No abstract

Ischemia followed by reperfusion (I/R) in the presence of polymorphonuclear leukocytes (PMNs) results in cardiac contractile dysfunction. Inhibiting protein kinase C (PKC) inhibits the release of superoxide from PMNs. The compound Gö 6983 is an inhibitor of all five PKC isoforms present in PMNs. Therefore, we hypothesized that Gö 6983 could attenuate PMN-induced cardiac dysfunction by suppression of superoxide production from PMNs. We studied isolated rat hearts following ischemia (20 minutes) and reperfusion (45 minutes) infused with activated PMNs. In hearts reperfused with PMNs and Gö 6983 (100 nM, n = 7), left ventricular developed pressure (LVDP) and the rate of LVDP (+dP/dt max) recovered to 89 +/- 7% and 74 +/- 2% of baseline values, respectively, at 45 minutes postreperfusion compared with I/R hearts (n = 9) receiving PMNs alone, which only recovered to 55 +/- 3% and 45 +/- 5% of baseline values for LVDP and +dP/dtmax, respectively (P < 0.01). Gö 6983 (100 nM) significantly reduced PMN adherence to the endothelium and infiltration into the myocardium compared with I/R + PMN hearts (P < 0.01), and significantly inhibited superoxide release from PMNs by 90 +/- 2% (P < 0.01). In the presence of PMNs, Gö 6983 attenuated post-I/R cardiac contractile dysfunction, which may be related in part to decreased superoxide production.

Ischemia followed by reperfusion (I/R) in the presence of polymorphonuclear leukocytes (PMNs) results in a marked cardiac contractile dysfunction. A cell-permeable protein kinase C (PKC) ␤II peptide inhibitor was used to test the hypothesis that PKC ␤II inhibition could attenuate PMN-induced cardiac dysfunction by suppression of superoxide production from PMNs and increase NO release from vascular endothelium. The effects of the PKC ␤II peptide inhibitor were examined in isolated ischemic (20 min) and reperfused (45 min) rat hearts with PMNs. The PKC ␤II inhibitor (10 M; n ϭ 7) significantly attenuated PMN-induced cardiac dysfunction compared with I/R hearts (n ϭ 9) receiving PMNs alone in left ventricular developed pressure (LVDP) and the maximal rate of LVDP (ϩdP/ dt max ) cardiac function indices (p Ͻ 0.01). The PKC ␤II inhibitor at 10 M significantly increased endothelial NO release from a basal value of 1.85 Ϯ 0.18 pmol NO/mg tissue to 3.49 Ϯ 0.62 pmol NO/mg tissue from rat aorta. It also significantly inhibited superoxide release (i.e., absorbance) from N-formyl-L-methionyl-L-leucyl-L-phenylalanine-stimulated rat PMNs from 0.13 Ϯ 0.01 to 0.02 Ϯ 0.004 (p Ͻ 0.01) at 10 M. Histological analysis of the left ventricle of representative rat hearts from each group showed that the PKC ␤II peptide inhibitor-treated hearts experienced a marked reduction in PMN vascular adherence and infiltration into the postreperfused cardiac tissue compared with I/R ϩ PMN hearts (p Ͻ 0.01). These results suggest that the PKC ␤II peptide inhibitor attenuates PMN-induced post-I/R cardiac contractile dysfunction by increasing endothelial NO release and by inhibiting superoxide release from PMNs.In the setting of myocardial ischemia, it is imperative that blood flow be restored as soon as possible. Early reperfusion remains the most effective way of limiting myocardial necrosis and improving ventricular function in experimental models and human patients (Forman et al., 1989). However, reperfusion results in a marked degree of cardiac contractile dysfunction and myocardial cell injury. A harmful cascade of events accelerates structural and functional changes in endothelial cells, resulting in a progressive decrease in microcirculatory flow (Forman et al., 1989;Lefer and Lefer, 1996). These events occur sequentially and include a decreased endothelial release of NO; up-regulation of adhesion molecules on the endothelial surface, leading to enhanced leukocyte-endothelium interaction; infiltration of polymorphonuclear leukocytes (PMNs) into the myocardium; and subsequent release of superoxide radicals, which are largely responsible for producing cardiac dysfunction and enhanced necrosis Entman et al., 1992;Lefer and Lefer, 1996).The time course of events is similar in the ex vivo and in vivo myocardial I/R models within the first 30 min of reperfusion with respect to PMN/endothelial interaction. However, the in vivo model requires a longer reperfusion period (i.e., 270 min) to accumulate PMNs (Tsao and Ma et al., 1993;Young et al....

