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Chen Q, Sun J, Liu X, Qin Z, Li J, Ma J, Xue Z, Li Y, Yang Z, Sun Q, Wu L, Chang E, Zhao H, Zhang Y, Gu J, Ma D. Dexmedetomidine and argon in combination against ferroptosis through tackling TXNIP-mediated oxidative stress in DCD porcine livers. Cell Death Discov 2024; 10:319. [PMID: 38992027 PMCID: PMC11239900 DOI: 10.1038/s41420-024-02071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024] Open
Abstract
Graft availability from donation after circulatory death (DCD) is significantly limited by ischaemia reperfusion (IR) injury. Effective strategies to mitigate IR injury in DCD grafts are essential to improve graft quality and expand the donor pool. In this study, liver grafts from DCD pigs were preserved in the University of Wisconsin (UW) solution saturated with 0.1 nM dexmedetomidine (Dex) and various concentrations of noble gases Argon (Ar) and/or Xenon (Xe) at 4 °C for 24 or 72 h. The combined 50% Ar and Dex provided maximum protection to liver grafts by reducing morphological damage, apoptosis, necroptosis, ferroptosis, hepatocyte glycogen depletion, reticulin framework collapse, iron deposition, and oxidative stress. In vitro, human liver Hep G2 cells were preserved in the UW solution saturated with 0.1 nM Dex and 50% Ar in combination at 4 °C for 24 h, followed by recovery in medium at 37 °C for up to 48 h to mimic clinical IR injury. This treatment significantly increased the expression of anti-oxidative stress proteins by promoting the translocation of thioredoxin-interacting protein (TXNIP) to mitochondria, thereby inhibiting ferroptosis, increasing plasma membrane integrity, and maintaining cell viability.In summary, The combination of 0.1 nM Dex and 50% Ar may be a promising strategy to reduce ferroptosis and other form cell death, and preserve liver grafts.
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Affiliation(s)
- Qian Chen
- Department of Anesthesiology, Perioperative and Systems Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, Zhejiang, China
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Jiashi Sun
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Xiangfeng Liu
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhigang Qin
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jieyu Li
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianbo Ma
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhengwei Xue
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yirong Li
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ziheng Yang
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Qizhe Sun
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Lingzhi Wu
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Enqiang Chang
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Hailin Zhao
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
| | - Yiwen Zhang
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK
- Department of Anesthesiology, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Jianteng Gu
- Department of Anesthesiology, Southwest Hospital, Army Medical University, Chongqing, China.
| | - Daqing Ma
- Department of Anesthesiology, Perioperative and Systems Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, Zhejiang, China.
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK.
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Merigo G, Florio G, Madotto F, Magliocca A, Silvestri I, Fumagalli F, Cerrato M, Motta F, De Giorgio D, Panigada M, Zanella A, Grasselli G, Ristagno G. Treatment with inhaled Argon: a systematic review of pre-clinical and clinical studies with meta-analysis on neuroprotective effect. EBioMedicine 2024; 103:105143. [PMID: 38691938 PMCID: PMC11070688 DOI: 10.1016/j.ebiom.2024.105143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Argon (Ar) has been proposed as a potential therapeutic agent in multiple clinical conditions, specifically in organ protection. However, conflicting data on pre-clinical models, together with a great variability in Ar administration protocols and outcome assessments, have been reported. The aim of this study was to review evidence on treatment with Ar, with an extensive investigation on its neuroprotective effect, and to summarise all tested administration protocols. METHODS Using the PubMed database, all existing pre-clinical and clinical studies on the treatment with Ar were systematically reviewed (registration: https://doi.org/10.17605/OSF.IO/7983D). Study titles and abstracts were screened, extracting data from relevant studies post full-text review. Exclusion criteria included absence of full text and non-English language. Furthermore, meta-analysis was also performed to assess Ar potential as neuroprotectant agent in different clinical conditions: cardiac arrest, traumatic brain injury, ischemic stroke, perinatal hypoxic-ischemic encephalopathy, subarachnoid haemorrhage. Standardised mean differences for neurological, cognitive and locomotor, histological, and physiological measures were evaluated, through appropriate tests, clinical, and laboratory variables. In vivo studies were evaluated for risk of bias using the Systematic Review Center for Laboratory Animal Experimentation tool, while in vitro studies underwent assessment with a tool developed by the Office of Health Assessment and Translation. FINDINGS The systematic review detected 60 experimental studies (16 in vitro, 7 ex vivo, 31 in vivo, 6 with both in vitro and in vivo) investigating the role of Ar. Only one clinical study was found. Data from six in vitro and nineteen in vivo studies were included in the meta-analyses. In pre-clinical models, Ar administration resulted in improved neurological, cognitive and locomotor, and histological outcomes without any change in physiological parameters (i.e., absence of adverse events). INTERPRETATION This systematic review and meta-analysis based on experimental studies supports the neuroprotective effect of Ar, thus providing a rationale for potential translation of Ar treatment in humans. Despite adherence to established guidelines and methodologies, limitations in data availability prevented further analyses to investigate potential sources of heterogeneity due to study design. FUNDING This study was funded in part by Italian Ministry of Health-Current researchIRCCS and by Ministero della Salute Italiano, Ricerca Finalizzata, project no. RF 2019-12371416.
