A novel nonsense mutation in the EYA1 gene associated with branchio-oto-renal/branchiootic syndrome in an Afrikaner kindred.

Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder characterized by the associations of hearing loss, branchial arch defects and renal anomalies. Branchiootic (BO) syndrome is a related disorder that presents without the highly variable characteristic renal anomalies of BOR syndrome. Dominant mutations in the human homologue of the Drosophila eyes absent gene (EYA1) are frequently the cause of both BOR and BO syndromes. We report a South African family of Afrikaner descent with affected individuals presenting with pre-auricular abnormalities and either hearing loss or bilateral absence of the kidneys. Genetic analysis of the pedigree detected a novel EYA1 heterozygous nonsense mutation in affected family members but not in unaffected family members or a random DNA panel. Through mutational analysis, we conclude that this particular mutation is the cause of BOR/BO syndrome in this family as a result of a truncation of the EYA1 protein that ablates the critical EYA homologous region. To the best of our knowledge, this is the first case of BOR/BO syndrome reported in Africa or in those of the Afrikaner descent.

The effects of sodium bicarbonate on thioridazine-induced cardiac dysfunction in the isolated perfused rat heart.

To determine the site of thioridazine-induced cardiotoxicity and investigate the effectiveness of sodium bicarbonate (NaHCO3) therapy, isolated rat hearts were perfused with Krebs-Henseleit-Bicarbonate buffer (KHB) at a constant coronary flow of 10 mL/min and electrically paced at 300 bpm. Experimental protocol included 15 min intervals of KHB, thioridazine (TDZ), TDZ + NaHCO3, KHB. Left ventricular (LV) pressure was measured with a balloon-tipped catheter placed in the LV via the mitral valve. Coronary perfusion pressure was monitored continuously as an index of coronary vascular resistance (CVR). LV generated pressure (LVGP) was used as our index of cardiac function and was calculated by subtracting LV end diastolic pressure (LVEDP) from LV peak systolic pressure (LVPSP). TDZ at 7,500 ng/mL was chosen as the toxic dose. NaHCO3 treatment was at an approximate sodium = 155 mM and pH = 7.60. Hearts perfused with TDZ resulted in a progressive decrease in LVGP. After 15 min of TDZ perfusion, LVGP decreased by 50%, and 75% at 30 min (n = 5). TDZ increased LVEDP and decreased LVPSP. TDZ perfusion increased CVR by 83%. In another experiment, hearts were perfused with TDZ for 15 min and then for an additional 15 min with TDZ + NaHCO3. NaHCO3 treatment transiently (approximately 5 min) increased LVGP by 23% (n=5). During NaHCO3 treatment, LVPSP increased and LVEDP and CVR decreased during the first 5 min. During the remainder of the NaHCO3 protocol, the hearts failed, similar to TDZ alone. TDZ diminished left ventricular function and promoted coronary artery vasoconstriction. NaHCO3 temporariy reversed these toxic effects.

Lithium has no direct effect on cardiac function in the isolated, perfused rat heart.

To determine if lithium exerts direct cardiac toxicity, using an isolated, perfused rat heart model, paced and unpaced beating rat hearts were perfused with Krebs-Henseleit bicarbonate solution and left ventricular pressures were measured via a balloon-tipped catheter positioned in the left ventricle via the mitral valve. Following a stabilization period, hearts were then perfused with Krebs-Henseleit bicarbonate solution containing 1, 10, and 100 mM ionized lithium chloride or lithium carbonate in an antecedent dose-response protocol and perfused for 10 min. at each dose. To control for the possibility of osmotic effects from the high dose of lithium, an additional group was studied in which hearts were perfused with Krebs-Henseleit bicarbonate solution for an initial stabilization period, then perfused for an additional 20 min. with Krebs-Henseleit bicarbonate solution alone, and finally with Krebs-Henseleit bicarbonate solution containing mannitol (200 mOsm/l) for 10 min. Lithium did not have any effect on left ventricular peak systolic pressure, left ventricular end diastolic pressure, heart rate or coronary haemodynamics at concentrations of 1 or 10 mM. At 100 mM LiCl and Li2CO3, left ventricular peak systolic pressure decreased transiently during the first minute of lithium infusion, but recovered significant function by 10 min. Heart rate decreased significantly by 10 min. of infusion. These effects were also seen in the osmotic controls and thus do not appear to be a direct effect of lithium. At the doses tested, lithium had no direct effect on cardiac function which could not be explained by an osmotic effect.

