Estrés oxidativo en el recién nacido y su influencia en la fisiología vascular pulmonar / Oxidative stress in the newborn and its influence on pulmonary vascular physiology

El radical libre es cualquier especial química que contenga uno más electrones no apareados, y es habitual que las reacciones en las que interviene sean procesos en cadena. Los lípidos, los ácido nucleicos, los hidratos de carbono y las proteínas son susceptibles al ataque de los radicales libre, que sufren un daño oxidativo in vivo, lo que degenera en fenómenos de necrosis o de apoptosis celular. En contraposición a tales sistemas de oxidación, las células cuentan con enzimas y moléculas antioxidantes. Este delicado equilibrio existente en el organismo en condiciones de normoxia entre los mecanismos oxidantes y antioxidantes se define como estrés oxidativo. El desequilibrio de estos sistemas, en particular el estrés oxidativo derivado de un déficit en la maduración de los sistemas antioxidantes en el neonato, participa directa o indirectamente en la génesis de la patología clínica, contribuyendo tanto a la patogenia como al pronóstico. Además, hay condiciones inherentes al recién nacido que incrementan su susceptibilidad al daño pulmonar, convirtiendo al pulmón en un órgano crítico en este proceso de adaptación a la vida extrauterina, sobre todo teniendo en cuenta que la maduración pulmonar continúa durante la etapa postnatal. En cualquier caso, se sabe que los recién nacidos tienen una mayor resistencia a la toxicidad por el oxígeno, posiblemente relacionada con su capacidad para aumentar la concentración de las enzimas oxidantes. Por otro lo anterior, se concluye que el conocimiento de estas vías de señalización puede contribuir en gran manera al desarrollo de futuros tratamientos, aunque en la actualidad la terapéutica con antioxidantes se está estudiando en modelos experimentales, aún no es una práctica habitual en niños recién nacidos

A free radical is any chemical species that has one or more unpaired electrons. These species usually take part in chain reactions. Lipids, nucleis acids, carbohydrates and proteins are susceptible to free radical attack, which produces in vivo oxidative damage that degenerates into cellular necrosis or apoptosis. To combat these oxidation systems, the cells are equipped with enzymes and antioxidant molecules. The delicate balance between oxidant and antioxidant mechanisms, which exists in the organism under conditions of normoxia, is defined as oxidative stress. An imbalance in these systems, in particular, oxidative stress derived from a lack of maturity of the antioxidant systems in the newborn infant, participates directly or indirectly in the clinical onset of disease, playing a role in both the pathogenesis and the prognosis. Moreover, there are conditions inherent in the newborn infant that increase his or her susceptibility to pulmonary damage, making the lung a critical organ in the process of adaptation of the infant to extrauterine life, especially since the lung continues to mature after birth. In any case, newborn infants are known to be more resistant to oxygen toxicity, possibly due, at least in part, to their ability to increase antioxidant enzyme levels. Thus, the authors conclude that the knowledge of these signalling pathways may contribute substantially to the development of future treatments. Although, at the present time, antioxidant therapy is being studied in experimental models, it is not yet a routine practice in newborn infants

Hipertensión pulmonar persistente neonatal / Persistent pulmonary hypertension of the newborn

Introducción: La hipertensión pulmonar persistente neonatal es una enfermedad confluente de múltiples y muy diferentes orígenes etiopatogénicos. Supone el 2% de los niños ingresados en las unidades de cuidados intensivos neonatales. Se diferencian cuadros primarios y secundarios. Material y métodos: Se ha realizado una búsqueda bibliográficaa través de PubMed, seleccionando los artículos relevantes publicados hasta septiembre de 2004 que incluyeran los términos «persistent pulmonary hypertension newborn», tanto en ciencias básicas como clínicas. Resultados: En total se seleccionaron 87 artículos que permitenabordar el estudio de la epidemiología patogenia, criterios diagnósticos, etiología, clínica, diagnóstico diferencial, tratamiento y pronóstico de la hipertensión pulmonar persistente neonatal. Conclusiones: El objetivo fundamental del tratamiento es la reducción de las resistencias vasculares periféricas, manteniendo la presión arterial sistémica y el volumen/minuto. Las secuelas de mayor relevancia y prevalencia son las respiratorias y neurológicas. Las tasas de mortalidad en la hipertensión pulmonar persistente neonatal oscilan en torno al 10-40%

Background: Persistent pulmonary hypertension of the newborn is a complex, multifactorial clinical syndrome, associated with primary and secondary cardiopulmonary diseases. It is responsible for 2% of the admissions to the newborn intensive care unit. Material and methods: A review of the recent literature (up until September 2004) in basic and clinical science, indexed in Medline, that mentions the MeSh term "Persistent pulmonary hypertension of the newborn" in basic and clinical science. Results: In all, we selected 87 articles that provide informationon the epidemiology, pathogenesis, diagnostic criteria,etiology, clinical features, differential diagnosis, treatment andprognosis of persistent pulmonary hypertension of the newborn. Conclusions: The main objective of the treatment of newborns with persistent pulmonary hypertension is to lower the peripheral vascularr esistance, while maintaining the blood pressureand the cardiac output. It mar be associated withsignificant respiratory and neurological morbidity. The mortality rate ranges between 10% and 40%

Propafenone modulates potassium channel activities of vascular smooth muscle from rat portal veins.

