1
|
Wei HL, Ao MQ, Wang MY, Zhou GP, Yu YS, Tao Q, Zhang H. Disrupted resting-state functional connectivity of the thalamus in patients with coronary heart disease. Heliyon 2023; 9:e13423. [PMID: 36814614 PMCID: PMC9939614 DOI: 10.1016/j.heliyon.2023.e13423] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Background Although homeostasis of the cardiovascular system is regulated by the cerebral cortex via the autonomic nervous system, the role of abnormal brain functional connectivity (FC) networks in patients with cardiac dysfunction remains unclear. Here, we report thalamus-based FC alterations and their relationship with clinical characteristics in patients with coronary heart disease (CHD). Methods We employed resting-state functional magnetic resonance imaging (rs-fMRI) to acquire imaging data in twenty-six patients with CHD alongside sixteen healthy controls (HCs). Next, we performed a thalamus-based FC analysis to profile abnormal FC patterns in the whole brain. Subsequently, the mean time series of the brain regions that survived in the FC analysis were used to determine correlations with clinical parameters in patients with CHD. Results We found no statistically significant differences in demographic and clinical data between patients with CHD and HCs. Patients with CHD showed decreased FC patterns between bilateral thalami and left hemisphere, encompassing supplementary motor area, superior frontal gyrus, superior parietal gyrus, inferior parietal gyrus, middle cingulate cortex, lingual gyrus and calcarine sulcus. Conclusions These findings not only have implications in clarifying the relationship between cerebral functional imbalance and cardiovascular system, but also provide valuable insights to guide future evaluation and management of cardiac autonomic regulation via the brain-heart axis.
Collapse
Key Words
- ANS, autonomic nervous system
- CHD, coronary heart disease
- CNS, central nervous system
- CVD, cardiovascular disease
- Coronary heart disease
- DMN, default mode network
- ECN, executive control network
- FC, functional connectivity
- Functional connectivity analysis
- Functional magnetic resonance imaging
- IPG, inferior parietal gyrus
- MCC, middle cingulate cortex
- MCI, myocardial ischemia
- MoCA, Montreal Cognitive Assessment
- Resting-state
- Rs-fMRI, resting-state functional magnetic resonance imaging
- SFG, superior frontal gyrus
- SMA, supplementary motor area
- SMN, sensorimotor network
- SN, salient network
- SNS, sympathetic nervous system
- SPG, superior parietal gyrus
- Thalamus
Collapse
Affiliation(s)
- Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Ming-Qiang Ao
- Department of Cardiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Meng-Yao Wang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China
| | - Qin Tao
- Department of Cardiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China,Corresponding author.
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu 211100, China,Corresponding author. Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169, Hushan Road, Nanjing, Jiangsu Province, 211100, China.
| |
Collapse
|
2
|
Warner II ER, Satapathy SK. Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions. J Clin Exp Hepatol 2023; 13:162-177. [PMID: 36647414 PMCID: PMC9840086 DOI: 10.1016/j.jceh.2022.06.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Cirrhosis predisposes to abnormalities in energy, hormonal, and immunological homeostasis. Disturbances in these metabolic processes create susceptibility to sarcopenia or pathological muscle wasting. Sarcopenia is prevalent in cirrhosis and its presence portends significant adverse outcomes including the length of hospital stay, infectious complications, and mortality. This highlights the importance of identification of at-risk individuals with early nutritional, therapeutic and physical therapy intervention. This manuscript summarizes literature relevant to sarcopenia in cirrhosis, describes current knowledge, and elucidates possible future directions.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- ACE-I, angiotensin-converting enzyme inhibitor
- AKI, acute kidney injury
- ALM, appendicular lean mass
- ARB, angiotensin receptor blocker
- ASM, appendicular skeletal mass
- AT1R, angiotensin type 1 receptor
- AT2R, angiotensin type 2 receptor
- ATP, adenosine-5′-triphosphate
- AWGS, Asian Working Group for Sarcopenia
- BCAA, branched chained amino acids
- BIA, bioelectrical impedance analysis
- BMI, body mass index
- CART, classification and regression tree
- CKD, chronic kidney disease
- CRP, C-reactive protein
- DEXA, dual energy X-ray absorptiometry
- EAA, essential amino acids
- ESPEN-SIG, European Society for Clinical Nutrition and Metabolism Special Interests Groups
- ESRD, end-stage renal disease
- EWGSOP, European Working Group on Sarcopenia in Older People
- FAD, flavin adenine dinucleotide
- FADH2, flavin adenine dinucleotide +2 hydrogen
- FNIH, Foundation for the National Institutes of Health
- GTP, guanosine-5′-triphosphate
- GnRH, gonadotrophin-releasing hormone
- HCC, hepatocellular carcinoma
- HPT, hypothalamic-pituitary-testicular
- IFN-γ, interferon γ
- IGF-1, insulin-like growth factor 1
- IL-1, interleukin-1
- IL-6, interleukin-6
- IWGS, International Working Group on Sarcopenia
- LH, luteinizing hormone
- MELD, Model for End-Stage Liver Disease
- MuRF1, muscle RING-finger-1
- NAD, nicotinamide adenine dinucleotide
- NADH, nicotinamide adenine dinucleotide + hydrogen
- NADPH, nicotinamide adenine dinucleotide phosphate
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- NF-κβ, nuclear factor κβ
- NHANES, National Health and Nutritional Examination Survey
- PMI, psoas muscle index
- PMTH, psoas muscle thickness
- RAAS, renin-angiotensin-aldosterone system
- ROS, reactive oxygen species
- SARC-F, Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls
- SHBG, sex hormone binding globulin
- SMI, skeletal muscle index
- SNS, sympathetic nervous system
- SPPB, Short Performance Physical Battery
- TNF-α, tumor necrosis factor α
- UCSF, University of California, San Francisco
- UNOS, United Network of Organ Sharing
- cirrhosis
- energy
- mTOR, mammalian target of rapamycin
