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Liebrecht LK, Khoraki J, Li R, Archambault C, Bane J, Deitch R, Broadway M, Eldering G, Mangino MJ. Metabolic Tissue Swelling and Local Microcirculation in Splanchnic Artery Occlusion Shock: Implications for Critical Illness. J Pharmacol Exp Ther 2024; 388:27-36. [PMID: 37739805 PMCID: PMC10765417 DOI: 10.1124/jpet.123.001831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023] Open
Abstract
Trauma is a leading cause of death in the United States. Advancements in shock resuscitation have been disappointing because the correct upstream mechanisms of injury are not being targeted. Recently, significant advancements have been shown using new cell-impermeant molecules that work by transferring metabolic water from swollen ischemic cells to the capillary, which restores tissue perfusion by microcirculatory decompression. The rapid normalization of oxygen transfer improves resuscitation outcomes. Since poor resuscitation and perfusion of trauma patients also causes critical illness and sepsis and can be mimicked by ischemia-reperfusion of splanchnic tissues, we hypothesized that inadequate oxygenation of the gut during trauma drives development of later shock and critical illness. We further hypothesized that this is caused by ischemia-induced water shifts causing compression no-reflow. To test this, the superior mesenteric artery of juvenile anesthetized swine was occluded for 30 minutes followed by 8 hours of reperfusion to induce mild splanchnic artery occlusion (SAO) shock. One group received the impermeant polyethylene glycol 20,000 Da (PEG-20k) that prevents metabolic cell swelling, and the other received a lactated Ringer's vehicle. Survival doubled in PEG-20k-treated swine along with improved macrohemodynamics and intestinal mucosal perfusion. Villus morphometry and plasma inflammatory cytokines normalized with impermeants. Plasma endotoxin rose over time after reperfusion, and impermeants abolished the rise. Inert osmotically active cell impermeants like PEG-20k improve intestinal reperfusion injury, SAO shock, and early signs of sepsis, which may be due to early restoration of mucosal perfusion and preservation of the septic barrier by reversal of ischemic compression no-reflow. SIGNIFICANCE STATEMENT: Significant advancements in treating shock and ischemia have been disappointing because the correct upstream causes have not been targeted. This study supports that poor tissue perfusion after intestinal ischemia from shock is caused by capillary compression no-reflow secondary to metabolic cell and tissue swelling since selectively targeting this issue with novel polyethylene glycol 20,000 Da-based cell-impermeant intravenous solutions reduces splanchnic artery occlusion shock, doubles survival time, restores tissue microperfusion, and preserves gut barrier function.
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Affiliation(s)
- Loren K Liebrecht
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Jad Khoraki
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Ru Li
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Caitlin Archambault
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - John Bane
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Rebecca Deitch
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Michael Broadway
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Gerard Eldering
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
| | - Martin J Mangino
- Departments of Surgery (L.K.L., J.K., R.L., C.A., J.B., R.D., M.J.M.), Respiratory Therapy (M.B.), and Physiology and Biophysics (M.J.M.), Virginia Commonwealth University, School of Medicine, Richmond, Virginia and Perfusion Medical, Inc. (L.K.L., G.E., M.J.M.), Reston, Virginia
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Kang HS, Khoraki J, Li R, Xu H, Archambault C, Liebrecht LK, Mangino MJ. Restoring microcirculatory perfusion in a preclinical model of severe hemorrhagic shock: The role of microcirculatory function. J Trauma Acute Care Surg 2023; 95:755-761. [PMID: 37335954 DOI: 10.1097/ta.0000000000004003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND No reflow in capillaries (no reflow) is the lack of tissue perfusion that occurs once central hemodynamics are restored. This prevents oxygen transfer and debt repayment to vital tissues after shock resuscitation. Since metabolic swelling of cells and tissues can cause no reflow, it is a target for study in shock. We hypothesize no reflow secondary to metabolic cell swelling causes the problem not addressed by current strategies that increase central hemodynamics alone. METHODS Anesthetized swine were bled until plasma lactate reached 7.5 mM to 9 mM. Intravenous low volume resuscitation solutions were administered (6.8 mL/kg over 5 minutes) consisting of; (1) lactated Ringer (LR), (2) autologous whole blood, (3) high-dose vitamin C (200 mg/kg), or (4) 10% PEG-20k, a polymer-based cell impermeant that corrects metabolic cell swelling. Outcomes were macrohemodynamics (MAP), plasma lactate, capillary flow in the gut and tongue mucosa using orthogonal polarization spectral imaging (OPSI), and survival to 4 hours. RESULTS All PEG-20k resuscitated swine survived 240 minutes with MAP above 60 mm Hg compared with 50% and 0% of the whole blood and LR groups, respectively. The vitamin C group died at just over 2 hours with MAPs below 40 and high lactate. The LR swine only survived 30 minutes and died with low MAP and high lactate. Capillary flow positively correlated ( p < 0.05) with survival and MAP. Sublingual OPSI correlated with intestinal OPSI and OPSI was validated with a histological technique. DISCUSSION Targeting micro-hemodynamics in resuscitation may be more important than macrohemodynamics. Fixing both is optimal. Sublingual OPSI is clinically achievable to assess micro-hemodynamic status. Targeting tissue cell swelling that occurs during ATP depletion in shock using optimized osmotically active cell impermeants in crystalloid low volume resuscitation solutions improves perfusion in shocked tissues, which leverages a primary mechanism of injury.
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Affiliation(s)
- Hae Sung Kang
- From the Departments of Surgery, Virginia Commonwealth University, School of Medicine, Richmond, VA
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Kang HS, Wickramaratne N, Liebrecht LK, Mangino MJ. Effects of polyethylene glycol-20k IV solution on donor management in a canine model of donor brain death. Biomed Pharmacother 2022; 152:113293. [PMID: 35714513 DOI: 10.1016/j.biopha.2022.113293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditionally, vasopressors and crystalloids have been used to stabilize brain dead donors; however, the use of crystalloid is fraught with complications. This study aimed to investigate the effectiveness of a newly developed impermeant solution, polyethylene glycol-20k IV solution (PEG-20k) for resuscitation and support of brain dead organ donors. METHODS Brain death was induced in adult beagle dogs and a set volume of PEG-20k or crystalloid solution was given thereafter. The animals were then resuscitated over 16 h with vasopressors and crystalloid as necessary to maintain mean arterial pressure of 80-100 mmHg. The kidneys were procured and cold-stored for 24 h, after which they were analyzed using the isolated perfused kidney model. RESULTS The study group required significantly less crystalloid volume and vasopressors while having less urine output and requiring less potassium supplementation than the control group. Though the two groups' mean arterial pressure and lactate levels were comparable, the study group's kidneys showed less preservation injury after short-term reperfusion indexed by decreased lactate dehydrogenase release and higher creatinine clearance than the control group. CONCLUSIONS The use of polyethylene glycol-20k IV solution for resuscitating brain dead donors decreases cell swelling and improves intravascular volume, thereby improving end organ oxygen delivery before procurement and so preventing ischemia-reperfusion injury after transplantation.
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Affiliation(s)
- Hae Sung Kang
- Departments of Surgery Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Niluka Wickramaratne
- Departments of Surgery Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Loren K Liebrecht
- Departments of Surgery Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Martin J Mangino
- Departments of Surgery Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA; Emergency Medicine Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA; Physiology and Biophysics Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA.
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Khoraki J, Campos GM, Alwatari Y, Mazzini GS, Mangino MJ, Wolfe LG. Perioperative outcomes of inpatient laparoscopic Heller myotomy and per-oral endoscopic myotomy in the United States. Surgery 2021; 171:1263-1272. [PMID: 34774290 DOI: 10.1016/j.surg.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Per-oral endoscopic myotomy is an alternative to pneumatic dilation and laparoscopic Heller myotomy to treat lower esophageal sphincter diseases. Laparoscopic Heller myotomy and per-oral endoscopic myotomy perioperative outcomes data come from relatively small retrospective series and 1 randomized trial. We aimed to estimate the number of inpatient procedures performed in the United States and compare perioperative outcomes and costs of laparoscopic Heller myotomy and per-oral endoscopic myotomy using a nationally representative database. METHODS Cross-sectional retrospective analysis of hospital admissions for laparoscopic Heller myotomy or per-oral endoscopic myotomy from October 2015 through December 2018 in the National Inpatient Sample. Patient and hospital characteristics, concurrent antireflux procedures, perioperative adverse events (any adverse event and those associated with extended length of stay ≥3 days), mortality, length of stay, and costs were compared. Logistic regression evaluated factors independently associated with adverse events. RESULTS An estimated 11,270 patients had laparoscopic Heller myotomy (n = 9,555) or per-oral endoscopic myotomy (n = 1,715) without significant differences in demographics and comorbidities. A concurrent anti-reflux procedure was more frequent with laparoscopic Heller myotomy (72.8% vs 15.5%, P < .001). Overall adverse event rate was higher with per-oral endoscopic myotomy (13.3% vs 24.8%, P < .001), and mortality was similar. Per-oral endoscopic myotomy had higher rates of adverse events associated with extended length of stay (9.3% vs 16.6%, P < .001), infectious adverse events (3.5% vs 8.2%, P < .001), gastrointestinal bleeding (3.4% vs 5.8%, P = .04), accidental injuries (3% vs 5.5%, P = .03), and thoracic adverse events (4.5% vs 9%, P < .01). Rates of adverse events of both procedures remained similar during the years of the study. Per-oral endoscopic myotomy was independently associated with adverse events. Length of stay (laparoscopic Heller myotomy: 3.2 ± 0.1 vs per-oral endoscopic myotomy: 3.7 ± 0.3 days, P = .17) and costs (laparoscopic Heller myotomy: $15,471 ± 406 vs per-oral endoscopic myotomy: $15,146 ± 1,308, P = .82) were similar. CONCLUSION In this national database review, laparoscopic Heller myotomy had a lower rate of perioperative adverse events at similar length of stay and costs than per-oral endoscopic myotomy. Laparoscopic Heller myotomy remains a safer procedure than per-oral endoscopic myotomy for a myotomy of the distal esophagus and lower esophageal sphincter in the United States.
