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Zijlstra MK, Gampa A, Joseph N, Sonnenberg A, Fimmel CJ. Progressive changes in platelet counts and Fib-4 scores precede the diagnosis of advanced fibrosis in NASH patients. World J Hepatol 2023; 15:225-236. [PMID: 36926233 PMCID: PMC10011908 DOI: 10.4254/wjh.v15.i2.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Cirrhosis and its complications develop in a subgroup of patients with non-alcoholic fatty liver disease (NASH). Early detection of liver fibrosis represents an important goal of clinical care.
AIM To test the hypothesis that the development of cirrhosis in nonalcoholic fatty liver disease patients is preceded by the long-term trends of platelet counts and Fib-4 scores.
METHODS We identified all patients in our healthcare system who had undergone fibrosis staging by liver biopsy or magnetic resonance elastography (MRE) for non-alcoholic fatty liver disease during the past decade (n = 310). Platelet counts, serum glutamic-pyruvic transaminase and serum glutamic oxalacetic transaminase values preceding the staging tests were extracted from the electronic medical record system, and Fib-4 scores were calculated. Potential predictors of advanced fibrosis were evaluated using multivariate regression analysis.
RESULTS Significant decreases in platelet counts and increases in Fib-4 scores were observed in all fibrosis stages, particularly in patients with cirrhosis. In the liver biopsy group, the presence of cirrhosis was best predicted by the combination of the Fib-4 score at the time closest to staging (P < 0.0001), the presence of diabetes (P = 0.0001), and the correlation coefficient of the preceding time-dependent drop in platelet count (P = 0.044). In the MRE group, Fib4 score (P = 0.0025) and platelet drop (P = 0.0373) were significant predictors. In comparison, the time-dependent rise of the Fib-4 score did not contribute in a statistically significant way.
CONCLUSION Time-dependent changes in platelet counts and Fib-4 scores contribute to the prediction of cirrhosis in NASH patients with biopsy- or MRE-staged fibrosis. Their incorporation into predictive algorithms may assist in the earlier identification of high-risk patients.
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Affiliation(s)
- Michael K Zijlstra
- Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
| | - Anuhya Gampa
- Division of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Nora Joseph
- Department of Pathology, NorthShore University Health System, Evanston, IL 60201, United States
| | - Amnon Sonnenberg
- Portland VA Medical Center, Portland, OR 97239, United States
- Department of Gastroenterology, Oregon Health Sciences University, Portland, OR 97201, United States
| | - Claus J Fimmel
- Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
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Zijlstra MK, Fidel Nague K, Louie P, Imas P, Sonnenberg A, Fimmel CJ. Successful Hepatitis C Birth Cohort Screening and Linkage to Care in a US Community Health System. J Public Health Manag Pract 2022; 28:E825-E830. [PMID: 36194824 PMCID: PMC9528933 DOI: 10.1097/phh.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CONTEXT Birth cohort ("baby boomer") screening represents a well-validated strategy for the identification of asymptomatic hepatitis C-infected patients. However, successful linkage of newly diagnosed patients to antiviral therapy has been more difficult to accomplish. OBJECTIVE To analyze the results of a systemwide birth cohort screening program in a US community health care system. DESIGN We analyzed the data from an ongoing hepatitis C virus (HCV) screening and treatment program that was established at NorthShore University Health System in 2015. Hepatitis C virus screening by primary care providers was prompted through automated Best Practice and Health Maintenance alerts. Patient visits and screening orders were tracked using a customized HCV dashboard. Virologic, demographic, and treatment data were assessed and compared with those of a cohort of patients with previously established HCV infection. RESULTS Since program inception, 61 8161 (64.3%) of the entire NorthShore baby boomer population of 96 001 patients have completed HCV antibody testing, and 160 patients (0.26%) were antibody positive. Of 152 antibody-positive patients who underwent HCV RNA testing, 53 (34.2%) were viremic. A total of 39 of 53 patients (73.6%) underwent antiviral therapy and achieved a sustained virologic response. Compared with patients identified through screening, a comparison cohort of patients with previously established HCV had more advanced fibrosis and significantly lower dropout rates. The COVID-19 pandemic was associated with a decrease in the number of outpatient visits of screening-eligible patients and with a reduction in HCV screening rates. CONCLUSION Our data demonstrate the electronic medical records-assisted systemwide implementation of HCV birth cohort screening and successful linkage to antiviral therapy in a community-based US multihospital system.
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Affiliation(s)
- Michael K. Zijlstra
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Kristine Fidel Nague
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Patrick Louie
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Polina Imas
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Amnon Sonnenberg
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
| | - Claus J. Fimmel
- Department of Medicine, NorthShore University Health System, Evanston, Illinois (Drs Zijlstra and Fimmel and Ms Fidel Nague); Departments of Pharmacy (Dr Louie) and Clinical Analytics (Ms Imas), NorthShore University Health System, Skokie, Illinois; and Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon (Dr Sonnenberg)
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Zijlstra MK, Silvers RI, Fimmel CJ, Krantz S. Esophageal Perforation Due to a Calcium Supplement Tablet. Case Rep Gastroenterol 2022; 16:435-440. [PMID: 35949232 PMCID: PMC9294933 DOI: 10.1159/000523952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
Pill-induced esophagitis due to calcium supplements is extremely uncommon. We present a 60-year-old female patient with pill-induced esophageal perforation complicated by mediastinal abscess and esophago-pleural fistula following ingestion of a single over-the-counter “bone supplement” tablet containing mainly calcium.
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Affiliation(s)
- Michael K. Zijlstra
- Department of Medicine, University of Chicago (NorthShore) Program, Chicago, Illinois, USA
- *Michael K. Zijlstra,
| | - Robert I. Silvers
- Department of Radiology, NorthShore University Health System, Chicago, Illinois, USA
| | - Claus J. Fimmel
- Division of Gastroenterology, NorthShore University Health System, Chicago, Illinois, USA
| | - Seth Krantz
- Department of Surgery, NorthShore University Health System, Chicago, Illinois, USA
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Fimmel CJ, Khan MQ, Belopolsky Y, Imas P, Gampa A, Sonnenberg A. Sustained and cumulative impact of an electronic medical record-based alert on a hepatitis C birth cohort screening programme. J Viral Hepat 2021; 28:1200-1205. [PMID: 33896092 DOI: 10.1111/jvh.13524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/27/2021] [Indexed: 01/30/2023]
Abstract
The study aimed to assess the effect of an electronic medical record-embedded best practice alert (BPA) on HCV age cohort screening in primary care clinics. HCV testing by primary care physicians was monitored prior and subsequent to the implantation of the BPA. Four intervals of 9 months duration were analysed in detail, including a pre-BPA baseline analysis and three annual post-BPA assessments. Pre- and post-BPA orders consistently followed a power law distribution, characterized by small groups of physicians placing the majority of test orders. Significant correlations were present between the numbers of tests orders by each physician, suggesting that 'high' and 'low' screening performances tended to be physician-specific. Testing rates increased markedly in response to the BPA, resulting in completion of screening in 56.8% (50,468 of 88,914%) of the entire age cohort within less than 3 years. In conclusion, HCV age cohort testing by primary care physicians follows a power-law distribution, with high-performing physicians contributing disproportionately to the overall effort. A simple BPA resulted in a sufficient increase in testing to allow testing of the entire target population within a reasonable time frame.
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Affiliation(s)
- Claus J Fimmel
- Division of Gastroenterology and Hepatology, NorthShore University Health System, Evanston, Illinois, USA
| | - Mohammad Q Khan
- Division of Gastroenterology and Hepatology, NorthShore University Health System, Evanston, Illinois, USA
| | - Yuliya Belopolsky
- Division of Gastroenterology and Hepatology, NorthShore University Health System, Evanston, Illinois, USA
| | - Polina Imas
- Division of Gastroenterology and Hepatology, NorthShore University Health System, Evanston, Illinois, USA
| | - Anuhya Gampa
- Division of Gastroenterology and Hepatology, NorthShore University Health System, Evanston, Illinois, USA
| | - Amnon Sonnenberg
- Division of Gastroenterology and Hepatology, Oregon Health & Science University and Portland VA Medical Center, Portland, Oregon, USA
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Ferral H, Fimmel CJ, Sonnenberg A, Alonzo MJ, Aquisto TM. Transjugular Liver Biopsy with Hemodynamic Evaluation: Correlation between Hepatic Venous Pressure Gradient and Histologic Diagnosis of Cirrhosis. J Clin Imaging Sci 2021; 11:25. [PMID: 33948340 PMCID: PMC8088477 DOI: 10.25259/jcis_233_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: Measurement of hepatic vein pressures is the accepted gold standard for the evaluation of portal hypertension. This study was conducted to evaluate the correlation between hepatic vein pressure measurements and histologic findings from transjugular liver biopsies. The hypothesis was that higher hepatic venous pressure gradients would correlate with a histologic diagnosis of cirrhosis. Material and Methods: We identified all patients who underwent transjugular liver biopsies at our institution between January 2015 and December 2019. Of these, 178 patients who had undergone hemodynamic evaluations during the biopsy procedure were included in the study. Demographic information and laboratory data were extracted from the patients’ electronic medical records. The hepatic vein pressure gradient (HVPG) was determined by subtracting the free hepatic venous pressure from the wedged hepatic venous pressure (WHVP), and the portosystemic gradient (PSG) was determined by subtracting the right atrial pressure from the WHVP. HVPG and PSG were compared by linear regression analysis and by calculating their receiver operating characteristics (ROC). Results: HVPG and PSG measurements were significantly associated with cirrhosis, with area under the ROC curve of 0.79 and 0.78, respectively. At the optimal cutoff of 9 mmHg, sensitivity and specificity for HVPG were 71% and 83% for HVPG and 67 % and 81% for PSG, respectively. No statistical difference was observed between the two measurements. Conclusion: A transhepatic venous pressure gradient above a cutoff of 9 mmHg is predictive of histologic cirrhosis, regardless of whether it is expressed as HVPG or PSG, with acceptable to excellent performance characteristics.
