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Yan Y, Kamenshchikov N, Zheng Z, Lei C. Inhaled nitric oxide and postoperative outcomes in cardiac surgery with cardiopulmonary bypass: A systematic review and meta-analysis. Nitric Oxide 2024; 146:64-74. [PMID: 38556145 DOI: 10.1016/j.niox.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
Cardiac surgeries under cardiopulmonary bypass (CPB) are complex procedures with high incidence of complications, morbidity and mortality. The inhaled nitric oxide (iNO) has been frequently used as an important composite of perioperative management during cardiac surgery under CPB. We conducted a meta-analysis of published randomized clinical trials (RCTs) to assess the effects of iNO on reducing postoperative complications, including the duration of postoperative mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, mortality, hemodynamic improvement (the composite right ventricular failure, low cardiac output syndrome, pulmonary arterial pressure, and vasoactive inotropic score) and myocardial injury biomarker (postoperative troponin I levels). Subgroup analyses were performed to assess the effect of modification and interaction. These included iNO dosage, the timing and duration of iNO therapy, different populations (children and adults), and comparators (other vasodilators and placebo or standard care). A comprehensive search for iNO and cardiac surgery was performed on online databases. Twenty-seven studies were included after removing the duplicates and irrelevant articles. The results suggested that iNO could reduce the duration of mechanical ventilation, but had no significance in the ICU stay, hospital stay, and mortality. This may be attributed to the small sample size of the most included studies and heterogeneity in timing, dosage and duration of iNO administration. Well-designed, large-scale, multicenter clinical trials are needed to further explore the effect of iNO in improving postoperative prognosis in cardiovascular surgical patients.
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Affiliation(s)
- Yun Yan
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China; Department of Anesthesiology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, China
| | - Nikolay Kamenshchikov
- Laboratory of Critical Care Medicine, Department of Anesthesiology and Intensive Care, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk, 634012, Russian Federation
| | - Ziyu Zheng
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
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Strickland B, Stuart Harris N. Adapting nitric oxide: A review of its foundation, uses in austere medical conditions, and emerging applications. Nitric Oxide 2024; 146:58-63. [PMID: 38583684 DOI: 10.1016/j.niox.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
Nitric oxide was first identified as a novel and effective treatment for persistent pulmonary hypertension of the newborn (PPHN), and has since been found to be efficacious in treating acute respiratory distress syndrome (ARDS) and pulmonary hypertension. Physicians and researchers have also found it shows promise in resource-constrained settings, both within and outside of the hospital, such as in high altitude pulmonary edema (HAPE) and COVID-19. The treatment has been well tolerated in these settings, and is both efficacious and versatile when studied across a variety of clinical environments. Advancements in inhaled nitric oxide continue, and the gas is worthy of investigation as physicians contend with new respiratory and cardiovascular illnesses, as well as unforeseen logistical challenges.
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Affiliation(s)
- Brian Strickland
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA.
| | - N Stuart Harris
- Division of Wilderness Medicine, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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de Jager J, Brouwer F, Reijman J, van der Palen RLF, Steggerda SJ, Visser R, Te Pas AB, Dekker J. Occurrence of hyperoxia during iNO treatment for persistent pulmonary hypertension of the newborn: a cohort study. Eur J Pediatr 2024; 183:2455-2461. [PMID: 38470520 PMCID: PMC11035448 DOI: 10.1007/s00431-024-05506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/16/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024]
Abstract
High concentrations of oxygen are often needed to optimize oxygenation in infants with persistent pulmonary hypertension (PPHN), but this can also increase the risk of hyperoxemia. We determined the occurrence of hyperoxemia in infants treated for PPHN. Medical records of infants ≥ 34 + 0 weeks gestational age (GA) who received inhaled nitric oxide (iNO) were retrospectively reviewed for oxygenation parameters during iNO therapy. Oxygen was manually titrated to target arterial oxygen tension (PaO2) 10-13 kPa and peripheral oxygen saturation (SpO2) 92-98%. The main study outcomes were the incidence and duration of hyperoxemia and hypoxemia and the fraction of inspired oxygen (FiO2). A total of 181 infants were included. The median FiO2 was 0.43 (IQR 0.34-0.56) and the maximum FiO2 was 1.0 in 156/181 (86%) infants, resulting in at least one PaO2 > 13 kPa in 149/181 (82%) infants, of which 46/149 (31%) infants had minimal one PaO2 > 30 kPa. SpO2 was > 98% in 179/181 (99%) infants for 17.7% (8.2-35.6%) of the iNO time. PaO2 < 10 kPa occurred in 160/181 (88%) infants, of which 81/160 (51%) infants had minimal one PaO2 < 6.7 kPa. SpO2 was < 92% in 169/181 (93%) infants for 1.6% (0.5-4.3%) of the iNO time. Conclusion: While treatment of PPHN is focused on preventing and reversing hypoxemia, hyperoxemia occurs inadvertently in most patients. What is Known: • High concentrations of oxygen are often needed to prevent hypoxemia-induced deterioration of PPHN, but this can also increase the risk of hyperoxemia. • Infants with persistent pulmonary hypertension may be particularly vulnerable to the toxic effects of oxygen, and hyperoxemia could further induce pulmonary vasoconstriction, potentially worsening the condition. What is New: • Hyperoxemia occurs in the majority of infants with PPHN during treatment with iNO. • Infants with PPHN spent a considerably longer period with saturations above the target range compared to saturations below the target range.
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Affiliation(s)
- Justine de Jager
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Fleur Brouwer
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Reijman
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco Visser
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Janneke Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Pozdnyakova DD, Bakhareva TА, Baranova IA, Selemir VD, Chuchalin AG. [Rehabilitation program of post-COVID-19 syndrome with the use of nitric oxide and molecular hydrogen]. TERAPEVT ARKH 2024; 96:260-265. [PMID: 38713041 DOI: 10.26442/00403660.2024.03.202639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/30/2024] [Indexed: 05/08/2024]
Abstract
Рost-COVID-19 syndrome (PS) is one of the medical and social problem. According to WHO, 10-20% of COVID-19 patients suffer from PS. The use of medical gases - inhaled nitric oxide (iNO) and molecular hydrogen (iH2) - may influence on the mechanisms of development PC. AIM To evaluate the safety and efficacy of the combined inhalation of NO and H2 (iNO/iH2) in patients with respiratory manifestations of PS. MATERIALS AND METHODS 34 patients with PS (11 men/23 women, 60.0±11.7 years) were included in the prospective open-label controlled study in parallel groups: the main group (n=17) received iNO/iH2 for 90 minutes once a day for 10 days (concentration of NO 60 ppm, H2<4% in the gas mixture), the control group (n=17) didn't receive inhalations. The period from the confirmation of COVID-19 to the start of the study was 641.8±230.5 days. The groups did not differ in the baseline parameters. The clinical symptoms (from the self-observation diary and mMRC questionnaires, "dyspnea language"), FAS, HADS, SF-36 scores, 6-minute walk test, the blood serum parameters of oxidative stress, the dynamics of the microcirculation in the eye bulbar conjunctiva were evaluated. The individual dose of iNO has chosen during a 15-minute test (the positive dynamics of the microcirculation have indicated that the dose was selected correctly). RESULTS The decrease the symptoms severity, such as dyspnea, cough, fatigue and palpitations (p<0.005), the increase in SF-36 questionnaire scores (p=0.006) and a reducing of FAS score (p=0.001), as well as the anxiety component of HADS (p=0.02) were revealed at the end of treatment in the main group compared to the control group. We observed an improvement in distance walked (p=0.01) and the values SpO2 (p=0.04) in 6-minute walk test, the increase in the volumetric blood flow velocity in venules (p<0.001), and the date in oxidative damage (p<0.001) and antioxidant activity (p=0.03) parameters in the blood serum. CONCLUSION The results of the study demonstrate clinical efficacy iNO/iH2 on clinical indicators, parameters of oxidative stress and microcirculation in patients with PS.
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Affiliation(s)
| | - T А Bakhareva
- Pirogov Russian National Research Medical University
| | - I A Baranova
- Pirogov Russian National Research Medical University
| | - V D Selemir
- Russian Federal Nuclear Center - All-Russian Research Institute of Experimental Physics
| | - A G Chuchalin
- Pirogov Russian National Research Medical University
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Gurram Venkata SKR, Lodha A, Hicks M, Jain A, Lapointe A, Makary H, Kanungo J, Lee KS, Ye X, Shah PS, Soraisham AS. Neurodevelopmental outcomes of preterm neonates receiving rescue inhaled nitric oxide in the first week of age: a cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:211-216. [PMID: 37890983 DOI: 10.1136/archdischild-2023-325418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To assess the neurodevelopmental outcomes of preterm neonates who received inhaled nitric oxide (iNO) in the first week of age for hypoxaemic respiratory failure (HRF). METHODS In this retrospective cohort study, we included neonates born at <29 weeks gestational age (GA) between January 2010 and December 2018 who had a neurodevelopmental assessment at 18-24 months corrected age (CA) at one of the Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment (NDI). We performed propensity score-matched analysis to compare the outcomes of those who received and did not receive iNO. RESULTS Of the 5612 eligible neonates, 460 (8.2%) received iNO in the first week of age. Maternal age, receipt of antenatal corticosteroids, GA and birth weight were lower in the iNO group compared with the no-iNO group. Neonates in the iNO group had higher illness severity scores and higher rates of preterm prolonged rupture of membranes and were small for GA. Severe brain injury, bronchopulmonary dysplasia and mortality were higher in the iNO group. Of the 4889 survivors, 3754 (77%) neonates had follow-up data at 18-24 months CA. After propensity score matching, surviving infants who received rescue iNO were not associated with higher odds of NDI (adjusted OR 1.34; 95% CI 0.85 to 2.12). CONCLUSIONS In preterm neonates <29 weeks GA with HRF, rescue iNO use was not associated with worse neurodevelopmental outcomes among survivors who were assessed at 18-24 months CA.
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Affiliation(s)
| | - Abhay Lodha
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Matthew Hicks
- Pediatrics, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Amish Jain
- Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anie Lapointe
- Pediatrics, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
| | - Hala Makary
- Pediatrics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jaideep Kanungo
- Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kyong-Soon Lee
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xiang Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital Pediatrics, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Amuchou S Soraisham
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Kuitunen I, Renko M. Inhaled nitric oxide in acute bronchiolitis: A systematic review and meta-analysis. Pediatr Pulmonol 2024; 59:426-432. [PMID: 37988259 DOI: 10.1002/ppul.26767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Until date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis. DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING Pediatric specialized healthcare. PATIENTS All infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization. INTERVENTION Inhaled nitric oxide. MAIN OUTCOME MEASURES Need for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random-effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE. RESULTS 186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was -11.3 h (CI: -26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70-1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04-14.40). Evidence certainty in both was rated as low. CONCLUSIONS Low certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.
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Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjo Renko
- Department of Pediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Schlapbach LJ, Gibbons KS, Horton SB, Johnson K, Long DA, Buckley DHF, Erickson S, Festa M, d’Udekem Y, Alphonso N, Winlaw DS, Delzoppo C, van Loon K, Jones M, Young PJ, Butt W, Schibler A. Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC Randomized Clinical Trial. JAMA 2022; 328:38-47. [PMID: 35759691 PMCID: PMC9237803 DOI: 10.1001/jama.2022.9376] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/30/2022]
Abstract
IMPORTANCE In children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation). OBJECTIVE To determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease. DESIGN, SETTING, AND PARTICIPANTS Double-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between July 2017 and April 2021, with 28-day follow-up of the last participant completed on May 24, 2021. INTERVENTIONS Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n = 679) or standard care cardiopulmonary bypass without nitric oxide (n = 685). MAIN OUTCOMES AND MEASURES The primary end point was the number of ventilator-free days from commencement of bypass until day 28. There were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the intensive care unit; length of stay in the hospital; and postoperative troponin levels. RESULTS Among 1371 patients who were randomized (mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%) completed the trial. The number of ventilator-free days did not differ significantly between the nitric oxide and standard care groups, with a median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2), respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to 0.22; P = .92). A total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28, for an adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary outcomes were not significantly different between the groups. CONCLUSIONS AND RELEVANCE In children younger than 2 years undergoing cardiopulmonary bypass surgery for congenital heart disease, the use of nitric oxide via cardiopulmonary bypass did not significantly affect the number of ventilator-free days. These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12617000821392.
