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Radulović S, Kirsch A, Schilcher I, Lechleitner M, Nusshold C, Hallström S, Frank S. The capacity of el modified serum/Apo B depleted serum to protect vascular endothelial function. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.776] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Stochastic foam models are generated from Voronoi spatial partitioning, using the centers of equi-sized hard spheres in random periodic distributions as seed points. Models with different levels of polydispersity are generated by varying the packing of the spheres. Subsequent relaxation is then performed with the Surface Evolver software which minimizes the surface area for better resemblance with real foam structures. The polydispersity of the Voronoi precursors is conserved when the models are converted into equilibrium models. The relation between the sphere packing fraction and the resulting degree of volumetric polydispersity is examined and the relations between the polydispersity and a number of associated morphology parameters are then investigated for both the Voronoi and the equilibrium models. Comparisons with data from real foams in the literature indicate that the used method is somewhat limited in terms of spread in cell volume but it provides a very controlled way of varying the foam morphology while keeping it periodic and truly stochastic. The study shows several strikingly consistent relations between the spread in cell volume and other geometric parameters, considering the stochastic nature of the models.
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Affiliation(s)
- J Köll
- Department of Aeronautical and Vehicle Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - S Hallström
- Department of Aeronautical and Vehicle Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Rungatscher A, Daniele L, San Biagio L, Bombieri S, Hallström S, Luciani G, Faggian G. Autologous Transfusion of Stored Red Blood Cells Impairs Endothelium-Dependent Vasodilatation in Experimental Pulmonary Arterial Hypertension. This Effect Is Reversed by Inhaled Nitric Oxide. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1041] [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: 10/22/2022] Open
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Frank S, Opresnik S, Rao S, Hrzenjak A, Hallström S, Kozina A, Sreckovic I, Wadsack C, Holzer M, Marsche G, Birner-Gruenberger R, Stojakovic T, Scharnagl H. Endothelial lipase attenuates vasorelaxing capacity of HDL. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kozina A, Opresnik S, Hallström S, Schmidt K, Malli R, Graier W, Frank S. Acyl chain-dependent effect of lysophosphatidylcholine on endothelial nitric oxide synthase and no bioavailability in endothelial cells. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.329] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rungatscher A, Hallström S, Linardi D, Milani E, Gandhi K, Luciani G, Mazzucco A, Faggian G. S-Nitroso Human Serum Albumin Vs Inhaled Nitric Oxide in Experimental Right Ventricular Failure on Prolonged Overcirculation-Induced Pulmonary Hypertension. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.835] [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: 11/29/2022] Open
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Fügl A, Gasser H, Watzak G, Bucher A, Feierfeil J, Jürgens G, Watzek G, Hallström S, Gruber R. S-nitroso albumin enhances bone formation in a rabbit calvaria model. Int J Oral Maxillofac Surg 2014; 43:381-6. [DOI: 10.1016/j.ijom.2013.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/08/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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Santer D, Dietl W, Trescher K, Kreibich M, Dzilic E, Nagel F, Hallström S, Aumayr K, Fallouh H, Chambers D, Podesser B. The new St Thomas' Hospital polarized cardioplegia: improved efficacy of myocardial protection in pigs on CPB. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367373] [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: 10/25/2022]
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Abstract
Stochastic cellular models of rigid foam based on Voronoi spatial partitioning are generated and investigated for potential use in numerical analysis using finite element methods. Such partitions are deterministic once a distribution of cell nuclei has been defined. A drawback is that the models tend to exhibit a significant share of short edges and small faces. Such small geometrical features are not likely to occur in real foams since they are unfavorable from a surface energy point of view and they also generate problems in numerical analysis due to associated meshing challenges. Through minimization of the surface area, using the computer software Surface Evolver, the Voronoi models are brought to better resemblance with ideal dry foam and the occurrence of small geometrical features is strongly reduced. It is generally seen that different seed point distribution algorithms result in different model topologies. The presented methodology is systematic, parameterized and the results are very promising. Good grounds are provided for modeling of real rigid foam materials, that do not necessarily fully resemble ideal dry foam.
