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Biomedical subjects

M L Hess

Publications and source records attributed to M L Hess.

At least 55 records · Page 3Linked to original sources
PubMed1990

Accelerated coronary atherosclerosis in cardiac transplantation.

The implications of this new aggressive form of coronary disease for the transplant population are obvious. It appears that for the majority of transplant patients we have simply bought some time. We have given them a temporary respite from congestive failure and cardiomyopathy while they surmount the daily challenges imposed by immunosuppression. Clearly, this issue now looms as a major stumbling block toward improving long-term survival. It is no longer enough to simply perform the procedure and submit the patient to the rigors of transplantation, only to obtain 50 percent 5-year survival. We must pay particular attention to the patient postoperatively and make those modifications necessary to improve the individual's risk profile. Moreover, we must continue to concentrate our research efforts on interventions in accelerated coronary disease.

Coronary Disease↗
PubMed1989

Stimulated human neutrophils damage cardiac sarcoplasmic reticulum function by generation of oxidants.

An important aspect of myocardial injury is the role of neutrophils in post-ischemic damage to the heart. Stimulated neutrophils initiate a series of reactions that produce toxic oxidizing agents. Superoxide rapidly dismutases to H2O2 and neutrophils contain myeloperoxidase which catalyzes the oxidation of Cl- by H2O2 to yield hypochlorous acid (HOCl). The highly reactive HOCl combines non-enzymatically with nitrogenous compounds to generate long-lived, non-radical oxidants, monochloramine and taurine N-monochloramine. We investigated the role of oxygen radicals and long-lived oxidants on cardiac sarcoplasmic reticulum function, which plays a major role in the regulation of intracellular Ca2+ and thereby in the generation of force. Incubation of sarcoplasmic reticulum with phorbol myristate acetate (PMA)-stimulated neutrophils (4 x 10(6) cells/ml) significantly decreased calcium uptake rate (0.85 +/- 0.11 to 0.11 +/- 0.06 mumol/min per mg) and Ca2+-ATPase activity (1.67 +/- 0.08 to 0.46 +/- 0.10 mumol/min per mg). Inclusion of myeloperoxidase inhibitors (cyanide, sodium azide and 3-amino-1,2,4-triazole), catalase, superoxide dismutase plus catalase, and alpha-tocopherol significantly protected (P less than 0.01) calcium uptake rates and Ca2+-ATPase activity of sarcoplasmic reticulum. Superoxide dismutase (10 microgram/ml) alone or deferoxamine (1 mM) had no protective effect in this system. The maximum inhibition of sarcoplasmic reticulum function was observed with (3-4) x 10(6) cells/ml in 4-6 min. HOCl and NH2Cl inhibited calcium uptake rate and Ca2+-ATPase activity of sarcoplasmic reticulum in a dose-dependent manner (2-20 microM), whereas H2O2 damaged sarcoplasmic reticulum at concentrations ranging from 5 to 25 mM. HOCl (20 microM) inhibited 80-90% of Ca2+-uptake rate and Ca2+-ATPase activity and L-methionine (0.1-1 mM) provided complete protection. We conclude that stimulated neutrophils damage cardiac sarcoplasmic function by generation of myeloperoxidase-catalyzed oxidants.

Calcium↗
PubMed1989

Long-term oral therapy of congestive heart failure with phosphodiesterase inhibitors.

The existing management of severe chronic congestive heart failure carries a dismal prognosis. Mortality over 6 months is 50% by some estimates. This fact, coupled with increasing concern for the safety and efficacy of the digitalis glycosides, has stimulated an intense search for new oral cardiotonic agents suitable for chronic administration. Despite the ability of many phosphodiesterase inhibiting agents to affect profound hemodynamic improvements acutely after oral or intravenous administration, none of the four agents here reviewed in 30 clinical trials has been adequately proven to provide benefit over conventional long-term therapy of severe heart failure. The four drugs to have undergone long-term clinical trials are amrinone, milrinone, enoximone (MDL 17043), and piroximone (MDL 19,025). For amrinone, inefficacy was revealed through carefully designed, placebo-controlled studies despite initial enthusiasm generated by open uncontrolled trials. Enoximone has suffered rapid attenuation of its hemodynamic effectiveness in most studies, and piroximone failed in its only long-term trial. Therefore, final judgment on most of these agents must await completion of controlled clinical trials, and any initial optimism stimulated by the current uncontrolled studies should be met with reservation.