We have studied the effects of the class Ic antiarrhythmic propafenone on K+ currents in freshly isolated smooth muscle cells from rat portal veins and on the spontaneous contractions in whole tissues. Under Ca2+-free conditions, when cells were clamped at -80 mV (whole-cell configuration) depolarizing steps from -80 to +50 mV induced a family of K+ currents (I(Ktotal)) that mainly comprised the delayed rectifier current [I(K(V))], whereas when held at -10 mV only small-amplitude, noninactivating, currents (I(NI)) were recorded. Propafenone (10 microM) markedly inhibited I(Ktotal), but at potentials positive to +30 mV it also induced a noisy outwardly rectifying current [I(BK(Ca))] that was abolished by iberiotoxin (0.1 microM). Inhibition of I(Ktotal) by propafenone was concentration-dependent (EC50 = 0.059 +/- 0.009 microM). Propafenone also inhibited the transient outward current [I(K(A))] and ATP-sensitive potassium current [I(K(ATP))] induced by levcromakalim (10 microM). Inhibition of I(K(V)), I(K(A)), and I(K(ATP)) by propafenone was voltage-independent. In Ca(2+)-containing conditions propafenone inhibited I(K(V)) and I(BK(Ca)) and immediately abolished spontaneous outward transient K+ currents. In whole veins, propafenone behaved as the K(V) inhibitor 4-aminopyridine, increasing the amplitude and duration of spontaneous contractions. Propafenone also inhibited the inhibitory effects of the K(ATP) channel opener levcromakalim on spontaneous contractions. These results indicate that in vascular smooth muscle cells, propafenone inhibits K(V), K(A), BK(Ca), and K(ATP) channels. These actions correlated with its effects on mechanical activity in whole portal veins.

Nitric oxide- and nitric oxide donors-induced relaxation and its modulation by oxidative stress in piglet pulmonary arteries.

Inhaled nitric oxide (iNO) is widely used in the treatment of pulmonary hypertension while inhaled NO donors have been suggested as an alternative therapy. The differential susceptibility to inactivation by oxidative stress and oxyhaemoglobin of NO and two NO donors, sodium nitroprusside (SNP) and S-nitroso-N-acetyl-penicillamine (SNAP) were analysed in isolated endothelium-denuded pulmonary arteries from 2-week-old piglets stimulated with U46619. NO, SNAP and SNP relaxed the arteries (pIC(30)=7.73+/-0.12, 7.26+/-0.17 and 6.43+/-0.13, respectively) but NO was not detected electrochemically in the bath after the addition of SNP and only at concentrations at which SNAP produced more than 50% relaxation. The sGC inhibitor ODQ (10(-6) M) or the sarcoplasmic Ca(2+)-ATPase thapsigargin (2x10(-6) M) markedly inhibited the relaxation induced by NO, SNAP and SNP. Addition of oxyhaemoglobin (3x10(-7) M) or diethyldithiocarbamate (1 mM) markedly inhibited NO- (pIC(30)=6.88+/-0.07 and 6.92+/-0.18, respectively), weakly inhibited SNAP- and had no effect on SNP-induced relaxation. Xanthine oxidase (5 mu ml(-1)) plus hypoxanthine (10(-4) M) markedly inhibited NO- (pIC(30)=6.96+/-0.12) but not SNAP- or SNP-induced relaxation. Superoxide dismutase (SOD), MnCl(2), diphenileneiodonium and exposing the luminal surface of the rings outwards (inversion) potentiated the relaxant responses of NO (pIC(30)=8.52+/-0.16, 8.23+/-0.11, 8.01+/-0.11 and 8.20+/-0.10, respectively). However, SOD did not modify the NO detected by the electrode and had no effect on SNAP- or SNP-induced relaxation. Therefore, the kinetics and local distribution of NO release of NO donors influence the susceptibility to the scavenging effects of oxyhaemoglobin and superoxide.

Mechanisms involved in SNP-induced relaxation and [Ca+]i reduction in piglet pulmonary and systemic arteries.

