The effect of atrial natriuretic peptide infusion on intestinal injury in septic shock

Abstract

Background and Aims:The aim of this study is to assess the effect of atrial natriuretic peptide (ANP) on intestinal ischemia-reperfusion injury in septic shock.Material and Methods:A prospective randomized controlled, observer-blinded study was carried out in surgical Intensive Care Unit (ICU), University Hospital. Forty adult patients in septic shock were randomly divided into two groups, control group (Group C) received normal saline and ANP group (Group A) patients received ANP in the form of 1.5 mg vial added to 250 ml solvent in plastic bag (1 ml = 6 micg) given at 2 mcg/kg intravenous bolus over 1 min followed by 0.01 mcg/kg/min for 24 h. The primary outcome measurements were blood marker of intestinal hypoperfusion in form of intestinal fatty acid binding protein (I-FABP), malondialdehyde (MDA), myloperoxidase enzyme activity (MPO), protein carbonyl (PC), and glutathione peroxidase activity (GPA) measured before start of ANP infusion, 6 h, 12 h, and 24 h after start of infusion. The secondary outcome measurements were the duration of noradrenaline infusion, duration of ICU stay, hospital mortality rate, and complications related to ANP.Results:In comparison with Group C, Group A showed a significant decrease (P < 0.05) in serum level of MPO, MDA, PC, and I-FABP, with a significant increase (P < 0.05) in serum level of GPA, 6 h, 12 h, and 24 h after the start of ANP infusion. There was significant decrease (P < 0.05) in mean duration of noradrenaline infusion, the length of ICU stay and mortality rate in Group A in comparison with Group C. In Group A, seven patients had mean arterial blood pressure < 65 mmHg but respond to volume resuscitation, three patients serum sodium was 125–130 mmol/L.Conclusion:In cases of septic shock, concomitant administration of ANP with noradrenaline may have a protective effect against intestinal injury through a decrease in the level of intestinal hypoperfusion owing to its anti-inflammatory and antioxidant effect.

Reversal of the detrimental effects of social isolation on ischemic cerebral injury and stroke-associated pneumonia by inhibiting small intestinal γδ T-cell migration into the brain and lung

“…21,[76][77][78][79] Importantly, ANP exerts barrier-protective effects by reducing LPS-and TNF-a-induced increases in the permeability of endothelial cells and alleviating post-septic intestinal injury. 22,80 Furthermore, it has been documented that exogenous ANP has a protective role in terms of both neurofunctional improvement and infarct volume reduction in experimental models of ischemic stroke. 27 Corroborating these findings, our study showed that exogenous administration of ANP in a dose-dependent manner decreased cerebral infarct damage and ameliorated associated pneumonia in ISO mice.…”

RhANP attenuates endotoxin-derived cognitive dysfunction through subdiaphragmatic vagus nerve-mediated gut microbiota–brain axis

“…and adhesion molecules (vascular cell adhesion molecules, intercellular cell adhesion molecule-1, E-selectin, etc.) [ 17 , 28 – 31 ], suppressing LPS and TNF-α-induced increased permeability of endothelial cells [ 18 ], and alleviating post-septic intestinal injury [ 25 ]. However, the molecular mechanisms by which ANP modulates immune responses/immune cell activation are unclear.…”

“…In an experimental model of systemic LPS challenge-induced sepsis, ANP pretreatment could improve survival [ 24 ]. Furthermore, a prospective randomized controlled, observer‑blinded study found that ANP treatment could alleviate intestinal injury and reduce the length of intensive care unit (ICU) stay and mortality rate in patients with septic shock [ 25 ]. However, there are currently no reports of the effects of ANP on systemic LPS-induced endotoxemia-derived neuroinflammation and cognitive impairment.…”