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Affiliation(s)
- Hector Ferral
- Department of Radiology, University Medical Center New Orleans, New Orleans, Louisiana, United States
| | - Claus J Fimmel
- Department of Gastroenterology, NorthShore University Health System, Evanston, Illinois, United States
| | - Amnon Sonnenberg
- Department of Gastroenterology and Hepatology, Portland VA Medical Center and Oregon Health Sciences University, Portland, Oregon, United States
| | - Marc J Alonzo
- Department of Radiology, NorthShore University Health Sciences, Evanston, Illinois, United States
| | - Thomas M Aquisto
- Department of Radiology, NorthShore University Health Sciences, Evanston, Illinois, United States
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Khan MQ, Belopolsky Y, Gampa A, Greenberg I, Beig MI, Imas P, Sonnenberg A, Fimmel CJ. Effect of a Best Practice Alert on Birth-Cohort Screening for Hepatitis C Virus. Clin Transl Gastroenterol 2021; 12:e00297. [PMID: 33522731 PMCID: PMC7806234 DOI: 10.14309/ctg.0000000000000297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION We assessed the influence of a best practice alert (BPA) embedded within the electronic medical record on improving hepatitis C virus (HCV) birth-cohort screening by primary care physicians (PCPs). METHODS Screening by 155 PCPs was monitored during 2 consecutive 9-month periods before and after implementation of the BPA. All tests were reviewed to differentiate true screening from other testing indications. RESULTS Of 155 PCPs, 131 placed screening orders before and after BPA. Twenty-two PCPs started testing after BPA (P = 0.02). The number of tests placed and screening rates per PCP increased from 16 to 84 and from 3.3% to 13.2%, respectively (P < 0.0001). Before BPA, most PCPs rarely ordered screening HCV tests, whereas a small group of physicians generated most tests, indicative of an underlying power-law distribution. After the BPA, a new group of high-performing PCPs emerged, whose screening patterns were again characterized by a power-law distribution. However, pre-BPA test rates of individual PCPs were not predictive of their post-BPA rates. Overall, the introduction of the BPA narrowed the gap between low- and high-performing testers, indicating that modest increases in testing by a large number of low-performing PCPs could drive substantial improvement in program implementation. DISCUSSION HCV birth-cohort screening by PCPs was shaped by an underlying power-law distribution. This distribution was preserved after the implementation of a BPA, although pre-BPA test rates were not predictive of post-BPA rates. Increases in test rates by high- and low-performing PCPs both contributed to the overall success of the BPA.
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Affiliation(s)
- Mohammad Qasim Khan
- Department of Gastroenterology, NorthShore University Health System, Evanston, Illinois, USA
| | - Yuliya Belopolsky
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Anuhya Gampa
- Department of Gastroenterology, NorthShore University Health System, Evanston, Illinois, USA
| | - Ian Greenberg
- Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Muhammad Imran Beig
- Department of Clinical Analytics, NorthShore University Health System, Skokie, Illinois, USA
| | - Polina Imas
- Department of Clinical Analytics, NorthShore University Health System, Skokie, Illinois, USA
| | - Amnon Sonnenberg
- Portland VA Medical Center and Oregon Health and Science University, Portland, Oregon, USA
| | - Claus J. Fimmel
- Department of Gastroenterology, NorthShore University Health System, Evanston, Illinois, USA
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7
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Yeboah‐Korang A, Gentile NM, Fimmel CJ. PRO: Patients With Hepatitis C Virus With Pretreatment Metavir Stage 3 Fibrosis Do Not Require Hepatocellular Carcinoma Surveillance After Sustained Virological Response. Clin Liver Dis (Hoboken) 2018; 12:133-136. [PMID: 30988929 PMCID: PMC6385929 DOI: 10.1002/cld.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Amoah Yeboah‐Korang
- Section of Gastroenterology NorthShore University Health System Evanston HospitalEvanstonIL
| | - Nicole M. Gentile
- Section of Gastroenterology NorthShore University Health System Evanston HospitalEvanstonIL
| | - Claus J. Fimmel
- Section of Gastroenterology NorthShore University Health System Evanston HospitalEvanstonIL
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8
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Yeboah-Korang A, Beig MI, Khan MQ, Goldstein JL, Macapinlac DM, Maurer D, Sonnenberg A, Fimmel CJ. Hepatitis C Screening in Commercially Insured U.S. Birth-cohort Patients: Factors Associated with Testing and Effect of an EMR-based Screening Alert. J Transl Int Med 2018; 6:82-89. [PMID: 29984203 PMCID: PMC6032190 DOI: 10.2478/jtim-2018-0012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) testing rates among U.S. birth-cohort patients have been studied extensively, limited data exists to differentiate birth-cohort screening from risk- or liver disease-based testing. This study aims to identify factors associated with HCV antibody (HCV-Ab) testing in a group of insured birth cohort patients, to determine true birth cohort testing rates, and to determine whether an electronic medical record (EMR)-driven Best Practice Alert (BPA) would improve birth cohort testing rates. METHODS All birth-cohort outpatients between 2010 and 2015 were identified. HCV-Ab test results, clinical, and demographic variables were extracted from the EMR, and factors associated with testing were analyzed by logistic regression. True birth-cohort HCV screening rates were determined by detailed chart review for all outpatient visits during one calendar month. An automated Best Practice Alert was used to identify unscreened patients at the point of care, and to prompt HCV testing. Screening rates before and after system-wide implementation of the BPA were compared. RESULTS The historic HCV-Ab testing rate was 11.2% (11,976/106,753). Younger age, female gender, and African American, Asian, or Hispanic ethnicity, and medical comorbidities such as chronic hemodialysis, HIV infection, and rheumatologic and psychiatric comorbidities were associated with higher testing rates. However, during the one-month sampling period, true age cohort-based testing was performed in only 69/10,089 patients (0.68%). Following the system-wide implementation of the HCV BPA, testing rates increased from 0.68% to 10.76% (P<0.0001). CONCLUSIONS We documented low HCV-Ab testing rates in our baby boomers population. HCV testing was typically performed in the presence of known risk factors or established liver disease. The implementation of an EMR-based HCV BPA resulted in a marked increase in testing rates. Our study highlights current HCV screening gaps, and the utility of the EMR to improve screening rates and population health.
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Affiliation(s)
| | | | | | | | | | | | - Amnon Sonnenberg
- Portland VA Medical Center and Oregon Health & Science University, Portland, OR, USA
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Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, Talamonti MS, Berland LL, Pandharipande PV. Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017; 14:1429-1437. [DOI: 10.1016/j.jacr.2017.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 02/06/2023]
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10
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Khan MQ, Anand V, Hessefort N, Hassan A, Ahsan A, Sonnenberg A, Fimmel CJ. Utility of Electronic Medical record-based Fibrosis Scores in Predicting Advanced Cirrhosis in Patients with Hepatitic C Virus Infection. J Transl Int Med 2017; 5:43-48. [PMID: 28680838 DOI: 10.1515/jtim-2017-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether advanced cirrhosis - defined by the detection of nodular liver contours or portal venous collaterals on imaging studies - could be predicted by fibrosis algorithms, calculated using laboratory and demographic features extracted from patients' electronic medical records. To this end, we compared seven EMR-based fibrosis scores with liver imaging studies in a cohort of HCV patients. METHODS A search of our health system's patient data warehouse identified 867 patients with chronic HCV infection. A total of 565 patients had undergone at least one liver imaging study and had no confounding medical condition affecting the imaging features or fibrosis scores. Demographic and laboratory data were used to calculate APRI, Fib4, Fibrosis Index, Forns, GUCI, Lok Index and Vira-HepC scores for all viremic patients who had undergone liver imaging. Data points selected for the calculation of these scores were based on laboratory results obtained within the shortest possible time from the imaging study. Areas under the receiver operating curves (AUROC), optimum cut-offs, sensitivities, specificities and positive and negative predictive values were calculated for each score. RESULTS Seven algorithms were performed similarly in predicting cirrhosis. Sensitivities ranged from 0.65 to 1.00, specificities from 0.67 to 0.90, positive predictive values from 0.33 to 0.38, and negative predictive values from 0.93 to 1.00. No individual test was superior, as the confidence intervals of all AUROCs overlapped. CONCLUSIONS EMR-based scoring systems performed relatively well in ruling out advanced, radiologically-defined cirrhosis. However, their moderate sensitivity and positive predictive values limit their reliability for EMR-based diagnosis.
