RNA-sequencing reveals that STRN, ZNF484 and WNK1 add to the value of mitochondrial MT-COI and COX10 as markers of unstable coronary artery disease

Markers in monocytes, precursors of macrophages, which are related to CAD, are largely unknown. Therefore, we aimed to identify genes in monocytes predictive of a new ischemic event in patients with CAD and/or discriminate between stable CAD and acute coronary syndrome. We included 66 patients with stable CAD, of which 24 developed a new ischemic event, and 19 patients with ACS. Circulating CD14+ monocytes were isolated with magnetic beads. RNA sequencing analysis in monocytes of patients with (n = 13) versus without (n = 11) ischemic event at follow-up and in patients with ACS (n = 12) was validated with qPCR (n = 85). MT-COI, STRN and COX10 predicted new ischemic events in CAD patients (power for separation at 1% error rate of 0.97, 0.90 and 0.77 respectively). Low MT-COI and high STRN were also related to shorter time between blood sampling and event. COX10 and ZNF484 together with MT-COI, STRN and WNK1 separated ACS completely from stable CAD patients. RNA expressions in monocytes of MT-COI, COX10, STRN, WNK1 and ZNF484 were independent of cholesterol lowering and antiplatelet treatment. They were independent of troponin T, a marker of myocardial injury. But, COX10 and ZNF484 in human plaques correlated to plaque markers of M1 macrophage polarization, reflecting vascular injury. Expression of MT-COI, COX10, STRN and WNK1, but not that of ZNF484, PBMCs paired with that in monocytes. The prospective study of relation of MT-COI, COX10, STRN, WNK1 and ZNF484 with unstable CAD is warranted.

Oxidative status and metabolic profile in a long-lived bird preparing for extreme endurance migration

The high metabolic activity associated with endurance flights and intense fuelling of migrant birds may produce large quantities of reactive oxygen species, which cause oxidative damage. Yet it remains unknown how long-lived birds prepare for oxidative challenges prior to extreme flights. We combined blood measurements of oxidative status and enzyme and fat metabolism in Hudsonian godwits (Limosa haemastica, a long-lived shorebird) before they embarked on non-stop flights longer than 10,000 km during their northbound migrations. We found that godwits increased total antioxidant capacity (TAC) and reduced oxidative damage (TBARS) as the pre-migratory season progressed, despite higher basal metabolic rates before departure. Elevations in plasma β-hydroxybutyrate and uric acid suggest that lipid and protein breakdown supports energetic requirements prior to migration. Significant associations between blood mitochondrial cytochrome-c oxidase and plasma TAC (negative) and TBARS (positive) during winter indicate that greater enzyme activity can result in greater oxidative damage and antioxidant responses. However enzyme activity remained unchanged between winter and premigratory stages, so birds may be unable to adjust metabolic enzyme activity in anticipation of future demands. These results indicate that godwits enhance their oxidative status during migratory preparation, which might represent an adaptation to diminish the physiological costs of long-distance migration.

Bariatric Surgery Reduces Elevated Urinary Mitochondrial DNA Copy Number in Patients With Obesity

OBJECTIVE

Obesity is an independent risk factor for chronic kidney disease. Recently, urinary mitochondrial DNA (mtDNA) has been used as a surrogate marker of mitochondrial damage in various kidney diseases. However, there are no data regarding its use in patients with obesity or the change in urinary mtDNA copy number after surgery.

DESIGN

We prospectively recruited age- and sex-matched healthy volunteers and patients with obesity (n = 22 in each group: nine men and 13 women). The copy number of urinary and serum mtDNA nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND-1) and cytochrome-c oxidase 3 (mtCOX-3) was measured using quantitative PCR. We measured urinary mtDNA and body weight and carried out laboratory tests, 6 months after surgery.

RESULTS

Urinary mtND-1 copy number was significantly higher in the obese group than in healthy volunteers. However, urinary mtCOX-3 and serum ND-1 copy numbers in the obese group did not differ from that in the healthy volunteers. When patients with obesity were divided into two groups, according to their baseline mtND-1 copy number, bariatric surgery reduced the mtND-1 copy number (P = 0.006) in the high baseline mtDNA copy-number group. The change in urinary mtND-1 copy number was correlated with a change in urinary albumin (r = 0.478, P = 0.025).

CONCLUSIONS

Obesity is associated with elevated urinary mtND-1 copy number. Bariatric surgery reduces the elevated urinary mtND-1 copy number in patients with obesity. This suggests that bariatric surgery could attenuate mitochondrial damage in the kidney cells of patients with obesity.

Hyperspectral near-infrared spectroscopy assessment of the brain during hypoperfusion

Two-thirds of out-of-hospital cardiac arrest patients, who survive to hospital admission, die in the hospital from neurological injuries related to cerebral hypoperfusion. Therefore, noninvasive real-time monitoring of the cerebral oxygen metabolism in cardiac arrest patients is extremely important. Hyperspectral near-infrared spectroscopy (hNIRS) is a noninvasive technique that measures concentrations of the key chromophores in the brain, such as oxygenated hemoglobin, deoxygenated hemoglobin, and cytochrome C oxidase (CCO), an intracellular marker of oxygen consumption. We tested hNIRS on 10 patients undergoing transcatheter aortic valve insertion, where rapid ventricular pacing (RVP) is required to temporarily induce sudden hypotension and hypoperfusion that mimic cardiac arrest. Using multidistance hNIRS, we found that tissue oxygen saturation changes in the cerebral tissue were lower than those in the scalp during RVP. CCO redox changes were detected in cerebral tissue but not in the scalp during RVP. We have demonstrated that hNIRS is feasible and can detect sudden changes in cerebral oxygenation and metabolism in patients during profound hypotension.

Test-retest reliability of brain mitochondrial cytochrome-c-oxidase assessed by functional near-infrared spectroscopy

Functional near-infrared spectroscopy (fNIRS) is a noninvasive method for measuring in vivo both hemodynamic and mitochondrial metabolic activities in brain cortical structures. Although the test-retest reliability of the hemodynamic measures, such as reflected by oxygenated (HbO2), deoxygenated (HHb) hemoglobin, and the tissue oxygenation index (TOI), has been previously reported to be good to excellent, the reliability of the metabolic signal indexed by oxidized cytochrome-c-oxidase (oxCCO) has not been reported. The present test-retest study compared the reliability of the metabolic and hemodynamic signals in 10 healthy participants undergoing hypo- and hypercapnia challenges. The primary reliability measure was the intraclass correlation coefficient (ICC). Results of both hypo- and hypercapnia showed that the oxCCO signal (ICC  =  0.876  /  0.757) had robust reliability comparable with that of the HbO2 (ICC  =  0.841  /  0.801), HHb (ICC  =  0.804  /  0.571), and TOI (ICC  =  0.574  /  0.614) signals. These findings show that the oxCCO signal can be assessed by fNIRS with comparable reliability to the hemodynamic measures. We discuss the results in light of current interest in a mitochondrial metabolic marker derived from fNIRS.