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Affiliation(s)
- J Köll
- Department of Aeronautical and Vehicle Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - S Hallström
- Department of Aeronautical and Vehicle Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Trescher K, Hasun M, Baumgartner A, Dietl W, Wolfsberger M, Hallström S, Podesser BK. New HTK-N46B cardioplegia provides superior protection during ischemia/reperfusion in failing hearts. J Cardiovasc Surg (Torino) 2013; 54:413-421. [PMID: 23389583] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this paper was to improve operative outcome during open-heart surgery in patients with failing hearts, the composition of cardioplegic solutions has to be further optimized. HTK-N46b, a novel cardioplegic solution, has been developed for efficient protection of the energy state of myocytes as well as endothelial cells. Aim of this study is the evaluation of HTK-N46b in comparison to its precursor Custodiol® (HTK) in failing rat hearts undergoing ischemia/reperfusion. METHODS In male Sprague Dawley rats myocardial infarction (MI) was induced by LAD ligation. Six weeks after MI cardiac function was determined by transthoracic echocardiography. Sixteen animals with hearts showing a fractional shortening <25% were randomly assigned to two groups, HTK (N.=8) and HTK-N46b (N.=8). After excision hearts were evaluated in an erythrocyte-perfused isolated working heart model. Cold ischemia (4°C) for 60 minutes was followed by 45 minutes of reperfusion. Cardiac arrest was induced either with HTK or HTK-N46b at the beginning of ischemia. RESULTS At similar preischemic fractional shortening (HTK-N46b: 14.41±1.83% vs. HTK: 14.91±1.92%; NS) postischemic recovery of stroke volume and stroke work were significantly improved in the HTK-N46b rat hearts compared to HTK. Concerning recovery of coronary flow there was no difference between groups. At the end of reperfusion the HTK-N46b protected group revealed higher levels of ATP (HTK-N46b: 22.01±0.89 nmol/mg protein vs. HTK: 16.83±1.72 nmol/mg protein; P<0.05) and energy charge (HTK-N46b: 0.82±0.02 vs. HTK: 0.74±0.02; P<0.05). CONCLUSION HTK-N46b showed superior cardioprotective properties according to postischemic hemodynamic recovery and biochemical markers compared to HTK in failing rat hearts.
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Affiliation(s)
- K Trescher
- Ludwig Boltzmann Cluster for Cardiovascular Research, Medical University Vienna, Vienna, Austria
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Kreibich M, Dzilic E, Santer D, Krynicka J, Hallström S, Podesser BK, Trescher K. NO-donor S-NO-HSA preserves cardiac function during local and global ischemia. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332461] [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: 10/27/2022]
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Stiegler P, Stadlbauer-Köllner V, Sereinigg M, Hackl F, Puntschart A, Schweiger M, Prenner G, Schaffellner S, Iberer F, Lackner C, Jürgens G, Hallström S, Matzi V, Smolle-Jüttner FM, Tscheliessnigg KH. Hyperbaric oxygenation of UW solution positively impacts on the energy state of porcine pancreatic tissue*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0053-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rungatscher A, Hallström S, Linardi D, Suzuki H, Podesser B, Gasser H, Mazzucco A, Faggian G. 595 Cardioprotective Effects of S-Nitroso Human Serum Albumin (S-NO-HSA) during Cardioplegic Arrest and Cold Storage in a Working Heart Heterotopic Transplant Model. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.607] [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: 10/18/2022] Open
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Stadlbauer V, Mookerjee RP, Wright GAK, Davies NA, Jürgens G, Hallström S, Jalan R. Role of Toll-like receptors 2, 4, and 9 in mediating neutrophil dysfunction in alcoholic hepatitis. Am J Physiol Gastrointest Liver Physiol 2009. [PMID: 19033535 DOI: 10.1152/ajpqi.90512.2008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Neutrophil dysfunction in alcoholic hepatitis is associated with endotoxemia and an increased incidence of infection, but the mechanism is unclear. We aimed to investigate the role of Toll-like-receptors (TLR)2, 4, and 9 in mediating neutrophil dysfunction in alcoholic hepatitis. Neutrophils from healthy volunteers were incubated with alcoholic hepatitis patients' plasma (n = 12) with and without TLR2, 4, or 9 antagonists and with and without human albumin. TLR2, 4, and 9 expression, neutrophil oxidative burst, phagocytosis, and CXCR1+2 expression were measured by FACS analysis. Patients' plasma increased oxidative burst, decreased CXCR1+2 expression, and decreased phagocytosis of normal neutrophils in association with increased expression of TLR2, 4, and 9 and depletion of ATP. Inhibition of TLR2, 4, and 9 prevented the increase in oxidative burst and the decrease in CXCR1 and CXCR2 expression but did not prevent phagocytic dysfunction. Incubation with albumin completely prevented the patient plasma induced neutrophil dysfunction. Increased expression of TLR2, 4, and 9 is associated with neutrophil dysfunction, endotoxemia, and energy depletion. TLR2, 4, and 9 inhibition does not improve phagocytosis, indicating that TLR overexpression may be the result and not the cause of neutrophil activation. Albumin, an endotoxin scavenger, prevents the deleterious effect of patients' plasma on neutrophil phagocytosis, resting burst, and TLR expression.
