Acute mesenteric ischemia after cardiopulmonary bypass

Gennaro, Mark; Ascer, Enrico; Matano, Richard; Jacobowitz, Israel J.; Cunningham, Joseph N.; Uceda, Pablo V.

doi:10.1016/s0002-9610(05)81062-1

Cited by 70 publications

(39 citation statements)

References 28 publications

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“…I schemic injury to the intestine frequently occurs during abdominal surgery for aortic aneurysm repair or cardiopulmonary bypass (1). Other clinical complications, including acute superior mesenteric artery occlusion and mesenteric venous thrombosis, also lead to intestinal ischemia (2).…”

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confidence: 99%

The receptor for complement component C3a mediates protection from intestinal ischemia-reperfusion injuries by inhibiting neutrophil mobilization

Brennan

Lynch

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

138

157

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C3a is a key complement activation fragment, yet its neutrophil-expressed receptor (C3aR) still has no clearly defined role. In this study, we used a neutrophil-dependent mouse model of intestinal ischemia-reperfusion (IR) injury to explore the role of C3aR in acute tissue injuries. C3aR deficiency worsened intestinal injury, which corresponded with increased numbers of tissue-infiltrating neutrophils. Circulating neutrophils were significantly increased in C3aR −/− mice after intestinal ischemia, and C3aR −/− mice also mobilized more circulating neutrophils after granulocyte colony-stimulating factor infusion compared with WT mice, indicating a specific role for C3aR in constraining neutrophil mobilization in response to intestinal injury. In support of this role, C3aR −/− mice reconstituted with WT bone marrow reversed IR pathology back to WT levels. Complement C5a receptor (C5aR) antagonism in C3aR −/− mice also rectified the worsened pathology after intestinal IR injury but had no effect on circulating neutrophils, highlighting the opposing roles of C3a and C5a in disease pathogenesis. Finally, we found that using a potent C3a agonist to activate C3aR in vivo reduced neutrophil mobilization and ameliorated intestinal IR pathology in WT, but not C3aR −/− , mice. This study identifies a role for C3aR in regulating neutrophil mobilization after acute intestinal injury and highlights C3aR agonism as a potential treatment option for acute, neutrophil-driven pathologies.

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mentioning

confidence: 99%

The receptor for complement component C3a mediates protection from intestinal ischemia-reperfusion injuries by inhibiting neutrophil mobilization

Brennan

Lynch

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

138

157

View full text Add to dashboard Cite

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“…Other predisposingconditions include hypotension from cardiac heart failure, myocardial infarction, sepsis, aortic insufficiency, severe liver or renal disease, or recent major cardiac or abdominal surgery and the use of digitalis (Endress et al 1992;Bassiouny 1997;Sudhakar et al 1997;Cappell 1998;Liu et al 2000;Schoots et al 2004). Mesenteric venous thrombosis occurs in patients, who are found to have the following pre-disposing conditions: hypercoagulability (protein C and S or antithrombin III deficiency,) hematologic conditions (polycythemia vera) pregnancy, oral contraceptive use, malignancy, infections, portal hypertension, venous trauma (Zakhour et al 1987;Harward et al 1989;Grieshop et al 1991;Gennaro et al 1993;Cappell 1998;Liu et al 2000;Ağaoğlu et al 2005). The consequences of vascular occlusion depend on the vessels involved and the status of collateral channels (Brandt et al 2000).…”

Section: Pathogenesismentioning

confidence: 99%

“…The most important finding is pain disproportionate to physical examination findings. Depending on the type of mesenteric ischemia, patients may present with a variety of signs and symptoms (Zakhour et al 1987;Harward et al 1989;Grieshop et al 1991;Gennaro et al 1993;Lobo Martíez et al 1993;Rhee et al1994;Brandt et al 2000;Ağaoğlu et al 2005;Huang et al 2005). Acute arterial mesenteric ischemia typically has the most abrupt and painful presentation of all types.…”

Section: Presentation and Clinical Featuresmentioning

confidence: 99%

“…Abdominal angina is a syndrome of postprandial abdominal pain starting soon after eating and lasting for up to 3 hours. Weight loss, "food fear, early satiety, and altered bowel habits may be present (Grieshop et al 1991;Gennaro et al 1993;Ağaoğlu et al 2005). These patients have undergone a gradual progression of arterial occlusion and frequently have a better collateral supply.…”

Section: Presentation and Clinical Featuresmentioning

confidence: 99%

See 1 more Smart Citation

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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“…Intestinal ischemia-reperfusion injury may be caused by cardiovascular surgery including thoracoabdominal aortic aneurysm repair, cardiopulmonary bypass, and small bowel transplant. [2][3][4] Intestinal ischemia may increase the rapid progression of tissue necrosis and may cause serious metabolic disorders, reactive oxygen species production, bacterial translocation, release of proinflammatory cytokines (interleukin 1β and tumor necrosis factor α [TNF-α]), cell damage from inflammation, and multiple organ dysfunction syndrome. 5 Natural products for treatment may have advantages such as low toxicity and a wide range of sources.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Objectives: The purpose of this study was to evaluate the effect of intravenous injection of osthole on intestinal ischemia-reperfusion injury and parameters of oxidative stress. Materials and Methods: In 45 Kunming male mice, treatment included sham surgery (15 mice); intestinal ischemia-reperfusion injury (clamping of the superior mesenteric artery, 2 h; clamp release, 1 h; 15 mice); or osthole treatment before and after ischemia-reperfusion injury (15 mice). Evaluation included histopathology, determination of intestinal wet/dry weight ratio, and measurement of levels of diamine oxidase, superoxide dismutase, malondialdehyde, interleukin 1β, tumor necrosis factor α, and interleukin 2. Intestinal barrier permeability was evaluated with Evans blue test. Results: The mean wet-to-dry weight ratio, Evans blue content, and Chiu score were significantly greater in the ischemia-reperfusion than in the sham group and lower in the osthole-treated than the ischemia-reperfusion group. The mean serum diamine oxidase, malondialdehyde, interleukin 1β, and tumor necrosis factor α levels were significantly greater in the ischemia-reperfusion than in the sham group and lower in the osthole-treated than in the ischemia-reperfusion group. The mean superoxide dismutase activity and interleukin 2 levels were lower in the ischemia-reperfusion than in the sham group and greater in the osthole-treated than in the ischemia-reperfusion group. Conclusions: Treatment with osthole may protect against oxidative stress and tissue damage from intestinal ischemia-reperfusion injury.

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Acute mesenteric ischemia after cardiopulmonary bypass

Cited by 70 publications

References 28 publications

The receptor for complement component C3a mediates protection from intestinal ischemia-reperfusion injuries by inhibiting neutrophil mobilization

The receptor for complement component C3a mediates protection from intestinal ischemia-reperfusion injuries by inhibiting neutrophil mobilization

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

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