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Affiliation(s)
- Jad Khoraki
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA.
| | - Yahya Alwatari
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA
| | - Guilherme S Mazzini
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA
| | - Martin J Mangino
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA
| | - Luke G Wolfe
- Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University, Richmond, VA
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Liang L, Zhang G, Cheng C, Li H, Jin T, Su C, Xiao Y, Bradley J, Peberdy MA, Ornato JP, Mangino MJ, Tang W. High-resolution respirometry for evaluation of mitochondrial function on brain and heart homogenates in a rat model of cardiac arrest and cardiopulmonary resuscitation. Biomed Pharmacother 2021; 142:111935. [PMID: 34467895 DOI: 10.1016/j.biopha.2021.111935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022] Open
Abstract
The physiology and physiopathology process of mitochondrial function following cardiac arrest remains poorly understood. We aimed to assess mitochondrial respiratory function on the heart and brain homogenates from cardiac arrest rats. The expression level of SIRT1/PGC-1α pathway was measured by immunoblotting. 30 rats were assigned to the CA group and the sham group. Rats of CA were subjected to 6 min of untreated ventricular fibrillation (VF) followed by 8 min of cardiopulmonary resuscitation (CPR). Mitochondrial respiratory function was compromised following CA and I/R injury, as indicated by CIL (451.46 ± 71.48 vs. 909.91 ± 5.51 pmol/min*mg for the heart and 464.14 ± 8.22 vs. 570.53 ± 56.33 pmol/min*mg for the brain), CI (564.04 ± 64.34 vs. 2729.52 ± 347.39 pmol/min*mg for the heart and 726.07 ± 85.78 vs. 1762.82 ± 262.04 pmol/min*mg for the brain), RCR (1.88 ± 0.46 vs. 3.57 ± 0.38 for the heart and 2.05 ± 0.19 vs. 3.49 ± 0.19, for the brain) and OXPHOS coupling efficiency (0.45 ± 0.11 vs. 0.72 ± 0.03 for the heart and 0.52 ± 0.05 vs. 0.71 ± 0.01 for the brain). However, routine respiration was lower in the heart and comparable in the brain after CA. CIV did not change in the heart but was enhanced in the brain. Furthermore, both SIRT1 and PGC-1α were downregulated concurrently in the heart and brain. The mitochondrial respiratory function was compromised following CA and I/R injury, and the major affected respiratory state is complex I-linked respiration. Furthermore, the heart and the brain respond differently to the global I/R injury after CA in mitochondrial respiratory function. Inhibition of the SIRT1/PGC-1α pathway may be a major contributor to the impaired mitochondrial respiratory function.
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Affiliation(s)
- Lian Liang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-Sen University, Guangzhou, China
| | - Guozhen Zhang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, Tianjin Cancer Hospital Airport Free Trade Zone Hospital, Tianjin, China
| | - Cheng Cheng
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hui Li
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Intensive Care Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Tao Jin
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Chenglei Su
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Yan Xiao
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary A Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Martin J Mangino
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
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Su C, Xiao Y, Zhang G, Liang L, Li H, Cheng C, Jin T, Bradley J, Peberdy MA, Ornato JP, Mangino MJ, Tang W. Exogenous Nicotinamide Adenine Dinucleotide Attenuates Postresuscitation Myocardial and Neurologic Dysfunction in a Rat Model of Cardiac Arrest. Crit Care Med 2021; 50:e189-e198. [PMID: 34637412 DOI: 10.1097/ccm.0000000000005268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the therapeutic potential and underlying mechanisms of exogenous nicotinamide adenine dinucleotide+ on postresuscitation myocardial and neurologic dysfunction in a rat model of cardiac arrest. DESIGN Thirty-eight rats were randomized into three groups: 1) Sham, 2) Control, and 3) NAD. Except for the sham group, untreated ventricular fibrillation for 6 minutes followed by cardiopulmonary resuscitation was performed in the control and NAD groups. Nicotinamide adenine dinucleotide+ (20 mg/kg) was IV administered at the onset of return of spontaneous circulation. SETTING University-affiliated research laboratory. SUBJECTS Sprague-Dawley rats. INTERVENTIONS Nicotinamide adenine dinucleotide+. MEASUREMENTS AND MAIN RESULTS Hemodynamic and myocardial function were measured at baseline and within 4 hours following return of spontaneous circulation. Survival analysis and Neurologic Deficit Score were performed up to 72 hours after return of spontaneous circulation. Adenosine triphosphate (adenosine triphosphate) level was measured in both brain and heart tissue. Mitochondrial respiratory chain function, acetylation level, and expression of Sirtuin3 and NADH dehydrogenase (ubiquinone) 1 alpha subcomplex, 9 (NDUFA9) in isolated mitochondrial protein from both brain and heart tissue were evaluated at 4 hours following return of spontaneous circulation. The results demonstrated that nicotinamide adenine dinucleotide+ treatment improved mean arterial pressure (at 1 hr following return of spontaneous circulation, 94.69 ± 4.25 mm Hg vs 89.57 ± 7.71 mm Hg; p < 0.05), ejection fraction (at 1 hr following return of spontaneous circulation, 62.67% ± 6.71% vs 52.96% ± 9.37%; p < 0.05), Neurologic Deficit Score (at 24 hr following return of spontaneous circulation, 449.50 ± 82.58 vs 339.50 ± 90.66; p < 0.05), and survival rate compared with that of the control group. The adenosine triphosphate level and complex I respiratory were significantly restored in the NAD group compared with those of the control group. In addition, nicotinamide adenine dinucleotide+ treatment activated the Sirtuin3 pathway, down-regulating acetylated-NDUFA9 in the isolated mitochondria protein. CONCLUSIONS Exogenous nicotinamide adenine dinucleotide+ treatment attenuated postresuscitation myocardial and neurologic dysfunction. The responsible mechanisms may involve the preservation of mitochondrial complex I respiratory capacity and adenosine triphosphate production, which involves the Sirtuin3-NDUFA9 deacetylation.
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Affiliation(s)
- Chenglei Su
- Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA. Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Soochow, China. Departments of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA. Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA. Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA
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Wickramaratne N, Li R, Tian T, Khoraki J, Kang HS, Chmielewski C, Maitland J, Liebrecht LK, Fyffe-Freil R, Lindell SL, Mangino MJ. Cholangiocyte Epithelial to Mesenchymal Transition (EMT) is a potential molecular mechanism driving ischemic cholangiopathy in liver transplantation. PLoS One 2021; 16:e0246978. [PMID: 34234356 PMCID: PMC8263302 DOI: 10.1371/journal.pone.0246978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022] Open
Abstract
Donation after circulatory death (DCD) has expanded the donor pool for liver transplantation. However, ischemic cholangiopathy (IC) after DCD liver transplantation causes inferior outcomes. The molecular mechanisms of IC are currently unknown but may depend on ischemia-induced genetic reprograming of the biliary epithelium to mesenchymal-like cells. The main objective of this study was to determine if cholangiocytes undergo epithelial to mesenchymal transition (EMT) after exposure to DCD conditions and if this causally contributes to the phenotype of IC. Human cholangiocyte cultures were exposed to periods of warm and cold ischemia to mimic DCD liver donation. EMT was tested by assays of cell migration, cell morphology, and differential gene expression. Transplantation of syngeneic rat livers recovered under DCD conditions were evaluated for EMT changes by immunohistochemistry. Human cholangiocytes exposed to DCD conditions displayed migratory behavior and gene expression patterns consistent with EMT. E-cadherin and CK-7 expressions fell while N-cadherin, vimentin, TGFβ, and SNAIL rose, starting 24 hours and peaking 1–3 weeks after exposure. Cholangiocyte morphology changed from cuboidal (epithelial) before to spindle shaped (mesenchymal) a week after ischemia. These changes were blocked by pretreating cells with the Transforming Growth Factor beta (TGFβ) receptor antagonist Galunisertib (1 μM). Finally, rats with liver isografts cold stored for 20 hours in UW solution and exposed to warm ischemia (30 minutes) at recovery had elevated plasma bilirubin 1 week after transplantation and the liver tissue showed immunohistochemical evidence of early cholangiocyte EMT. Our findings show EMT occurs after exposure of human cholangiocytes to DCD conditions, which may be initiated by upstream signaling from autocrine derived TGFβ to cause mesenchymal specific morphological and migratory changes.
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Affiliation(s)
- Niluka Wickramaratne
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ru Li
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Tao Tian
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jad Khoraki
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Hae Sung Kang
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Courtney Chmielewski
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jerry Maitland
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Loren K. Liebrecht
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ria Fyffe-Freil
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Susanne Lyra Lindell
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Martin J. Mangino
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
- Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
- Department of Emergency Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
- * E-mail:
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Guo Q, Yang J, Hu Z, Xiao Y, Wu X, Bradley J, Peberdy MA, Ornato JP, Mangino MJ, Tang W. Polyethylene glycol-20k reduces post-resuscitation cerebral dysfunction in a rat model of cardiac arrest and resuscitation: A potential mechanism. Biomed Pharmacother 2021; 139:111646. [PMID: 33940509 DOI: 10.1016/j.biopha.2021.111646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
Out-of-hospital cardiac arrest (CA) is a leading cause of death in the United States. Severe post-resuscitation cerebral dysfunction is a primary cause of poor outcome. Therefore, we investigate the effects of polyethylene glycol-20k (PEG-20k), a cell impermeant, on post-resuscitation cerebral function. Thirty-two male Sprague-Dawley rats were randomized into four groups: 1) Control; 2) PEG-20k; 3) Sham control; 4) Sham with PEG-20k. To investigate blood brain barrier (BBB) permeability, ten additional rats were randomized into two groups: 1) CPR+Evans Blue (EB); 2) Sham+EB. Ventricular fibrillation was induced and untreated for 8 min, followed by 8 min of CPR, and resuscitation was attempted by defibrillation. Cerebral microcirculation was visualized at baseline, 2, 4 and 6 h after return of spontaneous circulation (ROSC). Brain edema was assessed by comparing wet-to-dry weight ratios after 6 h. S-100β, NSE and EB concentrations were analyzed to determine BBB permeability damage. For results, Post-resuscitation cerebral microcirculation was impaired compared to baseline and sham control (p < 0.05). However, dysfunction was reduced in animals treated with PEG-20k compared to control (p < 0.05). Post-resuscitation cerebral edema as measured by wet-to-dry weight ratio was lower in PEG-20k compared to control (3.23 ± 0.5 vs. 3.36 ± 0.4, p < 0.05). CA and CPR increased BBB permeability and damaged neuronal cell with associated elevation of S-100β sand NSE serum levels. PEG-20k administered during CPR improved cerebral microcirculation and reducing brain edema and injury.