From Jöbsis to the present day: a review of clinical near-infrared spectroscopy measurements of cerebral cytochrome-c-oxidase

Near-infrared spectroscopy (NIRS) measurements of cytochrome-c-oxidase (CCO) have the potential to yield crucial information about cerebral metabolism at the patient bedside. Developments in instrumentation and the analytical methods used to resolve changes in CCO have led to many clinical applications of the measurement since its first demonstration in 1977 by Jöbsis. There is a substantial literature of work on measures of CCO in animal and in vitro studies; however, this review focuses on translational studies. Almost 40 years from the advent of the first measurement of CCO using NIRS, this signal continues to hold significant interest in our understanding of the human brain in health and disease. We discuss methodologies for obtaining NIRS measurements of CCO in the clinic and review studies in neonates and adults.

Possible peripheral markers for chronic aluminium toxicity in Wistar rats

This investigation gives detailed analysis of peripheral marker enzymes as well as neurobehavioral tests following chronic aluminium (Al) exposure (10 mg/kg b.w. for 12 weeks intragastrically). We observed a significant decrease in the levels of serum cholinesterase after toxicity. The enzymatic activity of cytochrome oxidase (CO), the terminal enzyme of the electron transport chain, was significantly diminished and that of glucose-6-phosphate dehydrogenase (G-6-PD) was significantly enhanced. Neuromuscular co-ordination was assessed using motor and memory function tests. Deficits were observed suggesting a probable model for chronic Al neurotoxicity.

[The protective effect of autologous plasma against the development of oxidative stress in UV-irradiated lymphocytes of peripheral blood of donors]

The influence of UV-light (240-390 nm) at the dozes of 151 and 755 J/m2 on the intensity of processes of the lipid peroxidation, activity of lactate dehydrogenase (LDH), succinate dehydrogenase (SDH), cytochrome c oxidase and the level of the energy supply of donors' blood lymphocytes in the absence and presence of autologous plasma was investigated. It was shown that during the incubation of native and UV-irradiated lymphocytes, autologous plasma reduces the intensity of lipid peroxidation, thus protecting cells from oxidative stress. As a result, the endocellular level of ATP is restored in UV-irradiated lymphocytes (during the daily incubation), which reflects the intensification of the adaptive ability of cells in the presence of autologous plasma.

Alternative editing of cytochrome c oxidase III mRNA in trypanosome mitochondria generates protein diversity

Trypanosomes use RNA editing to produce most functional mitochondrial messenger RNA. Precise insertion and deletion of hundreds of uridines is necessary to make full-length cytochrome c oxidase III (COXIII) mRNA. We show that COXIII mRNA can be alternatively edited by a mechanism using an alternative guide RNA to make a stable mRNA. This alternatively edited mRNA is translated to produce a unique protein that fractionates with mitochondrial membranes and colocalizes with mitochondrial proteins in situ. Alternative RNA editing represents a previously unknown mechanism generating protein diversity and, as such, represents an important function for RNA editing.

Influenza virus associated encephalopathy

Perspective on the paper by Hosoya et al (see page 469)

Near infrared spectroscopy for evaluation of the trauma patient: a technology review

Clinicians now realize the limitations of the physical examination in detecting compensated shock states, the severity of uncompensated states, and in determining the adequacy of resuscitation in order to prevent subsequent post-traumatic multisystem organ failure and death. A renewed interest has developed in interrogating the state of oxygen transport at the end-organ level in the trauma patient. Although used as a research tool and now clinically to monitor cerebral oxygenation during complex cardiovascular and neurosurgery, near infrared absorption spectroscopy (NIRS) is being more aggressively investigated and now marketed clinically as a noninvasive means to assess tissue oxygenation in the trauma patient at the end organ level. This paper will describe the principles of NIRS and the basis for its proposed use in the trauma patient to assess tissue oxygenation. This includes its known limitations, current controversies, and what will be needed in the future to make this technology a part of the initial and ongoing assessment of the trauma patient. The ultimate goal of such techniques is to prevent misassessment of patients and inadequate resuscitation, which are believed to be major initiators in the development of multisystem organ failure and death.

Cerebral oxygen balance is impaired during repair of aortic coarctation in infants and children

OBJECTIVE

During repair of aortic coarctation through a left thoracotomy without cardiopulmonary bypass, clamping the proximal transverse aortic arch occludes antegrade flow to the left carotid and vertebral arteries. It is assumed that flow through the right carotid and vertebral arteries is adequate for cerebral perfusion. The study objective is to determine whether aortic occlusion impairs left hemispheric cerebral oxygen balance measured by near-infrared spectroscopy.

METHODS

In 18 children having repair of aortic coarctation, we measured the maximum change and integral for hemoglobin D (difference of oxyhemoglobin and deoxyhemoglobin), total oxygenation index, and the redox state of cytochrome aa3. Thirteen subjects had recordings from the left hemisphere to test the hypothesis that aortic occlusion impairs left hemispheric oxygen balance. Five subjects had recordings from the right hemisphere for comparison.

RESULTS

After aortic clamping, a significant decrease in hemoglobin D was observed in recordings from the left hemisphere compared with those from the right hemisphere (P = .03, maximum change in hemoglobin D). Total oxygenation index and cytochrome aa3 were generally preserved. There was an inverse linear relationship for the change in hemoglobin D during clamp application and after removal (Spearman rho = -0.74), with increased hemoglobin D after clamp removal in those subjects with the greatest decrease of hemoglobin D during arch occlusion. Linear regression analysis identified nitroprusside administration as significantly associated with a decrease in hemoglobin D (P < .001).

CONCLUSIONS

Significant impairment in left hemispheric cerebral oxygen balance was identified during arch clamping. The neurodevelopmental significance of impaired cerebral oxygen balance detected by near-infrared spectroscopy during aortic coarctation repair remains to be elucidated.

Physiological responses to sulfide toxicity by the air-breathing catfish, Hoplosternum littorale (Siluriformes, Callichthyidae)

Hemolytic anemia accompanied by changes in the immunology system is one of the sulfide intoxication harmful effects on Hoplosternum littorale. Hematological parameters are considered as effective indicators of stress caused by this hydrogen sulfide. During sulfide exposure, H. littorale neither alters the methemoglobin concentration nor forms sulfhemoglobin in the presence of high levels of dissolved sulfide in the water. Cytochrome c oxidase shows little activity in the gills and blood of H. littorale when exposed to sulfide. Alternative metabolic routes are suggested through which the accumulation of pyruvate leads to the formation of an end product other than lactate.