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Affiliation(s)
| | - Vijay Anand
- North Shore University Health System, Evanston, IL, USA
| | | | - Ammar Hassan
- North Shore University Health System, Evanston, IL, USA
| | - Alya Ahsan
- North Shore University Health System, Evanston, IL, USA
| | - Amnon Sonnenberg
- Portland VA Medical Center and the Oregon Health & Science University, Portland, OR, USA
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Abstract
The transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. The first TIPS was performed in Germany in 1988. The VIATORR self-expandable PTFE covered stent-graft (WL Gore, Flagstaff AZ) was approved by the FDA for a TIPS application in December of 2004. This stent-graft offers excellent shunt patency rates and it is possible that it has a beneficial effect on patient survival. Patient surveillance and post-procedural management have changed after the introduction of this stent-graft. This article presents the current management strategies that are followed at our Institution for patients who have undergone a TIPS procedure with a VIATORR stent graft including imaging follow-up, management of encephalopathy, medical management and nutritional aspects.
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Affiliation(s)
- Hector Ferral
- The Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, IL.
| | - Elisa Gomez-Reyes
- Departamento de Gastroenterologia, Instituto Nacional de la Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico
| | - Claus J Fimmel
- University of Chicago Pritzker School of Medicine, Section Chief of Hepatology, Division of Gastroenterology, NorthShore University HealthSystem, Evanston, IL
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Arora G, Flores R, Wright L, Fimmel CJ, Bode BP. Abstract 1323: Liver-specific knockout mice and liver-derived cell lines provide insights into potential roles for the GP73/GOLM1 HCC serum biomarker - association with sustained cell proliferation. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Golgi Protein-73kDa (GP73/GOLM1) is a resident cis Golgi Type II membrane protein that is nearly undetectable in normal liver, but whose expression is upregulated in hepatocellular carcinoma (HCC) and whose circulating levels increase in the plasma of patients with chronic liver disease and HCC. As such, it is the subject of ongoing clinical trials investigating its use as a serum biomarker for HCC. GP73/GOLM1 is cleaved by a proprotein convertase and secreted by proliferating cells, an activity possibly elevated in cancer, yet its biological role in the liver and in the pathogenesis of HCC remains unclear. In order to investigate possible biological roles for GP73/GOLM1, liver-specific knockout mice (C57BL/6) were generated using the Cre-loxP system, characterized by a “floxed” GOLM1 gene and Cre recombinase driven by the albumin promoter. GP73/GOLM1 Cre+/−genotypes were confirmed by PCR analysis. GP73/GOLM1Fl/Fl/Cre(+) animals showed no obvious biological phenotype compared to their Cre(-) littermates, and exhibited normal growth, behavior, and successful mating, suggesting that hepatic GP73/GOLM1 is not vital for normal physiological function, as might be hypothesized from its normally low expression in the liver. Previous studies indicated that GP73/GOLM1 expression was not upregulated in post-hepatectomy liver regeneration, suggesting that its activated expression in the liver is linked to inflammatory or carcinogenic processes rather than transiently increased mitosis. Examination of GP73/GOLM1 expression in 14 human HCC cell lines revealed similar expression levels in epithelial and mesenchymal cell lines, and in an SV40-transformed nontumorigenic human liver epithelial cell line. Rodent in vitro models of hepatocellular transformation revealed equal GP73/GOLM1 expression levels in nontumorigenic parent cell lines and their transformed tumorigenic derivatives. Collectively, the data from the in vivo and in vitro models thus far do not support a direct association of GP73/GOLM1 expression with liver mitogenesis or differentiation, but rather suggest that its expression may be linked to a sustained commitment to cell proliferation - such as occurs in cell lines, liver disease and cancerous transformation, promoted by an inflammatory microenvironment. Possible mechanistic roles for GP73/GOLM1 in HCC development and progression are currently being tested in carcinogenesis models with liver-specific knockout mice. A website on GP73/GOLM1 has also been established as a resource for the research community interested in the study of this protein.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1323. doi:1538-7445.AM2012-1323
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VanderHeyden TR, Yong SL, Breitschwerdt EB, Maggi RG, Mihalik AR, Parada JP, Fimmel CJ. Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient. BMC Infect Dis 2012; 12:17. [PMID: 22269175 PMCID: PMC3287964 DOI: 10.1186/1471-2334-12-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/23/2012] [Indexed: 11/15/2022] Open
Abstract
Background Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial. Case presentation We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy. Surgical pathology revealed florid necrotizing granulomatous hepatitis, favoring an infectious etiology. Despite extensive histological and serological evaluation a definitive diagnosis was not established initially. Thirteen months after initial presentation, hepatic bartonellosis was diagnosed by PCR studies from surgically excised liver tissue. Interestingly, the hepatic granulomas persisted and Bartonella henselae was isolated from the patient's enriched blood culture after several courses of antibiotic therapy. Conclusion The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection.
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Affiliation(s)
- Thomas R VanderHeyden
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA.
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14
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Abstract
BACKGROUND/AIMS Wilson disease (WD) is a disorder of copper transport caused by mutations within the ATP7B gene. WD is phenotypically variable and can present with predominantly hepatic or neurologic manifestations. The mechanisms responsible for this variability are unknown. GP73, a Golgi membrane protein, is expressed in hepatocytes in response to acute and chronic liver disease. METHODS Hepatocyte GP73 expression was examined in the livers of WD patients by semiquantitative immunohistochemistry. GP73 mRNA levels were measured in mice with a deletion of the WD gene (Atp7b(-/-)) by real-time PCR, and these values were compared to the concomitant histological abnormalities and previously reported copper levels. RESULTS Hepatocyte GP73 expression was more frequently observed in patients with hepatic versus neurologic presentation (79% vs. 30%, p<0.05). Furthermore, GP73 expression was significantly higher (44.7+/-14.0 vs. 2.0+/-0.81, p<0.05) in patients with hepatic phenotype. In Atp7b(-/-) mice, GP73 mRNA was significantly elevated at 20-46 weeks of age, coincident with extensive hepatic inflammation and fibrosis, but not at 6 weeks, when hepatic histology was normal despite significant copper overload. GP73 mRNA levels normalized concomitantly with the resolution of hepatic injury at 60-weeks. However, in tumor-like nodules GP73 was strikingly elevated. CONCLUSION Increased hepatocyte GP73 expression is more commonly a feature of hepatic than neurologic WD, and is triggered in response to inflammation, fibrosis, and dysplasia, rather than copper overload.
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Affiliation(s)
- Lorinda M Wright
- Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, Maywood, IL 60153, USA.
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15
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Fimmel CJ, Robertazzi S. Fulminant Hepatic Failure in an Adult Patient With Giant-Cell Hepatitis. Gastroenterol Hepatol (N Y) 2009; 5:504-506. [PMID: 37967409 PMCID: PMC2886430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
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16
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Fimmel CJ, Wright L. Golgi protein 73 as a biomarker of hepatocellular cancer: development of a quantitative serum assay and expression studies in hepatic and extrahepatic malignancies. Hepatology 2009; 49:1421-3. [PMID: 19402061 DOI: 10.1002/hep.22994] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Abstract
BACKGROUND The rising incidence of hepatocellular cancer in the US and worldwide has sparked a renewed interest in HCC serum markers. HCC typically develops in patients with chronic liver disease and cirrhosis. It is in these target populations that serum markers are most urgently needed. Unfortunately, the currently available markers lack sensitivity and specificity. A number of novel candidate markers have recently been introduced. METHODS We performed a review of the literature (2001-2006) of traditional and novel serum markers for hepatocellular cancer. RESULTS Several promising new HCC markers have been identified over the past 5 years. They include single proteins, complex proteomics features, and tumor-specific autoantibodies. The excitement about the new markers is tempered by the realization that none of them have yet met the most stringent criteria defined by the Early Detection Research Network (EDRN). CONCLUSION A new generation of HCC serum markers awaits validation in properly controlled clinical studies.
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Affiliation(s)
- Lorinda M Wright
- Division of Gastroenterology, Hepatology and Nutrition, Loyola University, Chicago, 2160 South First Avenue, Maywood, IL 60153, USA
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18
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Marrero JA, Romano PR, Nikolaeva O, Steel L, Mehta A, Fimmel CJ, Comunale MA, D'Amelio A, Lok AS, Block TM. GP73, a resident Golgi glycoprotein, is a novel serum marker for hepatocellular carcinoma. J Hepatol 2005; 43:1007-12. [PMID: 16137783 DOI: 10.1016/j.jhep.2005.05.028] [Citation(s) in RCA: 277] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 04/19/2005] [Accepted: 05/08/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS Golgi protein-73 (GP73) is up-regulated in hepatocellular carcinoma (HCC). The aims of this study were to determine if GP73 is detected in the serum, and to establish the sensitivity and specificity of serum GP73 for diagnosing HCC. METHODS Serum GP73 was detected by immunoblots and quantified by densitometric analysis. RESULTS A total of 352 patients were studied. Serum GP73 levels were significantly higher in patients with HCC compared to those with cirrhosis (P < 0.001). GP73 had a sensitivity of 69% and a specificity of 75% at the optimal cutoff point of 10 relative units, with an area under the receiver operating curve of 0.79 vs. 0.61 for AFP (P = 0.001). GP73 levels had significantly higher sensitivity (62%) than AFP (25%) for diagnosing early HCC (P < 0.0001). Moreover, GP73 levels were elevated in the serum of 57% (32/56) of individuals with HCC who had serum AFP levels less than 20ng/ml. CONCLUSIONS Higher levels of GP73 can be found in the serum of patients with HCC than of those without. GP73 was better than AFP for the diagnosis of early HCC. Further validation studies are needed to confirm the role of GP73 in the early detection of HCC.
