Lysosomal enzyme release during cardiopulmonary bypass

Gnanadurai, T.V.; Branthwaite, M. A.; Colbeck, Jill; Welman, E

doi:10.1111/j.1365-2044.1977.tb10074.x

Cited by 28 publications

(9 citation statements)

References 15 publications

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“…Measurements were conducted with a commercially available enzyme-linked immunoassay according to the manufacturer's instructions (12589 PMN Elastase, Merck immunoassay, Merck, Darmstadt, Germany). NAG and NAG b levels were measured after a fluorometric method, as initially described by Woollen and Walker 21 and subsequently modified by Gnanadurai et al 22 Imaging studies of the urinary tract were performed in all patients (DMSA scan, ultrasound, and voiding cystourethrography). Isotopic evaluation was performed within 96 hours of the UTI diagnosis, using a computer system ␥ camera equipped with a high-resolution parallel-hole collimator.…”

Section: Methodsmentioning

confidence: 99%

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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ABSTRACT. Objective. Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a 1 -antitrypsin complex (E-a 1 -Pi) for the detection of acute pyelonephritis in children.Methods. Eighty-three patients, 29 boys and 54 girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were prospectively studied. Fiftyseven healthy children served as controls. Dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and urinary E-a 1 -Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil count, urinary N-acetyl-␤-glucosaminidase (NAG), N-acetyl-␤-glucosaminidase b (NAG b), and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics. The same markers were also measured in the control subjects.Results. Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children (group A). It was normal in the remaining 53 children (group B). The sex and age distributions were not significantly different between the 2 groups, as well as between the patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA had body temperature >38°C, whereas all but 4 children with abnormal DMSA had temperature >38°C. Therefore, the temperature was significantly different between these 2 groups. The sensitivity and specificity of fever (>38°C) as an indicator of renal involvement based on isotopic findings were 86% and 64%, respectively. Given the significant number of the febrile children with normal DMSA scintiscans, group B was subdivided into B 1 with 19 febrile children (14 boys and 5 girls) and B 2 with 34 children whose body temperature was below 38°C (8 boys and 26 girls). The sex and age distribution was significantly different between groups B 1 and B 2 . The mean age of group B 1 was .78 years (range: 28 days to 9 years; median: .25 years; standard deviation: 2.1). All but 1 child in this group were younger than 1 year of age. In contrast, in group B 2 , there were only 4 infants, the remaining 30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation: 3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B 1 . This difference was not statistically significant. Similarly, body temperature was not significantly different between these 2 groups. The distribution of plasma E-a 1 -Pi values was normal in the control subjects. The sensitivity and specificity of plasma E-a 1 -Pi, as an indicator of renal involvement, were 96% and 50%, respectively, taking the 95th percentile of the reference range as a cutoff value. However, considering as a cutoff value the level of 72 g/dL (95th percentile of group B 2 ), its sensitivity and specificity were 74% and 86%, resp...

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Section: Methodsmentioning

confidence: 99%

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Fretzayas¹,

Moustaki²,

Gourgiotis³

et al. 2000

Pediatrics

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“…Usually during open heart surgery, latent organ damage is evidenced by the increased concentration of the serum lysosomal leaking enzyme, [3-glucuronidase [17]. The significant increase in the levels of renal tubular leaking enzymes also indicated that acute renal tubular damage had occurred in these cases.…”

