Oxidative stress during reperfusion of human hearts: potential sources of oxygen free radicals.

OBJECTIVE: The aim was to examine the role of neutrophil activation in the genesis of oxidative stress during the early phases of reperfusion after ischaemia in patients subjected to aortocoronary bypass grafting. METHODS: Ten selected patients were studied. All had normal ejection fraction and normal left ventricular end diastolic pressures before operation. Each patient required at least three grafts, so that the duration of aortic crossclamping exceeded 30 min, the minimum ischaemic period required to detect oxidative stress upon reperfusion. Oxidative stress was assessed by measuring the formation and release of oxidised glutathione (GSSG) in the coronary sinus 1 min before and 3 min after the start of the cardiopulmonary bypass, and then 1, 5, 10, and 20 min after removal of the aortic clamp, and again 5 and 10 min after the end of the cardiopulmonary bypass. The arterial-coronary sinus difference for neutrophils, elastase-alpha 1 protease complex (elastase), and creatine phosphokinase was also monitored at the same intervals. RESULTS: Before clamping GSSG was undetectable in arterial and coronary sinus blood. There was no significant arterial-coronary sinus difference for neutrophils or elastase [53(SEM 66) cell.ml-1 and 1.10(2.49) micrograms.litre-1, respectively[. Five minutes after re-establishment of coronary blood flow, there was both a release of GSSG into the coronary sinus [arterial-coronary sinus difference: 11(2.6) nmol.dl-1] and an accumulation of neutrophils in the heart [arterial-coronary sinus difference: 262(33), P < 0.01 cell.ml-1], whereas no elastase release from the heart was measured [arterial-coronary sinus difference 7.6(4.46) microgram.litre-1, NS]. The arterial levels of elastase increased progressively during the operation from 48(5) microgram.litre-1 (preclamping) to 405(62) microgram.litre-1, P < 0.01 (end of the cardiopulmonary bypass). CONCLUSIONS: These data indicate that, in man, neutrophils do accumulate in the myocardium during early reperfusion. However, they are not activated when oxidative stress occurs. It is unlikely that the neutrophil localisation in the heart has pathological significance in the production of oxygen free radicals during early reperfusion. Free radical accumulation in the coronary vessels may contribute to disorders of coronary flow associated with reperfusion.

Levels of atrial natriuretic factor in the plasma and urine of patients with and without heart failure.

We assayed the concentrations of atrial natriuretic factor and guanosine 3',5'-phosphate in the plasma and urine of six healthy subjects, 12 patients with coronary artery disease and 11 patients with congestive heart failure. Patients with coronary artery disease had normal levels of atrial natriuretic factor in the plasma and urine and a normal excretion of guanosine 3',5'-phosphate, while those with congestive heart failure had a raised level of atrial natriuretic factor in the plasma, an increased excretion of 3',5'-guanosine phosphate and normal excretion of atrial natriuretic factor. Thus, measurement of atrial natriuretic factor in the urine can not replace the assay of the peptide in plasma.

Plasma levels of atrial natriuretic factor (ANF) and urinary excretion of ANF, arginine vasopressin and catecholamines in children with congenital heart disease: effect of cardiac surgery.

We studied the changes in the plasma concentration of atrial natriuretic factor (ANF) and the urinary excretion of ANF, arginine vasopressin (AVP) and catecholamines in 22 children with congenital heart disease, divided into two groups. Group 1 included 11 children with congestive heart failure (CHF), treated with digitalis and diuretics. Group 2 included 11 children without CHF and without medical treatment. Each group was compared with a control group of 15 healthy, age-matched children. The plasma concentration of ANF was raised in both groups, but it was significantly higher in group 1 (235.5 +/- 82.9 pg/ml), compared to group 2 (48.4 +/- 29.4 pg/ml, P < 0.002). Urinary excretion of ANF was measurable in both groups and higher in group 1 (185.9 +/- 116.2 pg/kg per h) than in group 2 (48.5 +/- 30.7 pg/kg per h), but not significantly so. Urinary excretion of AVP and catecholamines was not different in children with congenital heart disease and healthy children. Twenty-four hours after surgery, plasma ANF diminished in group 1 (from 235.5 +/- 82.9 to 93.4 +/- 53.8 pg/ml, P < 0.003), but did not change in group 2. The urinary excretion of ANF was unchanged in both groups. In contrast, urinary excretion of AVP and catecholamines rose significantly in both groups. These data show that plasma ANF is increased in children with congenital heart disease, even in the absence of CHF. The measurement of urinary ANF is less reliable than a plasma assay. The postoperative increases in AVP and catecholamine urinary excretions could be responsible for the vasoconstriction and water retention typical of the postoperative period.

