Hypertonic saline solution for modifying tissue ischemia/reperfusion injury: Porcine aortic occlusion model
Keywords:
Saline solution, Myocardial contraction, Ischemia, Stroke volumen, Perfusion, Hypertonic
Abstract
Introduction:
Decreased blood flow disrupts the endothelium, changes the nitric oxide/endothelin -1 ratio, narrows the capillaries and results in microcirculatory dysfunction. Secondary anoxia leads to mitochondrial energy imbalance, depletion of adenosine-triphosphate and disruption of the intracellular hydrogen, sodium and calcium homeostasis. If the flow is restored, the reperfusion stimulates the endothelial expression of adhesion molecules attracting polymorphic nucleotides and platelets, with sub endothelial infiltration of these cells and their entrapment in the microvasculature, as well as vasoconstriction, endothelial edema and reduced flexibility of the cellular membrane. Ischemia/reperfusion may result in inflammation and organ failure.
Objective:
To determine whether hypertonic saline solution reduces the ischemic/reperfusion injury in the liver, the kidney, and the ileum.
Materials and methods:
Experimental trial in pigs. Aortic blood flow suppression (15 min) and reperfusion (60 min). The experimental group was pretreated with 7.5% hypertonic saline and the control group received normal 0.9% saline solution. Hemodynamic, gasometric, and biochemical measurements were taken, and the serum and tissue levels of ET-1, TNF-alpha, IL-10, and IL-2 were determined.
Results:
There were no significant differences in the tissue expression of ET-1, TNF-alpha, IL-10, and IL-2 between the two groups. The hemodynamic behavior was similar in both groups. The group treated with hypertonic solution showed an increasing post-perfusion systolic rate up to the basal values, while the systolic rate in the control group dropped significantly (p = 0.015).
Conclusion:
Hypertonic solution prior to the ischemic insult improves the ventricular function after reperfusion.
References
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25. Ke Q-H, Zheng S-S, Liang T-B, Xie H-Y, Xia W-L. Pretreatment of hypertonic saline can increase endogenous interleukin 10 release to attenuate hepatic ischemia reperfusion injury. Dig Dis Sci. 2006;51:2257-63.
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27. Taurà P, Ibarzabal A, Vendrell M, Adelsdorfer C, Delitala A, De Lacy B, et al. Pretreatment with endothelium-derived nitric oxide synthesis modulators on gastrointestinal microcirculation during NOTES: an experimental study. Surg Endosc. 2016, March 23. Epub ahead of print.
28. Flores J, DiBona DR, Beck CH, Leaf A. The role of cell swelling in ischemic renal damage and the protective effect of hypertonic solute. J Clin Invest. 1972;51:118-26.
29. Scherte ER, Valentine AK, Rademakers AM, Muir WW. Influence of 7% NaCl on the mechanical properties of the systemic circulation in the hypovolemic dog. Circ Shock. 1990;31:203-14.
30. Kreimeier U, Bruckner UB, Niemczyk S, Messmer K. Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: effect on regional blood flow. Cic Shock. 1990;32:83-99.
31. Mouren S, Delayance S, Mion G, Souktani R, Fellahi JL, Arthaud M, et al. Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood-perfused rabbit hearts. Anesth Analg. 1995;81: 777-82.
32. Wang Y-L, Lam K-K, Cheng P-Y, Kung C-W, Chen S-Y, Chao C-C, et al. The cardioprotective effect of hypertonic saline is associated with inhibitory effect on macrophage migration inhibitory factor in sepsis. Biomed Res Int. 2013;2013: 1-10.
33. Oliveira RP, Velasco I, Soriano FG, Friedman G. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care. 2002;6:418-23.
34. Han J, Ren H-Q, Zhao Q-B, Wu Y-L, Qiao Z-Y. Comparison of 3% and 7.5% hypertonic saline in resuscitation after traumatic hypovolemic shock. Shock. 2015;43:244-9.
35. Sidi A, Muehlschlegel JD, Kirby DS, Kirby RR, Lobato EB. Treating ischemic left ventricular dysfunction with hypertonic saline administered after coronary occlusion in pigs. J Cardiothorac Vasc Anesth. 2007;21:400-5.
36. Sánchez-Etayo G, Borrat X, Escobar B, Hessheimer A, Rodriguez-Laiz G, Taurá P. Effect of intra-abdominal pressure on hepatic microcirculation: implications of the endothelin-1 receptor. J Dig Dis. 2012;13:478-85.
37. Rizoli SB, Rhind SG, Shek PN, Inaba K, Filips D, Tien H, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, doubled-blinded trial. Ann Surg. 2006;243:47-57.