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Affiliation(s)
- Jorge A Marrero
- Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, Ann Arbor, MI 48109-0362, USA.
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19
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Brown KE, Broadhurst KA, Mathahs MM, Kladney RD, Fimmel CJ, Srivastava SK, Brunt EM. Immunodetection of aldose reductase in normal and diseased human liver. Histol Histopathol 2005; 20:429-36. [PMID: 15736047 DOI: 10.14670/hh-20.429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aldose reductase is an NADPH-dependent aldo-keto reductase best known as the rate-limiting enzyme of the polyol pathway that is implicated in the complications of diabetes. Aldose reductase appears to be involved in a variety of disease states other than diabetes, presumably due to its ability to catalyze the reduction of a broad spectrum of aldehydes, including some cytotoxic products of lipid peroxidation. Although the data regarding expression of aldose reductase in normal liver are conflicting, prior studies have suggested that the enzyme may be induced in diseased liver. The goal of these studies was to characterize expression of aldose reductase in normal and diseased human liver, using RT-PCR, Western analysis and immunohistochemistry. Aldose reductase transcripts and protein were detected at low levels in control human livers. In contrast, levels of aldose reductase mRNA and protein were increased in chronically diseased human livers. Immunohistochemistry demonstrated localization of aldose reductase in sinusoidal lining cells; dual immunofluorescence confocal microscopy with the macrophage marker, CD68, confirmed that the aldose reductase-positive sinusoidal lining cells were Kupffer cells. Abundant aldose reductase-positive, CD68-positive cells were present in the fibrous septa of cirrhotic livers, accounting for the increase in immunoreactive aldose reductase in diseased livers. Immunostaining of human lung, spleen and lymph node revealed that macrophages in those tissues also express aldose reductase. These data are the first to demonstrate that aldose reductase is expressed by human macrophages in various tissues and suggest that this enzyme may play a role in immune or inflammatory processes.
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Affiliation(s)
- K E Brown
- Iowa City Veterans Administration Medical Center, Iowa City, IA, USA.
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20
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Iftikhar R, Kladney RD, Havlioglu N, Schmitt-Gräff A, Gusmirovic I, Solomon H, Luxon BA, Bacon BR, Fimmel CJ. Disease- and cell-specific expression of GP73 in human liver disease. Am J Gastroenterol 2004; 99:1087-95. [PMID: 15180730 DOI: 10.1111/j.1572-0241.2004.30572.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES GP73, a Golgi membrane protein, is expressed at high levels in hepatocytes of patients with decompensated cirrhosis. Its expression in other forms of liver disease has not been investigated. Therefore, we studied GP73 expression in patients with noncirrhotic liver disease. METHODS GP73 expression was detected immunohistochemically and by immunofluorescence microscopy in patients with acute hepatitis of various etiologies, autoimmune hepatitis, chronic HCV infection, and alcoholic liver disease. In order to quantitate hepatocyte GP73 expression, an immunohistochemical scoring system was developed, and validated by a direct comparison with GP73 protein levels as determined by Western blotting. RESULTS GP73 immunostaining and Western blotting data were highly correlated, demonstrating the suitability of the immunohistochemical scoring system to quantitate hepatocyte GP73 expression. Hepatocyte GP73 expression was increased in patients with acute and autoimmune hepatitis. Treatment of autoimmune hepatitis was associated with a normalization of GP73 expression, indicating that the initial upregulation was reversible. Increased levels of GP73 expression were also noted in chronic HCV infection and alcoholic liver disease. Under these conditions, GP73 levels were correlated with disease stage but not grade. GP73 immunoreactivity was occasionally detected in alpha-SMA-positive, sinusoidal lining cells, suggesting activated stellate cells as a potential source of GP73. CONCLUSIONS Hepatocyte GP73 levels are upregulated in acute hepatitis and during the progression of liver disease to cirrhosis. This expression pattern suggests the presence of two regulatory mechanisms, the first triggered during acute hepatocellular injury, the second during the progression of chronic liver disease.
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Affiliation(s)
- Rehan Iftikhar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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21
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Neuschwander-Tetri BA, Fimmel CJ, Kladney RD, Wells LD, Talkad V. Differential expression of the trypsin inhibitor SPINK3 mRNA and the mouse ortholog of secretory granule protein ZG-16p mRNA in the mouse pancreas after repetitive injury. Pancreas 2004; 28:e104-11. [PMID: 15097871 DOI: 10.1097/00006676-200405000-00022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A mouse model using repetitive acinar cell injury caused by supraphysiologic doses of cerulein to induce the characteristic fibrosis and loss of acinar cell mass found in human chronic pancreatitis was employed to identify early changes in gene expression. A gene array was used to detect changes in 18,000 expressed sequence tags; changes in specific transcripts were confirmed by RNase protection assays. These methods identified SPINK3, the mouse homologue of human and rat protease inhibitor genes, as being highly expressed in the pancreas and induced after pancreatic injury. Because SPINK3 may be an important serine protease inhibitor, its up-regulation may reflect an important endogenous cytoprotective mechanism in preventing further injury. The up-regulation of SPINK3 was specific; the mouse homologue of the zymogen-processing protein ZG-16p was also highly expressed in the pancreas but sharply down-regulated early in the course of injury. These findings suggest that the pancreatic acinar cell may respond to injury with a program of self-preservation and loss of normal function.
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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer, but the third leading cause of cancer death, in the world, with more than 500,000 fatalities annually. The major etiology of HCC/liver cancer in people is hepatitis B virus (HBV), followed by hepatitis C virus infection (HCV), although nonviral causes also play a role in a minority of cases. Recent molecular studies confirm what was suspected: that HCC tissue from different individuals have many phenotypic differences. However, there are clearly features that unify HCC occurring in a background of viral hepatitis B and C. HCC due to HBV and HCV may be an indirect result of enhanced hepatocyte turnover that occurs in an effort to replace infected cells that have been immunologically attacked. Viral functions may also play a more direct role in mediating oncogenesis. This review considers the molecular and cellular mechanisms involved in primary hepatocellular carcinoma, using a viral perspective.
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Affiliation(s)
- Timothy M Block
- Department of Molecular Pharmacology and Biochemistry, Jefferson Center for Biomedical Research of Thomas Jefferson University, 700 East Butler Ave., Doylestown, PA 18901, USA.
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23
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Brown KE, Dennery PA, Ridnour LA, Fimmel CJ, Kladney RD, Brunt EM, Spitz DR. Effect of iron overload and dietary fat on indices of oxidative stress and hepatic fibrogenesis in rats. Liver Int 2003; 23:232-42. [PMID: 12895262 DOI: 10.1034/j.1600-0676.2003.00832.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS Oxidative stress is presumed to play an important role in hepatic fibrogenesis. Diets high in polyunsaturated fatty acids (PUFA) enhance fibrosis and have been associated with increased oxidative damage in some models of liver injury. The aim of this study was to determine the effects of dietary fat of varying PUFA content on iron-induced oxidative stress and fibrosis. METHODS Rats were given parenteral iron and diets supplemented with coconut oil, safflower oil or menhaden oil. RESULTS Hepatic iron overload was associated with induction of heme oxygenase-1, a sensitive indicator of oxidative stress, and with modest increases in hydroxyproline and procollagen I mRNA levels without histologically evident fibrosis, all of which were unaffected by dietary fat. In addition, iron loading was associated with increases in cysteine, gamma-glutamylcysteine and glutathione. Dietary fat brought about the expected alterations in peroxidizability, but did not alter indices of oxidative damage. CONCLUSION These data highlight the distinction between oxidative stress and oxidative damage and suggest that the former is not sufficient to elicit overt fibrosis. Furthermore, while hepatic iron overload leads to oxidative stress, there is an associated upregulation of antioxidant defenses involving thiol metabolism that may be a critical factor limiting the accumulation of oxidative damage.
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Affiliation(s)
- Kyle E Brown
- Gastroenterology Section, John Cochran VAMC, St. Louis, MO, USA.
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24
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Abstract
GP73 is a novel type II Golgi transmembrane protein that is expressed at high levels in the hepatocytes of patients with viral hepatitis (R. D. Kladney, G. A. Bulla, L. Guo, A. L. Mason, A. E. Tollefson, D. J. Simon, Z. Koutoubi, and C. J. Fimmel, 2000, Gene 249, 53-65) and is induced in cultured cells by infection with viruses including adenoviruses. Its biological function and the mechanisms by which its expression may be regulated by viral infection are unknown. Here we report that GP73 is induced at the RNA and protein level in human Hep3B hepatoma cells infected by human Ad5 and Ad2. Hep3B cells were infected with wild-type or mutant adenoviruses. GP73 expression was measured by RNase protection assay, immunoblotting, or immunofluorescence microscopy. GP73 RNA and protein levels were strikingly induced following infection. The rise in GP73 expression coincided with the appearance of the adenovirus E1A and DBP proteins and preceded the expression of the fiber protein, a marker of the late phase of infection. Infection did not affect the expression of giantin, GPP130, or golgin-84, three integral Golgi membrane proteins with structural similarities to GP73. Mapping studies using a panel of mutant adenoviruses demonstrated that the E1A C-terminus, specifically its CtBP interaction domain (CID), is required for GP73 expression. Subsequently, Hep3B cells were transiently transfected with plasmids expressing wild-type or mutant E1A proteins. These studies confirmed that E1A induced GP73 expression via the CID. Our studies establish GP73 as a novel adenovirus-induced cellular protein whose expression is regulated through the CID of the E1A protein.
