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Khan U, Hammer GB, Duncan-Azadi C, Suzuki Y, Chiles D, Chime S, Chappell P. A randomized, double-blind, dose-controlled study of the use of dexmedetomidine alone for procedural sedation of children and adolescents undergoing MRI scans. Paediatr Anaesth 2024; 34:405-414. [PMID: 38363011 DOI: 10.1111/pan.14857] [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: 11/08/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Dexmedetomidine is a selective α2-adrenergic agonist originally approved for sedation of adults in the intensive care unit and subsequently approved for procedural sedation in adults undergoing medical procedures. Dexmedetomidine is widely used off-label for procedural sedation in children. AIMS To evaluate efficacy and safety of monotherapy dexmedetomidine for magnetic resonance imaging procedural sedation of children ≥1month-<17years across three ascending doses. METHODS Randomized, double-blind, dose-ranging study of procedural sedation recruited patients at USA and Japanese sites from February 2020 to November 2021. Patients were stratified into Cohort A (≥1month-<2years) or Cohort B (≥2-<17years). Cohort A loading doses/maintenance infusions: 0.5 mcg/kg/0.5 mcg/kg/h, 1.0 mcg/kg/1.0 mcg/kg/h, and 1.5 mcg/kg/1.5 mcg/kg/h. Cohort B loading doses/maintenance infusions: 0.5 mcg/kg/0.5 mcg/kg/h, 1.2 mcg/kg/1.0 mcg/kg/h, and 2.0 mcg/kg/1.5 mcg/kg/h. Primary endpoint was percentage of overall patients completing MRI without rescue propofol at the high versus low dose. Key secondary endpoint was percentage in each age cohort who did not require propofol at the high versus low dose. RESULTS One hundred twenty-two patients received high- (n = 38), middle- (n = 42), or low-dose (n = 42) dexmedetomidine. A greater percentage completed MRI without propofol rescue, while receiving high- versus low-dose dexmedetomidine (24/38 [63.2%] vs. 6/42 [14.3%]) (odds ratio: 10.29, 95% confidence interval: 3.47-30.50, p < .001). Similar results were seen in both age cohorts. The most common adverse events were bradypnea, bradycardia, hypertension, and hypotension, and the majority were of mild-to-moderate severity. CONCLUSIONS Dexmedetomidine was well tolerated. The high dose was associated with meaningfully greater efficacy compared with lower doses. Based on these results, the recommended starting dose for procedural sedation in children ≥1month-<2years is loading dose 1.5 mcg/kg/maintenance infusion 1.5 mcg/kg/h; children ≥2-<17years is loading dose 2.0 mcg/kg/maintenance infusion 1.5 mcg/kg/h.
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Affiliation(s)
- Umar Khan
- Clinical Assistant Professor of Anesthesiology and Pain Management, Department of Anesthesiology and Pain Management, Children's Health System Texas, Dallas, Texas, USA
| | - Gregory B Hammer
- Professor, Anesthesiology, Perioperative and Pain Medicine, and Pediatrics, Stanford University, Stanford, California, USA
| | - Cassandra Duncan-Azadi
- Department of Anesthesiology, Division of Pediatric Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Yasuyuki Suzuki
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Deborah Chiles
- Post Approval Clinical Development, Pfizer, Inc., New York, New York, USA
| | - Sunring Chime
- Post Approval Clinical Development, Pfizer, Inc., New York, New York, USA
| | - Phillip Chappell
- Post Approval Clinical Development, Pfizer, Inc., New York, New York, USA
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Hallman IAM, Raekallio MR, Koho N, Weckman MJ, Karikoski NP. Effects of alpha-2-adrenoceptor agonism and antagonism on equine blood insulin and glucose concentrations after oral carbohydrate load. Vet J 2024; 304:106080. [PMID: 38360134 DOI: 10.1016/j.tvjl.2024.106080] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Alpha-2-adrenoceptor agonist detomidine is a commonly used sedative agent in horses. In addition to the sedative effect, detomidine has been reported to elicit changes in energy metabolism such as hypoinsulinaemia and hyperglycaemia. This study aimed to investigate the effects of detomidine with and without peripherally acting alpha-2-adrenoceptor antagonist vatinoxan on insulin and blood glucose (BG) concentrations in horses after a standard dose of oral carbohydrates. Sixteen horses were assigned to four intravenous treatments in a randomised cross-over design: saline (SAL), detomidine (0.02 mg/kg; DET), vatinoxan (0.2 mg/kg; VAT), and a combination of detomidine and vatinoxan (DET+VAT). Horses were administered corn syrup (0.45 mL/kg) immediately before each treatment. Blood samples were collected until 360 min. The differences between treatments were evaluated with repeated measures analysis of covariance and change from baseline was used as a response. P<0.05 was considered significant. After oral carbohydrate load, DET reduced insulin (median 30 min nadir 3.7, min-max 0.6-7.4 µIU/mL) significantly compared with SAL (P<0.0001; 17.4, 9.3-65.4 µIU/mL) and DET+VAT (P=0.0005; 6.4, 2.9-12.9 µIU/mL). BG increased significantly after DET (peak; 130.5, 8.8-15.8 mmol/L) compared with SAL (P<0.0001; 8.7, 6.9-12.4 mmol/L) and DET+VAT (P<0.0001; 8.5, 6.8-10.6 mmol/L). Vatinoxan alone reduced BG (peak median 7.6, 7.0-9.9 mmol/L) compared with SAL (P=0.02) and delayed insulin responses to carbohydrates. In conclusion, vatinoxan alleviated the detomidine-induced changes (DET+VAT compared to DET) in insulin and BG after oral carbohydrate load. Additionally, vatinoxan is potentially able to modulate BG concentration and insulin response after oral carbohydrate administration in horses, but more research is warranted.
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Affiliation(s)
- I A M Hallman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014, Finland.
| | - M R Raekallio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014, Finland
| | - N Koho
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014, Finland
| | - M J Weckman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014, Finland
| | - N P Karikoski
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, FI-00014, Finland
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Gao Q, Zhang Y, Wang X, Wang R, Zhang L. Regulation of nociception threshold by norepinephrine through adrenergic α2 receptor in rat models of Parkinson's disease. CNS Neurosci Ther 2024; 30:e14446. [PMID: 37721421 PMCID: PMC10916421 DOI: 10.1111/cns.14446] [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] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The mechanism of pain symptoms in Parkinson's disease (PD) is unclear. Norepinephrine (NE) regulates neuropathic pain through ascending and descending pathways. However, the loss of NE neurons in the brain of patients with PD is obvious, it is speculated that NE is involved in the occurrence of PD pain symptoms. AIMS To investigate the effect of NE on the activation of brain cells through adrenergic α2 receptor, so as to regulate the nociception threshold in a 6-OHDA-induced animal model of PD. METHODS PD rat model was established by 6-OHDA injection (6-OHDA group). DSP-4 (or anti-DBH-saporin) was used to reduce the NE level of the PD rat brain. The heat sensitivity threshold (HST) and pressure withdrawal threshold (PWT) were measured. Tyrosine hydroxylase and NE in rat brains were detected by Elisa. The percentage of GFAP-positive cells in the prefrontal cortex, cingulate gyrus and striatum of rats was detected by immunohistochemistry and immunofluorescence. GFAP protein was semiquantified by method of western blot. Then yohimbine and guanfacine were used to increase the NE level in PD rats, and the above experimental changes were observed after drug application. RESULTS The contents of NE in the brain of 6-OHDA-induced PD rats were lower than that of control group. After DSP-4 (or anti-DBH-saporin) injection, PD rats showed the lowest NE level (compared with 6-OHDA group, p ≤ 0.05), and after yohimbine and guanfacine were applied to 6-OHDA group, the contents of NE increased in the prefrontal cortex of rats. The HST and PWT of 6-OHDA group were significantly lower than those of control group, and after DSP-4 (or anti-DBH-saporin) injection, the HST and PWT of rats were lower than those of 6-OHDA group, and after the administration of yohimbine and guanfacine, both HST and PWT were significantly increased. GFAP-positive cells increased in prefrontal cortex and anterior cingulate gyrus of 6-OHDA group rats, and more significantly increased after DSP-4 (or anti-DBH-saporin) injection, and significantly reduced after yohimbine and guanfacine were used. CONCLUSIONS The change of norepinephrine content can affect the activation of prefrontal and cingulate gyrus glial cells and participate in the regulation of nociception threshold in PD rats. Adrenergic α2 receptor agonist and central presynaptic membrane α2 receptor blocker both affect cell activation and improve hyperalgesia.
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Affiliation(s)
- Qing Gao
- Department of NeurologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Yingying Zhang
- Department of NeurologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Xiaoying Wang
- Department of NeurologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Rui Wang
- Department of NeurologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Limei Zhang
- Department of NeurologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
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Vieira FG, Tassinari VR, Kidd JD, Moreno A, Thompson K, Perrin S, Gill A, Hatzipetros T. PERK modulation, with GSK2606414, Sephin1 or salubrinal, failed to produce therapeutic benefits in the SOD1G93A mouse model of ALS. PLoS One 2024; 19:e0292190. [PMID: 38359044 PMCID: PMC10868768 DOI: 10.1371/journal.pone.0292190] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) has been linked to overactivity of the protein kinase RNA-like ER kinase (PERK) branch of the unfolded protein response (UPR) pathway, both in ALS patients and mouse models. However, attempts to pharmacologically modulate PERK for therapeutic benefit have yielded inconsistent and often conflicting results. This study sought to address these discrepancies by comprehensively evaluating three commonly used, CNS-penetrant, PERK modulators (GSK2606414, salubrinal, and Sephin1) in the same experimental models, with the goal of assessing the viability of targeting the PERK pathway as a therapeutic strategy for ALS. To achieve this goal, a tunicamycin-challenge assay was developed using wild-type mice to monitor changes in liver UPR gene expression in response to PERK pathway modulation. Subsequently, multiple dosing regimens of each PERK modulator were tested in standardized, well-powered, gender-matched, and litter-matched survival efficacy studies using the SOD1G93A mouse model of ALS. The alpha-2-adrenergic receptor agonist clonidine was also tested to elucidate the results obtained from the Sephin1, and of the previously reported guanabenz studies, by comparing the effects of presence or absence of α-2 agonism. The results revealed that targeting PERK may not be an ideal approach for ALS treatment. Inhibiting PERK with GSK2606414 or activating it with salubrinal did not confer therapeutic benefits. While Sephin1 showed some promising therapeutic effects, it appears that these outcomes were mediated through PERK-independent mechanisms. Clonidine also produced some favorable therapeutic effects, which were unexpected and not linked to the UPR. In conclusion, this study highlights the challenges of pharmacologically targeting PERK for therapeutic purposes in the SOD1G93A mouse model and suggests that exploring other targets within, and outside, the UPR may be more promising avenues for ALS treatment.
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Affiliation(s)
- Fernando G. Vieira
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | | | - Joshua D. Kidd
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | - Andrew Moreno
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | - Kenneth Thompson
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | - Steven Perrin
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | - Alan Gill
- ALS Therapy Development Institute, Watertown, MA, United States of America
| | - Theo Hatzipetros
- ALS Therapy Development Institute, Watertown, MA, United States of America
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Portelli K, Kandraju H, Ryu M, Shah PS. Efficacy and safety of dexmedetomidine for analgesia and sedation in neonates: a systematic review. J Perinatol 2024; 44:164-172. [PMID: 37845426 DOI: 10.1038/s41372-023-01802-5] [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] [Received: 05/11/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Opioids and benzodiazepines have historically been employed for pain relief; however, they are associated with detrimental long-term neurodevelopmental consequences. Dexmedetomidine, a highly selective alpha-2-adrenoreceptor agonist, has piqued interest as a viable alternative for neonates, owing to its potential analgesic and neuroprotective attributes. We conducted a systematic review to assess the efficacy and safety of dexmedetomidine utilization in neonates. We conducted a comprehensive search of Ovid, MEDLINE, EMBASE, PubMed, Cochrane, and CINAHL, spanning from January 2010 to September 2022. Our review encompassed six studies involving 252 neonates. Overall, dexmedetomidine may be effective in achieving sedation and analgesia. Furthermore, it may reduce the need for adjunctive sedation or analgesia, shorten the time to extubation, decrease the duration of mechanical ventilation, and accelerate the attainment of full enteral feeds. Notably, no significant adverse effects associated with dexmedetomidine were reported. Nevertheless, additional well-designed studies to establish both the efficacy and safety of dexmedetomidine in neonatal care are needed.