Different effects of exercise tests on the antioxidant enzyme activities in lymphocytes and neutrophils

We have determined the effects of maximal and submaximal cycloergometer tests on the antioxidant enzyme defences of neutrophils and lymphocytes. We also compared the neutrophil and lymphocyte basal enzyme antioxidant activities. A total of 17 well-trained amateur athletes, runners, and cyclists participated in this study. Two tests were performed on an electromagnetic reduction cycloergometer: the maximal exercise test, and the submaximal prolonged exercise test. Blood samples were taken before and after the tests. Basal enzyme activity of superoxide dismutase was higher in lymphocytes but neutrophils presented higher activities of catalase and glutathione peroxidase. The maximal test increased the circulating number of lymphocytes and the activities of catalase and glutathione peroxidase. No changes were observed in lymphocyte number or in lymphocyte antioxidant enzyme activities after the submaximal test. The circulating number of neutrophils increased significantly after the submaximal test. Maximal and submaximal tests decreased the activities of neutrophil glutathione dependent antioxidant enzymes (glutathione peroxidase and glutathione reductase), but no changes were observed in catalase or superoxide dismutase activities after either test. Neither the maximal nor submaximal test produced increases in serum activities of lactate dehydrogenase and creatine kinase (CK).

[Effects of perfusion pressure on cerebral blood flow and oxygenation during normothermic cardiopulmonary bypass]

BACKGROUND

Central nervous system dysfunction after cardiopulmonary bypass (CPB) is an important cause of morbidity and mortality after cardiac surgery. Perfusion pressure (PP) during CPB could be one of the important determinants of cerebral blood flow (CBF). The objective of the present study was to determine the effect of PP on CBF and cerebral oxgenation during normothermic CPB.

METHODS

Twelve adult patients undergoing coronary artery bypass graft surgery were randomly assigned to one of two groups based on PP (High and Low group). Patients in High group received phenylephrine immediately after the onset of CPB to maintain PP between 60 and 80 mmHg. Oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), tissue oxygenation index (TOI), and oxidized cytochrome aa3 (CtOx) were measured by near-infrared spectroscopy, and internal jugular venous bulb blood oxygen saturation (SjvO2) was measured simultaneously. S-100 beta protein concentrations were also measured before and after CPB.

RESULTS

SjvO2 in High group increased significantly during CPB. CtOx in Low group decreased significantly during CPB, whereas TOI was unchanged. Although S-100 beta increased significantly at the end of CPB, there was no difference between the groups.

CONCLUSIONS

These results suggest that maintaining high PP is benefical for CBF during normothermic CPB.

Cytochrome c oxidase is decreased in Alzheimer's disease platelets

Cytochrome c oxidase (COX) activity reportedly is reduced in Alzheimer's disease (AD) brain and platelets. The reasons for the defect in either tissue are unknown, but its presence in a non-degenerating tissue suggests it is not simply a consequence of neurodegeneration. We now offer confirmation of the AD platelet COX defect. Compared to age-matched controls, in mitochondria isolated from AD platelets there was a 15% decrease in COX activity despite the fact that COX subunits were present at normal levels. Platelet ATP levels were diminished in AD (from 11.33 +/- 0.52 to 9.11 +/- 0.72 nmol/mg), while reactive oxygen species (ROS) were increased (from 97.03 +/- 25.9 to 338.3 +/- 100 K/mg). Platelet membrane fluidity, Vitamin E, and cholesterol content were similar between groups. We conclude that COX catalytic activity is indeed diminished in AD platelet mitochondria, does not result from altered membrane fluidity, and is associated with ROS overproduction and ATP under-production.

Laserspectroscopy in the fetus during labour

The newly available modified laserspectroscopy for fetal physiologic measurements provides information about biochemical parameters and is potentially an additional technique for fetal surveillance.

METHOD

Using laserspectroscopy it was possible to trace changes in absorbances at four different wavelengths and to calculate relative changes of HbO2, desaturated haemoglobin, total haemoglobin, and cytochrome aa3. Using an experimental set-up with fetal lamb during intermittend cord occlusion, we were able to study tissue oxygenation of the fetal brain (tpO2) under defined conditions. Furthermore, the NIR sensor was used during physiologic measurements in the human fetus.

RESULTS

As had been proposed earlier, it is obvious that the tolerance to hypoxia is increased after cord compression is repeated, as is indicated by the shifting of the cytochrome dissociation curve to the left. In the human fetus without fetal distress we observed stable values with only minor fluctuations related to changes of intrauterine pressure. On the other hand, in cases where there was an intrauterine complication the deterioration of oxygenation was detected form a decrease in HbO2 and cytochrome aa3.

DISCUSSION AND CONCLUSION

The routinely used CTG has been criticised for the effect of leading to an unacceptably high number of cesarean sections. Information on biochemical variables leads to better identification of fetal distress. In comparison to fetal blood sampling NIR laserspectroscopy holds the promise of a non-invasive tool providing continues monitoring.

Cerebrovascular response in small preterm infants during routine nursery gavage feedings

Although gavage feedings are considered a standard of care, they are often accompanied by hemodynamic changes that may have important effects on the cerebral circulation. In 23 premature infants receiving intermittent bolus gavage feeds, changes in cerebral hemodynamics and oxygenation were studied using near-infrared spectroscopy. Orogastric tube insertion resulted in an increased cerebral blood volume in 73% of the infants and in an increase in reduced hemoglobin and in cytochrome AA(3) oxygenase in approximately 66% of the patients. Within 10 min of initiating a gavage feed, cerebral blood volume, oxygenated hemoglobin, reduced hemoglobin, and cytochrome AA(3) oxygenase decreased from baseline in about 60% of the infants. Towards the end of the study, during the postfeeding period, cytochrome AA(3) oxygenase and oxygenated hemoglobin increased in 60%, while reduced hemoglobin decreased in 78% of the infants.

Effect of smoking cessation on mitochondrial respiratory chain function

OBJECTIVE

Chronic smoking has been associated with diverse mitochondrial respiratory chain (MRC) dysfunction in lymphocytes, although inhibition of complex IV activity is the most consistent and relevant finding. These mitochondrial abnormalities have been proposed to contribute to pathogenesis of diseases associated with tobacco consumption. We assessed MRC function in peripheral lymphocytes from heavy smokers after cessation in smoking habit.

PATIENTS AND METHODS

We studied MRC function from peripheral lymphocytes of 10 healthy chronic smoker individuals (age 43 +/- 6 years; 50% women) before cessation of tobacco consumption (t0), and 7 (t1) and 28 (t2) days after cessation. Smoking abstinence was ascertained by measuring carboxyhemoglobin levels and carbon monoxide (CO) concentration in exhaled breath. Ten healthy nonsmoker individuals matched by age and gender were used as controls. Lymphocytes were isolated by Ficoll's gradient, and protein content was determined by Bradford's technique. MRC function was studied through double means: 1) individual enzyme activities of complex II, III, and IV were analyzed by means of spectrophotometry; 2) oxygen consumption was measured polarographically using pyruvate, succinate, and glycerol-3-phosphate (complex I, II, and III substrates, respectively) after lymphocyte permeabilization. Enzyme and oxidative activities were corrected by citrate synthase activity.