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Affiliation(s)
- Raleigh D Kladney
- GI Section, John Cochran Veterans Affairs Medical Center, St. Louis, Missouri 63106, USA
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25
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Abstract
The cis-Golgi protein GPP130 reversibly redistributes to endosomes upon pH disruption, but the identity of the endosomes and the involved cycling route are unknown. It is also unknown whether any other early Golgi proteins participate in this pathway. Here, we analyze GPP130 and the structurally related Golgi protein GP73. Unlike the TGN marker TGN38/46, GPP130 and GP73 colocalized in the early Golgi and redistributed to the ER after brefeldin A treatment. Nevertheless, after pH disruption by monensin, GPP130 and GP73 redistributed to endosomes containing redistributed TGN38/46, but not other endosomal markers. In common with TGN38/46, the redistribution involved transient appearance on the plasma membrane, and upon monensin washout, the proteins moved back to the Golgi along a microtubule- and PI3 kinase-independent route. Although GP73 did not associate with GPP130, its steady-state Golgi targeting was also mediated by a lumenal predicted coiled-coil stem domain. These findings indicate that at least two early Golgi proteins, each containing stem domain Golgi targeting determinants, cycle to the cell surface and back along the late endosome independent TGN38/46 pathway.
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Affiliation(s)
- Sapna Puri
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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26
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Abstract
GP73 is a novel type II Golgi membrane protein of unknown function that is expressed in the hepatocytes of patients with adult giant-cell hepatitis (Gene 2000;249:53-65). Its expression pattern in human liver disease and the regulation of its expression in hepatocytes have not been systematically studied. The aims of the present study were to compare GP73 protein levels in viral and nonviral human liver disease and in normal livers, to identify its cellular sources, and to study the regulation of its expression in hepatoma cells in vitro. GP73 protein levels were quantitated in explant livers of patients with well-defined disease etiologies and compared with the levels in normal donor livers. GP73-expressing cells were identified immunohistochemically. GP73 expression in vitro was studied by Western blotting and immunofluorescence microscopy in HepG2 and SK-Hep-1 cells and in the HepG2-derived, hepatitis B virus (HBV)-transfected HepG2215 and HepG2T14.1 cell lines. Whole organ levels of GP73 were low in normal livers. Significant increases were found in liver disease due to viral causes (HBV, HCV) or nonviral causes (alcohol-induced liver disease, autoimmune hepatitis). In normal livers, GP73 was constitutively expressed by biliary epithelial cells but not by hepatocytes. Hepatocyte expression of GP73 was dramatically up-regulated in diseased livers, regardless of the etiology, whereas biliary epithelial cell expression did not change appreciably. GP73 was present at high levels in HepG2215 cells (a cell line that supports active HBV replication), but was absent in HepG2T14.1 cells (an HBV-transfected cell line that does not support HBV replication) and in HBV-free HepG2 cells. In SK-Hep-1 cells, GP73 expression was increased in response to interferon gamma (IFN-gamma), and inhibited by tumor necrosis factor alpha (TNF-alpha). In conclusion, increased expression of GP73 in hepatocytes appears to be a general feature of advanced liver disease, and may be regulated via distinct pathways that involve hepatotropic viruses or cytokines.
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Affiliation(s)
- Raleigh D Kladney
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
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27
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Abstract
OBJECTIVE The treatment of hepatitis C virus (HCV) infection in United States veterans has become a major task for the Veterans Administration Healthcare System. Although the comprehensive diagnosis and treatment of HCV-infected patients has been mandated, little is known about the performance characteristics of HCV clinics and about the outcomes of antiviral therapy in this unique patient population. METHODS We retrospectively examined clinic show rates, treatment eligibility, and the response to antiviral therapy in a dedicated HCV outpatient clinic in a large urban Veterans Affairs medical center. RESULTS Our data demonstrate that few veterans--regardless of their age or ethnic background--pursue evaluation and treatment of their HCV infection by hepatologists. A minority of those patients who undergo a comprehensive clinic evaluation meet the standard eligibility criteria for antiviral therapy. The overall efficacy of antiviral treatment, as measured by the sustained virological response rate, is substantially lower than previously reported in randomized clinical trials. HCV-infected veterans are characterized by a unique combination of risk factors that are predictive of a poor response to antiviral therapy, including a preponderance of male gender, HCV genotype I, age > 40 yr, and histologically advanced degrees of liver disease. CONCLUSIONS Our study demonstrates the limitations of outpatient HCV treatment initiatives in the United States veteran population, and suggests that the overall impact of current HCV treatment programs may be small.
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28
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Abstract
We report the isolation and characterization of GP73, a novel 73kDa human Golgi protein. The GP73 cDNA was cloned by differential screening of a cDNA library derived from the liver of a patient with adult giant-cell hepatitis (GCH), a rare form of hepatitis with presumed viral etiology. In vitro transcription-translation studies indicate that GP73 is an integral membrane protein, and immunolocalization experiments using epitope-tagged GP73 demonstrate that the protein is localized to the Golgi apparatus. Northern blot analysis of RNA from multiple human tissues reveals a single GP73 mRNA transcript with a size of approximately 3.0kb. Immunohistochemical studies using rabbit polyclonal antisera directed against recombinant GP73 demonstrate that the protein is preferentially expressed by epithelial cells in many human tissues. In normal livers, GP73 is consistently present in biliary epithelial cells, whereas hepatocytes show little or no signal. In contrast, livers of patients with GCH display strong GP73 immunoreactivity in multinucleated hepatocytes. GP73 mRNA and protein are expressed in highly differentiated HepG2 hepatoma cells after infection with adenovirus in vitro. We conclude that GP73 represents a novel, epithelial cell-specific integral membrane Golgi protein that can be upregulated in response to viral infection.
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MESH Headings
- Adult
- Amino Acid Sequence
- Animals
- Base Sequence
- Cell Line
- DNA, Complementary/chemistry
- DNA, Complementary/genetics
- Female
- Gene Expression
- Gene Expression Regulation
- Giant Cells/virology
- Golgi Apparatus/metabolism
- Hepatitis, Viral, Human/genetics
- Hepatitis, Viral, Human/virology
- Humans
- Male
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Molecular Sequence Data
- Protein Biosynthesis
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rabbits
- Sequence Analysis, DNA
- Tissue Distribution
- Transcription, Genetic
- Transfection
- Tumor Cells, Cultured
- Up-Regulation
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Affiliation(s)
- Raleigh D. Kladney
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
- St. Louis Veterans Affairs Medical Center, 915 North Grand Blvd., St. Louis, MO 63106, USA
| | - Gary A. Bulla
- Pediatric Research Institute, Saint Louis University, St. Louis, MO, USA
| | - Linsheng Guo
- Section of Gastroenterology and Hepatology, Ochsner Medical Institutions, New Orleans, LA, USA
| | - Andrew L. Mason
- Section of Gastroenterology and Hepatology, Ochsner Medical Institutions, New Orleans, LA, USA
| | - Ann E. Tollefson
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Daniela J. Simon
- Department of Pathology and Laboratory Medicine, Medical College of Philadelphia, and Hahnemann School of Medicine, Philadelphia, PA, USA
| | - Zaher Koutoubi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
- St. Louis Veterans Affairs Medical Center, 915 North Grand Blvd., St. Louis, MO 63106, USA
| | - Claus J. Fimmel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
- St. Louis Veterans Affairs Medical Center, 915 North Grand Blvd., St. Louis, MO 63106, USA
- Corresponding author. Tel.: +1-314-289-6434; fax: +1-314-289-7007
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30
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Abstract
Adult syncytial giant cell hepatitis (GCH) is an uncommon and often fulminant form of hepatitis that may be caused by infection with a novel paramyxo-like virus. We present the case of a 69-yr-old man who presented with acute, community-acquired hepatitis and chronic lymphocytic leukemia. A liver biopsy showed the typical findings of panlobular syncytial giant cell hepatitis. Electron microscopic examination demonstrated abundant nucleocapsid-like protein material in the cytoplasm and nuclei of affected hepatocytes. These structures were similar to, but distinct from, those of known paramyxoviridae, suggesting infection with a novel, related virus. In situ hybridization studies with a probe directed against the measles fusion protein gene gave a positive signal with a hepatocyte distribution. No signal was obtained with the measles nucleocapsid protein probe, suggesting that the disease agent was genetically distinct from, but related to, the measles virus. Subsequent liver biopsies were characterized by the gradual disappearance of the giant cell changes and by the concomitant development of cirrhosis. This is a case of adult GCH that resolved spontaneously and led to cirrhosis, thus implicating GCH as a potential cause of "cryptogenic" liver disease. Our findings provide further support for the existence of a distinct, as yet unidentified viral species as a cause of this disease.