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Affiliation(s)
- Qinyue Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, Shaanxi 710061, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jin Yang
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Zhangle Hu
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Yan Xiao
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaobo Wu
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Ann Peberdy
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Departments of Internal Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Martin J Mangino
- Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA; Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA
| | - Wanchun Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, Shaanxi 710061, China; Weil Institute of Emergency and Critical Care Research, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA.
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9
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Liang L, Zhang G, Li H, Cheng C, Jin T, Su C, Xiao Y, Bradley J, Peberdy MA, Ornato JP, Mangino MJ, Tang W. Combined Therapy With Polyethylene Glycol-20k and MCC950 Preserves Post-Resuscitated Myocardial Function in a Rat Model of Cardiac Arrest and Cardiopulmonary Resuscitation. J Am Heart Assoc 2021; 10:e019177. [PMID: 33884887 PMCID: PMC8200739 DOI: 10.1161/jaha.120.019177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background To investigate the therapeutic potential of combined therapy with polyethylene glycol-20k (PEG-20k) and MCC950 on post-resuscitation myocardial function in a rat model of cardiac arrest. Methods and Results Thirty rats were randomized into 5 groups: Sham, Control, PEG-20k, MCC950, PEG-20k+ MCC950. Except for sham, animals were subjected to 6 minutes of ventricular fibrillation followed by 8 minutes cardiopulmonary resuscitation. Two milliliters PEG-20k was administered by intravenous injection coincident with the start of cardiopulmonary resuscitation; MCC950 (10 mg/kg), a highly selective NLRP3 inflammasome inhibitor, was delivered immediately after restoration of spontaneous circulation. Myocardial function, sublingual microcirculation, mitochondrial function, plasma cardiac troponin I, and interleukin-1β, expression of proteins in SIRT1 (sirtuin 1)/PGC-1α (peroxisome proliferator-activated receptor gamma coactivator 1-alpha) and NLRP3 (the NOD-like receptor family protein 3) inflammasome pathways were evaluated. Following cardiopulmonary resuscitation, myocardial function was compromised with a significantly decreased cardiac output, ejection fraction, and increased myocardial performance index, cardiac troponin I. Sublingual microcirculation was disturbed with impaired perfused vessel density and microvascular flow index. Cardiac arrest reduced mitochondrial routine respiration, Complex I-linked respiration, respiratory control rates and oxidative phosphorylation coupling efficiency. PEG-20k or MCC950 alone restored mitochondrial respiratory function, restituted sublingual microcirculation, and preserved myocardial function, whereas a combination of PEG-20k and MCC950 further improved these aspects. PEG-20k restored the expression of SIRT1 and PGC-1α, and blunted activation of NLRP3 inflammasomes. MCC950 suppressed expression of cleaved-caspase-1/pro-caspase-1, ASC (apoptosis-associated speck-like protein), GSDMD [gasdermin d], and interleukin-1β. Conclusions Combined therapy with PEG-20k and MCC950 is superior to either therapy alone for preserving post-resuscitated myocardial function, restituting sublingual microcirculation at restoration of spontaneous circulation at 6 hours. The responsible mechanisms involve upregulated expression of SIRT1/PGC1-α in tandem with inhibition of NLRP3 inflammasomes.
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Affiliation(s)
- Lian Liang
- Department of Emergency Sun Yat-sen Memorial Hospital, Sun Yat-sen University Guangzhou China.,Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA.,Institute of Cardiopulmonary Cerebral Resuscitation Sun Yat-sen University Guangzhou China
| | - Guozhen Zhang
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Hui Li
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Cheng Cheng
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Tao Jin
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Chenglei Su
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Yan Xiao
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Jennifer Bradley
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
| | - Mary A Peberdy
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA.,Departments of Internal Medicine and Emergency Medicine Virginia Commonwealth University Health System Richmond VA
| | - Joseph P Ornato
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA.,Department of Emergency Medicine Virginia Commonwealth University Health System Richmond VA
| | - Martin J Mangino
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA.,Department of Surgery Virginia Commonwealth University Health System Richmond VA
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care Research Virginia Commonwealth University Richmond VA
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10
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Mazzini GS, Khoraki J, Browning MG, Wu J, Zhou H, Price ET, Wolfe LG, Mangino MJ, Campos GM. Gastric Bypass Increases Circulating Bile Acids and Activates Hepatic Farnesoid X Receptor (FXR) but Requires Intact Peroxisome Proliferator Activator Receptor Alpha (PPARα) Signaling to Significantly Reduce Liver Fat Content. J Gastrointest Surg 2021; 25:871-879. [PMID: 33555523 DOI: 10.1007/s11605-021-04908-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We interrogate effects of gastric bypass (RYGB), compared with a low-calorie diet, on bile acid (BA), liver fat, and FXR, PPARα, and targets in rats with obesity and non-alcoholic fatty liver disease (NAFLD). METHODS Male Wistar rats received a high-fat diet (obese/NAFLD, n=24) or standard chow (lean, n=8) for 12 weeks. Obese/NAFLD rats had RYGB (n=11), sham operation pair-fed to RYGB (pair-fed sham, n=8), or sham operation (sham, n=5). Lean rats had sham operation (lean sham, n=8). Post-operatively, five RYGB rats received PPARα antagonist GW6417. Sacrifice occurred at 7 weeks. We measured weight changes, fasting total plasma BA, and liver % steatosis, triglycerides, and mRNA expression of the nuclear receptors FXR, PPARα, and their targets SHP and CPT-I. RESULTS At sacrifice, obese sham was heavier (p<0.01) than all other groups that had lost similar weight loss. Obese sham had lower BA levels and lower hepatic FXR, SHP, and CPT-I mRNA expression than lean sham (P<0.05, for all comparisons). RYGB had increased BA levels compared with obese and pair-fed sham (P<0.05, for both), while pair-fed sham had BA levels, similar to obese sham. Compared with pair-fed sham, RYGB animals had increased liver FXR and PPARα expression and signaling (P<0.05). Percentage of steatosis was lower in RYGB and lean sham, relative to obese and pair-fed sham (P<0.05, for all comparisons). PPARα inhibition after RYGB resulted in similar weight loss but higher liver triglyceride content (P=0.01) compared with RYGB alone. CONCLUSIONS RYGB led to greater liver fat loss than low-calorie diet, an effect associated to increased fasting BA levels and increased expression of modulators of liver fat oxidation, FXR, and PPARα. However, intact PPARα signaling was necessary for resolution of NAFLD after RYGB.
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Affiliation(s)
- Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA.,Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre, RS, Brazil
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Matthew G Browning
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Jilin Wu
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Huiping Zhou
- Central Virginia Veterans Affairs Health Care System, Department of Microbiology and Immunology, Virginia Commonwealth University, 1220 E. Broad Street, Richmond, VA, USA
| | - Elvin T Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, Richmond, VA, USA
| | - Luke G Wolfe
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Martin J Mangino
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 E. Broad Street, Richmond, VA, USA.
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11
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Khoraki J, Sung Kang H, Wickramaratne N, Xu H, Li R, Mangino MJ. Low-Volume Resuscitation with Polyethylene Glycol-20k for Post-traumatic Hemorrhagic Shock in a Hybrid Model of Controlled and Uncontrolled Hemorrhage. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Quader M, Torrado JF, Mangino MJ, Toldo S. Temperature and flow rate limit the optimal ex-vivo perfusion of the heart - an experimental study. J Cardiothorac Surg 2020; 15:180. [PMID: 32698846 PMCID: PMC7376943 DOI: 10.1186/s13019-020-01223-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ex-vivo heart perfusion can be utilized to study a variety of physiologic and molecular pathways in a controlled system outside of the body. It can also be used in clinical settings such as for organ preservation before transplantation. Myocardial oxygen consumption (MVO2) correlates with energy production in the myocardium and can also be used to determine the balance between the oxygen supply and demand of the perfused heart. This study sought to determine an ex-vivo perfusion rate that matches the metabolic demands of the heart according to different temperatures and solution compositions (with and without the addition of erythrocytes), a flow below which the supply of oxygen is not sufficient to maintain an aerobic state of the perfused heart (“DCRIT”). Methods Under general anesthesia, rat hearts were procured and preserved by perfusing with the University of Wisconsin Belzer machine perfusion system (UW Belzer MPS) solution saturated with 100% O2. The key elements of this solution include supraphysiological potassium (to stop the heartbeat and reduce the cellular metabolic demand), starch, gluconate and mannitol (to maintain cell wall integrity), glucose (to sustain basal metabolism), and glutathione (to scavenge free radicals). Three groups of rat hearts (n = 7) were randomly allocated to be perfused at 15 °C, 22 °C or 37 °C, at a varying flow index (FI) starting from a minimum of 380 mL/min/100 g to less than 50 mL/min/100 g, decreasing by 50 mL/min/100 g at 10 min intervals while measuring the MVO2 at each FI. Lactate was measured from coronary sinus samples to determine the onset of tissue hypoxia/anaerobic state. Results The DCRIT at 15 °C was 99.9 ± 4.9 mL/min/100 g; however, at 22 °C and 37 °C we could not reach a DCRIT. The myocardial oxygen demand could not be met at 22 °C and 37 °C with the maximum FI above 380 mL/min/100 g even when erythrocytes (10% V/V) were added to the solution. At 15 °C, the production of lactate was evident only below the DCRIT, while at 22 °C lactate production was present at all flow indices. Conclusions Determining the DCRIT for optimal ex-vivo perfusion of the heart is necessary to ensure adequate tissue oxygenation and limit anaerobic state. Temperatures employed above 15 °C limit the efficient ex-vivo perfusion preservation of heart with the UW Belzer MPS solution.
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Affiliation(s)
- Mohammed Quader
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Box 980281, Richmond, VA, 23298, USA
| | - Juan Francisco Torrado
- Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Box 980281, Richmond, VA, 23298, USA.,Department of Cardiology, Clinic Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Martin J Mangino
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stefano Toldo
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA. .,Department of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Box 980281, Richmond, VA, 23298, USA.