Administration, Oral↗
PubMed1989

Inhibition by arachidonate of cerebral arteriolar dilation from acetylcholine.

After topical application of arachidonate (200 micrograms/ml) on the brain surface of anesthetized cats equipped with cranial windows, the vasodilator response to topical acetylcholine (10(-7) M) was either abolished or converted to vasoconstriction. This effect of arachidonate was prevented by pretreatment with topical deferoxamine (1 mM) to chelate free iron and inhibit the generation of hydroxyl radical from the Haber-Weiss reaction. Posttreatment with deferoxamine or with the combination of superoxide dismutase and catalase did not reestablish the vasodilator response to acetylcholine. Using a bioassay preparation in which one cranial window served as the donor for endothelium-derived relaxing factor (EDRF) while the other window was used to assay EDRF, we found that arachidonate applied to the donor window inhibited the generation and/or release of EDRF. Arachidonate applied to the assay window did not influence the response to EDRF. The results show that arachidonate interferes with the vasodilator response to acetylcholine, primarily because it inhibits the generation and release of EDRF. This effect is caused by injury to the endothelium induced by hydroxyl radical.

Acetylcholine↗
PubMed1988

Oxygen radical-mediated lipid peroxidation and inhibition of Ca2+-ATPase activity of cardiac sarcoplasmic reticulum.

Oxygen radicals have been implicated as important mediators of myocardial ischemic and reperfusion injury. A major product of oxygen radical formation is the highly reactive hydroxyl radical via a biological Fenton reaction. The sarcoplasmic reticulum is one of the major target organelles injured by this process. Using a oxygen radical generating system consisting of dihydroxyfumarate and Fe3+-ADP, we studied lipid peroxidation and Ca2+-ATPase of cardiac sarcoplasmic reticulum. Incubation of sarcoplasmic reticulum with dihydroxyfumarate plus Fe3+-ADP significantly inhibited enzyme activity. Addition of superoxide dismutase, superoxide dismutase plus catalase (15 micrograms/ml) or iron chelator, deferoxamine (1.25-1000 microM) protected Ca2+-ATPase activity. Time course studies showed that this system inhibited enzyme activity in 7.5 to 10 min. Similar exposure of sarcoplasmic reticulum to dihydroxyfumarate plus Fe3+-ADP stimulated malondialdehyde formation. This effect was inhibited by superoxide dismutase, catalase, singlet oxygen, and hydroxyl radical scavengers. EPR spin-trapping with 5,5-dimethyl-1-pyrroline-N-oxide verified production of the hydroxyl radical. The combination of dihydroxyfumarate and Fe3+-ADP resulted in a spectrum of hydroxyl radical spin trap adduct, which was abolished by ethanol, catalase, mannitol, and superoxide dismutase. The results demonstrate the role of oxygen radicals in causing inactivation of Ca2+-ATPase and inhibition of lipid peroxidation of the sarcoplasmic reticulum which could possibly be one of the important mechanisms of oxygen radical-mediated myocardial injury.

Adenosine Diphosphate↗
PubMed1988

Ureteric obstruction secondary to endometriosis. Report of three cases with a review of the literature.

Three cases of endometriosis are presented. In one patient bilateral obstruction was noted; in a second patient bilaterally enlarged kidneys with unilateral obstruction were found and in the third patient only unilateral obstruction was defined. Intrinsic ureteric obstruction and bilateral obstruction, both rare findings, are described in this report. The diagnosis, evaluation and management of these patients are discussed.

Adult↗
PubMed1988

Quantitative identification of superoxide anion as a negative inotropic species.

