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In-situ modified polyethersulfone oxygenation membrane with improved hemocompatibility and gas transfer efficiency. J Memb Sci 2022. [DOI: 10.1016/j.memsci.2022.121162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mayer D, Guerrero F, Goanvec C, Hetzel L, Linders J, Ljubkovic M, Kreczy A, Mayer C, Kirsch M, Ferenz KB. Prevention of Decompression Sickness by Novel Artificial Oxygen Carriers. Med Sci Sports Exerc 2021; 52:2127-2135. [PMID: 32251255 DOI: 10.1249/mss.0000000000002354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
For three decades, studies have demonstrated the therapeutic efficacy of perfluorocarbon (PFC) in reducing the onset of decompression trauma. However, none of these emulsion-based preparations are accepted for therapeutic use in the western world, mainly because of severe side effects and a long organ retention time. A new development to guarantee a stable dispersion without these disadvantages is the encapsulation of PFC in nanocapsules with an albumin shell. PURPOSE Newly designed albumin-derived perfluorocarbon-based artificial oxygen carriers (A-AOC) are used in a rodent in vivo model as a preventive therapy for decompression sickness (DCS). METHODS Thirty-seven rats were treated with A-AOC (n = 12), albumin nanocapsules filled with neutral oil (A-O-N, n = 12), or 5% human serum albumin solution (A-0-0, n = 13) before a simulated dive. Eleven rats, injected with A-AOC, stayed at normal pressure (A-AOC surface). Clinical, laboratory, and histological evaluations were performed. RESULTS The occurrence of DCS depended on the treatment group. A-AOC significantly reduced DCS appearance and mortality. Furthermore, a significant improvement of survival time was found (A-AOC compared with A-0-0). Histological assessment of A-AOC-dive compared with A-0-0-dive animals revealed significantly higher accumulation of macrophages, but less blood congestion in the spleen and significantly less hepatic circulatory disturbance, vacuolization, and cell damage. Compared with nondiving controls, lactate and myoglobin showed a significant increase in the A-0-0- but not in the A-AOC-dive group. CONCLUSION Intravenous application of A-AOC was well tolerated and effective in reducing the occurrence of DCS, and animals showed significantly higher survival rates and less symptoms compared with the albumin group (A-0-0). Analysis of histological results and fast reacting plasma parameters confirmed the preventive properties of A-AOC.
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Affiliation(s)
| | | | | | - Lisa Hetzel
- Institute of Physical Chemistry, University Duisburg-Essen, CENIDE, Essen, GERMANY
| | - Jürgen Linders
- Institute of Physical Chemistry, University Duisburg-Essen, CENIDE, Essen, GERMANY
| | - Marko Ljubkovic
- Department of Integrative Physiology, Medical School University of Split, Split, CROATIA
| | - Alfons Kreczy
- Department of Pathology, REGIOMED Klinikum Coburg, Coburg, GERMANY
| | - Christian Mayer
- Institute of Physical Chemistry, University Duisburg-Essen, CENIDE, Essen, GERMANY
| | - Michael Kirsch
- Institute of Physiological Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, GERMANY
| | - Katja Bettina Ferenz
- Institute of Physiology, University Hospital Essen, University Duisburg-Essen, CENIDE, Essen, GERMANY
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Mayer D, Ferenz KB. Perfluorocarbons for the treatment of decompression illness: how to bridge the gap between theory and practice. Eur J Appl Physiol 2019; 119:2421-2433. [PMID: 31686213 PMCID: PMC6858394 DOI: 10.1007/s00421-019-04252-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
Abstract
Decompression illness (DCI) is a complex clinical syndrome caused by supersaturation of respiratory gases in blood and tissues after abrupt reduction in ambient pressure. The resulting formation of gas bubbles combined with pulmonary barotrauma leads to venous and arterial gas embolism. Severity of DCI depends on the degree of direct tissue damage caused by growing bubbles or indirect cell injury by impaired oxygen transport, coagulopathy, endothelial dysfunction, and subsequent inflammatory processes. The standard therapy of DCI requires expensive and not ubiquitously accessible hyperbaric chambers, so there is an ongoing search for alternatives. In theory, perfluorocarbons (PFC) are ideal non-recompressive therapeutics, characterized by high solubility of gases. A dual mechanism allows capturing of excess nitrogen and delivery of additional oxygen. Since the 1980s, numerous animal studies have proven significant benefits concerning survival and reduction in DCI symptoms by intravenous application of emulsion-based PFC preparations. However, limited shelf-life, extended organ retention and severe side effects have prevented approval for human usage by regulatory authorities. These negative characteristics are mainly due to emulsifiers, which provide compatibility of PFC to the aqueous medium blood. The encapsulation of PFC with amphiphilic biopolymers, such as albumin, offers a new option to achieve the required biocompatibility avoiding toxic emulsifiers. Recent studies with PFC nanocapsules, which can also be used as artificial oxygen carriers, show promising results. This review summarizes the current state of research concerning DCI pathology and the therapeutic use of PFC including the new generation of non-emulsified formulations based on nanocapsules.