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13
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Ge W, Zheng G, Ji X, He F, Hu J, Bradley JL, Moore CE, Peberdy MA, Ornato JP, Mangino MJ, Tang W. Effects of Polyethylene Glycol-20k on Coronary Perfusion Pressure and Postresuscitation Myocardial and Cerebral Function in a Rat Model of Cardiac Arrest. J Am Heart Assoc 2020; 9:e014232. [PMID: 32013701 PMCID: PMC7033902 DOI: 10.1161/jaha.119.014232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/06/2019] [Indexed: 01/12/2023]
Abstract
Background Epinephrine increases the rate of return of spontaneous circulation. However, it increases severity of postresuscitation myocardial and cerebral dysfunction and reduces duration of survival. We investigated the effects of aortic infused polyethylene glycol, 20 000 molecular weight (PEG-20k) during cardiopulmonary resuscitation on coronary perfusion pressure, postresuscitation myocardial and cerebral function, and duration of survival in a rat model of cardiac arrest. Methods and Results Twenty-four male rats were randomized into 4 groups: (1) PEG-20k, (2) epinephrine, (3) saline control-intravenous, and (4) saline control-intra-aortic. Cardiopulmonary resuscitation was initiated after 6 minutes of untreated ventricular fibrillation. In PEG-20k and Saline-A, either PEG-20k (10% weight/volume in 10% estimated blood volume infused over 3 minutes) or saline was administered intra-aortically after 4 minutes of precordial compression. In epinephrine and placebo groups, either epinephrine (20 μg/kg) or saline placebo was administered intravenously after 4 minutes of precordial compression. Resuscitation was attempted after 8 minutes of cardiopulmonary resuscitation. Sublingual microcirculation was measured at baseline and 1, 3, and 5 hours after return of spontaneous circulation. Myocardial function was measured at baseline and 2, 4, and 6 hours after return of spontaneous circulation. Neurologic deficit scores were recorded at 24, 48, and 72 hours after return of spontaneous circulation. Aortic infusion of PEG-20k increased coronary perfusion pressure to the same extent as epinephrine. Postresuscitation sublingual microcirculation, myocardial and cerebral function, and duration of survival were improved in PEG-20k (P<0.05) compared with epinephrine (P<0.05). Conclusions Aortic infusion of PEG-20k during cardiopulmonary resuscitation increases coronary perfusion pressure to the same extent as epinephrine, improves postresuscitation myocardial and cerebral function, and increases duration of survival in a rat model of cardiac arrest.
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Affiliation(s)
- Weiwei Ge
- Department of Emergency SurgeryThe Second Hospital of Anhui Medical UniversityHefeiChina
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Guanghui Zheng
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Xianfei Ji
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Fenglian He
- Department of Emergency SurgeryThe Second Hospital of Anhui Medical UniversityHefeiChina
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Juntao Hu
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Jennifer L. Bradley
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Christine E. Moore
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
| | - Mary A. Peberdy
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
- Department of Internal Medicine and Emergency MedicineVirginia Commonwealth University Health SystemRichmondVA
| | - Joseph P. Ornato
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
- Department of Emergency MedicineVirginia Commonwealth University Health SystemRichmondVA
| | - Martin J. Mangino
- Department of Emergency MedicineVirginia Commonwealth University Health SystemRichmondVA
- Department of SurgeryVirginia Commonwealth University Health SystemRichmondVA
- Department of Physiology and BiophysicsVirginia Commonwealth UniversityRichmondVA
| | - Wanchun Tang
- Weil Institute of Emergency and Critical Care ResearchVirginia Commonwealth UniversityRichmondVA
- Department of Emergency MedicineVirginia Commonwealth University Health SystemRichmondVA
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14
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DeAntonio JH, Leichtle SW, Hobgood S, Boomer L, Aboutanos M, Mangino MJ, Wijesinghe DS, Jayaraman S. Medication Reconciliation and Patient Safety in Trauma: Applicability of Existing Strategies. J Surg Res 2020; 246:482-489. [DOI: 10.1016/j.jss.2019.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022]
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15
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Wickramaratne NA, Li R, Fyffe-Freil RC, Mangino MJ. Epithelial-to-Mesenchymal Transition: A Cellular Mediator of Biliary Injury after Liver Transplantation. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Liebrecht LK, Newton J, Martin EJ, Wickramaratne N, Jayaraman S, Han J, Aboutanos M, Brophy DF, Mangino MJ. Effects of a novel low volume resuscitation solutions on coagulation and platelet function. PLoS One 2019; 14:e0215386. [PMID: 31042735 PMCID: PMC6493729 DOI: 10.1371/journal.pone.0215386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Novel crystalloid solutions containing polyethylene glycol polymers (PEG-20k) produce dramatic resuscitation effects but dose-dependently produce a hypocoagulative state. The objective of this study was to examine possible mechanisms of this effect. Based on previous thromboelastography data, we hypothesize the effect is largely due to platelet interactions with the polymers. Methods Whole citrated blood from healthy volunteers was diluted ex-vivo 10% with crystalloids and tested for coagulation and platelet function. The specific tests included prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and von Willebrand factor (vWf) activity, thrombin generation, thromboelastography with and without platelet mapping, platelet flow cytometry, and erythrocyte sedimentation rate. Findings Fibrinogen and vWF activities, PT, and aPTT were not affected by PEG-20k dilutions. Thrombin activity was mildly suppressed with PEG-20k (TTP- 20%). Platelet mapping demonstrated significantly greater % inhibition of both ADP and arachidonic acid-induced platelet aggregation with PEG-20k, but direct ADP-activated gpIIa/IIIb (PAC1) and P-selectin (CD62P) binding site expression was not altered. Mild dose-dependent suppression of TEG-MA was seen with PEG-20k using platelet poor plasma. Erythrocyte Sedimentation Rates (ESR) were dramatically accelerated after dilution with 10% PEG-20k, which was competitively blocked by smaller PEG polymers, suggesting nonspecific PEG-20k cell binding effects. Conclusions PEG-20k creates a mild hypocoagulative state in whole blood at concentrations ≥10%, which may be due to platelet-PEG interactions at the IIb/IIIa interface with lesser effects on fibrin polymerization. This interaction may cause a functional thrombasthenia induced by nonspecific platelet surface passivation by the PEG polymer.
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Affiliation(s)
- Loren K. Liebrecht
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Jason Newton
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Erika J. Martin
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, United States of America
| | - Niluka Wickramaratne
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Jinfeng Han
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Michel Aboutanos
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Donald F. Brophy
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, United States of America
| | - Martin J. Mangino
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
- * E-mail:
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17
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Liebrecht LK, Newton J, Martin EJ, Wickramaratne N, Jayaraman S, Han J, Aboutanos M, Brophy DF, Mangino MJ. Thromboelastographic analysis of novel polyethylene glycol based low volume resuscitation solutions. PLoS One 2018; 13:e0207147. [PMID: 30439979 PMCID: PMC6237338 DOI: 10.1371/journal.pone.0207147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. METHODS Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG). FINDINGS In healthy volunteers and patients, 10% PEG-20k significantly increased clot amplification time (k), decreased propagation (angle), maximal clot size and strength (MA), and the overall coagulation index (CI), but not clot initiation (R) or fibrinolysis (Ly30), relative to paired saline dilutional controls. Clinically, K, angle, and MA were just outside of the normal limits in volunteers but not in patients. No statistical differences existed between PEG-20k and Hextend (HES) in either patient population. In a dose response series using volunteer blood, all effects of 10% PEG-20k on TEG were reversed and normalized by lower concentrations (7.5% and 5%). Furthermore, 7.5% PEG-20k produced similar resuscitation effects as 10% PEG in rodent hemorrhagic shock models (n = 5). CONCLUSIONS In conclusion, PEG-20k based LVR solutions produced a dose-dependent minor hypocoagulative state, possibly associated with changes in clot propagation and platelet function, which can be reversed by dose reduction in concentration while providing superior LVR, microvascular rescue, and lactate clearance compared to saline or starch.
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Affiliation(s)
- Loren K. Liebrecht
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Jason Newton
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Erika J. Martin
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States of America
| | - Nina Wickramaratne
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Jinfeng Han
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Michel Aboutanos
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Donald F. Brophy
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, United States of America
| | - Martin J. Mangino
- Department of Surgery, Division of Acute Care Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
- * E-mail:
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18
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Khoraki J, Mazzini GS, Browning MG, Mangino MJ, Wijesinghe DS, Aquilina G, Salluzzo J, Campos GM. Does Coexistence of Non-alcoholic Fatty Liver Disease and Type-2 Diabetes Impact Weight Loss or Remission of Type 2 Diabetes after Gastric Bypass? Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Kenning KL, Toldo S, Mezzaroma E, La Neve F, Mauro AG, Mangino MJ, Quader M. Decreasing Ischemic Injury in Donation after Circulatory Death Heart with Inflammasome Blocker. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Browning MG, Khoraki J, DeAntonio JH, Mazzini G, Mangino MJ, Siddiqui MS, Wolfe LG, Campos GM. Protective effect of black relative to white race against non-alcoholic fatty liver disease in patients with severe obesity, independent of type 2 diabetes. Int J Obes (Lond) 2017; 42:926-929. [PMID: 29437160 DOI: 10.1038/ijo.2017.309] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/16/2017] [Accepted: 11/26/2017] [Indexed: 12/15/2022]
Abstract
Severe obesity (body mass index ⩾35 kg m-2) and type 2 diabetes (T2D) are potent and additive risk factors for non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatitis (NASH). Scant available evidence indicates that black relative to white patients with severe obesity are less susceptible to NAFLD, but it is unclear if T2D abolishes this apparent racial disparity. Therefore, we compared biopsy-proven NAFLD and its progression between black (n=71) and white (n=155) patients with severe obesity stratified by presence or absence of T2D. Although prevalence of T2D was similar between races (37%, P>0.9), whites were significantly more likely than blacks to have NAFLD, NASH and advanced fibrosis (defined as bridging fibrosis and/or cirrhosis). Importantly, T2D was associated with increased odds of NAFLD, NASH and advanced fibrosis (defined as bridging fibrosis or cirrhosis) in whites only (P<0.05). In turn, a higher proportion of blacks than whites with T2D were free of NAFLD (58 versus 22%, P<0.01). These preliminary findings question translation of the powerful interconnection between T2D and NAFLD in whites with severe obesity to blacks and point to an important role of race in the pathophysiology and treatment of these diseases.
