Topical hepatic hypothermia attenuates pulmonary injury after hepatic ischemia and reperfusion

Sundeep Patel, H. Leon Pachter, Herman Yee, Jess D. Schwartz, Stuart G. Marcus, Peter Shamamian

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: Prolonged periods of hepatic ischemia are associated with hepatocellular injury and distant organ dysfunction in experimental models. Neutrophils (PMN) and tumor necrosis factor (TNF)-α have been implicated, mostly because of their local deleterious effects on the hepatocyte after hepatic ischemia and reperfusion (I/R) injury. We hypothesize that topical hepatic hypothermia (THH) reduces ischemia and reperfusion-induced hepatic necrosis, PMN infiltration, TNF-α release, and consequent acute pulmonary injury. Study Design: Sprague-Dawley rats (250 to 300 g) were evenly divided into three groups: 90 minutes of normothermic (37°C) partial hepatic ischemia (normothermic I/R), 90 minutes of hypothermic (25°C) partial hepatic ischemia (hypothermic I/R), and sham laparotomy (without ischemia). There were six animals in each experimental group per time point unless otherwise specified. Hepatic necrosis and PMN infiltration were evaluated and scored on hematoxylin and eosin-stained liver specimens 12 hours after reperfusion. Serum TNF-α levels were determined by ELISA at 0 minutes, 15 minutes, 30 minutes, 1 hour, and 12 hours postreperfusion. Pulmonary PMN infiltration and vascular permeability were measured by myeloperoxidase activity and Evans blue dye extravasation, respectively, to quantitate pulmonary injury 12 hours after reperfusion. Results: Normothermic I/R results in a significant increase in TNF-α at 15 and 30 minutes (p < 0.005), PMN infiltration (p < 0.001), and hepatic necrosis (p < 0.001), compared with sham. Institution of THH reduced peak serum TNF-α levels by 54% at 15 minutes (p < 0.005) and by 73% at 30 minutes (p < 0.001) postreperfusion compared with normothermic I/R. Similarly, hepatic PMN infiltration and necrosis at 12 hours were reduced by 60% (p < 0.05) and 47% (p < 0.05), respectively. Myeloperoxidase activity and Evans blue extravasation (measures of acute lung injury) were reduced by 42% and 39%, respectively, with institution of THH compared with animals undergoing normothermic I/R (p < 0.001). Conclusions: These results demonstrate that THH protects the liver from ischemia and reperfusion-induced necrosis and PMN infiltration. In addition, THH reduces the serum levels of TNF-α and associated pulmonary injury. These data suggest that the ischemic liver is a potential source of inflammatory mediators associated with hepatic ischemia and reperfusion-induced pulmonary injury. (C) 2000 by the American College of Surgeons.

Original languageEnglish (US)
Pages (from-to)650-656
Number of pages7
JournalJournal of the American College of Surgeons
Volume191
Issue number6
DOIs
StatePublished - 2000
Externally publishedYes

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Lung Injury
Hypothermia
Reperfusion
Ischemia
Liver
Tumor Necrosis Factor-alpha
Necrosis
Evans Blue
Acute Lung Injury
Peroxidase
Serum
Capillary Permeability
Hematoxylin
Eosine Yellowish-(YS)
Reperfusion Injury
Laparotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Topical hepatic hypothermia attenuates pulmonary injury after hepatic ischemia and reperfusion. / Patel, Sundeep; Leon Pachter, H.; Yee, Herman; Schwartz, Jess D.; Marcus, Stuart G.; Shamamian, Peter.

In: Journal of the American College of Surgeons, Vol. 191, No. 6, 2000, p. 650-656.

Research output: Contribution to journalArticle

Patel, Sundeep ; Leon Pachter, H. ; Yee, Herman ; Schwartz, Jess D. ; Marcus, Stuart G. ; Shamamian, Peter. / Topical hepatic hypothermia attenuates pulmonary injury after hepatic ischemia and reperfusion. In: Journal of the American College of Surgeons. 2000 ; Vol. 191, No. 6. pp. 650-656.
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T1 - Topical hepatic hypothermia attenuates pulmonary injury after hepatic ischemia and reperfusion

AU - Patel, Sundeep

AU - Leon Pachter, H.

AU - Yee, Herman

AU - Schwartz, Jess D.

AU - Marcus, Stuart G.

