Ultrastructure of coronary microvessels in conditions of heart reperfusion following prolonged ischemia while applying various methods of artificial hypothermia

It has been found out that in children with Roger's disease corrected in the conditions of two fundamentally different procedures of anesthetic management, myocardial reperfusion after cardiac arrest under artificial hypothermic circulation is accompanied by obstruction of more than 30% of coronary bed microvessels with hydropic endothelial cells or their cystiform fragments. The content of necrotic cells increases, while the "working" cells demonstrate a decrease in myocropinocytotic transport characteristics. Circulatory arrest under perfusionless hypothermia and immersion reperfusion do not result in a dramatic change of general morphology of microvessels as compared to the control group, while a heterogenic response of the structures responsible for transendothelial transfer of macromolecules provides the basis for recovery of the endothelium structure and function, as a patient's temperature reaches a standard value.     

Ultrastructure of coronary microvessels during heart reperfusion after prolonged ischemia under conditions of various forms of artificial hypothermia

It has been found that, in children with Roger’s disease corrected under conditions of two fundamentally different procedures of anesthetic management, myocardial reperfusion after cardiac arrest under artificial hypothermic circulation is accompanied with obstruction of more than 70% of coronary bed microvessels, one-third of them being blocked with hydropic endothelial cells or their cystiform fragments. It hampers or even totally prevents their functioning in the postoperative period. The content of necrotic cells increases, while the three “working” cell types demonstrate a decrease in myocropinocytotic transport. Circulatory arrest during perfusionless hypothermia and immersion reperfusion do not result in a dramatic change of general morphology of microvessels as compared to the control group maintaining the endothelial cell population unaltered. Ultrastructural organization of endothelial microvessels displayed no features of intracellular regeneration. However, a heterogenic response of the structures responsible for transendothelial transfer of macromolecules provides the basis for the recovery of endothelium structure and function, as a patient’s temperature reaches the standard value.     

Central A1-receptor activation associated with onset of torpor protects the heart against low temperature in the Syrian hamster

Body temperature drops dramatically during hibernation, but the heart retains the ability to contract and is resistant to induction of arrhythmia. Although adaptive changes in the heart prior to hibernation may be involved in the cold-resistant property, it remains unclear whether these changes are sufficient for maintaining cardiac pulsatility under an extreme hypothermic condition. We forcibly induced hypothermia in Syrian hamsters by pentobarbital anesthesia combined with cooling of the animals. This allows reproduction of a hypothermic condition in the absence of possible hibernation-specific reactions. Unlike hypothermia in natural hibernation, the forced induction of hypothermia caused atrioventricular block. Furthermore, J-waves, which are typically observed during hypothermia in nonhibernators, were recorded on an ECG. The origin of the J-wave seemed to be related to irreversible injury of the myocardium, because J-waves remained after recovery of body temperature. An abnormal ECG was also found when hypothermia was induced in hamsters that were well adapted to a cold and darkened environment or hamsters that had already experienced hibernation. These results suggest that acclimatization prior to hibernation does not have a crucial effect at least on acquisition of cardiac resistance to low temperature. In contrast, an abnormal ECG was not observed in the case of hypothermia induced by central administration of an adenosine A1-receptor agonist and subsequent cooling, confirming the importance of the adenosine system for inducing hibernation. Our results suggest that some specific mechanisms, which may be driven by a central adenosine system, operate for maintaining the proper cardiac pulsatility under extreme hypothermia.     