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Affiliation(s)
- M G Browning
- Department of Physical Therapy, Virginia Commonwealth University. Richmond, VA, USA
| | - J Khoraki
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
| | - J H DeAntonio
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
| | - G Mazzini
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
| | - M J Mangino
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
| | - M S Siddiqui
- Department of Internal Medicine, Virginia Commonwealth University. Richmond, VA, USA
| | - L G Wolfe
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
| | - G M Campos
- Department of Surgery, Virginia Commonwealth University. Richmond, VA, USA
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Plant V, Parrish DW, Limkemann A, Ferrada P, Aboutanos M, Mangino MJ. Low-Volume Resuscitation for Hemorrhagic Shock: Understanding the Mechanism of PEG-20k. J Pharmacol Exp Ther 2017; 361:334-340. [DOI: 10.1124/jpet.116.239822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Parrish D, Lindell SL, Reichstetter H, Aboutanos M, Mangino MJ. Cell Impermeant-based Low-volume Resuscitation in Hemorrhagic Shock: A Biological Basis for Injury Involving Cell Swelling. Ann Surg 2016; 263:565-72. [PMID: 25915911 DOI: 10.1097/sla.0000000000001049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the role of cell swelling in severe hemorrhagic shock and resuscitation injury. BACKGROUND Circulatory shock induces the loss of energy-dependent volume control mechanisms. As water enters ischemic cells, they swell, die, and compress nearby vascular structures, which further aggravates ischemia by reducing local microcirculatory flow and oxygenation. Loading the interstitial space with cell impermeant molecules prevents water movement into the cell by passive biophysical osmotic effects, which prevents swelling injury and no-reflow. METHODS Adult rats were hemorrhaged to a pressure of 30 to 35 mm Hg, held there until the plasma lactate reached 10 mM, and given a low-volume resuscitation (LVR) (10%-20% blood volume) with saline or various cell impermeants (sorbitol, raffinose, trehalose, gluconate, and polyethylene glycol-20k (PEG-20k). When lactate again reached 10 mM after LVR, full resuscitation was started with crystalloid and red cells. One hour after full resuscitation, the rats were euthanized. Capillary blood flow was measured by the colored microsphere technique. RESULTS Impermeants prevented ischemia-induced cell swelling in liver tissue and dramatically improved LVR outcomes in shocked rats. Small cell impermeants and PEG-20k in LVR solutions increased tolerance to the low flow state by two and fivefold, respectively, normalized arterial pressure during LVR, and lowered plasma lactate after full resuscitation, relative to saline. This was accompanied by higher capillary blood flow with cell impermeants. CONCLUSIONS Ischemia-induced lethal cell swelling during hemorrhagic shock is a key mediator of resuscitation injury, which can be prevented by cell impermeants in low-volume resuscitation solutions.
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Affiliation(s)
- Dan Parrish
- *From the Departments of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA †Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA ‡Physiology and Biophysics, Division of Acute Care Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
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Liu Q, Nassar A, Farias K, Buccini L, Mangino MJ, Baldwin W, Bennett A, O'Rourke C, Iuppa G, Soliman BG, Urcuyo-Llanes D, Okamoto T, Uso TD, Fung J, Abu-Elmagd K, Miller C, Quintini C. Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death. Am J Transplant 2016; 16:794-807. [PMID: 26663737 DOI: 10.1111/ajt.13546] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/08/2015] [Accepted: 09/25/2015] [Indexed: 01/25/2023]
Abstract
The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc., Denver, CO), Steen plus red blood cells (RBCs), or whole blood (WB). All livers were preserved for 10 h and reperfused to simulate transplantation for 24 h. During preservation, the NMP with Steen group presented the highest hepatocellular injury. At reperfusion, the CS group had the lowest bile production and the worst hepatocellular injury compared with all other groups, followed by NMP with Steen; the Steen plus RBC and WB groups presented the best functional and hepatocellular injury outcomes, with WB livers showing lower aspartate aminotransferase release and a trend toward better results for most parameters. Based on our results, a perfusate that contains an oxygen carrier is most effective in a model of NMP porcine DCD livers compared with Steen solution. Specifically, WB-perfused livers showed a trend toward better outcomes compared with Steen plus RBCs.
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Affiliation(s)
- Q Liu
- Cleveland Clinic, Cleveland, OH
| | | | | | | | - M J Mangino
- Virginia Commonwealth University, Richmond, VA
| | | | | | | | - G Iuppa
- Cleveland Clinic, Cleveland, OH
| | | | | | | | - T D Uso
- Cleveland Clinic, Cleveland, OH
| | - J Fung
- Cleveland Clinic, Cleveland, OH
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Limkemann A, Lindell SL, Reichstetter H, Plant V, Parrish D, Ramos C, Kowalski C, Quintini C, Mangino MJ. Donor gluconate rescues livers from uncontrolled donation after cardiac death. Surgery 2015; 159:852-61. [PMID: 26619928 DOI: 10.1016/j.surg.2015.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/02/2015] [Accepted: 10/14/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Ischemia from organ preservation or donation causes cells and tissues to swell owing to loss of energy-dependent mechanisms of control of cell volume. These volume changes cause substantial preservation injury, because preventing these changes by adding cell impermeants to preservation solutions decreases preservation injury. The objective of this study was to assess if this effect could be realized early in uncontrolled donation after cardiac death (DCD) livers by systemically loading donors with gluconate immediately after death to prevent accelerated swelling injury during the warm ischemia period before liver retrieval. METHODS Uncontrolled DCD rat livers were cold-stored in University of Wisconsin solution for 24 hours and reperfused on an isolated perfused liver (IPL) device for 2 hours or transplanted into a rat as an allograft for 7 days. Donors were pretreated with a solution of the impermeant gluconate or a saline control immediately after cardiac death. Livers were retrieved after 30 minutes. RESULTS In vivo, gluconate infusion in donors immediately before or after cardiac death prevented DCD-induced increases in total tissue water, decreased vascular resistance, increased oxygen consumption and synthesis of adenosine triphosphate, increased bile production, decreased lactate dehydrogenase release, and decreased histology injury scores after reperfusion on the IPL relative to saline-treated DCD controls. In the transplant model, donor gluconate pretreatment significantly decreased both alanine aminotransferase the first day after transplantation and total bilirubin the seventh day after transplantation. CONCLUSION Cell and tissue swelling plays a key role in preservation injury of uncontrolled DCD livers, which can be mitigated by early administration of gluconate solutions to the donor immediately after death.
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Affiliation(s)
- Ashley Limkemann
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Susanne L Lindell
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Heather Reichstetter
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Valerie Plant
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Dan Parrish
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Clementina Ramos
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | - Chris Kowalski
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA
| | | | - Martin J Mangino
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA; Department of Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA; Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA.
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Ramanathan R, Pettinato G, Beeston JT, Lee DD, Wen X, Mangino MJ, Fisher RA. Transplantation of human stem cell-derived hepatocytes in an animal model of acute liver failure. Surgery 2015; 158:349-59. [DOI: 10.1016/j.surg.2015.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/03/2015] [Accepted: 04/22/2015] [Indexed: 01/13/2023]
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Tian T, Lindell SL, Kowalski C, Mangino MJ. Moesin functionality in hypothermic liver preservation injury. Cryobiology 2014; 69:34-40. [PMID: 24836372 DOI: 10.1016/j.cryobiol.2014.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 01/27/2023]
Abstract
The objective of this study was to determine how expression and functionality of the cytoskeletal linker protein moesin is involved in hepatic hypothermic preservation injury. Mouse livers were cold stored in University of Wisconsin (UW) solution and reperfused on an isolated perfused liver (IPL) device for one hour. Human hepatocytes (HepG2) and human or murine sinusoidal endothelial cells (SECs) were cold stored and rewarmed to induce hypothermic preservation injury. The cells were transfected with: wild type moesin, an siRNA duplex specific for moesin, and the moesin mutants T558D and T558A. Tissue and cell moesin expression and its binding to actin were determined by Western blot. Liver IPL functional outcomes deteriorated proportional to the length of cold storage, which correlated with moesin disassociation from the actin cytoskeleton. Cell viability (LDH and WST-8) in the cell models progressively declined with increasing preservation time, which also correlated with moesin disassociation. Transfection of a moesin containing plasmid or an siRNA duplex specific for moesin into HepG2 cells resulted in increased and decreased moesin expression, respectively. Overexpression of moesin protected while moesin knock-down potentiated preservation injury in the HepG2 cell model. Hepatocytes expressing the T558A (inactive) and T558D (active) moesin binding mutants demonstrated significantly more and less preservation injury, respectively. Cold storage time dependently caused hepatocyte detachment from the matrix and cell death, which was prevented by the T558D active moesin mutation. In conclusion, moesin is causally involved in hypothermic liver cell preservation injury through control of its active binding molecular functionality.
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Affiliation(s)
- Tao Tian
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States
| | - Susanne L Lindell
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States
| | - Chris Kowalski
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States
| | - Martin J Mangino
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States; Department of Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States; Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, United States.
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Mangino MJ, Tian T, Lindell SL. Ezrin and its emerging role in tumor progression: response. Cryobiology 2013; 66:94. [PMID: 23274401 DOI: 10.1016/j.cryobiol.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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Abstract
With the successful testing of the immunosuppressive effects of cyclosporine in transplant patients in 1978, the field of organ transplants began an exponential growth. With that, the field of organ preservation became increasingly important as the need to increase preservation time and improve graft function became paramount. However, for every patient that receives a transplanted organ, there are four more on the waiting list. In addition, a patient dies from the lack of a transplant almost every 1(1/2) hour. To alleviate this donor crisis, there is a need to expand the donor pool to marginal donor organs. The main reason these organs are underutilized is because the current method of static preservation, simple cold storage, is ineffective. This article will provide a general review of the methods of preservation including simple cold storage, hypothermic machine perfusion, normothermic machine perfusion, and oxygen persufflation. In addition, the article will provide a review of how these dynamic preservation methods have improved the recovery and preservation of marginal donor organs including Donation after Cardiac Death and Fatty livers.