RESULTS

Smokers showed a significant decrease in complex IV activity (p = 0.05) and also in respiration of intact lymphocytes (p = 0.05) compared to controls. Eight chronic smokers remained abstinent during the study. Smoking cessation was associated with a significant recovery of complex IV (p = 0.01) and complex III (p = 0.05) activities. Oxidative activities did not show any change during the study.

CONCLUSION

Chronic smoking is associated with a decrease of complex IV and III activities of MRC, which return to normal values after cessation of tobacco smoking.

Oscillations in the near-infrared signal in patients with severe head injury

OBJECTIVE

To use a non-invasive system, near infrared spectroscopy (NIRS) to detect oscillations in cerebral blood oxygenation in intensive care patients with severe traumatic brain injury.

MATERIALS AND METHODS

9 patients (7 male, 2 female) with a GCS < 8 were monitored in the intensive care units at King's College Hospital and the Royal London Hospital. A CCD-based spectrometer was coupled to the patient's forehead with one excitation and one detection optode. Spectra in the range of approximately 600-800 nm were collected at intervals of 2-4 seconds (subject to signal strength) and a curve-fitting algorithm applied, thus extracting time series data for oxyhaemoglobin (HbO), deoxyhaemoglobin (Hb) and cytochrome-c-oxidase (Cyt-c). The oxyhaemoglobin data was subjected to Fast Fourier Transform analysis.

RESULTS

In all nine patients, unequivocal oscillations in the HbO signal were observed. The frequencies of these oscillations were at: 0.013-0.042 Hz (0.78-2.5 cycles min-1), 0.11 Hz (6.7 cycles min-1) and 0.19-0.28 Hz (12-16 cycles min-1).

CONCLUSIONS

The presence of oscillations at 0.013-0.033 Hz, 0.11 Hz and 0.19-0.28 Hz are compatible with B-waves, vasomotion and respiratory cycles (respectively). However, due to the unknown contribution of the scalp to the NIR signal this data must be interpreted with care. Further work is required in order to investigate this.

Unaltered cytochrome oxidase, glutamate dehydrogenase and glutaminase activities in platelets from patients with sporadic amyotrophic lateral sclerosis--a study of potential pathogenetic mechanisms in neurodegenerative diseases

Sporadic Amyotrophic Lateral Sclerosis (SALS) is a fatal neurologic disease characterized by degeneration of motor neurons in the spinal cord, brainstem and cortex. While familial cases of ALS exist, the sporadic form accounts for the majority of adult-onset cases. It has been hypothesized that the neurodegenerative mechanisms underlying SALS might arise from glutamate-mediated excitotoxicity and mitochondrial dysfunction. Studies on autopsied SALS spinal cord and brain have reported decreased cytochrome oxidase activity, decreased astrocytic glutamate-transporter protein, and alterations of glutamate levels and glutamate metabolizing enzyme activities. We conjectured that if alterations in glutamate metabolism and cytochrome oxidase activity occur in the SALS central nervous system these alterations may also be manifested in peripheral tissues such as platelets in living SALS patients. In this study we compared the activities of cytochrome oxidase, citrate synthase, glutamate dehydrogenase and glutaminase in platelets from SALS and control subjects. We found that there were no differences in any of the enzyme activities measured between the two groups. Our data argue against generalized ubiquitous biochemical alterations of these enzymes in SALS patients.

Spontaneous low frequency oscillations of cerebral hemodynamics and metabolism in human adults

We investigated slow spontaneous oscillations in cerebral oxygenation in the human adult's visual cortex. The rationale was (1) to demonstrate their detectability by near infrared spectroscopy (NIRS); (2) to analyze the spectral power of as well as the phase relationship between the different NIRS parameters (oxygenated and deoxygenated hemoglobin and cytochrome-oxidase; oxy-Hb/deoxy-Hb/Cyt-ox). Also (3) influences of functional stimulation and hypercapnia on power and phase shifts were investigated. The results show that-in line with the literature-low frequency oscillations (LFO) centred around 0.1 s(-1) and even slower oscillations at about 0.04 s(-1) (very low frequency, VLFO) can be distinguished. Their respective power differs between oxy-Hb, deoxy-Hb, and Cyt-ox. Either frequency (LFO and VLFO) is altered in magnitude by functional stimulation of the cortical area examined. Also we find a change of the phase shift between the vascular parameters (oxy-Hb, tot-Hb) and the metabolic parameter (Cyt-ox) evoked by the stimulation. It is shown that hypercapnia attenuates the LFO in oxy-Hb and deoxy-Hb.

CONCLUSIONS

(1) spontaneous vascular and metabolic LFO and VLFO can be reproducibly detected by NIRS in the human adult. (2) Their spectral characteristics and their response to hypercapnia are in line with those described in exposed cortex (for review see (Hudetz et al., 1998)) and correspond to findings with transcranial doppler sonography (TCD) (Diehl et al., 1995) and fMRI (Biswal et al., 1997). (3) The magnitude of and phase relation between NIRS-parameters at the LFO may allow for a local noninvasive assessment of autoregulatory mechanisms in the adult brain.

Optimizing cerebral oxygenation during cardiac surgery: a review of experimental and clinical investigations with near infrared spectrophotometry

OBJECTIVES

Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. This paper reviews studies in which we aimed to validate NIRS in an experimental model of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) (validation study), use the method in experimental settings to optimize cerebral oxygenation during CPB (oxygenation study), and test its utility during routine cardiac surgery (clinical study).

METHODS

Validation study: Forty 8-10 kg piglets underwent 60 min of DHCA at 15 degrees C, were extubated on the first postoperative day, and sacrificed on the 4th postoperative day for histologic investigations. During CPB and DHCA, the animals were investigated by NIRS (monitoring of cerebral oxygenated hemoglobin (HbO2) and oxidized cytochrome aa3 (Cytox)) and magnetic resonance spectroscopy (MRS) (monitoring of cerebral adenosine triphosphate (ATP) and phosphocreatine (PCr). Oxygenation study: A normoxic (n = 5) and a hyperoxic group (n = 5) of piglets underwent 120 min of DHCA and 6 h of reperfusion with NIRS monitoring. Neuronal damage was evaluated by histology. Clinical study: Patients (n = 41) undergoing routine cardiac surgery were investigated by NIRS and neuropsychological testings.

RESULTS

Validation study: Reductions of CytOx and HbO2 values were closely correlated with decreases in ATP, PCr, and pHi. The changes in CytOx and PCr showed the strongest correlation (r = 0.623). Maximal CytOx reduction during DHCA predicted brain damage. Oxygenation study: Histology revealed a significant increase in brain damage in the normoxic group. Cytox and HbO2 tended to be lower during DHCA (p = 0.16). Clinical study: During CPB, arterial PCO2, pH and temperature were closely related to CytOx and HbO2. Patients who suffered from neuropsychological deficits had a lower CytOx minimum compared to those without these.

CONCLUSIONS

NIRS measurements, especially the CytOx signal, correlate well with high energy phosphates and have a high sensitivity to predict histologic brain damage. NIRS is an important and useful tool in studies investigating cerebral oxygenation during CPB. The CytOx signal predicted impaired neuropsychological outcome in patients. Therefore, the CytOx signal holds much interest for future studies.