Effect of amiloride on age-dependent cardiac dysfunction after ischemia/reperfusion in the isolated, perfused rat heart.

This study was intended to compare the cardiac consequences of ischemia/reperfusion and amiloride treatment in immature (2-3 wk), juvenile (4-6 wk), and adult (3-5 mo) rats using an isolated, perfused heart model. Male immature, juvenile, and adult rats were anticoagulated and anesthetized. Hearts were harvested and coronary arteries were perfused on a Langendorff apparatus via retrograde perfusion of the aorta at a constant coronary flow (initially determined by perfusing the heart at 50 mm Hg perfusion pressure) with oxygenated Krebs-Henseleit-Bicarbonate (KHB) solution. Left ventricular peak systolic (LVPSP) and end diastolic (LVEDP) pressures were measured via a balloon-tipped catheter placed in the left ventricle through the mitral valve. Following a 20-30 min stabilization period, hearts underwent 30 min of normothermic ischemia and were then reperfused with Krebs-Henseleit-Bicarbonate alone for 30 min, or Krebs-Henseleit-Bicarbonate containing 500 microM amiloride for 5 min followed by Krebs-Henseleit-Bicarbonate alone for 25 min (n = 6/age group). Left ventricular generated pressure was calculated (left ventricular peak systolic-left ventricular end diastolic) and used as a measure of ventricular function. All hearts demonstrated a decrease in generated pressure, respectively, from preischemic levels at 15 and 30 min of reperfusion, although this decrease was significantly less for the immature hearts. Ischemia/reperfusion injury was attenuated by amiloride in adult and juvenile hearts, whereas ischemia/reperfusion injury was worsened by amiloride in immature hearts. Although immature hearts were relatively resistant to ischemia/reperfusion injury compared with adult and juvenile hearts, the presence of amiloride during reperfusion resulted in more severe ventricular dysfunction in immature hearts. These data suggest a differential age-dependent mechanism of sarcolemmal ion exchange in response to ischemia/reperfusion.

The effects of colchicine treatment on wound healing in a caustic murine injury model.

OBJECTIVE: The present study determined the effects of colchicine on wound repair in a murine model of dermal chemical injury. METHODS: Standardized 4.15 cm2 circular lesions were induced on the dorsum of adult male mice with NaOH. Five minutes of IN or 3N caused lesions of graded depth. Mice received colchicine (1 mg/kg) or phosphate-buffered saline intraperitoneally in equivalent volumes. Treatment began immediately postinjury and was continued on an alternating day schedule for 14 days. Wound size was measured every third day postinjury. On day 15 postinjury, wounds were histologically graded for depth of injury, degree of fibrosis, inflammatory cell response, and revascularization. All histological determinations and wound measurements were performed in a blinded fashion. RESULTS: All mice had a similar initial wound size and completed the experimental protocol. In dermal wounds of superficial depth, colchicine-treated mice (n = 20) had a larger wound size during days 6 through 9 of the experimental trial when compared to phosphate-buffered saline-treated mice (n = 18). In the deeper wounds, there were no significant differences in wound size between colchicine and phosphate-buffered saline-treated groups. Colchicine (n = 54) did not affect the degree of fibrosis at all depths of injury vs phosphate-buffered saline treatment in mice (n = 55). The degree of wound revascularization was less in colchicine-treated mice (n = 54) than phosphate-buffered saline-treated mice (n = 55). CONCLUSION: Colchicine did not improve wound healing in an alkaline-induced dermal injury.

The diabetogenic effects of acute verapamil poisoning.

Verapamil poisoning is known to produce hyperglycemia and metabolic acidosis in humans. The purpose of this study was to elucidate mechanisms of verapamil-induced hyperglycemia in awake dogs. Mongrel canines were chronically instrumented to permit studies in the conscious state. In six healthy dogs, steady-state glucose infusion requirement after 1 hr of insulin infusion at 1000 mU/min was 19 +/- 1 mg/kg/min. In six separate dogs, verapamil toxicity was induced via verapamil infusion in the portal vein; during verapamil toxicity, the glucose infusion requirement with an insulin infusion rate of 1000 mU/min was significantly decreased (3 +/- 1 mg/kg/min; p < 0.05, unpaired t test). Eleven other verapamil-toxic dogs were also treated with either saline (n = 6, 3.0 ml/kg/hr) or glucagon (n = 5, 10 microg/kg/min). Insulin concentrations were not changed vs basal concentrations in either group. Catecholamine concentrations increased at least 15-fold in all groups (from 458 +/- 169 to 6973 +/- 480 pg/L in the saline-treated group). Glucose concentrations increased in saline-treated animals from 3.7 +/- 0.3 to 11.2 +/- 1.0 micromol/L, and with glucagon treatment, increased from 3.3 +/- 0.3 to 16.1 +/- 1.6 micromol/L (p < 0.05 vs saline, ANOVA). Verapamil poisoning appears to produce hyperglycemia by inducing systemic insulin resistance, blocking insulin release, together with an intact stress hormone response and glucogenic capacity.