- metabolism
- muscle
- sarcopenia
Collapse
Affiliation(s)
- Edgewood R. Warner II
- Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Sanjaya K. Satapathy
- Division of Hepatology and Northwell Health Center for Liver Diseases and Transplantation, Department of Medicine, Donald and Barbara Zucker School of Medicine/Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| |
Collapse
|
3
|
Roberts CJ, Hopp FA, Hogan QH, Dean C. Anandamide in the dorsal periaqueductal gray inhibits sensory input without a correlation to sympathoexcitation. Neurobiol Pain 2022; 12:100104. [PMID: 36531614 PMCID: PMC9755024 DOI: 10.1016/j.ynpai.2022.100104] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
There is growing literature supporting cannabinoids as a potential therapeutic for pain conditions. The development of chronic pain has been associated with reduced concentrations of the endogenous cannabinoid anandamide (AEA) in the midbrain dorsal periaqueductal gray (dPAG), and microinjections of synthetic cannabinoids into the dPAG are antinociceptive. Therefore, the goal of this study was to examine the role of the dPAG in cannabinoid-mediated sensory inhibition. Given that cannabinoids in the dPAG also elicit sympathoexcitation, a secondary goal was to assess coordination between sympathetic and antinociceptive responses. AEA was microinjected into the dPAG while recording single unit activity of wide dynamic range (WDR) dorsal horn neurons (DHNs) evoked by high intensity mechanical stimulation of the hindpaw, concurrently with renal sympathetic nerve activity (RSNA), in anesthetized male rats. AEA microinjected into the dPAG decreased evoked DHN activity (n = 24 units), for half of which AEA also elicited sympathoexcitation. AEA actions were mediated by cannabinoid 1 receptors as confirmed by local pretreatment with the cannabinoid receptor antagonist AM281. dPAG microinjection of the synaptic excitant DL-homocysteic acid (DLH) also decreased evoked DHN activity (n = 27 units), but in all cases this was accompanied by sympathoexcitation. Thus, sensory inhibition elicited from the dPAG is not exclusively linked with sympathoexcitation, suggesting discrete neuronal circuits. The rostrocaudal location of sites may affect evoked responses as AEA produced sensory inhibition without sympathetic effects at 86 % of caudal compared to 25 % of rostral sites, supporting anatomically distinct neurocircuits. These data indicate that spatially selective manipulation of cannabinoid signaling could provide analgesia without potentially harmful autonomic activation.
Collapse
Key Words
- AEA, N-arachidonylethanolamine, anandamide
- Antinociception
- CB1R, cannabinoid type one receptor
- CV, cardiovascular
- Cannabinoid
- DHN, dorsal horn neuron
- DLH, DL-homocysteic acid
- Dorsal horn
- FAAH, fatty acid amide hydrolase
- GPCR, G protein-coupled receptor
- IML, intermediolateral cell column
- MAP, mean arterial pressure
- NTS, nucleus tractus solitarius
- PAG, periaqueductal gray
- PPAR, peroxisome proliferator activated receptor
- RSNA, renal sympathetic nerve activity
- RVLM, rostral ventrolateral medulla
- RVMM, rostral ventromedial medulla
- Rat
- SIA, stress-induced analgesia
- SNS, sympathetic nervous system
- Sympathetic nervous system
- TRPV1, transient receptor potential vanilloid type 1
- WDR, wide dynamic range
- dPAG, dorsal periaqueductal gray
- vPAG, ventral periaqueductal gray
Collapse
Affiliation(s)
- Christopher J. Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
| | - Francis A. Hopp
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
| | - Quinn H. Hogan
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
| | - Caron Dean
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA,Corresponding author at: Department of Anesthesiology, Research Service 151, Zablocki VA Medical Center, Milwaukee, WI 53295, USA.
| |
Collapse
|
4
|
Abstract
Hyponatremia is the most common electrolyte abnormality in patients with decompensated cirrhosis on Liver Transplantation (LT) waiting list. Most of these patients have dilutional or hypervolemic hyponatremia secondary to splanchnic vasodilatation. Excessive secretion of the antidiuretic hormone also plays an important role. Hypervolemic hyponatremia is commonly associated with refractory ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. Although uncommon, the use of diuretics and laxatives can cause hypovolemic hyponatremia that is characterized by the striking absence of ascites or pedal edema. Clinical features are often nonspecific and depend on the acuity of onset rather than the absolute value of serum sodium. Symptoms may be subtle, including nausea, lethargy, weakness, or anorexia. However, rarely patients may present with confusion, seizures, psychosis, or coma. Treatment includes discontinuation of diuretics, beta-blockers, and albumin infusion. Hypertonic saline (3%) infusion may be used in patients with very low serum sodium (<110 mmol/L) or when patients present with seizures or coma. Short-term use of Vasopressin (V2) receptor antagonists may also be used to normalize sodium levels prior to LT. However, all these measures may be futile, and LT remains the definite treatment in these patients to improve survival. In this review, we describe the classification, pathogenesis of hyponatremia, and its clinical implications in patients with cirrhosis. Approach to these patients along with management will also be discussed briefly.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- ACLF, acute-on-chronic liver failure
- ACTH, adrenocorticotropic hormone
- ADH
- ADH, antidiuretic hormone
- AKI, acute kidney injury
- AVP, arginine vasopressin
- CLIF, chronic liver failure
- CNS, central nervous system
- CTP, Child-Turcotte-Pugh
- CVVHD, continuous venovenous hemofiltration
- DAMP, damage-associated molecular patterns
- EABV, effective arterial blood volume
- FENa, fractional excretion of sodium
- HE, hepatic encephalopathy
- HRS, hepatorenal syndrome
- LT, liver transplantation
- LVP, large volume paracentesis
- MAP, mean arterial pressure
- MELD, model of end-stage liver disease
- NO, nitric oxide
- NSBB, nonselective beta-blockers