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Affiliation(s)
- V Stadlbauer
- Institute of Hepatology, UCL Medical School, 68-75 Chenies Mews, London WC1E 6H, UK
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Stadlbauer V, Mookerjee RP, Wright GAK, Davies NA, Jürgens G, Hallström S, Jalan R. Role of Toll-like receptors 2, 4, and 9 in mediating neutrophil dysfunction in alcoholic hepatitis. Am J Physiol Gastrointest Liver Physiol 2009; 296:G15-22. [PMID: 19033535 PMCID: PMC2636930 DOI: 10.1152/ajpgi.90512.2008] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [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] [Indexed: 01/31/2023]
Abstract
Neutrophil dysfunction in alcoholic hepatitis is associated with endotoxemia and an increased incidence of infection, but the mechanism is unclear. We aimed to investigate the role of Toll-like-receptors (TLR)2, 4, and 9 in mediating neutrophil dysfunction in alcoholic hepatitis. Neutrophils from healthy volunteers were incubated with alcoholic hepatitis patients' plasma (n = 12) with and without TLR2, 4, or 9 antagonists and with and without human albumin. TLR2, 4, and 9 expression, neutrophil oxidative burst, phagocytosis, and CXCR1+2 expression were measured by FACS analysis. Patients' plasma increased oxidative burst, decreased CXCR1+2 expression, and decreased phagocytosis of normal neutrophils in association with increased expression of TLR2, 4, and 9 and depletion of ATP. Inhibition of TLR2, 4, and 9 prevented the increase in oxidative burst and the decrease in CXCR1 and CXCR2 expression but did not prevent phagocytic dysfunction. Incubation with albumin completely prevented the patient plasma induced neutrophil dysfunction. Increased expression of TLR2, 4, and 9 is associated with neutrophil dysfunction, endotoxemia, and energy depletion. TLR2, 4, and 9 inhibition does not improve phagocytosis, indicating that TLR overexpression may be the result and not the cause of neutrophil activation. Albumin, an endotoxin scavenger, prevents the deleterious effect of patients' plasma on neutrophil phagocytosis, resting burst, and TLR expression.
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Affiliation(s)
- V. Stadlbauer
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - R. P. Mookerjee
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - G. A. K. Wright
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - N. A. Davies
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - G. Jürgens
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - S. Hallström
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
| | - R. Jalan
- Institute of Hepatology, UCL Medical School, London, United Kingdom; Department of Internal Medicine and Institute of Physiological Chemistry, Center of Physiological Medicine, Medical University Graz, Graz, Austria
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Huber S, Pelzmann B, Hallström S, Marte W, Mächler H, Koidl B. Does NADH supplementation protect the heart against reperfusion injury. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1038022] [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: 10/21/2022]
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Hasun M, Dietl W, Bauer M, Baumgartner A, Wolfsberger M, Trescher K, Hallström S, Podesser B. The new HTK-N46 cardioplegic solution provides superior myocardial protection during ischemia/reperfusion in failing rat hearts. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037798] [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: 10/21/2022]
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Baumgartner A, Bauer M, Dietl W, Hasun M, Jakubowski A, Trescher K, Hallström S, Podesser B. Evaluation of cardiac dysfunction in an animal model of endotoxin-induced septic shock. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1038016] [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: 10/21/2022]
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Podesser BK, Hallström S. Nitric oxide homeostasis as a target for drug additives to cardioplegia. Br J Pharmacol 2007; 151:930-40. [PMID: 17486142 PMCID: PMC2042932 DOI: 10.1038/sj.bjp.0707272] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 12/19/2006] [Revised: 03/06/2007] [Accepted: 04/02/2007] [Indexed: 11/09/2022] Open
Abstract
The vascular endothelium of the coronary arteries has been identified as the important organ that locally regulates coronary perfusion and cardiac function by paracrine secretion of nitric oxide (NO) and vasoactive peptides. NO is constitutively produced in endothelial cells by endothelial nitric oxide synthase (eNOS). NO derived from this enzyme exerts important biological functions including vasodilatation, scavenging of superoxide and inhibition of platelet aggregation. Routine cardiac surgery or cardiologic interventions lead to a serious temporary or persistent disturbance in NO homeostasis. The clinical consequences are "endothelial dysfunction", leading to "myocardial dysfunction": no- or low-reflow phenomenon and temporary reduction of myocardial pump function. Uncoupling of eNOS (one electron transfer to molecular oxygen, the second substrate of eNOS) during ischemia-reperfusion due to diminished availability of L-arginine and/or tetrahydrobiopterin is even discussed as one major source of superoxide formation. Therefore maintenance of normal NO homeostasis seems to be an important factor protecting from ischemia/reperfusion (I/R) injury. Both, the clinical situations of cardioplegic arrest as well as hypothermic cardioplegic storage are followed by reperfusion. However, the presently used cardioplegic solutions to arrest and/or store the heart, thereby reducing myocardial oxygen consumption and metabolism, are designed to preserve myocytes mainly and not endothelial cells. This review will focus on possible drug additives to cardioplegia, which may help to maintain normal NO homeostasis after I/R.