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Affiliation(s)
- C J Fimmel
- Department of Internal Medicine, Veterans Affairs Medical Center, St. Louis, Missouri, USA
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31
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Abstract
Polyenylphosphatidylcholine (PPC), a polyunsaturated phospholipid extract from soy beans, prevents the development of liver cirrhosis in animal models. Its mechanism of action is unknown. Based on the hypothesis that PPC might act by decreasing hepatic stellate cell proliferation, we studied the effect of PPC and its main components, dilinoleoylphosphatidylcholine (DLPC) and palmitoyl-linoleoylphosphatidylcholine (PLPC), on PDGF-induced stellate cell proliferation and intracellular signal transduction. Normal rat hepatic stellate cells in tissue culture were serumstarved, and incubated with 10ng/ml PDGF in the absence or presence of phospholipids. Cell proliferation was measured by 3H-thymidine incorporation. P44MAPK activation was determined by kinase assay, and AP-1 binding by electrophoretic mobility shift assay. PPC (200 ng/ml) significantly inhibited PDGF-induced proliferation (p < 0.05; ANOVA, n = 3) and antagonized PDGF-induced P44MAPK activation and AP-1 binding. This effect was mimicked by DLPC but not by PLPC. Neither DLPC nor PLPC prevented PDGF receptor activation. We conclude that PPC exerts a previously unrecognized effect on mitogen-induced stellate cell proliferation which may be mediated by DLPC. Inhibition of this cascade represents a potential mechanism for the inhibitory effect of PPC on hepatic fibrogenesis.
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Affiliation(s)
- L M Brady
- Department of Pediatrics, Saint Louis University School of Medicine, Missouri, USA
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32
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Fimmel CJ, Brown KE, O'Neill R, Kladney RD. Complement C4 protein expression by rat hepatic stellate cells. J Immunol 1996; 157:2601-9. [PMID: 8805663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Stellate cells play an important role in the production and turnover of the normal extracellular matrix of the liver and are key effector cells in the hepatic fibrogenesis that occurs in response to liver injury. In the present study, we used a rat model of long term dietary iron supplementation to identify stellate cell genes that are expressed during chronic hepatic iron overload. Using a subtraction cloning strategy, we identified a rat isoform of the complement C4 protein gene whose expression was strongly induced in stellate cells after iron overload. Highly purified, cultured stellate cells synthesized the C4 precursor protein and released its subunits into the culture medium. The C4 protein secreted in vitro was biologically active in a C4-specific hemolytic assay. C4 mRNA expression was minimal in freshly isolated stellate cells and increased between days 3 and 7 of primary culture, coincident with the expression of smooth muscle alpha-actin (alpha-SMA), a marker of cellular activation. C4 expression was absent in strongly alpha-SMA-positive, passaged cells, but was induced by IFN-gamma, which simultaneously inhibited alpha-SMA expression. Our studies establish hepatic stellate cells as a previously unrecognized source of C4 and raise the possibility that complement protein expression by the cells plays a role in the hepatic injury response and in fibrogenesis. Our in vitro data point to the presence of two distinct stimulatory pathways for C4 expression in stellate cells that differ with regard to their sensitivity to IFN-gamma and their relationship to cellular activation.
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Affiliation(s)
- C J Fimmel
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA
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Fimmel CJ, Brown KE, O'Neill R, Kladney RD. Complement C4 protein expression by rat hepatic stellate cells. The Journal of Immunology 1996. [DOI: 10.4049/jimmunol.157.6.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Stellate cells play an important role in the production and turnover of the normal extracellular matrix of the liver and are key effector cells in the hepatic fibrogenesis that occurs in response to liver injury. In the present study, we used a rat model of long term dietary iron supplementation to identify stellate cell genes that are expressed during chronic hepatic iron overload. Using a subtraction cloning strategy, we identified a rat isoform of the complement C4 protein gene whose expression was strongly induced in stellate cells after iron overload. Highly purified, cultured stellate cells synthesized the C4 precursor protein and released its subunits into the culture medium. The C4 protein secreted in vitro was biologically active in a C4-specific hemolytic assay. C4 mRNA expression was minimal in freshly isolated stellate cells and increased between days 3 and 7 of primary culture, coincident with the expression of smooth muscle alpha-actin (alpha-SMA), a marker of cellular activation. C4 expression was absent in strongly alpha-SMA-positive, passaged cells, but was induced by IFN-gamma, which simultaneously inhibited alpha-SMA expression. Our studies establish hepatic stellate cells as a previously unrecognized source of C4 and raise the possibility that complement protein expression by the cells plays a role in the hepatic injury response and in fibrogenesis. Our in vitro data point to the presence of two distinct stimulatory pathways for C4 expression in stellate cells that differ with regard to their sensitivity to IFN-gamma and their relationship to cellular activation.
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Affiliation(s)
- C J Fimmel
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA
| | - K E Brown
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA
| | - R O'Neill
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA
| | - R D Kladney
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250, USA
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Brundage L, Fimmel CJ, Mizushima S, Wickner W. SecY, SecE, and band 1 form the membrane-embedded domain of Escherichia coli preprotein translocase. J Biol Chem 1992; 267:4166-70. [PMID: 1531482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The preprotein translocase of Escherichia coli is a multisubunit enzyme with two domains, the peripheral membrane protein SecA and the membrane-embedded SecY/E protein. SecY/E has been isolated as a complex of three polypeptides, SecY, SecE, and band 1. We now present four lines of evidence that the active species of SecY/E is composed of a tightly associated complex of these three subunits: 1) antibodies to SecY efficiently precipitate SecY/E activity as well as all three polypeptides; 2) the proportions of SecY, SecE, and band 1 in the immunoprecipitates are the same as in the starting fraction; 3) the immunoprecipitable complex is not disrupted by treatment with either high salt or urea but is disrupted by brief incubation at 20 degrees C, and the kinetics of dissociation of both band 1 and SecE from SecY at 20 degrees C parallel the loss of translocation ATPase activity; 4) upon immunoprecipitation of similar units of activity of translocase from detergent solutions from either wild-type membranes or a SecY and SecE overproducer strain, the SecE and band 1 subunits are recovered in the same proportions. These data establish that the subunits of SecY/E are firmly associated and that it is the associated complex which is active for translocation.
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Affiliation(s)
- L Brundage
- Molecular Biology Institute, University of California, Los Angeles 90024-1570
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Abstract
Twenty four hour intragastric acidity was measured by continuous recording using intragastric combined glass electrodes in 46 duodenal ulcer patients within 48 hours of endoscopic confirmation of active ulceration. Acidity during predefined time periods was compared with that measured in 40 healthy controls without gastrointestinal disease: it was significantly higher in duodenal ulcer patients at all times, but 25% of ulcer patients had median 24 hour acidity within the interquartile range of the normal group. During the evening (18,00 to 22,00 h) ulcer patients had considerable acidity with a median of 39.8 (63.1-31.6) mmol/l (interquartile range) compared with 5.6 (22.3-0.4) mmol/l of controls. It is suggested that antisecretory treatment be directed to decrease this period of unbuffered acidity, as well as during the night, which is presently considered of prime importance.
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Affiliation(s)
- H S Merki
- DRK Hospital, Department of Gastroenterology, Berlin, FRG
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Muallem S, Schoeffield MS, Fimmel CJ, Pandol SJ. Agonist-sensitive calcium pool in the pancreatic acinar cell. II. Characterization of reloading. Am J Physiol 1988; 255:G229-35. [PMID: 3136660 DOI: 10.1152/ajpgi.1988.255.2.g229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
45Ca2+ fluxes and free cytosolic Ca2+ measurements in guinea pig pancreatic acini indicated that after agonist stimulation and the release of Ca2+ from the agonist-sensitive pool at least part of the Ca2+ is extruded from the cell, resulting in 45Ca2+ efflux. In the continued presence of agonist, the pool remains permeable to Ca2+ but partially refills with Ca2+. This reloading is dependent on the concentration of extracellular Ca2+. In the absence of extracellular Ca2+, the pool is completely depleted of Ca2+. However, with increasing concentrations of CaCl2 in the incubation solution (from 0.5 to 2.0 mM) there is increasing repletion of the pool with Ca2+ during agonist stimulation. With termination of agonist stimulation, the Ca2+ permeability of the agonist-sensitive pool is rapidly reduced to that measured in the unstimulated cell. As a result, the Ca2+ incorporated into the pool during the stimulation period is rapidly trapped within the pool and exchanges poorly with medium Ca2+. Subsequently, the pool completely refills with Ca2+. The rate of Ca2+ reloading at the termination of agonist stimulation is slower than the conversion of the pool to the impermeable state. In incubation media containing 1.3 mM CaCl2, the half-time for reloading at the termination of stimulation is 5 min. These observations demonstrate the characteristics of Ca2+ reloading of the agonist-sensitive pool both during stimulation and at the termination of stimulation.