- PAMP, pathogen-associated molecular patterns
- PICD, paracentesis-induced circulatory dysfunction
- PPCD, post-paracentesis circulatory dysfunction
- PRA, plasma renin activity
- RA, refractory ascites
- RAAS, renin-angiotensin-aldosterone-system
- RAI, relative adrenal insufficiency
- RBF, renal blood flow
- SBP, spontaneous bacterial peritonitis
- SIADH, syndrome of inappropriate ADH secretion
- SMT, standard medical treatment
- SNS, sympathetic nervous system
- TBW, total body water
- TIPS, transjugular intrahepatic portosystemic shunt
- advanced cirrhosis
- albumin
- hyponatremia
- liver transplantation
- sNa, serum sodium
Collapse
Affiliation(s)
- Dibya L. Praharaj
- Address for correspondence. Dibya L Praharaj, Assistant Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Science, Bhubaneswar, India
| | | |
Collapse
|
5
|
Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, Chawla YK, Chowdhury A, Chaoudhuri A, Eapen EC, Devarbhavi H, Dhiman R, Datta Gupta S, Duseja A, Jothimani D, Kapoor D, Kar P, Khuroo MS, Kumar A, Madan K, Mallick B, Maiwall R, Mohan N, Nagral A, Nath P, Panigrahi SC, Pawar A, Philips CA, Prahraj D, Puri P, Rastogi A, Saraswat VA, Saigal S, Shalimar, Shukla A, Singh SP, Verghese T, Wadhawan M. Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis. J Clin Exp Hepatol 2020; 10:339-376. [PMID: 32655238 PMCID: PMC7335721 DOI: 10.1016/j.jceh.2020.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Acute liver failure (ALF) is an infrequent, unpredictable, potentially fatal complication of acute liver injury (ALI) consequent to varied etiologies. Etiologies of ALF as reported in the literature have regional differences, which affects the clinical presentation and natural course. In this part of the consensus article designed to reflect the clinical practices in India, disease burden, epidemiology, clinical presentation, monitoring, and prognostication have been discussed. In India, viral hepatitis is the most frequent cause of ALF, with drug-induced hepatitis due to antituberculosis drugs being the second most frequent cause. The clinical presentation of ALF is characterized by jaundice, coagulopathy, and encephalopathy. It is important to differentiate ALF from other causes of liver failure, including acute on chronic liver failure, subacute liver failure, as well as certain tropical infections which can mimic this presentation. The disease often has a fulminant clinical course with high short-term mortality. Death is usually attributable to cerebral complications, infections, and resultant multiorgan failure. Timely liver transplantation (LT) can change the outcome, and hence, it is vital to provide intensive care to patients until LT can be arranged. It is equally important to assess prognosis to select patients who are suitable for LT. Several prognostic scores have been proposed, and their comparisons show that indigenously developed dynamic scores have an edge over scores described from the Western world. Management of ALF will be described in part 2 of this document.
Collapse
Key Words
- ACLF, acute on chronic liver failure
- AFLP, acute fatty liver of pregnancy
- AKI, Acute kidney injury
- ALF, Acute liver failure
- ALFED, Acute Liver Failure Early Dynamic
- ALT, alanine transaminase
- ANA, antinuclear antibody
- AP, Alkaline phosphatase
- APTT, activated partial thromboplastin time
- ASM, alternative system of medicine
- ASMA, antismooth muscle antibody
- AST, aspartate transaminase
- ATN, Acute tubular necrosis
- ATP, adenosine triphosphate
- ATT, anti-TB therapy
- AUROC, Area under the receiver operating characteristics curve
- BCS, Budd-Chiari syndrome
- BMI, body mass index
- CBF, cerebral blood flow
- CBFV, cerebral blood flow volume
- CE, cerebral edema
- CHBV, chronic HBV
- CLD, chronic liver disease
- CNS, central nervous system
- CPI, clinical prognostic indicator
- CSF, cerebrospinal fluid
- DAMPs, Damage-associated molecular patterns
- DILI, drug-induced liver injury
- EBV, Epstein-Barr virus
- ETCO2, End tidal CO2
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- HAV, hepatitis A virus
- HBV, Hepatitis B virus
- HELLP, hemolysis
- HEV, hepatitis E virus
- HLH, Hemophagocytic lymphohistiocytosis
- HSV, herpes simplex virus
- HV, hepatic vein
- HVOTO, hepatic venous outflow tract obstruction
- IAHG, International Autoimmune Hepatitis Group
- ICH, intracerebral hypertension
- ICP, intracerebral pressure
- ICU, intensive care unit
- IFN, interferon
- IL, interleukin
- IND-ALF, ALF of indeterminate etiology
- INDILI, Indian Network for DILI
- KCC, King's College Criteria
- LC, liver cirrhosis
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MAP, mean arterial pressure
- MHN, massive hepatic necrosis
- MPT, mitochondrial permeability transition
- MUAC, mid-upper arm circumference
- NAPQI, n-acetyl-p-benzo-quinone-imine
- NPV, negative predictive value
- NWI, New Wilson's Index
- ONSD, optic nerve sheath diameter
- PAMPs, pathogen-associated molecular patterns
- PCR, polymerase chain reaction
- PELD, Pediatric End-Stage Liver Disease
- PPV, positive predictive value
- PT, prothrombin time
- RAAS, renin–angiotensin–aldosterone system
- SHF, subacute hepatic failure
- SIRS, systemic inflammatory response syndrome
- SNS, sympathetic nervous system
- TB, tuberculosis
- TCD, transcranial Doppler
- TGF, tumor growth factor
- TJLB, transjugular liver biopsy
- TLR, toll-like receptor
- TNF, tumor necrosis factor
- TSFT, triceps skin fold thickness
- US, ultrasound
- USALF, US Acute Liver Failure
- VZV, varicella-zoster virus
- WD, Wilson disease
- Wilson disease (WD)
- YP, yellow phosphorus
- acute liver failure
- autoimmune hepatitis (AIH)
- drug-induced liver injury
- elevated liver enzymes, low platelets
- sALI, severe acute liver injury
- viral hepatitis
Collapse
Affiliation(s)
- Anil C. Anand
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Bhaskar Nandi
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Anil Arora
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sethu Babu
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad 500003, India
| | - Yogesh Batra
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Abhijit Chowdhury
