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Holm-Weber T, Skov F, Mohanakumar S, Thorup L, Riis T, Christensen MB, Sonne DP, Jensen PB, Bødtkjer DB, Hjortdal VE. Octreotide improves human lymphatic fluid transport a translational trial. Eur J Cardiothorac Surg 2024; 65:ezad380. [PMID: 37951584 PMCID: PMC10832356 DOI: 10.1093/ejcts/ezad380] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVES Chylothorax is a complex condition and many different pharmacological agents have been tried as treatment. Octreotide is used off-label to treat chylothorax, but the efficacy of octreotide remains unclear. A decrease in lymph production is suggested as the mechanism. In this cross-over study, we explore the direct effect of octreotide on human lymphatic drainage. METHODS Pre-clinical: the effect of octreotide on force generation was assessed during acute and prolonged drug incubation on human lymphatic vessels mounted in a myograph. Clinical: in a double-blinded, randomized, cross-over trial including 16 healthy adults, we administered either octreotide or saline as an intravenous infusion for 2.5 h. Near-infrared fluorescence imaging was used to examine spontaneous lymphatic contractions and lymph pressure in peripheral lymphatic vessels and plethysmography was performed to assess the capillary filtration rate, capillary filtration coefficient and isovolumetric pressures of the lower leg. RESULTS Pre-clinical: human thoracic duct (n = 12) contraction rate was concentration-dependently stimulated by octreotide with a maximum effect at 10 and 100 nmol/l in the myograph chamber. Clinical: spontaneous lymphatic contractions and lymph pressure evaluated by near-infrared fluorescence did not differ between octreotide or placebo (P = 0.36). Plethysmography revealed similar capillary filtration coefficients (P = 0.057), but almost a doubling of the isovolumetric pressures (P = 0.005) during octreotide infusion. CONCLUSIONS Octreotide stimulated lymphatic contractility in the pre-clinical setup but did not affect the spontaneous lymphatic contractions or lymph pressure in healthy individuals. Plethysmography revealed a doubling in the isovolumetric pressure. These results suggest that octreotide increases lymphatic drainage capacity in situations with high lymphatic afterload.
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Affiliation(s)
| | - Frederik Skov
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Lene Thorup
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Troels Riis
- Department of Clinical Pharmacology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Peick Sonne
- Department of Clinical Pharmacology, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Bo Jensen
- Department of Biochemistry, Bispebjerg Hospital, Copenhagen, Denmark
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Holm-Weber T, Kristensen RE, Mohanakumar S, Hjortdal VE. Gravity and lymphodynamics. Physiol Rep 2022; 10:e15289. [PMID: 35586957 PMCID: PMC9117968 DOI: 10.14814/phy2.15289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 01/12/2022] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
The lymphatic system is compromised in different groups of patients. To recognize pathology, we must know what is healthy. We use Near-Infrared Fluorescence (NIRF) to assess peripheral lymphatic function in humans. We have shown that external factors such as exercise, hyperthermia, and pharmacological mediators influence the function of peripheral lymphatic vessels. In this study, we explored the impact on lymphatic vessels by the ever-present external factor-gravity. We used NIRF imaging to investigate the lymphatic changes to gravity. Gravity was assessed by changing body position from supine to standing. We extracted following lymphatic functional parameters: lymphatic packet propulsion frequency (contractions/min), velocity (cm/s), and pressure (mmHg). Raw data analysis was performed using a custom-written Labview program. All sequences were analyzed by two observers and interclass correlation scores were calculated. All statistical analysis was performed using RStudio Team (2021). RStudio: Integrated Development Environment for R. RStudio, PBC. Healthy participants (n = 17, 11 males, age 28.1 ± 2.6 years) were included. The lymphatic packet propulsion frequency at baseline was 0.5 ± 0.2 contractions/min and rose within 3 min significantly to a maximum of 1.2 ± 0.5 contractions/min during upright posture and remained significantly higher than the baseline lymphatic packet propulsion frequency after lying down again for up to 6 min. The lymph velocity was 1.5 ± 0.4 cm/s at baseline and changed in both directions and without a specific pattern at different points in time during standing. Lymph pressure was significantly higher while standing (mean increase 9 mmHg, CI: 2-15 mmHg). The ICC scores were 89.8% (85.9%-92.7%), 59.3% (46.6%-69.6%) and 89.4% (79.0%-94.8%) in lymphatic packet propulsion frequency (130 observations), velocity (125 observations), and pressure (30 observations), respectively. The lymphatic system responds within few minutes to gravitational changes by increasing lymphatic packet propulsion frequency and pressure.