mia followed by reperfusion (I/R) in the presence of polymorphonuclear leukocytes (PMNs) results in marked cardiac contractile dysfunction. A cell-permeable PKC-peptide inhibitor was used to test the hypothesis that PKC-inhibition could attenuate PMN-induced cardiac contractile dysfunction by suppression of superoxide production from PMNs and increase nitric oxide (NO) release from vascular endothelium. The effects of the PKC-peptide inhibitor were examined in isolated ischemic (20 min) and reperfused (45 min) rat hearts reperfused with PMNs. The PKC-inhibitor (2.5 or 5 M, n ϭ 6) significantly attenuated PMN-induced cardiac dysfunction compared with I/R hearts (n ϭ 6) receiving PMNs alone in left ventricular developed pressure (LVDP) and the maximal rate of LVDP (ϩdP/ dt max) cardiac function indexes (P Ͻ 0.01), and these cardioprotective effects were blocked by the NO synthase inhibitor, N G -nitro-L-arginine methyl ester (50 M). Furthermore, the PKC-inhibitor significantly increased endothelial NO release 47 Ϯ 2% (2.5 M, P Ͻ 0.05) and 54 Ϯ 5% (5 M, P Ͻ 0.01) over basal values from the rat aorta and significantly inhibited superoxide release from phorbol-12-myristate-13-acetate-stimulated rat PMNs by 33 Ϯ 12% (2.5 M) and 40 Ϯ 8% (5 M) (P Ͻ 0.01). The PKC-inhibitor significantly attenuated PMN infiltration into the myocardium by 46 -48 Ϯ 4% (P Ͻ 0.01) at 2.5 and 5 M, respectively. In conclusion, these results suggest that the PKC-peptide inhibitor attenuates PMN-induced post-I/R cardiac contractile dysfunction by increasing endothelial NO release and by inhibiting superoxide release from PMNs thereby attenuating PMN infiltration into I/R myocardium. neutrophils; superoxide radicals; left ventricular developed pressure; endothelial dysfunction THE RESTORATION OF BLOOD FLOW is the primary objective for treatment of cardiac tissue experiencing prolonged ischemia (i.e., Ͼ20 min). However, reperfusion of blood flow induces endothelium and myocyte injury, resulting in cardiac contractile dysfunction (4, 23, 24). The sequential events associated with reperfusion injury are initiated by endothelial dysfunction, which is characterized by a reduction of the basal endothelial cell release of nitric oxide (NO) within the first 2.5-5 min postreperfusion (36). The decrease in endothelium-derived NO is associated with adhesion molecule upregulation on endothelial and polymorphonuclear leukocyte (PMN) cell membranes (26,39). This event promotes PMN-endothelium interaction, which occurs by 10 to 20 min postreperfusion, and subsequent PMN infiltration into the myocardium is observed by 30 min postreperfusion (20,21,35,39). The time course of events are similar in ex vivo and in vivo myocardial ischemia-reperfusion (I/R) models within the first 30 min of reperfusion with respect to endothelial dysfunction and PMN-endothelium interactions (26, 35-37). However, the in vivo model requires a longer reperfusion period (i.e., 270 min) to accumulate PMNs in the reperfused myocardium and induce myocardial injury (i.e., infarct size) (26, 3...

assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities