Implicancias estructurales y fisiológicas de la célula bacteriana en los mecanismos de resistencia antibiótica / Structural and physiological implications of bacterial cell in antibiotic resistance mechanisms

RESUMEN: La alta capacidad de adaptación de las bacterias a ambientes hostiles ha permitido el desarrollo de resistencia a antibacterianos, causando problemas de impacto mundial en la salud hospitalaria y de la comunidad, limitando las opciones terapéuticas lo que afecta el control de enfermedades, elevando las tasas de morbi-mortalidad. Esta capacidad de resistencia es mediada por factores estructurales y fisiológicos de las bacterias que actúan a diferentes niveles tanto extracelular como intracelular. A niveles extracelulares se destaca la capacidad de las poblaciones bacterianas en la formación de biopelículas y la regulación de señales celulares quorum sensing, permitiendo la evasión de la acción antibiótica. A nivel de envoltura celular se destaca el funcionamiento y comportamiento de la pared celular y de la membrana celular, principalmente por medio de la regulación de la expresión de canales de entrada o porinas y/ o bombas de expulsión que impiden el acceso o inducen la salida de antibióticos; otros mecanismos integran la modificación de la actividad de drogas por medio de la hidrólisis o modificación del sitio activo del fármaco. A nivel intracelular, las bacterias pueden cambiar los procesos de óxido/reducción, modificar los sitios objetivos del antibiótico e inactivar los grupos transfer, y modificar las subunidades ribosomales afectando la acción de los antibióticos que inhiben la síntesis de proteínas. A esto se añaden las modificaciones en la expresión génica y del código genético, que regula todos los anteriores, y es capaz de generar cambios adaptativos, resistencia a fármacos y desinfectantes, entre otros. La presente revisión tiene como objetivo describir las implicancias estructurales y fisiológicas de la célula bacteriana en los mecanismos de resistencia antibiótica considerando la organización estructural y fisiológica involucrada en los principales mecanismos de resistencia a antibióticos presentes en bacterias de importancia clínica que conllevan a fallas terapéuticas con alto costo en salud humana.

SUMMARY: The high adaptability of bacteria to hostile environments has favored antibacterial resistance development, impacting hospital and community healthcare worldwide. It has also affected disease control, limited therapeutic options and raised morbiditymortality rate. This resistance ability is mediated by structural and physiological factors of bacteria acting at both extracellular and cellular levels. The ability of bacterial populations in biofilm formation and regulation of cellular signal quorum sensing at the extracellular level, allows for the evasion of antibiotic action. At a cellular level, the performance and behavior of the cell wall and cell membrane is emphasized, mainly by regulating the expression of inlet channels or porins and/or expulsion pumps preventing access to, or inducing the outflow of antibiotics. Other mechanisms integrate modification of drug activity by hydrolysis or modification of the active site of the drug. Further into intracellular level, bacteria can change the oxidation/reduction processes; modify the target sites of the antibiotic and inactivate transfer groups. Bacteria can also modify the ribosomal subunits affecting the antibiotics which inhibit protein synthesis, and cause modifications of gene expression and genetic code that regulate the above mechanism. These may also generate adaptive changes and resistance to drugs and disinfectants. The aim of the present review is to describe the structural and physiological implications of bacterial cell in the mechanisms of antibiotic resistance. The study also considered the structural and physiological organization involved in the main mechanisms of antibiotic resistance in bacteria relevant to clinical healthcare.

Characteristics of dr1790 disruptant and its functional analysis in Deinococcus radiodurans

Deinococcus radiodurans (DR) is an extremophile that is well known for its resistance to radiation, oxidants and desiccation. The gene dr1790 of D. radiodurans was predicted to encode a yellow-related protein. The primary objective of the present study was to characterize the biological function of the DR1790 protein, which is a member of the ancient yellow/major royal jelly (MRJ) protein family, in prokaryotes. Fluorescence labeling demonstrated that the yellow-related protein encoded by dr1790 is a membrane protein. The deletion of the dr1790 gene decreased the cell growth rate and sensitivity to hydrogen peroxide and radiation and increased the membrane permeability of D. radiodurans. Transcript profiling by microarray and RT-PCR analyses of the dr1790 deletion mutant suggested that some genes that are involved in protein secretion and transport were strongly suppressed, while other genes that are involved in protein quality control, such as chaperones and proteases, were induced. In addition, the expression of genes with predicted functions that are involved in antioxidant systems, electron transport, and energy metabolism was significantly altered through the disruption of dr1790. Moreover, the results of proteomic analyses using 2-DE and MS also demonstrated that DR1790 contributed to D. radiodurans survival. Taken together, these results indicate that the DR1790 protein from the ancient yellow protein family plays a pleiotropic role in the survival of prokaryotic cells and contributes to the extraordinary resistance of D. radiodurans against oxidative and radiation stresses.

Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado / Introduction of virtual patients to clinical case portfolios for undergraduate medical students

Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

Selección espermática en semen congelado/descongelado de equino: evaluación de las membranas plasmática, acrosomal y potencial de membrana mitocondrial / Sperm selection in frozen/thawed semen of equine: evaluation of plasma, acrosome membranes and mitochondrial membrane potential

Los procedimientos de criopreservación inducen cambios morfofuncionales en los espermatozoides. Es importante post descongelación espermática utilizar procedimientos de selección que permitan recuperar espermatozoides altamente funcionales. El objetivo del presente estudio fue comparar la eficiencia del Swim-up y Equipure® en la selección de espermatozoides funcionales en semen descongelado de equino. Semen de 4 potros reproductores Criollos Chilenos (A, B, C y D), fueron descongelados separadamente y procesados (n=15) por: I.- Swim-up (SU) y II.- Equipure® (EQ). Post descongelación se determinó por citometría de flujo la viabilidad e integridad de membrana plasmática (SYBR-14/PI), potencial de membrana mitocondrial (YDm; JC-1), integridad de la membrana acrosomal (FITC-PSA/PI). La motilidad progresiva (%) en dos animales fue más alta (P<0,05) por SU comparado con EQ: A (55,7±5,8% v/s 38,17±3,7%) y C (37,5±7% vs. 32±2,1%, respectivamente). La integridad de la membrana plasmática (%), tres animales presentaron diferencias (P<0,05), siendo más alta por SU en dos animales comparado con EQ (A: 54,3±1,7 vs. 36,7±1,9, C: 36,1±5,7 vs. 29,4±4,8 y D: 34,4±9,4 vs. 52,7±5,2; respectivamente), solamente un animal fue superior EQ. En el YDm (%), diferencias significativas (P<0,05) fueron detectadas en los cuatro animales, siendo más altos en SU comparado con EQ (A: 69,1±8,6% vs. 47,4±3,3%, B: 59,34±12,3% vs. 24,8±1,5%, C: 54,9±12,3% vs. 43,2±3,1% y D: 53,1±17,6% vs. 37,5±5,7%; respectivamente). Los resultados obtenidos en el presente estudio demostraron que los métodos de selección espermática Swim-up y Equipure® permiten recuperar espermatozoides de diferente calidad funcional en semen congelado-descongelado de equino, presentándose diferencias individuales entre los animales con respecto a los métodos. Se observó una tendencia del método Swim-up en seleccionar espermatozoides de equino descongelados con mayor calidad funcional comparado con Equipure®.

Freeze-thaw procedures induce structural and functional changes in sperm. It is important to use post thaw sperm selection procedures that can retrieve highly functional sperm. The aim of this study was to compare the efficiency of the Swim-up and Equipure® in the selection of functional sperm of thawed equine semen. Semen of four Chilean Criollo reproductive stallions (A, B , C and D) were frozen and thawed using a standard protocol and processed separately (n = 15) : I. Swim-up (SU) and II. Equipure® (EQ). Post sperm selection,was determined by flow cytometry. Viability and plasma membrane integrity (SYRB-14/PI), mitochondrial membrane potential (YDm, JC -1), acrosome membrane integrity (FITC-PSA/PI). Progressive motility (%) was higher (P<0.05) in two animals per SU compared with EQ, A (55.7±5.8% vs. 38.17±3.7%) and C (37.5±7.0% vs. 32±2.1%, respectively). The viability and integrity of the plasma membrane (%), three animals showed differences (P<0.05), being higher for SU in two animals compared with EQ (A: 54.3±1.7 vs. 36.7±1.9, C: 36.1±5.7 vs. 29.4±4.8 and D: 34.4±9.4 vs. 52.7±5.2, respectively), only one animal was higher EQ. In YDm (%), significant differences were detected (P<0.05) in all four animals, being higher in SU compared with EQ (A: 69.1±8.6% vs. 47.4±3.3% B: 59.34±12.3% vs. 24.8±1.5%, C: 54.9±12.3% vs. 43.2±3.1% and D: 53.1±17.6% vs. 37.5±5.7%, respectively). The results obtained in this study showed that sperm selection methods Swim-up and Equipure® can retrieve different functional sperm quality in frozen-thawed equine semen, and that individual differences were registered among animals with respect to methods. In the Swim-up method a tendency for selecting higher functional quality in thawed equine sperm was observed when compared to Equipure®.