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Affiliation(s)
- Charles Y Lee
- Department of Mechanical Engineering and Engineering Science; University of North Carolina; Charlotte, NC USA
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Tian T, Lindell SL, Lam M, Mangino MJ. Ezrin functionality and hypothermic preservation injury in LLC-PK1 cells. Cryobiology 2012; 65:60-7. [PMID: 22554620 DOI: 10.1016/j.cryobiol.2012.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 02/06/2012] [Accepted: 04/12/2012] [Indexed: 12/21/2022]
Abstract
Renal epithelial cells from donor kidneys are susceptible to hypothermic preservation injury, which is attenuated when they over express the cytoskeletal linker protein ezrin. This study was designed to characterize the mechanisms of this protection. Renal epithelial cell lines were created from LLC-PK1 cells, which expressed mutant forms of ezrin with site directed alterations in membrane binding functionality. The study used cells expressing wild type ezrin, T567A, and T567D ezrin point mutants. The A and D mutants have constitutively inactive and active membrane binding conformations, respectively. Cells were cold stored (4 °C) for 6-24 h and reperfused for 1h to simulate transplant preservation injury. Preservation injury was assessed by mitochondrial activity (WST-1) and LDH release. Cells expressing the active ezrin mutant (T567D) showed significantly less preservation injury compared to wild type or the inactive mutant (T567A), while ezrin-specific siRNA knockdown and the inactive mutant potentiated preservation injury. Ezrin was extracted and identified from purified mitochondria. Furthermore, isolated mitochondria specifically bound anti-ezrin antibodies, which were reversed with the addition of exogenous recombinant ezrin. Recombinant wild type ezrin significantly reduced the sensitivity of the mitochondrial permeability transition pore (mPTP) to calcium, suggesting ezrin may modify mitochondrial function. In conclusion, the cytoskeletal linker protein ezrin plays a significant role in hypothermic preservation injury in renal epithelia. The mechanisms appear dependent on the molecule's open configuration (traditional linker functionality) and possibly a novel mitochondrial specific role, which may include modulation of mPTP function or calcium sensitivity.
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Affiliation(s)
- Tao Tian
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, USA
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Mangino MJ, Tian T, Lindell SL. Ezrin functionality and ischemia‐reperfusion (I/R) injury in transplantation. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.56.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martin J. Mangino
- SurgeryVirginia Commonwealth UniversityRichmondVA
- Physiology and BiophysicsVirginia Commonwealth UniversityRichmondVA
| | - Tao Tian
- SurgeryVirginia Commonwealth UniversityRichmondVA
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Abstract
Main Problem The molecular basis of renal preservation injury is not well understood. Since mouse kidney transplantation models are not useful in this setting, a mouse Isolated Perfused Kidney (IPK) model was developed to take advantage of mouse genetic design capabilities for testing complex biological hypothesis regarding mechanisms of preservation injury in transplanted kidneys. Methods Mouse kidneys were recovered, preserved, and reperfused in-vitro with an acellular physiological crystalloid buffer containing hypo-physiological oncotic pressure. Outcome variables were measured to predict preservation injury. These included perfusate flow, vascular resistance, VO2, urine output, GFR, proteinuria, LDH release, and edema. The model was tested by subjecting mouse kidneys to cold storage in University of Wisconsin (UW) solution for 24, 48, or 72 hours (time-dependent preservation injury), cold storage in Euro-Collins Solution (solution dependent preservation injury), and exposure to prior warm ischemia (DCD dependent preservation injury). Results The model accurately predicted the qualitative and quantitative changes in the readouts based on known responses to preservation injury in kidney transplants in large animals and humans. Conclusion The mouse IPK accurately predicts many of the variables associated with renal organ preservation injury in the very early phases of reperfusion and may provide an attractive model for studying the molecular basis of renal preservation injury.
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Affiliation(s)
- Susanne L Lindell
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA ; Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA
| | - Natascha Williams
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA
| | - Ilia Brusilovsky
- Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA
| | - Martin J Mangino
- Department of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA ; Department of Anesthesiology, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA ; Department of Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA ; Department of Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 232980, USA
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Mangino MJ, Lindell SL. 64. Perfusion preservation of DCD kidneys: Effects of temperature, solution, and machine. Cryobiology 2010. [DOI: 10.1016/j.cryobiol.2010.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mangino MJ, Tian T. Involvement of ezrin in cold storage preservation injury in renal proximal tubule epithelial cells: Possible structural and signaling roles. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.1218.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tao Tian
- Department of SurgeryVirginia Commonwealth UniversityMedical College of VirginiaRichmondVA
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Abstract
The damaging effects of intestinal ischemia-reperfusion (I/R) on the gut and remote organs can be attenuated by subjecting the intestine to a prior, less severe I/R insult, a process known as preconditioning. Because intestines of hibernating ground squirrels experience repeated cycles of hypoperfusion and reperfusion, we examined whether hibernation serves as a model for natural preconditioning against I/R-induced injury. We induced intestinal I/R in either the entire gut or in isolated intestinal loops using rats, summer ground squirrels, and hibernating squirrels during natural interbout arousals (IBA; body temperature 37-39 degrees C). In both models, I/R induced less mucosal damage in IBA squirrels than in summer squirrels or rats. Superior mesenteric artery I/R increased MPO activity in the gut mucosa and lung of rats and summer squirrels and the liver of rats but had no effect in IBA squirrels. I/R in isolated loops increased luminal albumin levels, suggesting increased gut permeability in rats and summer squirrels but not IBA squirrels. The results suggest that the hibernation phenotype is associated with natural protection against intestinal I/R injury.
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Affiliation(s)
- Courtney C Kurtz
- Department of Comparative Biosciences, University of Wisconsin School of Veterinary Medicine, Madison, WI, USA
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Mangino MJ, Brounts L, Harms B, Heise C. Lipoxin biosynthesis in inflammatory bowel disease. Prostaglandins Other Lipid Mediat 2005; 79:84-92. [PMID: 16516812 DOI: 10.1016/j.prostaglandins.2005.10.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 10/28/2005] [Accepted: 10/28/2005] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Lipoxins are anti-inflammatory lipid mediators that are produced in gut mucosa, which serve to limit and resolve persistent inflammation. The purpose of this study was to evaluate colonic lipoxin biosynthesis in patients with ulcerative colitis (UC) to establish a possible biochemical basis for persistent inflammation in UC. METHODS Colonic mucosa from patients with UC or organ donors (controls) was placed into tissue culture for 90 min. The conditioned media was assayed (ELISA) for lipoxin A4 (LXA) and the biologically active isomer 15-epi-LXA4 (aspirin triggered lipoxin, ATL). Mucosal tissue 15-lipoxygenase protein was determined by Western blot. RESULTS Patient colonic mucosa produced significantly lower (12-fold) amounts of LXA, relative to organ donors. This occurred irregardless of patient steroid treatment. However, patient tissue responded to in vitro aspirin by synthesizing biologically active ATL. For the first time, human colonic mucosa was found to synthesize 15-lipoxygenase-2, an epithelial-derived isoenzyme used for lipoxin synthesis. These levels were significantly lower in UC patients compared to the control tissue. Finally, mice chronically treated with a putative selective 15-lipoxygenase inhibitor (PD 146176) experienced significantly worse intestinal function during experimental colitis, relative to untreated mice. CONCLUSION Colonic mucosa from UC patients demonstrated defective lipoxin biosynthesis, which may contribute to the inability of these patients to resolve persistent colonic inflammation.
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Affiliation(s)
- Martin J Mangino
- Department of Surgery, University of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792, USA.
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Abstract
BACKGROUND Peroxynitrite anions may play a role in normothermic renal ischemia and reperfusion. The purpose of this study was to determine if endogenous peroxynitrite anion is involved in renal preservation injury. METHODS Experiments were conducted in isolated canine renal tubules and in a canine autotransplant model of hypothermic preservation injury. RESULTS Isolated renal tubules demonstrated progressive loss of membrane transport function after reperfusion with increasing cold storage times in UW solution as assessed by tetraethylammonium cation transport (TEA). This transport defect was not altered by reperfusion in the presence of WW85, a peroxynitrite decomposition catalyst. Likewise, tubule LDH release was not altered by WW85. Renal tubules did not demonstrate any evidence of peroxynitrite formation after cold storage (0-120 h) or after subsequent reperfusion in vitro as measured by nitrotyrosine adduct formation. Addition of exogenous peroxynitrite (1 mM) directly to freshly isolated renal tubules produced strong nitrotyrosine signals but failed to alter membrane function (TEA uptake). Conversely, SIN-1, a peroxynitrite generator molecule, failed to produce a nitrotyrosine signal in extracted renal tubule proteins but significantly impaired transport function. Finally, function of cold stored canine autografts was not affected by the scavenging of peroxynitrite anions (WW85) before kidney harvest and immediately at reperfusion. Tissue biopsies from cold stored kidney autografts also failed to show evidence of peroxynitrite synthesis either after cold storage (72 h) or after kidney transplantation (60 min reperfusion). CONCLUSIONS This study concludes that peroxynitrite anions are not formed and are not involved in renal preservation injury.
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Affiliation(s)
- Martin J Mangino
- Department of Surgery, University of Wisconsin Medical School, Madison, WI, USA.
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Compagnon P, Lindell S, Ametani MS, Gilligan B, Wang HB, D'Alessandro AM, Southard JH, Mangino MJ. Ischemic preconditioning and liver tolerance to warm or cold ischemia: experimental studies in large animals. Transplantation 2005; 79:1393-400. [PMID: 15912109 DOI: 10.1097/01.tp.0000164146.21136.0b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the rodent, ischemic preconditioning (IPC) has been shown to improve the tolerance of the liver to ischemia-reperfusion under normothermic or hypothermic conditions. The aim of the present study was to test this hypothesis in a dog model, which may be more relevant to the human. METHODS Beagle dogs were used in two distinct animal models of hepatic warm ischemia and orthotopic liver transplantation (hypothermic ischemia). IPC consisted of 10 minutes of ischemia followed by 10 minutes of reperfusion. In the first model, livers were exposed to 55 minutes prolonged warm ischemia and reperfused for 3 days (n = 6). In the second model, livers were retrieved and preserved for 48 hours at 4 degrees C in University of Wisconsin solution, transplanted, and reperfused without immunosuppression for 7 days (n = 5). In each model, nonpreconditioned animals served as controls (n = 5 in each group). Also, isolated dog hepatocytes were subjected to warm and cold storage ischemia-reperfusion to model the animal transplant studies using IPC. RESULTS In the first model (warm ischemia), IPC significantly decreased serum aminotransferase activity at 6 and 24 hours post-reperfusion. After 1 hour of reperfusion, preconditioned livers contained more adenosine triphosphate and produced more bile and less myeloperoxidase activity (neutrophils) relative to controls. In the second model (hypothermic preservation), IPC was not protective. Finally, IPC significantly attenuated hepatocyte cell death after cold storage and warm reperfusion in vitro. CONCLUSIONS IPC is effective in large animals for protecting the liver against warm ischemia-reperfusion injury but not injury associated with cold ischemia and reperfusion (preservation injury). However, the IPC effect observed in isolated hepatocytes suggests that preconditioning for preservation is theoretically possible.