Brain hemodynamic changes in preterm infants after maintenance dose caffeine and aminophylline treatment

OBJECTIVE

To investigate the acute effects of low-dose caffeine and aminophylline on cerebral blood flow in preterm infants, using both near-infrared spectroscopy (NIRS) and cerebral Doppler ultrasonography.

METHODS

Preterm infants with a gestational age of <32 weeks and birth weight of <1,500 g were randomized to receive either caffeine or aminophylline treatment for apnea of prematurity. The study period went from 30 min before to 60 min after the administration of the maintenance dose of pure caffeine (2.5 mg/kg once a day) or aminophylline (1.25 mg/kg twice a day). NIRS was used to measure changes in oxygenated hemoglobin (O(2)Hb), deoxygenated hemoglobin (HHb), oxidized-reduced cytochrome aa3 (CtOx), and mean cerebral oxygen saturation (SmO(2) = O(2)Hb/total Hb). Changes in cerebral blood volume (DeltaCBV) after caffeine or aminophylline administration were calculated. Cerebral blood flow velocity (CBV) in the pericallosal artery was evaluated by cerebral Doppler ultrasounds.

RESULTS

Data collected by NIRS and cerebral Doppler ultrasounds did not show significant differences before and after caffeine treatment. We observed a significant increase in O(2)Hb and HHb concentration and in CBV at 30 min after the infusion of aminophylline, which tended to return to baseline at the end of the study period.

CONCLUSION

Caffeine does not significantly affect brain hemodynamics, while aminophylline induces a significant transient increase in O(2)Hb and HHb concentration and CBV.

Pulsatility does not change cerebral oxygenation during cardiopulmonary bypass

BACKGROUND

To determine the effect of pulsatility during cardiopulmonary bypass (CPB) on cerebral oxygenation, we measured oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb) and oxidised cytochrome aa3 (CtO2) with near-infrared spectroscopy (NIRS) in 14 patients electively scheduled for cardiac surgery.

METHODS

Cerebral oxygenation was measured during steady state CPB at a core temperature of 32 degrees C. Non-pulsatile flow and pulsatile flow were performed for 10 min each.

RESULTS

After 14 min of CPB, HbO2, Hb and CtO2 were significantly below prebypass values. HbO2 and CtO2 did not alter with changing flow patterns. Hb significantly increased both during the period of nonpulsatile (median: -0.7 vs. 0.25 micromol/l; P<0.05) and pulsatile flow (median: 0.25 vs. 0.5 micromol/l; P<0.001). This increase was independent of flow pattern.

CONCLUSIONS

Neither oxygenated haemoglobin, nor intracellular oxygenation, represented by CtO2, indicated a beneficial effect of pulsatile perfusion during hypothermic CPB. These results, however, are only valid for short time effects within 10 min before rewarming from CPB and patients without flow-limiting stenoses of the carotid artery.

Changes in cerebral blood volume and cerebral oxygenation during periodic breathing in term infants

The present study is an analysis of changes in cerebral oxygenation and cerebral blood volume (CBV) during periodic breathing in healthy term infants by means of near infrared spectroscopy (NIRS). Polygraphy included electrocardiogram, electrooculogram, heart rate, oxygen saturation, side stream capnography, two respiratory effort sensors, a movement sensor, and NIRS. During periodic breathing analysis of behaviour of total haemoglobin (cHbtot), deltaCBV, the haemoglobin oxygenation index (cHbD), and cytochrome oxidase (CytOx) was performed. In ten healthy term infants 30 cycles of periodic breathing with a mean of 10 apnoeas per cycle were analysed. Corresponding cyclical variations of cHbD appeared in 98%, cyclical variations of cHbtot appeared in 42% of all apnoeas. During phases of apnoea, a mean decrease of cHbD of -3.45 micromol/l occurred 1.75 seconds after onset of apnoea, and a mean decrease of cHbtot of -0.79 micromol/occurred 0.74 seconds after onset of apnoea. During these apnoeas, the deltaCBV was -44 microl/100 g brain. During phases of ventilation, there was an increase of cHbD and cHbtot to the pre-apnoeic levels. There was a tendency that CytOx values decreased during periodic breathing, the amount of decrease was -0.32 micromol/l. In conclusion, the present study was able to show for the first time that there is cyclical desaturation and reoxygenation of cerebral blood during periodic breathing. Cyclical changes in CBV in association with periodic apnoea occurred only in 42% of apnoea.

The effects of cell ageing on metabolism in rainbow trout (Oncorhynchus mykiss) red blood cells

The effects of cell age on metabolism in the nucleated red blood cells of rainbow trout (Oncorhynchus mykiss) were examined. Red blood cells were separated according to age using fixed-angle centrifugation. The mean erythrocyte haemoglobin concentration in old red blood cells was found to be 120 % of that in young red blood cells. In young red blood cells, the activities of the mitochondrial enzymes citrate synthase and cytochrome oxidase were 135–200 %, respectively, of those measured in old red blood cells. The activity of the glycolytic enzyme lactate dehydrogenase in young red blood cells was 170 % of that in old red blood cells, whereas the activity of the glycolytic enzyme pyruvate kinase was not significantly affected by cell age. In addition, young red blood cells consumed over twice as much O(2) and devoted 50 % more O(2) to protein synthesis and the activity of Na(+)/K(+)-ATPase than old red blood cells. Red blood cell age did not significantly affect the rate of lactate production. This study shows that ageing in rainbow trout nucleated red blood cells is accompanied by a significant decline in aerobic energy production and the processes it supports, as well as a corresponding increase in the glycolytic contribution to metabolism.

The activity of cytochrome oxidase is increased in circulating lymphocytes of patients with chronic obstructive pulmonary disease, asthma, and chronic arthritis

We have previously shown that the activity of cytochrome oxidase (CytOx) in skeletal muscle of patients with chronic obstructive pulmonary disease (COPD) was higher than in healthy control subjects. The mechanisms and implications of this observation were unclear. In particular, it was not known if this abnormality can occur also in: (1) cell types other than muscle cells, and (2) other chronic inflammatory diseases. To obtain further insight into these questions, we measured the activity of CytOx in circulating lymphocytes in patients with stable COPD (n = 17), bronchial asthma (n = 6), or chronic arthritis (n = 5), and in healthy control subjects (n = 8). We found that, compared with healthy subjects (280 +/- 117 nKat/microg protein), patients with COPD showed increased CytOx activity (430 +/- 150 nKat/microg protein, p = 0.01) in lymphocytes. Further, this activity was negatively related to the degree of airflow obstruction present in these patients (r = -0.53, p < 0.05). We also found that the activity of CytOx in circulating lymphocytes was higher than normal in patients with chronic arthritis (411 +/- 130 nKat/microg protein, p < 0.05) and, particularly, in patients with bronchial asthma (1,667 +/- 1,027 nKat/microg protein, p < 0.001). These results show that the increased CytOx activity previously reported in skeletal muscle of patients with COPD is also detected in other cell types (such as circulating lymphocytes) and in other chronic inflammatory diseases (such as bronchial asthma and chronic arthritis). The mechanisms and implications of these findings deserve further investigation.