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Affiliation(s)
- B K Podesser
- The Ludwig Boltzmann Cluster for Cardiovascular Research, Medical University of Vienna Vienna, Austria
| | - S Hallström
- Institute of Physiological Chemistry, Center for Physiological Medicine, Medical University of Graz Graz, Austria
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Kröner A, Seitelberger R, Schirnhofer J, Bernecker O, Mallinger R, Hallström S, Ploner M, Podesser BK. Diltiazem during reperfusion preserves high energy phosphates by protection of mitochondrial integrity. Eur J Cardiothorac Surg 2002; 21:224-31. [PMID: 11825728 DOI: 10.1016/s1010-7940(01)01110-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/15/2022] Open
Abstract
OBJECTIVE This study evaluates the effects of diltiazem administered during reperfusion on hemodynamic, metabolic, and ultrastructural postischemic outcome. METHODS Hearts of 38 adult White New Zealand rabbits underwent 60 min of global cold ischemia followed by 40 min of reperfusion in an erythrocyte perfused isolated working heart model. Hearts were randomly assigned to four groups and received diltiazem (0.1, 0.25, and 0.5 micromol/l) during reperfusion only, or served as control. RESULTS The postischemic time courses of heart rate, aortic flow, and external stroke work clearly reflected the dose-dependent negative chronotropic and inotropic efficacy of diltiazem in the two higher concentrations. High energy phosphates (HEP) determined from myocardial biopsies taken after 40 min of reperfusion were significantly better preserved in all treatment groups compared to control hearts. Similarly ultrastructural grading of mitochondria and myofilaments revealed a significant reduction of reperfusion injury in hearts that received diltiazem compared to control. CONCLUSIONS Diltiazem protects mitochondrial integrity and function, thereby preserving myocardial HEP levels. Only low dose diltiazem (0.1 micromol/l) during reperfusion combines both, optimal mitochondrial preservation with minimal changes in hemodynamics.
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Affiliation(s)
- A Kröner
- Department of Cardiothoracic Surgery, AKH Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Kos T, Moser P, Yilmatz N, Mayer G, Pacher R, Hallström S. High-performance liquid chromatographic determination of p-aminohippuric acid and iothalamate in human serum and urine: comparison of two sample preparation methods. J Chromatogr B Biomed Sci Appl 2000; 740:81-5. [PMID: 10798296 DOI: 10.1016/s0378-4347(00)00024-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A high-performance liquid chromatography method applied to determine p-aminohippuric acid (PAH) and iothalamate (IOT) in serum and urine samples of patients was evaluated according to recovery, reproducibility and linearity utilizing narrow-bore columns. The mobile phase consisted of 0.15 M sodium dihydrogenphosphate with 1.2 mM tetrabutylammonium sulphate, the pH was adjusted to pH 4.6, acetonitrile was added to a final ratio of 95:5 (v/v), the flow-rate was set at 0.3 ml/min. The separation was achieved on a ODS Hypersil column (200 x 2.1 mm I.D.). The UV detector was set at 254 nm. PAH and IOT are used for evaluation of kidney function [effective renal plasma flow (ERPF) and glomerular filtration rate (GFR)]). Under the described chromatographic conditions two sample preparation techniques, ultrafiltration and acetonitrile precipitation were compared. The results demonstrate the accuracy of both methods in evaluation of ERPF and GFR. Due to its cost-effectiveness we recommend the acetonitrile precipitation method in clinical routine.
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Affiliation(s)
- T Kos
- Internal Medicine II, Department of Cardiology, General Hospital Vienna-AKH, Austria
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Podesser BK, Hallström S, Schima H, Huber L, Weisser J, Kröner A, Fürst W, Wolner E. The erythrocyte-perfused "working heart" model: hemodynamic and metabolic performance in comparison to crystalloid perfused hearts. J Pharmacol Toxicol Methods 1999; 41:9-15. [PMID: 10507753 DOI: 10.1016/s1056-8719(99)00018-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 11/23/2022]
Abstract
A brief period of ischemia was used to evaluate an erythrocyte-enriched Krebs-Henseleit (KH) buffer (n=8) compared to KH only (n=8) in an isolated working rabbit heart. Experimental protocol was as follows: preischemic baseline, 5 min of global ischemia followed by 45 min of reperfusion. Preischemic heart rate was identical, coronary flow was significantly lower (2.7 versus 5.6 mL/min/g wet wt, p<0.01), the other hemodynamic and biochemical values were significantly higher in erythrocyte-perfused hearts: aortic flow 23.5 versus 12.0, p<0.01; cardiac output 26.2 versus 17.6, p<0.01; all in mL/min/g wet wt; dp/dt max 1286 versus 997 mmHg/s, p<0.01; myocardial oxygen consumption 3.5 versus 2.3 micromol/min/g wet wt, p<0.05. During early reperfusion, in the erythrocyte-perfused hearts, coronary flow further increased (p<0.003), the other hemodynamic parameters returned to baseline values in both groups. High-energy phosphates showed significantly higher values (ATP 2.0+/-0.1 versus 1.3+/-0.1, p<0.05; CrP 2.0+/-0.2 versus 1.6+/-0.1, p<0.05 all in micromol/g wct wt), water content was significantly lower (81% versus 74%, p<0.05) in erythrocyte-perfused hearts. It can be concluded that the erythrocyte-perfused working heart model provides excellent oxygenation, leading to superior hemodynamic and metabolic performance. Additionally, in the erythrocyte-perfused hearts preservation of coronary flow reserve underlines the physiological competency of this preparation.