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
| | - Ashok Chaoudhuri
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Eapen C. Eapen
- Department of Hepatology, Christian Medical College, Vellore, India
| | - Harshad Devarbhavi
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
| | - RadhaKrishan Dhiman
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Ajay Duseja
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | | | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Mohamad S. Khuroo
- Department of Gastroenterology, Dr Khuroo’ S Medical Clinic, Srinagar, Kashmir, India
| | - Ashish Kumar
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Kaushal Madan
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Rakhi Maiwall
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the Medicity Hospital, Sector – 38, Gurgaon, Haryana, India
| | - Aabha Nagral
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Preetam Nath
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Sarat C. Panigrahi
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Ankush Pawar
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
| | - Cyriac A. Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, 682028, Kerala, India
| | - Dibyalochan Prahraj
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Pankaj Puri
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
| | - Amit Rastogi
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Sanjiv Saigal
- Department of Hepatology, Department of Liver Transplantation, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Akash Shukla
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Thomas Verghese
- Department of Gastroenterology, Government Medical College, Kozikhode, India
| | - Manav Wadhawan
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
| | - The INASL Task-Force on Acute Liver Failure
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad 500003, India
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Hepatology, Christian Medical College, Vellore, India
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
- Gleneagles Global Hospitals, Hyderabad, Telangana, India
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
- Department of Gastroenterology, Dr Khuroo’ S Medical Clinic, Srinagar, Kashmir, India
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the Medicity Hospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, 682028, Kerala, India
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
- Department of Hepatology, Department of Liver Transplantation, India
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
- Department of Gastroenterology, Government Medical College, Kozikhode, India
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
| |
Collapse
|
6
|
Lopaschuk GD, Verma S. Mechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors: A State-of-the-Art Review. JACC Basic Transl Sci 2020; 5:632-644. [PMID: 32613148 PMCID: PMC7315190 DOI: 10.1016/j.jacbts.2020.02.004] [Citation(s) in RCA: 368] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
Recent clinical trials have shown that sodium glucose co-transport 2 (SGLT2) inhibitors have dramatic beneficial cardiovascular outcomes. These include a reduced incidence of cardiovascular death and heart failure hospitalization in people with and without diabetes, and those with and without prevalent heart failure. The actual mechanism(s) responsible for these beneficial effects are not completely clear. Several potential theses have been proposed to explain the cardioprotective effects of SGLT2 inhibition, which include diuresis/natriuresis, blood pressure reduction, erythropoiesis, improved cardiac energy metabolism, inflammation reduction, inhibition of the sympathetic nervous system, prevention of adverse cardiac remodeling, prevention of ischemia/reperfusion injury, inhibition of the Na+/H+-exchanger, inhibition of SGLT1, reduction in hyperuricemia, increasing autophagy and lysosomal degradation, decreasing epicardial fat mass, increasing erythropoietin levels, increasing circulating pro-vascular progenitor cells, decreasing oxidative stress, and improving vascular function. The strengths and weaknesses of these proposed mechanisms are reviewed in an effort to try to synthesize and prioritize the mechanisms as they relate to clinical event reduction.
Collapse
Affiliation(s)
- Gary D. Lopaschuk
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Herat LY, Magno AL, Rudnicka C, Hricova J, Carnagarin R, Ward NC, Arcambal A, Kiuchi MG, Head GA, Schlaich MP, Matthews VB. SGLT2 Inhibitor-Induced Sympathoinhibition: A Novel Mechanism for Cardiorenal Protection. JACC Basic Transl Sci 2020; 5:169-179. [PMID: 32140623 PMCID: PMC7046513 DOI: 10.1016/j.jacbts.2019.11.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 02/09/2023]
Abstract
SGLT2 inhibitors improve cardiovascular outcomes. SGLT2 inhibitor–induced sympathetic nervous system inhibition may be an underlying mechanism. Chemical denervation in neurogenic hypertensive mice reduces renal SGLT2 expression. SGLT2 inhibition lowered blood pressure and resulted in significantly reduced tyrosine hydroxylase and norepinephrine levels in the kidney tissue of neurogenic hypertensive mice. Crosstalk between the sympathetic nervous system and SGLT2 regulation appears as a key mechanism of the cardiorenal protective effects demonstrated with SGLT2 inhibition.
Recent clinical trial data suggest a cardiorenal protective effect of sodium glucose cotransporter 2 (SGLT2) inhibition. We demonstrate that chemical denervation in neurogenic hypertensive Schlager (BPH/2J) mice reduced blood pressure, improved glucose homeostasis, and reduced renal SGLT2 protein expression. Inhibition of SGLT2 prevented weight gain, reduced blood pressure, significantly reduced elevations of tyrosine hydroxylase and norepinephrine, and protects against endothelial dysfunction. These findings provide evidence for significant crosstalk between activation of the sympathetic nervous system and SGLT2 regulation and possible ancillary effects on endothelial function, which may contribute to the observed cardiorenal protective effects of SGLT2 inhibition.