Neonatal intensive care applications of near-infrared spectroscopy

Near-infrared spectroscopy (NIRS) is a noninvasive technique for assessing cerebral hemodynamic variables and oxidative status in the neonatal intensive care setting. It can be performed for extended periods of time at the bedside without interfering with routine patient care. NIRS appears to have the ability to not only assess relative changes in oxygenated and deoxygenated hemoglobin, total hemoglobin, and cytochrome aa3, but it can also produce estimates of cerebral blood volume and cerebral blood flow. Research data document significant changes in these hemodynamic variables with patient activity and clinical interventions in both premature and term infants. NIRS may evolve into an important diagnostic and prognostic tool for neonatal neurologic outcome.

Near infrared spectroscopy-measured changes in cerebral blood volume and cytochrome aa3 in newborn lambs exposed to hypoxia and hypercapnia, and ischemia: a comparison with changes in brain perfusion and O2 metabolism

OBJECTIVES

Validation of near infrared spectroscopy (NIRS)-measured changes in cerebral blood volume (deltaCBV) and cytochrome aa3 (deltaCytaa3) as estimators of changes in brain perfusion and oxygenation in the newborn lamb during hypoxia and hypercarbia, and additional hypotension.

METHODS AND MATERIALS

In 33 newborn lambs brain perfusion assessed by carotid artery blood flow (deltaQcar: ml/min)and cerebral metabolic rate of oxygen (deltaCMRO2: ml O2/min) were related to NIRS-derived deltaCBV (ml/100 g) and deltaCytaa3 (microM) during combined hypoxia and hypercarbia and additional hypotension. Combined hypoxia and hypercapnia was induced by ventilation with 6-8% of O2 and 10% of CO2 during 30 min, and additional hypotension ( < 35 mmHg for 5 min) was induced by careful withdrawal of blood.

RESULTS

CBV increased during hypoxia and hypercarbia, decreased during additional hypotension and was related to deltaQcar: (0.009 ml/100 g change per ml/min Qcar: P < 0.0001). Cytaa3 increased during hypoxia and hypercarbia, decreased during subsequent additional hypotension andshowed a reverse relationship with deltaCMRO2 (-1.65 microM change per ml O2/min CMRO2: P <0.0001). Cytaa3 remained above baseline during reperfusion.

CONCLUSIONS

deltaCBV estimates changes in brain perfusion, but overestimates brain perfusion during hypotension. The pattern of deltaCytaa3 suggests less oxygen utilisation by brain tissue during hypoxia and subsequent reperfusion.

A comparison of the monitors INVOS 3100 and NIRO 500 in detecting changes in cerebral oxygenation

BACKGROUND

Measurements of cerebral haemoglobin oxygenation of 2 near-infrared spectroscopy devices (INVOS 3100 and NIRO 500) were compared during and after hypocapnia.

METHODS

Fifteen awake, healthy volunteers, who hyperventilated to obtain end-tidal CO2 (EtCO2) values of approximately 20 mmHg, were studied. During hyperventilation and 8 min thereafter, EtCO2, INVOS 3100 (RSO2 = regional cerebral oxygenation) and NIRO 500 recordings (HbO2 = oxyhaemoglobin, Hb = deoxyhaemoglobin, Hb-diff = HbO2-Hb, CtO2 = oxidised cytochrome oxidase aa3) were analysed.

RESULTS

Hyperventilation induced a significant decline in EtCO2 from 30.5 to 14.7 mmHg (P < 0.001) and RSO2 from 67.1% to 62.7% (P = 0.025). At hypocapnia, only Hb (+1.61 +/- 0.48 mumol/L; P < 0.001) and Hb-diff (-3.01 +/- 2.0 mumol/L; P < 0.001) indicated a decline in cerebral haemoglobin oxygenation. Within 8 min after hyperventilation, both EtCO2 and RSO2 normalised to values insignificantly different from baseline. In contrast, Hb and Hb-diff remained significantly different (Hb: +2.52 +/- 1.28 mumol/l; P < 0.001, Hb-diff: -4.31 +/- 4.0 mumol/L; P < 0.001). A correlation with EtCO2 was found for RSO2 (R = 0.35; P < 0.001) and CtO2 (R = 0.42; P < 0.001). All volunteers were continuously awake and none presented clinical symptoms of cerebral hypoxia.

CONCLUSION

Changes in cerebral haemoglobin oxygenation state were reflected more accurately by INVOS 3100 than NIRO 500. The cause may be the different technology of the monitors, since INVOS 3100 eliminates the contribution of extracranial oxygenation.

Effects of L-carnitine on erythrocyte acyl-CoA, free CoA, and glycerophospholipid acyltransferase in uremia

We studied the effects of L-carnitine treatment in the acyl flux of erythrocyte membranes from uremic patients. We found a significantly lower relative proportion of long-chain acyl-CoA (LCCoA) to free CoA (FCoA) in patients than in control subjects. In addition, patients had reduced activities of both carnitine palmitoyltransferase (CPT) and glycerophospholipid acyltransferase (LAT; CoA dependent), and increased ratios of long-chain acylcarnitine (LCAC) to free carnitine in their erythrocytes. These data support the hypothesis that acyl-trafficking is altered in erythrocytes in uremia. After treatment with L-carnitine, we observed a significant increase in CPT and LAT activities as well as in the LCCoA-FCoA ratio, and a significant decrease in the ratio of LCAC to free carnitine. These results support the conclusion that L-carnitine supplementation improves erythrocyte flux in uremic patients.

Cerebral oxygenation during cardiopulmonary bypass

Cerebral fractional oxygen extraction (FOE) was monitored in 30 children, using near infrared spectroscopy during cardiopulmonary bypass, to investigate the effect of hypothermia and circulatory arrest. One group of children (n = 15) underwent profound hypothermia with total circulatory arrest (n = 8) or continuous flow (n = 7). Another group (n = 15), of whom only one had circulatory arrest, underwent mild (n = 6) or moderate (n = 9) hypothermia. The mean FOE (SD) before bypass was 0.35 (0.12) and this correlated negatively with the preoperative arterial oxygen content (r = -0.58). Between the stage of cooling on bypass and cold bypass there was a reduction in FOE in all groups. Between cold bypass and rewarming there was an increase in FOE only in the groups with continuous flow. In the circulatory arrest group, the FOE remained low during rewarming and was significantly lower than that of the continuous flow group. No patients died and none had neurological abnormalities postoperatively. Apparent changes in oxidised cytochrome oxidase concentration were also monitored using near infrared spectroscopy. There was a fall in cytochrome aa3 on starting cardiopulmonary bypass, but there were no significant differences in the changes in cytochrome aa3 between any stage in any of the patient groups. Using this non-invasive technique, cooling was shown to reduce cerebral FOE. During rewarming on bypass there was an increase in cerebral FOE only in patients who had had continuous flow bypass. In contrast, the cerebral FOE in those with circulatory arrest remained constant after arrest and during the duration of the study. This may have implications for the timing of hypoxic brain injury.