Trypan blue exclusion assay by flow cytometry

Dye exclusion tests are used to determine the number of live and dead cells. These assays are based on the principle that intact plasma membranes in live cells exclude specific dyes, whereas dead cells do not. Although widely used, the trypan blue (TB) exclusion assay has limitations. The dye can be incorporated by live cells after a short exposure time, and personal reliability, related to the expertise of the analyst, can affect the results. We propose an alternative assay for evaluating cell viability that combines the TB exclusion test and the high sensitivity of the flow cytometry technique. Previous studies have demonstrated the ability of TB to emit fluorescence when complexed with proteins. According to our results, TB/bovine serum albumin and TB/cytoplasmic protein complexes emit fluorescence at 660 nm, which is detectable by flow cytometry using a 650-nm low-pass band filter. TB at 0.002% (w/v) was defined as the optimum concentration for distinguishing unstained living cells from fluorescent dead cells, and fluorescence emission was stable for 30 min after cell treatment. Although previous studies have shown that TB promotes green fluorescence quenching, TB at 0.002% did not interfere with green fluorescence in human live T-cells stained with anti-CD3/fluorescein isothiocyanate (FITC) monoclonal antibody. We observed a high correlation between the percentage of propidium iodide+CD3/FITC+ and TB+CD3/FITC+ cells, as well as similar double-stained cell profiles in flow cytometry dot-plot graphs. Taken together, the results indicate that a TB exclusion assay by flow cytometry can be employed as an alternative tool for quick and reliable cell viability analysis.

Statistical investigation of Kluyveromyces lactis cells permeabilization with ethanol by response surface methodology

The aim of our study was to select the optimal operating conditions to permeabilize Kluyveromyces lactis cells using ethanol as a solvent as an alternative to cell disruption and extraction. Cell permeabilization was carried out by a non-mechanical method consisting of chemical treatment with ethanol, and the results were expressed as β-galactosidase activity. Experiments were conducted under different conditions of ethanol concentration, treatment time and temperature according to a central composite rotatable design (CCRD), and the collected results were then worked out by response surface methodology (RSM). Cell permeabilization was improved by an increase in ethanol concentration and simultaneous decreases in the incubation temperature and treatment time. Such an approach allowed us to identify an optimal range of the independent variables within which the β-galactosidase activity was optimized. A maximum permeabilization of 2,816 mmol L-1 oNP min-1 g-1 was obtained by treating cells with 75.0% v/v of ethanol at 20.0 °C for 15.0 min. The proposed methodology resulted to be effective and suited for K. lactis cells permeabilization at a lab-scale and promises to be of possible interest for future applications mainly in the food industry.

Extracellular vesicles: structure, function, and potential clinical uses in renal diseases

Interest in the role of extracellular vesicles in various diseases including cancer has been increasing. Extracellular vesicles include microvesicles, exosomes, apoptotic bodies, and argosomes, and are classified by size, content, synthesis, and function. Currently, the best characterized are exosomes and microvesicles. Exosomes are small vesicles (40-100 nm) involved in intercellular communication regardless of the distance between them. They are found in various biological fluids such as plasma, serum, and breast milk, and are formed from multivesicular bodies through the inward budding of the endosome membrane. Microvesicles are 100-1000 nm vesicles released from the cell by the outward budding of the plasma membrane. The therapeutic potential of extracellular vesicles is very broad, with applications including a route of drug delivery and as biomarkers for diagnosis. Extracellular vesicles extracted from stem cells may be used for treatment of many diseases including kidney diseases. This review highlights mechanisms of synthesis and function, and the potential uses of well-characterized extracellular vesicles, mainly exosomes, with a special focus on renal functions and diseases.

