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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Schock ; Hämorrhagie ; Streßproteine ; Hitzeschockreaktion ; Hämoxygenase ; Key words Haemorrhage ; Shock ; Stress proteins ; Heat shock response ; Haeme oxygenase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: Recent evidence suggests a possible role for Haeme oxygenase (HO)-derived carbon monoxide (CO) in the regulation of vascular tone through elevation of cyclic 3′–5′ guanosine monophosphate (cGMP). Previous work from our laboratory has shown that blockade of the HO pathway by tin-protoporphyrin-IX (SnPP) after resuscitation from haemorrhage leads to a specific and profound increase in portal resistance while neither systemic nor hepatic arterial resistance are affected. We therefore investigated the organ-specific expression pattern of the stress-inducible protein haeme oxygenase-1/heat shock protein 32 after haemorrhage and resuscitation. Materials and methods: After approval of the protocol by the local review board, male Sprague-Dawley rats (n=6/group) were anaesthetised with pentobarbitone, instrumented for assessment of central haemodynamics, and subjected to haemorrhagic hypotension (40 mm Hg for 1 h) followed by resuscitation with 60% shed blood and Ringer’s solution or a time-matched sham protocol. Samples of liver, spleen, kidney, intestine, aorta, and lungs were harvested 5 h after the onset of resuscitation and subjected to Western-blot analysis using a specific anti-rat HO-1/hsp 32 antibody (StressGen, Sidney, Canada). Results: Resuscitation with shed blood/Ringer’s solution restored central haemodynamics and acid-base status while significant haemodilution was observed. Haemorrhage and resuscitation led to strong induction of HO-1 in the liver and slight induction in aortic tissue, while no increase in steady-state protein levels was observed in the other organs studied. Conclusion:These results suggest a specific contribution of the HO/CO pathway to maintenance of low hepatic portal resistance in vivo in a clinically relevant model of haemorrhagic shock and adequate resuscitation.
    Notes: Zusammenfassung Kohlenmonoxid (CO) entsteht als Intermediärstoffwechselprodukt im Hämabbau und kann nach neuesten Erkenntnissen ähnlich wie Stickstoffmonoxid über Aktivierung der Guanylatzyklase vasodilatorische Wirkungen entfalten. Für die endogene Bildung von CO ist ausschließlich die mikrosomale Hämoxygenase (HO) verantwortlich, die als konstitutives Enzym (HO-2) sowie in einer streßinduzierbaren Isoform (HO-1 oder Hitzeschockprotein 32) vorliegt. Hemmung des Hämstoffwechsels nach Schock und Volumentherapie führt nach eigenen Untersuchungen zu einer spezifischen Zunahme des Pfortaderwiderstands, ohne vasokonstriktorische Wirkungen in der systemischen Zirkulation hervorzurufen. In der vorliegenden Arbeit wurde daher das organspezifische Expressionsmuster der streßinduzierbaren Isoform des Enzyms nach hämorrhagischem Schock und Volumentherapie untersucht. Methoden und Ergebnisse: In einem kliniknah therapierten Schockmodell an der Ratte führte das Schockereignis zu einer geringfügigen Expression von HO-1 in Aortengewebe sowie zu einer ausgeprägten Expression in der Leber, während eine Induktion in anderen Organen wie Lunge, Darm oder Niere nach Hämorrhagie nicht nachweisbar war. Schlußfolgerung: Diese Ergebnisse legen nahe, daß HO-1/Hitzeschockprotein 32 in der Leber ein streßinduzierbares Vasodilatatorsystem, das zur Aufrechterhaltung der Leberperfusion nach hämorrhagischem Schock beiträgt, darstellt.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Key words Abdominal aortic aneurysm ; Cytokines ; Systemic inflammatory response syndrome ; Ischemia-reperfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To characterize the impact of abdominal aortic aneurysm repair (AAAR) on spontaneous as well as lipopolysaccharide (LPS)-induced gene expression of pro- and anti-inflammatory cytokines. Design: Prospective, controlled in vivo / ex vivo study. Setting: University hospital. Patients and interventions: Whole blood from 14 consecutive patients undergoing AAAR withdrawn prior to surgery (T1), at the end of ischemia (T2), 90 min after declamping (T3) and on the first postoperative day (T4) was cultured in the absence or presence of LPS. Five patients undergoing elective inguinal hernia repair served as controls. Measurements and results: While tumor necrosis factor (TNF), Interleukin (IL)-1 and IL-10 plasma concentrations did not increase significantly, IL-6 was elevated at each time point, as compared with T1. Despite the spontaneous release of trace amounts of IL-6, the ability of cultured whole blood to mount a cytokine response in vitro to LPS was impaired for all cytokines studied at T2 (TNF –62 %, IL-1 –51 %, IL-6 –20 %, IL-10 –51 %). The stimulated IL-6 response was restored early after declamping (T3: + 56 %) and enhanced 1 day after operation (T4: + 144 %). In contrast, stimulated TNF and IL-1 responses remained depressed at T3 (TNF –48 %, IL-1 –64 %) and T4 (TNF –40 %, IL-1 –24 %). A biphasic pattern was observed for IL-10 with initial depression at T3 (-51 %) and restoration at T4 ( + 40 %). Among the different cytokines monitored, only impaired TNF responsiveness at early reperfusion (T3) correlated with the postoperative course, as reflected by APACHE II. Cytokine response to LPS was maintained or even increased during and after surgery in the whole blood from patients undergoing hernia repair. Conclusions: Despite consistent development of clinical signs of systemic inflammatory response syndrome (SIRS) and spontaneous release of IL-6 abdominal aortic aneurysm repair produces a state of impaired pro-inflammatory cytokine response upon a subsequent in vitro Gram-negative stimulus. This early impairment of TNF responsiveness seems to correlate with an unfavorable postoperative course.
    Type of Medium: Electronic Resource
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