Insulin improves heart function and metabolism during non-ischemic cardiogenic shock in awake canines.

OBJECTIVES: This study was undertaken to examine in-situ heart function and metabolism during insulin treatment of verapamil-induced cardiogenic shock in awake canines. METHODS: Twenty mongrel canines were instrumented to monitor myocardial substrate uptakes (glucose, lactate, free fatty acids, oxygen [MVO2]), as well as ventricular (LV) end-systolic elastance (Emax), LV efficiency (LV minute work/MVO2), and Tau. Shock was induced by graded intraportal verapamil infusion followed by randomized assignment to one of 4 treatment groups: saline control (3.0 ml/kg/min, n = 5), epinephrine (5 micrograms/kg/min, n = 5), glucagon (10 micrograms/kg/min, n = 5) or insulin (1000 mU/min, n = 5) with dextrose to clamp arterial [glucose] +/- 10% of basal concentrations. RESULTS: Insulin treatment significantly increased Emax (34 +/- 3 vs. 17 +/- 3 mmHg/mm, saline control), and shortened Tau (9 +/- 3 ms) compared to saline control (42 +/- 5 ms), epinephrine (20 +/- 4 ms) and glucagon (35 +/- 8 ms). With insulin treatment, mechanical efficiency increased to 20,097 +/- 2070 vs. 12,424 +/- 1615 mmHg.mm/ml/O2/100 g in controls. Simultaneously, insulin increased myocardial lactate uptake (35 +/- 2 vs. 17 +/- 4 mumol/min/100 g. saline control), but did not increase glucose uptake. Epinephrine and glucagon decreased mechanical efficiency compared to saline controls, coincident with increased myocardial fatty acid consumption, but without increasing lactate uptake. One dog died early with glucagon treatment before the first death in the saline-treated group. CONCLUSIONS: Insulin improves systolic and diastolic heart function during aerobic shock and accelerates in-vivo myocardial lactate oxidation.

Antioxidant effects of pyruvate in isolated rat hearts.

Sprague-Dawley rat hearts were perfused under constant flow conditions, and a balloon was inserted into the left ventricle to measure heart rate (HR) and left ventricular pressures. Left ventricular generated pressure (LVGP) was calculated as peak systolic minus end diastolic pressure. Three substrate groups, pyruvate (5 mM), glucose (15 mM) and octanoate (0.5 mM), were employed. Oxidative stress was induced by perfusion with tertiary-butyl hydroperoxide (tBHP, 0.35 mM, 12 min) followed by 25 min of perfusion with control buffer. Hearts perfused with pyruvate showed no significant decrease in contractile function following tBHP treatment (HR x LVGP = 17666 +/- 585 mmHg/min, initial: 16414 +/- 2083 post-tBHP treatment). Glucose-perfused hearts had an intermediate decrease in function (19174 +/- 828 mmHg/min, initial; 4379 +/- 2083 post-tBHP), while octanoate-perfused hearts recovered no contractile function. Peak release of LDH was lowest in hearts perfused with pyruvate (115 +/- 17 mU/g wet wt/min), intermediate in glucose-perfused hearts (1575 +/- 380) and highest in octanoate-perfused hearts (3074 +/- 499). Thiobarbituric acid reactive substances (TBARS) were unchanged in hearts perfused with pyruvate (16.2 +/- 5 nmoles/g wet wt), but increased significantly in glucose-perfused hearts (36.1 +/- 1) and in octanoate-perfused hearts (45.5 +/- 9). Total glutathione levels were unchanged in hearts perfused with pyruvate (753 +/- 68 nmoles/g wet wt), but significantly decreased in glucose-perfused hearts (594 +/- 68) and in octanoate-perfused hearts (445 +/- 38) following tBHP-treatment. Pyruvate significantly reduced oxidative injury. In contrast, glucose provided a small reduction in injury while octanoate-perfused hearts had the most severe injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Beneficial myocardial metabolic effects of insulin during verapamil toxicity in the anesthetized canine.