Collapse
Affiliation(s)
- Lakshini Y Herat
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Aaron L Magno
- Research Centre, Royal Perth Hospital, Perth, Australia
| | | | - Jana Hricova
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Natalie C Ward
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia.,School of Public Health, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Angelique Arcambal
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia.,Université de La Réunion, Saint-Denis, Réunion, France
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Geoff A Head
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Department of Cardiology and Department of Nephrology, Royal Perth Hospital, Perth, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| |
Collapse
|
8
|
Waldron NH, Fudim M, Mathew JP, Piccini JP. Neuromodulation for the Treatment of Heart Rhythm Disorders. JACC Basic Transl Sci 2019; 4:546-562. [PMID: 31468010 PMCID: PMC6712352 DOI: 10.1016/j.jacbts.2019.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis. Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias. Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
Collapse
Key Words
- AERP, atrial effective refractory period
- AF, atrial fibrillation
- AGP, autonomic ganglionic plexus
- ANS, autonomic nervous system
- CABG, coronary artery bypass grafting
- HRV, heart rate variability
- ICD, implantable cardioverter-defibrillator
- LLVNS, low-level vagal nerve stimulation
- OSA, obstructive sleep apnea
- POAF, post-operative atrial fibrillation
- PVI, pulmonary vein isolation
- RDN, renal denervation
- SCS, spinal cord stimulation
- SGB, stellate ganglion blockade
- SNS, sympathetic nervous system
- VF, ventricular fibrillation
- VNS, vagal nerve stimulation
- VT, ventricular tachycardia
- arrhythmia
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- neuromodulation
- ventricular arrhythmias
Collapse
Affiliation(s)
- Nathan H Waldron
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
9
|
Liu J, Wang Y, Lin L. Small molecules for fat combustion: targeting obesity. Acta Pharm Sin B 2019; 9:220-36. [PMID: 30976490 DOI: 10.1016/j.apsb.2018.09.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/01/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022] Open
Abstract
Obesity is increasing in an alarming rate worldwide, which causes higher risks of some diseases, such as type 2 diabetes, cardiovascular diseases, and cancer. Current therapeutic approaches, either pancreatic lipase inhibitors or appetite suppressors, are generally of limited effectiveness. Brown adipose tissue (BAT) and beige cells dissipate fatty acids as heat to maintain body temperature, termed non-shivering thermogenesis; the activity and mass of BAT and beige cells are negatively correlated with overweight and obesity. The existence of BAT and beige cells in human adults provides an effective weight reduction therapy, a process likely to be amenable to pharmacological intervention. Herein, we combed through the physiology of thermogenesis and the role of BAT and beige cells in combating with obesity. We summarized the thermogenic regulators identified in the past decades, targeting G protein-coupled receptors, transient receptor potential channels, nuclear receptors and miscellaneous pathways. Advances in clinical trials were also presented. The main purpose of this review is to provide a comprehensive and up-to-date knowledge from the biological importance of thermogenesis in energy homeostasis to the representative thermogenic regulators for treating obesity. Thermogenic regulators might have a large potential for further investigations to be developed as lead compounds in fighting obesity.
Collapse
Key Words
- AKT, protein kinase B
- ALDH9, aldehyde dehydrogenase 9
- AMPK, AMP-activated protein kinase
- ATP, adenosine triphosphate
- BA, bile acids
- BAT, brown adipose tissue
- BMP8b, bone morphogenetic protein 8b
- Beige cells
- Brown adipose tissue
- C/EBPα, CCAAT/enhancer binding protein α
- CLA, cis-12 conjugated linoleic acid
- CRABP-II, cellular RA binding protein type II
- CRE, cAMP response element
- Cidea, cell death-inducing DNA fragmentation factor α-like effector A
- Dio2, iodothyronine deiodinase type 2
- ERE, estrogen response element
- ERs, estrogen receptors
- FAS, fatty acid synthase
- FGF21, fibroblast growth factor 21
- GPCRs, G protein-coupled receptors
- HFD, high fat diet
- LXR, liver X receptors
- MAPK, mitogen-activated protein kinase
- OXPHOS, oxidative phosphorylation
- Obesity
- PDEs, phosphodiesterases
- PET-CT, positron emission tomography combined with computed tomography
- PGC-1α, peroxisome proliferator-activated receptor γ coactivator 1-α
- PKA, protein kinase A
- PPARs, peroxisome proliferator-activated receptors
- PPREs, peroxisome proliferator response elements
- PRDM16, PR domain containing 16
- PTP1B, protein-tyrosine phosphatase 1B
- PXR, pregnane X receptor
- RA, retinoic acid
- RAR, RA receptor
- RARE, RA response element
- RMR, resting metabolic rate
- RXR, retinoid X receptor
- SIRT1, silent mating type information regulation 2 homolog 1
- SNS, sympathetic nervous system
- TFAM, mitochondrial transcription factor A
- TMEM26, transmembrane protein 26
- TRPs, transient receptor potential cation channels
- Thermogenesis
- UCP1, uncoupling protein 1
- Uncoupling protein 1
- VDR, vitamin D receptor
- VDRE, VDR response elements
- WAT, white adipose tissue
- cAMP, cyclic adenosine monophosphate
- cGMP, cyclic guanosine monophosphate
- β3-AR, β3-adrenergic receptor
Collapse
|
10
|
Li Z, Organ CL, Kang J, Polhemus DJ, Trivedi RK, Sharp TE, Jenkins JS, Tao YX, Xian M, Lefer DJ. Hydrogen Sulfide Attenuates Renin Angiotensin and Aldosterone Pathological Signaling to Preserve Kidney Function and Improve Exercise Tolerance in Heart Failure. ACTA ACUST UNITED AC 2018; 3:796-809. [PMID: 30623139 PMCID: PMC6315048 DOI: 10.1016/j.jacbts.2018.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/22/2022]
Abstract
Cardioprotective effects of H2S have been well documented. However, the lack of evidence supporting the benefits afforded by delayed H2S therapy warrants further investigation. Using a murine model of transverse aortic constriction-induced heart failure, this study showed that delayed H2S therapy protects multiple organs including the heart, kidney, and blood-vessel; reduces oxidative stress; attenuates renal sympathetic and renin-angiotensin-aldosterone system pathological activation; and ultimately improves exercise capacity. These findings provide further insights into H2S-mediated cardiovascular protection and implicate the benefits of using H2S-based therapies clinically for the treatment of heart failure.