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Affiliation(s)
- B K Podesser
- Department of Cardiothoracic Surgery, University of Vienna, AKH Wien, Austria.
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Zegner M, Podesser B, Koci G, Weisser J, Hallström S, Schima H, Wollenek G. Bewertung der Reperfusion unter Einfluß von Ramiprilat—Untersuchungen am isolierten «Working-heart-Modell». Eur Surg 1996. [DOI: 10.1007/bf02616280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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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Gasser H, Hallström S, Redl H, Schlag G. Oxidatively modified plasma phospholipids containing reactive carbonyl functions measured by HPLC: evidence for phosphatidylcholine-bound aldehydes in plasma of burn patients. Free Radic Res 1995; 22:327-36. [PMID: 7633563 DOI: 10.3109/10715769509145645] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A HPLC method has been developed to measure phosphatidylcholine (PC) containing reactive carbonyl functions in the sn-acyl residue in order to study processes in which such reactive carbonyls can be formed due to e.g. oxidative fragmentation. The method has been applied to determine PC-bound carbonyls as 2,4-dinitrophenylhydrazones (DNPH) in plasma of burn patients. Plasma from healthy volunteers served as controls. Additionally, in vitro oxidation experiments (A: plasma, buffer diluted; B: plasma + iron-EDTA complex and C: plasma + iron-EDTA complex + H2O2) have been performed to obtain and to identify 2,4-dinitrophenylhydrazine derivatizable carbonyl functions in plasma PC. Both, the PC-aldehydes and PC-aldehyde DNPH derivatives were cleavable with phospholipase C. Quantification was based on thin-layer chromatography purified soybean phosphatidylcholine, which was identically oxidized and derivatized as the plasma lipids in vitro.
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Affiliation(s)
- H Gasser
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Reithmann C, Hallström S, Pilz G, Kapsner T, Schlag G, Werdan K. Desensitization of rat cardiomyocyte adenylyl cyclase stimulation by plasma of noradrenaline-treated patients with septic shock. Circ Shock 1993; 41:48-59. [PMID: 8403246] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to test the possibility that the mechanisms of catecholamine-induced desensitization of cardiac beta-adrenoceptor stimulation are modified in septic shock. Exposure of neonatal rat cardiomyocytes for 48 hr to plasma of noradrenaline-treated patients with septic shock led to a down-regulation of beta-adrenoceptors by 35%, an increase in the level of inhibitory G protein alpha-subunits by 60%, and a decrease in isoproterenol-stimulated adenylyl cyclase activity by 50% in membranes prepared from the rat cardiomyocytes. Similar alterations were observed following pretreatment of the cells with plasma of adrenaline-treated patients with cardiogenic shock. In contrast, exposure of the cardiomyocytes to plasma of intensive care patients without shock, and to plasma of dopamine-treated patients with septic shock did not induce alterations of the cardiomyocyte adenylyl cyclase system. The dosage of the catecholamines had to be increased within the first two days of treatment in the noradrenaline-treated patients, but not in the dopamine-treated patients with septic shock. Thus, this observed tolerance to noradrenaline in the treatment of septic shock may, in part, be due to a desensitization of cardiac beta-adrenoceptor stimulation induced by the beta-adrenoceptor stimulatory effect of noradrenaline.
