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Yamada Y, Iemura J, Kambara A, Tateishi N, Kozaki Y, Yamada M, Maruyama J, Azuma E. Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin. THE JOURNAL OF EXTRACORPOREAL TECHNOLOGY 2023; 55:23-29. [PMID: 37034101 PMCID: PMC10071503 DOI: 10.1051/ject/2023003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 03/29/2023]
Abstract
Background: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca2+ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. Methods: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. Results: The dosing ratio of protamine-to-heparin = 1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107 = 14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin = 1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin = 1.0 (odds ratio = 3.890, 95% CI = 1.130–13.300, p-value = 0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (p = 0.04). Conclusions: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.
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Affiliation(s)
- Yasuharu Yamada
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Department of Clinical Engineering, Faculty of Medical Engineering, Suzuka University of Medical Science Mie 513-8670 Japan
- Corresponding author:
| | - Junzo Iemura
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Department of Cardiovascular Surgery, Okanami General Hospital Mie 518-0121 Japan
| | - Atushi Kambara
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Department of Cardiovascular Surgery, Okanami General Hospital Mie 518-0121 Japan
| | - Noboru Tateishi
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Division of Clinical Engineering, Okanami General Hospital Mie 518-0121 Japan
| | - Yuji Kozaki
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Division of Clinical Engineering, Okanami General Hospital Mie 518-0121 Japan
| | - Masako Yamada
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Department of Clinical Engineering, Mie University Hospital Mie 514-0001 Japan
| | - Junko Maruyama
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Department of Clinical Engineering, Faculty of Medical Engineering, Suzuka University of Medical Science Mie 513-8670 Japan
| | - Eiichi Azuma
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Department of Clinical Engineering, Faculty of Medical Engineering, Suzuka University of Medical Science Mie 513-8670 Japan
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Meloni BP, Milani D, Cross JL, Clark VW, Edwards AB, Anderton RS, Blacker DJ, Knuckey NW. Assessment of the Neuroprotective Effects of Arginine-Rich Protamine Peptides, Poly-Arginine Peptides (R12-Cyclic, R22) and Arginine-Tryptophan-Containing Peptides Following In Vitro Excitotoxicity and/or Permanent Middle Cerebral Artery Occlusion in Rats. Neuromolecular Med 2017; 19:271-285. [PMID: 28523591 DOI: 10.1007/s12017-017-8441-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/12/2017] [Indexed: 12/22/2022]
Abstract
We have demonstrated that arginine-rich and poly-arginine peptides possess potent neuroprotective properties with arginine content and peptide positive charge being particularly critical for neuroprotective efficacy. In addition, the presence of other amino acids within arginine-rich peptides, as well as chemical modifications, peptide length and cell-penetrating properties also influence the level of neuroprotection. Against this background, we have examined the neuroprotective efficacy of arginine-rich protamine peptides, a cyclic (R12-c) poly-arginine peptide and a R22 poly-arginine peptide, as well as arginine peptides containing tryptophan or other amino acids (phenylalanine, tyrosine, glycine or leucine) in in vitro glutamic acid excitotoxicity and in vivo rat permanent middle cerebral artery occlusion models of stroke. In vitro studies demonstrated that protamine and poly-arginine peptides (R12-c, R22) were neuroprotective. Arginine-tryptophan-containing peptides were highly neuroprotective, with R12W8a being the most potent arginine-rich peptide identified in our laboratory. Peptides containing phenylalanine or tyrosine substituted in place of tryptophan in R12W8a were also highly neuroprotective, whereas leucine, and in particular glycine substitutions, decreased peptide efficacy. In vivo studies with protamine administered intravenously at 1000 nmol/kg 30 min after MCAO significantly reduced infarct volume and cerebral oedema by 22.5 and 38.6%, respectively. The R12W8a peptide was highly toxic when administered intravenously at 300 or 100 nmol/kg and ineffective at reducing infarct volume when administered at 30 nmol/kg 30 min after MCAO, unlike R18 (30 nmol/kg), which significantly reduced infarct volume by 20.4%. However, both R12W8a and R18 significantly reduced cerebral oedema by 19.8 and 42.2%, respectively. Protamine, R12W8a and R18 also reduced neuronal glutamic acid-induced calcium influx. These findings further highlight the neuroprotective properties of arginine-rich peptides and support the view that they represent a new class of neuroprotective agent.
