1
|
Selli AL, Ghasemi M, Watters T, Burton F, Smith G, Dietrichs ES. Proarrhythmic changes in human cardiomyocytes during hypothermia by milrinone and isoprenaline, but not levosimendan: an experimental in vitro study. Scand J Trauma Resusc Emerg Med 2023; 31:61. [PMID: 37880801 PMCID: PMC10601188 DOI: 10.1186/s13049-023-01134-5] [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: 08/25/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Accidental hypothermia, recognized by core temperature below 35 °C, is a lethal condition with a mortality rate up to 25%. Hypothermia-induced cardiac dysfunction causing increased total peripheral resistance and reduced cardiac output contributes to the high mortality rate in this patient group. Recent studies, in vivo and in vitro, have suggested levosimendan, milrinone and isoprenaline as inotropic treatment strategies in this patient group. However, these drugs may pose increased risk of ventricular arrhythmias during hypothermia. Our aim was therefore to describe the effects of levosimendan, milrinone and isoprenaline on the action potential in human cardiomyocytes during hypothermia. METHODS Using an experimental in vitro-design, levosimendan, milrinone and isoprenaline were incubated with iCell2 hiPSC-derived cardiomyocytes and cellular action potential waveforms and contraction were recorded from monolayers of cultured cells. Experiments were conducted at temperatures from 37 °C down to 26 °C. One-way repeated measures ANOVA was performed to evaluate differences from baseline recordings and one-way ANOVA was performed to evaluate differences between drugs, untreated control and between drug concentrations at the specific temperatures. RESULTS Milrinone and isoprenaline both significantly increases action potential triangulation during hypothermia, and thereby the risk of ventricular arrhythmias. Levosimendan, however, does not increase triangulation and the contractile properties also remain preserved during hypothermia down to 26 °C. CONCLUSIONS Levosimendan remains a promising candidate drug for inotropic treatment of hypothermic patients as it possesses ability to treat hypothermia-induced cardiac dysfunction and no increased risk of ventricular arrhythmias is detected. Milrinone and isoprenaline, on the other hand, appears more dangerous in the hypothermic setting.
Collapse
Affiliation(s)
- Anders Lund Selli
- Experimental and Clinical Pharmacology, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Postboks 6050, 9037, Langnes, Tromsø, Norway
| | | | | | - Francis Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
- Clyde Biosciences, Newhouse, Scotland
| | - Godfrey Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
- Clyde Biosciences, Newhouse, Scotland
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Postboks 6050, 9037, Langnes, Tromsø, Norway.
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway.
- Institute of Oral Biology, University of Oslo, Oslo, Norway.
| |
Collapse
|
2
|
Selli AL, Kuzmiszyn AK, Smaglyukova N, Kondratiev T, Fuskevåg OM, Sager G, Dietrichs ES. Pharmacodynamic properties for inhibition of cAMP- and cGMP elimination by pentoxifylline remain unaltered in vitro during hypothermia. Scand J Trauma Resusc Emerg Med 2022; 30:73. [PMID: 36522632 PMCID: PMC9756503 DOI: 10.1186/s13049-022-01060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rewarming from hypothermia is associated with severe complications, one of which is hypothermia-induced cardiac dysfunction. This condition is characterized by decreased cardiac output accompanied by increased total peripheral resistance. This contributes to mortality rate approaching 40%. Despite this, no pharmacological interventions are recommended for these patients below 30 °C. Raising the intracellular levels of cAMP and/or cGMP, through PDE3- and PDE5-inhibitors respectively, have showed the ability to alleviate hypothermia-induced cardiac dysfunction in vivo. Drugs that raise levels of both cAMP and cGMP could therefore prove beneficial in patients suffering from hypothermia-induced cardiac dysfunction. METHODS The unselective PDE-inhibitor pentoxifylline was investigated to determine its ability to reach the intracellular space, inhibit PDE3 and PDE5 and inhibit cellular efflux of cAMP and cGMP at temperatures 37, 34, 30, 28, 24 and 20 °C. Recombinant human PDE-enzymes and human erythrocytes were used in the experiments. IC50-values were calculated at all temperatures to determine temperature-dependent changes. RESULTS At 20 °C, the IC50-value for PDE5-mediated enzymatic breakdown of cGMP was significantly increased compared to normothermia (IC50: 39.4 µM ± 10.9 µM vs. 7.70 µM ± 0.265 µM, p-value = 0.011). No other significant changes in IC50-values were observed during hypothermia. CONCLUSIONS This study shows that pentoxifylline has minimal temperature-dependent pharmacodynamic changes, and that it can inhibit elimination of both cAMP and cGMP at low temperatures. This can potentially be effective treatment of hypothermia-induced cardiac dysfunction. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Anders Lund Selli
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Adrina Kalasho Kuzmiszyn
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.420120.50000 0004 0481 3017Research and Development Department, Norwegian Air Ambulance Foundation, Oslo, Norway ,grid.412244.50000 0004 4689 5540Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Natalia Smaglyukova
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Timofey Kondratiev
- grid.10919.300000000122595234Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ole-Martin Fuskevåg
- grid.412244.50000 0004 4689 5540Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Georg Sager
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Erik Sveberg Dietrichs
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.413684.c0000 0004 0512 8628Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
3
|