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Affiliation(s)
- Luregn J. Schlapbach
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care and Neonatology, and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kristen S. Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen B. Horton
- Cardiac Surgical Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Kerry Johnson
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Debbie A. Long
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David H. F. Buckley
- Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand
| | - Simon Erickson
- Paediatric Critical Care, Perth Children’s Hospital, Western Australia and The University of Western Australia, Crawley, Western Australia, Australia
| | - Marino Festa
- Kids Critical Care Research, Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Yves d’Udekem
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Children’s National Hospital and The George Washington University School of Medicine and Health Sciences, Seattle, Washington
- Heart Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Nelson Alphonso
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Cardiac Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Medicine, Children’s Health Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - David S. Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Carmel Delzoppo
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kim van Loon
- Department of Anaesthesiology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Mark Jones
- Institute of Evidence Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul J. Young
- The Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Warwick Butt
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, Melbourne Medical School University of Melbourne, Victoria, Australia
- Central Clinical School Faculty of Medicine Monash University, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Critical Care Research Group, Wesley Medical Research, St Andrew’s War Memorial Hospital, Brisbane, Queensland, Australia
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Hong YH, Narwane M, Liu LYM, Huang YD, Chung CW, Chen YH, Liao BW, Chang YH, Wu CR, Huang HC, Hsu IJ, Cheng LY, Wu LY, Chueh YL, Chen Y, Lin CH, Lu TT. Enhanced Oral NO Delivery through Bioinorganic Engineering of Acid-Sensitive Prodrug into a Transformer-like DNIC@MOF Microrod. ACS Appl Mater Interfaces 2022; 14:3849-3863. [PMID: 35019259 DOI: 10.1021/acsami.1c21409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nitric oxide (NO) is an endogenous gasotransmitter regulating alternative physiological processes in the cardiovascular system. To achieve translational application of NO, continued efforts are made on the development of orally active NO prodrugs for long-term treatment of chronic cardiovascular diseases. Herein, immobilization of NO-delivery [Fe2(μ-SCH2CH2COOH)2(NO)4] (DNIC-2) onto MIL-88B, a metal-organic framework (MOF) consisting of biocompatible Fe3+ and 1,4-benzenedicarboxylate (BDC), was performed to prepare a DNIC@MOF microrod for enhanced oral delivery of NO. In simulated gastric fluid, protonation of the BDC linker in DNIC@MOF initiates its transformation into a DNIC@tMOF microrod, which consisted of DNIC-2 well dispersed and confined within the BDC-based framework. Moreover, subsequent deprotonation of the BDC-based framework in DNIC@tMOF under simulated intestinal conditions promotes the release of DNIC-2 and NO. Of importance, this discovery of transformer-like DNIC@MOF provides a parallel insight into its stepwise transformation into DNIC@tMOF in the stomach followed by subsequent conversion into molecular DNIC-2 in the small intestine and release of NO in the bloodstream of mice. In comparison with acid-sensitive DNIC-2, oral administration of DNIC@MOF results in a 2.2-fold increase in the oral bioavailability of NO to 65.7% in mice and an effective reduction of systolic blood pressure (SBP) to a ΔSBP of 60.9 ± 4.7 mmHg in spontaneously hypertensive rats for 12 h.
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Affiliation(s)
- Yong-Huei Hong
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Manmath Narwane
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Lawrence Yu-Min Liu
- Department of Medicine, Mackay Medical College, New Taipei City 252005, Taiwan
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu 300044, Taiwan
| | - Yi-Da Huang
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Chieh-Wei Chung
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yi-Hong Chen
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Bo-Wen Liao
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yu-Hsiang Chang
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Cheng-Ru Wu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Hsi-Chien Huang
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - I-Jui Hsu
- Department of Molecular Science and Engineering, Research and Development Center of Smart Textile Technology, National Taipei University of Technology, Taipei 106344, Taiwan
| | - Ling-Yun Cheng
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 320314, Taiwan
| | - Liang-Yi Wu
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan 320314, Taiwan
| | - Yu-Lun Chueh
- Department of Material Science and Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Yunching Chen
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Chia-Her Lin
- Department of Chemistry, National Taiwan Normal University, Taipei 116059, Taiwan
| | - Tsai-Te Lu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
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9
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Yao S, Wang Y, Chi J, Yu Y, Zhao Y, Luo Y, Wang Y. Porous MOF Microneedle Array Patch with Photothermal Responsive Nitric Oxide Delivery for Wound Healing. Adv Sci (Weinh) 2022; 9:e2103449. [PMID: 34783460 PMCID: PMC8787387 DOI: 10.1002/advs.202103449] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/01/2021] [Indexed: 05/09/2023]
Abstract
Patches with the capacity of controllable delivering active molecules toward the wound bed to promote wound healing are expectant all along. Herein, a novel porous metal-organic framework (MOF) microneedle (MN) patch enabling photothermal-responsive nitric oxide (NO) delivery for promoting diabetic wound healing is presented. As the NO-loadable copper-benzene-1,3,5-tricarboxylate (HKUST-1) MOF is encapsulated with graphene oxide (GO), the resultant NO@HKUST-1@GO microparticles (NHGs) are imparted with the feature of near-infrared ray (NIR) photothermal response, which facilitate the controlled release of NO molecules. When these NHGs are embedded in a porous PEGDA-MN, the porous structure, larger specific surface area, and sufficient mechanical strength of the integrated MN could promote a more accurate and deeper delivery of NO molecules into the wound site. By applying the resultant NHG-MN to the wound of a type I diabetic rat model, the authors demonstrate that it is capable of accelerating vascularization, tissue regeneration, and collagen deposition, indicating its bright prospect applied in wound healing and other therapeutic scenarios.
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Affiliation(s)
- Shun Yao
- State Key Laboratory of Toxicology and Medical CountermeasuresBeijing Institute of Pharmacology and ToxicologyBeijing100850China
| | - Yuetong Wang
- Department of Rheumatology and ImmunologyInstitute of Translational MedicineThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing210008China
- State Key Laboratory of BioelectronicsSchool of Biological Science and Medical EngineeringSoutheast UniversityNanjing210096China
| | - Junjie Chi
- State Key Laboratory of BioelectronicsSchool of Biological Science and Medical EngineeringSoutheast UniversityNanjing210096China
- Wenzhou InstituteUniversity of Chinese Academy of SciencesWenzhouZhejiang325001China
| | - Yunru Yu
- State Key Laboratory of BioelectronicsSchool of Biological Science and Medical EngineeringSoutheast UniversityNanjing210096China
- Wenzhou InstituteUniversity of Chinese Academy of SciencesWenzhouZhejiang325001China
| | - Yuanjin Zhao
- Department of Rheumatology and ImmunologyInstitute of Translational MedicineThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjing210008China
- State Key Laboratory of BioelectronicsSchool of Biological Science and Medical EngineeringSoutheast UniversityNanjing210096China
| | - Yuan Luo
- State Key Laboratory of Toxicology and Medical CountermeasuresBeijing Institute of Pharmacology and ToxicologyBeijing100850China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical CountermeasuresBeijing Institute of Pharmacology and ToxicologyBeijing100850China
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10
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Bacharier LB, Maspero JF, Katelaris CH, Fiocchi AG, Gagnon R, de Mir I, Jain N, Sher LD, Mao X, Liu D, Zhang Y, Khan AH, Kapoor U, Khokhar FA, Rowe PJ, Deniz Y, Ruddy M, Laws E, Patel N, Weinreich DM, Yancopoulos GD, Amin N, Mannent LP, Lederer DJ, Hardin M. Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma. N Engl J Med 2021; 385:2230-2240. [PMID: 34879449 DOI: 10.1056/nejmoa2106567] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [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: 11/19/2022]
Abstract
BACKGROUND Children with moderate-to-severe asthma continue to have disease complications despite the receipt of standard-of-care therapy. The monoclonal antibody dupilumab has been approved for the treatment of adults and adolescents with asthma as well as with other type 2 inflammatory diseases. METHODS In this 52-week phase 3, randomized, double-blind, placebo-controlled trial, we assigned 408 children between the ages of 6 and 11 years who had uncontrolled moderate-to-severe asthma to receive a subcutaneous injection of dupilumab (at a dose of 100 mg for those weighing ≤30 kg and 200 mg for those weighing >30 kg) or matched placebo every 2 weeks. All the children continued to receive a stable dose of standard background therapy. The primary end point was the annualized rate of severe asthma exacerbations. Secondary end points included the change from baseline in the percentage of predicted prebronchodilator forced expiratory volume in 1 second (ppFEV1) at week 12 and in the score on the Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) at week 24. End points were evaluated in the two primary efficacy populations who had either a type 2 inflammatory asthma phenotype (≥150 blood eosinophils per cubic millimeter or a fraction of exhaled nitric oxide of ≥20 ppb at baseline) or a blood eosinophil count of at least 300 cells per cubic millimeter at baseline. RESULTS In patients with the type 2 inflammatory phenotype, the annualized rate of severe asthma exacerbations was 0.31 (95% confidence interval [CI], 0.22 to 0.42) with dupilumab and 0.75 (95% CI, 0.54 to 1.03) with placebo (relative risk reduction in the dupilumab group, 59.3%; 95% CI, 39.5 to 72.6; P<0.001). The mean (±SE) change from baseline in the ppFEV1 was 10.5±1.0 percentage points with dupilumab and 5.3±1.4 percentage points with placebo (mean difference, 5.2 percentage points; 95% CI, 2.1 to 8.3; P<0.001). Dupilumab also resulted in significantly better asthma control than placebo (P<0.001). Similar results were observed in the patients with an eosinophil count of at least 300 cells per cubic millimeter at baseline. The incidence of serious adverse events was similar in the two groups. CONCLUSIONS Among children with uncontrolled moderate-to-severe asthma, those who received add-on dupilumab had fewer asthma exacerbations and better lung function and asthma control than those who received placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; Liberty Asthma VOYAGE ClinicalTrials.gov number, NCT02948959.).
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Affiliation(s)
- Leonard B Bacharier
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Jorge F Maspero
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Constance H Katelaris
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Alessandro G Fiocchi
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Remi Gagnon
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Ines de Mir
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Neal Jain
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Lawrence D Sher
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Xuezhou Mao
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Dongfang Liu
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yi Zhang
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Asif H Khan
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Upender Kapoor
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Faisal A Khokhar
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Paul J Rowe
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Yamo Deniz
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Marcella Ruddy
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Elizabeth Laws
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Naimish Patel
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David M Weinreich
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - George D Yancopoulos
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Nikhil Amin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Leda P Mannent
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - David J Lederer
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
| | - Megan Hardin
- From Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville (L.B.B.); Fundación CIDEA, Buenos Aires (J.F.M.); Campbelltown Hospital, Campbelltown, NSW, and Western Sydney University, Sydney (C.H.K.) - both in Australia; Bambino Gesù Children's Hospital IRCCS, Rome (A.G.F.); Clinique Spécialisée en Allergie de la Capitale, Quebec, QC, Canada (R.G.); Hospital Vall d'Hebron, Barcelona (I.M.); Arizona Allergy and Immunology Research, Gilbert (N.J.); Peninsula Research Associates, Rolling Hills Estates, CA (L.D.S.); Sanofi, Bridgewater, NJ (X.M., U.K., P.J.R., E.L.); Sanofi, Beijing (D.L.); Regeneron Pharmaceuticals, Tarrytown, NY (Y.Z., F.A.K., Y.D., M.R., D.M.W., G.D.Y., N.A., D.J.L.); Sanofi, Chilly-Mazarin, France (A.H.K., L.P.M.); and Sanofi Genzyme, Cambridge, MA (N.P., M.H.)
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11
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Han B, Song M, Li L, Sun X, Lei Y. The Application of Nitric Oxide for Ocular Hypertension Treatment. Molecules 2021; 26:molecules26237306. [PMID: 34885889 PMCID: PMC8659272 DOI: 10.3390/molecules26237306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 12/21/2022] Open
Abstract
Despite of various therapeutic methods for treating ocular hypertension and glaucoma, it still remains the leading cause of irreversible blindness. Intraocular pressure (IOP) lowering is the most effective way to slow disease progression and prevent blindness. Among the ocular hypotensive drugs currently in use, only a couple act on the conventional outflow system, which is the main pathway for aqueous humor outflow and the major lesion site resulting in ocular hypertension. Nitric oxide (NO) is a commendable new class of glaucoma drugs that acts on the conventional outflow pathway. An increasing number of nitric oxide donors have been developed for glaucoma and ocular hypertension treatment. Here, we will review how NO lowers IOP and the types of nitric oxide donors that have been developed. And a brief analysis of the advantages and challenges associated with the application will be made. The literature used in this review is based on Pubmed database search using ‘nitric oxide’ and ‘glaucoma’ as key words.