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Affiliation(s)
- C Reithmann
- Department of Medicine, Klinikum Grosshadern, University of Munich, Germany
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Junger WG, Hallström S, Liu FC, Redl H, Schlag G. The enzymatic and release characteristics of sheep neutrophil elastase: a comparison with human neutrophil elastase. Biol Chem Hoppe Seyler 1992; 373:691-8. [PMID: 1418684 DOI: 10.1515/bchm3.1992.373.2.691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sheep are often used to study tissue damage following shock after traumatic injury and in the course of other diseases. The processes involved are thought to be caused at least in part by elastase released from polymorphonuclear leukocytes (PMNs). Since little is known about elastase and its role as a mediator of tissue damage in sheep, we studied the biochemical properties and release characteristics to sheep leukocyte elastase (SLE) in comparison of those of human leukocyte elastase (HLE). Both enzymes showed similar molecular masses, amino-acid compositions, N-terminal amino-acid sequences, and abilities to digest elastin substrates. Differences, however, were found in kinetic parameters measured with the elastase-specific substrate N-methoxysuccinyl-(L-alanyl)2-L-prolyl-L- valine-4-nitroanilide (MeoSuc-AAPV-pNa). The Michaelis constant (Km) of ovine elastase was nearly 10 times higher (1.82 mM) than the Km of HLE (0.21 mM). Values of SLE calculated for kcat were 70% and for kcat/Km 8% of corresponding values determined for HLE. In addition, significant differences between sheep and human PMNs were found in in vitro stimulation experiments. In contrast to human PMNs, sheep neutrophils released no active elastase, and only 50 to 70% of the H2O2 produced by human PMNs. This failure to release active elastase could not be explained by a lower elastase content of sheep PMNs, as there were no significant differences found between the elastase contents of sheep and human PMNs. We conclude that elastase liberated by stimulated sheep PMNs is inactivated by a concomitantly released proteinase inhibitor also located within the sheep PMNs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W G Junger
- Department of Surgery, University of California, San Diego Medical Center
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Fürst W, Hallström S. Simultaneous determination of myocardial nucleotides, nucleosides, purine bases and creatine phosphate by ion-pair high-performance liquid chromatography. J Chromatogr 1992; 578:39-44. [PMID: 1400784 DOI: 10.1016/0378-4347(92)80222-c] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An ion-pair reversed-phase high-performance liquid chromatographic method is described for the separation and quantification of myocardial nucleotides, nucleosides, their metabolites and creatine phosphate-related compounds in a single run. Separation of a standard mixture containing 21 compounds was achieved on a 5-microns Hypersil ODS column with a 5-min isocratic elution (buffer: 0.1 M NaH2PO4, pH 5.5, containing 5.9 mM tetrabutylammonium hydrogen-sulphate) followed by a slow linear gradient to 17% acetonitrile. The method was applied to extracts of freeze-clamped rat heart tissue samples as well as to extracts of neonatal rat heart cardiomyocytes, and it provided good resolution of high-energy phosphates, including creatine phosphate, as well as of their degradation products.
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Affiliation(s)
- W Fürst
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Junger WG, Hallström S, Redl H, Schlag G. Inhibition of Human, Ovine, and Baboon Neutrophil Elastase with Eglin c and Secretory Leukocyte Proteinase Inhibitor. ACTA ACUST UNITED AC 1992; 373:119-22. [PMID: 1350199 DOI: 10.1515/bchm3.1992.373.1.119] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
The association rate constants (kon) of human, ovine, and baboon neutrophil elastase with two recombinant serine proteinase inhibitors (Eglin c, secretory leukocyte proteinase inhibitor) were compared. The association rate constant of sheep leukocyte elastase (SLE) with Eglin c is about 100 times lower (kon = 2.2 x 10(5) M-1s-1) than that of human elastase (kon = 2.4 x 10(7) M-1s-1). Baboon elastase, however, is as effectively blocked with Eglin c (kon = 2.5 x 10(7) M-1s-1) as human elastase. Secretory leukocyte proteinase inhibitor (SLPI) blocks the elastase of all three species with high efficiency; baboon elastase shows the highest association rate constant (kon = 5.6 x 10(7) M-1s-1) followed by human elastase (kon = 4.1 x 10(7) M-1s-1) and finally sheep elastase (kon = 1.2 x 10(7) M-1s-1). These findings demonstrate marked differences in the inhibition kinetic properties of ovine and human elastase. Concerning a future clinical application of proteinase inhibitors, the baboon seems a more suitable model than sheep to evaluate the effects of Eglin c and SLPI, since both inhibitors block baboon and human elastase with comparable efficiency.
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Affiliation(s)
- W G Junger
- Department of Surgery, University of California San Diego
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Werdan K, Müller U, Reithmann C, Pfeifer A, Hallström S, Koidl B, Schlag G. Mechanisms in acute septic cardiomyopathy: evidence from isolated myocytes. Basic Res Cardiol 1991; 86:411-21. [PMID: 1662946 DOI: 10.1007/bf02190709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although often not considered, the heart is one of the targets of multiple organ failure in sepsis and septic shock, with myocardial depression being a prominent component of this "acute septic cardiomyopathy". Hypotheses concerning the etiology of this depression are increasingly elucidated on a cellular level, including dysfunction of the beta-adrenoceptor/G protein/adenylate cyclase system, calcium channel blockade by cardiodepressant factor, contractile impairment by activated leucocytes, as well as inhibition of protein synthesis by Pseudomonas exotoxin A. In the search for "mechanisms of myocardial depression in sepsis", isolated cardiomyocytes may play a role as research tools with respect to: a) discrimination between direct and indirect cardiodepressant effects; b) identifying not only the acute, but also chronic toxin- and mediator-induced cardiodepression; c) clarification of the mechanism of action of cardiodepressant bacterial toxins and sepsis mediators; d) establishment of in vitro models of leucocyte-mediated cardiodepression in sepsis.