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Affiliation(s)
- Thomas Holm-Weber
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Eskild Kristensen
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sheyanth Mohanakumar
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Mohanakumar S, Kelly B, Turquetto ALR, Alstrup M, Amato LP, Barnabe MSR, Silveira JBD, Amaral F, Manso PH, Jatene MB, Hjortdal VE. Functional lymphatic reserve capacity is depressed in patients with a Fontan circulation. Physiol Rep 2021; 9:e14862. [PMID: 34057301 PMCID: PMC8165731 DOI: 10.14814/phy2.14862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background Lymphatic abnormalities play a role in effusions in individuals with a Fontan circulation. Recent results using near‐infrared fluorescence imaging disclosed an increased contraction frequency of lymphatic vessels in Fontan patients compared to healthy controls. It is proposed that the elevated lymphatic pumping seen in the Fontan patients is necessary to maintain habitual interstitial fluid balance. Hyperthermia has previously been used as a tool for lymphatic stress test. By increasing fluid filtration in the capillary bed, the lymphatic workload and contraction frequency are increased accordingly. Using near‐infrared fluorescence imaging, the lymphatic functional reserve capacity in Fontan patients were explored with a lymphatic stress test. Methods Fontan patients (n = 33) were compared to a group of 15 healthy individuals of equal age, weight, and gender. The function of the superficial lymphatic vessels in the lower leg during rest and after inducing hyperthermia was investigated, using near‐infrared fluorescence imaging. Results Baseline values in the Fontan patients showed a 57% higher contraction frequency compared to the healthy controls (0.4 ± 0.3 min−1 vs. 0.3 ± 0.2 min−1, p = 0.0445). After inducing stress on the lymphatic vessels with hyperthermia the ability to increase contraction frequency was decreased in the Fontan patients compared to the controls (0.6 ± 0.5 min−1 vs. 1.2 ± 0.8 min−1, p = 0.0102). Conclusions Fontan patients had a higher lymphatic contraction frequency during normal circumstances. In the Fontan patients, the hyperthermia response is dampened indicating that the functional lymphatic reserve capacity is depressed. This diminished reserve capacity could be part of the explanation as to why some Fontan patients develop late‐onset lymphatic complications.
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Affiliation(s)
- Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Benjamin Kelly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | | | - Fernando Amaral
- Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.,Pediatric and Adult Congenital Heart Disease Unit, Hospital das Clínicas, Ribeirão Preto, Brazil
| | - Paulo Henrique Manso
- Ribeirão Preto Medical School - University of São Paulo, Ribeirão Preto, Brazil.,Pediatric and Adult Congenital Heart Disease Unit, Hospital das Clínicas, Ribeirão Preto, Brazil
| | | | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
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Markthaler D, Mohanakumar S, Wiegand S, Hansen N. Thermodynamik von biologischen Wirt‐Gast‐Komplexen: Thermodiffusion und Bindungsaffinitäten. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055114] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D. Markthaler
- Universität Stuttgart Institut für Technische Thermodynamik und Thermische Verfahrenstechnik (ITT) Pfaffenwaldring 9 70569 Stuttgart Deutschland
| | - S. Mohanakumar
- Forschungszentrum Jülich GmbH Institut für Biologische Informationsprozesse (IBI) Wilhelm-Johnen-Straße 52428 Jülich Deutschland
| | - S. Wiegand
- Forschungszentrum Jülich GmbH Institut für Biologische Informationsprozesse (IBI) Wilhelm-Johnen-Straße 52428 Jülich Deutschland
| | - N. Hansen
- Universität Stuttgart Institut für Technische Thermodynamik und Thermische Verfahrenstechnik (ITT) Pfaffenwaldring 9 70569 Stuttgart Deutschland
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Kelly B, Mohanakumar S, Telinius N, Alstrup M, Hjortdal V. Function of Upper Extremity Human Lymphatics Assessed by Near-Infrared Fluorescence Imaging. Lymphat Res Biol 2020; 18:226-231. [DOI: 10.1089/lrb.2019.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Benjamin Kelly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Telinius
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vibeke Hjortdal
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Mohanakumar S, Telinius N, Kelly B, Hjortdal V. Reduced Lymphatic Function Predisposes to Calcium Channel Blocker Edema: A Randomized Placebo-Controlled Clinical Trial. Lymphat Res Biol 2019; 18:156-165. [PMID: 31429625 DOI: 10.1089/lrb.2019.0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/12/2022] Open
Abstract
Background: The current belief is that the calcium channel blocker (CCB)-induced edema is due to a preferential arterial over venous dilatation leading to increased fluid filtration. We challenged this conviction by measuring the lymphatic removal of interstitial fluid during chronic systemic treatment with the CCB, amlodipine. Lymphatic vessels could potentially be an off-target effect of the drugs and play a role in CCB edema. Methods and Results: Sixteen healthy postmenopausal women completed a 12-week double-blinded randomized placebo-controlled crossover trial. Lymphatic function was assessed by near-infrared fluorescence imaging. The lymphatic function during amlodipine treatment compared with placebo did not show any difference in pumping pressure (53.9 ± 13.9 mmHg vs. 54.7 ± 9.4 mmHg, p = 0.829), contraction frequency (0.4 ± 0.2/min vs. 0.4 ± 0.3/min, p = 0.932), refill time (440 ± 438 seconds vs. 442 ± 419 seconds, p = 0.990), or propagation velocity of lymph packets (18 ± 10 mm/s vs. 15 ± 7 mm/s, p = 0.124). However, the subjects who developed edema during CCB treatment had a 20% lower baseline lymphatic pumping pressure (48.9 ± 4.4 mmHg, n = 7) than the subjects not affected by treatment (59.1 ± 1.2 mmHg, n = 9, p = 0.025). Contraction frequency, refill time, and lymph packet velocity showed no differences in baseline values between the two groups. Conclusion: Our results suggest that CCB does not directly impair lymphatic function. However, our results show that a reduced lymphatic function predisposes to CCB edema, which may explain why some patients develop edema during treatment.