OBJECTIVE: Myocardial depression from verapamil toxicity may result from alterations in carbohydrate metabolism as well as calcium-channel antagonism. We hypothesized that pharmacologic doses of insulin may be effective in reversing both of these deficits. DESIGN: Randomized, controlled, prospective study. SETTING: Laboratory of an urban hospital. SUBJECTS: Thirty mongrel dogs. INTERVENTIONS: Thirty mongrel canines were anesthetized with alpha-chloralose. Toxicity was induced by the administration of 0.1 mg/kg/min iv of verapamil, until there was a 50% reduction in mean arterial pressure, for 30 mins (titration), followed by a continuous verapamil infusion of 1 mg/kg/hr. Animals (n = 6 per group) were randomized to the control group (saline only) or to one of four treatment protocols: a) calcium chloride (20 mg/kg), then 0.6 mg/kg/hr; b) hyperinsulinemia-euglycemia (4.0 U/min of recombinant insulin, with arterial glucose concentration clamped to +/- 10 mg/dL [+/- 0.5 mmol/L] of the basal value); c) epinephrine, with a starting rate of 1.0 microgram/kg/min, titrated to maintain left ventricular pressure at basal values; or d) glucagon, a 0.2-mg/kg bolus, followed by a 150-microgram/kg/hr infusion. Animals were monitored until death or 240 mins; infusate volumes were held constant for all groups. MEASUREMENTS AND MAIN RESULTS: During verapamil titration, the myocardial respiratory quotient increased from 0.84 +/- 0.05 to 1.07 +/- 0.11 (p < .05, paired t-test) and myocardial glucose uptake doubled, despite a reduction in cardiac work (p < .05, paired t-test). Net myocardial lactate uptake also increased significantly, excluding myocardial ischemia. In controls, this trend continued, indicating preferential carbohydrate metabolism during untreated verapamil toxicity. Despite hyperglycemia, the plasma insulin concentration was not significantly different in controls (basal value 11 +/- 2 vs. 39 +/- 21 microU/mL at 30 mins). Hyperinsulinemia-euglycemia increased both myocardial glucose and lactate uptake five-fold, and significantly increased the ratio of myocardial oxygen delivery/work, along with superior improvements in maximal left ventricular elastance at end systole compared with other treatments (p < .05 vs. other treatments, contrast analysis). CONCLUSIONS: Verapamil toxicity renders the heart dependent on carbohydrate metabolism. Inasmuch as the positive inotropic effects of all treatments were coincident with increased indices of myocardial carbohydrate uptake, adequate treatment of verapamil toxicity appeared to require maximal myocardial carbohydrate utilization. Hyperinsulinemia-euglycemia allows larger increases in myocardial carbohydrate metabolism and myocardial contractility than calcium chloride, epinephrine, or glucagon, resulting in improved survival rates during severe verapamil toxicity.

Magnesium potentiates imipramine toxicity in the isolated rat heart.

STUDY OBJECTIVE: To study the effect of magnesium on cardiac function and hemodynamics during imipramine toxicity. DESIGN: After stabilization, isolated, beating rat hearts were perfused with Krebs-Henseleit bicarbonate buffer (KHB) solution containing 2.0 mg/L imipramine (IMIP) and 2.4 mEq [Mg2+] until toxicity, defined as 25% widening of the ventricular depolarization duration (VDD). Experiments were performed at either constant coronary perfusion pressure or flow. SETTING: Animal research laboratory of a large, urban hospital. MEASUREMENTS: Heart rate, VDD, left ventricular pressure and +/- dP/dt, and coronary flow. INTERVENTIONS: On onset of toxicity, KHB+IMIP was switched to either control (KHB+IMIP), magnesium (KHB+IMIP+4.0 or 6.0 mEq/L [Mg2+]), or hypertonic alkaline treatment (165 mEq/L [Na+], pH 7.55). RESULTS: At a constant coronary perfusion pressure of 100 mm Hg, magnesium at 6.0 mEq produced significant decreases in heart rate, left ventricular pressure, +dP/dt, and increase in VDD versus control. With coronary flow held constant, magnesium reduced left ventricular pressure and +dP/dt but not heart rate or VDD. Incidences of electromechanical dissociation and asystole were higher with magnesium versus control. Hypertonic alkaline treatment tended to improve all parameters in constant pressure and constant flow experiments. CONCLUSION: Magnesium potentiates IMIP-induced negative inotropic effects and cardiac conduction defects in isolated rat hearts.