Collapse
Affiliation(s)
- Zhen Li
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Chelsea L. Organ
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jianming Kang
- Department of Chemistry, Washington State University, Pullman, Washington
| | - David J. Polhemus
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Rishi K. Trivedi
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Thomas E. Sharp
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jack S. Jenkins
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ya-xiong Tao
- Department of Anatomy, Physiology, and Pharmacology, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - Ming Xian
- Department of Chemistry, Washington State University, Pullman, Washington
| | - David J. Lefer
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Address for correspondence: Dr. David J. Lefer, Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, 533 Bolivar Street, Room 408, New Orleans, Louisiana 70112.
| |
Collapse
|
11
|
Matthews VB, Rudnicka C, Schlaich MP. A cautionary note for researchers treating mice with the neurotransmitter norepinephrine. Biochem Biophys Rep 2018; 15:103-106. [PMID: 30148215 PMCID: PMC6105757 DOI: 10.1016/j.bbrep.2018.08.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/03/2022] Open
Abstract
The sympathetic nervous system plays a crucial role in metabolic function and glucose homeostasis. Norepinephrine is the main neurotransmitter released from sympathetic neurons. The major goal of our studies was to examine the impact of norepinephrine on metabolism related gene expression in obesity in vivo. Interestingly, we discovered that norepinephrine had a detrimental effect in our studies. C57BL6/J mice fed a high fat diet were intraperitoneally injected with 0.2 or 2 mg/kg/day norepinephrine. These doses of norepinephrine have been used previously by other researchers. Survival of the mice was documented. Kidney and bladder tissues were excised and fixed for histological studies. A subset of norepinephrine treated mice experienced unexpected adverse events which included bladder distension and reduced kidney perfusion as suggested by kidney discolouration. This eventuated in the mice having to be sacrificed or the mice succumbed to the pathological condition. To our knowledge, such an effect of norepinephrine has not been previously reported in mice. Morphological examination of kidney and bladder indicated marked detrimental architectural changes, which we postulate is associated with norepinephrine induced vasoconstriction, urinary retention and renal impairment. Our studies highlight that administration of norepinephrine to mice may trigger adverse effects relating predominantly to the urogenital tract which can result in decline in a subpopulation of these mice. Researchers administering norepinephrine in mouse models should be aware and look out for these unexpected adverse events associated with the use of norepinephrine.
Collapse
Affiliation(s)
- Vance B. Matthews
- Dobney Hypertension Centre, School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Crawley, Western Australia, Australia
| | - Caroline Rudnicka
- Research Centre, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Crawley, Western Australia, Australia
- Department of Cardiology and Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
12
|
Douris N, Desai BN, Fisher FM, Cisu T, Fowler AJ, Zarebidaki E, Nguyen NLT, Morgan DA, Bartness TJ, Rahmouni K, Flier JS, Maratos-Flier E. Beta-adrenergic receptors are critical for weight loss but not for other metabolic adaptations to the consumption of a ketogenic diet in male mice. Mol Metab 2017; 6:854-62. [PMID: 28752049 DOI: 10.1016/j.molmet.2017.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 11/21/2022] Open
Abstract
Objective We have previously shown that the consumption of a low-carbohydrate ketogenic diet (KD) by mice leads to a distinct physiologic state associated with weight loss, increased metabolic rate, and improved insulin sensitivity [1]. Furthermore, we identified fibroblast growth factor 21 (FGF21) as a necessary mediator of the changes, as mice lacking FGF21 fed KD gain rather than lose weight [2]. FGF21 activates the sympathetic nervous system (SNS) [3], which is a key regulator of metabolic rate. Thus, we considered that the SNS may play a role in mediating the metabolic adaption to ketosis. Methods To test this hypothesis, we measured the response of mice lacking all three β-adrenergic receptors (β-less mice) to KD feeding. Results In contrast to wild-type (WT) controls, β-less mice gained weight, increased adipose tissue depots mass, and did not increase energy expenditure when consuming KD. Remarkably, despite weight-gain, β-less mice were insulin sensitive. KD-induced changes in hepatic gene expression of β-less mice were similar to those seen in WT controls eating KD. Expression of FGF21 mRNA rose over 60-fold in both WT and β-less mice fed KD, and corresponding circulating FGF21 levels were 12.5 ng/ml in KD-fed wild type controls and 35.5 ng/ml in KD-fed β-less mice. Conclusions The response of β-less mice distinguishes at least two distinct categories of physiologic effects in mice consuming KD. In the liver, KD regulates peroxisome proliferator-activated receptor alpha (PPARα)-dependent pathways through an action of FGF21 independent of the SNS and beta-adrenergic receptors. In sharp contrast, induction of interscapular brown adipose tissue (BAT) and increased energy expenditure absolutely require SNS signals involving action on one or more β-adrenergic receptors. In this way, the key metabolic actions of FGF21 in response to KD have diverse effector mechanisms. Ketogenic diets lead to rapid increases in energy expenditure via increased sympathetic outflow to BAT. Long term the diet leads to weight loss. β-adrenergic receptors mediate these effects; in mice lacking all three β-receptors the effects of the ketogenic diet are not observed. Browning of subcutaneous fat by the diet is partially activated by presumed peripheral mechanisms in the absence of β-adrenergic receptors. Sympathetic nervous system activity not required for improved insulin sensitivity and activation of fatty acid oxidation in the liver.
Collapse
Key Words
- BAT, brown adipose tissue
- EE, energy expenditure
- FGF21, fibroblast growth factor 21
- IP, intraperitoneal
- ITT, insulin tolerance test
- IWAT, inguinal white adipose tissue
- KD, ketogenic diet
- Ketogenic diet
- PPARα, peroxisome proliferator-activated receptor alpha
- SEM, standard error of the mean
- SNA, sympathetic nerve activity
- SNS, sympathetic nervous system
- Sympathetic nervous system
- UCP1, uncoupling protein 1
- Weight loss
- β-Adrenergic receptors
- β-less, lacking β1, β2, β3 adrenergic receptors
Collapse
|
13
|
Ohtomo T, Ino K, Miyashita R, Chigira M, Nakamura M, Someya K, Inaba N, Fujita M, Takagi M, Yamada J. Chronic high-fat feeding impairs adaptive induction of mitochondrial fatty acid combustion-associated proteins in brown adipose tissue of mice. Biochem Biophys Rep 2017; 10:32-38. [PMID: 28955734 PMCID: PMC5614659 DOI: 10.1016/j.bbrep.2017.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/04/2017] [Accepted: 02/15/2017] [Indexed: 11/13/2022] Open
Abstract
Since brown adipose tissue (BAT) is involved in thermogenesis using fatty acids as a fuel, BAT activation is a potential strategy for treating obesity and diabetes. However, whether BAT fatty acid combusting capacity is preserved in these conditions has remained unclear. We therefore evaluated expression levels of fatty acid oxidation-associated enzymes and uncoupling protein 1 (Ucp1) in BAT by western blot using a diet-induced obesity C57BL/6J mouse model. In C57BL/6J mice fed a high-fat diet (HFD) over 2–4 weeks, carnitine palmitoyltransferase 2 (Cpt2), acyl-CoA thioesterase (Acot) 2, Acot11 and Ucp1 levels were significantly increased compared with baseline and control low-fat diet (LFD)-fed mice. Similar results were obtained in other mouse strains, including ddY, ICR and KK-Ay, but the magnitudes of the increase in Ucp1 level were much smaller than in C57BL/6J mice, with decreased Acot11 levels after HFD-feeding. In C57BL/6J mice, increased levels of these mitochondrial proteins declined to near baseline levels after a longer-term HFD-feeding (20 weeks), concurrent with the accumulation of unilocular, large lipid droplets in brown adipocytes. Extramitochondrial Acot11 and acyl-CoA oxidase remained elevated. Treatment of mice with Wy-14,643 also increased these proteins, but was less effective than 4 week-HFD, suggesting that mechanisms other than peroxisome proliferator-activated receptor α were also involved in the upregulation. These results suggest that BAT enhances its fatty acid combusting capacity in response to fat overload, however profound obesity deprives BAT of the responsiveness to fat, possibly via mitochondrial alteration. BAT activation is a potential strategy for treating obesity and diabetes. BAT enhances its fatty acid combusting capacity in response to high-fat feeding. Profound obesity deprives BAT of the responsiveness to fat overload. Susceptibility to BAT activation could depend on the degree of obesity.