Endothelium of myocardium microvessel under conditions of hypothermia, ischemia, reperfusion and pharmaco-cold cardioplegia with calcium antagonist

Microvessels of the right atrium endothelium were investigated with electron microscope for patients with congenital heart disease receiving surgical treatment under deep perfusionless hypothermia and various methods of pharmaco-cold cardioplegia. In group 1, pharmaco-cold cardioplegia was performed, with hyperosmolar normopotash solution cooled down to 2-4 degrees C. In group 2, the same solution combined with isoptin, a potash-ion blocker, was applied. It has been shown that during global ischemia, stability of ion gradients on plasmalemma of endothelial cells is impaired, irrespective of the composition of cardioplegia solution. Alongside with this, ultrastructural reactions in group 1 proceed towards hyperosmia of endothelium accompanied by building up a large group of cells following coagulation necrosis. In group 2, by contrast, an intracellular edema progresses. The cardioprotective effect of isoptin, which is able to block Ca2+, manifests itself most vividly at reperfusion, when the blocking of cell potash overload prevents the development of dystrophic and destructive changes in endothelium of coronary microvessels, which present one of the most severe consequences in the process of blood flow recovery in ischemic tissues.     

Effect of oral vitamin E supplementation on oxidative stress in guinea-pigs with short-term hypothermia

Effects of oral vitamin E supplementation on blood malondialdehyde (MDA), glutathione (GSH) and vitamin E levels and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities in acute hypothermia of guinea-pigs were investigated. Thirty male guinea pigs, weighing 500-800 g were randomly divided into one of three experimental groups: A (control, without cooling), B (hypothermic) and C (hypothermic with vitamin E supplementation). The guinea-pigs of group C received daily oral supplementation of 460 mg kg(-1) bw vitamin E for 4 days before inducing hypothermia. Twenty-four hours after the last vitamin E supplementation, the guinea-pigs of the B and C groups were cooled by immersion into cold water (10-12 degrees C), and the control guinea-pigs were immersed into water of body temperature (37 degrees C) up to the neck for 5 min without using any anaesthetic or tranquilizer. Rectal body temperatures of groups were measured and blood samples for biochemical analysis were collected immediately after the cooling. The body temperature, GSH and vitamin E levels and GSH-Px enzyme activity of hypothermic guinea-pigs were lower (p < 0.05), but SOD enzyme activity was not different (p > 0.05) from those of control animals. Although, the body temperature of hypothermic with vitamin E supplementation group was lower (p < 0.05), all other parameters of this group were not different (p > 0.05) from the controls. It was concluded that oral supplementation of vitamin E can alleviate the lipid peroxidation-induced disturbances associated with hypothermia by increasing the serum vitamin E level to normal. However, more studies are needed to prove whether this vitamin can improve quality of life during the cold seasons.     

Hypothermia produces rat liver proteomic changes as in hibernating mammals but decreases endoplasmic reticulum chaperones

Hypothermia is used in the clinic for protection of organs such as the brain against ischemic injury during aortic/complex congenital cardiac surgery or post-resuscitation encephalopathy. The principal mechanism of hypothermic protection is suppression of metabolism, however, the pleiotropic effects of cooling are incompletely understood. Here, we used a rat model system to evaluate metabolic changes induced by deep hypothermia. The hypothermia-induced changes were identified using fluorescence-based two-dimensional (2-D) difference gel electrophoresis (DIGE) and matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF/TOF) tandem mass spectrometry. Rats were randomly assigned to a normothermic control group (37°C, n=6) or hypothermia group (23°C, n=6) that received surface cooling for 3h. Liver tissue was excised for assessment. Functional profiling of differently expressed proteins was performed as an enrichment analysis of Gene Ontology (GO) terms and pathways. We found that the livers of anesthetized rats with deep hypothermia showed significant downregulation of proteins in the endoplasmic reticulum and mitochondria, and of those involved in ATP binding, amino acid metabolism and urea cycle, response to oxidative stress, anti-apoptosis, negative regulation of apoptosis. The changes in the proteome of the hypothermic rats showed similarities, except with regard to endoplasmic reticulum chaperones, to those identified elsewhere in mammals undergoing hibernation.     

Effect of alcohol on thermal balance of man in cold water.