Aminophylline fails to improve the outcome of cardiopulmonary resuscitation from prolonged ventricular fibrillation: a placebo-controlled, randomized, blinded experimental study.

OBJECTIVES: The purpose of this study was to evaluate systematically the effects of the adenosine antagonist aminophylline on resuscitation outcome in a canine model of postcardioversion nonperfusing rhythm. BACKGROUND: Theoretic considerations and experimental studies indicate that myocardial adenosine accumulation during prolonged ventricular fibrillation might play a significant role in postcardioversion asystole and electromechanical dissociation. A recent uncontrolled clinical trial has suggested that the adenosine antagonist aminophylline might improve the outcome of cardiopulmonary resuscitation from refractory bradyasystolic cardiac arrest. METHODS: Two placebo-controlled, randomized, blinded experimental studies were performed. In protocol 1 (20 dogs), ventricular fibrillation was induced and maintained for 7.5 min. Sixty seconds before cardioversion, dogs received 1 mg of epinephrine followed by 250 mg of aminophylline or placebo. In protocol 2 (20 dogs), dogs were cardioverted to electromechanical dissociation after 5 min of unsupported ventricular fibrillation. Sixty seconds later, all dogs received 1 mg of epinephrine followed by 250 mg of aminophylline or placebo. In both experiments, resuscitation efforts were continued until return of spontaneous circulation, or up to 30 min. The primary end point was survival to 1 h. RESULTS: In protocol 1, 4 of 10 dogs survived in the aminophylline group, whereas 7 of 10 dogs survived in the placebo group, a nonsignificant trend toward unfavorable outcome from aminophylline. Pretreatment with aminophylline increased the number of cardioversion applications required to terminate ventricular fibrillation. In protocol 2, 5 of 10 and 6 of 10 dogs survived in the aminophylline and placebo groups, respectively. CONCLUSIONS: The results of this study suggest that aminophylline fails to improve the outcome of resuscitation from prolonged ventricular fibrillation. It does not reverse established electromechanical dissociation and may in fact increase the number of cardioversion applications required to terminate ventricular fibrillation. The rationale for conducting clinical trials with aminophylline during cardiopulmonary resuscitation is questionable.

Insulin is a superior antidote for cardiovascular toxicity induced by verapamil in the anesthetized canine.

Because of its positive inotropic effects that are independent of cyclic AMP, insulin was compared to epinephrine and glucagon as a novel treatment for cardiac toxicity from verapamil. Twenty-four alpha-chloralose-anesthetized mongrel canines of either sex were instrumented to monitor standard hemodynamic and cardiodynamic parameters and maximum elastance at end systole, via the transit-time technique, as our index of contractility. Toxicity was induced by 0.1 mg/kg/min of verapamil (i.v.), until 50% reduction in mean arterial blood pressure or complete AV dissociation for 30 min. This was followed by continuous infusion of 1.0 mg/kg/hr of verapamil during one of four treatment protocols: 1) control (0.9% NaCl, 2.0 ml/min); 2) epinephrine (1.0 micrograms/kg/min); 3) hyperinsulinemic-euglycemic (HIE) clamp (recombinant insulin at 4.0 U/min with 20% dextrose, arterial glucose clamped); or 4) glucagon (0.2-0.25-mg/kg bolus infusion followed by 150-micrograms/kg/min infusion). Treatments were continued until death or 240 min after which time surviving animals received a 3.0-mg/kg additional bolus of verapamil. Verapamil decreased all hemodynamic parameters during titration. All controls died within 85 min. All treatments tended to improve hemodynamics; however, HIE significantly improved maximum elastance at end systole, left ventricular end diastolic pressure and coronary artery blood flow vs. other treatments (P < .05, repeated measures). Glucagon transiently restored sinus rhythm (four animals), but in all cases reverted to A-V dissociation, coincident with sharp decreases in circumflex artery blood flow and contractility.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic insulin resistance during chronic hyperdynamic sepsis.