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12
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Michaelsen VS, Ribeiro RVP, Brambate E, Ali A, Wang A, Pires L, Kawashima M, Zhang Y, Gazzalle A, Keshavjee S, Del Sorbo L, Cypel M. A novel pre-clinical strategy to deliver antimicrobial doses of inhaled nitric oxide. PLoS One 2021; 16:e0258368. [PMID: 34644318 PMCID: PMC8513841 DOI: 10.1371/journal.pone.0258368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/25/2021] [Indexed: 11/26/2022] Open
Abstract
Effective treatment of respiratory infections continues to be a major challenge. In high doses (≥160 ppm), inhaled Nitric Oxide (iNO) has been shown to act as a broad-spectrum antimicrobial agent, including its efficacy in vitro for coronavirus family. However, the safety of prolonged in vivo implementation of high-dose iNO therapy has not been studied. Herein we aim to explore the feasibility and safety of delivering continuous high-dose iNO over an extended period of time using an in vivo animal model. Yorkshire pigs were randomized to one of the following two groups: group 1, standard ventilation; and group 2, standard ventilation + continuous iNO 160 ppm + methylene blue (MB) as intravenous bolus, whenever required, to maintain metHb <6%. Both groups were ventilated continuously for 6 hours, then the animals were weaned from sedation, mechanical ventilation and followed for 3 days. During treatment, and on the third post-operative day, physiologic assessments were performed to monitor lung function and other significative markers were assessed for potential pulmonary or systemic injury. No significant change in lung function, or inflammatory markers were observed during the study period. Both gas exchange function, lung tissue cytokine analysis and histology were similar between treated and control animals. During treatment, levels of metHb were maintained <6% by administration of MB, and NO2 remained <5 ppm. Additionally, considering extrapulmonary effects, no significant changes were observed in biochemistry markers. Our findings showed that high-dose iNO delivered continuously over 6 hours with adjuvant MB is clinically feasible and safe. These findings support the development of investigations of continuous high-dose iNO treatment of respiratory tract infections, including SARS-CoV-2.
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Affiliation(s)
- Vinicius S. Michaelsen
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rafaela V. P. Ribeiro
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Edson Brambate
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aadil Ali
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aizhou Wang
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Layla Pires
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mitsuaki Kawashima
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yu Zhang
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anajara Gazzalle
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lorenzo Del Sorbo
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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13
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Zavorsky GS, Almamary AS, Alqahtani MK, Shan SHS, Gardenhire DS. The need for race-specific reference equations for pulmonary diffusing capacity for nitric oxide. BMC Pulm Med 2021; 21:232. [PMID: 34256739 PMCID: PMC8278768 DOI: 10.1186/s12890-021-01591-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/31/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few reference equations exist for healthy adults of various races for pulmonary diffusing capacity for nitric oxide (DLNO). The purpose of this study was to collect pilot data to demonstrate that race-specific reference equations are needed for DLNO. METHODS African Americans (blacks) were chosen as the comparative racial group. In 2016, a total of 59 healthy black subjects (27 males and 32 females) were recruited to perform a full battery of pulmonary function tests. In the development of DLNO reference equations, a white reference sample (randomly drawn from a population) matched to the black sample for sex, age, and height was used. Multiple linear regression equations for DLNO, alveolar volume (VA), and pulmonary diffusing capacity for carbon monoxide (DLCO) using a 5-6 s breath-hold were developed. RESULTS Our models demonstrated that sex, age2, race, and height explained 71% of the variance in DLNO and DLCO, with race accounting for approximately 5-10% of the total variance. After normalizing for sex, age2, and height, blacks had a 12.4 and 3.9 mL/min/mmHg lower DLNO and DLCO, respectively, compared to whites. The lower diffusing capacity values in blacks are due, in part, to their 0.6 L lower VA (controlling for sex and height). CONCLUSION The results of this pilot data reveal small but important and statistically significant racial differences in DLNO and DLCO in adults. Future reference equations should account for racial differences. If these differences are not accounted for, then the risk of falsely diagnosing lung disease increase in blacks when using reference equations for whites.
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Affiliation(s)
- Gerald Stanley Zavorsky
- Pulmonary Services Department, University of California, Davis, Medical Center, 2315 Stockton Boulevard, Room 5703, Sacramento, CA, 95817, USA.
| | - Ahmad Saleh Almamary
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Shi Huh Samuel Shan
- Department of Respiratory Therapy, Georgia State University, Atlanta, GA, USA
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14
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Hao GW, Tu GW, Yu SJ, Luo JC, Liu K, Wang H, Ma GG, Su Y, Hou JY, Lai H, Fang Y, Luo Z. Inhaled nitric oxide reduces the intrapulmonary shunt to ameliorate severe hypoxemia after acute type A aortic dissection surgery. Nitric Oxide 2021; 109-110:26-32. [PMID: 33667622 DOI: 10.1016/j.niox.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the relationship between the intrapulmonary shunt and PaO2/FiO2 in severe hypoxemic patients after acute type A aortic dissection (ATAAD) surgery and to evaluate the effect of inhaled nitric oxide (iNO) on intrapulmonary shunt. METHODS Postoperative ATAAD patients with PaO2/FiO2 ≤ 150 mmHg were enrolled. Intrapulmonary shunt was calculated from oxygen content of different sites (artery [CaO2], mixed venous [CvO2], and alveolar capillary [CcO2]) using the Fick equation, where intrapulmonary shunt = (CcO2-CaO2)/(CcO2-CvO2). Related variables were measured at baseline (positive end expiratory pressure [PEEP] 5 cm H2O), 30 min after increasing PEEP (PEEP 10 cm H2O), 30 min after 5 ppm iNO therapy (PEEP 10 cm H2O + iNO), and 30 min after decreasing PEEP (PEEP 5 cm H2O + iNO). RESULTS A total of 20 patients were enrolled between April 2019 and December 2019. Intrapulmonary shunt and PaO2/FiO2 were correlated in severe hypoxemic, postoperative ATAAD patients (adjusted R2 = 0.467, p < 0.001). A mixed model for repeated measures revealed that iNO, rather than increasing PEEP, significantly decreased the intrapulmonary shunt (by 15% at a PEEP of 5 cm H2O and 16% at a PEEP of 10 cm H2O, p < 0.001 each) and increased PaO2/FiO2 (by 63% at a PEEP of 5 cm H2O and 65% at a PEEP of 10 cm H2O, p < 0.001 each). After iNO therapy, the decrement of intrapulmonary shunt and the increment of PaO2/FiO2 were also correlated (adjusted R2 = 0.375, p < 0.001). CONCLUSIONS This study showed that intrapulmonary shunt and PaO2/FiO2 were correlated in severe hypoxemic, postoperative ATAAD patients. Furthermore, iNO, rather than increasing PEEP, significantly decreased the intrapulmonary shunt to improve severe hypoxemic conditions.
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Affiliation(s)
- Guang-Wei Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shen-Ji Yu
- Department of Nursing, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jing-Chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Huan Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jun-Yi Hou
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hao Lai
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Fang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China; Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital Fudan University, No. 668 Jinghu Road, Huli District, Xiamen, 361015, China.
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15
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Ruta VM, Motoc NS, Todea DA, Alexescu TG, Valean D, Cozac S, Coste SC, Codea RA, Ungur RA, Pop CM, Milena AM. Modification of exhaled air nitric oxide in patients with asthma - cortisone monotherapy or dual inhalation therapy? Ann Agric Environ Med 2021; 28:89-93. [PMID: 33775072 DOI: 10.26444/aaem/130712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Asthma, a chronic lung disease, is a major health challenge worldwide with increased addressability to health services. There are different asthma phenotypes, which have different evolution and can be specifically tracked. The measurement of fractional expired nitric oxide (FeNo) with different devices reflects the eosinophilic inflammation of the airways, and can be used to evaluate the allergic phenotype and predict the treatment responses. The new GINA (Global Initiative for Asthma) guideline recommends FeNO monitoring to assess adherence to cortisone treatment in high doses before prescribing biological treatment, and as a means of monitoring the decrease in oral corticosteroid treatment. OBJECTIVE The aim of the study is to analyze the applicability of FeNO in monitoring response to therapy. MATERIAL AND METHODS An observational study was carried out on 129 subjects with a previously established diagnosis of asthma. The research was based on the determination of FeNO with NObreath. Those with intermediate FeNO received a low dose of inhaled corticosteroids in mono/dual therapy, those with increased FeNO received medium ICS mono/dual therapy. FeNO testing, its values and doses of ICS were below the the ATS / ERS guidelines. RESULTS FeNO reduction is strictly dependent on the cortisone dose. Applying the dual therapy from the beginning does not bring additional benefits in comparison with cortisone in monotherapy, in terms of FeNO value. CONCLUSIONS Recommendations that include FeNO testing can help monitor response to treatment.
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Affiliation(s)
| | - Nicoleta Stefania Motoc
- Department of Pneumology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Adina Todea
- Department of Pneumology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Gabriela Alexescu
- Department of Internal Medicine, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Valean
- MD student 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefania Cozac
- MD student 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorina Cezara Coste
- Department of Internal Medicine, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Razvan Andrei Codea
- Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - Rodica Ana Ungur
- Department of Rehabilitation, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Carmen Monica Pop
- Department of Pneumology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adina Man Milena
- Department of Pneumology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a significant clinical problem characterized by refractory and severe hypoxemia secondary to elevated pulmonary vascular resistance resulting in right-to-left extrapulmonary shunting of deoxygenated blood. PPHN is associated with diverse cardiopulmonary disorders and a high early mortality rate for infants with severe PPHN. Surviving infants with PPHN have an increased risk of long-term morbidities. PPHN physiology can be categorized by (1) maladaptation: pulmonary vessels have normal structure and number but have abnormal vasoreactivity; (2) excessive muscularization: increased smooth muscle cell thickness and increased distal extension of muscle to vessels that are usually not muscularized; and (3) underdevelopment: lung hypoplasia associated with decreased pulmonary artery number. Treatment involves adequate lung recruitment, optimization of cardiac output and left ventricular function, and pulmonary vasodilators such as inhaled nitric oxide. Infants who fail to respond to conventional therapy should be evaluated for lethal lung disorders including alveolar-capillary dysplasia, T-box transcription factor 4 gene, thyroid transcription factor-1, ATP-binding cassette A3 gene, and surfactant protein diseases.
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Affiliation(s)
- Erica Mandell
- Department of Pediatrics, The Pediatric Heart Lung Center, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - John P Kinsella
- Department of Pediatrics, The Pediatric Heart Lung Center, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Steven H Abman
- Department of Pediatrics, The Pediatric Heart Lung Center, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Section of Pulmonary Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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17
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Garfield B, McFadyen C, Briar C, Bleakley C, Vlachou A, Baldwin M, Lees N, Price S, Ledot S, McCabe C, Wort SJ, Patel BV, Price LC. Potential for personalised application of inhaled nitric oxide in COVID-19 pneumonia. Br J Anaesth 2021; 126:e72-e75. [PMID: 33288208 PMCID: PMC7666572 DOI: 10.1016/j.bja.2020.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Benjamin Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Charlotte Briar
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | | | | | - Melissa Baldwin
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Nick Lees
- Adult Intensive Care Unit, Harefield Hospital, Harefield, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - S John Wort
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - Brijesh V Patel
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; Anaesthetics, Pain Medicine and Intensive Care, Surgery and Cancer, Imperial College London, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK.
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18
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Pieretti JC, Rubilar O, Weller RB, Tortella GR, Seabra AB. Nitric oxide (NO) and nanoparticles - Potential small tools for the war against COVID-19 and other human coronavirus infections. Virus Res 2021; 291:198202. [PMID: 33086123 PMCID: PMC7568847 DOI: 10.1016/j.virusres.2020.198202] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
The endogenous free radical nitric oxide (NO) plays a pivotal role in the immunological system. NO has already been reported as a potential candidate for use in the treatment of human coronavirus infections, including COVID-19. In fact, inhaled NO has been used in clinical settings for its antiviral respiratory action, and in the regulation of blood pressure to avoid clot formation. In this mini-review, we discuss recent progress concerning the antivirus activity of NO in clinical, pre-clinical and research settings, and its beneficial effects in the treatment of clinical complications in patients infected with coronaviruses and other respiratory viral diseases, including COVID-19. We also highlight promising therapeutic effects of NO donors allied to nanomaterials to combat COVID-19 and other human coronavirus infections. Nanomaterials can be designed to deliver sustained, localized NO release directly at the desired application site, enhancing the beneficial effects of NO and minimizing the side effects. Challenges and perspectives are presented to open new fields of research.