AU - Shamamian, Peter

PY - 2000

Y1 - 2000

N2 - Background: Prolonged periods of hepatic ischemia are associated with hepatocellular injury and distant organ dysfunction in experimental models. Neutrophils (PMN) and tumor necrosis factor (TNF)-α have been implicated, mostly because of their local deleterious effects on the hepatocyte after hepatic ischemia and reperfusion (I/R) injury. We hypothesize that topical hepatic hypothermia (THH) reduces ischemia and reperfusion-induced hepatic necrosis, PMN infiltration, TNF-α release, and consequent acute pulmonary injury. Study Design: Sprague-Dawley rats (250 to 300 g) were evenly divided into three groups: 90 minutes of normothermic (37°C) partial hepatic ischemia (normothermic I/R), 90 minutes of hypothermic (25°C) partial hepatic ischemia (hypothermic I/R), and sham laparotomy (without ischemia). There were six animals in each experimental group per time point unless otherwise specified. Hepatic necrosis and PMN infiltration were evaluated and scored on hematoxylin and eosin-stained liver specimens 12 hours after reperfusion. Serum TNF-α levels were determined by ELISA at 0 minutes, 15 minutes, 30 minutes, 1 hour, and 12 hours postreperfusion. Pulmonary PMN infiltration and vascular permeability were measured by myeloperoxidase activity and Evans blue dye extravasation, respectively, to quantitate pulmonary injury 12 hours after reperfusion. Results: Normothermic I/R results in a significant increase in TNF-α at 15 and 30 minutes (p < 0.005), PMN infiltration (p < 0.001), and hepatic necrosis (p < 0.001), compared with sham. Institution of THH reduced peak serum TNF-α levels by 54% at 15 minutes (p < 0.005) and by 73% at 30 minutes (p < 0.001) postreperfusion compared with normothermic I/R. Similarly, hepatic PMN infiltration and necrosis at 12 hours were reduced by 60% (p < 0.05) and 47% (p < 0.05), respectively. Myeloperoxidase activity and Evans blue extravasation (measures of acute lung injury) were reduced by 42% and 39%, respectively, with institution of THH compared with animals undergoing normothermic I/R (p < 0.001). Conclusions: These results demonstrate that THH protects the liver from ischemia and reperfusion-induced necrosis and PMN infiltration. In addition, THH reduces the serum levels of TNF-α and associated pulmonary injury. These data suggest that the ischemic liver is a potential source of inflammatory mediators associated with hepatic ischemia and reperfusion-induced pulmonary injury. (C) 2000 by the American College of Surgeons.

AB - Background: Prolonged periods of hepatic ischemia are associated with hepatocellular injury and distant organ dysfunction in experimental models. Neutrophils (PMN) and tumor necrosis factor (TNF)-α have been implicated, mostly because of their local deleterious effects on the hepatocyte after hepatic ischemia and reperfusion (I/R) injury. We hypothesize that topical hepatic hypothermia (THH) reduces ischemia and reperfusion-induced hepatic necrosis, PMN infiltration, TNF-α release, and consequent acute pulmonary injury. Study Design: Sprague-Dawley rats (250 to 300 g) were evenly divided into three groups: 90 minutes of normothermic (37°C) partial hepatic ischemia (normothermic I/R), 90 minutes of hypothermic (25°C) partial hepatic ischemia (hypothermic I/R), and sham laparotomy (without ischemia). There were six animals in each experimental group per time point unless otherwise specified. Hepatic necrosis and PMN infiltration were evaluated and scored on hematoxylin and eosin-stained liver specimens 12 hours after reperfusion. Serum TNF-α levels were determined by ELISA at 0 minutes, 15 minutes, 30 minutes, 1 hour, and 12 hours postreperfusion. Pulmonary PMN infiltration and vascular permeability were measured by myeloperoxidase activity and Evans blue dye extravasation, respectively, to quantitate pulmonary injury 12 hours after reperfusion. Results: Normothermic I/R results in a significant increase in TNF-α at 15 and 30 minutes (p < 0.005), PMN infiltration (p < 0.001), and hepatic necrosis (p < 0.001), compared with sham. Institution of THH reduced peak serum TNF-α levels by 54% at 15 minutes (p < 0.005) and by 73% at 30 minutes (p < 0.001) postreperfusion compared with normothermic I/R. Similarly, hepatic PMN infiltration and necrosis at 12 hours were reduced by 60% (p < 0.05) and 47% (p < 0.05), respectively. Myeloperoxidase activity and Evans blue extravasation (measures of acute lung injury) were reduced by 42% and 39%, respectively, with institution of THH compared with animals undergoing normothermic I/R (p < 0.001). Conclusions: These results demonstrate that THH protects the liver from ischemia and reperfusion-induced necrosis and PMN infiltration. In addition, THH reduces the serum levels of TNF-α and associated pulmonary injury. These data suggest that the ischemic liver is a potential source of inflammatory mediators associated with hepatic ischemia and reperfusion-induced pulmonary injury. (C) 2000 by the American College of Surgeons.

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