Inhaled Carbon Monoxide (CO) Prevents Lung Oedema Induced by Endotoxic Shock

Therapeutic applications of carbon monoxide

Heme oxygenase-1 (HO-1) is a regulated enzyme induced in multiple stress states. Carbon monoxide (CO) is a product of HO catalysis of heme. In many circumstances, CO appears to functionally replace HO-1, and CO is known to have endogenous anti-inflammatory, anti-apoptotic, and antiproliferative effects. CO is well studied in anoxia-reoxygenation and ischemia-reperfusion models and has advanced to phase II trials for treatment of several clinical entities. In alternative injury models, laboratories have used sepsis, acute lung injury, and systemic inflammatory challenges to assess the ability of CO to rescue cells, organs, and organisms. Hopefully, the research supporting the protective effects of CO in animal models will translate into therapeutic benefits for patients. Preclinical studies of CO are now moving towards more complex damage models that reflect polymicrobial sepsis or two-step injuries, such as sepsis complicated by acute respiratory distress syndrome. Furthermore, co-treatment and post-treatment with CO are being explored in which the insult occurs before there is an opportunity to intervene therapeutically. The aim of this review is to discuss the potential therapeutic implications of CO with a focus on lung injury and sepsis-related models.

Carbon monoxide in sepsis

Despite modern practices in critical care medicine, sepsis or systemic inflammatory response syndrome remains a leading cause of morbidity and mortality in the intensive care unit. Thus, the need to identify new therapeutic tools for the treatment of sepsis is urgent. In this context, carbon monoxide has become a promising therapeutic molecule that can potentially prevent uncontrolled inflammation in sepsis. In humans, carbon monoxide arises endogenously from the degradation of heme by heme oxygenase enzymes. Both endogenously synthesized and exogenously applied carbon monoxide can exert antiinflammatory and antiapoptotic effects in cells and tissues. Based on these properties, carbon monoxide, when applied at low concentration, conferred protection in a variety of cellular and rodent models of sepsis, and furthermore reduced morbidity and mortality in vivo. Therefore, application of carbon monoxide may have a major impact on the future of sepsis treatment. This review summarizes evidence for salutary effects of carbon monoxide in sepsis of various organs, including lung, heart, kidney, liver, and intestine, and discusses the potential translation of the data into human clinical trials.

Microvascular and systemic effects following top load administration of saturated carbon monoxide-saline solution

OBJECTIVE

To determine how top loads with different doses of carbon monoxide (CO)-saturated saline solutions (CO-saline) affect microvascular and systemic hemodynamics and to delineate the corresponding biochemical mechanisms.

DESIGN

Prospective study.

SETTING

University research laboratory.

SUBJECTS

Male Golden Syrian hamsters.

INTERVENTIONS

Hamsters implemented with a dorsal window chamber were given different volumes (characterized as percent of blood volume, BV) by intravenous injection of CO-saturated saline.

MEASUREMENTS AND MAIN RESULTS

Hamsters were observed until 90 mins after infusion of CO-saline solution. In the 20% BV CO-saline infusion group, observation was extended until 180 mins. Systemic variables measured included mean arterial pressure, heart rate, systemic arterial blood gases, and cardiac output and index. Microvascular hemodynamic measurements included vessel diameter, red blood cell velocity, and functional capillary density. Cyclic guanosine monophosphate (cGMP) content in the chamber tissue was measured by enzyme immunoassay. 10% BV of CO-saline increased flow maximally in the microcirculation at 30 mins after infusion (207% in arterioles and 238% in venules, p < .05 vs. baseline). Functional capillary density was significantly increased in both 10% and 15% groups (p < .05 vs. baseline), and cardiac index increased 130% (p < .05 vs. baseline) at 10 mins after 10% CO-saline infusion. There were no changes of microhemodynamic variables and functional capillary density with 2.5%, 5%, and 20% CO-saline infusion during the observation period. Microvascular hemodynamic changes by 10% CO-saline infusion were inhibited completely by L-NAME pretreatment and partially by 1H-[1,2,4]oxadiazole[4,3-a]quinoxqalin-1-one pretreatment. cGMP content in skin fold tissues was related to changes of vessel diameter.

CONCLUSIONS

Intravenous injection of CO-saturated saline caused vasodilation and improved microvascular hemodynamics in the hamster window chamber model in a dose-dependent manner. These changes were related to increased cardiac output and local cGMP content. These results support the possible use of CO-saturated solutions as a vasodilator in critical conditions.

[Carbon monoxide--poison or potential therapeutic?]

Carbon monoxide (CO) is much more than just a toxic gas. Carbon monoxide is produced endogenously by the enzyme heme oxygenase and has important functions under physiological and pathophysiological conditions. Recent studies suggested antioxidative, anti-inflammatory, antiproliferative, anti-apoptotic, and vasodilating characteristics. Regarding clinically-relevant diseases in anesthesiology and critical care medicine, such as adult respiratory distress syndrome (ARDS), sepsis, or during organ transplantation, cytoprotective properties have been demonstrated by low-dose CO in experimental models. In view of a potential CO application in future human studies, this review discusses what is known to date about CO as it relates to functional, protective and toxic aspects.