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Affiliation(s)
- Joana C Pieretti
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil
| | - Olga Rubilar
- Department of Chemical Engineering, Universidad de La Frontera, Temuco, Chile; Centro de Excelencia en Investigación Biotecnologica Aplicada al Medio Ambiente (CIBAMA-BIOREN), Universidad de La Frontera, Temuco, Chile
| | - Richard B Weller
- Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Gonzalo R Tortella
- Department of Chemical Engineering, Universidad de La Frontera, Temuco, Chile; Centro de Excelencia en Investigación Biotecnologica Aplicada al Medio Ambiente (CIBAMA-BIOREN), Universidad de La Frontera, Temuco, Chile
| | - Amedea B Seabra
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil.
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Tang C, Jin X, Klosterman SJ, Wang Y. Convergent and distinctive functions of transcription factors VdYap1, VdAtf1, and VdSkn7 in the regulation of nitrosative stress resistance, microsclerotia formation, and virulence in Verticillium dahliae. Mol Plant Pathol 2020; 21:1451-1466. [PMID: 32954659 PMCID: PMC7549003 DOI: 10.1111/mpp.12988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 05/13/2023]
Abstract
Reactive oxygen/nitrogen species (ROS/RNS) play a fundamental role in plant-fungal interactions. How pathogenic fungi manipulate plant-derived ROS/RNS is of importance to the outcomes of these interactions. In this study, we explored the individual and combined contributions of three transcription factors, VdAtf1, VdYap1, and VdSkn7, in the response to ROS/RNS, microsclerotia formation, and virulence in the plant wilt pathogen Verticillium dahliae. We showed that VdYap1 is essential for ROS response. Additionally, mutants lacking any combination of the three genes shared significant hypersensitivity to nitro-oxidative stress like sodium nitroprusside dehydrate and double deletions lacking VdYap1 and VdAtf1 resulted in further increased sensitivity to ROS. Double deletion of VdAtf1 and VdSkn7 reduced melanin production and virulence while simultaneous lack of VdSkn7 and VdYap1 disrupted nitrogen metabolism and ROS resistance. Finally, comparison of transcriptional profiles of the respective single or double mutants in response to nitro-oxidative stress revealed that the three transcription factors are involved in denitrification of nitrated alkanes and lipids to protect against nitro-oxidative stress. Taken together, our results demonstrate convergent and distinctive functions of VdYap1, VdAtf1, and VdSkn7 in V. dahliae, and provide new data on their roles in response to ROS/RNS in fungi.
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Affiliation(s)
- Chen Tang
- Beijing Key Laboratory for Forest Pest ControlCollege of ForestryBeijing Forestry UniversityBeijingChina
| | - Xianjiang Jin
- Beijing Key Laboratory for Forest Pest ControlCollege of ForestryBeijing Forestry UniversityBeijingChina
| | - Steven J. Klosterman
- United States Department of AgricultureAgricultural Research ServiceSalinasCaliforniaUSA
| | - Yonglin Wang
- Beijing Key Laboratory for Forest Pest ControlCollege of ForestryBeijing Forestry UniversityBeijingChina
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Pieretti JC, Junho CVC, Carneiro-Ramos MS, Seabra AB. H 2S- and NO-releasing gasotransmitter platform: A crosstalk signaling pathway in the treatment of acute kidney injury. Pharmacol Res 2020; 161:105121. [PMID: 32798649 PMCID: PMC7426260 DOI: 10.1016/j.phrs.2020.105121] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a syndrome affecting most patients hospitalized due to kidney disease; it accounts for 15 % of patients hospitalized in intensive care units worldwide. AKI is mainly caused by ischemia and reperfusion (IR) injury, which temporarily obstructs the blood flow, increases inflammation processes and induces oxidative stress. AKI treatments available nowadays present notable disadvantages, mostly for patients with other comorbidities. Thus, it is important to investigate different approaches to help minimizing side effects such as the ones observed in patients subjected to the aforementioned treatments. Therefore, the aim of the current review is to highlight the potential of two endogenous gasotransmitters - hydrogen sulfide (H2S) and nitric oxide (NO) - and their crosstalk in AKI treatment. Both H2S and NO are endogenous signalling molecules involved in several physiological and pathophysiological processes, such as the ones taking place in the renal system. Overall, these molecules act by decreasing inflammation, controlling reactive oxygen species (ROS) concentrations, activating/inactivating pro-inflammatory cytokines, as well as promoting vasodilation and decreasing apoptosis, hypertrophy and autophagy. Since these gasotransmitters are found in gaseous state at environmental conditions, they can be directly applied by inhalation, or in combination with H2S and NO donors, which are compounds capable of releasing these molecules at biological conditions, thus enabling higher stability and slow release of NO and H2S. Moreover, the combination between these donor compounds and nanomaterials has the potential to enable targeted treatments, reduce side effects and increase the potential of H2S and NO. Finally, it is essential highlighting challenges to, and perspectives in, pharmacological applications of H2S and NO to treat AKI, mainly in combination with nanoparticulated delivery platforms.
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Affiliation(s)
- Joana Claudio Pieretti
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil
| | | | | | - Amedea Barozzi Seabra
- Center for Natural and Human Sciences (CCNH), Federal University of ABC (UFABC), Santo André, SP, Brazil.
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21
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Hedenstierna G, Chen L, Hedenstierna M, Lieberman R, Fine DH. Nitric oxide dosed in short bursts at high concentrations may protect against Covid 19. Nitric Oxide 2020; 103:1-3. [PMID: 32590117 PMCID: PMC7836301 DOI: 10.1016/j.niox.2020.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
It has long been suggested that NO may inhibit an early stage in viral replication. Furthermore, in vitro tests have shown that NO inhibits the replication cycle of severe acute respiratory syndrome coronavirus. Despite smoking being listed as a risk factor to contract Covid-19, only a low proportion of the smokers suffered from SARS-corona infection in China 2003, and from Covid-19 in China, Europe and the US. We hypothesize, that the intermittent bursts of high NO concentration in cigarette smoke may be a mechanism in protecting against the virus. Mainstream smoke from cigarettes contains NO at peak concentrations of between about 250 ppm and 1350 ppm in each puff as compared to medicinal use of no more than 80 to a maximum of 160 ppm. The diffusion of NO through the cell wall to reach the virus should be significantly more effective at the very high NO concentration in the smoke, according to classic laws of physics. The only oxide of nitrogen in the mainstream smoke is NO, and the NO2 concentration that is inhaled is very low or undetectable, and methemoglobin levels are lower in smokers than non-smokers, reasonably explained by the breaths of air in between the puffs that wash out the NO. Specialized iNO machines can now be developed to provide the drug intermittently in short bursts at high concentration dose, which would then provide both a preventative drug for those at high risk, as well as an effective treatment, without the health hazards associated with smoking.
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Affiliation(s)
| | - Luni Chen
- Department of MTC, Karolinska Institute, Solna, Sweden
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22
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Praveen A, Pandey A, Gupta M. Protective role of nitric oxide on nitrogen-thiol metabolism and amino acids profiling during arsenic exposure in Oryza sativa L. Ecotoxicology 2020; 29:825-836. [PMID: 32656654 DOI: 10.1007/s10646-020-02250-z] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
Nitric oxide (NO) being a signaling molecule inside the plant cells, play significant role in signaling cascades and protection against environmental stresses. However, the protective role of NO in alleviating As toxicity in rice plants is currently not available. In the present study, the level of NO, nitrogen (N), inorganic N (nitrate, ammonium), thiols {TT (Total thiols), NPT (Nonprotein thiol)} and AAs contents along with N assimilating enzymes (NR, GDH, GOGAT) were analyzed after exposure of AsIII/NO treatment alone, and in combination. NO supplementation enhanced the content of N, inorganic N & thiol contents, NR, GOGAT activities, when compared with AsIII exposure alone. In AsIII exposed rice seedlings, content of AAs (except His, Arg, Met) reduced over the control, while supplementation of SNP improved AAs contents, compared to AsIII treatment alone. In conclusion, rice seedlings supplemented with NO tolerate the AsIII toxicity by reducing the N related parameters, thiol contents, altering the AA profile and enhanced the nutritional quality by increasing EAAs (essential amino acids) and NEAAs (non-essential amino acids).
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Affiliation(s)
- Afsana Praveen
- Ecotoxicogenomics Lab, Department of Biotechnology, Jamia Millia Islamia, New Delhi-25, India
| | - Ashutosh Pandey
- National Institute of Plant Genome Research, Aruna Asaf Ali marg, New Delhi-67, India
| | - Meetu Gupta
- Ecotoxicogenomics Lab, Department of Biotechnology, Jamia Millia Islamia, New Delhi-25, India.
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Tavazzi G, Pozzi M, Mongodi S, Dammassa V, Romito G, Mojoli F. Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia. Crit Care 2020; 24:508. [PMID: 32807220 PMCID: PMC7429937 DOI: 10.1186/s13054-020-03222-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy.
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, DEA Piano -1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Marco Pozzi
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, DEA Piano -1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Silvia Mongodi
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, DEA Piano -1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Valentino Dammassa
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Giovanni Romito
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Francesco Mojoli
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, DEA Piano -1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy
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24
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Kamenshchikov NO, Anfinogenova YJ, Kozlov BN, Svirko YS, Pekarskiy SE, Evtushenko VV, Lugovsky VA, Shipulin VM, Lomivorotov VV, Podoksenov YK. Nitric oxide delivery during cardiopulmonary bypass reduces acute kidney injury: A randomized trial. J Thorac Cardiovasc Surg 2020; 163:1393-1403.e9. [PMID: 32718702 DOI: 10.1016/j.jtcvs.2020.03.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to evaluate the effects of nitric oxide (NO) supplementation to the CPB circuit on the development of cardiac surgery-associated AKI. METHODS This prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at ClinicalTrials.gov (identifier NCT03527381). Patients were randomly allocated to either NO supplementation to the CPB bypass circuit (NO treatment group; n = 48) or usual care (control group; n = 48). In the NO treatment group, 40-ppm NO was administered during the entire CPB period. The primary outcome was the incidence of AKI. RESULTS NO treatment was associated with a significant decrease in AKI incidence (10 cases [20.8%] vs 20 cases [41.6%] in the control group; relative risk, 0.5; 95% confidence interval, 0.26-0.95; P = .023) and a higher median urine output during CPB (2.6 mL/kg/h [interquartile range (IQR), 2.1-5.08 mL/kg/h] vs 1.7 mL/kg/h [IQR, 0.80-2.50 mL/kg/h]; P = .0002). The median urinary neutrophil gelatinase-associated lipocalin level at 4 hours after surgery was significantly lower in the NO treatment group (1.12 ng/mL [IQR, 0.75-5.8 ng/mL] vs 4.62 ng/mL [IQR, 2.02-34.55 ng/mL]; P = .005). In the NO treatment group, concentrations of NO metabolites were significantly increased at 5 minutes postclamping, at 5 minutes after declamping, and at the end of the operation. Concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not differ significantly between the 2 groups. CONCLUSIONS NO administration in patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a lower incidence of AKI.
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Affiliation(s)
- Nikolay O Kamenshchikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia.
| | - Yana J Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Boris N Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Department of Cardiovascular Surgery, Siberian State Medical University, Tomsk, Russia
| | - Yulia S Svirko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Department of Cardiovascular Surgery, Siberian State Medical University, Tomsk, Russia
| | - Stanislav E Pekarskiy
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Vladimir V Evtushenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Vladimir A Lugovsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Vladimir M Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Department of Cardiovascular Surgery, Siberian State Medical University, Tomsk, Russia
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Critical Care, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Yuriy K Podoksenov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Department of Cardiovascular Surgery, Siberian State Medical University, Tomsk, Russia
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25
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Schultz J, Andersen A, Gade IL, Kjaergaard B, Nielsen-Kudsk JE. Riociguat, sildenafil and inhaled nitric oxide reduces pulmonary vascular resistance and improves right ventricular function in a porcine model of acute pulmonary embolism. Eur Heart J Acute Cardiovasc Care 2020; 9:293-301. [PMID: 31025569 DOI: 10.1177/2048872619840772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary vasodilators as add-on to current treatment strategies in acute pulmonary embolism may improve right ventricular unloading and hence improve patient outcome. We aimed to investigate whether stimulation of the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway with riociguat, sildenafil or inhaled NO causes pulmonary vasodilation and improves right ventricular function in a porcine model of acute intermediate risk pulmonary embolism. METHODS Two large autologous blood clots were administered to the pulmonary circulation of 28 pigs (60 kg). Animals were randomized to four increasing, clinically equivalent doses of riociguat (n=6), sildenafil (n=6), inhaled NO (n=6) or vehicle (n=6). Sham animals (n=4) did not receive pulmonary embolism or treatment. Haemodynamic responses were evaluated at baseline, after pulmonary embolism and after each dose using invasive pressure measurements, transoesophageal echocardiography, respiratory parameters and blood analysis. RESULTS Pulmonary embolism caused a three-fold increase in pulmonary vascular resistance compared with baseline (pulmonary embolism: 352±29 vs. baseline: 107±6 dynes, p<0.0001). All treatments lowered pulmonary vascular resistance compared with vehicle (riociguat: -158±35, sildenafil: -224±35, inhaled NO: -156±35 dynes, p<0.0001). Sildenafil, but neither inhaled NO nor riociguat, caused a decrease in systemic vascular resistance (sildenafil 678±41 vs. vehicle 1081±93 dynes, p=0.02) and increased cardiac output (sildenafil 8.8±0.8 vs. vehicle: 5.9±0.2 L/min, p<0.001). Systemic blood pressure was unaltered in all treatment groups. CONCLUSION Stimulation of the NO-sGC-cGMP pathway by riociguat, sildenafil and inhaled NO reduces pulmonary vascular resistance in a porcine model of acute pulmonary embolism without lowering systemic blood pressure.
