The Journal of surgical research
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Postischemic reperfusion injury is caused by microcirculatory disturbances, including both nutritive perfusion failure (no reflow) and leukocyte activation (reflow paradox). Recent studies brought evidence that pentoxifylline (PTX) reduces tissue injury, decreases enzyme release, and improves survival after normothermic liver ischemia/reperfusion. The mechanisms of action, however, by which PTX protects postischemic tissue from injury have not been elucidated yet. ⋯ Microvascular reperfusion after 20 min portal triad cross-clamping was characterized by the cessation of blood flow within individual sinusoids (no reflow) and accumulation of leukocytes within the hepatic microvasculature, with stasis in sinusoids and rolling and firm adherence in postsinusoidal venules. PTX (20 mg/kg x hr i.v.) significantly (P < 0.05) attenuated microvascular leukocyte accumulation (44,600 +/- 1833 mm(-3) vs 67,684 +/- 2620 mm(-3) in saline-treated controls) and firm adherence of leukocytes in postsinusoidal venules (316.9 +/- 40.9 mm(-2) vs 522.9 +/- 95.0 mm(-2)); however, PTX did not influence manifestation of individual sinusoidal perfusion failure. Since reperfusion-induced parenchymal cell damage was found reduced in treated animals, we conclude that PTX attenuates postischemic injury in rat liver by reduction of leukocytic/inflammatory response but not by prevention of nutritive perfusion failure.
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Gut and hepatic dysfunction, during and after hypovolemic shock, have been implicated as causative mechanisms in the development of multiple system organ failure in the trauma patient. Current techniques of assessment of perfusion only detect changes in systemic oxygen transport. We designed an animal model that can measure changes in oxygen transport in the liver and gut during hypovolemic shock and resuscitation. ⋯ These data show that hepatic and gut vascular beds are better perfused when resuscitation from hemorrhage is guided by systemic oxygen transport measurements compared to resuscitation guided by blood pressure.
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Early release of macrophage-derived proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin (IL)-1, and IL-6, are important in the pathogenesis of septic shock and multisystem organ failure in various models of sepsis. IL-10 is a mediator that inhibits cytokine release from activated macrophages. The aim of this study was to determine if IL-10 would decrease serum cytokine elevation in a murine model of cecal ligation and puncture (CLP). ⋯ Prophylactic or therapeutic administration of IL-10 significantly attenuated this early rise in serum cytokines. These results support the hypothesis that (1) CLP produces an early systemic rise in macrophage-derived cytokines and (2) IL-10 given either before or after the onset of CLP-induced intraabdominal infection and sepsis is able to inhibit this early release of macrophage-derived systemic mediators. IL-10 has potential clinical benefits in the therapeutic management of intraabdominal infection and sepsis.
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Recent studies indicate that polymicrobial sepsis can markedly increase inducible macrophage Ao (nonnecrotic cellular suicide) and that this is associated with decreased M phi function. In vitro studies suggest that M phi Ao can be induced by IL-1 beta via interleukin-1 beta-converting enzyme (ICE, a cysteine protease), prostanoids, or reactive oxygen/nitrogen. However, the mechanism(s) underlying this process in septic M phi remains unknown. ⋯ However, only the nonspecific cysteine protease inhibitors (Iodo and meth) and the NO inhibitor LNMA blocked septic mouse M phi Ao. Furthermore, only PM phi from CLP mice treated with Iodo, but not LNMA or IBU, showed an improved capacity to release IL-6. We conclude that increased M phi Ao seen during sepsis appears to be mediated by both ICE-like cysteine protease activation and NO release but the level/mechanism of action of these inhibitors differs.