Intravenous perflubron emulsion administration improves the recovery of auditory evoked potentials after temporary brain stem ischemia in dogs

Perfluorocarbon emulsions improve cognitive recovery after lateral fluid percussion brain injury in rats

OBJECTIVE

Perfluorocarbon emulsions have been shown to improve outcomes in stroke models. This study examined the effect of Oxycyte, a third-generation perfluorocarbon emulsion (04RD33; Synthetic Blood International, Inc., Costa Mesa, CA) treatment on cognitive recovery and mitochondrial oxygen consumption after a moderate lateral fluid percussion injury (LFPI).

METHODS

Adult male Sprague-Dawley rats (Harlan Bioproducts for Science, Indianapolis, IN) were allocated to 4 groups: 1) LFPI treated with a lower dose of Oxycyte (4.5 mL/kg); 2) LFPI with a higher dose of Oxycyte (9.0 mL/kg); 3) LFPI with saline infusion; and 4) sham animals treated with saline. Fifteen minutes after receiving moderate LFPI or sham surgery, animals were infused intravenously with Oxycyte or saline within 30 minutes while breathing 100% O2. Animals breathed 100% O2 continuously for a total of 4 hours after injury. At 11 to 15 days after LFPI, animals were assessed for cognitive deficits using the Morris water maze test. They were sacrificed at Day 15 after injury for histology to assess hippocampal neuronal cell loss. In a parallel study, mitochondrial oxygen consumption values were measured by the Cartesian diver microrespirometer method.

RESULTS

We found that injured animals treated with a lower or higher dose of Oxycyte had significant improvement in cognitive function when compared with injured saline-control animals (P < 0.05). Moreover, injured animals that received either dose of Oxycyte had significantly less neuronal cell loss in the hippocampal CA3 region compared with saline-treated animals (P < 0.05). Furthermore, a lower dose of Oxycyte significantly improved mitochondrial oxygen consumption levels (P < 0.05).

CONCLUSION

The current study demonstrates that Oxycyte can improve cognitive recovery and reduce CA3 neuronal cell loss after traumatic brain injury in rats.

Cerebral physiology of cardiac surgical patients treated with the perfluorocarbon emulsion, AF0144

BACKGROUND

Perfluorooctyl bromide is a biologically inert compound with short biologic retention and high oxygen solubility. The purpose of this study was to assess the effect of the perfluorocarbon emulsion, AF0144 (Perflubron, Alliance Pharmaceutical Corp, San Diego, CA), used in conjunction with acute normovolemic hemodilution on cerebral blood flow and cerebral emboli measurements during coronary artery bypass grafting with cardiopulmonary bypass.

METHODS

Thirty-six adult cardiac surgical patients were enrolled in a single-institution, randomized, controlled, single-blind dose escalation trial. Autologous whole blood was harvested from each patient to target an on-bypass hematocrit of 20% to 22%. Placebo, low dose (1.8 g/kg) or high dose (2.7 g/kg) AF0144 was administered. Transcranial Doppler ultrasonography was used to quantitate cerebral emboli and xenon-133 clearance was used to measure cerebral blood flow.

RESULTS

Cerebral blood flow was increased in both AF0144-treated groups compared with placebo (p = 0.006, low dose vs control; p = 0.036, high dose vs control). Numbers of cerebral emboli were greater in the high-dose AF0144-treated group versus control during the time periods from aortic cannulation through aortic cross-clamp placement (p = 0.026) and from aortic cross-clamp placement through cross-clamp removal (p = 0.008).

CONCLUSIONS

The perfluorocarbon emulsion, AF0144, increased cerebral blood flow during cardiopulmonary bypass. In addition, total cerebral emboli load during bypass was greater in patients receiving high-dose AF0144.

IBC’s 5th Annual Conference on Blood Substitutes

IBC's 5(th) Annual Conference on Blood Substitutes was held on November 20-21, 1997. Approximately 100 medical researchers, academic scientists, blood substitute company speakers and representatives from major pharmaceutical companies with an interest or partner in the field attended. The papers presented focused on the progress in clinical trials for those compounds in human study, on preclinical models for predicting efficacy in humans, and on novel approaches and agents for the delivery of oxygen. Both perfluorocarbons (PFC) and haemoglobin-based oxygen carriers were described. Several lectures addressed the history of the field and future directions for laboratory and clinical investigation. The following is a summary of some of the presentations. This summary is divided into 3 sections. The first section provides a historical overview and discusses the changes in the perceived need for a blood substitute. Section 2 comprises an update of company activities. The final section focuses on likely future directions for laboratory and human clinical study.