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Affiliation(s)
- Jacob Schultz
- Department of Cardiology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Asger Andersen
- Department of Cardiology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Inger Lise Gade
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark
- Department of Haematology, Aalborg University Hospital, Denmark
| | | | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
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Banez MJ, Geluz MI, Chandra A, Hamdan T, Biswas OS, Bryan NS, Von Schwarz ER. A systemic review on the antioxidant and anti-inflammatory effects of resveratrol, curcumin, and dietary nitric oxide supplementation on human cardiovascular health. Nutr Res 2020; 78:11-26. [PMID: 32428778 DOI: 10.1016/j.nutres.2020.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [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: 09/22/2019] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022]
Abstract
The potential benefits of supplemental nutrients and dietary interventions against cardiovascular morbidity and mortality have been extensively investigated throughout the years. Numerous supplements claim cardioprotection and reduction of cardiovascular risk factors, but the roles of many supplements have not been determined. In the vast number of supplements on the market asserting cardioprotective effects, only 3 have been thoroughly evaluated and consistently reported as effective by our clinic patients. They have used supplements such as fish oil, multivitamins, and calcium, but many had not known of the benefits of resveratrol, curcumin, and nitric oxide as supplements for improving cardiovascular health. The cardioprotective effects of these dietary supplements in both animal models and humans have been explored with proposed mechanisms of action mostly attributed to antioxidant and anti-inflammatory properties. Resveratrol is one of the most studied polyphenols with established cardiovascular benefits. Preclinical studies have demonstrated these effects exerted via improved inflammatory markers, atherogenic profile, glucose metabolism, and endothelial function and are further supported by clinical trials. Curcumin has a well-established anti-inflammatory role by regulating numerous transcription factors and cytokines linked to inflammation. Inflammation is an underlying pathology in cardiovascular diseases, rendering curcumin a potential therapeutic compound. Similarly, nitric oxide supplementation has demonstrated cardiovascular benefits by normalizing blood pressure; enhancing blood flow; and reducing inflammation, immune dysfunction, and oxidative stress. A comprehensive review was performed evaluating the cardioprotective effects of these 3 dietary supplements with hope to provide updated information, promote further awareness of these supplements, and inspire future studies on their effects on cardiovascular health.
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Affiliation(s)
- Melissa J Banez
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
| | - Matthew I Geluz
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
| | - Anjali Chandra
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
| | - Tesnim Hamdan
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
| | - Olivia S Biswas
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
| | - Nathan S Bryan
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030.
| | - Ernst R Von Schwarz
- Southern California Hospital Heart Institute, 3831 Hughes Ave, Suite 105, Culver City, CA 90232.
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27
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Li Y, Wu Y, Liao W, Hu L, Dawuda MM, Jin X, Tang Z, Yang J, Yu J. Nitric oxide is involved in the brassinolide-induced adventitious root development in cucumber. BMC Plant Biol 2020; 20:102. [PMID: 32138654 PMCID: PMC7059714 DOI: 10.1186/s12870-020-2320-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Brassinolide (BR), as a new type of plant hormones, is involved in the processes of plant growth and stress response. Previous studies have reported the roles of BR in regulating plant developmental processes and also response tolerance to abiotic stresses in plants. The main purpose of our study was to explore whether nitric oxide (NO) plays a role in the process of BR-induced adventitious root formation in cucumber (Cucumis sativus L.). RESULTS Exogenous application of 1 μM BR significantly promoted adventitious rooting, while high concentrations of BR (2-8 μM) effectively inhibited adventitious rooting. NO donor (S-nitroso-N-acerylpenicillamine, SNAP) promoted the occurrence of adventitious roots. Simultaneously, BR and SNAP applied together significantly promoted adventitious rooting and the combined effect was superior to the application of BR or SNAP alone. Moreover, NO scavenger (c-PTIO) and inhibitors (L-NAME and Tungstate) inhibited the positive effects of BR on adventitious rooting. BR at 1 μM also increased endogenous NO content, NO synthase (NOS-like) and Nitrate reductase (NR) activities, while BRz (a specific BR biosynthesis inhibitor) decreased these effects. In addition, the relative expression level of NR was up-regulated by BR and SNAP, whereas BRz down-regulated it. The application of NO inhibitor (Tungstate) in BR also inhibited the up-regulation of NR. CONCLUSION BR promoted the formation of adventitious roots by inducing the production of endogenous NO in cucumber.
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Affiliation(s)
- Yutong Li
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Yue Wu
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Weibiao Liao
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Linli Hu
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Mohammed Mujitaba Dawuda
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
- Department of Horticulture, FoA, University for Development Studies, P. O. Box TL 1882, Tamale, Ghana
| | - Xin Jin
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Zhongqi Tang
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Jianjun Yang
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China
| | - Jihua Yu
- College of Horticulture, Gansu Agricultural University, Lanzhou, 730070, People's Republic of China.
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28
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Lakshminrusimha S, Kinsella JP, Krishnan US, Van Meurs K, Edwards EM, Bhatt DR, Chandrasekharan P, Oei JL, Manja V, Ramanathan R, Abman SH. Just Say No to iNO in Preterms-Really? J Pediatr 2020; 218:243-252. [PMID: 31810629 DOI: 10.1016/j.jpeds.2019.10.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - John P Kinsella
- Department of Pediatrics, University of Colorado, Aurora, CO
| | | | - Krisa Van Meurs
- Department of Pediatrics, Stanford University, Palo Alto, CA
| | | | | | | | - Ju-Lee Oei
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Veena Manja
- Department of Pediatrics, University of California at Davis, Sacramento, CA
| | - Rangasamy Ramanathan
- Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado, Aurora, CO
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29
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Abstract
Randomized controlled trials in the 1990s confirmed the safety and efficacy of inhaled nitric oxide (iNO) in near-term and term newborns with hypoxemic respiratory failure and pulmonary hypertension, demonstrating improved oxygenation and reduced need for extracorporeal membrane oxygenation (ECMO) therapy. However, in about 30% to 40% of sick newborns, these improvements in oxygenation and hemodynamics are not sustained and affected infants often require rapid transfer to an ECMO center despite the initiation of iNO. Abrupt discontinuation of iNO therapy before transport in patients who have had little apparent clinical benefit can be harmful because of acute deterioration with severe hypoxemia. Thus, continued use of iNO therapy during hospital transfer of infants with pulmonary hypertension is important. In this review, we describe: 1) the history of iNO use during transport; 2) a practical approach to iNO during transport; and 3) guidelines for the initiation of iNO before or during transport.
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Affiliation(s)
- Jason Gien
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
- Children's Hospital Colorado, Aurora, CO
| | | | - John P Kinsella
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
- Children's Hospital Colorado, Aurora, CO
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30
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Sunil B, Rajsheel P, Aswani V, Bapatla RB, Talla SK, Raghavendra AS. Photosynthesis is sensitive to nitric oxide and respiration sensitive to hydrogen peroxide: Studies with pea mesophyll protoplasts. J Plant Physiol 2020; 246-247:153133. [PMID: 32065920 DOI: 10.1016/j.jplph.2020.153133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 05/27/2023]
Abstract
Reports on the effect of nitric oxide (NO) or reactive oxygen species (ROS) on photosynthesis and respiration in leaf tissues are intriguing; therefore, the effects of exogenous addition of sodium nitroprusside (SNP, releases NO) or H2O2 on the photosynthetic O2 evolution and respiratory O2 uptake by mesophyll protoplasts in pea (Pisum sativum) were evaluated in the present study. Low concentrations of SNP or H2O2 were used to minimize nonspecific effects. The effects of NO or H2O2 on respiration and photosynthesis were different. The presence of NO decreased the rate of photosynthesis but caused a marginal stimulation of dark respiration. Conversely, externally administered H2O2 drastically decreased the rate of respiration but only slightly decreased photosynthesis. The PS I activity was more sensitive to NO than PS II. On the other hand, 100 μM H2O2 had no effect on the photochemical reactions of either PS I or PS II. The sensitivity of photosynthesis to antimycin A or SHAM (reflecting the interplay between chloroplasts and mitochondria) was not affected by NO. By contrast, H2O2 markedly decreased the sensitivity of photosynthesis to antimycin A and SHAM. It can be concluded that chloroplasts are the primary targets of NO, while mitochondria are the primary targets of ROS in plant cells. We propose that H2O2 can be an important signal to modulate the crosstalk between chloroplasts and mitochondria.
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Affiliation(s)
- Bobba Sunil
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Pidakala Rajsheel
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Vetcha Aswani
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Ramesh B Bapatla
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Sai K Talla
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India
| | - Agepati S Raghavendra
- Department of Plant Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India.
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31
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MESH Headings
- Administration, Inhalation
- Female
- Hernias, Diaphragmatic, Congenital/blood
- Hernias, Diaphragmatic, Congenital/drug therapy
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/congenital
- Hypertension, Pulmonary/drug therapy
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/drug therapy
- Male
- Nitric Oxide/administration & dosage
- Platelet Count
- Retrospective Studies
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Affiliation(s)
- Christopher S Thom
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Devine
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stacey Kleinman
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik A Jensen
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michele P Lambert
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael A Padula
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Xiong Y, Chang LL, Tran B, Dai T, Zhong R, Mao YC, Zhu YZ. ZYZ-803, a novel hydrogen sulfide-nitric oxide conjugated donor, promotes angiogenesis via cross-talk between STAT3 and CaMKII. Acta Pharmacol Sin 2020; 41:218-228. [PMID: 31316179 PMCID: PMC7468320 DOI: 10.1038/s41401-019-0255-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/21/2019] [Indexed: 02/05/2023] Open
Abstract
Endothelial angiogenesis plays a vital role in recovery from chronic ischemic injuries. ZYZ-803 is a hybrid donor of hydrogen sulfide (H2S) and nitric oxide (NO). Previous studies showed that ZYZ-803 stimulated endothelial cell angiogenesis both in vitro and in vivo. In this study, we investigated whether the signal transducer and activator of transcription 3 (STAT3) and Ca2+/CaM-dependent protein kinase II (CaMKII) signaling was involved in ZYZ-803-induced angiogenesis. Treatment with ZYZ-803 (1 μM) significantly increased the phosphorylation of STAT3 (Tyr705) and CaMKII (Thr286) in human umbilical vein endothelial cells (HUVECs), these two effects had a similar time course. Pretreatment with WP1066 (STAT3 inhibitor) or KN93 (CAMKII inhibitor) blocked ZYZ-803-induced STAT3/CAMKII activation and significantly suppressed the proliferation and migration of HUVECs. In addition, pretreatment with the inhibitors significantly decreased ZYZ-803-induced tube formations along with the outgrowths of branch-like microvessels in aortic rings. In the mice with femoral artery ligation, administration of ZYZ-803 significantly increased the blood perfusion and vascular density in the hind limb, whereas co-administration of WP1066 or KN93 abrogated ZYZ-803-induced angiogenesis. By using STAT3 siRNA, we further explored the cross-talk between STAT3 and CaMKII in ZYZ-803-induced angiogenesis. We found that STAT3 knockdown suppressed ZYZ-803-induced HUVEC angiogenesis and affected CaMKII expression. ZYZ-803 treatment markedly enhanced the interaction between CaMKII and STAT3. ZYZ-803 treatment induced the nuclear translocation of STAT3. We demonstrated that both STAT3 and CaMKII functioned as positive regulators in ZYZ-803-induced endothelial angiogenesis and STAT3 was important in ZYZ-803-induced CaMKII activation, which highlights the beneficial role of ZYZ-803 in STAT3/CaMKII-related cardiovascular diseases.