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Affiliation(s)
- Giulia Merigo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano Florio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabiana Madotto
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aurora Magliocca
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ivan Silvestri
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Fumagalli
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marianna Cerrato
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Motta
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Daria De Giorgio
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zanella
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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Hammami I, Farjot G, Naveau M, Rousseaud A, Prangé T, Katz I, Colloc'h N. Method for the Identification of Potentially Bioactive Argon Binding Sites in Protein Families. J Chem Inf Model 2022; 62:1318-1327. [PMID: 35179902 DOI: 10.1021/acs.jcim.2c00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Argon belongs to the group of chemically inert noble gases, which display a remarkable spectrum of clinically useful biological properties. In an attempt to better understand noble gases, notably argon's mechanism of action, we mined a massive noble gas modeling database which lists all possible noble gas binding sites in the proteins from the Protein Data Bank. We developed a method of analysis to identify among all predicted noble gas binding sites the potentially relevant ones within protein families which are likely to be modulated by Ar. Our method consists in determining within structurally aligned proteins the conserved binding sites whose shape, localization, hydrophobicity, and binding energies are to be further examined. This method was applied to the analysis of two protein families where crystallographic noble gas binding sites have been experimentally determined. Our findings indicate that among the most conserved binding sites, either the most hydrophobic one and/or the site which has the best binding energy corresponds to the crystallographic noble gas binding sites with the best occupancies, therefore the best affinity for the gas. This method will allow us to predict relevant noble gas binding sites that have potential pharmacological interest and thus potential Ar targets that will be prioritized for further studies including in vitro validation.
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Affiliation(s)
- Islem Hammami
- ISTCT UMR 6030 CNRS Univ. Caen Normandie, GIP Cyceron, 14074 Caen, France.,Air Liquide Santé International, Innovation Campus Paris, 78354 Les Loges-en-Josas, France
| | - Géraldine Farjot
- Air Liquide Santé International, Innovation Campus Paris, 78354 Les Loges-en-Josas, France
| | - Mikaël Naveau
- UAR 3408 US 50 CNRS INSERM Université de Caen-Normandie, GIP Cyceron, 14074 Caen, France
| | - Audrey Rousseaud
- Air Liquide Santé International, Innovation Campus Paris, 78354 Les Loges-en-Josas, France
| | - Thierry Prangé
- CiTCoM UMR 8038 CNRS Université de Paris, Faculté de Pharmacie, 75006 Paris, France
| | - Ira Katz
- Air Liquide Santé International, Innovation Campus Paris, 78354 Les Loges-en-Josas, France
| | - Nathalie Colloc'h
- ISTCT UMR 6030 CNRS Univ. Caen Normandie, GIP Cyceron, 14074 Caen, France
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De Giorgio D, Magliocca A, Fumagalli F, Novelli D, Olivari D, Staszewsky L, Latini R, Ristagno G. Ventilation with the noble gas argon in an in vivo model of idiopathic pulmonary arterial hypertension in rats. Med Gas Res 2021; 11:124-125. [PMID: 33942784 PMCID: PMC8174406 DOI: 10.4103/2045-9912.314333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Daria De Giorgio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Aurora Magliocca
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Deborah Novelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Davide Olivari
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lidia Staszewsky
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Roberto Latini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan; Department of Anesthesiology, Intensive Care and Emergency Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Nespoli F, Redaelli S, Ruggeri L, Fumagalli F, Olivari D, Ristagno G. A complete review of preclinical and clinical uses of the noble gas argon: Evidence of safety and protection. Ann Card Anaesth 2020; 22:122-135. [PMID: 30971592 PMCID: PMC6489383 DOI: 10.4103/aca.aca_111_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The noble gas argon (Ar) is a "biologically" active element and has been extensively studied preclinically for its organ protection properties. This work reviews all preclinical studies employing Ar and describes the clinical uses reported in literature, analyzing 55 pertinent articles found by means of a search on PubMed and Embase. Ventilation with Ar has been tested in different models of acute disease at concentrations ranging from 20% to 80% and for durations between a few minutes up to days. Overall, lesser cell death, smaller infarct size, and better functional recovery after ischemia have been repeatedly observed. Modulation of the molecular pathways involved in cell survival, with resulting anti-apoptotic and pro-survival effects, appeared as the determinant mechanism by which Ar fulfills its protective role. These beneficial effects have been reported regardless of onset and duration of Ar exposure, especially after cardiac arrest. In addition, ventilation with Ar was safe both in animals and humans. Thus, preclinical and clinical data support future clinical studies on the role of inhalatory Ar as an organ protector.