Kuzmiszyn AK, Selli AL, Smaglyukova N, Kondratiev T, Fuskevåg OM, Lyså RA, Ravna AW, Tveita T, Sager G, Dietrichs ES. Treatment of Cardiovascular Dysfunction with PDE3-Inhibitors in Moderate and Severe Hypothermia—Effects on Cellular Elimination of Cyclic Adenosine Monophosphate and Cyclic Guanosine Monophosphate. Front Physiol 2022; 13:923091. [PMID: 35910566 PMCID: PMC9326216 DOI: 10.3389/fphys.2022.923091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Rewarming from accidental hypothermia is often complicated by hypothermia-induced cardiovascular dysfunction, which could lead to shock. Current guidelines do not recommend any pharmacological treatment at core temperatures below 30°C, due to lack of knowledge. However, previous in vivo studies have shown promising results when using phosphodiesterase 3 (PDE3) inhibitors, which possess the combined effects of supporting cardiac function and alleviating the peripheral vascular resistance through changes in cyclic nucleotide levels. This study therefore aims to investigate whether PDE3 inhibitors milrinone, amrinone, and levosimendan are able to modulate cyclic nucleotide regulation in hypothermic settings. Materials and methods: The effect of PDE3 inhibitors were studied by using recombinant phosphodiesterase enzymes and inverted erythrocyte membranes at six different temperatures—37°C, 34°C, 32°C, 28°C, 24°C, and 20°C- in order to evaluate the degree of enzymatic degradation, as well as measuring cellular efflux of both cAMP and cGMP. The resulting dose-response curves at every temperature were used to calculate IC50 and Ki values. Results: Milrinone IC50 and Ki values for cGMP efflux were significantly lower at 24°C (IC50: 8.62 ± 2.69 µM) and 20°C (IC50: 7.35 ± 3.51 µM), compared to 37°C (IC50: 22.84 ± 1.52 µM). There were no significant changes in IC50 and Ki values for enzymatic breakdown of cAMP and cGMP. Conclusion: Milrinone, amrinone and levosimendan, were all able to suppress enzymatic degradation and inhibit extrusion of cGMP and cAMP below 30°C. Our results show that these drugs have preserved effect on their target molecules during hypothermia, indicating that they could provide an important treatment option for hypothermia-induced cardiac dysfunction.
Collapse
Affiliation(s)
- Adrina Kalasho Kuzmiszyn
- Norwegian Air Ambulance Foundation, Research and Development Department, Oslo, Norway
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Anders Lund Selli
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Natalia Smaglyukova
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Timofei Kondratiev
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole-Martin Fuskevåg
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Roy Andre Lyså
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aina Westrheim Ravna
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torkjel Tveita
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Georg Sager
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik Sveberg Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- *Correspondence: Erik Sveberg Dietrichs,
| |
Collapse
|
4
|
Selli AL, Kuzmiszyn AK, Smaglyukova N, Kondratiev TV, Fuskevåg OM, Lyså RA, Ravna AW, Tveita T, Sager G, Dietrichs ES. Treatment of Cardiovascular Dysfunction With PDE5-Inhibitors - Temperature Dependent Effects on Transport and Metabolism of cAMP and cGMP. Front Physiol 2021; 12:695779. [PMID: 34393818 PMCID: PMC8361756 DOI: 10.3389/fphys.2021.695779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/09/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction Cardiovascular dysfunction is a potentially lethal complication of hypothermia. Due to a knowledge gap, pharmacological interventions are not recommended at core temperatures below 30°C. Yet, further cooling is induced in surgical procedures and survival of accidental hypothermia is reported after rewarming from below 15°C, advocating a need for evidence-based treatment guidelines. In vivo studies have proposed vasodilation and afterload reduction through arteriole smooth muscle cGMP-elevation as a favorable strategy to prevent cardiovascular dysfunction in hypothermia. Further development of treatment guidelines demand information about temperature-dependent changes in pharmacological effects of clinically relevant vasodilators. Materials and Methods Human phosphodiesterase-enzymes and inverted erythrocytes were utilized to evaluate how vasodilators sildenafil and vardenafil affected cellular efflux and enzymatic breakdown of cAMP and cGMP, at 37°C, 34°C, 32°C, 28°C, 24°C, and 20°C. The ability of both drugs to reach their cytosolic site of action was assessed at the same temperatures. IC50- and Ki-values were calculated from dose–response curves at all temperatures, to evaluate temperature-dependent effects of both drugs. Results Both drugs were able to reach the intracellular space at all hypothermic temperatures, with no reduction compared to normothermia. Sildenafil IC50 and Ki-values increased during hypothermia for enzymatic breakdown of both cAMP (IC50: 122 ± 18.9 μM at 37°C vs. 269 ± 14.7 μM at 20°C, p < 0.05) and cGMP (IC50: 0.009 ± 0.000 μM at 37°C vs. 0.024 ± 0.004 μM at 32°C, p < 0.05), while no significant changes were detected for vardenafil. Neither of the drugs showed significant hypothermia-induced changes in IC50 and Ki–values for inhibition of cellular cAMP and cGMP efflux. Conclusion Sildenafil and particularly vardenafil were ableto inhibit elimination of cGMP down to 20°C. As the cellular effects of these drugs can cause afterload reduction, they show potential in treating cardiovascular dysfunction during hypothermia. As in normothermia, both drugs showed higher selectivity for inhibition of cGMP-elimination than cAMP-elimination at low core temperatures, indicating that risk for cardiotoxic side effects is not increased by hypothermia.
Collapse
Affiliation(s)
- Anders L Selli
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Adrina K Kuzmiszyn
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Natalia Smaglyukova
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Timofei V Kondratiev
- Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ole-Martin Fuskevåg
- Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North Norway, Tromsø, Norway
| | - Roy A Lyså
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Aina W Ravna
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Torkjel Tveita
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Georg Sager
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Erik S Dietrichs
- Experimental and Clinical Pharmacology, Department of Medical Biology, UiT - The Arctic University of Norway, Tromsø, Norway.,Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|