Platelet mitochondrial respiratory chain function in Parkinson's disease

Reports on mitochondrial respiratory chain (MRC) complex I (CI) dysfunction in the substantia nigra in Parkinson's disease (PD) support the oxidative stress hypothesis in the neuropathogenesis of PD. Studies in peripheral tissue have found variable decreased CI and occasionally other complex activity suggestive of systemic impairment of MRC function in PD; however, MRC activity may be influenced by numerous variables. We conducted spectrophotometric measurements of MRC function in platelet mitochondrial preparations in 13 individuals with PD and 9 age-matched controls (CON) and have identified additional variables that may affect MRC activity. Mean CI, CIII, CIV, and citrate synthase (CS) activities were similar between PD and CON. CIII and CIV, specific and CS-corrected, activities were significantly positively correlated with CI in combined and individual group data, with the exception of CIII CS-corrected and CIV specific activities in CON and PD, respectively. CIII and CS specific activities were negatively correlated with age in CON, but varied randomly in PD. In PD, CIII specific activity was 1.4-fold higher in those with a history of environmental risk factors for PD and CIV specific activity was lower in those with a positive family history of PD [8.34 +/- 0.74 (n = 4) vs. 12.4 +/- 1.1 (SEM) min-1 mg-1; p = 0.046]. Group heterogeneity, variables affecting enzyme activity, and intrinsic properties of cells may thus contribute to conflicting data in studies of MRC function in platelets and other tissues.

Higher hematocrit improves cerebral outcome after deep hypothermic circulatory arrest

BACKGROUND

Various degrees of hemodilution are currently in clinical use during deep hypothermic circulatory arrest to counteract deleterious rheologic effects linked with brain injury by previous reports.

MATERIAL AND METHODS

Seventeen piglets were randomly assigned to three groups. Group I piglets (n = 7) received colloid and crystalloid prime (hematocrit < 10%), group II piglets (n = 5) received blood and crystalloid prime (hematocrit 20%), group III piglets (n = 5) received blood prime (hematocrit 30%). All groups underwent 60 minutes of deep hypothermic circulatory arrest at 15 degrees C with continuous magnetic resonance spectroscopy and near-infrared spectroscopy Neurologic recovery was evaluated for 4 days (neurologic deficit score 0, normal, to 500, brain death; overall performance category 1, normal, to 5, brain death). Neurohistologic score (0, normal, to 5+, necrosis) was assessed after the animals were euthanized on day 4.

RESULTS

Group I had significant loss of phosphocreatine and intracellular acidosis during early cooling (phosphocreatine in group I, 86.3% +/- 26.8%; group II, 117.3% +/- 8.6%; group III, 110.9% +/- 2.68%; p = 0.0008; intracellular pH in group I, 6.95 +/- 0.18; group II, 7.28 +/- 0.04; group III, 7.49 +/- 0.04; p = 0.0048). Final recovery was the same for all groups. Cytochrome aa3 was more reduced in group I during deep hypothermic circulatory arrest than in either of the other groups (group I, -43.6 +/- 2.6; group II, -16.0 +/- 5.2; group III, 1.3 +/= 3.1; p < 0.0001). Neurologic deficit score was best preserved in group III (p < 0.05 group II vs group III) on the first postoperative day, although this difference diminished with time and all animals were neurologically normal after 4 days. Histologic assessment was worst among group I in neocortex area (group I, 1.33 +/- 0.3; group II, 0.22 +/- 0.1; group III, 0.40 +/- 0.2, p < 0.05, group I vs group II; p = 0.0287, group I vs group III).

CONCLUSION

Extreme hemodilution during cardiopulmonary bypass may cause inadequate oxygen delivery during early cooling. The higher hematocrit with a blood prime is associated with improved cerebral recovery after deep hypothermic circulatory arrest.

Recent developments in cerebral monitoring--near-infrared light spectroscopy. An overview

A recent development has been the resurgence of interest in the concept of near-infrared light spectroscopy as a method of monitoring cerebral perfusion. Although this technique has been in use for 40 years, the principle has been primarily employed in peripheral pulse oximetry. Infrared light of wavelengths 600-1300 nanometres (nm) penetrate human tissue to a depth of several centimetres. Within the human brain this light is attenuated by the chromophores oxyhaemoglobin, deoxyhaemoglobin and also oxidised cytochrome a3. Positioning a near-infrared light source and a photodetector in a side by side configuration detects light attenuated and reflected in a parabolic path through the scalp, skull and brain tissue.

Non-invasive measurement of cardiac oxygenation and haemodynamics during transient episodes of coronary artery occlusion and reperfusion in the pig

1. The non-invasive method of near-infrared spectroscopy was used to measure myocardial oxygenation and haemodynamics in response to left anterior descending coronary artery occlusion in a porcine model. 2. Near-infrared spectroscopy measures changes in haemoglobin (and myoglobin) oxygenation and blood volume to yield information on tissue perfusion and flow. It also measures the redox state of cytochrome aa3, thus providing information about intracellular oxygen utilization. 3. Left anterior descending coronary artery occlusion was induced to produce periods of ischaemia lasting between 24s and 13.5 min (n = 13). The changes in deoxyhaemoglobin, oxyhaemoglobin and cytochrome aa3 measured during occlusion were all highly significant compared with baseline variation. In all occlusions (n = 13) a rapid decrease in oxyhaemoglobin concentration (-75.83 +/- 3.27 mumol/l, mean +/- SEM) with a simultaneous increase in deoxyhaemoglobin of 9.27 +/- 1.69 mumol/l was measured. The total haemoglobin concentration also fell by -71.3 +/- 5.32 mumol/l. Cytochrome aa3 was also reduced during occlusion (-8.35 +/- 1.044) mumol/l. 4. Over the range 24-60s occlusion, the magnitude of the fall in total haemoglobin and oxyhaemoglobin correlated with the duration of occlusion (P < 0.003 and 0.013 respectively). For total haemoglobin only the magnitude of the fall correlated with the increase upon release of occlusion (r = 0.89, P < 0.003). 5. Release of occlusion (n = 8) resulted in an immediate increase in the concentration of deoxyhaemoglobin at 9.88 +/- 1.06s, then total haemoglobin at 13.62 +/- 1.23s and finally oxyhaemoglobin at 29.75 +/- 5.96s. The difference between the timing of the maxima after reperfusion is significant (P < 0.002 and P < 0.007 respectively). Moreover, the time for the deoxyhaemoglobin signal to reach maximum values was found to correlate with the duration of occlusion (P < 0.04). This could be indicative of the PO2 of the ischaemic tissues and an immediate off-loading of oxygen from oxyhaemoglobin. The results are reliable, reproducible and sensitive enough to detect the kinetics of haemoglobin oxygenation from a beating heart in situ.