Isoproterenol induces release of atrial natriuretic peptide from rat atrium in vitro.

To investigate the mechanism underlying the release of atrial natriuretic peptide (ANP) in in vitro condition, isolated, superfused rat atria were subjected to adrenergic, chronotropic, and mechanical stimulation. First administration of isoproterenol (Iso; either 10(-9) or 10(-6) M) caused a release of ANP, which was transient. Subsequent increments in concentration of Iso always resulted in a much lower release of ANP, despite the increased effects on the mechanical function of the atria. Stretching of the atria resulted in a transient release of ANP. Subsequent increments in stretching were followed by decreasing release of ANP. The total score of ANP in atrial tissue after Iso and stretching was not measurably depleted. Pacing the atria with increasing frequency did not induce release of ANP. Depolarization with 40 mM KCl abolished the release of ANP in response to Iso but not the release induced by stretch. In the presence of low external Ca2+, which abolished mechanical activity, both Iso and stretch could still induce release of ANP. Propranolol abolished the release of ANP by Iso but not that induced by stretching. Prazosin did not affect the release by either stretch or Iso. Stretching the atria 20 min after administration of Iso did not cause any further release of ANP. On the other hand, adding Iso 20 min after stretching induced a release of ANP. It is concluded that Iso and stretch cause a transient release from isolated strips of atria. The amount of ANP released is not related to the dose of Iso or to the load applied. Mechanisms involved in the release mediated by the two stimuli are different.(ABSTRACT TRUNCATED AT 250 WORDS)

A new diagnostic test for primary aldosteronism.

Isotonic-isooncotic central volume expansion by head-out water immersion was induced in six aldosterone-producing adenoma subjects and in six patients with idiopathic hyperaldosteronism. Plasma renin activity and plasma aldosterone levels did not significantly change during water immersion while serum cortisol was significantly suppressed (P less than .001) and the aldosterone-cortisol ratio increased (P less than .02) in aldosterone-producing adenoma patients. Water immersion also revealed the failure of plasma aldosterone levels to decrease below 10 ng/dL in these subjects, thus confirming previous results obtained during isotonic saline infusion. Otherwise, plasma renin activity and plasma aldosterone were significantly reduced (P less than .05 and P less than .01 respectively) by water immersion and plasma aldosterone invariably fell below 10 ng/dL in patients with idiopathic aldosteronism. In view of the diagnostic reliability of such a suppression test we conclude that water immersion is suitable for discriminating between the two forms of primary aldosteronism. We therefore suggest its use for assessing renin-aldosterone responsiveness in primary aldosteronism.

Effect of congestive heart failure on rate of atrial natriuretic factor release in response to stretch and isoprenaline.

STUDY OBJECTIVE: The aim was to investigate the pattern of release of atrial natriuretic factor induced by mechanical and adrenergic stimulation from atria of rats with or without congestive heart failure. DESIGN: Monocrotaline, a pyrrolizidine alkaloid, was given to rats to cause severe pulmonary hypertension, leading to a marked degree of right ventricular hypertrophy and failure. Measurements of noradrenaline and atrial natriuretic factor were performed in each cardiac chamber and in plasma. Right and left atria of control rats and rats with congestive heart failure were isolated and subjected to mechanical or adrenergic stimulation to study the in vitro release of atrial natriuretic factor. MATERIALS: Studies were performed on plasma, ventricles, and isolated right and left atria of 276 male Wistar rats, 80-100 g weight, with or without congestive heart failure. MEASUREMENTS AND MAIN RESULTS: In monocrotaline rats right and left ventricular concentrations of noradrenaline were significantly reduced. In the same rats concentrations of atrial natriuretic factor fell to 15.2% in the right atria and to 65.5% in the left atria. Whole heart content of atrial natriuretic factor was diminished, while plasma concentrations were increased sevenfold. Isolated hypertrophied right atria of failing hearts did not release atrial natriuretic factor in response to stretch or to isoprenaline (10(-9)M) and they were insensitive to the inotropic action of isoprenaline. On the other hand, non-hypertrophied left atria from the same animals released increased amounts of atrial natriuretic factor under basal conditions and after both stimuli, despite reduced tissue stores of the peptide. CONCLUSIONS: Heart failure may deplete cardiac stores of noradrenaline and atrial natriuretic factor, especially in hypertrophied chambers, and can result in a decrease in the release of atrial natriuretic factor from atrial tissue in response to mechanical and adrenergic stimulation.