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Affiliation(s)
- Dirk Mayer
- Department of Gastroenterology, REGIOMED Klinikum Coburg, 96450, Coburg, Germany
| | - Katja Bettina Ferenz
- Institute of Physiology, CENIDE, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
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Liu M, Zeng Q, Li Y, Liu G, Ji B. Neurologic recovery after deep hypothermic circulatory arrest in rats: A description of a long‐term survival model without blood priming. Artif Organs 2019; 43:551-560. [PMID: 30536407 DOI: 10.1111/aor.13407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/25/2018] [Accepted: 11/29/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Mingyue Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Qingdong Zeng
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
- Department of Anesthesiology Beijing Jishuitan Hospital Beijing China
| | - Yongnan Li
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
- Department of Cardiac Surgery, Lanzhou University Second Hospital Lanzhou University Lanzhou China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease Chinese Academy of Medical Science and Peking Union Medical College Beijing China
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Effects of perfluorocarbon emulsions on microvascular blood flow and oxygen transport in a model of severe arterial gas embolism. J Surg Res 2014; 187:324-33. [DOI: 10.1016/j.jss.2013.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/18/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
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Klinger AL, Kandel J, Pichette B, Eckmann DM. Pefluorocarbon inhibition of bubble induced Ca2+ transients in an in vitro model of vascular gas embolism. Exp Biol Med (Maywood) 2013; 239:116-22. [PMID: 24131543 DOI: 10.1177/1535370213506434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Endothelial injury resulting from deleterious interaction of gas microbubbles occurs in many surgical procedures and other medical interventions. The symptoms of vascular air embolism (VAE), while serious, are often difficult to detect, and there are essentially no pharmaceutical preventative or post-event treatments currently available. Perfluorocarbons (PFCs), however, have shown particular promise as a therapeutic option in reducing endothelial injury both in- and ex-vivo. Recently, we demonstrated the effectiveness of Oxycyte, a third-generation PFC formulated in a phosphotidylcholine emulsion, using an in vitro model of VAE developed in our laboratory. This apparatus allows live cell imaging concurrent with precise manipulation of physiologically sized microbubbles so that they may be brought into individual contact with human umbilical vein endothelial cells dye-loaded with the Ca(2+) sensitive Fluo-4. Herein, we expand use of this fluorescence microscopy-based cell culture model. Specifically, we examined the concentration dependence of Oxycyte in reducing both the amplitude and frequency of large intracellular Ca(2+) currents that are both a hallmark of bubble contact and a quantifiable indication that abnormal intracellular signaling has been triggered. We measured dose dependence curves and fit the resultant data using a modified Black and Leff operational model of agonism. The half maximal inhibitory concentrations of Oxycyte for (i) inhibition of occurrence and (ii) amplitude reduction were 229 ± 49 µM and 226 ± 167 µM, respectively. This investigation shows the preferential gas/liquid interface occupancy of the PFC component of Oxycyte over that of mechanosensing glycocalyx components and validates Oxycyte's specific surfactant mechanism of action. Further, no lethality was observed for any concentration of this bioinert PFC, as it acts as a competitive allosteric inhibitor of syndecan activation to ameliorate cell response to bubble contact.
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Affiliation(s)
- Alexandra L Klinger
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Juenemann M, Yeniguen M, Schleicher N, Blumenstein J, Nedelmann M, Tschernatsch M, Bachmann G, Kaps M, Urbanek P, Schoenburg M, Gerriets T. Impact of bubble size in a rat model of cerebral air microembolization. J Cardiothorac Surg 2013; 8:198. [PMID: 24139539 PMCID: PMC4016598 DOI: 10.1186/1749-8090-8-198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022] Open
Abstract
Background Cerebral air microembolization (CAM) is a frequent side effect of diagnostic or therapeutic interventions. Besides reduction of the amount of bubbles, filter systems in the clinical setting may also lead to a dispersion of large gas bubbles and therefore to an increase of the gas–liquid-endothelium interface. We evaluated the production and application of different strictly defined bubble diameters in a rat model of CAM and assessed functional outcome and infarct volumes in relation to the bubble diameter. Methods Gas emboli of defined number and diameter were injected into the carotid artery of rats. Group I (n = 7) received 1800 air bubbles with a diameter of 45 μm, group II (n = 7) 40 bubbles of 160 μm, controls (n = 6) saline without gas bubbles; group I and II yielded the same total injection volume of air with 86 nl. Functional outcome was assessed at baseline, after 4 h and 24 h following cerebral MR imaging and infarct size calculation. Results Computer-aided evaluation of bubble diameters showed high constancy (group I: 45.83 μm ± 2.79; group II: 159 μm ± 1.26). Animals in group I and II suffered cerebral ischemia and clinical deterioration without significant difference. Infarct sizes did not differ significantly between the two groups (p = 0.931 u-test). Conclusions We present further development of a new method, which allows reliable and controlled CAM with different bubble diameters, producing neurological deficits due to unilateral cerebral damage. Our findings could not display a strong dependency of stroke frequency and severity on bubble diameter.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tibo Gerriets
- Department of Neurology, Justus-Liebig-University Giessen, Giessen, Germany.