Reduced oxygen intermediates have been shown to directly depress cardiac muscle function at the subcellular, tissue, and whole animal levels. The exact species of reduced oxygen intermediate [superoxide anion radical (O2-.), H2O2, hydroxyl free radical (HO.)] and the concentrations necessary to depress cardiac muscle function have not been quantified. To better understand the role of O2-. and H2O2, we have studied rabbit right ventricular papillary muscle function in the presence of these reduced oxygen intermediates generated by a xanthine-xanthine oxidase system at 37 degrees C. In the presence of xanthine (0.1 mM) and xanthine oxidase (0.02 U/ml), 57.5 +/- 0.85 nmol.l-1.s-1 O2-. and 69.25 +/- 5.3 nmol.l-1.s-1 H2O2 were produced. In the presence of superoxide dismutase (SOD), O2-. was eliminated and H2O2 concentration increased. Catalase effectively eliminated the accumulation of H2O2 without significantly changing the rate of O2-. generation. When applied to isometrically contracting right ventricular papillary muscles, this system, with or without SOD and catalase, had no effect on peak developed tension or +/- dT/dt derived either from length-tension or force-frequency studies. However, when the xanthine oxidase concentration was increased to 0.112 U/ml, the rate of O2-. generation increased to 196.67 +/- 3.26 nmol.l-1.s-1 and H2O2 production increased to 142.19 +/- 9.3 nmol.l-1.s-1 with significant depression of papillary muscle tension development. SOD virtually eliminated O2-. production, whereas H2O2 production increased to 199.48 +/- 9.8 nmol.l-1.s-1 with no effect on papillary muscle tension development.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

The effect of oxygen free radicals on calcium permeability and calcium loading at steady state in cardiac sarcoplasmic reticulum.

It has been proposed that oxygen free radical production is an important mediator of the myocardial dysfunction during the course of acute ischemia. We tested this hypothesis by characterizing the pathway of calcium efflux across sarcoplasmic reticulum (SR) membranes affected by oxygen free radicals. The effect of oxygen free radicals on the steady state calcium load, calcium permeability, and Ca,Mg-ATPase activity of isolated canine cardiac SR vesicles was investigated at pH 7.0. In vitro generation of oxygen free radicals by xanthine oxidase (0.09 units/ml), acting on xanthine in doses up to 50 microM as a substrate, increased the permeability of the SR vesicles to calcium, determined by measuring net efflux of calcium after stopping pump-mediated fluxes, and decreased total intravesicular calcium and free intravesicular calcium with no effect on Ca,Mg-ATPase activity. The effect of oxygen free radicals on calcium permeability was calcium gradient-dependent. Xanthine alone or xanthine plus denatured xanthine oxidase had no effect on this system. Superoxide dismutase (SOD, 56 units/ml), but not denatured SOD, significantly inhibited the effect of xanthine-xanthine oxidase reaction. The calcium permeability of the SR membrane decreased with decreasing calcium load. In addition, inasmuch as extravesicular calcium exerts only a slight effect on calcium permeability, the decrease in the permeability with calcium load is specifically related to the calcium load. Oxygen free radical-induced increase in calcium permeability was unaffected by Mg concentration between 2.1 and 21 mM. In summary, our data reveal that .O2- can produce a diminished level of accumulated calcium, which is reflected by the decreased calcium load and an increase in passive calcium permeability, and that the decreased calcium accumulation in the presence of the xanthine-xanthine oxidase system may not be mainly due to an inhibited calcium pump but due to an increased calcium permeability. Our results also suggest that increased SR membrane passive calcium permeability induced by oxygen free radicals is not carrier mediated. It is postulated that, with the oxygen free radical-mediated progressive increase in calcium permeability, free cytosolic calcium concentrations would increase in ischemic myocardium.

Animals↗
PubMed1988

Enhancement of crystalloid cardioplegic protection against global normothermic ischemia by superoxide dismutase plus catalase but not diltiazem in the isolated, working rat heart.