Disturbances in normal glucose metabolism and homeostasis which manifest as hyperglycemia and glucose intolerance are often observed during clinical sepsis. Skeletal and myocardial muscle as well as whole body insulin resistance have been demonstrated in this laboratory and others during experimental and clinical sepsis. The existence of hepatic insulin resistance in sepsis has yet to be fully elucidated. This study was undertaken to assess hepatic insulin resistance during chronic hyperdynamic sepsis. Animals were randomly assigned to a septic (n = 7), sham (n = 7), or control (n = 7) group. Sepsis was induced in anesthetized dogs via a midline laparotomy whereby a fecal-soaked gauze sponge was placed amid the intestines. Sham animals underwent a laparotomy with mechanical manipulation of the intestines but no fecal implant. Control animals had no previous surgery. Sham and control dogs were pair-fed with the septic dogs. On postoperative day 7, after an overnight fast, animals were anesthetized, intubated, and ventilated. Via a left subcostal laparotomy, electromagnetic flow probes were placed to measure hepatic arterial and portal venous blood flows. Cannulae were placed in femoral, portal, and hepatic veins and femoral artery and used to calculate hepatic outputs of glucose, lactate, and oxygen during a basal period and hyperinsulinemic-euglycemic clamps which used intravenous insulin infusions which ranged from 0.4 to 4,000 mU/min. Mean arterial blood pressure decreased with increasing insulin concentrations in septic animals while no change was seen in control or sham animals. In control and sham animals, net hepatic glucose output (NHGO) decreased in response to increasing insulin levels. Septic animals showed no such inverse relationship and, moreover, showed no change in glucose output response to any insulin infusion, i.e., hepatic insulin unresponsiveness during sepsis. Net hepatic lactate output during basal pre-insulin period during sepsis was negative. This was in contrast to the positive outputs in control and sham animals. Glucose infusion rates (GIR) increased during insulin infusion but were not different between groups at any insulin infusion rate. These data demonstrated a hepatic insulin resistance (unresponsiveness) during chronic hyperdynamic, hypermetabolic sepsis.

Hepatic insulin resistance during canine sepsis.

Glucose dyshomeostasis and insulin resistance are well-documented characteristics of sepsis. The insulin resistance could be manifested in a decreased peripheral glucose uptake and/or an increased hepatic glucose output. To investigate the hepatic and peripheral responses to insulin in a three-day model of sepsis, 14 mongrel dogs were studied. Animals were randomly assigned to a SEPTIC (n = 5), SHAM (n = 4), or CONTROL (n = 5) group. Sepsis was induced in anesthetized dogs via a midline laparotomy with subsequent placement of a fecal-soaked gauze sponge around intestines. SHAM and CONTROL dogs were pair-fed with the SEPTIC dogs. On the third day, animals were anesthetized, intubated, and ventilated. Via a left-side laparotomy, electromagnetic flow probes were placed to measure hepatic arterial and portal venous blood flows. Cannulas were placed in femoral, portal, and hepatic veins and femoral artery to measure hepatic outputs of glucose, lactate, and oxygen during hyperinsulinemic-euglycemic clamps ranging from 0.4 to 4,000 mU insulin/min. Portal venous insulin concentrations in SEPTIC animals were significantly increased compared to CONTROL animals during 0.4 and 4 mU insulin/min infusions. An insulin infusion rate of 40 mU/min significantly decreased net hepatic glucose output (NHGO) in CONTROL animals but did not affect NHGO in SHAM or SEPTIC animals. An insulin infusion rate of 4,000 mU/min significantly decreased NHGO in all groups. An attempt to analyze the ED50 of the three dose-response curves was inconclusive. Glucose infusion rates (GIR) increased during insulin infusion but the GIR were not different between groups at any insulin infusion rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine reversal of in vivo hepatic responsiveness to insulin.