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Affiliation(s)
- Katelyn Portelli
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Hemasree Kandraju
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Michelle Ryu
- Library and knowledge services, Trillium Health Partners, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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Hastings LE, Frye EV, Carlson ER, Chuong V, Matthews AN, Koob GF, Vendruscolo LF, Marchette RCN. Cold nociception as a measure of hyperalgesia during spontaneous heroin withdrawal in mice. Pharmacol Biochem Behav 2024; 235:173694. [PMID: 38128767 PMCID: PMC10842911 DOI: 10.1016/j.pbb.2023.173694] [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: 08/10/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Opioids are powerful analgesic drugs that are used clinically to treat pain. However, chronic opioid use causes compensatory neuroadaptations that result in greater pain sensitivity during withdrawal, known as opioid withdrawal-induced hyperalgesia (OWIH). Cold nociception tests are commonly used in humans, but preclinical studies often use mechanical and heat stimuli to measure OWIH. Thus, further characterization of cold nociception stimuli is needed in preclinical models. We assessed three cold nociception tests-thermal gradient ring (5-30 °C, 5-50 °C, 15-40 °C, and 25-50 °C), dynamic cold plate (4 °C to -1 °C at -1 °C/min, -1 °C to 4 °C at +1 °C/min), and stable cold plate (10 °C, 6 °C, and 2 °C)-to measure hyperalgesia in a mouse protocol of heroin dependence. On the thermal gradient ring, mice in the heroin withdrawal group preferred warmer temperatures, and the results depended on the ring's temperature range. On the dynamic cold plate, heroin withdrawal increased the number of nociceptive responses, with a temperature ramp from 4 °C to -1 °C yielding the largest response. On the stable cold plate, heroin withdrawal increased the number of nociceptive responses, and a plate temperature of 2 °C yielded the most significant increase in responses. Among the three tests, the stable cold plate elicited the most robust change in behavior between heroin-dependent and nondependent mice and had the highest throughput. To pharmacologically characterize the stable cold plate test, we used μ-opioid and non-opioid receptor-targeting drugs that have been previously shown to reverse OWIH in mechanical and heat nociception assays. The full μ-opioid receptor agonist methadone and μ-opioid receptor partial agonist buprenorphine decreased OWIH, whereas the preferential μ-opioid receptor antagonist naltrexone increased OWIH. Two N-methyl-d-aspartate receptor antagonists (ketamine, MK-801), a corticotropin-releasing factor 1 receptor antagonist (R121919), a β2-adrenergic receptor antagonist (butoxamine), an α2-adrenergic receptor agonist (lofexidine), and a 5-hydroxytryptamine-3 receptor antagonist (ondansetron) had no effect on OWIH. These data demonstrate that the stable cold plate at 2 °C yields a robust, reliable, and concise measure of OWIH that is sensitive to opioid agonists.
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Affiliation(s)
- Lyndsay E Hastings
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Emma V Frye
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Erika R Carlson
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Vicky Chuong
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Intitute on Drug Abuse, Intramural Research Program, and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research, Baltimore, MD, USA
| | - Aniah N Matthews
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - George F Koob
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Leandro F Vendruscolo
- Stress and Addiction Neuroscience Unit, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research, Baltimore, MD, USA
| | - Renata C N Marchette
- Neurobiology of Addiction Section, Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.
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Abe S, Suzuki K, Hamamura M, Tamanoi T, Takahashi K, Wakamatsu K, Yoshida K, Kawaai H, Yamazaki S. Ventricular Tachycardia Following Ephedrine During Dexmedetomidine Dental Procedural Sedation. Anesth Prog 2023; 70:184-190. [PMID: 38221700 DOI: 10.2344/anpr-70-03-04] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/17/2023] [Indexed: 01/16/2024] Open
Abstract
We present the case of a 46-year-old man who received ephedrine for hypotension after surgery for a mandibular lesion under intravenous (IV) moderate sedation with dexmedetomidine (DEX) and experienced transient ventricular tachycardia (VT). The patient was scheduled to have cystectomy and multiple apicoectomies for the mandibular periapical infection and the simple bone cyst. Other than obesity, snoring, and a nonalcoholic fatty liver, he denied any other significant medical history, medications, or allergies. The surgery was successful; however, his blood pressure dropped after stopping the DEX infusion. Ephedrine was administered IV several times, which resulted in the onset of VT on the electrocardiogram (ECG). His blood pressure could not be measured at the time, but he was able to respond and breathe independently. A defibrillator was immediately made available. The ECG revealed a spontaneous transition from VT to atrial fibrillation with ST depression. Because he was unable to revert to a normal sinus rhythm, the patient was transferred to a general hospital, where he underwent additional testing. No abnormalities were observed in his heart or brain. After DEX administration, its long-lasting alpha-2 adrenoceptor agonist effects can cause vasodilation and inhibition of sympathetic activity, leading to hypotension in some patients. Should that occur, ephedrine can be used to increase blood pressure, but it may also provoke transient coronary artery spasms and lead to VT. Consequently, extreme caution should be exercised in patients who develop hypotension following DEX administration. We also recognize the significance of regular training sessions, such as advanced cardiac life support programs.
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Affiliation(s)
- Shota Abe
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Kanami Suzuki
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Maki Hamamura
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Takashi Tamanoi
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Koji Takahashi
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Keiichiro Wakamatsu
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Kenji Yoshida
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Hiroyoshi Kawaai
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
| | - Shinya Yamazaki
- Department of Dental Anesthesiology, Ohu University, School of Dentistry, Fukushima, Japan
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Su X, Lu F, Chen Y, Wang M, Tang G, Lin W, Liu Y, Wang H, Yin H, Wang Y. α 2 -ADRENORECEPTOR ANTAGONIST AMELIORATES SEPSIS-ASSOCIATED PULMONARY FIBROSIS BY SUPPRESSING NOREPINEPHRINE-MEDIATED FIBROBLAST DIFFERENTIATION VIA INHIBITING PKC ACTIVATION. Shock 2023; 60:771-780. [PMID: 37878498 DOI: 10.1097/shk.0000000000002240] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Pulmonary fibrosis is an important factor affecting the prognosis of severe septic patients with acute lung injury. The objective of this study was to explore the effect of norepinephrine (NE) and α 2 -adrenoreceptor (AR) on sepsis-associated pulmonary fibrosis and the mechanism underlying these effects. We found pulmonary fibrotic changes, and increased NE production and α 2A -AR expression in the pulmonary tissue of mice subjected to cecal ligation and puncture surgery. Reserpine and yohimbine alleviated pulmonary fibrosis in mice with sepsis by exhausting NE derived from the lung's adrenergic nerve and blocking α 2 -AR, respectively. There was no significant difference in the expression of the three α 1 -AR subtypes. The effect of NE on promoting pulmonary fibroblast differentiation in vitro was suppressed by yohimbine. Both the protein and mRNA expression levels of α 2A -AR were increased in pulmonary fibroblasts treated with LPS. Clonidine, a selective α 2 -AR agonist, enhanced LPS-induced differentiation in pulmonary fibroblasts, as indicated by the increase in α-smooth muscle actin and collagen I/III, which was mitigated by inhibiting PKC and p38. Further in vivo results indicated that yohimbine alleviated pulmonary fibrosis and inhibited the phosphorylation of PKC, p38, and Smad2/3 in lung tissue of mice exposed to LPS for 4 weeks. Clonidine showed the opposite effect to yohimbine, which aggravated LPS-induced pulmonary fibrosis. These findings demonstrated that the sepsis-induced increase in NE promoted fibroblast differentiation via activating α 2 -AR. Blockage of α 2 -AR effectively ameliorated sepsis-associated pulmonary fibrosis by abolishing NE-induced lung fibroblast differentiation and inhibiting the PKC-p38-Smad2/3 pathway.
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Affiliation(s)
- Xingyu Su
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Fan Lu
- Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yihua Chen
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Miao Wang
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Guoqing Tang
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Wan Lin
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Yingwen Liu
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Huadong Wang
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
| | - Haiyan Yin
- Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiyang Wang
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People's Republic of China, School of Medicine, Jinan University, Guangzhou, China
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Bromfalk Å, Hultin M, Myrberg T, Engström Å, Walldén J. Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Paediatr Anaesth 2023; 33:962-972. [PMID: 37528645 DOI: 10.1111/pan.14740] [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: 09/26/2022] [Revised: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2-6 years. METHODS In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured. RESULTS After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups. CONCLUSIONS No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2 -agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.
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Affiliation(s)
- Åsa Bromfalk
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sunderbyn), Umeå University, Umeå, Sweden
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health, Education and Technology, Lulea University of Technology, Luleå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
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10
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Malaca S, Pesaresi M, Kapoor A, Berretta P, Busardò FP, Pirani F. Pharmacology and toxicology of xylazine: quid novum? Eur Rev Med Pharmacol Sci 2023; 27:7337-7345. [PMID: 37606142 DOI: 10.26355/eurrev_202308_33305] [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: 08/23/2023]
Abstract
The current opioid overdose crisis is characterized by the presence of unknown psychoactive adulterants. Xylazine is an alpha-2 receptor agonist that is not approved for human use but is commonly used in veterinary medicine due to its sedative and muscle-relaxant properties. Cases of human intoxication due to accidental or voluntary use have been reported since the 1980s. However, reports of adulteration of illicit opioids (heroin and illicit fentanyl) with xylazine have been increasing all over Western countries. In humans, xylazine causes respiratory depression, bradycardia, and hypotension-posing individuals, using xylazine-adulterated opioids. We present a narrative review of the latest intoxication cases related to xylazine, to bring awareness to readers and also to help pathologists to detect and deal with xylazine cases.
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Affiliation(s)
- S Malaca
- Department of Excellence of Biomedical Sciences and Public Health, Section of Legal Medicine, Unit of Forensic Toxicology, Marche Polytechnic University, Ancona, Italy.
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11
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Avci O, Taskiran AS, Gundogdu O. Dexmedetomidine, an α 2 agonist, increases the morphine analgesic effect and decreases morphine tolerance development by suppressing oxidative stress and TNF/IL-1 signalling pathway in rats. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:327-340. [PMID: 37286034 DOI: 10.1016/j.redare.2022.04.002] [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] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/18/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND The aim of the present study is to examine the possible effect de dexmedetomidine on the development of morphine tolerance in rats including nociception, morphine analgesia, apoptosis, oxidative stress, and tumour necrosis factor (TNF)/ interleukin-1 (IL-1) pathways. MATERIALS AND METHODS In this study, 36 Wistar Albino (225-245 g) rats were used. Animals were divided into 6 groups: saline (S), 20 mcg/kg dexmedetomidine (D), 5 mg/kg morphine (M), M + D, morphine tolerance (MT), and MT + D. The analgesic effect was measured with hot plate and tail-flick analgesia tests. After the analgesia tests, the dorsal root ganglia (DRG) tissues were excised. Oxidative stress parameters [total antioxidant status (TAS), total oxidant status (TOS)], TNF, IL-1 and apoptosis enzymes (Caspase-3, Caspase-9), were measured in DRG tissues. RESULTS Dexmedetomidine showed an antinociceptive effect when given alone (p < 0.05 to p < 0.001). In addition, dexmedetomidine increased the analgesic effect of morphine (p < 0.001), and also decreased the tolerance to morphine at a significant level (p < 0.01 to p < 0.001). Moreover, it decreased oxidative stress (p < 0.001) and TNF/IL-1 levels when given as an additional drug of single-dose morphine and morphine tolerance group (p < 0.001). Furthermore, dexmedetomidine decreased Caspase-3 and Caspase-9 levels after tolerance development (p < 0.001). CONCLUSION Dexmedetomidine has antinociceptive properties, and it increases the analgesic effect of morphine and also prevents tolerance development. These effects probably occur by the modulation of oxidative stress, inflammation and apoptosis.
