoxide (CO) may provide a therapeutic option. OBJECTIVES This study explores the mechanisms of CO-dependent protection in a mouse model of VILI. METHODS Mice were ventilated (12 ml/kg, 1-8 h) with air in the absence or presence of CO (250 ppm). Airway pressures, blood pressure, and blood gases were monitored. Lung tissue was analyzed for inflammation, injury, and gene expression. Bronchoalveolar lavage fluid was analyzed for protein, cell and neutrophil counts, and cytokines. MEASUREMENTS AND MAIN RESULTS Mechanical ventilation caused significant lung injury reflected by increases in protein concentration, total cell and neutrophil counts in the bronchoalveolar lavage fluid, as well as the induction of heme oxygenase-1 and heat shock protein-70 in lung tissue. In contrast, CO application prevented lung injury during ventilation, inhibited stress-gene up-regulation, and decreased lung neutrophil infiltration. These effects were preceded by the inhibition of ventilation-induced cytokine and chemokine production. Furthermore, CO prevented the early ventilation-dependent up-regulation of early growth response-1 (Egr-1). Egr-1-deficient mice did not sustain lung injury after ventilation, relative to wild-type mice, suggesting that Egr-1 acts as a key proinflammatory regulator in VILI. Moreover, inhibition of peroxysome proliferator-activated receptor (PPAR)-gamma, an antiinflammatory nuclear regulator, by GW9662 abolished the protective effects of CO. CONCLUSIONS Mechanical ventilation causes profound lung injury and inflammatory responses. CO treatment conferred protection in this model dependent on PPAR-gamma and inhibition of Egr-1.
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Affiliation(s)
- Alexander Hoetzel
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Abstract
PURPOSE OF REVIEW This review will assess recent clinical and mechanistic data examining glutamine's ability to reduce morbidity and mortality in critical illness. RECENT FINDINGS Updated metaanalysis data reveal a significant benefit of glutamine supplementation on mortality, length of stay, and infectious morbidity in critical illness. Recent data support glutamine's use in critically ill patients requiring parenteral nutrition and new data reveal safety and efficacy in head-injured patients. Further, new findings on glutamine's beneficial effect on insulin resistance in critical illness will be reviewed. Recent laboratory data have clarified a number of key mechanistic pathways by which glutamine may improve outcome in critical illness. SUMMARY Severe glutamine deficiencies occur rapidly in critical illness. The magnitude of glutamine deficiency is correlated with ICU mortality. Further, metaanalysis reveals glutamine reduces morbidity and mortality in critical illness. It is likely that our new understanding of the molecular pathways by which glutamine acts will lead to insight on how best to utilize glutamine as a nutritional therapy. Presently, randomized, multicenter clinical trials utilizing glutamine as both nutritional replacement and pharmacologic intervention, independent of nutritional needs, are ongoing.
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Zheng Z, Kim JY, Ma H, Lee JE, Yenari MA. Anti-inflammatory effects of the 70 kDa heat shock protein in experimental stroke. J Cereb Blood Flow Metab 2008; 28:53-63. [PMID: 17473852 DOI: 10.1038/sj.jcbfm.9600502] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The 70-kDa heat shock protein (Hsp70) is involved in protecting the brain from a variety of insults including stroke. Although the mechanism has been largely considered to be because of its chaperone functions, recent work indicates that Hsp70 also modulates inflammatory responses. To explore how and whether Hsp70 regulate immune responses in brain ischemia, mice overexpressing Hsp70 (Hsp Tg) were subjected to 2 h middle cerebral artery occlusion, followed by 24 h reperfusion. Parallel experiments were performed using a brain inflammation model. Hsp Tg microglia cocultured with astrocytes were used to evaluate the direct effects of Hsp70 on cytotoxicity of microglia. Compared with wild-type (Wt) littermates, Hsp Tg mice showed decreased infarct size and improved neurological deficits. The number of activated microglia/macrophages were also reduced in ischemic brains of Hsp Tg mice. Similar observations were made in a model of brain inflammation that does not result in brain cell death. Overexpression of Hsp70 in microglia completely prevented microglia-induced cytotoxicity to astrocytes. Activation of the inflammatory transcription factor, nuclear factor-kappaB (NF-kappaB) was inhibited significantly in Hsp Tg mice and microglia. This was associated with decreased phosphorylation of NF-kappaB inhibitor protein, IkappaBalpha, and decreased expression of several NFkappaB-regulated genes. Co-immunoprecipitation studies revealed an interaction of Hsp70 with NF-kappaB and IkappaBalpha, but not with IkappaB kinase, IKKgamma, suggesting that Hsp70 binds to the NF-kappaB:IkappaB complex preventing IkappaB phosphorylation by IKK. The findings of the present work establish an anti-inflammatory role for Hsp70 in the context of brain ischemia as a novel mechanism of protection.