Modulation by adenosine of hepatic responsiveness to insulin was investigated in vivo in 10 healthy mongrel dogs of both sexes by determining net hepatic glucose output (NHGO) in response to insulin during the presence or absence of exogenous adenosine infusion. In addition, two separate series of experiments were performed to study the effect of adenosine (n = 7) or glucagon (n = 5) on NHGO. Basal NHGO, quantitated via the Fick principle, was significantly decreased by insulin infusion (4 U/min; 4.8 +/- 0.6 vs. -1.7 +/- 2.6 mg.kg-1.min-1, P less than 0.05). The addition of an intrahepatic arterial infusion of adenosine (10 mumol/min) during insulin infusion caused glucose output to return to basal levels (insulin, -1.7 +/- 2.6 mg.kg-1.min-1; insulin + adenosine, 3.8 +/- 1.6 mg.kg-1.min-1, P less than 0.05). The addition of intrahepatic arterial saline (control) during insulin infusion had no effect on insulin's action (insulin, -1.0 +/- 1.9 mg.kg-1.min-1; insulin + saline, -1.2 +/- 1.6 mg.kg-1.min-1, P greater than 0.05). Hepatic glucose, lactate, and oxygen deliveries were not affected during either insulin or insulin plus adenosine infusion. Intrahepatic arterial infusion of adenosine alone had no effect on NHGO, whereas intrahepatic arterial infusion of glucagon alone stimulated glucose output approximately fivefold (basal, 2.7 +/- 0.4 mg.kg-1.min-1; glucagon, 15.5 +/- 1.2 mg.kg-1.min-1, P less than 0.01). These results show that adenosine completely reversed the inhibition by insulin of NHGO. These data suggest that adenosine may act as a modulator of insulin action on the liver.

Insulin and beta adrenergic effects during endotoxin shock: in vivo myocardial interactions.

STUDY OBJECTIVE - Catecholamine concentrations are raised during endotoxin shock and may be responsible for myocardial insulin resistance in such a condition. The purpose of the investigation was to examine the effect of insulin on myocardial contractility and glucose uptake in the presence of beta adrenergic blockade during endotoxin shock. DESIGN - Endotoxin shock was obtained in dogs by giving S Typhimurium endotoxin intravenously (1 mg.kg-1) and the cardiac responses to insulin were determined under hyperinsulinaemic (4 U.min-1) euglycaemic clamp conditions during continuous beta adrenergic blockade (propranolol 150 micrograms.kg-1 + 5 micrograms.kg-1.min-1). SUBJECTS - 19 mongrel dogs of either sex, weight 20-25 kg, were studied under pentobarbitone anaesthesia. Seven dogs received endotoxin plus propranolol, and seven others received propranolol alone (control group). Five dogs received endotoxin but no propranolol or insulin. All other procedures were the same in each group. MEASUREMENTS and RESULTS - The exposed heart was prepared for coronary sinus blood sampling and measurements of circumflex artery blood flow (Q), instantaneous left ventricular pressure, and left ventricular wall thickness. Glucose uptake was calculated from product of Q and aortic-coronary sinus concentration difference. End systolic pressure-dimension relationship was used to assess contractility. Myocardial performance was assessed from left ventricular dP/dtmax. Basal shock measurements were made 60 min post endotoxin. beta Adrenergic blockade did not interfere with insulin stimulated glucose uptake in controls, but was unable to restore the uptake response during endotoxin shock. Contractility was increased during endotoxin shock and this effect was abolished by beta adrenergic blockade. In controls the only variable affected by beta adrenergic blockade was left ventricular dP/dtmax (decreased). Insulin increased contractility during beta adrenergic blockade in controls but not in shock. Myocardial performance was depressed during shock. In controls, insulin increased myocardial performance; in shock this response was attenuated. CONCLUSIONS - The findings confirm that the myocardium becomes less responsive to the glucose uptake stimulating and positive inotropic effects of insulin during endotoxin shock. The data show that beta adrenergic activity is responsible for the increased contractile state of the heart during acute endotoxin shock, but is not the cause of the observed insulin resistant state.

When does the heart fail during shock?

Early reports have attributed cardiac failure during acute and chronic models of shock to peripheral vascular dysfunction and decreased venous return. More recently interest has focused on the heart as a primary target responsible for cardiovascular changes associated with acute endotoxin or hemorrhagic shock. At present, it remains controversial whether the heart fails early following the induction of experimental hypodynamic shock. Data from our laboratory have shown that myocardial contractility was increased early following acute endotoxin and splanchnic artery occlusion shock, and it was not until the agonal or terminal phase that contractility was depressed. We have used the slope of the left ventricular pressure-dimension relationship (Ees) as our index of contractile function. This technique is preferential since it is not affected by changes in the loading conditions on the heart. Unlike most reports that have used LV dP/dt as an index of contractility in the intact animal, we have shown that Ees and LV dP/dt do not uniformly reflect changes in contractility. LV dP/dt and related measures do, however, reflect the overall global changes in myocardial performance, which are affected by changes in preload, afterload, heart rate, and contractility. The reductions in LV dP/dt therefore mainly reflect the changes in arterial blood pressure associated with acute hypodynamic shock. The increase in contractility reported during endotoxin shock were shown to be induced by stimulation of beta-adrenergic receptors--when the beta-blocking drug, propranolol, was given to animals during shock, contractility decreased. The mechanism(s) responsible for the failure of the heart during the late or agonal periods of shock is (are) unknown. We have shown in dogs who die as a result of endotoxin shock that the hearts exhibit a progressive energy deficit, whereas animals surviving the experimental protocol maintained levels of ATP and creatine phosphate. It is unclear if the changes in high-energy phosphates during endotoxin shock cause irreversibility. Other potential mediators of cardiac failure have included ischemia/hypoxia, toxic myocardial depressant factors, deterioration of sympathetic influences on the heart, electrophysiologic and ionic disturbances, etc. The relationship between these factors and failure of the heart in vivo during various shock paradigms remains to be elucidated.