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Affiliation(s)
- O Avci
- Facultad de Medicina, Universidad Sivas Cumhuriyet, Departamento de Anestesiología y Reanimación, Sivas, Turkey
| | - A S Taskiran
- Facultad de Medicina, Universidad Sivas Cumhuriyet, Departamento de Fisiología, Sivas, Turkey
| | - O Gundogdu
- Facultad de Medicina, Universidad Sivas Cumhuriyet, Departamento de Anestesiología y Reanimación, Sivas, Turkey.
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12
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Jöhr M. A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing. Curr Opin Anaesthesiol 2023; 36:311-317. [PMID: 36745083 DOI: 10.1097/aco.0000000000001236] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion. RECENT FINDINGS The role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α 2 -agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life. SUMMARY Midazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.
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Affiliation(s)
- Martin Jöhr
- Paediatric Anaesthesia, Luzerner Kantonsspital, Luzern Switzerland
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13
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Obeng S, Leon F, Patel A, Zuarth Gonzalez JD, Chaves Da Silva L, Restrepo LF, Gamez-Jimenez LR, Ho NP, Guerrero Calvache MP, Pallares VLC, Helmes JA, Shiomitsu SK, Soto PL, McCurdy CR, McMahon LR, Wilkerson JL, Hiranita T. Interactive Effects of µ-Opioid and Adrenergic- α 2 Receptor Agonists in Rats: Pharmacological Investigation of the Primary Kratom Alkaloid Mitragynine and Its Metabolite 7-Hydroxymitragynine. J Pharmacol Exp Ther 2022; 383:182-198. [PMID: 36153006 PMCID: PMC9667981 DOI: 10.1124/jpet.122.001192] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/09/2022] [Indexed: 01/07/2023] Open
Abstract
The primary kratom alkaloid mitragynine is proposed to act through multiple mechanisms, including actions at µ-opioid receptors (MORs) and adrenergic-α 2 receptors (Aα 2Rs), as well as conversion in vivo to a MOR agonist metabolite (i.e., 7-hydroxymitragynine). Aα 2R and MOR agonists can produce antinociceptive synergism. Here, contributions of both receptors to produce mitragynine-related effects were assessed by measuring receptor binding in cell membranes and, in rats, pharmacological behavioral effect antagonism studies. Mitragynine displayed binding affinity at both receptors, whereas 7-hydroxymitragynine only displayed MOR binding affinity. Compounds were tested for their capacity to decrease food-maintained responding and rectal temperature and to produce antinociception in a hotplate test. Prototypical MOR agonists and 7-hydroxymitragynine, but not mitragynine, produced antinociception. MOR agonist and 7-hydroxymitragynine rate-deceasing and antinociceptive effects were antagonized by the opioid antagonist naltrexone but not by the Aα 2R antagonist yohimbine. Hypothermia only resulted from reference Aα 2R agonists. The rate-deceasing and hypothermic effects of reference Aα 2R agonists were antagonized by yohimbine but not naltrexone. Neither naltrexone nor yohimbine antagonized the rate-decreasing effects of mitragynine. Mitragynine and 7-hydroxymitragynine increased the potency of the antinociceptive effects of Aα 2R but not MOR reference agonists. Only mitragynine produced hypothermic effects. Isobolographic analyses for the rate-decreasing effects of the reference Aα 2R and MOR agonists were also conducted. These results suggest mitragynine and 7-hydroxymitragynine may produce antinociceptive synergism with Aα 2R and MOR agonists. When combined with Aα 2R agonists, mitragynine could also produce hypothermic synergism. SIGNIFICANCE STATEMENT: Mitragynine is proposed to target the µ-opioid receptor (MOR) and adrenergic-α2 receptor (Aα2R) and to produce behavioral effects through conversion to its MOR agonist metabolite 7-hydroxymitragynine. Isobolographic analyses indicated supra-additivity in some dose ratio combinations. This study suggests mitragynine and 7-hydroxymitragynine may produce antinociceptive synergism with Aα2R and MOR agonists. When combined with Aα2R agonists, mitragynine could also produce hypothermic synergism.
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Affiliation(s)
- Samuel Obeng
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Francisco Leon
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Avi Patel
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Julio D Zuarth Gonzalez
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Lucas Chaves Da Silva
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Luis F Restrepo
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Lea R Gamez-Jimenez
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Nicholas P Ho
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Maria P Guerrero Calvache
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Victoria L C Pallares
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Justin A Helmes
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Sakura K Shiomitsu
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Paul L Soto
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Christopher R McCurdy
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Lance R McMahon
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Jenny L Wilkerson
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
| | - Takato Hiranita
- Departments of Pharmacodynamics (S.O., A.P., J.D.Z.G., L.C.D.S., L.F.R., L.R.G-J., N.P.H., M.P.G.C., V.L.C.P., J.A.H., S.K.S., L.R.M., J.L.W., T.H.), Medicinal Chemistry (S.O., F.L., C.R.M.), and Pharmaceutics (C.R.M.), and Translational Drug Development Core (C.R.M.), Clinical and Translational Sciences Institute, College of Pharmacy, University of Florida, Gainesville, Florida; Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (F.L.); Department of Psychology, Louisiana State University, Baton Rouge, Louisiana (P.L.S.), Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, Amarillo, Texas (L.R.M., J.L.W., T.H.); Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, Alabama (S.O.); Department of Pharmacology, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas (T.H.)
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14
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Vitale V, Vezzosi T, Di Franco C, Briganti A, Tognetti R, Conte G, Bucchioni E, Sgorbini M. Equine echocardiography: Can dobutamine infusion correct alterations due to sedation with alpha-2 agonists? PLoS One 2022; 17:e0276256. [PMID: 36256667 PMCID: PMC9578622 DOI: 10.1371/journal.pone.0276256] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
For the echocardiographic examination horses should not be sedated unless absolutely necessary because this alters cardiac dimensions and indices of function. However, some horses do not tolerate the echocardiographic procedure and require sedation to conduct the examination safely and obtain good quality images. The objective of this study was to evaluate whether the concurrent infusion of dobutamine in horses sedated with romifidine counteracts the cardiovascular changes observed with sedation alone. Twelve healthy untrained Standardbred mares were used. Three echocardiographic examinations were performed on the same day for each subject: a) without any treatment under resting conditions (WT); b) under sedation with romifidine administered intravenously (RT); c) under sedation with romifidine and concurrent intravenous infusion with dobutamine (RDT). A three-hour washout period was observed between each examination and the order of the examinations was randomly decided by rolling a dice. The measurements on the images recorded were performed offline at the end of the study protocol and at this point the operator was blinded to the horse and treatment administered. Left ventricular internal diameter (LVID) in diastole, left ventricular free wall (LVFW) in systole, and fractional shortening (FS) were higher in the WT group compared with the other two groups. No differences in the other M-mode and B-mode values were observed. A continuous rate infusion of dobutamine did not counteract the alterations caused by sedation and led to similar echocardiographic measurements to those obtained after romifidine administration.
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Affiliation(s)
- Valentina Vitale
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
- * E-mail:
| | - Tommaso Vezzosi
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
| | - Chiara Di Franco
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
| | - Rosalba Tognetti
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
| | - Giuseppe Conte
- Department of Agricultural, Food and Agro-Environmental Sciences, Pisa, Italy
| | | | - Micaela Sgorbini
- Department of Veterinary Sciences, University of Pisa, San Piero a Grado, Pisa, Italy
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15
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Chen S, Li A, Wu J, Huang Y, Zou T, Tailaiti T, Wang J. Dexmedetomidine reduces myocardial ischemia-reperfusion injury in young mice through MIF/AMPK/GLUT4 axis. BMC Anesthesiol 2022; 22:289. [PMID: 36104681 PMCID: PMC9472426 DOI: 10.1186/s12871-022-01825-z] [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] [Received: 12/29/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reperfusion of ischemic tissue has adverse impact on the myocardium. Dexmedetomidine (Dex) is a α2-adrenergic receptor (α2-AR) agonist with sedative and analgesic effects. Macrophage migration inhibition factor (MIF) is a pressure-regulating cytokine and is responsible for inflammatory and immune diseases. This study aims to reveal the consequences of Dex on myocardial ischemia-reperfusion injury (IRI) in young mice. METHODS Fifty mice were raised and examined. At the end of the experiment, all mice were euthanized. The anterior descending department of the left coronary artery in mice was under ischemia for 60 min, then the ligation line was released and reperfused for 120 min to establish the IRI model. Mice were randomly divided into Sham, control, treatment using 4,5-dihydro-3-(4-hydroxyphenyl)-5-isoxazoleacetic acid (ISO-1), Dex treatment, and Dex combined ISO-1 treatment groups. Interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF-α) were determined by enzyme-linked immunosorbent assay (ELISA). Reactive oxygen species (ROS) and ATP levels were recorded. The expressions of MIF, P-adenosine monophosphate-activated kinase α (AMPKα), glucose transporter (GLUT)4, Bax and Bcl-2 were detected by Western Blot (WB). Hematoxylin and Eosin (H&E) staining was used to study cell morphology. Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay. Echocardiography was carried out at the end of reperfusion, and the infarct size was calculated by Electron microscopy. RESULTS I/R + Dex group showed significantly increased IL-6 and TNF-α levels and reduced myocardial cell necrosis and apoptosis. H&E staining showed alleviated myocardial disorder, myocardial cell swelling, myocardial fiber fracture, and inflammatory cell infiltration in I/R + Dex group. Myocardial cell necrosis and apoptosis were significantly reduced in I/R + Dex group. ATP level in myocardial tissue of mice in I/R group was substantially decreased, while that in Dex group was increased. WB results showed that MIF, P-AMPK α, GLUT4 and Bcl-2 levels were increased and Bax levels were decreased in I/R + Dex group. CONCLUSION Dex may exert myocardial protection in young mice through MIF/AMPK/GLUT4 axis.
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Affiliation(s)
- Siyu Chen
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Aimei Li
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Jianjiang Wu
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Yidan Huang
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Tiantian Zou
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Taiwangu Tailaiti
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China
| | - Jiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830054, Uygur Autonomous Region, China.
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16
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Andersen JH, Karlsen A, Geisler A, Jaeger P, Grevstad U, Dahl JB, Mathiesen O. Alpha 2 -receptor agonists as adjuvants for brachial plexus nerve blocks-A systematic review with meta-analyses. Acta Anaesthesiol Scand 2022; 66:186-206. [PMID: 34811722 DOI: 10.1111/aas.14002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for brachial plexus blocks (BPB). METHODS We included randomised controlled trials on upper limb surgery with BPBs in adults, comparing dexmedetomidine with clonidine or either drug with placebo. The primary outcome was duration of analgesia. Secondary outcomes included adverse and serious adverse events. The review was conducted using Cochrane standards, trial sequential analyses (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We included 101 trials with 6248 patients. Overall, duration of analgesia was prolonged with both clonidine (176 min [TSA adj. 95% CI: 118, 205, p < .00001; 33 trials]) and dexmedetomidine (292 min [TSA adj. 95% CI: 245 329, p < .00001; 53 trials]), but was longer for dexmedetomidine than clonidine (205 min [TSA adj. 95% CI: 157, 254, p < .00001; 19 trials]). Compared with placebo, dexmedetomidine was associated with bradycardia (RR 4.2 [95% CI 2.2, 8.3]), and both clonidine (RR 4.5 [95% CI 1.1, 18.3]) and dexmedetomidine (RR 3.9 [95% CI 2.0, 7.5]) were associated with hypotension. Serious adverse events were mostly related to block technique. GRADE-rated quality of evidence was low or very low. CONCLUSION Alpha2-receptor agonists used as adjuvants for BPBs lead to a prolonged duration of analgesia, with dexmedetomidine as the most efficient. Alpha2-receptor agonists were associated with increased risk of cardiovascular adverse events. The quality of evidence was low to very low.