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Affiliation(s)
- Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Niklas Telinius
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Benjamin Kelly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Mohanakumar S, Telinius N, Kelly B, Lauridsen H, Boedtkjer D, Pedersen M, de Leval M, Hjortdal V. Morphology and Function of the Lymphatic Vasculature in Patients With a Fontan Circulation. Circ Cardiovasc Imaging 2019; 12:e008074. [DOI: 10.1161/circimaging.118.008074] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark (S.M., N.T., B.K., V.H.)
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
| | - Niklas Telinius
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark (S.M., N.T., B.K., V.H.)
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
| | - Benjamin Kelly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark (S.M., N.T., B.K., V.H.)
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
| | - Henrik Lauridsen
- Comparative Medicine Lab, Department of Clinical Medicine (H.L., M.P.), Aarhus University, Denmark
| | - Donna Boedtkjer
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
- Department of Biomedicine (D.B.), Aarhus University, Denmark
| | - Michael Pedersen
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
- Comparative Medicine Lab, Department of Clinical Medicine (H.L., M.P.), Aarhus University, Denmark
| | - Marc de Leval
- The Harley Street Clinic Children’s Hospital, London, United Kingdom (M.d.L.)
| | - Vibeke Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark (S.M., N.T., B.K., V.H.)
- Department of Clinical Medicine (S.M., N.T., B.K., D.B., M.P., V.H.), Aarhus University, Denmark
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Mohanakumar S, Majgaard J, Telinius N, Katballe N, Pahle E, Hjortdal V, Boedtkjer D. Spontaneous and α-adrenoceptor-induced contractility in human collecting lymphatic vessels require chloride. Am J Physiol Heart Circ Physiol 2018; 315:H389-H401. [PMID: 29631375 DOI: 10.1152/ajpheart.00551.2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 02/07/2023]
Abstract
Human lymphatic vessels are myogenically active and respond to sympathetic stimulation. The role of various cations in this behavior has recently been investigated, but whether the anion Cl- is essential is unclear. With ethical approval and informed consent, human thoracic duct and mesenteric lymphatic vessels were obtained from surgical patients. Spontaneous or norepinephrine-induced isometric force production from isolated vessels was measured by wire myography; the transmembrane Cl- gradient and Cl- channels were investigated by substitution of extracellular Cl- with the impermeant anion aspartate and inhibition of Cl- transport and channels with the clinical diuretics furosemide and bendroflumethiazide as well as DIDS and 5-nitro-2-(3-phenylpropylamino)benzoic acid. The molecular expression of Ca2+-activated Cl- channels was investigated by RT-PCR, and proteins were localized using immunoreactivity. Spontaneous and norepinephrine-induced contractility in human lymphatic vessels was highly abrogated after Cl- substitution with aspartate. About 100-300 µM DIDS or 5-nitro-2-(3-phenylpropylamino)benzoic acid inhibited spontaneous contractile behavior. Norepinephrine-stimulated tone was furthermore markedly abrogated by 200 µM DIDS. Furosemide lowered only spontaneous constrictions, whereas bendroflumethiazide had nonspecific inhibitory effects. Consistent expression of transmembrane member 16A [TMEM16A (anoctamin-1)] was found in both the thoracic duct and mesenteric lymphatic vessels, and immunoreactivity with different antibodies localized TMEM16A to lymphatic smooth muscle cells and interstitial cells. The significant change in contractile function observed with inhibitors and anion substitution suggests that Cl- movement over the plasma membrane of lymphatic myocytes is integral for spontaneous and α-adrenoceptor-evoked contractility in human collecting lymphatic vessels. Consistent detection and localization of TMEM16A to myocytes suggests that this channel could play a major functional role. NEW & NOTEWORTHY In this study, we report the first observations of Cl- being a critical ionic component of spontaneous and agonist-evoked contractility in human lymphatics. The most consistently expressed Ca2+-activated Cl- channel gene in the human thoracic duct and mesenteric lymphatic vessels appears to be transmembrane member 16A, suggesting that this channel plays a major role.