Collapse
Key Words
- Acot, acyl-CoA thioesterase
- Acox, acyl-CoA oxidase
- Acyl-CoA thioesterase
- BAT, brown adipose tissue
- Brown adipose tissue
- Cpt, carnitine palmitoyltransferase
- ETC, electron transport chain
- Fatty acid oxidation
- HFD and LFD, high- and low-fat diet
- Obesity
- Ppar, peroxisome proliferator-activated receptor
- SNS, sympathetic nervous system
- TCA, tricarboxylic acid
- TG, triglyceride
- Ucp, uncoupling protein
- Uncoupling protein
- WAT, white adipose tissue
Collapse
Affiliation(s)
- Takayuki Ohtomo
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Kanako Ino
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Ryota Miyashita
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Maya Chigira
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Masahiko Nakamura
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Koji Someya
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Niro Inaba
- Center for the Advancement of Pharmaceutical Education, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Mariko Fujita
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Mitsuhiro Takagi
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Junji Yamada
- Department of Pharmacotherapeutics, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| |
Collapse
|
14
|
da Silva Gonçalves Bos D, Happé C, Schalij I, Pijacka W, Paton JFR, Guignabert C, Tu L, Thuillet R, Bogaard HJ, van Rossum AC, Vonk-Noordegraaf A, de Man FS, Handoko ML. Renal Denervation Reduces Pulmonary Vascular Remodeling and Right Ventricular Diastolic Stiffness in Experimental Pulmonary Hypertension. JACC Basic Transl Sci 2017; 2:22-35. [PMID: 29034356 PMCID: PMC5628179 DOI: 10.1016/j.jacbts.2016.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/17/2016] [Accepted: 09/20/2016] [Indexed: 01/20/2023]
Abstract
Neurohormonal overactivation plays an important role in pulmonary hypertension (PH). In this context, renal denervation, which aims to inhibit the neurohormonal systems, may be a promising adjunct therapy in PH. In this proof-of-concept study, we have demonstrated in 2 experimental models of PH that renal denervation delayed disease progression, reduced pulmonary vascular remodeling, lowered right ventricular afterload, and decreased right ventricular diastolic stiffness, most likely by suppression of the renin-angiotensin-aldosterone system.
Collapse
Key Words
- AT1, angiotensin II type 1
- Ea, right ventricular afterload
- Eed, right ventricular stiffness
- Ees, right ventricular contractility
- MCT, monocrotaline model
- PH, pulmonary hypertension
- RAAS, renin angiotensin-aldosterone system
- RD, renal denervation
- SNS, sympathetic nervous system
- SuHx, sugen combined with hypoxia model
- pulmonary hypertension
- renin angiotensin system
- right ventricular failure
- sympathetic nervous system
Collapse
Affiliation(s)
- Denielli da Silva Gonçalves Bos
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Chris Happé
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Ingrid Schalij
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Wioletta Pijacka
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - Christophe Guignabert
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Ly Tu
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Raphaël Thuillet
- University of Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Harm-Jan Bogaard
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - Frances S de Man
- Department of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Physiology VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands.,Department of Cardiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Rojas JM, Bruinstroop E, Printz RL, Alijagic-Boers A, Foppen E, Turney MK, George L, Beck-Sickinger AG, Kalsbeek A, Niswender KD. Central nervous system neuropeptide Y regulates mediators of hepatic phospholipid remodeling and very low-density lipoprotein triglyceride secretion via sympathetic innervation. Mol Metab 2015; 4:210-21. [PMID: 25737956 PMCID: PMC4338317 DOI: 10.1016/j.molmet.2015.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 12/29/2014] [Accepted: 01/09/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Elevated very low-density lipoprotein (VLDL)-triglyceride (TG) secretion from the liver contributes to an atherogenic dyslipidemia that is associated with obesity, diabetes and the metabolic syndrome. Numerous models of obesity and diabetes are characterized by increased central nervous system (CNS) neuropeptide Y (NPY); in fact, a single intracerebroventricular (icv) administration of NPY in lean fasted rats elevates hepatic VLDL-TG secretion and does so, in large part, via signaling through the CNS NPY Y1 receptor. Thus, our overarching hypothesis is that elevated CNS NPY action contributes to dyslipidemia by activating central circuits that modulate liver lipid metabolism. METHODS Chow-fed Zucker fatty (ZF) rats were pair-fed by matching their caloric intake to that of lean controls and effects on body weight, plasma TG, and liver content of TG and phospholipid (PL) were compared to ad-libitum (ad-lib) fed ZF rats. Additionally, lean 4-h fasted rats with intact or disrupted hepatic sympathetic innervation were treated with icv NPY or NPY Y1 receptor agonist to identify novel hepatic mechanisms by which NPY promotes VLDL particle maturation and secretion. RESULTS Manipulation of plasma TG levels in obese ZF rats, through pair-feeding had no effect on liver TG content; however, hepatic PL content was substantially reduced and was tightly correlated with plasma TG levels. Treatment with icv NPY or a selective NPY Y1 receptor agonist in lean fasted rats robustly activated key hepatic regulatory proteins, stearoyl-CoA desaturase-1 (SCD-1), ADP-ribosylation factor-1 (ARF-1), and lipin-1, known to be involved in remodeling liver PL into TG for VLDL maturation and secretion. Lastly, we show that the effects of CNS NPY on key liporegulatory proteins are attenuated by hepatic sympathetic denervation. CONCLUSIONS These data support a model in which CNS NPY modulates mediators of hepatic PL remodeling and VLDL maturation to stimulate VLDL-TG secretion that is dependent on the Y1 receptor and sympathetic signaling to the liver.