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Affiliation(s)
- Jakob H Andersen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Anders Karlsen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Anja Geisler
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
| | - Pia Jaeger
- Department of Anaesthesiology, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Grevstad
- Department of Anaesthesiology, Gentofte Hospital, Hellerup, Denmark
| | - Jørgen B Dahl
- Department of Anaesthesiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Mathiesen
- Department of Anaesthesiology, Centre for Anaesthesiological Research, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Zhang SJ, Lai G, Griffis CA, Schiltz M, Aroke EN. α 2-Adrenergic Receptor Agonist, an Attractive but Underused ERAS Component in Improving Fast-Track Recovery and Surgical Outcomes. AANA J 2021; 89:529-537. [PMID: 34809759] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have been implemented in many institutions to attenuate the stress of surgery and facilitate early recovery. Careful selection of multimodal analgesic medication plays an essential role in achieving the goals of ERAS protocols. Clonidine and dexmedetomidine are α2-adrenergic receptor (α2-AR) agonists that can greatly enhance various ERAS components owing to their unique pharmacologic properties: antinociception, anxiolysis, anti-inflammation, and renal protection. The α2-AR agonists exert supraspinal and spinal antinociceptive effects by potentiating descending pain modulatory pathways and inhibiting peripheral C fibers. These antinociceptive effects of α2-AR agonists are independent of opioid receptors and result in analgesic synergy with opioid agonists. Several meta-analyses and systematic reviews have reported that α2-AR agonists decrease opioid consumption and side effects in adult and pediatric surgical patients. Given the wide distribution of α2-ARs in the body, α2-AR agonists have been associated with a reduction in anxiety, perioperative stress, inflammation, postoperative nausea and vomiting, shivering, and cognitive dysfunction. This course describes the basic and applied pharmacology of the α2-AR agonists and provides emerging evidence to support their utility in acute pain management and ERAS protocols. Perioperative administration of α2-AR agonists can enhance pain management, decrease adverse effects, and promote surgical recovery.
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Affiliation(s)
- Sarah Jingying Zhang
- is an assistant professor of nursing, Program of Nurse Anesthesiology, University of South Florida, Tampa, Florida; adjunct assistant professor of nursing, Program of Nurse Anesthesia, Samuel Merritt University, Oakland, California.
| | - Gloria Lai
- Department of Anesthesiology, University of California Davis, Davis California. E-mail:
| | - Charles A Griffis
- is a clinical instructor of anesthesiology, Program of Nurse Anesthesia, University of Southern California, Los Angeles, California. E-mail:
| | - Michelle Schiltz
- Department of Anesthesiology, Kaiser Permanente-South Sacramento Medical Center, Sacramento, California.
| | - Edwin N Aroke
- is an associate professor of nursing, Nurse Anesthesia Program, University of Alabama at Birmingham, Birmingham, Alabama.
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18
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Affiliation(s)
- Erick Richmond
- Pediatric Endocrinology, National Children's Hospital, San José, Costa Rica
| | - Alan D Rogol
- Pediatric Endocrinology, University of Virginia, Charlottesville, VA, USA.
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Vidal-Sanz M, Lafuente MP, Mayor-Torroglosa S, Aguilera ME, Miralles de Imperial J, Villegas-Pérez MP. Brimonidine's Neuroprotective Effects against Transient Ischaemia-Induced Retinal Ganglion Cell Death. Eur J Ophthalmol 2018; 11 Suppl 2:S36-40. [PMID: 11592529 DOI: 10.1177/112067210101102s04] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Brimonidine is a lowering pressure agent currently used in glaucoma. This chronic degenerative condition is characterised by neuronal death, and an agent which offers neuroprotection may slow down or impede the progression of neuronal cell death. Methods The effects of brimonidine (BMD) on the short- and long-term survival of retinal ganglion cells (RGCs) after transient retinal ischaemia are reported here using a rat model. The fluorescent tracer Fluorogold (FG) was applied to both superior colliculi to retrogradely label RGCs. A ninety-minute period of ischaemia was induced and densities of surviving RGCs were estimated over time by counting FG-labelled RGCs in 12 standard regions of each retina. Results Seven days after inducing transient ischaemia, there was loss of approximately half of the RGC population. Topical pre-treatment with 0.1% or 0.5% BMD prevented ischaemia-induced RGC death. Conclusions These results indicate that optimal neuroprotective effects against the early loss of RGCs are seen with 0.1% or 0.5% BMD. Ischaemia-induced RGC loss continued between day 7 and day 21 in the vehicle treated groups and amounted to approximately 25% of the RGC population. Topical pre-treatment with 0.1% or 0.5% BMD was also effective in reducing the slow loss of RGCs.
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Affiliation(s)
- M Vidal-Sanz
- Department of Ophthalmology, University of Murcia, Spain.
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Abstract
Dexmedetomidine Diminishes Halothane Anesthetic Requirements in Rats Through a Postsynaptic Alpha 2 Adrenergic Receptor. By Segal IS, Vickery RG, Walton JK, Doze VA, and Maze M. ANESTHESIOLOGY 1988; 125:590-4. Abstract reprinted with permission.The effect of 4(5)-[1-(2,3-dimethylphenyl)ethyl]imidazole (medetomidine), the α2 adrenergic agonist, on anesthetic requirements was investigated in rats anesthetized with halothane. Halothane MAC was determined before and after either dexmedetomidine (D-enantiomer) or levomedetomidine (L-enantiomer) 10, 30, and 100 μg/kg, or vehicle intraperitoneally. There was a dose-dependent increase in MAC with the D-, but not the L-, stereoisomer. At the highest dose of dexmedetomidine (100 μg/kg), halothane could be discontinued for up to 30 min with no response to tail clamping. To determine whether α2 adrenoreceptors mediated this effect of dexmedetomidine on MAC, cohorts of rats were pretreated with idazoxan, 10 mg/kg intraperitoneally, a highly selective α2 antagonist. This completely prevented the reduction of MAC caused by dexmedetomidine. To determine whether the reduction of MAC caused by dexmedetomidine was mediated in part through either opiate or adenosine receptors, groups of rats were pretreated with either naltrexone, 5 mg/kg intraperitoneally, an opiate antagonist, or 8-phenyltheophylline, 2.5 mg/kg intraperitoneally, an A1 adenosine antagonist. These two pretreatments did not alter the reduction of MAC by dexmedetomidine. To determine whether postsynaptic mechanisms mediate the anesthetic effect of dexmedetomidine, rats were depleted of central catecholamine stores with either n-(2-chloroethyl)-n-ethyl-2-bromobenzylamine or reserpine and α-methyl-para-tyrosine, and MAC was determined before and after each dose of dexmedetomidine. While the catecholamine-depleted rats had a lower basal MAC than the vehicle controls, there was still a profound reduction in halothane MAC after administration of dexmedetomidine. The reduction of MAC by dexmedetomidine was blocked with idazoxan in the catecholamine-depleted rats. These data indicate that the reduction of MAC caused by dexmedetomidine is mediated through α2 adrenoreceptors with no apparent involvement of either opiate or A1 adenosine receptors. Data from catecholamine-depleted rats suggest that the mediating mechanism must involve site(s) other than or in addition to the presynaptic α2 adrenergic receptors on noradrenergic neurons. The authors conclude that central postsynaptic α2 adrenergic receptors mediate a significant part of the reduction of anesthetic requirements caused by dexmedetomidine.
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Affiliation(s)
- Mervyn Maze
- From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
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21
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Martin E, Ramsay G, Mantz J, Sum-Ping STJ. The Role of the α2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit. J Intensive Care Med 2016; 18:29-41. [PMID: 15189665 DOI: 10.1177/0885066602239122] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dexmedetomidine was evaluated for sedation of 401 postsurgical patients in this double-blind, randomized, placebocontrolled, multicenter trial. Dexmedetomidine or saline was started on arrival in the intensive care unit (ICU) (1.0 mcg/kg for 10 minutes), then titrated at 0.2 to 0.7 mcg/kg/h to effect. Patients could be given propofol if necessary. Morphine was administered for pain. Sixty percent of the dexmedetomidine patients required no other sedative to maintain an RSS ≥ 3; 21% required < 50 mg propofol. In contrast, 76% of the control group received propofol; 59% required ≥ 50 mg. Dexmedetomidine patients required significantly less morphine for pain relief (P < .001). Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation. Nurses judged the dexmedetomidine patients were easier to manage. Later, fewer dexmedetomidine patients remembered pain or discomfort. The majority of dexmedetomidine patients maintained blood pressures within normal range, without rebound. Hypertension, atelectasis, and rigors occurred more frequently in the control group, while hypotension and bradycardia occurred more frequently in the dexmedetomidine group. Preoperative cardiovascular conditions were not risk factors for dexmedetomidine patients.
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Affiliation(s)
- Eike Martin
- Klinik für Anaesthesiologie Universitatskliniken, Heidelberg, Germany
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Plambech MZ, Afshari A. Dexmedetomidine in the pediatric population: a review. Minerva Anestesiol 2015; 81:320-332. [PMID: 24824958] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dexmedetomidine, an alpha-2 agonist approved only for sedation in adult intensive care patients, is increasingly used off-label in- and outside Europe in the pediatric setting for various indications such as to prevent agitation, as premedication in the form of intranasal, buccal and oral solution, as adjunct for elective surgery, as sedative for magnetic resonance imaging, as intraoperative analgesia, for extracorporeal shock wave lithotripsy, and as adjuvant to ropi- and bupivacaine for nerve blocks. Dexmedetomidine is also used intravenously at different intensive care units with the purpose of sedation of children. In this paper, we assess 51 minor trials in the form of 44 randomized controlled trials and 7 prospective observational studies in an attempt to update the available evidence on dexmedetomidine use in pediatrics. Furthermore, we discuss its potential indications, benefits and adverse effects. However, it is important to state that much of the existing evidence favoring dexmedetomidine in children is either extrapolated from adult studies or based on small randomized controlled trials and observational studies with their inherent methodological shortcomings and confounding factors. Based on the best current evidence dexmedetomidine is found suitable and safe for various indications. However, in order to discover its full potential, indications, dosing and safety profile for various ages and procedures, it should urgently be examined by conducting good quality pediatric trials. Finally, we provide the readers with guidance on how to apply and dose dexmedetomidine for pediatric sedation and for other indications.
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Affiliation(s)
- M Z Plambech
- Department of Anesthesiology, Copenhagen University, Hvidovre Hospital, Hvidovre, Denmark -
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Del Rosso JQ. Management of facial erythema of rosacea: what is the role of topical α-adrenergic receptor agonist therapy? J Am Acad Dermatol 2014; 69:S44-56. [PMID: 24229637 DOI: 10.1016/j.jaad.2013.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 12/19/2022]
Abstract
Several more recent advances have led to a better understanding of the pathophysiologic mechanisms involved in rosacea and therapeutic modalities used for treatment. Although the clinical features may vary among patients, there are some unifying mechanisms that appear to relate to the more common presentations of rosacea. Both neurovascular dysregulation and augmented immune detection and response appear to play central roles that lead to many of the signs and symptoms of rosacea. Diffuse central facial erythema is a very common finding that intensifies during flares and persists to varying degrees between flares. This background of facial redness occurs secondary to vasodilation and fixed vascular changes that develop over time. Physical modalities are commonly used to treat the erythema that persists as a result of fixed changes in superficial cutaneous vasculature that do not remit after treatment with agents whose mechanisms are active primarily against some of the inflammatory processes operative in rosacea (ie metronidazole, azelaic acid, tetracyclines). As enlarged superficial cutaneous vessels that contribute to the fixed background facial redness of rosacea remain vasoactive to sympathetic nervous system innervation, topical α-adrenergic receptor agonists, namely brimonidine and oxymetazoline, are currently under evaluation for the treatment of facial erythema of rosacea. This article focuses on the clinical differentiation of facial erythema of rosacea and its management.
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Affiliation(s)
- James Q Del Rosso
- Dermatology Residency Program, Valley Hospital Medical Center Las Vegas, Las Vegas, Nevada; Dermatology, Touro University College of Osteopathic Medicine, Henderson, Nevada; Dermatology and Cutaneous Surgery, Las Vegas Skin and Cancer Clinics, Las Vegas and Henderson, Nevada.