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Affiliation(s)
- Sheyanth Mohanakumar
- Department of Biomedicine, Aarhus University , Aarhus , Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Jens Majgaard
- Department of Biomedicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Niklas Telinius
- Department of Biomedicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Niels Katballe
- Department of Clinical Medicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Einar Pahle
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Vibeke Hjortdal
- Department of Clinical Medicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Donna Boedtkjer
- Department of Biomedicine, Aarhus University , Aarhus , Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus , Denmark.,Deptartment of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Aarhus , Denmark
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El Dabagh YSH, Mohanakumar S, Hagensen MK, Pedersen M. Remote Ischemic Conditioning in Rodents: Tourniquet vs. Cuff Occlusion. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.727.10] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Sheyanth Mohanakumar
- Department of Cardiothoracic and Vascular SurgeryAarhus University HospitalAarhus NDenmark
| | - Mette K. Hagensen
- Department of Clinical BiochemistryAarhus University HospitalAarhus NDenmark
| | - Michael Pedersen
- Comparative Medicine LaboratoryAarhus University HospitalAarhus NDenmark
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10
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Telinius N, Majgaard J, Mohanakumar S, Pahle E, Nielsen J, Hjortdal V, Aalkjær C, Boedtkjer DB. Spontaneous and Evoked Contractility of Human Intestinal Lymphatic Vessels. Lymphat Res Biol 2017; 15:17-22. [DOI: 10.1089/lrb.2016.0039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niklas Telinius
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Majgaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Sheyanth Mohanakumar
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Einar Pahle
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Jørn Nielsen
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Donna Briggs Boedtkjer
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Telinius N, Mohanakumar S, Majgaard J, Kim S, Pilegaard H, Pahle E, Nielsen J, de Leval M, Aalkjaer C, Hjortdal V, Boedtkjer DB. Human lymphatic vessel contractile activity is inhibited in vitro but not in vivo by the calcium channel blocker nifedipine. J Physiol 2014; 592:4697-714. [PMID: 25172950 DOI: 10.1113/jphysiol.2014.276683] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Calcium channel blockers (CCB) are widely prescribed anti-hypertensive agents. The commonest side-effect, peripheral oedema, is attributed to a larger arterial than venous dilatation causing increased fluid filtration. Whether CCB treatment is detrimental to human lymphatic vessel function and thereby exacerbates oedema formation is unknown. We observed that spontaneous lymphatic contractions in isolated human vessels (thoracic duct and mesenteric lymphatics) maintained under isometric conditions were inhibited by therapeutic concentrations (nanomolar) of the CCB nifedipine while higher than therapeutic concentrations of verapamil (micromolar) were necessary to inhibit activity. Nifedipine also inhibited spontaneous action potentials measured by sharp microelectrodes. Furthermore, noradrenaline did not elicit normal increases in lymphatic vessel tone when maximal constriction was reduced to 29.4 ± 4.9% of control in the presence of 20 nmol l(-1) nifedipine. Transcripts for the L-type calcium channel gene CACNA1C were consistently detected from human thoracic duct samples examined and the CaV1.2 protein was localized by immunoreactivity to lymphatic smooth muscle cells. While human lymphatics ex vivo were highly sensitive to nifedipine, this was not apparent in vivo when nifedipine was compared to placebo in a randomized, double-blinded clinical trial: conversely, lymphatic vessel contraction frequency was increased and refill time was faster despite all subjects achieving target nifedipine plasma concentrations. We conclude that human lymphatic vessels are highly sensitive to nifedipine in vitro but that care must be taken when extrapolating in vitro observations of lymphatic vessel function to the clinical situation, as similar changes in lymphatic function were not evident in our clinical trial comparing nifedipine treatment to placebo.
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Affiliation(s)
- Niklas Telinius
- Department of Biomedicine, Aarhus University, Aarhus, Denmark Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sheyanth Mohanakumar
- Department of Biomedicine, Aarhus University, Aarhus, Denmark Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Majgaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Sukhan Kim
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hans Pilegaard
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Einar Pahle
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Jørn Nielsen
- Department of Surgery, Viborg Hospital, Viborg, Denmark
| | - Marc de Leval
- International Congenital Cardiac Centre, Harley Street Clinic, London, UK
| | | | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Donna Briggs Boedtkjer
- Department of Biomedicine, Aarhus University, Aarhus, Denmark Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark
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