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Schlag G, Redl H, Hallström S, Radmore K, Davies J. Hyperdynamic sepsis in baboons: I. Aspects of hemodynamics. Circ Shock 1991; 34:311-8. [PMID: 1884434] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The baboon has a number of advantages as a shock model, as its physiological as well as its biochemical behaviour is similar to man. Therefore we have tried to set up a model to mimic the early hyperdynamic phase of clinical sepsis. Seven baboons, 21-25 kg body weight were kept under EEG servocontrolled anesthesia for 8 hr. During this time live E. coli (ATC #33985) 2 x 10(10) BW/8 hr were continuously infused intravenously. Adequate fluid supply with Ringer's solution (up to 40 ml/kg/hr) was given to keep the pulmonary artery wedge pressure at baseline levels; this procedure resulted in a hyperdynamic response with a cardiac output (CO) 20-35% above baseline and a decrease (20-39%) in mean arterial pressure (MAP), leading to a 50% decrease in peripheral resistance. The pulmonary vascular changes were reflected in an increase of the mean pulmonary pressure (PA) to 42% above baseline and a marked rise in pulmonary vascular resistance (PVR) to 50% above baseline with no additional changes in pulmonary gas exchange. After 8 hr both CO and MAP were inversely correlated (r = 0.9-1) with dramatically increased catecholamine plasma levels (15 times above baseline). With continuous infusion of live E. coli (blood levels 10(5)-10(6) CFU/ml) and massive fluid supply we have successfully mimicked hyperdynamic sepsis with severe organ failure after an 8-hr observation period.
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Affiliation(s)
- G Schlag
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Abstract
The immediate organ damage seen after multiple trauma and in shock is a typical example of non-bacterial inflammation triggered by activation of various mediators of both the humoral and cellular systems. Anaphylatoxins and the low-flow syndrome during the shock phase account for increased PMN* margination, which in turn causes pulmonary leukostasis and may provoke massive mediator release by PMN (oxygen radicals, proteinases, eicosanoids, PAF etc). This probably leads to severe endothelial cell damage, especially in the lung. Adherence of PMN to the endothelium appears to create the micro-environment where high concentrations of proteolytic enzymes and reactive oxygen radicals exert a deleterious effect on the cell membrane. Endothelial cell membrane injury leads to increased vascular permeability and cell edema. The development of the 'organ in shock' may require a few hours and initially cause minor or no functional impairment at all. Only when shock is severe is there early organ failure, which in this stage may still be an expression of non-bacterial inflammation. Numerous studies have reported the existence of shock-induced cardiodepressant substances in association with various forms of circulatory shock. We have determined a net negative inotropic effect of the low-molecular-weight plasma fraction in severe hypovolemic-traumatic shock and have isolated a cardiodepressant factor (CDF), which by blockade of the calcium inward current has a negative inotropic a chronotropic effect. The intestine as a shock organ appears to range first among the organs involved. The translocation of bacteria from the intestinal tract, the 'intestine in shock' represents the trigger reaction that eventually leads from the 'organ in shock', early organ failure to late (septic) organ failure. Here the most prominent factor is endotoxin (LPS) as a basic mediator of gram-negative bacteria, which also triggers the activation of humoral and cellular systems. The posttraumatic hyperdynamic phase commonly starts on days 3-5 and is mainly caused by bacteremia and/or endotoxemia. Macrophages have a major impact on the late phase of organ failure. At present, the most prominent cellular mediator of the lethal effect of endotoxin is thought to be cachectin, which is identical with the tumor necrotising factor (TNF). TNF is secreted by monocytes/macrophages (MO/MA) in response to LPS. Via macrophage derived cytokines and by LPS there is activation of endothelial cells, with increased adhesiveness for PMN. Both due to this increased adhesiveness and the presence of LPS and cytokines, PMN undergo massive activation, which causes mediator release and tissue damage.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G Schlag
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Hallström S, Koidl B, Müller U, Werdan K, Schlag G. A cardiodepressant factor isolated from blood blocks Ca2+ current in cardiomyocytes. Am J Physiol 1991; 260:H869-76. [PMID: 2000981 DOI: 10.1152/ajpheart.1991.260.3.h869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A cardiodepressant factor (CDF) was isolated (salt free) from the plasma of dogs after hypovolemic-traumatic shock by column chromatography. CDF was found to exert a concentration-dependent negative inotropic effect in guinea pig papillary muscle; it reduced the amplitude of cell wall motion, the contraction and relaxation velocity, and the frequency of spontaneously beating rat cardiomyocytes in culture, effects that were rapidly reversible upon washout. By means of electrophysiological methods (whole cell recording with patch electrodes and voltage clamp) we tested the effect of CDF on adult guinea pig cardiomyocytes: application of CDF initially decreased the plateau by 7 mV (150 ms after peak of action potential) and reduced the action potential duration by 93 ms (76% of control action potential duration) at 50% and 88 ms (79%) at 90% of repolarization. The plateau was further reduced by 13 mV and the action potential duration was prolonged by 25 ms (106%) at 50% and was prolonged drastically by 156 ms (137%) at 90% of repolarization compared with control. Voltage-clamp experiments have shown that the most prominent effect of CDF is a strong reduction of ICa accompanied by inhibition of IK and subsequent repolarization. Similar results have been obtained with neonatal rat cardiomyocytes. Blockage of the calcium inward current can explain the negative inotropic and chronotropic effect of CDF in cardiomyocytes.
