Intravenous adenosine for refractory pulmonary hypertension in a low-weight premature newborn: A potential new drug for rescue therapy

Motti, Alessandro; Tissot, Cécile; Rimensberger, Peter C.; Prina-Rousso, Aline; Aggoun, Yacine; Berner, Michel; Beghetti, Maurice; Cruz, Eduardo M. da

doi:10.1097/01.pcc.0000225000.78627.eb

Cited by 22 publications

(10 citation statements)

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“…For example, studies in both rats and human subjects showed that oral administration of adenosine in sucrose solutions decreased blood glucose and insulin concentrations due to its inhibitory effect on α-glucosidase ( 7 , 8 ) . Continuous intravenous infusion of adenosine in premature infants was also reported to have dramatic beneficial effects on neonatal refractory pulmonary hypertension ( 9 ) , in addition to attenuating the proliferation of both human and rat glomerular mesangial cells associated with hypertension and diabetes ( 10 ) .…”

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Anti-metabolic syndrome effects of adenosine ingestion in stroke-prone spontaneously hypertensive rats fed a high-fat diet

et al. 2010

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We have demonstrated previously that both acute and chronic oral administration of adenosine have novel functions such as anti-hypertensive effects and improved hyperlipidaemia in stroke-prone spontaneously hypertensive rats (SHRSP) fed a normal diet. The purpose of the present study was to investigate the effect of adenosine administration on metabolic syndrome-related parameters in SHRSP fed a high-fat diet. Six-week-old rats were divided into three groups, and were administered either water (control) or adenosine (10 or 100 mg/l) for 8 weeks. During this period, the rats had free access to a high-fat diet based on AIN-93M. The results showed that hypertension, plasma lipid, NO, insulin, glucose and urinary 8-hydroxy-2 0 -deoxyguanosine levels improved significantly in both adenosine groups. The mRNA expression levels of genes involved in anti-oxidative activity and adenosine receptors were also altered in the adenosine groups. Administration of adenosine also increased plasma adiponectin levels, accompanied by upregulation of mRNA expression level of adiponectin and adiponectin receptor 1 in perirenal fat and adiponectin receptor 2 in the liver. In conclusion, oral administration of adenosine is effective for improving metabolic syndrome-related parameters in SHRSP, and accordingly it may prevent the progression of the metabolic syndrome. High-fat diet: Blood pressure: Glucose metabolism: Lipid profileObesity has become increasingly prevalent worldwide as a result of changes in lifestyle, especially eating habits, and it is involved in the aetiology of a number of conditions such as CVD, hypertension, stroke and diabetes (1,2) . Overconsumption of high-energy food and lower energy expenditure have resulted in an alarming increase in the incidence of obesity (3) . The fact that clinically diagnosed insulin resistance, hypertension, increased fat distribution and high plasma TAG levels have been associated with the development of diseases associated with metabolic syndrome-related parameters has attracted attention from the scientific community. Prevention and improvement of obesity and metabolic syndrome-related diseases are therefore important issues in modern society, and represent an effective strategy for the promotion of better health.Adenosine is an endogenous purine nucleoside that modulates many physiological processes, with these effects being mediated by the activation of specific subtypes of adenosine receptors, termed A 1 , A 2A , A 2B and A 3 ( 4,5) . Adenosine can be extracted from plant and mammalian tissues. Higher adenosine concentrations in the plant and mammalian tissues result from enhanced excretion of adenosine or diminished uptake of adenosine (6) . Previous studies have provided evidence to support the physiological role of adenosine in general health. For example, studies in both rats and human subjects showed that oral administration of adenosine in sucrose solutions decreased blood glucose and insulin concentrations due to its inhibitory effect on a-glucosidase (7,8) . Continuous int...

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Anti-metabolic syndrome effects of adenosine ingestion in stroke-prone spontaneously hypertensive rats fed a high-fat diet

et al. 2010

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“…In addition, although experience with continuous adenosine infusion is still at an early stage, it might be worth considering its administration as a rescue therapy or even as an alternative to ECMO [74].…”

Section: Novel Therapeutic Strategiesmentioning

confidence: 98%

Persistent Pulmonary Hypertension of the Newborn: Therapeutical Approach

Latini

Vecchio²,

Felice³

et al. 2008

MRMC

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Persistent pulmonary hypertension of the newborn (PPHN), is defined as a failure of the pulmonary vasculature to relax at birth and consequently of the normal adaptation to extra uterine life of the fetal heart/lung system, resulting in hypoxemia. This condition, occurs in about 1-2 newborns per 1000 live births and despite significant improvements in treatment it is associated with substantial infant mortality and morbidity. Over the years wider application of inhaled nitric oxide (iNO) therapy and improved ventilation strategies including surfactant, high-frequency oscillatory ventilation has led to a decrease in the need for invasive life-sustaining therapies such as extracorporeal membrane oxygenation (ECMO). Mortality rate varies from 10 to 20 % of affected newborns in developed countries, but it is much higher when PPHN is refractory to the above reported therapies or when they are not available. As a consequence, development of new therapeutic strategies for severe PPHN is crucial. In particular, recent studies seem to show that sildenafil, a phosphodiesterase inhibitor type 5 that selectively reduces pulmonary vascular resistance may be a useful therapeutic adjunct to critically ill neonates with PPHN.

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“…[364][365][366] Investigations support use of inhaled iloprost (synthetic analog of prostacyclin) or adenosine infusion as modes of therapy for PPHN. [367][368][369][370][371][372] ECMO remains the therapy of choice for patients with refractory PPHN and sepsis. [373][374][375][376] Extracorporeal therapies Various extracorporeal therapies such as extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), and blood purification (hemofiltration, hemoperfusion, and therapeutic plasma exchange) have been reported with various successes in the management of pediatric sepsis and septic shock.…”

Section: Vasopressorsmentioning

confidence: 99%

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Erratum

2017

Critical Care Medicine

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Intravenous adenosine for refractory pulmonary hypertension in a low-weight premature newborn: A potential new drug for rescue therapy

Abstract: Although experience with continuous adenosine infusion is still at an early stage, it might be worth considering its administration as a rescue therapy or even as an alternative to extracorporeal membrane oxygenation.

Cited by 22 publications

References 13 publications

Anti-metabolic syndrome effects of adenosine ingestion in stroke-prone spontaneously hypertensive rats fed a high-fat diet

Anti-metabolic syndrome effects of adenosine ingestion in stroke-prone spontaneously hypertensive rats fed a high-fat diet

Persistent Pulmonary Hypertension of the Newborn: Therapeutical Approach

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Erratum

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