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Affiliation(s)
- Ying Xiong
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China
| | - Ling-Ling Chang
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China
| | - Bahieu Tran
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China
| | - Tao Dai
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China
| | - Rui Zhong
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China
| | - Yi-Cheng Mao
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China.
| | - Yi-Zhun Zhu
- Institute of Biomedical Science and School of Pharmacy, Fudan University, Shanghai, 200032, China.
- School of Pharmacy, Macau University of Science and Technology, Macau, China.
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Alvarenga R, Auad AM, Moraes JC, Silva SE. Do silicon and nitric oxide induce resistance to Mahanarva spectabilis (Hemiptera: Cercopidae) in forage grasses? Pest Manag Sci 2019; 75:3282-3292. [PMID: 31006949 DOI: 10.1002/ps.5450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Great efforts have been made to identify grasses that are resistant to spittlebugs (Hemiptera: Cercopidae). However, the time required to develop and launch new cultivars is relatively long. The employment of resistance inducers is a current strategy that may be useful for the control of insect pests. This analysis evaluates the feasibility of using the chemical inducers silicon and nitric oxide to increase spittlebug resistance based on changes in forage grass vegetative characteristics and the biological traits of Mahanarva spectabilis (Distant, 1909). RESULTS Mahanarva spectabilis nymphs and adults can cause significant damage to forage grasses. Furthermore, silicon and nitric oxide inducers were not sufficient to lessen this damage by positively influencing the growth and development of forage grasses. These inducers did not negatively alter the biological parameters of M. spectabilis or diminish its population. However, phenolic compound concentrations increased when forage grasses were treated with silicon or attacked by adult insects, but this parameter was not useful to predict spittlebug resistance. This fact suggests that the physiological and biochemical changes caused by silicon should be further studied. CONCLUSION The current analysis demonstrated that application of the chemical inducers silicon and nitric oxide is currently not a viable strategy for the effective and economic management of M. spectabilis on Brachiaria ruziziensis, Pennisetum purpureum and Digitaria sp. © 2019 Society of Chemical Industry.
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Affiliation(s)
| | - Alexander M Auad
- Laboratory of Entomology, Brazilian Agricultural Research Corporation, Embrapa Dairy Cattle, Juiz de Fora, Brazil
| | - Jair C Moraes
- Entomology Department, Federal University of Lavras, Lavras, Brazil
| | - Sandra Eb Silva
- Laboratory of Entomology, Brazilian Agricultural Research Corporation, Embrapa Dairy Cattle, Juiz de Fora, Brazil
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Sung YC, Jin PR, Chu LA, Hsu FF, Wang MR, Chang CC, Chiou SJ, Qiu JT, Gao DY, Lin CC, Chen YS, Hsu YC, Wang J, Wang FN, Yu PL, Chiang AS, Wu AYT, Ko JJS, Lai CPK, Lu TT, Chen Y. Delivery of nitric oxide with a nanocarrier promotes tumour vessel normalization and potentiates anti-cancer therapies. Nat Nanotechnol 2019; 14:1160-1169. [PMID: 31740794 DOI: 10.1038/s41565-019-0570-3] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/03/2019] [Indexed: 05/28/2023]
Abstract
Abnormal tumour vasculature has a significant impact on tumour progression and response to therapy. Nitric oxide (NO) regulates angiogenesis and maintains vascular homeostasis and, thus, can be delivered to normalize tumour vasculature. However, a NO-delivery system with a prolonged half-life and a sustained release mechanism is currently lacking. Here we report the development of NanoNO, a nanoscale carrier that enables sustained NO release to efficiently deliver NO into hepatocellular carcinoma. Low-dose NanoNO normalizes tumour vessels and improves the delivery and effectiveness of chemotherapeutics and tumour necrosis factor-related, apoptosis-inducing, ligand-based therapy in both primary tumours and metastases. Furthermore, low-dose NanoNO reprogrammes the immunosuppressive tumour microenvironment toward an immunostimulatory phenotype, thereby improving the efficacy of cancer vaccine immunotherapy. Our findings demonstrate the ability of nanoscale NO delivery to efficiently reprogramme tumour vasculature and immune microenvironments to overcome resistance to cancer therapy, resulting in a therapeutic benefit.
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Affiliation(s)
- Yun-Chieh Sung
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Pei-Ru Jin
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
| | - Li-An Chu
- Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Fu-Fei Hsu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Mei-Ren Wang
- Department of Chemistry, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Chih-Chun Chang
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
| | - Show-Jen Chiou
- Department of Applied Chemistry, National Chiayi University, Chiayi, Taiwan
| | - Jiantai Timothy Qiu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Yu Gao
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
| | - Chu-Chi Lin
- Department of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Sing Chen
- Department of Biomedical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Jane Wang
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Fu-Nien Wang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Pei-Lun Yu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ann-Shyn Chiang
- Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Anthony Yan-Tang Wu
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
- Chemical Biology and Molecular Biophysics Program, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University, Taipei, Taiwan
| | - John Jun-Sheng Ko
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
| | - Charles Pin-Kuang Lai
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei, Taiwan
- Chemical Biology and Molecular Biophysics Program, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Tsai-Te Lu
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan.
- Department of Chemistry, Chung Yuan Christian University, Taoyuan, Taiwan.
| | - Yunching Chen
- Institute of Biomedical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan.
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Cochius-den Otter S, Schaible T, Greenough A, van Heijst A, Patel N, Allegaert K, van Rosmalen J, Tibboel D. The CoDiNOS trial protocol: an international randomised controlled trial of intravenous sildenafil versus inhaled nitric oxide for the treatment of pulmonary hypertension in neonates with congenital diaphragmatic hernia. BMJ Open 2019; 9:e032122. [PMID: 31694851 PMCID: PMC6858099 DOI: 10.1136/bmjopen-2019-032122] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that impairs normal lung development, causing pulmonary hypertension (PH). PH in CDH newborns is the main determinant for morbidity and mortality. Different therapies are still mainly based on 'trial and error'. Inhaled nitric oxide (iNO) is often the drug of first choice. However, iNO does not seem to improve mortality. Intravenous sildenafil has reduced mortality in newborns with PH without CDH, but prospective data in CDH patients are lacking. METHODS AND ANALYSIS In an open label, multicentre, international randomised controlled trial in Europe, Canada and Australia, 330 newborns with CDH and PH are recruited over a 4-year period (2018-2022). Patients are randomised for intravenous sildenafil or iNO. Sildenafil is given in a loading dose of 0.4 mg/kg in 3 hours; followed by continuous infusion of 1.6 mg/kg/day, iNO is dosed at 20 ppm. Primary outcome is absence of PH on day 14 without pulmonary vasodilator therapy and/or absence of death within the first 28 days of life. Secondary outcome measures include clinical and echocardiographic markers of PH in the first year of life. We hypothesise that sildenafil gives a 25% reduction in the primary outcome from 68% to 48% on day 14, for which a sample size of 330 patients is needed. An intention-to-treat analysis will be performed. A p-value (two-sided) <0.05 is considered significant in all analyses. ETHICS AND DISSEMINATION Ethics approval has been granted by the ethics committee in Rotterdam (MEC-2017-324) and the central Committee on Research Involving Human Subjects (NL60229.078.17) in the Netherlands. The principles of the Declaration of Helsinki, the Medical Research Involving Human Subjects Act and the national rules and regulations on personal data protection will be used. Parental informed consent will be obtained. TRIAL REGISTRATION NUMBER NTR6982; Pre-results.
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Affiliation(s)
- Suzan Cochius-den Otter
- Department of Intensive care and Pediatric Surgery, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Thomas Schaible
- Department of Neonatology, University Medical Center, Mannheim, Mannheim, Germany
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Arno van Heijst
- Department of Pediatrics, Division of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children Glasgow, Glasgow, UK
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Dick Tibboel
- Department of Intensive care and Pediatric Surgery, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Fang L, Ju W, Yang C, Duan C, Cui Y, Han F, Shen G, Zhang C. Application of signaling molecules in reducing metal accumulation in alfalfa and alleviating metal-induced phytotoxicity in Pb/Cd-contaminated soil. Ecotoxicol Environ Saf 2019; 182:109459. [PMID: 31344591 DOI: 10.1016/j.ecoenv.2019.109459] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
The utilization of forages grown on metal-contaminated soil can increase the risk of heavy metals entering the food chain and affecting human health because of elevated toxic metal concentrations. Meanwhile, hydrogen sulfide (H2S) and nitric oxide (NO) as signaling molecules are known to promote plant growth in metal-contaminated soils. However, the regulatory mechanisms of such molecules in plant physiology and soil biochemistry have not been well-documented. Hence, we investigate the role of the exogenous application of H2S and NO on alfalfa growth in lead/cadmium (Pb/Cd)-contaminated soil. Our results indicate that the signaling molecules increase the alfalfa chlorophyll and biomass content and improve alfalfa growth. Further, H2S and NO reduce the translocation and bioconcentration factors of Pb and Cd, potentially reducing the risk of heavy metals entering the food chain. These signaling molecules reduce metal-induced oxidative damage to alfalfa by mitigating reactive oxygen species accumulation and increasing antioxidant enzyme activities. Their exogenous application increases soil enzymatic activities, particularly of catalase and polyphenol oxidase, without significantly changing the composition and structure of rhizosphere bacterial communities. Interestingly, H2S addition enriches the abundance of plant-growth-promoting rhizobacteria in soil, including Nocardioides, Rhizobium, and Glycomyces. H2S is more effective than NO in improving alfalfa growth and reducing heavy-metal contamination of the food chain. These results provide new insights into the exogenous application of signaling molecules in alleviating metal-induced phytotoxicity, including an efficient strategy for the safe use of forages.
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Affiliation(s)
- Linchuan Fang
- State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau, Northwest A&F University, Yangling, 712100, China; CAS Center for Excellence in Quaternary Science and Global Change, Chinese Academy of Sciences, Xian, 710061, China
| | - Wenliang Ju
- Institute of Soil and Water Conservation, Chinese Academy of Sciences, Ministry of Water Resources, Yangling, 712100, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Congli Yang
- State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau, Northwest A&F University, Yangling, 712100, China
| | - Chengjiao Duan
- Institute of Soil and Water Conservation, Chinese Academy of Sciences, Ministry of Water Resources, Yangling, 712100, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yongxing Cui
- Institute of Soil and Water Conservation, Chinese Academy of Sciences, Ministry of Water Resources, Yangling, 712100, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Fu Han
- State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau, Northwest A&F University, Yangling, 712100, China
| | - Guoting Shen
- State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau, Northwest A&F University, Yangling, 712100, China
| | - Chao Zhang
- State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau, Northwest A&F University, Yangling, 712100, China.
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Abstract
BACKGROUND The molecular studies showed that Nitric oxide (NO) is an essential factor which regulates pulmonary artery tension. However, the conclusions of existing clinical studies were inconsistent. OBJECTIVE This meta-analysis is aimed to determine whether the inhalation of NO could improve oxygenation and reduce rate of death and use of extracorporeal membrane oxygenation (ECMO). METHODS The strategies used to search PubMed, The Cochrane Central Register of Controlled trials in the Cochrane Library, Embase, Web of science, Clinical Trials Registry, and China Biology Medicine disc, from inception to February, 2018. The primary outcomes were death or use of ECMO, death before hospital discharge, use of ECMO before hospital discharge, change in PaO2 after treatment. We assess the risk of bias in each included study by Cochrane Handbook, and calculated typical estimates of RR, each with its 95% CI, and for continuous outcomes, WMD or a summary estimate for SMD, each with its 95% CI. RESULTS Nine randomized controlled trials (RCTs) with a total of 856 participants were included in this meta-analysis. This meta-analysis revealed that the experimental group had significantly lower death or use of ECMO (RR 0.66, 95% CI 0.57-0.77, I = 0%, P < .00001) and lower use of ECMO before hospital discharge (RR 0.89, 95% CI 0.50-0.71, I = 0%, P < .00001) compared to control group. And in the infants without diaphragmatic hernia, experimental group had significantly higher change in PaO2 after treatment (MD 50.40, 95% CI 32.14-68.66, P < .00001). The meta-analysis also showing a tendency to improve in the death before hospital discharge (RR 0.89, 95% CI 0.60-1.31, I = 0%, P = .55) and the change in PaO2 after treatment of the infants with diaphragmatic hernia (MD 6.70, 95% CI -2.32 to 15.72, P < .00001, P = .15), but no difference between experimental group and control group. CONCLUSION We found that NO inhalation can improve oxygenation and reduce rate of death and use of ECMO in this meta-analysis. Therefore, we recommend the use of NO inhalation for infants born at or near term with respiratory failure.