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Abstract
BACKGROUND Awake fibreoptic intubation (AFOI) frequently requires sedation, anxiolysis and relief of discomfort without impairing ventilation and depressing cardiovascular function. The goal is to allow the patient to be responsive and co-operative. Medications such as fentanyl, remifentanil, midazolam and propofol have been reported to assist AFOI; however,these agents are associated with cardiovascular or respiratory adverse effects. Dexmedetomidine has been proposed as an alternative to facilitate AFOI. OBJECTIVES The primary objective of this review is to evaluate and compare the efficacy and safety of dexmedetomidine in the management of patients with a difficult or unstable airway undergoing awake fibreoptic intubation (AFOI). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2012, Issue 5), MEDLINE (1966 to May 2012) through Ovid, EMBASE (1980 to May 2012) and Web of Science (1945 to May 2012); we screened the reference lists of all eligible trials and reviews to look for further trials and contacted authors of trials to ask for additional information. We searched for ongoing trials at http://www.controlledtrials.com/ and http://clinicaltrials.gov/ . We reran our search of all databases listed above on 21 November 2013. SELECTION CRITERIA We included published and unpublished randomized controlled trials, regardless of blinding or language of publication, in participants 18 years of age or older who were scheduled for an elective AFOI because of an anticipated difficult airway. Participants received dexmedetomidine or control medications. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data on study design, participants, interventions and outcomes. We assessed risk of bias using The Cochrane Collaboration's tool. We estimated risk ratios (RRs) or mean differences (MDs) with 95% confidence internals (CIs) for outcomes with sufficient data; for other outcomes, we performed a qualitative analysis. MAIN RESULTS We identified four randomized controlled trials (RCTs), which included 211 participants. The four trials compared dexmedetomidine with midazolam, fentanyl, propofol or a sodium chloride placebo, respectively. The trials showed low or unclear risk of bias primarily because information provided on allocation concealment and other potential sources of bias was inadequate. Owing to clinical heterogeneity and potential methodological heterogeneity, it was impossible to conduct a full meta-analysis. We described findings from individual studies or presented them in tabular form. Limited evidence was available for assessment of the outcomes of interest for this review. Results of the limited included trials showed that dexmedetomidine significantly reduced participants' discomfort with no significant differences in airway obstruction, low oxygen levels or treatment-emergent cardiovascular adverse events noted during AFOI compared with control groups. When the search was rerun (from May 2012 to November 2013), it was noted that four studies are awaiting assessment. We will deal with these studies when we update the review. AUTHORS' CONCLUSIONS Small, limited trials provide weak evidence to support dexmedetomidine as an option for patients with an anticipated difficult airway who undergo AFOI. The findings of this review should be further corroborated by additional controlled investigations.
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Affiliation(s)
- Xing-Ying He
- Department of Anaesthesiology, Changzheng Hospital, The Second Military Medical University, Fengyang Road 415, Shanghai, China, 200003
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Escrivá E, Martínez-Costa L. [Incomplete Horner's syndrome as a presenting sign of fourth ventricle ependymoma]. ACTA ACUST UNITED AC 2013; 88:359-61. [PMID: 23988043 DOI: 10.1016/j.oftal.2012.05.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 03/21/2012] [Accepted: 05/22/2012] [Indexed: 11/17/2022]
Abstract
CASE REPORT The case of 44 year old male patient with palpebral ptosis and trigeminal neuralgia as presenting sign of fourth ventricle ependymoma is reported. After surgical treatment, the patient developed a residual paresis of the sixth cranial nerve. DISCUSSION Horner's syndrome occurs due to an alteration of the sympathetic innervations of the eye and adnexa. Some tumours may be the cause, in our case an ependymoma of the fourth ventricle, which onset exceptionally with blepharoptosis and involvement of the ophthalmic division of trigeminal nerve, due to the proximity of these nerve fibres at the brainstem.
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Affiliation(s)
- E Escrivá
- Servicio de Oftalmología, Hospital Dr. Peset, Valencia, España.
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Lee D, Kim KY, Noh YH, Chai S, Lindsey JD, Ellisman MH, Weinreb RN, Ju WK. Brimonidine blocks glutamate excitotoxicity-induced oxidative stress and preserves mitochondrial transcription factor a in ischemic retinal injury. PLoS One 2012; 7:e47098. [PMID: 23056591 PMCID: PMC3467218 DOI: 10.1371/journal.pone.0047098] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/10/2012] [Indexed: 11/19/2022] Open
Abstract
Glutamate excitotoxicity-induced oxidative stress have been linked to mitochondrial dysfunction in retinal ischemia and optic neuropathies including glaucoma. Brimonindine (BMD), an alpha 2-adrenergic receptor agonist, contributes to the neuroprotection of retinal ganglion cells (RGCs) against glutamate excitotoxicity or oxidative stress. However, the molecular mechanisms of BMD-associated mitochondrial preservation in RGC protection against glutamate excitotoxicity-induced oxidative stress following retinal ischemic injury remain largely unknown. Here, we tested whether activation of alpha 2 adrenergic receptor by systemic BMD treatment blocks glutamate excitotoxicity-induced oxidative stress, and preserves the expression of mitochondrial transcription factor A (Tfam) and oxidative phosphorylation (OXPHOS) complex in ischemic retina. Sprague-Dawley rats received BMD (1 mg/kg/day) or vehicle (0.9% saline) systemically and then transient ischemia was induced by acute intraocular pressure elevation. Systemic BMD treatment significantly increased RGC survival at 4 weeks after ischemia. At 24 hours, BMD significantly decreased Bax expression but increased Bcl-xL and phosphorylated Bad protein expression in ischemic retina. Importantly. BMD significantly blocked the upregulations of N-methyl-D-aspartate receptors 1 and 2A protein expression, as well as of SOD2 protein expression in ischemic retina at 24 hours. During the early neurodegeneration following ischemic injury (12–72 hours), Tfam and OXPHOS complex protein expression were significantly increased in vehicle-treated retina. At 24 hours after ischemia, Tfam immunoreactivity was increased in the outer plexiform layer, inner nuclear layer, inner plexiform layer and ganglion cell layer. Further, Tfam protein was expressed predominantly in RGCs. Finally, BMD preserved Tfam immunoreactivity in RGCs as well as Tfam/OXPHOS complex protein expression in the retinal extracts against ischemic injury. Our findings suggest that systemic BMD treatment protects RGCs by blockade of glutamate excitotoxicity-induced oxidative stress and subsequent preservation of Tfam/OXPHOS complex expression in ischemic retina.
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Affiliation(s)
- Dongwook Lee
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Keun-Young Kim
- Center for Research on Biological Systems, National Center for Microscopy and Imaging Research, and Department of Neuroscience, University of California San Diego, La Jolla, California, United States of America
| | - You Hyun Noh
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
| | - Stephen Chai
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
| | - James D. Lindsey
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
| | - Mark H. Ellisman
- Center for Research on Biological Systems, National Center for Microscopy and Imaging Research, and Department of Neuroscience, University of California San Diego, La Jolla, California, United States of America
| | - Robert N. Weinreb
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
| | - Won-Kyu Ju
- The Sophie and Arthur Laboratory for Optic Nerve Biology, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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Iizuka T, Shimoyama N, Notoya A. [Dexmedetomidine for endoscopic submucosal dissection in a patient with severe chronic obstructive pulmonary disease]. Masui 2011; 60:96-99. [PMID: 21348258] [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: 05/30/2023]
Abstract
Here we report an anesthetic management of a 74-year-old man with gastric cancer and severe chronic obstructive pulmonary disease (COPD) undergoing endoscopic submucosal dissection (ESD). We maintained spontaneous breathing during ESD under monitored anesthesia care with dexmedetomidine (DEX). ESD lasted 5.5 hours with sufficient analgesia, and he required no airway management with the exception of supplemental mask oxygen during the procedures. He tolerated the procedure well and recovered with no complications. He was discharged without sequelae on the fifth postoperative day. DEX is a selective alpha2 agonist that has both sedative and analgesic properties, and it does not suppress ventilation. It should be used judiciously, and understanding the potential adverse effects and how to treat them is of paramount importance. However, with vigilant monitoring of blood pressure, heart rate, and level of consciousness during the ESD, it can be administered safely, thus lessening the anesthetic requirements and possibly improving the surgical outcome of the high risk patients. Especially, patients with severe COPD have demonstrated an increased risk for oxygen desaturation following general anesthesia, and to avoid this complication, spontaneous breathing sedation with DEX during ESD is one of the suitable management methods for COPD patients.
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Affiliation(s)
- Toru Iizuka
- Department of Anesthesia, National Cancer Center Hospital, Tokyo 104-0045
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Stylianou C, Galli-Tsinopoulou A, Grammatikopoulou MG, Koliakos G, Varlamis G. Ghrelin and growth hormone serum levels during the clonidine test in children with short stature and variable growth hormone status. Hormones (Athens) 2011; 10:39-45. [PMID: 21349805 DOI: 10.14310/horm.2002.1291] [Citation(s) in RCA: 2] [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: 11/20/2022]
Abstract
OBJECTIVE The exact role of ghrelin in the control of growth hormone (GH) secretion has not been completely clarified as yet. The aim of the present study was 1) to investigate the effect of a substance promoting GH secretion (clonidine) on ghrelin levels in children with short stature with growth hormone deficiency (GHD) and normal growth hormone (NGH), and 2) to assess possible correlations between GH and ghrelin values during the clonidine test. DESIGN Eighteen prepubertal children with short stature were included in the study. Using the results of two GH-provocative tests (glucagon and clonidine), the participants were divided into two groups: GHD and NGH. In both groups, ghrelin levels were determined during the clonidine stimulation test. RESULTS Different responses regarding ghrelin levels during the clonidine stimulation test were observed in the two study groups (GHD and NGH). A decrease in ghrelin levels was observed in the NGH children accompanied by a rise in the circulating GH levels, whereas the GHD children demonstrated a rise in both ghrelin and GH levels. CONCLUSIONS The data indicate an inverse relationship between circulating ghrelin and GH in NGH children, suggesting the presence of a negative feedback loop between ghrelin and GH. Analogous changes were not observed in GHD children.
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Affiliation(s)
- Charilaos Stylianou
- Fourth Department of Pediatrics, Medical School, Aristotle University, Thessaloniki, Greece.
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Zangeneh FZ, Mohammadi A, Ejtemaeimehr S, Naghizadeh MM, Fatemeh A. The role of opioid system and its interaction with sympathetic nervous system in the processing of polycystic ovary syndrome modeling in rat. Arch Gynecol Obstet 2010; 283:885-92. [PMID: 21132313 DOI: 10.1007/s00404-010-1776-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 11/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was conducted to evaluate the effect of interaction of sympathetic and opioid systems in the processing of polycystic ovary syndrome modeling in rat. METHODS Ninety adult female rats (7-8 weeks of age) were treated with EV for 60 days for induction of follicular cysts (PCO modeling). Clonidine and yohimbine were used for sympathic agonist and antagonist and nalterxone was used for opioid system inhibition. Interactions of two systems were studied. RESULTS Our results indicate that both systems and interaction of two systems are effective in processing modeling of PCOS in rat. Interaction of two system drugs decreased estradiol (P < 0.05). Qualitative analysis showed that the bulk of cysts and corpus lutea and dominant follicles were increased in PCO rats in comparison with control group. CONCLUSION Therefore there could been an alternative in the treatment of the polycystic ovary syndrome in the rat by using adrenergic agonist and antagonists in combination with naltrexone.
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Affiliation(s)
- Farideh Zafari Zangeneh
- Vali-e-Asr, Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Assie G, Louiset E, Sturm N, René-Corail F, Groussin L, Bertherat J, Thomas M, Lefebvre H, Feige JJ, Clauser E, Chabre O, Cherradi N. Systematic analysis of G protein-coupled receptor gene expression in adrenocorticotropin-independent macronodular adrenocortical hyperplasia identifies novel targets for pharmacological control of adrenal Cushing's syndrome. J Clin Endocrinol Metab 2010; 95:E253-62. [PMID: 20660048 DOI: 10.1210/jc.2009-2281] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [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: 02/12/2023]
Abstract
CONTEXT Stimulation of cortisol secretion through abnormally expressed G protein-coupled receptors (GPCRs) is a frequent feature of ACTH-independent macronodular adrenal hyperplasia (AIMAH). This has opened a pharmacological strategy that targets GPCRs for the treatment of Cushing's syndrome in AIMAH. However, only few drugs are available for the presently described GPCRs. OBJECTIVE The objective of the study was to identify new GPCR targets for the pharmacological treatment of adrenal Cushing's syndrome. DESIGN AND PATIENTS We designed a cDNA chip containing 865 nucleotidic sequences of GPCRs. mRNAs were extracted from three normal adrenals, 18 AIMAHs, four adrenals from Cushing's disease patients, and 13 cortisol-secreting adenomas. A set of GPCR mRNAs that showed significantly higher or lower expression in AIMAH than in normal adrenal were studied by quantitative RT-PCR analysis. Analysis of protein expression and function were performed on selected GPCRs. SETTING The study was conducted at a tertiary care center and basic research laboratories. RESULTS The ACTH MC2 receptor showed a low expression in 15 of 18 AIMAHs samples, whereas several previously undescribed GPCR genes were found highly expressed in a subset of AIMAH, such as the receptors for motilin (MLNR; three of 18 AIMAHs) and γ-aminobutyric acid (GABBR1; five of 18 AIMAHs), and the α2A adrenergic receptor (ADRA2A; 13 of 18 AIMAHs), on which we focused our attention. Western blot and immunochemistry analyses showed expression of ADRA2A protein in AIMAH but not in normal adrenal cortex. The ADRA2A agonist clonidine enhanced both basal and stimulated cortisol production. Clonidine-induced increase in basal cortisol levels was blocked by the ADRA2A antagonist yohimbine. CONCLUSION ADRA2A is a potential target for pharmacological treatment of Cushing's syndrome linked to AIMAH.