Section: Discussionmentioning

confidence: 97%

Pharmacological intervention for renal protection during cardiopulmonary bypass

et al. 1993

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The possibility of minimizing organ damage following cardiopulmonary bypass (CPB) was examined. In the control group, n = 21, upon completion of CPB, elevation of the lysosomal enzyme beta-glucuronidase, which is a sensitive indicator of cellular damage, was affected by the concentration of granulocyte elastase (r = 0.59) or the endothelial-derived constricting factor, endothelin, (r = 0.8). Renal damage, which was detected by an increase in renal tubular enzymes (N-acetyl-beta-D-glucosaminidase and gamma-glutamyltranspeptidase) in urine, was also affected by endothelin (r = 0.79, r = 0.56), elastase (r = 0.6, r = 0.71), and by free hemoglobin levels (r = 0.76, r = 0.82). Next, the efficacy of pharmacological intervention for the prevention of renal damage was evaluated. During CPB, the administration of an elastase inhibitor (ulinastatin, 3 x 10(5) IU), n = 8, or a calcium antagonist (nicaldipine HCl, elastase release inhibitor; 5 gamma/kg per min), n = 8, significantly reduced the elevation of beta-glucuronidase and renal tubular enzymes (p < 0.05). Although the ulinastatin and nicardipine groups demonstrated low values of elastase in the Intensive Care Unit (ICU), only the values of the nicardipine group reached statistical significance (p < 0.05). A reduction in endothelin levels compared to the control group was observed in the nicardipine group. However, preventive and counteractive effects of nicardipine against vasoconstriction caused by endothelin were also considered to play an important role in the prevention of renal damage. The addition of haptoglobin (4,000 IU) to the priming solution of the CPB also reduced levels of renal tubular enzymes (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Furthermore, it has been reported that lysosomal enzyme release occurs during cardiopulmonary bypass in man, resulting in an increase of 35% in the activity of β-glucuronidase (Gnanadurai et al, 1977). Furthermore, it has been reported that lysosomal enzyme release occurs during cardiopulmonary bypass in man, resulting in an increase of 35% in the activity of β-glucuronidase (Gnanadurai et al, 1977).…”

Section: Clinical Applicationmentioning

confidence: 99%

“…In some of our patients, negative deconjugation results were obtained which, in our opinion, could be explained by the experimental error of our analytical assay. Furthermore, it has been reported that lysosomal enzyme release occurs during cardiopulmonary bypass in man, resulting in an increase of 35% in the activity of β-glucuronidase (Gnanadurai et al, 1977). This release of lysosomal enzymes originates from damaged renal cells (Hashimoto et al, 1993).…”

Section: Clinical Applicationmentioning

confidence: 99%

High‐performance liquid chromatography assay using ultraviolet detection for urinary quantification of milrinone concentrations in cardiac surgery patients undergoing cardiopulmonary bypass

Gavra

Nguyen

Beauregard

et al. 2014

Biomedical Chromatography

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An analytical assay using liquid-liquid extraction and high-performance liquid chromatography with ultraviolet detection was developed for the quantification of total (conjugated and unconjugated) urinary concentrations of milrinone after the inhalation of a 5 mg dose in 15 cardiac patients undergoing cardiopulmonary bypass. Urine samples (700 μL) were extracted with ethyl-acetate and subsequently underwent acid back-extraction before and after deconjugation by mild acid hydrolysis. Milrinone was separated on a strong cation exchange analytical column. The mobile phase consisted of a constant mixture of acetonitrile:tetrahydrofurane-NaH2 PO4 buffer (40:60 v/v, pH 3.0). Thirteen calibration curves were linear in the concentration range of 31.25-4000 ng/mL, using olprinone as the internal standard (r(2) range 0.9911-0.9999, n = 13). Mean milrinone recovery and accuracy were respectively 85.2 ± 3.1% and ≥93%. Intra- and inter-day precisions (coefficients of variation) were ≤5% and ≤8%, respectively. Over a 24 h collection period, the cumulative urinary milrinone recovered from 15 patients was 26.1 ± 7.7% of the nominal 5 mg dose administered. The relative amount of milrinone glucuronic acid conjugate was negligible in the urine of patients undergoing cardiopulmonary bypass This method proved to be reliable, specific and accurate to determine the cumulative amount of total milrinone recovered in urine after inhalation.

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Lysosomal enzyme release during cardiopulmonary bypass

Cited by 28 publications

References 15 publications

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Polymorphonuclear Elastase as a Diagnostic Marker of Acute Pyelonephritis in Children

Pharmacological intervention for renal protection during cardiopulmonary bypass

High‐performance liquid chromatography assay using ultraviolet detection for urinary quantification of milrinone concentrations in cardiac surgery patients undergoing cardiopulmonary bypass

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