2. Festjens N, Berghe TV, Vandenabeele P. Necrosis, a well-orchestrated form of cell demise:signalling cascades, important mediators and concomitant immune response. Biochim Biophys Acta. 2006;1757:1371-87.
3. Heino A, Hartikainen J, Merasto ME, Koski EM, Tenhunen J, Alhava E, et al. Effects of dobutamine on splanchnic tissue perfusion during partial superior mesenteric artery occlusion. Crit Care Med. 2000;28:3484-90.
4. Souza DG, Teixeira MM. The balance between the production of tumor necrosis factor-alpha and interleukin-10 determines tissue injury and lethality during intestinal ischemia and reperfusion. Mem Inst Oswaldo Cruz. 2005;100 Suppl: 59-66.
5. Porta F, Takala J, Weikert C, Bracht H, Kolarova A, Lauterburg BH, et al. Effects of prolonged endotoxemia on liver, skeletal muscle and kidney mitochondrial function. Crit Care. 2006;10:R118.
6. Li R, Zijlstra JG, Kamps JAAM, van Meurs M, Molema G. Abrupt reflow enhances cytokine-induced proinflammatory activation of endothelial cells during simulated shock and resuscitation. Shock. 2014;42:356-64.
7. Peralta C, Jiménez-Castro MB, Gracia-Sancho J. Hepatic ischemia and reperfusion injury: effects on the liver sinusoidal milieu. J Hepatol. 2013;59:1094-106.
8. Resnick N, Yahav H, Shay-Salit A, Shushy M, Schubert S, Zilberman LCM, et al. Fluid shear stress and the vascular endothelium: for better and for worse. Prog Biophys Mol Biol. 2003;81:177-99.
9. Gourdin MJ, Bree B, Kock MD. The impact of ischaemia -reperfusion on the blood vessel. Eur J Anaesthesiol. 2009;26:537-47.
10. Gracia-Sancho J, Casillas-Ramirez A, Peralta C. Molecular pathways in protecting the liver from ischaemia/reperfusion injury: a 2015 update. Clin Sci (Lond). 2015;129: 345-62. [ Links ]
11. Sasaki M, Joh T. Oxidative stress and ischemia-reperfusion injury in gastrointestinal tract and antioxidant protective agents. J Clin Biochem Nutr. 2007;40:1-12.
12. Romanenko VG, Davies PF, Levitan I. Dual effect of fluid shear stress on volume-regulated anion current in bovine aortic endothelial cells. Am JPhysiol Cell Physiol. 2002;282: C708-18.
13. Huang Y, Rabb H, Womer KL. Ischemia-reperfusion and immediate T cell responses. Cell Immunol. 2007;248: 4-11.
14. Vardanian AJ, Busuttil RW, Kupiec-Weglinski JW. Molecular mediators of liver ischemia and reperfusion injury: a brief review. Mol Med. 2008;14:337-45.
15. Webster K. Mitochondrial membrane permeabilization and cell death during myocardial infarction: roles of calcium and reactive oxygen species. Future Cardiol. 2012;8:863-84.
16. Oro go AM, Gustafsson ÁB. Cell death in the myocardium: my heart won't go on. IUBMB Life. 2013;65:651-6.
17. Attuwaybi B1, Kozar RA, Gates KS, Moore-Olufemi S, Sato N, Weisbrodt NWMF. Hypertonic saline prevents inflammation, injury, and impaire intestinal transit after gut ischemia/reperfusion by inducing heme oxygenase 1 enzyme. J Trauma Acute Care Surg. 2004;56:749-59.
18. Braz JRC, do Nascimento PJ, Paiva Filho O, Braz LG, Vane LA, Vianna PTG, et al. The early systemic and gastrointestinal oxygenation effects of hemorrhagic shock resuscitation with hypertonic saline and hypertonic saline 6% dextran-70: a comparative study in dogs. Anesth Analg. 2004;99: 536-46.
19. Gurfinkel V, Poggetti RS, Fontes B, da Costa Ferreira Novo F, Birolini D. Hypertonic saline improves tissue oxygenation and reduces systemic and pulmonary inflammatory response caused by hemorrhagic shock. J Trauma. 2003;54: 1137-45.
20. Moore FA, McKinley BA, Moore EE. The next generation in shock resuscitation. Lancet. 2004;363:1988-96.
21. Victorino GP, Newton CR, Curran B. Effect of hypertonic saline on microvascular permeability in the activated endothelium. J Surg Res. 2003;112:79-83.