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Affiliation(s)
- Guillaume Assie
- Université Paris Descartes, Institut National de la Santé et de la Recherche Médicale Unité 567, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
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Koppo K, Larrouy D, Marques MA, Berlan M, Bajzova M, Polak J, Van de Voorde J, Bülow J, Lafontan M, Crampes F, Langin D, Stich V, de Glisezinski I. Lipid mobilization in subcutaneous adipose tissue during exercise in lean and obese humans. Roles of insulin and natriuretic peptides. Am J Physiol Endocrinol Metab 2010; 299:E258-65. [PMID: 20484012 DOI: 10.1152/ajpendo.00767.2009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 11/22/2022]
Abstract
The aim of this study was to evaluate the relative contributions of various hormones involved in the regulation of lipid mobilization in subcutaneous adipose tissue (SCAT) during exercise and to assess the impact of obesity on this regulation. Eight lean and eight obese men performed a 60-min cycle exercise bout at 50% of their peak oxygen uptake on two occasions: during intravenous infusion of octreotide (a somatostatin analog) or physiological saline (control condition). Lipolysis in SCAT was evaluated using in situ microdialysis. One microdialysis probe was perfused with the adrenergic blockers phentolamine and propranolol while another probe was perfused with the phosphodiesterase and adenosine receptor inhibitor aminophylline. Compared with the control condition, infusion of octreotide reduced plasma insulin levels in lean (from approximately 3.5 to 0.5 microU/ml) and in obese (from approximately 9 to 2 microU/ml), blunted the exercise-induced rise in plasma GH and epinephrine levels in both groups, and enhanced the exercise-induced natriuretic peptide (NP) levels in lean but not in obese subjects. In both groups, octreotide infusion resulted in higher exercise-induced increases in dialysate glycerol concentrations in the phentolamine-containing probe while no difference in lipolytic response was found in the aminophylline-containing probe. The results suggest that insulin antilipolytic action plays a role in the regulation of lipolysis during exercise in lean as well as in obese subjects. The octreotide-induced enhancement of exercise lipolysis in lean subjects was associated with an increased exercise-induced plasma NP response. Adenosine may contribute to the inhibition of basal lipolysis in both subject groups.
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Affiliation(s)
- Katrien Koppo
- Department of Sports Medicine, Third Faculty of Medicine, Charles University of Prague, Ruska 87, Prague 10, Czech Republic.
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Parent BA, Munoz R, Shiderly D, Chrysostomou C. Use of dexmedetomidine in sustained ventricular tachycardia. Anaesth Intensive Care 2010; 38:781. [PMID: 20715753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Beltran EJ, Papadopoulos CM, Tsai SY, Kartje GL, Wolf WA. Long-term motor improvement after stroke is enhanced by short-term treatment with the alpha-2 antagonist, atipamezole. Brain Res 2010; 1346:174-82. [PMID: 20510888 DOI: 10.1016/j.brainres.2010.05.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/19/2010] [Accepted: 05/20/2010] [Indexed: 12/15/2022]
Abstract
Drugs that increase central noradrenergic activity have been shown to enhance the rate of recovery of motor function in pre-clinical models of brain damage. Less is known about whether noradrenergic agents can improve the extent of motor recovery and whether such improvement can be sustained over time. This study was designed to determine if increasing central noradrenergic tone using atipamezole, an alpha-2 adrenoceptor antagonist, could induce a long-term improvement in motor performance in rats subjected to ischemic brain damage caused by permanent middle cerebral artery occlusion. The importance of pairing physical "rehabilitation" with enhanced noradrenergic activity was also investigated. Atipamezole (1 mg/kg, s.c.) or vehicle (sterile saline) was administered once daily on Days 2-8 post-operatively. Half of each drug group was housed under enriched environment conditions supplemented with daily focused activity sessions while the other half received standard housing with no focused activity. Skilled motor performance in forelimb reaching and ladder rung walking was assessed for 8 weeks post-operatively. Animals receiving atipamezole plus rehabilitation exhibited significantly greater motor improvement in both behavioral tests as compared to vehicle-treated animals receiving rehabilitation. Interestingly, animals receiving atipamezole without rehabilitation exhibited a significant motor improvement in the ladder rung walk test but not the forelimb reaching test. These results suggest that a short-term increase in noradrenergic activity can lead to sustained motor improvement following stroke, especially when paired with rehabilitation.
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Heusler P, Rauly-Lestienne I, Tourette A, Tardif S, Ailhaud MC, Croville G, Cussac D. Actions of the prototypical 5-HT1A receptor agonist 8-OH-DPAT at human alpha2-adrenoceptors: (+)8-OH-DPAT, but not (-)8-OH-DPAT is an alpha2B subtype preferential agonist. Eur J Pharmacol 2010; 640:8-14. [PMID: 20450907 DOI: 10.1016/j.ejphar.2010.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/22/2010] [Accepted: 04/19/2010] [Indexed: 11/18/2022]
Abstract
8-OH-DPAT [8-hydroxy-2-(di-n-propylamino)tetralin] is the prototypical agonist at serotonin 5-HT1A receptors; however, activity at other targets contributes to the functional effects of the compound as well. We examined the properties of 8-OH-DPAT and its enantiomers at recombinant human (h)alpha2-adrenoceptor subtypes, using a panel of radioligand binding and functional tests. In competition binding experiments using [3H]-RX821002, about 10-fold selectivity of (+)8-OH-DPAT for the halpha2B subtype (pKi about 7) over halpha2A- and halpha2C-adrenoceptors was observed. In contrast, the S(-) enantiomer of 8-OH-DPAT showed similar weak affinities for the three receptor subtypes (pKis<6). The binding affinity of (+)8-OH-DPAT at the halpha2B- and the halpha2A-adrenoceptor was found sensitive to GTPgammaS, a receptor/G protein-uncoupling agent, indicating agonist properties of the drug. Furthermore, using [35S]GTPgammaS binding determination at CHO-halpha2B or CHO-halpha2A cell membranes and G protein coupled inwardly rectifying potassium (GIRK) current recordings in Xenopus oocytes expressing halpha2B, partial agonist activity of (+)8-OH-DPAT at the respective receptors was confirmed in these two different functional assays. Potency of (+)8-OH-DPAT for stimulation of [35S]GTPgammaS incorporation was lower at the halpha2A- than at the halpha2B-adrenoceptor, consistent with binding affinities. Thus, (+)8-OH-DPAT and, as a consequence, racemic (+/-)8-OH-DPAT are partial agonists at halpha2-adrenoceptors with selectivity for the halpha2B subtype, a property that might contribute to the effects of the compound described in native systems.
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Affiliation(s)
- Peter Heusler
- Department of Cellular and Molecular Biology, Centre de Recherche Pierre Fabre, 17, avenue Jean Moulin, F-81106 Castres Cedex, France.
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Inyushin MU, Arencibia-Albite F, Vázquez-Torres R, Vélez-Hernández ME, Jiménez-Rivera CA. Alpha-2 noradrenergic receptor activation inhibits the hyperpolarization-activated cation current (Ih) in neurons of the ventral tegmental area. Neuroscience 2010; 167:287-97. [PMID: 20122999 PMCID: PMC2854519 DOI: 10.1016/j.neuroscience.2010.01.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 12/28/2009] [Accepted: 01/25/2010] [Indexed: 01/13/2023]
Abstract
The ventral tegmental area (VTA) is the source of dopaminergic projections innervating cortical structures and ventral forebrain. Dysfunction of this mesocorticolimbic system is critically involved in psychiatric disorders such as addiction and schizophrenia. Changes in VTA dopamine (DA) neuronal activity can alter neurotransmitter release at target regions which modify information processing in the reward circuit. Here we studied the effect of alpha-2 noradrenergic receptor activation on the hyperpolarization-activated cation current (I(h)) in DA neurons of the rat VTA. Brain slice preparations using whole-cell current and voltage-clamp techniques were employed. Clonidine and UK14304 (alpha-2 receptor selective agonists) were found to decrease I(h) amplitude and to slow its rate of activation indicating a negative shift in the current's voltage dependence. Two non-subtype-selective alpha-2 receptor antagonists, yohimbine and RS79948, prevented the effects of alpha-2 receptor activation. RX821002, a noradrenergic antagonist specific for alpha-2A and alpha-2D did not prevent I(h) inhibition. This result suggests that clonidine might be acting via an alpha-2C subtype since this receptor is the most abundant variant in the VTA. Analysis of a second messenger system associated with the alpha-2 receptor revealed that I(h) inhibition is independent of cyclic AMP (cAMP) and resulted from the activation of protein kinase C. It is suggested that the alpha-2 mediated hyperpolarizing shift in I(h) voltage dependence can facilitate the transition from pacemaker firing to afferent-driven burst activity. This transition may play a key role on the changes in synaptic plasticity that occurs in the mesocorticolimbic system under pathological conditions.
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Affiliation(s)
- M U Inyushin
- Department of Physiology, Universidad Central del Caribe, Medical School, PO Box 60-327, Bayamón, Puerto Rico
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Stopping long-acting beta-2 agonists. Med Lett Drugs Ther 2010; 52:21. [PMID: 20336032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Gong H, Liu Q, Yang X, Liu Z, Liu G, Li Z. Effects of selective alpha 2-adrenoreceptor stimulation on capsaicin-evoked substance P release from primary cultured dorsal root ganglion neurons. Pharmazie 2010; 65:202-205. [PMID: 20383941] [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: 05/29/2023]
Abstract
Alpha2 adrenoreceptors are expressed in dorsal root ganglion (DRG) neurons and may be involved in inflammation or other physiological and pathophysiological conditions. To determine the effects of administration of selective alpha2 adrenoreceptor agonists or antagonists on substance P (SP) release from DRG neurons without or with capsaicin stimulation, primary cultured embryonic rat DRG neurons were preincubated with the selective alpha2 adrenoreceptor agonist clonidine (10(-5) mol/L) or the alpha2 adrenoreceptor antagonist yohimbine (10(-5) mol/L) for 4 days, respectively, followed by the addition of capsaicin (10(-7) nmol/L) for additional 10 min. Cultures were examined by radioimmunoassay (RIA) for detecting SP levels released from DRG neurons before and after capsaicin stimulation. Expression of SP mRNA and vanilloid receptor 1 (VR1) mRNA was determined by RT-PCR. Administration of the selective alpha2 adrenoreceptor agonist clonidine for 4 days could decrease capsaicin-evoked SP release but not basal SP release. Administration of clonidine could decrease VR1 mRNA expression but not SP mRNA. Administration of the selective alpha2 adrenoreceptor antagonist yohimbine did not have these effects. The inhibitory role of the selective alpha2 adrenoreceptor agonist clonidine on capsaicin-evoked SP release may be through decreasing VR1 mRNA levels then reducing the sensitivity of nociceptors to capsaicin. The data provided in the present study suggest that adrenergic modulation on primary sensory neurons by an alpha2 adrenoreceptor agonist may contribute to the analgesic effects in neurogenic inflammation.