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Affiliation(s)
- S Muallem
- Research Institute, Cedars-Sinai Medical Center, Los Angeles
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37
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Muallem S, Schoeffield MS, Fimmel CJ, Pandol SJ. Agonist-sensitive calcium pool in the pancreatic acinar cell. I. Permeability properties. Am J Physiol 1988; 255:G221-8. [PMID: 3136659 DOI: 10.1152/ajpgi.1988.255.2.g221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
45Ca2+ fluxes and free cytosolic Ca2+ [( Ca2+]i) were used to describe the Ca2+ permeability and Ca2+ reloading of the agonist-sensitive pool at rest, during stimulation, and at termination of stimulation. A sequence of stimulation with carbachol, inhibition with atropine (cycling), and restimulation with cholecystokinin octapeptide (CCK-8) was used to follow Ca2+ reloading. Reloading of the pool required extracellular Ca2+ and was measured as an increased rate and extent of 45Ca2+ uptake into the acini. The 45Ca2+ incorporated into cycled acini could be completely released with CCK-8. The dose-response curves for 45Ca uptake and release were identical to those of the hormonally evoked [Ca2+]i increase. The increased 45Ca2+ uptake during reloading was not due to an expansion of any intracellular pool size but reflects the labeling of the pool to isotopic equilibrium in cycled acini. The rate constant of Ca2+ efflux from the pool of resting cells was approximately 0.67 +/- 0.01/h. With stimulation, the Ca2+ permeability of the pool membrane rapidly increased, resulting in Ca2+ release into the cytosol and an increase in [Ca2+]i. With termination of stimulation, the Ca2+ permeability of the pool membrane rapidly decreased while the pool continued to reload with extracellular Ca2+. Labeling of the pool to isotopic equilibrium allowed determination of the amount of Ca2+ released from the pool, which was 2.94 +/- 0.06 nmol/mg protein. This indicates that total Ca2+ concentration in the pool is in the millimolar range.
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Affiliation(s)
- S Muallem
- Research Institute, Cedars-Sinai Medical Center, Los Angeles
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Hinder RA, Fimmel CJ, Rickards E, von Ritter C, Svensson LG, Blum AL. Stimulation of gastric acid secretion increases mucosal blood flow in immediate vicinity of parietal cells in baboons. Dig Dis Sci 1988; 33:545-51. [PMID: 3359908 DOI: 10.1007/bf01798355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In acute experiments carried out in 27 baboons under general anesthesia, the regional gastric mucosal and muscle layer blood flow and gastric acid secretion were measured during 4 hr. Baboons were allocated to each of the following six groups: control, gastric acid stimulation with histamine 40 micrograms/kg/hr intravenous, inhibition of basal or stimulated acid secretion with either ranitidine 50 mg intravenous or omeprazole 1 microgram/kg/hr. There were no significant cardiovascular alterations during the experiments. Histamine stimulation produced a concomitant rise in acid secretion and increase in blood flow only to the mucosal layer of the parietal-cell-bearing area of the stomach. Neither the underlying muscle layer nor the non-parietal-cell-bearing fundic or antral mucosa took part in this response, suggesting that a mechanism controlling blood flow is present in close proximity to the parietal cells. It was also established that the increase in blood flow occurs in response to parietal cell activity and not as a result of the action of histamine on the vascular system. Suppression of both basal and stimulated acid secretion did not cause a fall of mucosal blood flow below basal levels in any part of the stomach, indicating that drugs that inhibit parietal cell activity can be used in conditions where gastric mucosal ischemia should be avoided.
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Affiliation(s)
- R A Hinder
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
We investigated the effect of a slow-release formula of trimoprostil, a prostaglandin E2 analogue, at a dose of 3 mg b.d. on circadian intragastric acidity in nine healthy volunteers using ambulatory pH-metry in a placebo-controlled study. The effect of trimoprostil was long lasting (8 hours during the night). However, it lowered gastric pH on average only by 0.4 pH units. In four of the six women severe side-effects occurred in the form of abdominal cramping, metrorrhagia, and/or diarrhoea. These disadvantages may limit the clinical use of this drug.
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Affiliation(s)
- C Emde
- Stadtspital Triemli, Zurich, Switzerland
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40
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von Ritter C, Hinder RA, Womack W, Bauerfeind P, Fimmel CJ, Kvietys PR, Granger DN, Blum AL. Microsphere estimates of blood flow: methodological considerations. Am J Physiol 1988; 254:G275-9. [PMID: 3348380 DOI: 10.1152/ajpgi.1988.254.2.g275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The microsphere technique is a standard method for measuring blood flow in experimental animals. Sporadic reports have appeared outlining the limitations of this method. In this study we have systematically assessed the effect of blood withdrawals for reference sampling, microsphere numbers, and anesthesia on blood flow estimates using radioactive microspheres in dogs. Experiments were performed on 18 conscious and 12 anesthetized dogs. Four blood flow estimates were performed over 120 min using 1 X 10(6) microspheres (15 microns) each time. The effects of excessive numbers of microspheres (13 million), pentobarbital sodium anesthesia (30 mg/kg), and replacement of volume loss for reference samples with dextran 70 were assessed. In both conscious and anesthetized dogs a progressive decrease in gastric mucosal blood flow and cardiac output was observed over 120 min. This was also observed in the pancreas in conscious dogs. The major factor responsible for these changes was the volume loss due to reference sample withdrawals. Replacement of the withdrawn blood with dextran 70 led to stable blood flows to all organs. The injection of excessive numbers of microspheres did not modify hemodynamics to a greater extent than did the injection of 4 million microspheres. Anesthesia exerted no influence on blood flow other than raising coronary flow. We conclude that although blood flow to the gastric mucosa and the pancreas is sensitive to the minor hemodynamic changes associated with the microsphere technique, replacement of volume loss for reference samples ensures stable blood flow to all organs over a 120-min period.
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Affiliation(s)
- C von Ritter
- Department of Surgery, University of Witwatersrand, Johannesburg, South Africa
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41
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Fimmel CJ, Hinder RA, Blum AL. Induction of anacidity restores gastric aminopyrine clearance in canine hemorrhagic shock. Digestion 1988; 40:52-60. [PMID: 3234617 DOI: 10.1159/000199642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The determinants of gastric aminopyrine clearance were studied in a canine hemorrhagic shock model. Adult mongrel dogs were anesthetized, and their stomachs perfused with 0.1 N HCl through an esophageal and a duodenal cannula. Blood flow to the serosal layer of the anterior gastric wall was measured by a laser flowmeter. Hemorrhagic shock was induced by controlled arterial bleeding to a mean systolic blood pressure of 40 +/- 5 mm Hg (n = 8), resulting in a 36 +/- 8% drop of gastric wall blood flow. In contrast, the aminopyrine clearance did not reveal the expected drop and remained unchanged during shock. When acid secretion was abolished by intravenous omeprazole (1.3 mg/kg bolus plus 0.75 mg/kg/h infusion), aminopyrine concentrations dropped in the gastric perfusate and rose in the serum during shock, resulting in a similar decrease in the clearance (53 +/- 25%) as compared to the flowmeter readings. In control experiments without hemorrhagic shock, omeprazole did not affect the concentrations of aminopyrine in serum and in the perfusate, or the recovery of 14C-labeled aminopyrine in the mucosa at the end of the experiment. These studies indicate that the aminopyrine clearance is impaired in hemorrhagic shock, and that complete inhibition of acid secretion by omeprazole restores the apparent aminopyrine clearance by divergent effects on blood and gastric juice concentrations of aminopyrine.
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Affiliation(s)
- C J Fimmel
- Department of Medicine, Sepulveda VA Hospital, Calif
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42
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Pandol SJ, Schoeffield MS, Fimmel CJ, Muallem S. The agonist-sensitive calcium pool in the pancreatic acinar cell. Activation of plasma membrane Ca2+ influx mechanism. J Biol Chem 1987; 262:16963-8. [PMID: 3680283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The purposes of the present study were to investigate the characteristics and regulation of Ca2+ influx across the plasma membrane in pancreatic acini and to demonstrate the role of this Ca2+ influx in the mechanism of reloading of the agonist-sensitive Ca2+ pool. In pancreatic acini, depleted of intracellular Ca2+ by stimulation with carbachol in the absence of extracellular Ca2+, 25 microM LaCl3 inhibited the increase in free cytosolic Ca2+ ([Ca2+]i) and reloading of the agonist-sensitive pool that occurred with the addition of extracellular CaCl2 to the medium. LaCl3 also inhibited the increase in cellular 45Ca2+ uptake that occurred during agonist stimulation and its termination but not cellular 45Ca2+ uptake into unstimulated acini. In acini depleted of intracellular Ca2+, increased cellular Ca2+ influx and reloading of the agonist-sensitive pool occurred even if extracellular CaCl2 was added 10 min after the termination of agonist action. Maximal reloading was independent of the extracellular Ca2+ concentration between 0.5 and 2.0 mM CaCl2. However, the time to maximal reloading was longer at lower extracellular Ca2+ concentrations. These results demonstrate a plasma membrane Ca2+ influx mechanism in the pancreatic acinar cell that is activated during cell stimulation. This transport remains activated as long as the agonist-sensitive pool is not completely loaded with Ca2+ suggesting that the Ca2+ influx mechanism is regulated by the quantity of Ca2+ in the agonist-sensitive pool. The activation of this Ca2+ transport mechanism functions to allow Ca2+ influx across the plasma membrane and Ca2+ reloading of the agonist-sensitive pool. Furthermore, these results suggest that during reloading Ca2+ crosses the plasma membrane into the cytosol before entering the agonist-sensitive pool.