[Effects of acute administration of nifedipine on exercise-induced microalbuminuria in normotensive patients with type 1 diabetes]. / Effetto della somministrazione acuta di nifedipina sulla microalbuminuria da sforzo in pazienti diabetici di tipo 1 normotesi.

The aim of our study was to evaluate the acute effect of nifedipine, a calcium channel blocker, on exercise-induced microalbuminuria in normotensive and normoalbuminuric type 1 diabetic patients. Fifteen normotensive diabetic patients who were normoalbuminuric at rest (8 males and 7 females; age 16-35 years) and 10 normal subjects (6 males and 4 females; age 18-40 years) performed 4 submaximal cycloergometric exercises (90% of theoretical maximum heart rate); the first two exercises were performed in basal condition and the other 2 after 24 h of therapy with nifedipine AR (20 mg/b.i.d.) or placebo (2 cps/die). One hour after exercise in basal condition the microalbuminuria was 78 +/- 17 micrograms/min in diabetic patients vs 16 +/- 4 micrograms/min in normal subjects (p less than 0.001). After placebo no significant changes with respect to basal levels were observed 1 hour after exercise in either diabetic patients (82 +/- 16 microgram/min) or normal subjects (20 +/- 5 micrograms/min). In diabetic patients after nifedipine, systolic blood pressure was reduced both at rest and after exercise (p less than 0.05) with respect to basal condition or placebo. The urinary albumin excretion rate at rest was not modified, but it was significantly reduced 1 hour after exercise: 58 +/- 15 micrograms/min (p less than 0.01 vs placebo). This reduction correlated well with the reduction of exercise blood pressure in diabetic patients (r = 0.91, p less than 0.001). Our results indicate that acute administration of nifedipine reduced exercise-induced microalbuminuria in normotensive diabetic patients, probably by means of a reduction in exercise blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of prolonged infusions of atrial natriuretic peptide and isoproterenol on the mechanical and endocrine function of isolated atria.

We have measured the rate of release of atrial natriuretic peptide in response to stretch and to isoproterenol from superfused atria isolated from rats after chronic in vivo infusion of either atrial natriuretic peptide or isoproterenol. The infusion lasted seven days, using minipumps filled with: 1) saline; 2) synthetic atrial natriuretic peptide to release 3 micrograms/kg/h; 3) l-isoproterenol HCl to release 400 micrograms/kg/h. Infusion of isoproterenol caused hypertrophy of the left chambers of the heart, a decrease of atrial content of atrial peptide with increased plasma levels. Infusion of atrial natriuretic peptide resulted only in elevated plasma levels of the peptide. Atria from animals infused with atrial natriuretic peptide responded to stretch and to isoproterenol (10(-9) M) with a prompt and transient release of peptide. Atria from animals infused with isoproterenol showed a severe reduction in sensitivity to the inotropic and chronotropic action of the drug. Their basal release of atrial peptide was extremely reduced and they were unable to respond to stretch or to isoproterenol. These data indicate that high circulating levels of atrial natriuretic peptide do not influence the release of the peptide from the atria, while high levels of isoproterenol drastically reduce it. Beta adrenoceptor desensitization, atrial hypertrophy and decrease of stores of atrial peptide are likely to account for this phenomenon.

[Interference of some detergent micelles with the titration of protein]. / Interferenza di alcune miscele di detergenti con il dosaggio di proteine.

We have examined the possible interferences with spectrophotometric protein determination of some detergents commonly used for the solubilization of membrane proteins. The results show that some mixtures of Triton X100 with SDS or DOC, at given concentrations, interfere with BSA determination by the method of Lowry.