Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

Role of heme oxygenase/carbon monoxide pathway on the vascular response to noradrenaline in portal hypertensive rats.

1. Portal hypertension (PH), a major syndrome in cirrhosis, producing hyperdynamic splanchnic circulation and hyperaemia. In order to elucidate the contribution of heme oxygenase to the vascular hyporeactivity, we assessed the activity of heme oxygenase-1 (HO-1), measured the in vivo pressure response to noradrenaline (NA) and investigated the effects of blocking the carbon monoxide (CO) and nitric oxide (NO) pathways in a prehepatic model of PH in rats. 2. Portal hypertension was induced by partial portal vein ligation (PPVL). Noradrenaline was injected intravenously. Liver, spleen and mesentery homogenates were prepared for measurement of HO-1 activity and expression. Four groups of rats were used: (i) a sham group; (ii) a PPVL group; (iii) a sham group pretreated with Zn-protoporphyrin IX (ZnPPIX); and (iv) a PPVL group pretreated with ZnPPIX. Each group was studied before and after treatment with the NO synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME). 3. For basal pressures and the pressure response to NA, inhibition of CO and NO pathways by ZnPPIX and L-NAME, respectively, produced an increase in mean arterial pressure (MAP) in sham-operated and in PH rats. Similarly, when both inhibitors were used together in either sham or PPVL rats, a greater increase in MAP was observed. 4. These results, together with the increased HO-1 activity and expression only in the PH group, have led us to suggest that the heme oxygenase/CO pathway is involved in the vascular response to NA in PH rats.

Regulation of endothelial nitric oxide synthase expression by albumin-derived advanced glycosylation end products.

We examined whether albumin-derived advanced glycosylation end products (AGEs) downregulate the expression of endothelial nitric oxide synthase (NOS). Significant reductions in NOS activity and cGMP levels in bovine aortic endothelial cells were observed when exposed to different concentrations of albumin-derived AGEs. Western and Northern blot analyses showed significant decreases at the protein and transcript levels. Both reductions became evident after 24 hours of exposure. Nuclear run-on assays showed that AGE-BSA did not modify the transcription rate of the NOS III gene; however, AGE-BSA treatment markedly reduced the half-life of NOS III mRNA. In addition, AGE-treated endothelial cells displayed significant reduction on their antiplatelet properties. These results indicate that NOS expression is reduced by AGEs by increasing the rate of mRNA degradation and may be relevant to the impairment of some endothelial functions observed in diabetes and aging. The full text of this article is available at http://www.circresaha.org.

Norepinephrine uptake modifications in circumventricular organs, pons and myelencephalic areas and nuclei in prehepatic portal hypertensive rats.

Peripheral noradrenergic activity is enhanced in portal hypertension and correlates with the progression of the disease. However, little is known about the status of central norepinephrine (NE) in portal hypertension. The aim of the present work was to study the uptake of NE in several areas rich in NE in experimental prehepatic portal hypertension. The experiments were performed in vitro in several encephalic areas and nuclei, obtained according to the 'punch-out technique'. Results showed that in portal hypertensive rats NE uptake enhanced in all areas and nuclei studies (subfornical organ, organum vasculosum lamina terminalis, area postrema, locus coeruleus and nucleus tractus solitarius). The present results suggest that these encephalic areas and brainstem nuclei may be related to the development and/or maintenance of portal hypertension in this animal model.

An experimental model of liver damage and portal hypertension induced by a single dose of monocrotaline.

BACKGROUND/AIMS: Hepatic cirrhosis accompanied by portal hypertension is a common cause of death in human beings. The aim of the present study was to develop an experimental model of hepatic portal hypertension associated with liver damage. METHODOLOGY: To develop liver damage in rats, we used the toxic alkaloid monocrotaline. Two groups of male Wistar rats were used. Group 1 was injected with a single dose of monocrotaline (60 mg/kg of body weight) intraperitoneally. Group 2 was injected with an equal volume of saline solution. After 44 days, the animals underwent the following tests: splenoportography and measurement of portal pressure, hepatic serum biochemical tests, and light and electron microscopy. RESULTS: Group 1 showed a significant increase in splenic pressure, superior and inferior collateral circulation, and an increase in portal vein diameter. Serious alterations were detected in hepatic serum markers. Light microscopy showed different degrees of hepatocyte damage, varying from edema to focal necrosis. Ultrastructural changes were of membrane disruption, mitochondrial and nuclear alterations. CONCLUSIONS: The present experimental model could be useful in establishing the pathophysiological changes associated with portal hypertension due to liver damage.