Effects of a diet low in copper on copper-status indicators in postmenopausal women

To study the effects of low copper intake in older individuals, 12 postmenopausal women, aged 63.1 +/- 8.8 y, were fed a diet containing 9 micromol (0.57 mg) Cu/d for 105 d, followed by a copper-repletion period of 35 d during which the diet was supplemented with 31.5 micromol (2.0 mg) Cu/d. Plasma copper and ceruloplasmin did not change significantly during copper depletion but ceruloplasmin decreased during copper repletion. Erythrocyte superoxide dismutase activity dropped significantly during low copper intake from 3450 to 2600 U/g hemoglobin, but did not increase during copper repletion. Platelet cytochrome c oxidase activity changed significantly (P<0.0001) from 1740 to 810 U/g protein during copper depletion, then increased to 1000 U/g protein during copper repletion. Erythrocyte glutathione peroxidase activity responded similarly. Clotting factor VIII activity increased significantly during copper depletion, then dropped during copper repletion. Low copper intakes did not induce the changes in serum cholesterol and hematology generally found in copper-deficient animal models. These results indicate that a paradigm shift may be needed in evaluating copper status in adult humans. Sensitive indicators of copper include functional activities of platelet cytochrome c oxidase, platelet copper, glutathione peroxidase, and clotting factor VIII. Plasma copper, ceruloplasmin, and cholesterol are relatively insensitive indicators. Also, the recovery from mild copper depletion may require more aggressive intervention tha 2 mg Cu/d for 35 d.

Reduced carnitine palmitoyl transferase activity and altered acyl-trafficking in red blood cells from hemodialysis patients

We measured carnitine palmitoyl transferase activity, free carnitine, and long chain acyl carnitine levels in erythrocytes from 15 uremic patients and 25 controls. Carnitine palmitoyl transferase levels in patients were significantly lower than in controls. The levels of free carnitine and long chain acyl carnitines as well as the long chain acyl carnitine/free carnitine ratio were significantly higher in patients than in controls. Our results suggest that hemodialysis causes alteration in the acyl-trafficking in red blood cells membrane.

Correlation between NIR spectroscopy and pulse oximetry in the fetus

At the Women's University Hospital Würzburg, pulse oximetry as well as Near Infrared Spectroscopy (NIR) measurements are performed on the fetus during labor in order to compare both methods. Changes of oxygen saturation seem to be positively correlated to concentration changes of oxidized hemoglobin measured by NIR, partially correlated to those of total hemoglobin, and partially correlated negatively to those of reduced hemoglobin. No correlation was found between oxygen saturation changes and those of cytochrome aa3, perhaps due to a longer lagtime. Pulse oximetry as well as NIR Spectroscopy may prove helpful tools for fetal surveillance. Both must be studied particularly with reference to FBA and fetal outcome before clinical decisions can be influenced by these methods.

Compensatory elevation of complex II activity in Leber's hereditary optic neuropathy

AIMS

To evaluate the mitochondrial respiratory enzyme activities in blood cells of Leber's hereditary optic neuropathy (LHON) with 11778 point mutation of mitochondrial DNA.

METHODS

Assays for the activities of NADH-cytochrome c reductase (complex I+complex III), succinate-cytochrome c reductase (complex II+complex III), and cytochrome c oxidase (complex IV) on blood cell mitochondria of seven LHON patients and 15 normal controls.

RESULTS

There was no statistically significant difference in NADH-cytochrome c reductase and cytochrome c oxidase activities between LHON patients and controls, but activities of succinate-cytochrome c reductase in LHON patients was significantly elevated compared with normal controls.

CONCLUSION

The observations that the activity of NADH-cytochrome c reductase is normal but that of succinate-cytochrome c reductase is increased in LHON patients with 11778 point mutation of mitochondrial DNA indicate an elevation of complex II activity, which may be due to a nuclear compensatory effect for defects of the respiratory function of mitochondria.

The influence of arterial carbon dioxide on cerebral oxygenation and haemodynamics during ECMO in normoxaemic and hypoxaemic piglets

OBJECTIVE

To investigate the cerebrovascular response to changes in arterial CO2 tension during extracorporeal membrane oxygenation (ECMO) in normoxaemic and hypoxaemic piglets.

METHODS

Four groups of six anaesthetized, paralysed and mechanically ventilated piglets: group 1-normoxaemia without ECMO, group 2-ECMO after normoxaemia, group 3-hypoxaemia without ECMO, and group 4-ECMO after hypoxaemia, were exposed successively to hypercapnia and hypocapnia. Changes in cerebral concentrations of oxyhaemoglobin (cO2Hb), deoxyhaemoglobin (cHHb), (oxidized-reduced) cytochrome aa3 (cCyt.aa3) and blood volume (CBV) were continuously measured using near infrared spectrophotometry. Heart rate, arterial O2 saturation, arterial blood pressure, central venous pressure, intracranial pressure (ICP) and left common carotid artery blood flow (LCaBF) were measured simultaneously.

RESULTS

Hypercapnia resulted in increased CBV, cO2Hb and ICP in all groups, while cHHb was decreased. No changes in LCaBF were found. Hypocapnia resulted in decreased cO2Hb and increased cHHb except in group 3. LCaBF decreased in all groups except group 2. CBV decreased only in groups 2 and 4. No effect on ICP was observed in any of the groups. The other variables showed no important changes either during hypercapnia or hypocapnia. ECMO after hypoxaemia resulted in a greater response of cO2Hb and cO2Hb and cHHb during hypocapnia. The effect of hypercapnia on CBV while on ECMO was greater than without ECMO.

CONCLUSION

Since cerebrovascular reactivity to CO2 remains intact during ECMO in piglets, it is important to keep arterial CO2 tension stable and in normal range during clinical ECMO.

Reduced copper enzyme activities in blood cells of children with cystic fibrosis

Cystic fibrosis patients are at risk for nutrient deficiencies from malabsorption related to exocrine pancreatic insufficiency. This research examined the copper homeostasis of children with cystic fibrosis. Our objective was to measure cytochrome oxidase and copper-zinc superoxide dismutase activities in mononuclear cells, neutrophils, and erythrocytes of adolescents with cystic fibrosis, as well as plasma copper and ceruloplasmin. Thirteen adolescents with pancreatic insufficiency caused by cystic fibrosis were compared with 10 age- and sex-matched control subjects. Serum copper concentrations and ceruloplasmin measurements were not significantly different between the two groups. Cytochrome oxidase activity was significantly lower in the mononuclear cells and copper-zinc superoxide dismutase activity was significantly lower in the neutrophils and erythrocytes of the cystic fibrosis group. Other measures of trace element status such as hemoglobin concentration, serum ferritin, serum zinc, glutathione peroxidase activity, and manganese superoxide dismutase activity were not different between the two groups. Reductions in the activity of two copper-dependent enzymes suggest abnormal copper homeostasis in this population.