Perfluorocarbon Emulsion Improves Cerebral Oxygenation and Mitochondrial Function after Fluid Percussion Brain Injury in Rats

OBJECTIVE

Cerebral ischemia is a common secondary sequela of traumatic brain injury (TBI). Experimental models of stroke have demonstrated reductions in ischemia after perfluorocarbon (PFC) administration; however, there are no published reports of PFC efficacy after TBI. The current study analyzed the effect of the PFC emulsion Oxygent (AF0144; Alliance Pharmaceutical Corp., San Diego, CA) on cerebral oxygenation, mitochondrial redox potential, and free radical formation after lateral fluid percussion injury.

METHODS

After fluid percussion injury, five 2.25 ml/kg doses of PFC or saline were administered to rats breathing 100% O(2), and oxygen tension was recorded. In a second experiment, a single bolus (11.25 ml/kg) of PFC or saline was given after injury, and redox potential and free radical formation were measured at 1 or 4 hours with Alamar blue dye and dihydrorhodamine 123, respectively.

RESULTS

Cerebral oxygen tension was significantly increased in both injured and sham animals treated with 11.25 ml/kg of PFC as compared with saline (P < 0.05). Likewise, PFC significantly increased mitochondrial redox potential as compared with saline at 4 hours after injury (P < 0.01). Mitochondrial peroxynitrite and peroxide production also increased with the administration of PFC (P < 0.05).

CONCLUSION

The current study demonstrates that a PFC emulsion can significantly increase cerebral oxygenation after TBI and enhance mitochondrial function at 4 hours after injury as compared with saline. This study demonstrates a new therapeutic potential for PFC to enhance cerebral oxygenation and aerobic metabolism after TBI. However, the increased free radical formation with high-dose PFCs suggests the need for further studies combining PFCs with free radical scavengers.

Perfluorocarbon emulsion improves oxygenation of the cat primary visual cortex

Tissue PO2 was measured in the primary visual cortex of anesthetized, artificially ventilated, normovolemic cats to evaluate the effect of small doses [1 g perfluorocarbon (PFC)/kg] of a PFC emulsion (1 g PFC/1.1 ml emulsion; Alliance Pharmaceutical, San Diego, CA) on brain oxygenation. The change in tissue PO2 (DeltaPO2), resulting from briefly changing the respiratory gas from room air to 100% oxygen, was measured before and after intravenous infusion of the emulsion. Before emulsion, DeltaPO2 was 51.1 +/- 45.6 Torr (n = 8 cats). Increases in DeltaPO2 of 34.0 +/- 26.1 (SD) % (n = 8) and 16. 3 +/- 8.4% (n = 6) were observed after the first and second emulsion infusions, respectively. The further increase in DeltaPO2 after the third dose (7.9 +/- 10.5%; n = 7) was not statistically significant. The observed increases in tissue oxygenation as a result of the PFC infusions appear to be the result of enhanced oxygen transport to the tissue.

The protective effects of alpha-melanocyte stimulating hormone on canine brain stem ischemia

OBJECTIVE

To evaluate the influence of alpha-melanocyte stimulating hormone (alpha-MSH), an anti-inflammatory antagonist of the production and action of proinflammatory cytokines, 26 dogs were divided into four groups and exposed to isolated, reversible brain stem ischemia in the presence or absence of alpha-MSH treatment.

METHODS

Brain stem auditory evoked potentials (BAEPs) and regional cerebral blood flow were measured during ischemia and for 5 hours after reperfusion. Group I was composed of five dogs that underwent surgical preparation only. Group II was composed of seven dogs that were exposed to 20 minutes of ischemia without treatment. Group III was comprised of seven dogs exposed to 20 minutes of ischemia with alpha-MSH treatment before and during ischemia. Group IV was composed of seven dogs exposed to 20 minutes of brain stem ischemia with alpha-MSH treatment only during reperfusion.

RESULTS

During the ischemic period, BAEPs were abolished in all animals within 10 minutes. With reperfusion, the BAEPs increased to approximately 36% of baseline in Group II dogs that received no treatment. However, this increase was approximately 63% in animals that received alpha-MSH both before and during ischemia (Group III). In Group IV dogs that received alpha-MSH only during reperfusion, BAEPs were increased approximately 10 to 14% more than in Group II during the late reperfusion period.

CONCLUSION

The improved recovery of BAEPs in dogs treated with alpha-MSH suggests that this peptide may have neuroprotective effects in brain stem ischemia and reperfusion injury. This effect may be caused by an antagonistic action of alpha-MSH on cytokine-induced ischemic brain damage.