Oxygen-derived free radicals and intracellular calcium overload have been implicated as mediators of myocardial ischemia/reperfusion injury. We hypothesized that free radical scavengers or calcium channel blockers could enhance the protection afforded the isolated, working rat heart by crystalloid cardioplegia against this type of injury at 37 degrees C. Hearts from 42 male rats in seven groups (n = 6) were studied in an isolated, working heart preparation measuring aortic flow (ml/min/gm dry wt), peak systolic pressure (mm Hg), coronary artery flow (ml/min/gm dry wt), and calculated coronary vascular resistance (dyne.sec.cm-5/gm dry wt). Creatine kinase and lactate dehydrogenase release were measured before ischemia and at various times during the postischemic reperfusion period. Time-matched control hearts (group 1) were perfused for 2 hours. After finding that 30 minutes of ischemia and 10 minutes of reperfusion (group 2) produced significant (p less than 0.01) functional impairment that was completely protected (group 3) by a preischemic bolus of St. Thomas' Hospital cardioplegic solution, we again found significant (p less than 0.01) functional impairment after 40 minutes of ischemia and 10 minutes (group 4) or 20 minutes (group 5) of reperfusion despite a preischemic bolus of St. Thomas' Hospital cardioplegic solution. Diltiazem (10 mg/L) plus St. Thomas' Hospital cardioplegic solution (group 6) did not significantly (p less than 0.01) enhance functional recovery. Addition of superoxide dismutase plus catalase (200 microns/ml) (group 7) produced marked improvement in functional recovery that did not differ significantly (p less than 0.01) from control results (group 1). The creatine kinase and lactate dehydrogenase data strongly supported the preceding functional data. Coronary flow and vascular resistance were not significantly (p less than 0.01) changed from control values in any group. We conclude that the addition of superoxide dismutase and catalase but not diltiazem to St. Thomas' Hospital cardioplegic solution can significantly enhance myocardial protection against normothermic ischemia/reperfusion injury. This implicates oxygen-derived free radicals as mediators of this type of injury.

Animals↗
PubMed1987

Phospholipid alterations in canine cardiac sarcoplasmic reticulum induced by an acid-active phospholipase C.

Phospholipid alterations and phospholipase activities were studied in a preparation of canine cardiac sarcoplasmic reticulum (SR) known to contain lysosomes. Incubation of SR at pH 5.0 (37 degrees C) resulted in a loss in total lipid phosphorus which was maximal (10%) by 30 min. whereas a modest increase in lipid phosphorus occurred during incubation at pH 7.0. The content of phospholipid phosphorus was decreased (8.6-19.0%) in sphingomyelin, phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine when SR was incubated at pH 5.0; however phosphatidic acid increased 14% relative to control. Lysophospholipids were not detected. Liposomes of 1-acyl 2-[1 14C]-linoleoyl-sn-glycero-3-phosphoryl-ethanolamine (14C-PE) were hydrolyzed by SR at pH 5.0 to yield radiolabelled diglyceride (18.1 nmol/hr mg protein) and free fatty acid (8.3 nmol/hr mg protein). SR-mediated diglyceride production at pH 5.0, but not free fatty acid release, was markedly potentiated when 14C-PE was peroxidized by preincubation at pH 5.0 for 3-24 hours at 37 degrees C. After 24 hours of preincubation at pH 5.0 the specific activity of SR-mediated diglyceride production was 188% of control. A comparable increase in diglyceride production occurred when 14C-PE was peroxidized at pH 7.0 and hydrolyzed by SR at pH 5.0. No increase in enzymatic activity occurred when liposomes were both preincubated and assayed at pH 7.0. When 14C-PE was exposed to air at pH 5.0 or 7.0 more polar radiolabelled derivatives were formed as determined by thin layer chromatography. Up to twice as much polar lipid was formed at pH 5.0 compared to pH 7.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

The effects of dihydroxyfumarate on isolated rabbit papillary muscle function: evidence for an iron dependent non-hydroxyl radical mechanism.

To delineate the active free radical species mediating the toxic effects of autoxidizing dihydroxyfumarate (DHF), isolated rabbit right ventricular papillary muscles were exposed to 4.5 mM DHF in the presence of FeCl3, ADP and bovine albumin. In the absence of free radical scavengers a 47.3 +/- 11.5% (mean +/- standard deviation) depression in contractile force was noted over 60 minutes. Neither the combination of superoxide dismutase (SOD) 3,200 u/cc and catalase (CAT) 2,950 u/cc nor mannitol 0.1 M provided statistically significant protection. Deferoxamine mesylate (DFX) 10 mg/cc (15 mM) did provide significant protection of muscle function both in the presence and absence of SOD and CAT (p less than 0.01). The degree of protection conferred by DFX alone was statistically similar to that of DFX with SOD and CAT. This data suggests the involvement of an iron-oxygen complex not dependent on superoxide or hydrogen peroxide for its formation and not readily scavenged by mannitol. The perferryl ion may be representative of such a species. Alternatively, a reactive complex similar to the 'Crypto-OH' radical proposed by Youngman may be formed by the reaction of DHF with iron and oxygen.

Animals↗
PubMed1987

Calmodulin participation in oxygen radical-induced cardiac sarcoplasmic reticulum calcium uptake reduction.