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Affiliation(s)
- Huicui Gong
- Department of Anatomy, Shandong University School of Medicine, Jinan, China
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Kozlovskiĭ VI, Zinchuk VV, Chlopicki S. [Role of NO in the coronary vessel responses to agonists of various adrenoceptor subtypes]. Eksp Klin Farmakol 2010; 73:10-13. [PMID: 20369594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We have studied the role of NO in coronary flow responses to agonists of alfa-2, beta-1, beta-2 and beta-3 adrenoceptors in the isolated mouse heart perfused according to the Langendorff method. The selective alfa-2 adrenoceptor agonist clonidine (10(-8) - 10(-6) M) displayed coronary vasoconstrictor properties as it induced dose-dependent decrease in the coronary flow. On the contrary, the nonselective beta-1/beta2/beta-3 adrenoceptor agonist isoprenaline (10(-8) - 10(-7) M) was a coronary vasodilator and caused dose-dependent increase in the coronary flow. The response to clonidine or isoprenaline was not changed by the presence of the NO-synthase inhibitor L-NO-nitroarginine methyl ester (L-NAME, 5 x 10(-4) M). The selective beta-3 adrenoceptor agonist BRL 37344 at high concentrations (10(-6) - 10(-5) M) produced a coronary vasodilator effect, but this effect was completely blocked by the beta-1/beta-2 adrenoceptor antagonist nadolol (10(-5) M). It is concluded that NO does not play any significant role in the coronary vascular responces mediated by alfa-2, beta-1, and beta-2 adrenoceptors in the isolated mouse heart. The functionally active beta-3 adrenoceptors seem to be not active in the coronary circulation in the isolated mouse heart.
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Liu H, Gong H, Liu Z, Yang X, Liu G, Li Z. Effects of acute exposure of alpha 1- and alpha 2-adrenoreceptor agonist or antagonist on capsaicin-evoked substance P release from dorsal root ganglion neurons in vitro. Pharmazie 2010; 65:47-50. [PMID: 20187578] [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: 05/28/2023]
Abstract
Peripheral alpha-adrenoceptors are involved in mediating neurogenic inflammation. To characterize the effects of acute administration of selective alpha adrenoreceptor agonists or antagonists on capsaicin-evoked substance P (SP) release from dorsal root ganglion (DRG) neurons, dissociated cultured DRG neurons were preincubated with selective alpha 1-adrenoreceptor agonist phenylephrine (10(-5) mol/L), alpha 1-adrenoreceptor antagonist prazosin (10(-6) mol/L), alpha 2-adrenoreceptor agonist clonidine (10(-5) mol/L), alpha 2-adrenoreceptor antagonist yohimbine (10(-5) mol/L) for 10 min, followed by the addition of capsaicin (10(-7) nmol/L) for additional 10 min. Radioimmunoassay (RIA) was employed to determine if the capsaicin-evoked enhancement of neuropeptide release was subject to adrenergic modulation. Expression of SP mRNA was determined by RT-PCR. Acute exposure of selective alpha 1-adrenoreceptor agonist phenylephrine could increase capsaicin-evoked SP release from primary cultured DRG neurons. Expression of SP mRNA was not affected by acute stimulation with these adrenoreceptor agonists or antagonists. The data provided in the present study suggest that the excitatory effect of alpha 1-adrenoreceptor agonist on capsaicin-evoked release of neuropeptide from primary cultured DRG neurons is likely to be mediated by activation of VR1 to influence capsaicin sensitivity but not by promotion of SP synthesis under acute stimulative states.
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Affiliation(s)
- Huaxiang Liu
- Department of Rheumatology, Qilu Hospital, Shandong University, Jinan, China
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Suleyman H, Dursun H, Bilici M, Cadirci E, Halici Z, Gulaboglu M, Albayrak F. Relation of adrenergic receptors, which have roles in gastroprotective and anti-inflammatory effect of adrenal gland hormones, with cyclooxygenase enzyme levels in rats. J Physiol Pharmacol 2009; 60:129-134. [PMID: 20065506] [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] [Received: 01/21/2009] [Accepted: 11/06/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIMS COX-2 enzyme inhibition is responsible for the anti-inflammatory effects of NSAIDs, COX-1 for their effects upon the gastrointestinal system (GIS), along with other side effects. We investigated the relationship between COX levels and those adrenergic receptors known to play a role in gastroprotection and anti-inflammatory activity. METHOD The effects of adrenaline and prednisolone on gastric COX-1 and COX-2 levels in both intact and adrenalectomized rats treated with doxazosin, yohimbine, propranolol, and metoprolol were determined. RESULTS We found that adrenaline increases COX-1 levels in the gastric tissue of both intact and adrenalectomized rats by stimulating alpha-2 receptors. Adrenaline decreases COX-2 levels by stimulating beta-2 adrenergic receptors. Prednisolone inhibits both COX-1 and COX-2 in the gastric tissue of intact rats. In adrenalectomized rats, prednisolone increases gastric COX-1 by stimulating alpha-2 receptors, and decreases COX-2 levels by stimulating beta-2 receptors. CONCLUSION Prednisolone cannot bind to a adrenergic receptors in the presence of adrenaline (intact rats) but, in its absence (adrenalectomy), binds to alpha-2 receptors, and stimulates them more effectively than adrenaline, suggesting a direct relationship between alpha-2 adrenergic receptors and COX-1 levels, whereas beta-2 receptors are directly related to COX-2 levels.
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Affiliation(s)
- H Suleyman
- Faculty of Medicine, Department of Pharmacology, Ataturk University, Erzurum, Turkey.
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Zhang YM, Peng J, Hu CP, Jiang QT, Jiang GL, Li YJ. Clonidine induces calcitonin gene-related peptide expression via nitric oxide pathway in endothelial cells. Peptides 2009; 30:1746-52. [PMID: 19520131 DOI: 10.1016/j.peptides.2009.06.001] [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] [Received: 02/23/2009] [Revised: 05/30/2009] [Accepted: 06/01/2009] [Indexed: 11/25/2022]
Abstract
The present study was to determine whether clonidine could induce calcitonin gene-related peptide (CGRP) production and the underlying mechanisms. Human umbilical vein endothelial cells were treated with clonidine and the dose-effect or time-effect relationship of clonidine on CGRP production was examined. Yohimbine (a alpha(2)-adrenoceptor blocker) and L-NAME (an antagonist of nitric oxide synthase, NOS) were chosen to explore the role of alpha(2)-adrenoceptor and nitric oxide pathway in the effect of clonidine on endothelial cell-derived CGRP production. The level of CGRP mRNA or protein was detected by Real Time-PCR or radioimmunoassay. Nitric oxide content was measured by nitroreduction assay. The study showed that clonidine was able to induce CGRP mRNA (alpha- and beta-isoforms) expression in a dose-dependent manner in endothelial cells. The effect of clonidine on endothelial cell-derived CGRP synthesis and secretion was attenuated in the presence of yohimbine. L-NAME treatment could also inhibit clonidine-induced CGRP synthesis and secretion concomitantly with the decreased NO content in culture medium. These results suggest that clonidine could stimulate CGRP synthesis and secretion in endothelial cells through the activation of alpha(2)-adrenoceptor, which is related to the NO pathway.
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Affiliation(s)
- Yi-Min Zhang
- Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, 110 Xiang-Ya Road, Changsha, Hunan, China
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Lahiri P, Chaudhuri U, Dasgupta AK, Ray SN, Saha S, Mukherjee P. Insensitivity to the α2-adrenergic receptor blocker yohimbine hydrochloride and occurrence of spontaneous platelet macroaggregation (SPMA) in diabetes. Platelets 2009; 16:111-5. [PMID: 15823867 DOI: 10.1080/09537100400005659] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report here a study of platelet aggregation in diabetes, induced by epinephrine and its inhibition by yohimbine hydrochloride (YH), an alpha(2)-adrenergic receptor-blocking agent. Interestingly, emergence of spontaneous platelet macroaggregation (SPMA) was observed in six out of 75 cases in the absence of any agonist. The SPMA cases were strongly associated with insensitivity to YH (in contrast with non-SPMA cases) when epinephrine was used as an agonist. We suggest that the observed correlation is a result of over expression of platelet alpha(2)-adrenoceptors in such subjects. The quantitative nature of the effect is supported by the observation that addition of YH at higher concentration (more than 5 microM) led to restoration of the adrenergic receptor-blocking activity of the said agent. Eventually for non-SPMA subjects YH exhibited blocking activity even at lower concentration. The aggregation profile and the platelet morphology of the SPMA cases had distinctive features as compared to microaggregates formed in other diabetic subjects (non-SPMA cases).
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Affiliation(s)
- Prabir Lahiri
- Institute of Haematology and Transfusion Medicine, Medical College, Kolkata, India
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Tachibana T, Sugahara K, Ueda H, Cline MA. Role of adrenergic alpha-2-receptors on feeding behavior in layer-type chicks. Gen Comp Endocrinol 2009; 161:407-11. [PMID: 19233186 DOI: 10.1016/j.ygcen.2009.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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] [Received: 10/24/2008] [Revised: 02/07/2009] [Accepted: 02/12/2009] [Indexed: 11/24/2022]
Abstract
The present study was designed to investigate the role of brain adrenergic alpha-2-receptors on feeding regulation of layer-type chicks. Intracerebroventricular injection of the adrenergic alpha-2-receptor agonist, clonidine, stimulated food intake. This effect was blocked by co-injection of the alpha-2-receptor antagonist, yohimbine, demonstrating that the alpha-2-receptor is related to stimulation of feeding in layer-type chicks. Stimulation of food intake caused by neuropeptide Y and beta-endorphin was attenuated by co-injection with yohimbine. However, yohimbine did not block prolactin-releasing peptide stimulation of food intake. It is therefore likely that brain adrenergic alpha-2-receptors mediate the orexigenic effects of neuropeptide Y and beta-endorphin in layer-type chicks.
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Affiliation(s)
- Tetsuya Tachibana
- Laboratory of Animal Production, Department of Agrobiological Science, Faculty of Agriculture, Ehime University, Tarumi 3-5-7, Matsuyama 790-8566, Japan.
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Abstract
BACKGROUND Withdrawal is a necessary step prior to drug-free treatment or as the end point of long-term substitution treatment. OBJECTIVES To assess the effectiveness of interventions involving the use of alpha2-adrenergic agonists to manage opioid withdrawal. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2008), MEDLINE (January 1966-July 2008), EMBASE (January 1985-2008 Week 31), PsycINFO (1967 to 7 August 2008) and reference lists of articles. We also contacted manufacturers in the field. SELECTION CRITERIA Controlled trials comparing alpha2-adrenergic agonists with reducing doses of methadone, symptomatic medications or placebo, or comparing different alpha2-adrenergic agonists to modify the signs and symptoms of withdrawal in participants who were opioid dependent. DATA COLLECTION AND ANALYSIS One author assessed studies for inclusion and undertook data extraction. Inclusion decisions and the overall process were confirmed by consultation between all authors. MAIN RESULTS Twenty-four studies, involving 1631 participants, were included. Twenty-one were randomised controlled trials.Thirteen studies compared a treatment regime based on an alpha2-adrenergic agonist with one based on reducing doses of methadone. Diversity in study design, assessment and reporting of outcomes limited the extent of quantitative analysis.Alpha2-adrenergic agonists are more effective than placebo in ameliorating withdrawal, and despite higher rates of adverse effects, are associated with significantly higher rates of completion of treatment.For the comparison of alpha2-adrenergic agonist regimes with reducing doses of methadone, there were insufficient data for statistical analysis, but withdrawal intensity appears similar to or marginally greater with alpha2-adrenergic agonists, while signs and symptoms of withdrawal occur and resolve earlier. Participants stay in treatment longer with methadone. No significant difference was detected in rates of completion of withdrawal with adrenergic agonists compared to reducing doses of methadone, or clonidine compared to lofexidine. Clonidine is associated with more adverse effects than reducing doses of methadone. Lofexidine does not reduce blood pressure to the same extent as clonidine, but is otherwise similar to clonidine AUTHORS' CONCLUSIONS Clonidine and lofexidine are more effective than placebo for the management of withdrawal from heroin or methadone. No significant difference in efficacy was detected for treatment regimes based on clonidine or lofexidine, and those based on reducing doses of methadone over a period of around 10 days but methadone is associated with fewer adverse effects than clonidine, and lofexidine has a better safety profile than clonidine.
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Affiliation(s)
- Linda Gowing
- Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005.