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Walton DM, Minton SD, Cook AD. The potential of transdermal nitric oxide treatment for diabetic peripheral neuropathy and diabetic foot ulcers. Diabetes Metab Syndr 2019; 13:3053-3056. [PMID: 30030157 DOI: 10.1016/j.dsx.2018.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/15/2018] [Indexed: 11/22/2022]
Abstract
The Center for Disease Control (CDC) estimates that 29 million Americans have diabetes, and 70% of diabetic patients develop diabetic peripheral neuropathy [1,2]. Up to 27% of the direct medical cost of diabetes may be attributed to DPN [3]. A 2013 article from the American Diabetes Association reported a $176 billion direct medical cost of diabetes in 2012 [4]. DPN patients often suffer from shooting and burning pain in their distal limbs and a severe loss of sensation. Diabetic foot ulcers, infections, and amputations may follow. Currently available treatments: tricyclic antidepressants, anticonvulsants such as gabapentin and pregabalin, serotonin and norepinephrine reuptake inhibitor, duloxetine, topical 5% lidocaine (applied to the most painful area) can manage painful symptoms but do not address the underlying pathologies of DPN and diabetic wound ulcers. A combination of pain-reducing medications can provide relief when individual medications fail, and opioids such as tramadol and oxycodone may be administered with these medications to reduce pain [5]. Due to the prevalence of diabetes, DPN, and diabetic foot ulcers, and because of the lack of available effective treatments to directly address the pathology contributing to these conditions, novel treatments are being sought. Our hypothesis is that a deficiency of nitric oxide synthase in diabetic patients leads to a lack of vascularization of the peripheral nerves, which causes DPN; and this could be treated with vasodilators such as nitric oxide. In this paper, the mechanisms of DPN are reviewed and analyzed to elucidate the potential of a transdermal nitric oxide application for the treatment of DPN and diabetic wound ulcers by increasing vasodilation.
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Schlapbach LJ, Horton SB, Long DA, Beca J, Erickson S, Festa M, d’Udekem Y, Alphonso N, Winlaw D, Johnson K, Delzoppo C, van Loon K, Gannon B, Fooken J, Blumenthal A, Young P, Jones M, Butt W, Schibler A. Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial. BMJ Open 2019; 9:e026664. [PMID: 31420383 PMCID: PMC6701583 DOI: 10.1136/bmjopen-2018-026664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. METHODS AND ANALYSIS The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. ETHICS AND DISSEMINATION The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12617000821392.
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Stephen Brian Horton
- Cardiac Surgical Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Debbie Amanda Long
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - John Beca
- Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand
| | - Simon Erickson
- Paediatric Critical Care, Perth Children’s Hospital, Western Australia and The University of Western Australia, Crawley, Western Australia, Australia
| | - Marino Festa
- Kids Critical Care Research, Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, Children’s Health Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Nelson Alphonso
- Cardiac Surgery, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - David Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Johnson
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Carmel Delzoppo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kim van Loon
- Division of Anaesthetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B Gannon
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Antje Blumenthal
- The Infection and Inflammation Group, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Paul Young
- The Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Jones
- School of Public Health, Bond University, Gold Coast, Brisbane, Australia
| | - Warwick Butt
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
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Marrazzo F, Spina S, Zadek F, Lama T, Xu C, Larson G, Rezoagli E, Malhotra R, Zheng H, Bittner EA, Shelton K, Melnitchouk S, Roy N, Sundt TM, Riley WD, Williams P, Fisher D, Kacmarek RM, Thompson TB, Bonventre J, Zapol W, Ichinose F, Berra L. Protocol of a randomised controlled trial in cardiac surgical patients with endothelial dysfunction aimed to prevent postoperative acute kidney injury by administering nitric oxide gas. BMJ Open 2019; 9:e026848. [PMID: 31278097 PMCID: PMC6615910 DOI: 10.1136/bmjopen-2018-026848] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) is a common complication in cardiac surgery. Levels of intravascular haemolysis are strongly associated with postoperative AKI and with prolonged (>90 min) use of cardiopulmonary bypass (CPB). Ferrous plasma haemoglobin released into the circulation acts as a scavenger of nitric oxide (NO) produced by endothelial cells. Consequently, the vascular bioavailability of NO is reduced, leading to vasoconstriction and impaired renal function. In patients with cardiovascular risk factors, the endothelium is dysfunctional and cannot replenish the NO deficit. A previous clinical study in young cardiac surgical patients with rheumatic fever, without evidence of endothelial dysfunction, showed that supplementation of NO gas decreases AKI by converting ferrous plasma haemoglobin to ferric methaemoglobin, thus preserving vascular NO. In this current trial, we hypothesised that 24 hours administration of NO gas will reduce AKI following CPB in patients with endothelial dysfunction. METHODS This is a single-centre, randomised (1:1) controlled, parallel-arm superiority trial that includes patients with endothelial dysfunction, stable kidney function and who are undergoing cardiac surgery procedures with an expected CPB duration >90 min. After randomisation, 80 parts per million (ppm) NO (intervention group) or 80 ppm nitrogen (N2, control group) are added to the gas mixture. Test gases (N2 or NO) are delivered during CPB and for 24 hours after surgery. The primary study outcome is the occurrence of AKI among study groups. Key secondary outcomes include AKI severity, occurrence of renal replacement therapy, major adverse kidney events at 6 weeks after surgery and mortality. We are recruiting 250 patients, allowing detection of a 35% AKI relative risk reduction, assuming a two-sided error of 0.05. ETHICS AND DISSEMINATION The Partners Human Research Committee approved this trial. Recruitment began in February 2017. Dissemination plans include presentations at scientific conferences, scientific publications and advertising flyers and posters at Massachusetts General Hospital. TRIAL REGISTRATION NUMBER NCT02836899.
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Affiliation(s)
- Francesco Marrazzo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stefano Spina
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesco Zadek
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tenzing Lama
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Changhan Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grant Larson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emanuele Rezoagli
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rajeev Malhotra
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hui Zheng
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Shelton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Serguei Melnitchouk
- Department of Cardiac surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathalie Roy
- Department of Cardiac surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thoralf M Sundt
- Department of Cardiac surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William D Riley
- Department of Surgery, Cardiac Surgery, Perfusion Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Purris Williams
- Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Fisher
- Respiratory Care Services, Boston Medical Center, Boston, Massachusetts, USA
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, USA
- Department of Anesthesiology, Harvard University, Boston, USA
| | - Taylor B Thompson
- Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Bonventre
- Department of Medicine, Division of Renal Medicine, Brigham and Women’s Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Warren Zapol
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fumito Ichinose
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Su CH, Li WP, Tsao LC, Wang LC, Hsu YP, Wang WJ, Liao MC, Lee CL, Yeh CS. Enhancing Microcirculation on Multitriggering Manner Facilitates Angiogenesis and Collagen Deposition on Wound Healing by Photoreleased NO from Hemin-Derivatized Colloids. ACS Nano 2019; 13:4290-4301. [PMID: 30883107 DOI: 10.1021/acsnano.8b09417] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A deficiency of nitric oxide (NO) supply has been found to impair wound healing. The exogenous topical delivery of NO is a promising approach to enhance vasodilation and stimulate angiogenesis and collagen deposition. In this study, the CN groups on the surface of Prussian blue (PB) nanocubes were carefully reduced to -CH2-NH2 to conjugate with COOH group of hemin consisting of a Fe-porphyrin structure with strong affinity toward NO. Accordingly, the NO gas was able to coordinate to hemin-modified PB nanocubes. The hemin-modified PB carrying NO (PB-NO) can be responsible to near-infrared (NIR) light (808 nm) exposure to induce the thermo-induced liberation of NO based on the light-to-heat transformation property of PB nanocubes. The NO supply on the incisional wound sites can be readily topically dropped the colloidal solution of PB-NO for receiving NIR light irradiation. The enhanced blood flow was in a controllable manner whenever the wound sites containing PB-NO received NIR light irradiation. The promotion of blood perfusion following the on-demand multidelivery of NO has effectively facilitated the process of wound closure to enhance angiogensis and collagen deposition.
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Affiliation(s)
- Chia-Hao Su
- Institute for Translational Research in Biomedicine , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung 833 , Taiwan
| | | | | | | | | | | | - Min-Chiao Liao
- Institute for Translational Research in Biomedicine , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung 833 , Taiwan
| | - Chin-Lai Lee
- Institute for Translational Research in Biomedicine , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung 833 , Taiwan
| | - Chen-Sheng Yeh
- Department of Medicinal and Applied Chemistry , Kaohsiung Medical University , Kaohsiung 807 , Taiwan
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Bearl DW, Dodd DA, Thurm C, Hall M, Soslow JH, Feingold B, Godown J. Practice Variation, Costs and Outcomes Associated with the Use of Inhaled Nitric Oxide in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2019; 40:650-657. [PMID: 30547294 PMCID: PMC6855671 DOI: 10.1007/s00246-018-2042-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/08/2018] [Indexed: 01/06/2023]
Abstract
Right ventricular (RV) failure is a potentially fatal complication following heart transplantation (HTx). Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that is used to decrease pulmonary vascular resistance immediately post-HTx to reduce the risk of RV failure. The aim of this study was to describe utilization patterns, costs, and outcomes associated with post-transplant iNO use in children. All pediatric HTx recipients (2002-2016) were identified from a unique linked PHIS/SRTR dataset. Post-HTx iNO use was determined based on hospital billing data. Utilization patterns and associated costs were described. The association of iNO support with post-HTx survival was assessed using the Kaplan-Meier method and a multivariable Cox proportional hazards model was used to adjust for risk factors. A total of 2833 pediatric HTx recipients from 28 centers were identified with 1057 (36.5%) receiving iNO post-HTx. Post-HTx iNO use showed significant increase overall (17.2-54.7%, p < 0.001) and wide variation among centers (9-100%, p < 0.001). Patients with congenital heart disease (aOR 1.4, 95% CI 1.2, 1.6), requiring mechanical ventilation at HTx (aOR 1.3, 95% CI 1.1, 1.6), and pre-transplant iNO (aOR 9.3, 95% CI 5.4, 16) were more likely to receive iNO post-HTx. The median daily cost of iNO was $2617 (IQR $1843-$3646). Patients who required > 5 days of iNO post-HTx demonstrated inferior 1-year post-HTx survival (p < 0.001) and iNO use > 5 days was independently associated with worse post-HTx survival (AHR 1.6, 95% CI 1.2, 2.1; p < 0.001). There is wide variation in iNO use among centers following pediatric HTx with use increasing over time despite significant incremental cost. Prolonged iNO use post-HTx is associated with worse survival, likely serving as a marker of residual illness severity. Further research is needed to define the populations that derive the greatest benefit from this costly therapy.
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Affiliation(s)
- David W Bearl
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, 2200 Children's Way, Suite 5230 DOT, Nashville, TN, 37232-9119, USA.
| | - Debra A Dodd
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, 2200 Children's Way, Suite 5230 DOT, Nashville, TN, 37232-9119, USA
| | - Cary Thurm
- Children's Hospital Association, Lenexa, KS, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS, USA
| | - Jonathan H Soslow
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, 2200 Children's Way, Suite 5230 DOT, Nashville, TN, 37232-9119, USA
| | - Brian Feingold
- Pediatrics and Clinical and Translational Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Justin Godown
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, 2200 Children's Way, Suite 5230 DOT, Nashville, TN, 37232-9119, USA
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Auckburally A, Grubb TL, Wiklund M, Nyman G. Effects of ventilation mode and blood flow on arterial oxygenation during pulse-delivered inhaled nitric oxide in anesthetized horses. Am J Vet Res 2019; 80:275-283. [PMID: 30801218 DOI: 10.2460/ajvr.80.3.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the impact of mechanical ventilation (MV) and perfusion conditions on the efficacy of pulse-delivered inhaled nitric oxide (PiNO) in anesthetized horses. ANIMALS 27 healthy adult horses. PROCEDURES Anesthetized horses were allocated into 4 groups: spontaneous breathing (SB) with low (< 70 mm Hg) mean arterial blood pressure (MAP; group SB-L; n = 7), SB with physiologically normal (≥ 70 mm Hg) MAP (group SB-N; 8), MV with low MAP (group MV-L; 6), and MV with physiologically normal MAP (group MV-N; 6). Dobutamine was used to maintain MAP > 70 mm Hg. Data were collected after a 60-minute equilibration period and at 15 and 30 minutes during PiNO administration. Variables included Pao2, arterial oxygen saturation and content, oxygen delivery, and physiologic dead space-to-tidal volume ratio. Data were analyzed with Shapiro-Wilk, Mann-Whitney U, and Friedman ANOVA tests. RESULTS Pao2, arterial oxygen saturation, arterial oxygen content, and oxygen delivery increased significantly with PiNO in the SB-L, SB-N, and MV-N groups; were significantly lower in group MV-L than in group MV-N; and were lower in MV-N than in both SB groups during PiNO. Physiologic dead space-to-tidal volume ratio was highest in the MV-L group. CONCLUSIONS AND CLINICAL RELEVANCE Pulmonary perfusion impacted PiNO efficacy during MV but not during SB. Use of PiNO failed to increase oxygenation in the MV-L group, likely because of profound ventilation-perfusion mismatching. During SB, PiNO improved oxygenation irrespective of the magnitude of blood flow, but hypoventilation and hypercarbia persisted. Use of PiNO was most effective in horses with adequate perfusion.