22. Zani BG, Bohlen HG. Sodium channels are required during in vivo sodium chloride hyperosmolarity to stimulate increase in intestinal endothelial nitric oxide production. Am J Physiol Heart Circ Physiol. 2005;288:H89-95.
23. Lu Y, Cai X, Gu L, Mu H, Huang W. Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock. J Zhejiang Univ Sci B. 2007;8:70-5.
24. Oreopoulos GD, Wu H, Szaszi K, Fan J, Marshall JC, Khadaroo RG, et al. Hypertonic preconditioning prevents hepatocellular injury following ischemia/reperfusion in mice: a role for interleukin 10. Hepatology. 2004;40:211-20.
25. Ke Q-H, Zheng S-S, Liang T-B, Xie H-Y, Xia W-L. Pretreatment of hypertonic saline can increase endogenous interleukin 10 release to attenuate hepatic ischemia reperfusion injury. Dig Dis Sci. 2006;51:2257-63.
26. Gonzalez E, Kozar R, Suliburk JW, Weisbrodt NW, Mercer DW, Moore F. Conventional dose hypertonic saline provides optimal gut protection and limits remote organ injury after gut ischemia reperfusion. J Trauma Inj Infect Crit Care. 2006;61:66-73.
27. Taurà P, Ibarzabal A, Vendrell M, Adelsdorfer C, Delitala A, De Lacy B, et al. Pretreatment with endothelium-derived nitric oxide synthesis modulators on gastrointestinal microcirculation during NOTES: an experimental study. Surg Endosc. 2016, March 23. Epub ahead of print.
28. Flores J, DiBona DR, Beck CH, Leaf A. The role of cell swelling in ischemic renal damage and the protective effect of hypertonic solute. J Clin Invest. 1972;51:118-26.
29. Scherte ER, Valentine AK, Rademakers AM, Muir WW. Influence of 7% NaCl on the mechanical properties of the systemic circulation in the hypovolemic dog. Circ Shock. 1990;31:203-14.
30. Kreimeier U, Bruckner UB, Niemczyk S, Messmer K. Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: effect on regional blood flow. Cic Shock. 1990;32:83-99.
31. Mouren S, Delayance S, Mion G, Souktani R, Fellahi JL, Arthaud M, et al. Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood-perfused rabbit hearts. Anesth Analg. 1995;81: 777-82.
32. Wang Y-L, Lam K-K, Cheng P-Y, Kung C-W, Chen S-Y, Chao C-C, et al. The cardioprotective effect of hypertonic saline is associated with inhibitory effect on macrophage migration inhibitory factor in sepsis. Biomed Res Int. 2013;2013: 1-10.
33. Oliveira RP, Velasco I, Soriano FG, Friedman G. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care. 2002;6:418-23.
34. Han J, Ren H-Q, Zhao Q-B, Wu Y-L, Qiao Z-Y. Comparison of 3% and 7.5% hypertonic saline in resuscitation after traumatic hypovolemic shock. Shock. 2015;43:244-9.
35. Sidi A, Muehlschlegel JD, Kirby DS, Kirby RR, Lobato EB. Treating ischemic left ventricular dysfunction with hypertonic saline administered after coronary occlusion in pigs. J Cardiothorac Vasc Anesth. 2007;21:400-5.
36. Sánchez-Etayo G, Borrat X, Escobar B, Hessheimer A, Rodriguez-Laiz G, Taurá P. Effect of intra-abdominal pressure on hepatic microcirculation: implications of the endothelin-1 receptor. J Dig Dis. 2012;13:478-85.
37. Rizoli SB, Rhind SG, Shek PN, Inaba K, Filips D, Tien H, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, doubled-blinded trial. Ann Surg. 2006;243:47-57.
How to Cite
1.
Escobar B, Guevara-Cruz OA, Navarro-Vargas JR, Giraldo-Fajardo AF, Dumar-Rodriguez JA, Borrero-Cortés C. Hypertonic saline solution for modifying tissue ischemia/reperfusion injury: Porcine aortic occlusion model. Colomb. J. Anesthesiol. [Internet]. 2017 Oct. 1 [cited 2024 Apr. 23];45(4):280–290. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/553
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2017-10-01
How to Cite
1.
Escobar B, Guevara-Cruz OA, Navarro-Vargas JR, Giraldo-Fajardo AF, Dumar-Rodriguez JA, Borrero-Cortés C. Hypertonic saline solution for modifying tissue ischemia/reperfusion injury: Porcine aortic occlusion model. Colomb. J. Anesthesiol. [Internet]. 2017 Oct. 1 [cited 2024 Apr. 23];45(4):280–290. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/553
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