Thermotropic liquid crystal phase behaviour of synthetic branched chain Alkylglycosides

We have synthesized some of glycolipids which can be used as a model for studying the behavior of the cell membrane. We used monosaccharide and disaccharide sugars as the carbohydrate moieties while the lipid moieties derived from Guerbet alcohols. These alcohols are branched at position 2. Liquid crystals studies on these synthetic glycolipids have been carried out using optical polarizing microscopy, differential scanning calorimetry and small angle X-ray scattering. Interesting phase behaviour has been observed for these branched chain glycolipids to compared to those of straight counterparts

Localización extra nuclear de receptores esteroides y activación de mecanismos no genómicos / Extra nuclear localization of steroid receptors and non genomic activation mechanisms

Los receptores de hormonas esteroides han sido considerados históricamente como factores de transcripción nucleares. Sin embargo, en los últimos años surgieron evidencias que indican que su activación desencadena eventos rápidos, independientes de la transcripción y que involucran a diferentes segundos mensajeros; muchos de estos receptores han sido localizados en la membrana celular. Por otra parte, se han caracterizado varios receptores de hormonas esteroides noveles, de estructura molecular diferente al receptor clásico, localizados principalmente en la membrana celular. Esta revisión enfoca los diferentes efectos iniciados por los glucocorticoides, mineralocorticoides, andrógenos, estrógenos y progesterona, y los posibles receptores involucrados en los mismos.

Steroid hormone receptors have been historically considered as nuclear transcription factors. Nevertheless, in the last years, many of them have been detected in the cellular membrane. It has been postulated that their activation can induce transcription independent rapid events involving different second messengers. In addition, several novel steroid hormone receptors, showing a different molecular structure than the classical ones, have also been characterized and most of them are also located in the plasmatic membrane. This review focuses on the variety of effects initiated by glucocorticoids, mineralocorticoids, androgens, estrogens and progesterone, and the possible receptors involved mediating these effects.

The extracellular matrix of the lung and its role in edema formation

The extracellular matrix is composed of a three-dimensional fiber mesh filled with different macromolecules such as: collagen (mainly type I and III), elastin, glycosaminoglycans, and proteoglycans. In the lung, the extracellular matrix has several functions which provide: 1) mechanical tensile and compressive strength and elasticity, 2) low mechanical tissue compliance contributing to the maintenance of normal interstitial fluid dynamics, 3) low resistive pathway for an effective gas exchange, d) control of cell behavior by the binding of growth factors, chemokines, cytokines and the interaction with cell-surface receptors, and e) tissue repair and remodeling. Fragmentation and disorganization of extracellular matrix components comprises the protective role of the extracellular matrix, leading to interstitial and eventually severe lung edema. Thus, once conditions of increased microvascular filtration are established, matrix remodeling proceeds fairly rapidly due to the activation of proteases. Conversely, a massive matrix deposition of collagen fiber decreases interstitial compliance and therefore makes the tissue safety factor stronger. As a result, changes in lung extracellular matrix significantly affect edema formation and distribution in the lung.

A matriz extracelular é um aglomerado tridimensional demacromoléculas composta por: fibras colágenas (principalmente, tipos I e III), elastina, glicosaminoglicanos e proteoglicanos. No pulmão, a matriz extracelular tem várias funções, tais como: 1) promover estresse tensil e elasticidade tecidual, 2) contribuir para a manutenção da dinâmica de fluidos no interstício, 3) propiciar efetiva troca gasosa, 4) controlar a função celular através de sua ligação com fatores de crescimento, quimiocinas, citocinas e interação com receptores de superfície, e 5) remodelamento e reparo tecidual. A fragmentação e a desorganização da matriz extracelular pode acarretar edema intersticial e, eventualmente, edema alveolar grave. Logo, quando há aumento da filtração microvascular ocorre rápido remodelamento da matriz por ativação de proteases. Destarte, a deposição de fibras colágenas reduz a complacência intersticial limitando o edema. Em conclusão, modificações na matriz extracelular podem afetar a formação e distribuição do edema no pulmão.