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Affiliation(s)
- Zhen Zheng
- Department of Neurology, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA
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Abstract
A recent editorial in Critical Care Medicine was titled "Glutamine, a life-saving nutrient, but why?" (2003; 31:2555-2556). This review will attempt to utilize new understanding of gene-nutrient interactions and molecular medicine to address potential mechanisms by which glutamine may be lifesaving after critical illness and injury. Recent meta-analysis data reveal that glutamine seems to exert a beneficial effect on mortality in critically ill patients. However, this effect seems to be dose and route dependent. The questions that remain to be answered are in what settings and via what method of administration does this phamaconutrient show optimal benefit? It is likely that examination of the molecular mechanisms by which glutamine exerts its effects will lead to an understanding of how best to utilize glutamine as both a pharmacologic and a nutritional agent. Clearly, clinical critical illness leads to a marked deficiency in glutamine that is correlated with mortality in the intensive care unit setting. It makes obvious sense that the deficiency of this vital stress nutrient should be replaced. In addition, recent laboratory data reveal glutamine may act via mechanisms independent of its role as a metabolic fuel. These include enhanced stress protein response, attenuation of the inflammatory response, improved tissue metabolic function, and attenuation of oxidant stress. Present data indicate that glutamine functions as a metabolic fuel and "stress-signaling molecule" after illness and injury. Thus, deficiencies observed in critical illness demand replacement for both pharmacologic and metabolic optimization. Presently, randomized, multicenter, clinical trials utilizing glutamine as a pharmacologic and a nutritional agent are ongoing.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, CO, USA.
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Singleton KD, Wischmeyer PE. Glutamine's protection against sepsis and lung injury is dependent on heat shock protein 70 expression. Am J Physiol Regul Integr Comp Physiol 2007; 292:R1839-45. [PMID: 17234954 DOI: 10.1152/ajpregu.00755.2006] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Glutamine (GLN) has been shown to protect against inflammatory injury and illness in experimental and clinical settings. The mechanism of this protection is unknown; however, laboratory and clinical trial data have indicated a relationship between GLN-mediated protection and enhanced heat shock protein 70 (HSP70) expression. The aim of this study was to examine the hypothesis that GLN's beneficial effect on survival, tissue injury, and inflammatory response after inflammatory injury is dependent on HSP70 expression. Mice with a specific deletion of the HSP70 gene underwent cecal ligation and puncture (CLP)-induced sepsis and were treated with GLN (0.75 g/kg) or a saline placebo 1 h post-CLP. Lung tissue NF-κB activation, inflammatory cytokine response, and lung injury were assessed post-CLP. Survival was assessed for 5 days post-CLP. Our results indicate that GLN administration improved survival in Hsp70+/+mice vs. Hsp70+/+mice not receiving GLN; however, GLN exerted no survival benefit in Hsp70−/−mice. This was accompanied by a significant decrease in lung injury, attenuation of NF-κB activation, and proinflammatory cytokine expression in GLN-treated Hsp70+/+mice vs. Hsp70+/+mice not receiving GLN. In the Hsp70−/−mice, GLN's attenuation of lung injury, NF-κB activation, and proinflammatory cytokine expression was lost. These results confirm our hypothesis that HSP70 expression is required for GLN's effects on survival, tissue injury, and the inflammatory response after global inflammatory injury.
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Affiliation(s)
- Kristen D Singleton
- Univ of Colorado Health Sciences Center, Dept of Anesthesiology, Denver, CO 80262, USA.
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Gatt M, Reddy BS, MacFie J. Review article: bacterial translocation in the critically ill--evidence and methods of prevention. Aliment Pharmacol Ther 2007; 25:741-57. [PMID: 17373913 DOI: 10.1111/j.1365-2036.2006.03174.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delayed sepsis, systemic inflammatory response syndrome (SIRS) and multiorgan failure remain major causes of morbidity and mortality on intensive care units. One factor thought to be important in the aetiology of SIRS is failure of the intestinal barrier resulting in bacterial translocation and subsequent sepsis. AIM This review summarizes the current knowledge about bacterial translocation and methods to prevent it. METHODS Relevant studies during 1966-2006 were identified from a literature search. Factors, which detrimentally affect intestinal barrier function, are discussed, as are methods that may attenuate bacterial translocation in the critically ill patient. RESULTS Methodological problems in confirming bacterial translocation have restricted investigations to patients undergoing laparotomy. There are only limited data available relating to specific interventions that might preserve intestinal barrier function or limit bacterial translocation in the intensive care setting. These can be categorized broadly into pre-epithelial, epithelial and post-epithelial interventions. CONCLUSIONS A better understanding of factors that influence translocation could result in the implementation of interventions which contribute to improved patient outcomes. Glutamine supplementation, targeted nutritional intervention, maintaining splanchnic flow, the judicious use of antibiotics and directed selective gut decontamination regimens hold some promise of limiting bacterial translocation. Further research is required.
