Document Detail

Adenosine A2A receptor agonist improves cardiac dysfunction from pulmonary ischemia-reperfusion injury.
MedLine Citation:
PMID:  15797048     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Ischemia-reperfusion (IR) injury negatively impacts patient outcome in lung transplantation. Clinically, we observed that lung transplant patients with ischemia-reperfusion injury tend to have cardiac dysfunction. Previous studies have shown that ATL-146e (4-{3-[6-amino-9-(5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl)-9H-purin-2-yl]-prop-2-ynyl}-cyclohexanecarboxylic acid methyl ester), a selective adenosine A2A receptor agonist, reduces lung inflammation after ischemia-reperfusion. We hypothesized that pulmonary ischemia-reperfusion causes secondary heart dysfunction and ATL-146e will improve this dysfunction. METHODS: We utilized an in vivo rabbit lung ischemia-reperfusion model. The Sham group underwent 120 minutes single lung ventilation. The IR and ATL groups underwent 90 minutes right lung ischemia with 30 minutes right lung reperfusion. The ATL-146e was given intravenously to the ATL group during reperfusion. Cardiac output and arterial blood gases were monitored, and neutrophil sequestration was measured by myeloperoxidase activity. RESULTS: Upon reperfusion, cardiac output (mL/min) significantly dropped in the IR and ATL groups. By 15 minutes reperfusion, cardiac output in the ATL group improved significantly over the IR group and remained significant thereafter. Lung myeloperoxidase activity was significantly reduced by ATL-146e. Although never hypoxemic, arterial oxygenation was lower in the IR and ATL groups while central venous pressures and mean arterial pressures were similar among groups. A separate experiment demonstrated that reperfusion with the antioxidant N-(2-mercaptopropionyl)glycine prevented cardiac dysfunction. CONCLUSIONS: Pulmonary ischemia-reperfusion causes cardiac dysfunction independent of preload, afterload, and oxygenation. The ATL-146e improves this dysfunction presumably by the antiinflammatory effects of adenosine A2A receptor activation on neutrophils. One likely mechanism involves the release of oxidants from the ischemic lung upon reperfusion, which has immediate negative effects on the heart.
T Brett Reece; Victor E Laubach; Curtis G Tribble; Thomas S Maxey; Peter I Ellman; Patrick S Warren; Andrew M Schulman; Joel Linden; John A Kern; Irving L Kron
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-03-30     Completed Date:  2006-08-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1189-95     Citation Subset:  AIM; IM    
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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MeSH Terms
Antioxidants / pharmacology
Blood Pressure / drug effects
Cardiac Output / drug effects
Cyclohexanecarboxylic Acids / pharmacology*
Heart / drug effects*,  physiopathology
Lung / blood supply*
Neutrophil Activation
Oxygen / blood
Peroxidase / metabolism
Purines / pharmacology*
Reactive Oxygen Species / metabolism
Receptor, Adenosine A2A / agonists*
Reperfusion Injury / physiopathology*
Grant Support
Reg. No./Substance:
0/ATL 146e; 0/Antioxidants; 0/Cyclohexanecarboxylic Acids; 0/Purines; 0/Reactive Oxygen Species; 0/Receptor, Adenosine A2A; 7782-44-7/Oxygen; EC

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