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Affiliation(s)
- Philippe Compagnon
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine, Madison, WI 53792, USA
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Abstract
BACKGROUND Donation of kidneys from non-heart beating donors (NHBD) is increasingly being used to expand the donor pool. Warm ischemic injury of these kidneys suffered at harvest results in DGF at transplantation. In this study, we used hypothermic continuous machine perfusion preservation to mitigate this injury using two available solutions. METHODS Dog kidneys (beagles) were exposed to 0, 60, or 75 min of in situ warm ischemia (37 degrees C), followed by 24 to 72 hr preservation by machine perfusion with Belzer MPS solution or the UW-solution (Viaspan). Auto-transplantation was performed with immediate contralateral nephrectomy. Survival and renal function (serum creatinine) were evaluated for up to 10 days posttransplant. RESULTS Both solutions were equally effective for 72 hr machine perfusion preservation of dog kidneys giving 100% survival with only minor renal injury. Both solutions were also equally effective for preservation of kidneys exposed to 60 min of warm ischemia. However, only the UW solution gave reliable preservation (86% survival vs. 25% survival) in kidneys exposed to 75 min of warm ischemia and 24 hr machine perfusion. CONCLUSION UW solution used with continuous hypothermic machine perfusion preservation can rescue canine kidneys from severe warm ischemic injury.
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Affiliation(s)
- Susanne L Lindell
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine, Madison, WI, USA
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Lindell SL, Klahn SL, Piazza TM, Mangino MJ, Torrealba JR, Southard JH, Carey HV. Natural resistance to liver cold ischemia-reperfusion injury associated with the hibernation phenotype. Am J Physiol Gastrointest Liver Physiol 2005; 288:G473-80. [PMID: 15701622 DOI: 10.1152/ajpgi.00223.2004] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The success of liver grafts is currently limited by the length of time organs are cold preserved before transplant. Novel insights to improve viability of cold-stored organs may emerge from studies with animals that naturally experience low body temperatures (T(b)) for extended periods. In this study, we tested whether livers from hibernating ground squirrels tolerate cold ischemia-warm reperfusion (cold I/R) for longer times and with better quality than livers from rats or summer squirrels. Hibernators were used when torpid (T(b) < 10 degrees C) or aroused (T(b) = 37 degrees C). Livers were stored at 4 degrees C in University of Wisconsin solution for 0-72 h and then reperfused with 37 degrees C buffer in vitro. Lactate dehydrogenase (LDH) release after 60 min was increased 37-fold in rat livers after 72 h cold I/R but only 10-fold in summer livers and approximately three- to sixfold in torpid and aroused hibernator livers, despite twofold higher total LDH content in livers from hibernators compared with rats or summer squirrels. Reperfusion for up to 240 min had the least effect on LDH release in livers from hibernators and the greatest effect in rats. Compared with rats or summer squirrels, livers from hibernators after 72 h cold I/R showed better maintenance of mitochondrial respiration, bile production, and sinusoidal lining cell viability, as well as lower vascular resistance and Kupffer cell phagocytosis. These results demonstrate that the hibernation phenotype in ground squirrels confers superior resistance to liver cold I/R injury compared with rats and summer squirrels. Because hibernation-induced protection is not dependent on animals being in the torpid state, the mechanisms responsible for this effect may provide new strategies for liver preservation in humans.
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Affiliation(s)
- Susanne L Lindell
- Department of Comparative Biosciences, University of Wisconsin, 2015 Linden Dr., Madison WI 53706, USA
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Gilligan BJ, Woo HM, Kosieradzki M, Torrealba JR, Southard JH, Mangino MJ. Prolonged hypothermia causes primary nonfunction in preserved canine renal allografts due to humoral rejection. Am J Transplant 2004; 4:1266-73. [PMID: 15268727 DOI: 10.1111/j.1600-6143.2004.00503.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Canine kidney preservation models have historically used autotransplants to avoid the complications of rejection, although clinically all transplants are allografts. This study investigated the effects of preservation time and method on early kidney function in a canine allograft vs. autograft model. Kidneys were harvested from beagles, preserved by cold storage (CS) in UW solution for 0, 24 or 72 h, or by machine perfusion (MP) with Belzer MPS for 72 h. In some experiments 45 min of warm ischemia (WI) was performed in situ before harvest. Allograft recipients received steroid immunosuppression. Kidney function was assessed by serum creatinine and survival for 7 days. Allografts preserved for 0 and 24 h performed as well as autografts. Allografts preserved for 72 h by either CS or MP had a higher incidence of primary nonfunction (PNF) compared with autografts, as determined by survival (50% vs. 100%, p < 0.003). Primary nonfunction kidneys had thrombotic microangiopathy, vascular and peritubular capillary binding of IgM and complement C4d, and evidence of circulating donor-specific antibodies; all consistent with humoral rejection. These responses were dependent on hypothermia time and were not attributable to ischemia, immunosuppression, preservation solution, or cellular rejection. In conclusion, prolonged hypothermia can cause PNF in allografts owing to acute humoral rejection.
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Abstract
The nuclear enzyme poly(ADP-ribose) polymerase (PARP) has been implicated in ischemia-reperfusion injury in many tissues under normothermic conditions. The purpose of this study was to determine whether PARP contributes to mechanisms of the hypothermic ischemia-reperfusion injury that occurs when kidneys are cold stored for transplantation. Cortical tissue slice PARP enzyme activity rose significantly with prolonged cold storage and was dependent on both reperfusion and preservation quality. However, prior exposure to warm ischemia abrogated this increase. PARP protein increased with cold storage but was not dependent on reperfusion. PARP enzyme activity rose quickly after reperfusion in buffer and was not different when whole blood was used. Addition of exogenous hydrogen peroxide (3 mM) to normal renal slices significantly increased PARP activity over 4 h in the cortex but not in the medulla, but the medullary basal PARP synthesis rate was five times higher than that in the cortex. However, the reactive oxygen species (ROS) inhibitors catalase (2,000 U/ml), Trolox (200 microM), and DMSO (15 mM) did not reduce reperfusion-induced PARP activity in cold-stored cortical slices. Finally, PARP inhibitors potentiated preservation injury in isolated canine proximal renal tubules. In conclusion, canine renal PARP enzyme activity rises with prolonged cold storage after reperfusion and may play a protective rather than an injurious role in hypothermic preservation for transplantation. ROS are sufficient but not necessary to activate PARP under these conditions.
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Affiliation(s)
- Martin J Mangino
- Department of Surgery, University of Wisconsin, 600 Highland Ave., Madison, WI 53792, USA.
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Mangino MJ, Kosieradzki M, Gilligan B, Woo H, Southard JH. The effects of donor brain death on renal function and arachidonic acid metabolism in a large animal model of hypothermic preservation injury. Transplantation 2003; 75:1640-7. [PMID: 12777849 DOI: 10.1097/01.tp.0000062541.10466.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Donor brain death (BD) has been implicated as a risk factor for the poor performance of kidneys after transplantation in small but not large animal models. This study determined the effects of donor BD on renal function and lipid mediator metabolism in a large animal model of renal hypothermic preservation injury. METHODS Adult beagle donors were subjected to explosive BD for 16 hr. After BD, the kidneys were removed, cold stored for 24 hr in cold University of Wisconsin solution, and allotransplanted into recipient dogs for either 4 hr (group 1) or 7 days (group 2). Controls for both groups consisted of kidneys obtained from living donors. Renal allograft function and tissue arachidonic acid (AA) metabolism were determined after reperfusion. RESULTS Short-term renal function after transplantation was generally unaffected by BD. Renal blood flow decreased after reperfusion but was not altered during the 16-hr BD period. Neutrophil infiltration significantly increased in kidneys from brain-dead donors before storage and after 4 hr of reperfusion. Renal cortex and medulla AA metabolism were not significantly affected by BD after short-term reperfusion except when thiol-ether leukotrienes (LTC(4)/D(4)/E(4)) were increased with BD. Serum creatinine was elevated during 7 days, but, surprisingly, BD significantly attenuated this injury. CONCLUSION BD in large mammals does not significantly affect renal allograft function or AA metabolism after transplantation. The role of BD in human renal preservation injury and inflammation should be reevaluated.
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Affiliation(s)
- Martin J Mangino
- Department of Surgery, University of Wisconsin School of Medicine, Madison 53792, USA.
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Abstract
BACKGROUND Renal ischemic preconditioning (IPC) is a phenomenon whereby a brief period of ischemia and reperfusion (I/R) provides tolerance to subsequent periods of ischemia. IPC has been demonstrated to protect rodent kidneys during I/R. The applicability to large mammals, including human beings, is unclear. The objective of this study was to determine if renal IPC has a beneficial effect in a large animal model of warm I/R and hypothermic preservation injury, which occurs with renal allografting. METHODS Renal ischemia (45 minutes) and reperfusion was studied in untreated dogs and in dogs receiving IPC (10-minute/10-minute I/R). IPC was administered immediately before I/R (early IPC) or 24 hours before I/R (delayed IPC). In another group of dogs, pharmacologically induced IPC was attempted with local intra-arterial administration of dipyridamole (2.4 mg/kg/min) to increase local adenosine concentrations. Finally, IPC was induced in kidneys before harvest, cold stored for 24 hours in University of Wisconsin flush solution, and subsequently reperfused for 4 hours in allogeneic recipients. Renal functional parameters, including vascular resistance, glomerular filtration rate, urine production, oxygen consumption, and proximal tubular fluid reabsorption, were monitored during the reperfusion period and were compared with the control ischemic group. RESULTS Renal function significantly declined during I/R, relative to the nonischemic contralateral kidney but was not different with any form of IPC, relative to the ischemic control group not treated with IPC. IPC pretreatment also did not affect the preservation injury observed in cold-stored kidneys reperfused after transplantation. CONCLUSIONS It is concluded that IPC has no significantly measurable effects in warm or hypothermic renal I/R injury in large animals. The clinical usefulness of IPC in human renal ischemic conditions remains uncertain.