The effect of scavengers of oxygen radicals on canine cardiac sarcoplasmic reticulum (SR) Ca2+ uptake velocity was investigated at pH 6.4, the intracellular pH of the ischemic myocardium. With the generation of oxygen radicals from a xanthine-xanthine oxidase reaction, there was a significant depression of SR Ca2+ uptake velocity. Xanthine alone or xanthine plus denatured xanthine oxidase had no effect on this system. Superoxide dismutase (SOD), a scavenger of .O2-, or denatured SOD had no effect on the depression of Ca2+ uptake velocity induced by the xanthine-xanthine oxidase reaction. However, catalase, which can impair hydroxyl radical (.OH) formation by destroying the precursor H2O2, significantly inhibited the effect of the xanthine-xanthine oxidase reaction. This effect of catalase was enhanced by SOD, but not by denatured SOD. Dimethyl sulfoxide (Me2SO), a known .OH scavenger, completely inhibited the effect of the xanthine-xanthine oxidase reaction. The observed effect of oxygen radicals and radical scavengers was not seen in the calmodulin-depleted SR vesicles. Addition of exogenous calmodulin, however, reproduced the effect of oxygen radicals and the scavengers. The effect of oxygen radicals was enhanced by the calmodulin antagonists (compounds 48/80 and W-7) at concentrations which showed no effect alone on Ca2+ uptake velocity. Taken together, these findings strongly suggest that .OH, but not .O2-, is involved in a mechanism that may cause SR dysfunction, and that the effect of oxygen radicals is calmodulin dependent.

Animals↗
PubMed1987

Early and late forms of cyclosporine nephrotoxicity: studies in cardiac transplant recipients.

To characterize the two forms of cyclosporine nephrotoxicity, we examined renal function in the immediate and late postoperative periods after cardiac transplantation. Moderate azotemia occurred during the first postoperative week in 58% of 43 cyclosporine-treated recipients, but in only 34% of 41 azathioprine-treated recipients, and 4% of 25 patients undergoing cardiopulmonary bypass for nontransplant surgery (both P less than .01 v cyclosporine). Acute renal failure developed in an additional 12% of the cyclosporine-treated group. Late postoperative renal dysfunction also occurred with a high prevalence. Life-table analysis indicated that at 6 months 55%, at 12 months 17%, at 24 months 4%, and at 36 months no cyclosporine-treated recipients retained normal renal function. Three renal biopsies performed in subjects with late nephrotoxicity demonstrated prominent interstitial fibrosis. Although one patient subsequently required chronic dialysis, reduction of cyclosporine dosage from a mean of 5.3 +/- 0.7 mg/kg/d to a mean of 2.3 +/- 0.3 mg/kg/d 9 to 21 months after transplantation with concurrent initiation of azathioprine therapy to prevent rejection led to an improvement of renal function in the five patients so treated. These data indicate that there are two distinct forms of cyclosporine nephrotoxicity. Although both occur with high prevalence, the early form does not appear to be a specific risk factor for the late form.

Acute Kidney Injury↗
PubMed1987

Pretransplant transfusions in cardiac allograft recipients.

The role of pretransplant transfusion in cardiac allograft recipients was determined retrospectively in 68 patients. Three groups were studied: group 1 (n = 29) received no pretransplant transfusion, group 2 (n = 15) received transfusion over one year prior to transplantation, and Group 3 (n = 24) received 5 or 10 50-100 ml units of random donor red blood cells or buffy coat 2-4 weeks prior to transplantation. Data were analyzed for survival, number of rejection episodes, and number of infections. Immunosuppression included azathioprine, prednisone, and antithymocyte globulin. Survival in transfused patients (groups 2 and 3) was 68% and 51% at 1 and 5 years, respectively, while in the nontransfused population (group 1) it was 35% and 16%. The incidence of rejection episodes per year of survival was similar in the three groups (group 1: 1.3, group 2: 1.1, group 3: 1.3; P greater than 0.05). The number of infections per year of survival were greater in the transfused patients but this did not achieve statistical significance (group 1: 1.0, group 2: 1.2, group 3: 1.7; P greater than 0.05). Thus, we conclude that cardiac transplant recipients who have received blood transfusions prior to transplantation may have enhanced survival over patients who have not received preoperative transfusions.

Blood Transfusion↗