Adenosine restores myocardial responsiveness to insulin during acute endotoxin shock in vivo.

We recently reported that adenosine potentiated insulin-stimulated myocardial glucose uptake (MGU) in vivo and that adenosine receptor blockade resulted in myocardial insulin resistance. Since myocardial insulin resistance has been reported to occur during endotoxin shock, we decided to investigate whether infusion of adenosine could ameliorate this condition. Studies were performed in pentobarbital-anesthetized dogs that were instrumented to measure mean arterial blood pressure (MAP), circumflex arterial blood flow (Q), myocardial glucose uptake (MGU), and oxygen uptake (MVO2). Endotoxin shock was induced by administration of an intravenous bolus of Salmonella typhymurium endotoxin (1 mg/kg). The response to insulin was determined during hyperinsulinemic (4 U/min), euglycemic clamp (INS). The ability of adenosine to potentiate insulin-stimulated glucose uptake was measured during sequential infusions of adenosine (0.01 mumol/min to 10 mumol/min) or during infusion of a single concentration of adenosine (1.0 mumol/min) into the circumflex artery. In control dogs INS resulted in an approximate twofold elevation of myocardial glucose uptake over basal values (2.6 +/- 0.4 to 4.9 +/- 0.7 mg/min; mean +/- S.E.M.). There was no significant effect of INS on MAP, Q, or MVO2 in this group. Adenosine infusions resulted in potentiation of insulin-stimulated MGU. During shock INS elevated MAP, Q, and MVO2 to levels that were not significantly different from the control group, but did not raise MGU above the pre-endotoxin level. Adenosine infusions elevated insulin-stimulated MGU during shock to levels similar to those observed in the control group during respective adenosine infusion rates. MAP and MVO2 were not significantly altered by INS + adenosine in the shock group as compared with the effect of INS alone. From these results we conclude that adenosine restored the myocardial glucose uptake response to insulin during endotoxin shock. The response of the oxygen supply to demand ratio to INS suggests that myocardial adenosine production may be reduced during endotoxin shock.

The effect of hypodynamic endotoxin shock on myocardial high energy phosphates in the rat.

High energy phosphate concentrations were determined in the isolated perfused (in vitro) and intact (in situ) heart preparations in the rat during a control period and at various time intervals (1,2,4,8 or 16 h) following the intraperitoneal injection of 4 mg.kg-1 E coli endotoxin. Arterial glucose and lactate concentrations were determined just prior to excising the hearts. Following the induction of endotoxin shock, myocardial ATP and creatine phosphate decreased in both the in situ and in vitro preparations, while AMP increased only in the in situ group. There was no significant alteration in ADP in either group throughout the 16 h experimental period. Myocardial energy charge decreased at 1 h following endotoxin shock and remained depressed throughout the 16 h study period. Total heart weights as well as the wet/dry ratio were unaltered throughout the experiment. The reductions in ATP and creatine phosphate during endotoxin shock were a direct result of the shock state and not due to the loss of myocardial mass or the presence of oedema. One hour following the induction of endotoxin shock plasma glucose increased then returned to the control value by 2 h and remained at the pre-endotoxin level throughout the experimental protocol. Arterial lactate concentration increased following endotoxin administration and remained elevated until 16 h, where it was not different from the control value. Data from the present study clearly indicate a myocardial energy deficit during acute hypodynamic endotoxin shock in the rat and may provide a mechanism for the cardiac dysfunction normally associated with this shock paradigm.