Collapse
Key Words
- AGPAT, 1-acyl-glycerol-3-phosphate acyltransferase
- ARF-1, ADP-ribosylation factor-1
- ApoB, apolipoprotein B
- CNS, central nervous system
- Cyto, cytoplasmic
- DAG, diacylglycerol
- DGAT, diacylglycerol acyltransferase
- ER, endoplasmic reticulum
- FFA(s), free fatty acid(s)
- GAPDH, glyceraldehyde 3-phosphate dehydrogenase
- HDAC-1, histone deacetylase-1
- Lipin-1
- NE, norepinephrine
- NPY Y1 receptor
- NPY, neuropeptide Y
- Nuc, nuclear
- PA, phosphatidic acid
- PAP-1, phosphatidic acid phosphatase-1
- PF, pair-fed
- PL, phospholipid
- PLD, phospholipase D
- POMC, proopiomelanocortin
- Phospholipid
- RPL13A, ribosomal protein L13a
- RT-PCR, real-time PCR
- SCD-1, stearoyl-CoA desaturase-1
- SNS, sympathetic nervous system
- Sham, sham-denervation
- Sx, sympathetic denervation
- Sympathetic denervation
- TG, triglyceride
- Triglyceride
- VLDL
- VLDL, very low-density lipoprotein
- Veh, vehicle
- ZF, Zucker fatty
- ad-lib, ad-libitum
- icv, intracerebroventricular
Collapse
Affiliation(s)
- Jennifer M. Rojas
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Eveline Bruinstroop
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard L. Printz
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Aldijana Alijagic-Boers
- Department of Hypothalamic Integration Mechanisms, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Science, Amsterdam, The Netherlands
| | - Ewout Foppen
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maxine K. Turney
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Leena George
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Annette G. Beck-Sickinger
- Institute of Biochemistry, Faculty of Bioscience, Pharmacy and Psychology, Leipzig University, Leipzig, Germany
| | - Andries Kalsbeek
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hypothalamic Integration Mechanisms, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Science, Amsterdam, The Netherlands
| | - Kevin D. Niswender
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, United States
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, United States
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| |
Collapse
|
16
|
Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol 2014; 4:302-11. [PMID: 25755577 PMCID: PMC4298636 DOI: 10.1016/j.jceh.2014.08.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/27/2014] [Indexed: 02/09/2023] Open
Abstract
Albumin is a negatively charged, relatively small protein synthesized by liver cells. Is the most abundant protein in extracellular fluid and accounts for about 70% of the plasma colloid osmotic pressure. Therefore it plays a crucial role in regulating fluid distribution in the body. In addition, albumin possesses functional domains with important non-oncotic properties, such as potent anti-oxydant and scavenging activities, binding of highly toxic reactive metal species and a great amount of endogenous and exogenous substances. We have recently learned that albumin in cirrhosis undergoes a number of post-transcriptional changes that greatly impair its non-oncotic properties. The overall assessment of these changes clearly shows that the relative abundance of the native form of albumin is significantly reduced in hospitalized patients with cirrhosis and that these abnormalities worsen in parallel with the increasing severity of the disease. Thus, it is time to abandon the concept of serum albumin concentration and refer to the effective albumin concentration, that is the native intact albumin. Given the pathophysiological context in which we use human albumin in patients with cirrhosis, who are characterized by peripheral vasodilation and a low-grade but sustained inflammatory state, the use of albumin in patients with cirrhosis should aim at enhancing effective hypovolemia and exploiting its antioxidant and scavenging activities. The indications for the use of albumin in cirrhosis that clearly emerge from evidence-based medicine are represented by conditions characterized by an acute aggravation of effective hypovolemia and inflammation, such as such post-paracentesis circulatory dysfunction, spontaneous bacterial peritonitis, and hepatorenal syndrome. Other indications to the use of albumin that still require further studies are represented by bacterial infections other than spontaneous bacterial peritonitis, hepatic encephalopathy and long-term treatment of ascites, which has been debated for the last half-century.
Collapse
Key Words
- ACB, albumin cobalt binding
- ACLF, acute-on-chronic liver failure
- EASL, European Association for the Study of the Liver
- EPR, electron paramagnetic resonance
- HE, hepatic encephalopathy
- HPLC, high performance liquid chromatography
- HRS, hepatorenal syndrome
- IMA, ischemia-modified albumin
- MALDI-TOF, Matrix-Assisted Laser Desorption/Ionization with Time of flight technique
- MARS, Molecular Adsorbent Recirculating Systems
- MELD, model for end stage liver disease
- NO, nitric oxide
- PPCD, post-paracentesis circulatory dysfunction
- RAAS, renin-angiotensin-aldosteron axis
- ROS, reactive oxygen species
- SBP, spontaneous bacterial peritonitis
- SNS, sympathetic nervous system
- albumin
- ascites
- bacterial infections
- cirrhosis of the liver
- non-oncotic properties of albumin
Collapse
Affiliation(s)
- Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | | | | |
Collapse
|