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Giacomini M, Borotto E, Bosotti L, Denkewitz T, Reali-Forster C, Carlucci P, Centanni S, Mantero A, Iapichino G. Vardenafil and Weaning from Inhaled Nitric Oxide: Effect on Pulmonary Hypertension in ARDS. Anaesth Intensive Care 2019; 35:91-3. [PMID: 17323673 DOI: 10.1177/0310057x0703500113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/16/2022]
Abstract
We report a 66-year-old patient with refractory pulmonary hypertension secondary to ARDS who was being treated with inhaled nitric oxide. Enteral vardenafil (phosphodiesterase-5 inhibitor) was tried at two different doses (10 mg and 5 mg), in order to wean the patient from nitric oxide. The higher dose decreased pulmonary pressure but caused systemic hypotension and the drug was discontinued. Subsequently, a 5 mg dose of vardenafil decreased pulmonary pressure without hypotension. Pulmonary hypertension was controlled using vardenafil 10-15 mg divided in 2-3 daily doses. This therapy allowed nitric oxide withdrawal, weaning from mechanical ventilation and discharge from ICU. Vardenafil acted in synergy with inhaled nitric oxide, permitted nitric oxide reduction and discontinuation and proved to be effective as a single, long-term treatment for pulmonary hypertension.
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Affiliation(s)
- M Giacomini
- Anesthesia and Intensive Care Department, Cardiology Department and Pneumology Unit, Milan University, San Paolo Hospital, Milan, Italy
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Abstract
Nitric oxide (NO) is a gas that induces relaxation of smooth muscle cells in the vasculature. Because NO reacts with oxyhaemoglobin with high affinity, the gas is rapidly scavenged by oxyhaemoglobin in red blood cells and the vasodilating effects of inhaled NO are limited to ventilated regions in the lung. NO therefore has the unique ability to induce pulmonary vasodilatation specifically in the portions of the lung with adequate ventilation, thereby improving oxygenation of blood and decreasing intrapulmonary right to left shunting. Inhaled NO is used to treat a spectrum of cardiopulmonary conditions, including pulmonary hypertension in children and adults. However, the widespread use of inhaled NO is limited by logistical and financial barriers. We have designed, developed and tested a simple and economic NO generation device, which uses pulsed electrical discharges in air to produce therapeutic levels of NO that can be used for inhalation therapy. LINKED ARTICLES: This article is part of a themed section on Nitric Oxide 20 Years from the 1998 Nobel Prize. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.2/issuetoc.
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Affiliation(s)
- Binglan Yu
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Donald B Bloch
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
- Division of Rheumatology, Allergy and Immunology, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - Warren M Zapol
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
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46
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Ben Bouallègue F, Vauchot F, Bourdon A, Benkiran M, Boissin C, Charriot J, Bourdin A, Mariano-Goulart D. RV function improvement following nitric oxide inhalation demonstrated by gated blood pool SPECT in a patient with primary pulmonary hypertension. J Nucl Cardiol 2018; 25:2174-2176. [PMID: 29322380 DOI: 10.1007/s12350-017-1171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Fayçal Ben Bouallègue
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France.
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France.
| | - Fabien Vauchot
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Aurélie Bourdon
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Meriem Benkiran
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Clément Boissin
- Pneumology Department, Montpellier University Hospital, Montpellier, France
| | - Jérémy Charriot
- Pneumology Department, Montpellier University Hospital, Montpellier, France
| | - Arnaud Bourdin
- Pneumology Department, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France
| | - Denis Mariano-Goulart
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France
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Godolphin PJ, Montgomery AA, Woodhouse LJ, Bereczki D, Berge E, Collins R, Díez-Tejedor E, Gommans J, Lees KR, Ozturk S, Phillips S, Pocock S, Prasad K, Szatmari S, Wang Y, Bath PM, Sprigg N. Central adjudication of serious adverse events did not affect trial's safety results: Data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. PLoS One 2018; 13:e0208142. [PMID: 30475912 PMCID: PMC6258247 DOI: 10.1371/journal.pone.0208142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Central adjudication of serious adverse events (SAEs) can be undertaken in clinical trials, especially for open-label studies where outcome assessment may be at risk of bias. This study explored the effect of central adjudication of SAEs on the safety results of the Efficacy of Nitric Oxide in Stroke (ENOS) Trial. METHODS ENOS assigned patients with acute stroke at random to receive either transdermal glyceryl trinitrate (GTN) or no GTN and to Stop or Continue previous antihypertensive treatment. SAEs were reported by local investigators who were not blinded to treatment allocation. Central adjudicators, blinded to treatment allocation, reviewed the investigators reports and used evidence available to confirm or re-categorise the classification of event, likely causality, diagnosis and expectedness of event. RESULTS Of 4011 patients enrolled in ENOS, 1473 SAEs were reported by local investigators; this was reduced to 1444 after the review by adjudicators, with 29 re-classified as not an SAE. There was fair agreement between investigators and adjudicators regarding likely causality, with 808 agreements and 644 disagreements (56% crude agreement, weighted kappa, κ = 0.31). Agreement increased upon dichotomisation of the causality categories, with 1432 agreements and 20 disagreements (99% crude agreement, kappa = 0.54). Repeating the main trial safety analysis with investigator reported events showed that adjudication had no effect on the main trial safety conclusions. CONCLUSIONS In a large trial, with many SAEs reported, central adjudication of these events did not affect trial conclusions. This suggests that adjudication of SAEs in a clinical trial where the intervention already has a well-established safety profile may not be necessary. Potential efficiency savings (financial, logistical) can be made through not adjudicating SAEs.
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Affiliation(s)
- Peter J. Godolphin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Alan A. Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Eivind Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Exuperio Díez-Tejedor
- Department of Neurology, La Paz University Hospital–Autonoma University of Madrid, Madrid, Spain
| | | | | | | | - Stephen Phillips
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
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Nagasaka Y, Fernandez BO, Steinbicker AU, Spagnolli E, Malhotra R, Bloch DB, Bloch KD, Zapol WM, Feelisch M. Pharmacological preconditioning with inhaled nitric oxide (NO): Organ-specific differences in the lifetime of blood and tissue NO metabolites. Nitric Oxide 2018; 80:52-60. [PMID: 30114529 PMCID: PMC6198794 DOI: 10.1016/j.niox.2018.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endogenous nitric oxide (NO) may contribute to ischemic and anesthetic preconditioning while exogenous NO protects against ischemia-reperfusion (I/R) injury in the heart and other organs. Why those beneficial effects observed in animal models do not always translate into clinical effectiveness remains unclear. To mitigate reperfusion damage a source of NO is required. NO inhalation is known to increase tissue NO metabolites, but little information exists about the lifetime of these species. We therefore sought to investigate the fate of major NO metabolite classes following NO inhalation in mice in vivo. METHODS C57BL/6J mice were exposed to 80 ppm NO for 1 h. NO metabolites were measured in blood (plasma and erythrocytes) and tissues (heart, liver, lung, kidney and brain) immediately after NO exposure and up to 48 h thereafter. Concentrations of S-nitrosothiols, N-nitrosamines and NO-heme products as well as nitrite and nitrate were quantified by gas-phase chemiluminescence and ion chromatography. In separate experiments, mice breathed 80 ppm NO for 1 h prior to cardiac I/R injury (induced by coronary arterial ligation for 1 h, followed by recovery). After sacrifice, the size of the myocardial infarction (MI) and the area at risk (AAR) were measured. RESULTS After NO inhalation, elevated nitroso/nitrosyl levels returned to baseline over the next 24 h, with distinct multi-phasic decay profiles in each compartment. S/N-nitroso compounds and NO-hemoglobin in blood decreased exponentially, but remained above baseline for up to 30min, whereas nitrate was elevated for up to 3hrs after discontinuing NO breathing. Hepatic S/N-nitroso species concentrations remained steady for 30min before dropping exponentially. Nitrate only rose in blood, liver and kidney; nitrite tended to be lower in all organs immediately after NO inhalation but fluctuated considerably in concentration thereafter. NO inhalation before myocardial ischemia decreased the ratio of MI/AAR by 30% vs controls (p = 0.002); only cardiac S-nitrosothiols and NO-hemes were elevated at time of reperfusion onset. CONCLUSIONS Metabolites in blood do not reflect NO metabolite status of any organ. Although NO is rapidly inactivated by hemoglobin-mediated oxidation in the circulation, long-lived tissue metabolites may account for the myocardial preconditioning effects of inhaled NO. NO inhalation may afford similar protection in other organs.
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Affiliation(s)
- Yasuko Nagasaka
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bernadette O Fernandez
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Andrea U Steinbicker
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, University of Münster, Münster, Germany
| | - Ester Spagnolli
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajeev Malhotra
- Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, UK
| | - Donald B Bloch
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth D Bloch
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, UK
| | - Warren M Zapol
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Martin Feelisch
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, UK; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
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Moon CY, Nam OH, Kim M, Lee HS, Kaushik SN, Cruz Walma DA, Jun HW, Cheon K, Choi SC. Effects of the nitric oxide releasing biomimetic nanomatrix gel on pulp-dentin regeneration: Pilot study. PLoS One 2018; 13:e0205534. [PMID: 30308037 PMCID: PMC6181396 DOI: 10.1371/journal.pone.0205534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation.
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Affiliation(s)
- Chan-Yang Moon
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Misun Kim
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Sagar N. Kaushik
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - David A. Cruz Walma
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ho-Wook Jun
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kyounga Cheon
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail: (SCC); (KC)
| | - Sung Chul Choi
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
- * E-mail: (SCC); (KC)
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Thomas CA, Valentine K. Utility of routine methemoglobin laboratory assays in critically ill pediatric subjects receiving inhaled nitric oxide. J Crit Care 2018; 48:63-65. [PMID: 30172035 DOI: 10.1016/j.jcrc.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/04/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Inhaled nitric oxide (iNO) has been associated with safety risks including reports of methemoglobinemia. While standard of care recommends routine monitoring of methemoglobin in subjects on iNO therapy, the utility of this practice remains unknown. MATERIALS AND METHODS This retrospective chart review aimed to determine the frequency of methemoglobinemia in pediatric patients receiving iNO. Included subjects were under 18 years of age receiving iNO therapy with at least one methemoglobin concentration measured from 10/18/2014 to 11/18/2016. RESULTS In total, 1809 methemoglobin concentrations were collected in 247 subjects during the study period. Median age was 0.33 (0.04-0.83) years. The mean methemoglobin concentration was 1.33% (±0.42) while receiving a mean iNO dose of 11.71 ppm (±7.97). Twenty-nine subjects had a total of 131 methemoglobin concentrations analyzed while receiving iNO doses above 20 ppm which were similar to the entire cohort at 1.33% (±0.42); (p = .95). CONCLUSIONS Pediatric patients receiving iNO at doses below 40 ppm have minimal risk of developing clinically significant methemoglobinemia. Routine, ongoing monitoring of metHb levels in all pediatric subjects receiving iNO therapy at doses <40 ppm without the presence of risk factors predisposing the subject to increased risk of methemoglobinemia is unnecessary and should be avoided.
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Affiliation(s)
- Christopher A Thomas
- Department of Pharmacy Services, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, USA.
| | - Kevin Valentine
- Section of Pediatric Cardiac Intensive Care, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Indianapolis, IN, USA; Department of Pediatrics, Indiana University School of Medicine, 340 W. 10th St. #6200, Indianapolis, IN, USA
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