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Affiliation(s)
- Francesca Nespoli
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Simone Redaelli
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Ruggeri
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Fumagalli
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Davide Olivari
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Ristagno
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Abstract
PURPOSE OF REVIEW Ex-vivo lung perfusion (EVLP) has been developed to expand the donor pool for lung transplantation recipients. The role of EVLP in organ preservation, evaluation and potential reconditioning is reviewed. RECENT FINDINGS EVLP has been shown to significantly increase the utilization of donor lungs for transplantation. Evidence suggests that patient outcomes from EVLP lungs are comparable to standard procurement technique. Novel strategies are being developed to treat and recondition injured donor lungs. EVLP may also prove to be a tool for translational research of lung diseases. SUMMARY EVLP has been shown to be an effective system to expand donor pool for lung transplantation without detriment to recipients. Future potential ex-vivo developments may further improve patient outcomes as well as increasing availability of donor organs.
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7
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Optimizing organs for transplantation; advancements in perfusion and preservation methods. Transplant Rev (Orlando) 2019; 34:100514. [PMID: 31645271 DOI: 10.1016/j.trre.2019.100514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023]
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8
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Suleiman S, Klassen S, Katz I, Balakirski G, Krabbe J, von Stillfried S, Kintsler S, Braunschweig T, Babendreyer A, Spillner J, Kalverkamp S, Schröder T, Moeller M, Coburn M, Uhlig S, Martin C, Rieg AD. Argon reduces the pulmonary vascular tone in rats and humans by GABA-receptor activation. Sci Rep 2019; 9:1902. [PMID: 30760775 PMCID: PMC6374423 DOI: 10.1038/s41598-018-38267-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022] Open
Abstract
Argon exerts neuroprotection. Thus, it might improve patients' neurological outcome after cerebral disorders or cardiopulmonary resuscitation. However, limited data are available concerning its effect on pulmonary vessel and airways. We used rat isolated perfused lungs (IPL) and precision-cut lung slices (PCLS) of rats and humans to assess this topic. IPL: Airway and perfusion parameters, oedema formation and the pulmonary capillary pressure (Pcap) were measured and the precapillary and postcapillary resistance (Rpost) was calculated. In IPLs and PCLS, the pulmonary vessel tone was enhanced with ET-1 or remained unchanged. IPLs were ventilated and PCLS were gassed with argon-mixture or room-air. IPL: Argon reduced the ET-1-induced increase of Pcap, Rpost and oedema formation (p < 0.05). PCLS (rat): Argon relaxed naïve pulmonary arteries (PAs) (p < 0.05). PCLS (rat/human): Argon attenuated the ET-1-induced contraction in PAs (p < 0.05). Inhibition of GABAB-receptors abolished argon-induced relaxation (p < 0.05) in naïve or ET-1-pre-contracted PAs; whereas inhibition of GABAA-receptors only affected ET-1-pre-contracted PAs (p < 0.01). GABAA/B-receptor agonists attenuated ET-1-induced contraction in PAs and baclofen (GABAB-agonist) even in pulmonary veins (p < 0.001). PLCS (rat): Argon did not affect the airways. Finally, argon decreases the pulmonary vessel tone by activation of GABA-receptors. Hence, argon might be applicable in patients with pulmonary hypertension and right ventricular failure.
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Affiliation(s)
- Said Suleiman
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Sergej Klassen
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Ira Katz
- Medical Research & Development, Air Liquide Santé Internationale, Centre de Recherche Paris-Saclay, 78354, Jouy-en-Josas, France
| | - Galina Balakirski
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Julia Krabbe
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | | | - Svetlana Kintsler
- Institute of Pathology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Aaron Babendreyer
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Jan Spillner
- Department of Cardiac and Thoracic Surgery, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Sebastian Kalverkamp
- Department of Cardiac and Thoracic Surgery, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Thomas Schröder
- Department of Surgery, Luisenhospital Aachen, 52064, Aachen, Germany
| | - Manfred Moeller
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Christian Martin
- Institute of Pharmacology and Toxicology, Medical Faculty RWTH-Aachen, 52074, Aachen, Germany
| | - Annette D Rieg
- Department of Anaesthesiology, Medical Faculty RWTH Aachen, 52074, Aachen, Germany.
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Abstract
This article summarizes recent knowledge and clinical advances in machine perfusion (MP) of thoracic organs. MP of thoracic organs has gained much attention during the last decade. Clinical studies are investigating the role of MP to preserve, resuscitate, and assess heart and lungs prior to transplantation. Currently, MP of the cardiac allograft is essential in all type DCD heart transplantation while MP of the pulmonary allograft is mandatory in uncontrolled DCD lung transplantation. MP of thoracic organs also offers an exciting platform to further investigate downregulation of the innate and adaptive immunity prior to reperfusion of the allograft in recipients. MP provides a promising technology that allows pre-transplant preservation, resuscitation, assessment, repair, and conditioning of cardiac and pulmonary allografts outside the body in a near physiologic state prior to planned transplantation. Results of ongoing clinical trials are awaited to estimate the true clinical value of this new technology in advancing the field of heart and lung transplantation by increasing the total number and the quality of available organs and by further improving recipient early and long-term outcome.
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Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, KU Leuven University, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
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