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Torres Filho IP, Pedro JRP, Narayanan SV, Nguyen NM, Roseff SD, Spiess BD. Perfluorocarbon emulsion improves oxygen transport of normal and sickle cell human bloodin vitro. J Biomed Mater Res A 2013; 102:2105-15. [DOI: 10.1002/jbm.a.34885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/10/2013] [Accepted: 07/17/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Ivo P. Torres Filho
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- Department of Emergency Medicine; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- US Army Institute of Surgical Research; Damage Control Resuscitation; San Antonio Texas 78234
| | - José Ricardo P. Pedro
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Srinivasan V. Narayanan
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Nguyen M. Nguyen
- Department of Physiology and Biophysics; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Susan D. Roseff
- Department of Pathology; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
| | - Bruce D. Spiess
- Department of Emergency Medicine; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
- Department of Anesthesiology; Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University; Richmond Virginia 23298-0695
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Golukhova EZ, Polunina AG, Zhuravleva SV, Lefterova NP, Begachev AV. Size of left cardiac chambers correlates with cerebral microembolic load in open heart operations. Cardiol Res Pract 2010; 2010:143679. [PMID: 20631826 PMCID: PMC2901602 DOI: 10.4061/2010/143679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/29/2010] [Accepted: 05/04/2010] [Indexed: 01/05/2023] Open
Abstract
Background. Microemboli are a widely recognized etiological factor of cerebral complications in cardiac surgery patients. The present study was aimed to determine if size of left cardiac chambers relates to cerebral microembolic load in open heart operations. Methods. Thirty patients participated in the study. Echocardiography was performed in 2-3 days before surgery. A transcranial Doppler system was used for registering intraoperative microemboli. Results. Preoperative left atrium and left ventricular end-systolic and end-diastolic sizes significantly correlated with intraoperative microembolic load (rs = 0.48, 0.57 and 0.53, Ps < .01, resp.). The associations between left ventricular diameters and number of cerebral microemboli remained significant when cardiopulmonary bypass time was included as a covariate into the analysis. Conclusions. The present results demonstrate that increased size of left heart chambers is an influential risk factor for elevated cerebral microembolic load during open heart operations. Mini-invasive surgery and carbon dioxide insufflation into wound cavity may be considered as neuroprotective approaches in patients with high risk of cerebral microembolism.
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Affiliation(s)
- Elena Z Golukhova
- A. N. Bakulev Scientific Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow 119571, Russia
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A rat model for cerebral air microembolisation. J Neurosci Methods 2010; 190:10-3. [DOI: 10.1016/j.jneumeth.2010.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 04/12/2010] [Accepted: 04/14/2010] [Indexed: 12/20/2022]
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Spiess BD. Perfluorocarbon emulsions as a promising technology: a review of tissue and vascular gas dynamics. J Appl Physiol (1985) 2009; 106:1444-52. [PMID: 19179651 DOI: 10.1152/japplphysiol.90995.2008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perfluorocarbon (PFC) emulsions are halogen-substituted carbon nonpolar oils with resultant enhanced dissolved respiratory gas (O(2), N(2), CO(2), nitric oxide) capabilities. In the first demonstration of enhanced O(2) solubility, inhaled PFC could sustain rat metabolism. Intravenous emulsions were then trialed as "blood substitutes." In the last 10 yr, biocomputational modeling has enhanced our mechanistic understanding of PFCs. Contemporary research is now taking advantage of these physiological discoveries and applying PFCs as "oxygen therapeutics," as well as ways to enhance other gas movements. One particularly promising area of research is the treatment of gas embolism (arterial and venous emboli/decompression sickness). An expansive understanding of PFC-enhanced diffusive gas movements through tissue and vasculature may have analogous applications for O(2) or other respiratory gases and should provide a revolution in medicine. This review will stress the fundamental knowledge we now have regarding how respiratory gas movements are changed when intravenous PFC is present.
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Affiliation(s)
- Bruce D Spiess
- Department of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Reanimation Engineering Shock Center, Richmond, Virginia, USA.
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Lange F, Yoshitani K, Proia AD, Mackensen GB, Grocott HP. Perfluorocarbon Administration During Cardiopulmonary Bypass in Rats: An Inflammatory Link to Adverse Outcome? Anesth Analg 2008; 106:24-31, table of contents. [DOI: 10.1213/01.ane.0000297439.90773.c7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ruest P, Aroichane M, Cordahi G, Bureau N. Possible venous air embolism during open eye surgery in a child. Can J Anaesth 2007; 54:840-4. [DOI: 10.1007/bf03021713] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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