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Impact of poly-arginine peptides R18D and R18 on alteplase and tenecteplase thrombolysis in vitro, and neuroprotective stability to proteolysis. J Thromb Thrombolysis 2022; 54:172-182. [PMID: 35305237 PMCID: PMC9259545 DOI: 10.1007/s11239-022-02642-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 10/26/2022]
Abstract
The poly-arginine peptides R18D and R18 represent novel potential neuroprotective treatments for acute ischaemic stroke. Here we examined whether R18D and R18 had any significant effects on the thrombolytic activity of alteplase (tPA) and tenecteplase (TNK) on clots formed from whole blood in an in vitro thrombolysis plate assay. R18D and R18 were examined at concentrations of 0.25, 0.5, 1, 2, 4, 8 and 16 µM during the 1-h thrombolytic assay. We also included the well-characterised neuroprotective NA-1 peptide as a control. R18D, R18 and NA-1 all reduced tPA or TNK percentage clot lysis by 0-9.35%, 0-3.44% and 0-4.8%, respectively. R18D, R18 and NA-1 had a modest and variable effect on the lag time, increasing the time to the commencement of thrombolysis by 0-9.9 min, 0-5.53 min and 0-7.16 min, respectively. Lastly, R18 and NA-1 appeared to increase the maximal activity of the thrombolysis reaction. In addition, the in vitro anti-excitotoxic neuroprotective efficacy of R18D and R18 was not affected by pre-incubation for 1-2 h or overnight with tPA or TNK, whereas only R18D retained high anti-excitotoxic neuroprotective efficacy when pre-incubated in a synthetic trypsin (TrypLE Express). The present in vitro findings suggest that neither R18D or R18 when co-administered with the thrombolytic inducing agents tPA or TNK are likely to have a significant impact when used clinically during clot thrombolysis and confirm the superior proteolytic stability of the R18D peptide.
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Drolz A, Horvatits T, Roedl K, Rutter K, Brunner R, Zauner C, Schellongowski P, Heinz G, Funk GC, Trauner M, Schneeweiss B, Fuhrmann V. Acid-base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease. Ann Intensive Care 2018; 8:48. [PMID: 29675709 PMCID: PMC5908779 DOI: 10.1186/s13613-018-0391-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values < 7.1 showed a 100% mortality rate. Acidosis attributable to lactate and unmeasured anions was independently associated with mortality in liver cirrhosis. Conclusions Cirrhosis and especially ACLF are associated with metabolic acidosis and acidemia owing to lactate and unmeasured anions. Acidosis and acidemia, respectively, are associated with increased 28-day mortality in liver cirrhosis. Lactate and unmeasured anions are main contributors to metabolic imbalance in cirrhosis and ACLF. Electronic supplementary material The online version of this article (10.1186/s13613-018-0391-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Drolz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. .,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Horvatits
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karoline Rutter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Richard Brunner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Division of Oncology and Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute for COPD, Otto-Wagner Hospital, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Valentin Fuhrmann
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Zingg T, Bhattacharya B, Maerz LL. Metabolic acidosis and the role of unmeasured anions in critical illness and injury. J Surg Res 2017; 224:5-17. [PMID: 29506851 DOI: 10.1016/j.jss.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/04/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022]
Abstract
Acid-base disorders are frequently present in critically ill patients. Metabolic acidosis is associated with increased mortality, but it is unclear whether as a marker of the severity of the disease process or as a direct effector. The understanding of the metabolic component of acid-base derangements has evolved over time, and several theories and models for precise quantification and interpretation have been postulated during the last century. Unmeasured anions are the footprints of dissociated fixed acids and may be responsible for a significant component of metabolic acidosis. Their nature, origin, and prognostic value are incompletely understood. This review provides a historical overview of how the understanding of the metabolic component of acid-base disorders has evolved over time and describes the theoretical models and their corresponding tools applicable to clinical practice, with an emphasis on the role of unmeasured anions in general and several specific settings.
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Affiliation(s)
- Tobias Zingg
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut.
| | - Bishwajit Bhattacharya
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Linda L Maerz
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
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Fettig PK, Bailey DB, Gannon KM. Determination of strong ion gap in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2012; 22:447-52. [PMID: 22809147 DOI: 10.1111/j.1476-4431.2012.00772.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 05/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine and compare reference intervals of the strong ion gap (SIG) in a group of healthy dogs determined with 2 different equations. DESIGN Prospective observational study. SETTING Tertiary referral and teaching hospital. ANIMALS Fifty-four healthy dogs. INTERVENTIONS None. MEASUREMENTS Serum biochemistry and blood gas analyses were performed for each dog. From these values, SIG was calculated using 2 different equations: SIG(1) = SID(a) {[Na (+)] + [K(+)] - [Cl(-)]+ [2 × Ca(2+)] + [2 × Mg(2+)] - [L-lactate]}- SID(e) {TCO(2) + A(-)} and SIG(2) = [albumin] × 4.9-anion gap. Reference intervals were established for each SIG equation using the mean ± 1.96 × standard deviation (SD). RESULTS For SIG(1), the median was 7.13 mEq/L (range, 1.05-11.30 mEq/L) and the derived reference interval was 1.85-10.61 mEq/L. Median SIG(2) was -0.22 mEq/L (range, -5.34-6.61 mEq/L) and the mean SIG(2) was -0.09 mEq/L (95% confidence interval for the mean, -0.82-0.65 mEq/L). The derived reference interval was -5.36-5.18 mEq/L. The results of the SIG calculations were significantly different (P < 0.0001) between the 2 equations used. CONCLUSION The 2 equations used to calculate SIG yielded significantly different results and cannot be used interchangeably. The authors believe SIG(2) to be a more accurate reflection of acid-base status in healthy dogs, and recommend that this calculation be used for future studies.
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Funk GC, Doberer D, Sterz F, Richling N, Kneidinger N, Lindner G, Schneeweiss B, Eisenburger P. The strong ion gap and outcome after cardiac arrest in patients treated with therapeutic hypothermia: a retrospective study. Intensive Care Med 2008; 35:232-9. [PMID: 18853143 DOI: 10.1007/s00134-008-1315-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 09/25/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study investigates whether the strong ion gap (SIG) is associated with long-term outcome after cardiac arrest in patients treated with therapeutic hypothermia. The hypothesis of the study was that an elevated SIG was associated with unfavourable outcome after cardiac arrest. DESIGN Retrospective review of records from 1995 to 2007 of patients who received cardiopulmonary resuscitation. SETTING Emergency department of a university hospital. PATIENTS Patients who were successfully resuscitated after cardiac arrest (n = 288) and treated with mild therapeutic hypothermia. INTERVENTIONS None. MEASUREMENTS AND RESULTS Acid-base variables were calculated according to Stewart's approach, as modified by Figge and Fencl, and were determined immediately on admission and 12 h after the return of spontaneous circulation. Acid-base variables were determined at 37 degrees C and are reported without correction for patient temperature. Differences in SIG were compared between patients with favourable (survival 6 months with cerebral performance category 1 or 2) and unfavourable outcomes. SIG on admission and 12 h after return of spontaneous circulation was higher in patients with unfavourable outcome (n = 151; 52%). SIG 12 h after return of spontaneous circulation was identified as an independent predictor of outcome. A SIG > 8.9 mmol/L was associated with an increased cumulative hazard of death. CONCLUSIONS An elevated SIG 12 h after return of spontaneous circulation may be associated with unfavourable outcome in patients after cardiac arrest treated with mild therapeutic hypothermia. The unmeasured anions hidden behind an elevated SIG may represent markers of tissue damage.
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Affiliation(s)
- Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria
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