Tyrosine hydroxilase activity in discrete brain regions from prehepatic portal hypertensive rats.

BACKGROUND/AIMS: Portal hypertension in patients and rat models are characterized by splanchnic and systemic hemodynamic alterations. Both the central and autonomic nervous systems are implicated in its pathophysiology. The aim of our research was to study the tyrosine hydroxylase activity and the rate limiting step in the biosynthesis of catecholamines in partial ligated portal hypertensive and in control rat brains. METHODOLOGY: The following seven discrete brain regions were investigated: Subfornical Organ, Organum Vasculosum Lamina Terminalis, Median Eminence, Periventricular Nucleus, Area Postrema, Locus Coeruleus and Nucleus Tractus Solitarius. RESULTS: The enzyme activity showed a significant increment in six nuclei and a decrease in Area Postrema Nucleus when portal hypertensive rats were compared to controls. CONCLUSIONS: These results suggest the participation of some discrete brain regions in the mechanism of hepatic portal hypertension under the present rat model.

Norepinephrine uptake is enhanced in discrete telencephalic and diencephalic areas and nuclei in prehepatic portal hypertensive rats.

Several evidences support the hypothesis that central catecholamines may play a significant role in the production and/or maintenance of different alterations that characterize portal hypertension. The aim of the present work was to study the possible modifications in norepinephrine (NE) metabolism in several telencephalic and diencephalic areas rich in NE in experimental prehepatic portal hypertension. NE uptake was studied as an index of NE metabolism. The experiments were carried out in vitro in encephalic areas and nuclei, obtained according to the punch-out technique. Results indicated that portal hypertensive rats showed an enhancement of NE uptake in olfactory bulb (OB), preoptic area (PA), and supraoptic, periventricular, paraventricular, and arcuate nuclei (SON, PeVN, PaVN, and AN, respectively) compared to sham-operated rats. However, no modifications on NE uptake was observed in the median eminence (ME). Present results suggest that the changes observed in central NE uptake may be related to the development and/or maintenance of the portal hypertensive state.

Systemic baroreflex alterations in prehepatic portal hypertensive conscious rats.

In portal hypertensive patients and experimental models, hyperdynamic circulatory disturbances associated to a reduced peripheral resistance and an increased cardiac output appeared. The aim of this research is the study of the baroreflex system behavior partially portal vein ligated-portal hypertensive rats. Sham operated rats (S) (n = 7) and portal hypertensive rats (PH) (n = 9) were used. In anesthetized rats, catheters were introduced into a jugular vein for drug injection and into the ventral tail artery to record blood pressure and heart rate. When rats were conscious and moving freely, a bolus injection of phenylephrine hydrochloride (6 micrograms/kg) was injected in the vein. A sigmoid curve relating systolic blood pressure and heart period was dressed. We analyzed: 1) The gain or sensitivity: the slope of the regression line; 2) The threshold: systolic blood pressure at which the regression begins to be linear. The results were: mean arterial pressure (mmHg): S = 103 +/- 7; PH = 109 +/- 3; gain (ms/mmHg): S = 1.29 +/- 0.10; PH = 0.62 +/- 0.04 (p < 0.001); threshold (mmHg): S = 145 +/- 7; PH = 146 +/- 4. The baroreceptor reflex sensitivity was significantly decreased. No differences appeared in the mean arterial pressure and in the reflex threshold. It is suggested that portal hypertension induces alterations in baroreflex regulation of arterial blood pressure.

Prehepatic portal hypertension in rats modifies norepinephrine metabolism in hypothalamus, medulla oblongata and portal vein.

The present experiments investigated the possible relationship between portal hypertension and norepinephrine metabolism in the central nervous system (hypothalamus and medulla oblongata) and the portal vein in the rat. Group I (72), portal hypertensive, and group II (70) sham-operated animals, were sacrificed day 14, and endogenous norepinephrine content, uptake and release from hypothalamus, medulla oblongata, and portal vein were investigated. In group I our results showed increases in norepinephrine storage (69%; 8.3%) and release (19.7%; 43.8%) and a diminished uptake (42.3%; 27.5%) in the hypothalamus and medulla oblongata, respectively. Portal veins showed a decreased content and uptake (62.5% and 43.5%, respectively) and increased release (25%) compared to group II rats. These results suggest a close relationship between the central nervous system and rat portal hypertension, perhaps related to modifications of central sympathetic activity.