Plasma membranes from insect midgut cells

As membranas plasmáticas das células intestinais dos insetos apresentam um domínio apical e outro basal. O domínio apical é geralmente modificado em microvilosidades com organização molecular similar a de outros animais, embora possam diferir naqueles insetos que apresentam vesículas secretoras em trânsito que brotam lateralmente ou destacam-se das extremidades das microvilosidades. Outras modificações microvilares estão associadas a bombeamento de prótons ou a interrelações com uma membrana lipídica (a membrana perimicrovilar) que reveste as microvilosidades de células intestinais de hemípteros (pulgões e percevejos). Admite-se que as membranas perimicrovilares estejam envolvidas na absorção de aminoácidos a partir de dietas diluídas. As membranas microvilares e perimicrovilares tem densidades distintas (e conteúdo protéico) que dependem do táxon do inseto. O papel desempenhado pelas proteínas microvilares e perimicrovilares na fisiologia intestinal dos insetos é revisto, procurando fornecer uma visão coerente dos dados e chamando a atenção para novos objetivos de pesquisa.

Determinación de IgG en eritrocitos senescentes por un ensayo enzimático con consumo de antiglobulina / Determination of senescent red blood cells bound IgG using an enzyme test based an the consuption of antiglobulin

Durante el envejecimiento de los GR se acumula IgG autóloga sobre la membrana eritrocitaria. Esta IgG esta dirigida a un neo antígeno de senescencia, ubicado en la proteína banda 3. El objetivo de este trabajo fue determinar pequeñas cantidades de IgG en la membrana del GR utilizando un inmunoensayo con antiglobulina conjugada con una enzima. Las suspensiones de GRSe y GRJ fueron incubadas con anti-IgG humana conjugada con fosfatasa alcalina. Se transfirieron alícuotas a microplacas sensibilizadas con IgG humana. Se agregó el sustrato de la enzima y se midió la IgG libre. Las concentraciones de IgG unida a la membrana eritrocitaria en GRSe (13.31 x 10-4(g/(L(1.57 x 10-4) fueron significativamente mayores (p(0.0001) que los valores observados en GR (3.35 x 10-4(g/(L(1.39 x 10-4). Los resultados obtenidos indican que esta metodología constituye una herramienta útil para determinar pequeñas contidades de IgG unida a la membrana eritrocitaria.

Functional roles of plasma membrane localized estrogen receptors.

A series of emerging data supports the existence and importance of plasma membrane localized estrogen receptors in a variety of cells that are targets for the steroid hormone action. When estradiol (E2) binds to the cell surface protein, the ensuing signal transduction event triggers downstream signaling cascades that contribute to important biological functions. Aside from the classical signaling through nuclear estrogen receptors, we have provided evidence for the functional roles of an estrogen receptor localized in the plasma membrane. This review highlights some of the recent advances made in the understanding of the genomic/non-genomic actions of plasma membrane localized estrogen receptors.

Effect of hypothermia on brain cell membrane function and energy metabolism after transient global hypoxia-ischemia in the newborn piglet

This study was done to determine the effects of hypothermia on brain cell membrane function and energy metabolism after transient hypoxia-ischemia (HI) in the newborn piglet. Cerebral HI was induced by temporarily complete occlusion of bilateral common carotid arteries with surgical clips and simultaneous breathing with 8% oxygen for 30 min, followed by release of carotid occlusion and normoxic ventilation for 4 hr. Rectal temperature was maintained between 38.0 and 39.0 degrees C in normothermic groups, and between 34.0 and 35.0 degrees C in hypothermic groups for 4 hr after HI. During HI, heart rate, glucose and lactate level in the blood and cerebrospinal fluid increased, and base excess, pH and blood pressure decreased significantly in both normothermic and hypothermic groups. After HI, these abnormalities returned to normal in normothermic group, but lactic acidosis persisted in hypothermic group. Decreased cerebral Na(+),K(+)- ATPase activity and increased lipid peroxidation products, indicative of HI- induced brain injury, were more profound in hypothermic group than in normothermic group. Brain ATP and phosphocreatine levels were not different between normothermic and hypothermic groups. In summary, hypothermia applied immediately after HI for 4 hr did not improve the recovery of brain cell membrane function and energy metabolism in the newborn piglet.