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Affiliation(s)
- Maciej Kosieradzki
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine, Madison, Wis, USA
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Bloch KE, Adams JA, Bassuk JJ, Mangino MJ, Sackner MA. Noninvasive monitoring of cardiac output in human neonates and juvenile piglets by inductance cardiography (thoracocardiography). J Crit Care 2002; 17:259-66. [PMID: 12501155 DOI: 10.1053/jcrc.2002.36756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Thoracocardiography has been used in adult patients to noninvasively estimate changes in cardiac output (CO) by analysis of ventricular volume curves recorded by an inductive plethysmographic transducer encircling the chest at the level of the heart. The purpose of this study was to investigate the potential of thoracocardiography to monitor cardiac output in human neonates and in a small animal model, the juvenile piglet. MATERIALS AND METHODS In 6 human premature neonates weighing 1.0 to 1.6 kg the effect of periodic respiration on CO was studied with thoracocardiography. In 9 piglets weighing 8.5 to 10.2 kg changes in CO were estimated simultaneously by thoracocardiography and thermodilution during fluid loading and rapid atrial pacing. RESULTS In human neonates, CO during breathing was 136% to 320% of the corresponding value during apneas. In piglets, CO by thermodilution ranged from 0.25 to 3.26 L/min. The mean difference in 40 paired estimates of relative changes in CO by thoracocardiography and thermodilution was 3%, limits of agreement (bias +/- 2 SD) were +/- 30%. CONCLUSIONS In neonates, increases in CO during respiratory phases of periodic breathing are consistent with expected cardiorespiratory interactions. Thoracocardiography monitored changes in CO in piglets with acceptable accuracy. Thoracocardiography holds promise for noninvasive monitoring in human neonates but further validation is required.
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Affiliation(s)
- Konrad E Bloch
- PulmoDepartment of Internal Medicine, University Hospital of Zürich, Switzerland.
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Abstract
Ischemic preconditioning (IPC) is a phenomenon of protection in various tissues from normothermic ischemic injury by previous exposure to short cycles of ischemia-reperfusion. The ability of IPC to protect hepatocytes from a model of hypothermic transplant preservation injury was tested in this study. Rat hepatocytes were subjected to 30min of warm ischemia (37 degrees C) followed by 24 or 48h of hypothermic (4 degrees C) storage in UW solution and subsequent re-oxygenation at normothermia for 1h. Studies were performed with untreated control cells and cells treated with IPC (10min anoxia followed by 10min re-oxygenation, 1 cycle). Hepatocytes exposed to IPC prior to warm ischemia released significantly less LDH and had higher ATP concentrations, relative to untreated ischemic hepatocytes. IPC significantly reduced LDH release after 24h of cold storage before reperfusion and after 48h of cold storage and after 60min of warm re-oxygenation, relative to the corresponding untreated hepatocytes. ATP levels were also significantly higher when IPC was used prior to the warm and cold ischemia-re-oxygenation protocols. In parallel studies, IPC increased new protein synthesis and lactate after cold storage and reperfusion compared to untreated cells but no differences in the patterns of protein banding were detected on electrophoresis between the groups. In conclusion, IPC significantly improves hepatocyte viability and energy metabolism in a model of hypothermic preservation injury preceded by normothermic ischemia. These protective effects on viability may be related to enhanced protein and ATP synthesis at reperfusion.
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Affiliation(s)
- Philippe Compagnon
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI 53792, USA
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Compagnon P, Wang H, Lindell SL, Ametani MS, Mangino MJ, D'Alessandro AM, Southard JH. Brain death does not affect hepatic allograft function and survival after orthotopic transplantation in a canine model. Transplantation 2002; 73:1218-27. [PMID: 11981412 DOI: 10.1097/00007890-200204270-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain death has been shown to decrease graft function and survival in rodent models. The aim of this study was to evaluate how brain death affects graft viability in the donor and liver tolerance to cold preservation as assessed by survival in a canine transplant model. METHODS Beagle dogs were used for the study. Non-brain dead (BD) donors served as controls. Brain death was induced by sudden inflation of a subdural balloon catheter with continuous monitoring of arterial blood pressure and electroencephalographic activity. Sixteen hours after confirmation of brain death, liver grafts were retrieved. All livers were flushed in situ and preserved for 24 hr in cold University of Wisconsin solution before transplantation. Recipient survival rates, serum hepatic enzyme levels, coagulation, and metabolic parameters of the recipients were analyzed. RESULTS No significant changes were observed in serum aminotransferases (alanine and aspartate transaminases) and lactate dehydrogenase levels in the BD donor. After preservation, control (n=6) and BD livers (n=5) showed full functional recovery after transplant with 100% survival in both groups at day 7. There was no significant difference in peak serum alanine, aspartate transaminases, and lactate dehydrogenase after transplantation in recipients who received a liver from BD donor compared to control group. BD livers were functionally as capable as control livers in correcting metabolic acidosis during the first 24 hr posttransplantation. Coagulation profiles (index normalized ratio, activated partial thromboplastin time) after reperfusion were similar between groups. CONCLUSION In contrast to previous reports in rodent models, our study shows that brain death does not cause significant liver dysfunction in the donor before organ removal. Donor brain death and prolonged liver graft preservation do not interact significantly to impair liver function and survival after transplantation.
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Affiliation(s)
- Philippe Compagnon
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI 53792, USA
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Affiliation(s)
- H V Carey
- Department of Comparative Biosciences School of Veterinary Medicine, University of Wisconsin Madison, WI 53706, USA.
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Abstract
OBJECTIVE To determine whether a motion platform that imparts noninvasive periodic acceleration (pGz) forces to the body causes systemic vasodilation and changes local organ blood flow. DESIGN Prospective paired blocked design. SETTING Medical center research laboratory. SUBJECTS Juvenile Yorkshire pigs. INTERVENTIONS Juvenile pigs (12 kg) were anesthetized, paralyzed, and placed on a motion platform that oscillated at a frequency of 4 Hz and a force of approximately 0.4 G. MEASUREMENTS AND MAIN RESULTS Regional blood flows, as assessed by colored microspheres, increased during pGz relative to values obtained before pGz. Blood flow (mL.min-1.100 g-1) significantly increased to the epicardium (71%), endocardium (93%), cerebrum (183%), brain stem (177%), renal cortex (53%), ileal mucosa (69%), gastric antral mucosa (72%), and liver (86%). Spleen and skeletal muscle blood flow increased without statistical significance, 38% and 158% with pGz, relative to paired control values. Regional blood flows returned to baseline 10 mins after discontinuation of pGz, except in the myocardial layers, where blood flow remained significantly elevated. There was no difference compared with baseline in heart rate, arterial blood gases, and blood pressure, but serum nitrite concentration was significantly higher (58%) during pGz. In another series of animals, pGz increased pulmonary artery blood flow directly proportional to the magnitude of the applied acceleration force with frequency held constant. CONCLUSIONS Periodic sinusoidal inertial forces in the spinal axis increase blood flow to tissues. The increased blood flow is reversible and may be caused by vasodilation secondary to local mediator release. These effects may be desirable in clinical conditions of low tissue oxygen delivery and perfusion.
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Affiliation(s)
- J A Adams
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL, USA
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Abstract
The effects of periodic Gz acceleration (pGz) on cardiovascular function and hemodynamics were determined in a pig model of acute cardiopulmonary resuscitation (CPR). The application of pGz (horizontal head-to-foot oscillations) at 2 Hz increased cardiac output in fibrillated animals proportional to the amplitude of the applied acceleration force that plateaued at 0.7 G. Cardiac output in fibrillating animals was restored to 20% of the values obtained before fibrillation with pGz-CPR and arterial blood gas values were normal during this period. The central vascular pressure gradient driving blood flow was only about 6 mmHg, suggesting low vascular resistance during pGz-CPR. In another study, capillary blood flow was determined before and after pGz-CPR using colored microspheres. Capillary perfusion was detected in all tissue beds studied during pGz-CPR. Significant capillary blood flow was detected in the endocardium and brain stem during pGz-CPR that represented 39 and 197% of control values before fibrillation, respectively. Thus, the cardiac output during pGz-CPR was preferentially distributed to the myocardial and brain tissues. In a final group, animals were successfully resuscitated with return of spontaneous circulation (ROSC) after pGz-CPR for 15 min following cardiac fibrillation with a 3-min non-intervention period. Following ROSC, blood pressure was maintained at pre-arrest values for 2 h without any pharmacological or mechanical support. Arterial blood gases during the pGz-CPR and the ROSC periods were normal and not different from values obtained before fibrillation. None of the control animals (18 min of fibrillation without pGz-CPR) survived the experimental protocol and only two of these six animals briefly returned to spontaneous circulation (<20 min). In conclusion, experimental pGz-CPR produces cardiac output, capillary blood flow, and ventilation sufficient to maintain fibrillating animals for 18 min with ROSC for 2 h without support.
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Affiliation(s)
- J A Adams
- Department of Research, Division of Neonatology, Mount Sinai Medical Center, and Miami Heart Research Institute, 4300 Alton Road, 3 Blum, Miami Beach, FL 33140, USA.
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Abstract
A motion platform was developed that oscillates an animal in a foot-to-head direction (z-plane). The platform varies the frequency and intensity of acceleration, imparting periodic sinusoidal inertial forces (pG(z)) to the body. The aim of the study was to characterize ventilation produced by the noninvasive motion ventilator (NIMV) in animals with healthy and diseased lungs. Incremental increases in pG(z) (acceleration) with the frequency held constant (f = 4 Hz) produced almost linear increases in minute ventilation (VE). Frequencies of 2-4 Hz produced the greatest VE and tidal volume (VT) for any given acceleration between +/-0.2 and +/-0.8 G. Increasing the force due to acceleration produced proportional increases in both transpulmonary and transdiaphragmatic pressures. Increasing transpulmonary pressure by increasing pG(z) produced linear increases in VT, similar to spontaneous breathing. NIMV reversed deliberately induced hypoventilation and normalized the changes in arterial blood gases induced by meconium aspiration. In conclusion, a novel motion platform is described that imparts periodic sinusoidal acceleration forces at moderate frequencies (4 Hz) to the whole body in the z-plane. These forces, when properly adjusted, are capable of highly effective ventilation of normal and diseased lungs. Such noninvasive ventilation is accomplished at airway pressures equivalent to atmospheric or continuous positive airway pressure, with acceleration forces less than +/-1 G(z).
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Affiliation(s)
- J A Adams
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach 33140, Florida.
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