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Affiliation(s)
- Bruno P Meloni
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia. .,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia. .,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia.
| | - Diego Milani
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia.,School of Heath Sciences, The University Notre Dame Australia, Fremantle, WA, Australia
| | - Jane L Cross
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia.,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia
| | - Vince W Clark
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia.,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia
| | - Adam B Edwards
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia.,School of Heath Sciences, The University Notre Dame Australia, Fremantle, WA, Australia
| | - Ryan S Anderton
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia.,School of Heath Sciences, The University Notre Dame Australia, Fremantle, WA, Australia
| | - David J Blacker
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia
| | - Neville W Knuckey
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, 8 Verdun St, Nedlands, WA, 6009, Australia.,Department of Neurosurgery, Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, WA, Australia.,Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Nedlands, WA, Australia
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Cui HZ, Oh HC, Li X, Lee YJ, Cho KW, Kang DG, Lee HS. Ethanol extract of Lycopus lucidus elicits positive inotropic effect via activation of Ca2+ entry and Ca2+ release in beating rabbit atria. J Med Food 2014; 16:633-40. [PMID: 23875903 DOI: 10.1089/jmf.2012.2487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lycopus lucidus Turcz has been widely used as a traditional Oriental medicine (TOM) in Korea and China and prescribed for the enhancement of heart function. However, the precise effects have yet to be defined. The purpose of the present study was, therefore, to address whether the ethanol extract of Lycopus lucidus Turcz (ELT) has a positive inotropic effect. ELT-induced changes in atrial mechanical dynamics (pulse pressure, dp/dt, and stroke volume), and cAMP efflux were measured in perfused beating rabbit atria. Three active components, rosmarinic acid, betulinic acid, and oleanolic acid were identified in ELT by high performance liquid chromatography analysis. ELT increased atrial dynamics in a concentration-dependent manner without changes in atrial cAMP levels and cAMP efflux. The ELT-induced positive inotropic effect was blocked by inhibition of the L-type Ca(2+) channels and sarcoplasmic reticulum (SR). Inhibitors of β-adrenoceptors had no effect on the ELT-induced positive inotropic effect. The results suggest that ELT exerts a positive inotropic effect via activation of Ca(2+) entry through L-type Ca(2+) channel and Ca(2+) release from the SR in beating rabbit atria.
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Affiliation(s)
- Hao Zhen Cui
- Professional Graduate School of Oriental Medicine and College of Oriental Medicine, Wonkwang University, Iksan, Jeonbuk, Korea
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Porta M, Diaz-Sylvester PL, Neumann JT, Escobar AL, Fleischer S, Copello JA. Coupled gating of skeletal muscle ryanodine receptors is modulated by Ca2+, Mg2+, and ATP. Am J Physiol Cell Physiol 2012; 303:C682-97. [PMID: 22785120 DOI: 10.1152/ajpcell.00150.2012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coupled gating (synchronous openings and closures) of groups of skeletal muscle ryanodine receptors (RyR1), which mimics RyR1-mediated Ca(2+) release underlying Ca(2+) sparks, was first described by Marx et al. (Marx SO, Ondrias K, Marks AR. Science 281: 818-821, 1998). The nature of the RyR1-RyR1 interactions for coupled gating still needs to be characterized. Consequently, we defined planar lipid bilayer conditions where ∼25% of multichannel reconstitutions contain mixtures of coupled and independently gating RyR1. In ∼10% of the cases, all RyRs (2-10 channels; most frequently 3-4) gated in coupled fashion, allowing for quantification. Our results indicated that coupling required cytosolic solutions containing ATP/Mg(2+) and high (50 mM) luminal Ca(2+) (Ca(lum)) or Sr(2+) solutions. Bursts of coupled activity (events) started and ended abruptly, with all channels activating/deactivating within ∼300 μs. Coupled RyR1 were heterogeneous, where highly active RyR1 ("drivers") seemed open during the entire coupled event (P(o) = 1), while other RyR1s ("followers") displayed abundant flickering and smaller amplitude. Drivers mean open time increased with cytosolic Ca(2+) (Ca(cyt)) or caffeine, whereas followers flicker frequency was Ca(cyt) independent and more sensitive to inhibition by cytosolic Mg(2+). Coupled events were insensitive to varying lumen-to-cytosol Ca(2+) fluxes from ∼1 to 8 pA, which does not corroborate coupling of neighboring RyR1 by local Ca(2+)-induced Ca(2+) release. However, coupling requires specific Ca(lum) sites, as it was lost when Ca(lum) was replaced by luminal Ba(2+) or Mg(2+). In summary, coupled events reveal complex interactions among heterogeneous RyR1, differentially modulated by cytosolic ATP/Mg(2+), Ca(cyt), and Ca(lum,) which under cell-like ionic conditions may parallel synchronous RyR1 gating during Ca(2+) sparks.
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Affiliation(s)
- Maura Porta
- Dept. of Pharmacology, Southern Illinois Univ. School of Medicine, Springfield, IL 62794-962, USA
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