Membrane stretch increases the activity of Ca(2+)-activated K+ channels in rabbit coronary vascular smooth muscles

It has been proposed that Ca(2+)-activated K+ channels play an essential role in maintaining vascular tone during stretch of blood vessel. However, the underlying mechanism of stretch-induced change of Ca(2+)-activated K+ channel activities are still unknown. The present experiment was designed to investigate the effect of membrane stretch on these channels whose activity was measured from rabbit coronary smooth muscle cells using a patch clamp technique. Ca(2+)-activated K+ channel were identified by their Ca2+ and voltage dependencies and its large conductances as in other preparations. Perfusion of cells with a hypotonic solution, which mimics stretching the cell membrane by making a cell swelling, produced an increase in channel activity in cell-attached patch mode. The similar increase was observed when negative pressure was applied into the patch pipette for stretching the cell membrane within a patch area. In inside-out patch, stretch still increased channel activity even under the conditions which exclude the possible involvement of secondary messengers, or of transmembrane Ca2+ influx via stretch-activated cation channels. Pretreatment of arachidonic acid or albumin showed no effect on stretch-induced channel activation, excluding the possibility of fatty acids mediated channel activation during membrane stretch. These results indicate that the stretch may directly increase the activity of Ca(2+)-activated K+ channels in our experimental condition.

Essential fatty acids in health and disease.

Essential fatty acids (EFAs) form an important component of cell membranes, are eicosanoid precursors and are therefore required for both the structure and function of every cell in the body. EFAs can modulate the activity of protein kinase C, T and B cell response, free radical generation and lipid peroxidation, lymphokine secretion and cell proliferation. EFAs also have anti-mutagenic, anti-bacterial, anti-fungal and anti-viral properties. EFAs and their metabolites lower serum cholesterol, triglycerides and blood pressure. EFAs appear to be of benefit in atopic eczema, premenstrual syndrome, psoriasis, auto-immune disorders especially rheumatoid arthritis and systemic lupus erythematosus, prevention of target organ damage in diabetes mellitus, peptic ulcer disease, ulcerative colitis, coronary heart disease and atherosclerosis. EFAs and their metabolites can selectively kill tumor cells both in vitro and in vivo without harming normal cells. In addition, EFAs seem to play a fundamental role in inflammation and immune response. In view of their actions and relative safety, it is anticipated that EFAs may be useful in the management of several diseases.

O acometimento cardiovascular na cirrose hepática: cardiomiopatia cirrótica / The cardiovascular involvement in liver cirrhosis: cirrhotic cardiomyopathy

A classificaçäo etiológica das cardiomiopatias definida pela Organizaçäo Mundial da Saúde abrange 140 itens distribuídos em 40 subcategorias distintas. Esta ampla diversidade reflete a natureza multifatorial dos mecanismos de agressäo ao músculo cardíaco. As alteraçöes hemodinâmicas e neurohumorais inerentes à fisiopatologia da cirrose hepática, associadas ao caráter geralmente insidioso de sua evoluçäo, promovem um estado de disfunçäo ventricular progressivo. Os primeiros relatos acerca do envolvimento cardiovascular na cirrose hepática surgiram e 1953 com o estudo da circulaçäo hiperdinâmica em cirróticos, vinculada à elevaçäo do débito cardíaco e a reduçäo da resistência vascular periférica. Trabalhos subsequentes realizados em pacientes com cirrose hepática näo-alcoólicos, revelaram comprometimento ventricular esquerdo sob condiçöes de estresse físico ou farmacológico independente da açäo primária do álcool no miocárdio. Estes elementos permitiram a identificaçäo de nova entidade no conjunto das síndromes de insuficiência cardíaca de alto débito, denominada; cardiomiopatia cirrótica, cujos aspectos fisiopatólogicos clínicos e terapêuticos seräo o alvo desta revisäo.

Canales de iones / Ions channels

Los canales de iones son glucoproteínas estructurales de la membrana celular que participan en la función, sobre todo de células excitables, para generar el potencial de acción y además ayudan a mantener el equilibrio de iones y de agua en los espacios intra y extracelulares. En la presente revisión se mencionan, entre otros aspectos, su estructura, los principios básicos de su función y algunas de las enfermedades hereditarias que ocurren habitualmente por una formación anormal de estas estructuras. La habilidad que tenemos de pensar y movernos depende de los cambios de voltaje iniciados por la movilización de iones, lo cual regula la función nerviosa y muscular. Por mucho tiempo se ha sabido que estos canales son blanco de manipulación por varios fármacos aplicados, sobre todo, a nivel de la clínica cardiovascular; otros medicamentos, usados ampliamente en forma secundaria, también pueden alterar la función de los canales induciendo efectos colaterales que pueden ser graves. Todos estos aspectos y algunos otros se mencionan en la presente revisión