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Uysal H, Larsson LE, Efendi H, Burke D, Ertekin C. Medium-latency reflex response of soleus elicited by peroneal nerve stimulation. Exp Brain Res 2008; 193:275-86. [PMID: 18985330 DOI: 10.1007/s00221-008-1621-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 10/10/2008] [Indexed: 11/29/2022]
Abstract
A medium-latency response (MLR) has been recorded from soleus during stance and walking, and has been attributed to stretch-evoked volleys in group II afferents. The present paper describes a MLR in soleus evoked by stimulating the deep peroneal nerve, documents its characteristics and addresses its likely origin. The MLR of soleus was recorded in healthy subjects and hemiplegic patients, following electrical stimulation of the deep peroneal nerve at the fibula at rest, during voluntary dorsiflexion, during plantar flexion, during external restraint to the ankle dorsiflexion movement, during limb cooling, during limb ischaemia and 1 h after the ingestion of tizanidine. The dorsiflexion movement of the foot was measured using an accelerometer. During cooling, ischaemia and after tizanidine, changes in the MLR were compared with changes in the soleus H reflex, Achilles tendon reflex and, during cooling, F waves of abductor hallucis. The MLR was facilitated by voluntary dorsiflexion, was suppressed during plantar flexion, disappeared when ankle movement was prevented, and was enhanced in patients with spastic hemiplegia. Cooling delayed the MLR significantly more than the Achilles tendon reflex and the abductor hallucis F wave. During ischaemia the response was significantly less affected than the Achilles tendon reflex and the soleus H reflex. Tizanidine suppressed the MLR, but not the soleus H and tendon reflexes. The latencies and the experiments using cooling, ischaemia and tizanidine implicate soleus group II afferents in the genesis of this response.
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Affiliation(s)
- Hilmi Uysal
- The Department of Clinical Neurophysiology, Ege University Medical School Hospital, Izmir, Turkey.
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Abstract
Alpha-2 adrenoceptors (alpha(2)-ARs) are critically involved in regulating neurotransmitter release from sympathetic nerves and neurons and play an important role in the regulation of awareness, arousal and vigilance. In our recent study, dexmedetomidine, a full alpha(2)-AR agonist, produced antiaggressive effects in the social conflict test in mice at doses that were twice smaller than those producing sedation. The aim of this study was to ascertain antiaggressive effect of a novel drug naphthylmedetomidine, with a more selective alpha(2)-AR activity. Behavioral effects of naphthylmedetomidine (150-1200 microg/kg i.p.) were studied in the activity cage and in the social conflict tests in mice. Naphthylmedetomidine dose dependently decreased aggressive behavior during social conflict in aggressive mice with significant reduction already at the lowest doses tested (150 microg/kg), whereas locomotion and social investigation were significantly decreased only after four times bigger dose of naphthylmedetomidine (600 microg/kg) in aggressive mice. Naphthylmedetomidine had no effect on aggression in nonaggressive mice. Naphthylmedetomidine reduced locomotion in the activity cage significantly only at the highest doses tested (600 and 1200 microg/kg), and this effect was only partially reversed by administration of high doses of an alpha-2 antagonist atipamezole (3 and 10 mg/kg). In nonaggressive mice, the difference between the dose reducing dominant social behavior (social investigation) and locomotion (150 and 300 microg/kg, respectively) was smaller than in aggressive mice. In conclusion, naphthylmedetomidine showed a very strong and selective antiaggressive effect in aggressive mice, which was devoid of locomotion-inhibiting/sedative effect. This study suggests that naphthylmedetomidine may have clinical potential as antiaggressive drug.
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Affiliation(s)
- Martin Votava
- Charles University in Prague, 3rd Faculty of Medicine, Pharmacology Department, Prague, Czech Republic.
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Franco W, Leite RDS. Dobutamine inhibits vasopressin-mediated water transport across toad bladder epithelium. Comp Biochem Physiol C Toxicol Pharmacol 2008; 148:68-71. [PMID: 18434255 DOI: 10.1016/j.cbpc.2008.03.008] [Citation(s) in RCA: 2] [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] [Received: 01/04/2008] [Revised: 03/09/2008] [Accepted: 03/10/2008] [Indexed: 11/26/2022]
Abstract
This study aimed to investigate the effect of dobutamine on water transport across toad bladder epithelium. Water flow through the membrane was measured gravimetrically in bladder sac preparations. Dobutamine had no effect on basal water transport, but partially inhibited transport stimulated by vasopressin. Similarly, dobutamine exerted no influence on the hydrosmotic response to 8-chlorophenylthio-cAMP, but interfered with the response to phosphodiesterase inhibitor 1-methyl-3-isobutyl-xanthine. These results demonstrate that this catecholamine may inhibit vasopressin-stimulated water transport at a site prior to cAMP formation. The use of propranolol was ineffective in blocking the effect of dobutamine on transport stimulated by vasopressin, indicating that beta-adrenoceptors play no role in this effect. On the other hand, phentolamine significantly reduced the effect of dobutamine, indicating the involvement of alpha-adrenoceptors in such event. Rauwolscine also inhibited the effect of dobutamine, pointing to the specific contribution of the alpha(2)-adrenoceptors to this effect. Taken together, the results of this study demonstrate that dobutamine inhibits vasopressin-stimulated water transport in toad bladders through a mechanism mediated by the stimulation of alpha(2)-adrenoceptors, thus suggesting that such a drug may exert a direct cellular effect on membrane permeability to water in transporting epithelia. The current study may provide a better understanding of the effects of dobutamine on renal function by contributing towards the elucidation of its action mechanism.
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Affiliation(s)
- Wilson Franco
- Departamento de Ciências Fisiológicas, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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Sáiz J, Pazos A, Del Olmo E, Sáiz V, Sánchez A. Yohimbine-induced alterations in alpha(2)-adrenoceptors in kidney regions of the spontaneously hypertensive rats: an autoradiographic analysis. Pharmacol Rep 2008; 60:391-398. [PMID: 18622064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 01/31/2008] [Indexed: 05/26/2023]
Abstract
We have tested the hypothesis that a pharmacologically determined alteration in renal alpha(2)-adrenoceptor (alpha(2)-AR) density might be a pathophysiologically important factor of genetic hypertension in the spontaneously hypertensive rats (SHRs). First, we compared he regional distribution and biochemical parameters of alpha(2)-ARs in SHRs and Wistar-Kyoto (WKY) rats, using the full agonist [(3)H]UK 14304. Secondly, we evaluated the effect of selective blockade and stimulation of alpha(2)-ARs on the development of hypertension and on renal alpha(2)-AR density and regional distribution in SHRs. [(3)H]UK 14304 binding was distributed predominantly over the outer medulla, less abundantly over the inner medulla and was almost absent from the renal cortex. Renal alpha(2)-ARs were found to be increased in SHRs at the ages tested compared with their respective controls and the increase was completely localized to the outer medulla. In these rats, blood pressures immediately before sacrifice were significantly higher in the hypertensive group compared with normotensive controls. The daily administration of SK&F 86,466 or clonidine significantly decreased the blood pressure but the autoradiographic studies showed that the prolonged administration of yohimbine to rats for two weeks resulted in a large increase in the density of alpha(2)-ARs in some areas of the rat kidney but not in others. Taken together these data do not support the hypothesis that alteration in renal alpha(2)-ARs (as measured by autoradiography) is crucial for the maintenance of hypertension in the SHR model.
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Affiliation(s)
- Jesús Sáiz
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Córdoba, Avenida Menéndez Pidal, s/n, 14071 Córdoba, Spain.
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Tribouillard-Tanvier D, Béringue V, Desban N, Gug F, Bach S, Voisset C, Galons H, Laude H, Vilette D, Blondel M. Antihypertensive drug guanabenz is active in vivo against both yeast and mammalian prions. PLoS One 2008; 3:e1981. [PMID: 18431471 PMCID: PMC2291559 DOI: 10.1371/journal.pone.0001981] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 03/10/2008] [Indexed: 11/24/2022] Open
Abstract
Background Prion-based diseases are incurable transmissible neurodegenerative disorders affecting animals and humans. Methodology/Principal Findings Here we report the discovery of the in vivo antiprion activity of Guanabenz (GA), an agonist of α2-adrenergic receptors routinely used in human medicine as an antihypertensive drug. We isolated GA in a screen for drugs active in vivo against two different yeast prions using a previously described yeast-based two steps assay. GA was then shown to promote ovine PrPSc clearance in a cell-based assay. These effects are very specific as evidenced by the lack of activity of some GA analogues that we generated. GA antiprion activity does not involve its agonist activity on α2-adrenergic receptors as other chemically close anti-hypertensive agents possessing related mechanism of action were found inactive against prions. Finally, GA showed activity in a transgenic mouse-based in vivo assay for ovine prion propagation, prolonging slightly but significantly the survival of treated animals. Conclusion/Significance GA thus adds to the short list of compounds active in vivo in animal models for the treatment of prion-based diseases. Because it has been administrated for many years to treat hypertension on a daily basis, without major side-effects, our results suggest that it could be evaluated in human as a potential treatment for prion-based diseases.
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Affiliation(s)
- Déborah Tribouillard-Tanvier
- INSERM U613, Brest, France
- Univ Brest, Faculté de Médecine et des Sciences de la Santé, UMR-S613, Brest, France
- Etablissement Français du Sang (EFS) Bretagne, Brest, France
- CHU Brest, Hop Morvan, Laboratoire de Génétique Moléculaire, Brest, France
- CNRS UPS2682, Station Biologique, Protein Phosphorylation and Disease Laboratory, Place Georges Teissier, Roscoff, France
| | - Vincent Béringue
- Institut National de la Recherche Agronomique (INRA), UR892, Virologie Immunologie Moléculaires, Jouy-en-Josas, France
| | - Nathalie Desban
- CNRS UPS2682, Station Biologique, Protein Phosphorylation and Disease Laboratory, Place Georges Teissier, Roscoff, France
| | - Fabienne Gug
- INSERM U648, Laboratoire de Chimie Organique 2, Université Paris Descartes, Paris, France
| | - Stéphane Bach
- CNRS UPS2682, Station Biologique, Protein Phosphorylation and Disease Laboratory, Place Georges Teissier, Roscoff, France
| | - Cécile Voisset
- INSERM U613, Brest, France
- Univ Brest, Faculté de Médecine et des Sciences de la Santé, UMR-S613, Brest, France
- Etablissement Français du Sang (EFS) Bretagne, Brest, France
- CHU Brest, Hop Morvan, Laboratoire de Génétique Moléculaire, Brest, France
| | - Hervé Galons
- INSERM U648, Laboratoire de Chimie Organique 2, Université Paris Descartes, Paris, France
| | - Hubert Laude
- Institut National de la Recherche Agronomique (INRA), UR892, Virologie Immunologie Moléculaires, Jouy-en-Josas, France
| | - Didier Vilette
- Institut National de la Recherche Agronomique (INRA), UR892, Virologie Immunologie Moléculaires, Jouy-en-Josas, France
| | - Marc Blondel
- INSERM U613, Brest, France
- Univ Brest, Faculté de Médecine et des Sciences de la Santé, UMR-S613, Brest, France
- Etablissement Français du Sang (EFS) Bretagne, Brest, France
- CHU Brest, Hop Morvan, Laboratoire de Génétique Moléculaire, Brest, France
- * To whom correspondence should be addressed. E-mail:
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Il'inykh FA, Bannova AV, Kalinina TS, Dygalo NN. [Effects of ligands of alpha2-adrenoceptors on mRNA level of apoptotic proteins in the developing rat brain]. Izv Akad Nauk Ser Biol 2008:104-109. [PMID: 18491567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The effects of antagonist of alpha2-adrenoceptors yohimbine and their agonist clonidine on Bax and Bcl-XL mRNA levels in neonatal rat brain were studied. Yohimbine decreased Bax mRNA level in the cerebellum, increased the ratio between Bcl-XL and Bax mRNA levels in the cerebellum, cortex, and hippocampus, and increased Bcl-XL mRNA level in the cortex and hippocampus of 6-day-old-rat pups 24 h after injection. Administration of clonidine 20 min after yohimbine administration abolished its effect on Bcl-XL mRNA level in the hippocampus. The data obtained indicate that the blockade of alpha2-adrenoceptors induces antiapoptotic changes in the developing rat brain, some of which can be abolished after coadministration with the agonist of these receptors.
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