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Affiliation(s)
- M Gatt
- Combined Gastroenterology Research Unit, Scarborough General Hospital, Woodlands Drive, Scarborough, UK
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Umenai T, Nakajima Y, Sessler DI, Taniguchi S, Yaku H, Mizobe T. Perioperative Amino Acid Infusion Improves Recovery and Shortens the Duration of Hospitalization After Off-Pump Coronary Artery Bypass Grafting. Anesth Analg 2006; 103:1386-93. [PMID: 17122208 DOI: 10.1213/01.ane.0000240972.84337.7c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Perioperative amino acid infusion helps maintain core temperature and improves patient outcomes after gynecologic and orthopedic surgery. In the present study we prospectively determined the effect of amino acid infusion on esophageal core temperature and postoperative outcomes during off-pump coronary artery bypass grafting (CABG). One-hundred-eighty consecutive patients undergoing primary elective or urgent off-pump CABG were randomly divided into two groups: the i.v. amino acid infusion group (4 kJ kg(-1) h(-1) starting 2 h before surgery) and the saline infusion group (similar period and volume of saline infusion). The esophageal core temperature at the end of surgery was 35.6 (35.3-35.8) degrees C [mean (95% confidence interval)] in the saline infusion group and 36.1 degrees C (35.9-36.3) degrees C in the amino acid infusion group (P = 0.01). Kaplan-Meier analysis demonstrated that patients given amino acids required a significantly shorter duration of postoperative mechanical ventilation than patients given saline [median (95% confidence interval), 3.0 (2.5-3.9) vs 4.5 (3.8-5.8) h; P = 0.01]. Furthermore, intensive care unit stay [20 (19.5-38.4) vs 44 (21-45) h; P = 0.001] and days until fit for discharge from hospital [10 (9-11) vs 12 (11-13) days; P = 0.004] were significantly shorter in patients given amino acid. Perioperative amino acid infusion in patients undergoing off-pump CABG effectively minimizes intraoperative hypothermia and improves postoperative recovery.
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Abstract
PURPOSE OF REVIEW A recent editorial proclaimed, 'Glutamine, a life saving nutrient, but why?' This review will assess if recent data support glutamine as a life-saving nutrient in critical illness, and, if so, utilize new understanding of gene-nutrient interactions to address potential mechanisms by which glutamine may be 'life-saving'. RECENT FINDINGS Updated meta-analysis data reveal that glutamine appears to exert a beneficial effect on mortality in critical illness. The questions remaining to be answered regard in what settings and via what method of administration does this phamaconutrient show optimal benefit? It is likely that examination of molecular mechanisms by which glutamine functions will lead to an understanding of how best to utilize glutamine as a pharmacologic agent. Recent laboratory data reveal that these mechanisms include tissue protection, attenuation of inflammation, improved tissue metabolic function, and attenuation of oxidant stress. SUMMARY Glutamine may be potentially 'life-saving' in critical illness, particularly when administered in doses greater then 0.3 g/kg/day. Present data indicate that glutamine functions as a 'stress signaling molecule' following illness/injury and thus, needs to be given as a pharmacologic agent, rather then as nutritional replacement. Presently, multicenter clinical trials utilizing glutamine as a drug, independent of nutritional needs, are indicated.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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Abstract
PURPOSE OF REVIEW Recent literature has focused on the role of the gut and increased gut permeability as a driver of systemic inflammation in critical illness. Thus, the therapeutic potential for an agent to prevent gut barrier compromise and attenuate gut-derived inflammatory response is significant. RECENT FINDINGS In laboratory and clinical settings, glutamine can attenuate gut permeability following critical illness and injury. Further, recent literature has revealed other mechanisms by which glutamine may attenuate the systemic inflammatory response driven by the gut. These findings reveal that glutamine may act at multiple levels to attenuate gut injury and potential subsequent gut-derived systemic inflammatory response. These mechanisms focus around glutamine's ability to induce the cellular protective stress response in the gut. This leads to enhanced protection of the gut epithelial barrier and attenuation of generation of inflammatory mediators. SUMMARY These mechanistic findings, combined with a limited amount of clinical data showing benefit on gut permeability in illness and injury, indicate more formal studies need to be carried out looking the role of glutamine in gut protection and as an antiinflammatory in critical illness.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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