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Affiliation(s)
- S Hallström
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Hallström S, Vogl C, Redl H, Schlag G. Net inotropic plasma activity in canine hypovolemic traumatic shock: low molecular weight plasma fraction after prolonged hypotension depresses cardiac muscle performance in vitro. Circ Shock 1990; 30:129-44. [PMID: 2311203] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Numerous studies report controversial results about the occurrence and role of cardiodepressant substances in various forms of circulatory shock. We investigated the net inotropic effect of the low molecular weight fraction (mol wt less than or equal to 1,000) of plasma in prolonged canine hypovolemic traumatic shock using an in vitro guinea pig papillary muscle assay (isotonic mode). The shock plasma fractions (ultrafiltrates) after 4 hr of hypotension (mean arterial blood pressure 40-50 mm Hg) and immediately post-reinfusion significantly depressed papillary muscle function (P less than .02). The extent of papillary muscle shortening was decreased by 49.5 +/- 9.9% in pre- and 50.6 +/- 10.0% in post-reinfusion plasma ultrafiltrates (mean values +/- standard error of the mean; n = 6 shock experiments). In contrast, both the plasma ultrafiltrates from ten non-anesthetized healthy dogs and the control ultrafiltrates obtained prior to onset of shock in the experiments (-6.4 +/- 2.6; n = 6) induced no significant change of the in vitro performance of papillary muscle contraction. These results were achieved with plasma fractions in which ionized calcium and pH were adjusted to concentrations equivalent to the bioassay solution. Lactate acidosis and severe hypoglycemia (1.97 +/- 0.43 mM post-reinfusion) occurred in the shock experiments. Lack of energy substrate (glucose) was not responsible for the in vitro depression. Four depressive shock ultrafiltrates with glucose concentrations adjusted to control ultrafiltrate levels induced a 66.6 +/- 8.8% decrease in the extent of papillary muscle shortening. These results suggest that the possible occurrence of high net negative inotropic activity in plasma, especially just post-reinfusion, may play a role in the pathogenesis of irreversible circulatory shock.
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Affiliation(s)
- S Hallström
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Junger WG, Hallström S, Redl H, Schlag G. Characterization of sheep alpha-1-proteinase inhibitor: important differences from the human protein. Am Rev Respir Dis 1988; 138:1358. [PMID: 3264484 DOI: 10.1164/ajrccm/138.5.1358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Junger W, Hallström S, Redl H, Schlag G. Preliminary data on isolation of an elastase-like proteinase and its inhibitor from ovine neutrophil granulocytes. Biol Chem Hoppe Seyler 1988; 369 Suppl:63-8. [PMID: 3060145] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ovine polymorphonuclear leukocytes (PMNs) were purified by counterflow centrifugation of the buffy coat. The resulting cell preparation was gently sonicated and ultracentrifuged for separation of cytosol and cell organelles. The proteolytic activity of the isolated enzyme was determined with the specific substrate MeO-Suc-Ala-Ala-Pro-Val-Nan (methoxysuccinyl-[L-alanyl]2-L-prolyl-L-valine p-nitroanilide). Elastase-like activity was identified in the insoluble (particular) fraction, while an inhibitor of elastase activity was found in the supernatant (cytosolic fraction). Further purification of the elastase-like enzyme was achieved by cation exchange chromatography (SP-Sephadex C-25 and CM-Sephadex C-25) and gel permeation chromatography (Bio-Gel P-30). Purification of the inhibitor from cytosol was accomplished using anion exchange chromatography (DE32 diethylaminoethyl cellulose) and two gel permeation steps (Sephadex G-75 and TSK-G 2000 SW - HPLC column). Degrees of purity in all separation steps were controlled with SDS-polyacrylamide gel electrophoresis. The molecular mass of the elastase-like enzyme is in a range of 25 to 27 kDa. The isoelectric point is between 8.0 and 9.0. Three isoenzymes were found. The optimal activity lies at pH 8.0. The molecular mass of the inhibitor is about 40 kDa.
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Affiliation(s)
- W Junger
- Ludwig-Boltzmann-Institut für experimentelle Traumatologie, Wien
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Redl H, Hallström S, Lieners C, Fürst W, Schlang G. Proteolysis and lipid peroxidation--two aspects of cell injury in experimental hypovolemic-traumatic shock. Adv Exp Med Biol 1988; 240:449-55. [PMID: 3072855 DOI: 10.1007/978-1-4613-1057-0_55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- H Redl
- Ludwig Boltzmann Institute for Experimental Traumatology, Vienna, Austria
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