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Affiliation(s)
- S J Pandol
- Department of Medicine, Veterans Administration Medical Center, San Diego, CA 92161
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Abstract
Stimulation of the pancreatic acinar cells with Ca2+ mobilizing hormones increased the ATP-dependent Ca2+ uptake into the ER of permeabilized cells. Activation of the ER Ca2+ pump resulted in increased apparent affinity for Ca2+ from 0.26 to 0.09 uM and Vmax from 2.68 to 5.74 nmoles/mg prot./min. The apparent affinity of the pump for VO4 = was dependent on [Ca2+]. Activation of the pump also decreased apparent affinity for VO4 = from 12 to 32 uM at [Ca2+] of 0.138 uM. These findings suggest that pump activation is due to acceleration of the rate of the conformational transition between the VO4 = (E2) and Ca2+ (E1) sensitive forms of the pump.
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Affiliation(s)
- S Muallem
- Laboratory of Membrane Biology, Cedars-Sinai Medical Center, Los Angeles, Ca
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44
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Bauerfeind P, Cilluffo T, Fimmel CJ, Emde C, von Ritter C, Kohler W, Gugler R, Gasser T, Blum AL. Does smoking interfere with the effect of histamine H2-receptor antagonists on intragastric acidity in man? Gut 1987; 28:549-56. [PMID: 3596336 PMCID: PMC1432885 DOI: 10.1136/gut.28.5.549] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The interaction between smoking and the effect of histamine H2-antagonists on intragastric acidity was examined in a double blind double dummy placebo controlled study. Healthy volunteers, 11 smokers and 10 non-smokers, were given, on four separate days at least one week apart, either placebo or cimetidine 800 mg nocte or ranitidine 2 X 150 mg per day or ranitidine 300 mg nocte. Tablets were taken at 2115 and 0900 h. Smokers smoked a cigarette hourly from 0700 to 2300 h. Breakfast, lunch, and dinner were standardised. Intragastric acidity was measured with a combined intragastric glass electrode and a solid state recorder. The subjects were fully ambulatory. The three histamine H2-receptor antagonist regimens were less effective (p = 0.04) in smokers than in non-smokers, but the difference between acidity of smokers and non-smokers was small. Means of medians of pH during a 24-h period with placebo, cimetidine 800 mg, ranitidine 2 X 150 mg and ranitidine 300 mg were 1.6, 2.3, 3.1, and 2.7 in smokers and 1.5, 2.7, 3.2, and 3.1 in non-smokers, respectively. In a second part of the study seven chronic smokers were reexamined after acutely stopping smoking: inhibition of gastric acidity by histamine H2-receptor antagonists was similar before and after withdrawal. Smoking does not affect intragastric acidity in untreated volunteers and only slightly decreases the effectiveness of histamine H2-receptor antagonists on intragastric acidity. This effect best in part explains the unfavourable effect of smoking on healing of peptic ulcer in patients treated with these drugs.
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45
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Svensson LG, Von Ritter C, Oosthuizen MM, Fimmel CJ, Rickards E, Hunter SJ, Robinson MF, Hinder RA. Prevention of gastric mucosal lesions following aortic cross-clamping. Br J Surg 1987; 74:282-5. [PMID: 3580802 DOI: 10.1002/bjs.1800740418] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Stress ulceration is frequently encountered after cardiovascular surgery. In this study of 32 male baboons, severe gastric ischaemia was used to produce gastric stress lesions. The occurrence of these lesions was reduced by allopurinol (P = 0.03) and completely prevented by the combination of allopurinol with superoxide dismutase (P = 0.004). A shorter ischaemic period also reduced the number of lesions (P = 0.02). Concurrent with the stress lesion formation, there was a fall in mucosal glutathione and oxidized glutathione levels (P less than 0.05).
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46
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Hinder RA, Pace F, Fimmel CJ, Müller-Duysing W, Zollikofer C, Becker P, Leskosek B, Bauerfeind P, Blum AL. Is there a relationship between gastric mucosal blood flow and stress lesions in hemorrhagic shock? Digestion 1987; 38:74-82. [PMID: 3440509 DOI: 10.1159/000199575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The relationship between gastric mucosal blood flow and stress lesion formation during hemorrhagic shock was studied in anesthetized dogs. Shock was induced by graded arterial bleeding. Blood flow was measured by means of the radioactive microsphere technique. Mapping of blood flow was achieved by measuring the microsphere accumulation in mucosal and muscle segments of 1-2 cm side length of the entire stomach. To produce a varying incidence of lesions the metabolic acidosis of shock was either fully corrected by intravenous sodium bicarbonate (n = 5), partially corrected (n = 4) or left uncorrected (n = 3). Mucosal lesions developed more frequently in dogs without correction than in dogs with partial correction or full correction. In 4 dogs not subjected to shock, no mucosal lesions were observed at the end of the experiments. Mucosal blood flow varied from segment to segment by a factor of up to 20, but individual segments tended to maintain their relative flow values during shock. Correction of metabolic acidosis did not significantly affect blood flow. Likewise, flow was similar in segments with and without lesions. Therefore, low regional blood flow did not predispose to the development of lesions and high flow did not prevent them. We conclude that focal mucosal ischemia alone does not lead to stress lesion formation during hemorrhagic shock.
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Affiliation(s)
- R A Hinder
- Department of Surgery, Creighton University, Omaha, Nebr
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47
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Blum AL, Fimmel CJ. [Transport processes in the gastric mucosa and their pharmacologic modification]. Z Gastroenterol Verh 1986; 21:124-8. [PMID: 2422828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Muallem S, Fimmel CJ, Pandol SJ, Sachs G. Regulation of free cytosolic Ca2+ in the peptic and parietal cells of the rabbit gastric gland. J Biol Chem 1986; 261:2660-7. [PMID: 3005259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Quin 2-loaded isolated rabbit gastric glands and purified peptic cells were used to measure free cytosolic Ca2+ ([Ca2+]i) during hormone stimulation. Rabbit gastric glands are composed of peptic and parietal cells with less than 1% endocrine cells. Although both cell types responded to the same hormones, they may be distinguished in terms of the source of Ca2+ bringing about the change in [Ca2+]i. Experiments were designed to assign changes in [Ca2+]i to either the peptic or parietal cells and to attempt to maintain these distinctions in the mixed cell population of gastric glands. It was shown that the peptide cholecystokinin octapeptide induced a rapid and transient increase in [Ca2+]i of isolated peptic cells. This signal was independent of medium Ca2+ and insensitive to the Ca2+ channel blockers La3+ and nifedipine. In gastric glands, the Ca2+ outdependent increase in (Ca2+)i (the secondary transient) was slower and dose dependently blocked by La3+ and nifedipine. This allowed [Ca2+]i levels in the physiologically more intact rabbit gastric glands to be dissected and correlated with fluorescence changes of quin 2 in either cell type. The transient increase in [Ca2+]i coincided with a burst of pepsin but not acid secretion. A subsequent slower phase of pepsin secretion took place while the cells restored near resting [Ca2+]i. Using a combination of the Ca2+ ionophore A23187 and the protein kinase C activating phorbol ester 12-O-tetra-decanoylphorbol 13-acetate, the hormone response pattern of pepsin secretion could be mimicked. The intracellular Ca2+ stores of the peptic cells in the gastric gland remained depleted of Ca2+ until specific antagonists were added. The reloading of intracellular stores required medium Ca2+ although [Ca2+]i was maintained at resting level during the entire reloading period. Hence, a specialized pathway of Ca2+ reloading is postulated.
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Muallem S, Fimmel CJ, Pandol SJ, Sachs G. Regulation of free cytosolic Ca2+ in the peptic and parietal cells of the rabbit gastric gland. J Biol Chem 1986. [DOI: 10.1016/s0021-9258(17)35838-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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50
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Svensson LG, Rickards E, Coull A, Rogers G, Fimmel CJ, Hinder RA. Relationship of spinal cord blood flow to vascular anatomy during thoracic aortic cross-clamping and shunting. J Thorac Cardiovasc Surg 1986; 91:71-8. [PMID: 3941562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
No satisfactory explanation exists as to why paraplegia occurs despite distal aortic perfusion during thoracic aortic operations. We studied the hemodynamics, paraplegia rate, and spinal cord blood flow with radioactive microspheres in 17 male adult baboons, with particular reference to the arteria radicularis magna. The groups consisted of control animals, subjected to cross-clamping for 60 minutes, and animals with aorto-aortic shunts operational for 60 minutes. There were no significant left ventricular hemodynamic advantages with shunting. Shunting significantly increased lumbar spinal cord blood flow (p = 0.0009), which correlated with the distal aortic mean pressure (r = 0.59, p = 0.008). However, lower thoracic spinal cord blood flow did not increase during shunting (p = 0.2) and did not correlate with the distal aortic pressure (r = 0.11, p = 0.64). This is due to the vascular anatomy of the anterior spinal artery, which was, as in man, smaller above (0.278 mm) than below (0.744 mm) the entry of the arteria radicularis magna. Resistance to flow, as calculated by Poiseuille's equation, was 51.7 times greater up the anterior spinal artery as compared with down this artery. The vascular anatomy explains the absence of paraplegia in one baboon in the cross-clamp group and paraplegia in one baboon in the shunt group. Thus, distal aortic perfusion protects the spinal cord below the arteria radicularis magna but not above it.
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