1. We have compared the mechanisms involved in sodium nitroprusside (SNP)-induced relaxation and [Ca2+]i reduction in isolated piglet pulmonary (PA) and mesenteric (MA) arteries. 2. SNP (10(-8) M-3x10(-5) M) evoked a concentration-dependent relaxation of PA and MA (pD2=6.66+/-0.06 and 6.74+/-0.14, respectively) stimulated by noradrenaline, which was markedly reduced by the guanylate cyclase inhibitor ODQ. In fura 2-incubated PA and MA, SNP produced a parallel reduction in contractile force and in [Ca2+]i, expressed as the ratio of emitted fluorescence at 340 and 380 nm (F340/F380). 3. The inhibition of the Na+/K+-ATPase after the incubation in a K+-free medium or the exposure to ouabain (10(-6) M) inhibited SNP-induced relaxation in MA but not in PA. SNP-induced relaxation was not attenuated by 80 mM KCl plus nifedipine (10(-6) M) but was inhibited by thapsigargin (2x10(-6) M; pD2=5.69+/-0.19 and 5.89+/-0.19 for PA and MA, respectively). 4. Pretreatment of PA with thapsigargin and MA with thapsigargin plus ouabain induced a stronger inhibition on the reduction in [Ca2+]i than on the relaxation induced by SNP, indicating the existence of Ca2+-independent mechanisms. 5. The activation of the Na+/K+-ATPase by the addition of KCl after the incubation in a K+-free medium similarly reduced [Ca2+]i in PA and MA, whereas it relaxed with much less efficacy PA than MA. 6. We conclude that SNP reduces [Ca2+]i and causes relaxation through the activation of SERCA in PA and SERCA and Na+/K+-ATPase in MA. However, Ca2+-independent mechanisms also contribute to SNP-induced effects.

Relaxant effects of carbon monoxide compared with nitric oxide in pulmonary and systemic vessels of newborn piglets.

Nitric oxide (NO) has been implicated in a number of diverse physiologic processes, including regulation of vascular tone. Carbon monoxide (CO) is another endogenously generated diatomic gas that may play an important physiologic role in vascular smooth muscle homeostasis. The purpose of this study was to compare the responses to exogenous NO and CO in isolated vessels (pulmonary arteries, pulmonary veins, and mesenteric arteries) from 12- to 24-h-old and 2-wk-old piglets. Vessels precontracted with the thromboxane A(2) mimetic U46619 (10(-7) M) relaxed in response to CO (2 x 10(-6) to 2 x 10(-4) M) and NO (2 x 10(-9) to 2 x 10(-7) M); these effects were not affected by endothelium removal but were completely abolished by the soluble guanylate cyclase inhibitor ODQ (10(-5) M). In pulmonary arteries, the maximal relaxation to NO increased with postnatal age from 33 +/- 4% of the precontraction value to 56 +/- 5%, in 12- to 24-h-old and 2-week-old piglets, respectively (p < 0.01), but the response to CO decreased from 25 +/- 3% to 12 +/- 1%, respectively (p < 0.01). The maximal response to CO was greater in pulmonary veins than in pulmonary or mesenteric arteries for both age groups (p < 0.01). Vasorelaxation induced by endogenous NO (stimulated by acetylcholine) was also greater in pulmonary veins when compared with pulmonary arteries and increased with postnatal age in both vessels. In contrast, no age-related differences were observed in the vasorelaxation induced by the cGMP analog 8-bromo cGMP in pulmonary arteries. When the response to NO was analyzed under three different extracellular O(2) concentrations (PO(2) 4.51 +/- 0.03, 19. 32 +/- 0.17, and 86 +/- 0.62, kPa), no significant differences were found. However, in the presence of superoxide dismutase (100 U/mL). the response to CO remained unchanged, and the response to NO improved in pulmonary arteries from 2-week-old but not from newborn piglets. In conclusion, both NO and CO relaxed neonatal vessels through soluble guanylate cyclase activation. However, when compared with NO, CO exhibited a poor vasorelaxant activity. Pulmonary vasorelaxation induced by NO increased with postnatal age, whereas that induced by CO decreased. Changes in extracellular oxygen concentration did not alter the pulmonary vascular response to NO. However, the presence of superoxide dismutase improved the response to NO, indicating that oxidant activity limits the vasorelaxant response to NO but not to CO.

Vasodilator effects of sodium nitroprusside, levcromakalim and their combination in isolated rat aorta.

1. The endothelial modulation of the relaxant responses to the nitric oxide (NO) donor sodium nitroprusside (SNP) and the KATP channel opener levcromakalim (LEM) and the interactions between these agents were analysed in isolated rat aorta. 2. LEM-induced relaxation was unchanged by endothelium removal or by the presence of L-NAME (10-4 M) or ODQ (10-6 M). In contrast, in KCl- (25 mM), but not in noradrenaline- (NA, 10-6 M) contracted arteries, SNP-induced relaxation was augmented by endothelium removal but not by L-NAME, indomethacin, glibenclamide nor charybdotoxin plus apamin. 3. The isobolographic analysis of the interactions between exogenously activated KATP channels and cyclic GMP using mixtures of SNP and LEM revealed that there were no interactions between both drugs at the proportions at which both drugs were active. However, the points for the SNP : LEM mixtures in proportions 10:1 and 1:10,000 (i.e. at concentrations at which LEM and SNP were inactive, respectively) fell significantly above the line of additivity indicating that there were negative interactions between both drugs at these selected proportions (about 5- and 2 fold inhibition, respectively). The former interaction was sensitive to glibenclamide, whereas the latter was insensitive ODQ. The magnitude of the 10:1 SNP:LEM interaction was smaller in endothelium-intact arteries and was absent in arteries stimulated by NA. 4. In conclusion, the relaxations induced by LEM and SNP were additive. However, the presence of endothelium and low concentrations of LEM inhibited SNP-induced relaxation. Both inhibitory effects were not additive and were only observed in KCl- and not in NA-contracted aortae.