The effects of alcohol on core cooling rates (rectal and tympanic), skin temperatures, and metabolic rate were determined for 10 subjects rendered hypothermic by immersion for 45 min in 10 degrees C water. Experiments were duplicated with and without a 20-min period of exercise at the beginning of cold water immersion. Measurements were continued during rewarming in a hot bath. With blood alcohol concentrations averaging 82 mg 100 mL-1, core cooling rates and changes in skin temperatures were insignificantly different from controls, even if the exercise period was imposed. Alcohol reduced shivering metabolic rate by an overall mean of 13%, insufficient to affect cooling rate. Alcohol had no effect on metabolic rate during exercise. During rewarming by hot bath, the amount of 'afterdrop' and rate of increase in core temperature were unaffected by alcohol. It was concluded that alcohol in a moderate dosage does not influence the rate of progress into hypothermia or subsequent, efficient rewarming. This emphasizes that the high incidence of alcohol involvement in water-related fatalities is due to alcohol potentiation of accidents rather than any direct effects on cold water survival, although very high doses of alcohol leading to unconsciousness would increase rate of progress into hypothermia.     

Induction of VMAT-1 and TPH-1 expression induces vesicular accumulation of serotonin and protects cells and tissue from cooling/rewarming injury

DDT₁ MF-2 hamster ductus deferens cells are resistant to hypothermia due to serotonin secretion from secretory vesicles and subsequent cystathionine beta synthase (CBS) mediated formation of H₂S. We investigated whether the mechanism promoting resistance to hypothermia may be translationally induced in cells vulnerable to cold storage. Thus, VMAT-1 (vesicular monoamino transferase) and TPH-1 (tryptophan hydroxylase) were co-transfected in rat aortic smooth muscle cells (SMAC) and kidney tissue to create a serotonin-vesicular phenotype (named VTSMAC and VTkidney, respectively). Effects on hypothermic damage were assessed. VTSMAC showed a vesicular phenotype and an 8-fold increase in serotonin content and 5-fold increase in its release upon cooling. Cooled VTSMAC produced up to 10 fold higher concentrations of H₂S, and were protected from hypothermia, as shown by a 50% reduction of caspase 3/7 activity and 4 times higher survival compared to SMAC. Hypothermic resistance was abolished by the inhibition of CBS activity or blockade of serotonin re-uptake. In VTkidney slices, expression of CBS was 3 fold increased in cold preserved kidney tissue, with two-fold increase in H₂S concentration. While cooling induced substantial damage to empty vector transfected kidney as shown by caspase 3/7 activity and loss of FABP1, VTkidney was fully protected and comparable to non-cooled control. Thus, transfection of VMAT-1 and TPH-1 induced vesicular storage of serotonin which is triggered release upon cooling and has protective effects against hypothermia. The vesicular serotonergic phenotype protects against hypothermic damage through re-uptake of serotonin inducing CBS mediated H₂S production both in cells and kidney slices.     

Hypothermia downregulates inflammation but enhances IL-6 secretion by stimulated endothelial cells

Hypothermia is a standard method for organ protection during cardiac surgery in children. However, the mechanisms of hypothermia-induced cell protection have not yet been clearly established. Therefore, the aim of our studies was to elucidate molecular effects of clinically relevant mild and deep hypothermia on endothelial cells. The endothelium plays a pivotal role in the interaction between blood cells and actively participates in complex inflammatory events. We isolated primary human umbilical vein endothelial cells (HUVEC) and investigated cell viability, proliferation and inflammatory characteristics after TNF-α stimulation under mild (32 °C) and deep (17 °C) hypothermia in comparison to normothermia (37 °C). As a protective mechanism of endothelial cells kept under hypothermic conditions we found a significant upregulation of the antiapoptotic protein Bcl-2, resulting in the same cell viability under hypothermic conditions. Unexpectedly we demonstrated significantly higher IL-6 release after 6 h of mild hypothermia. In contrast, hypothermia diminished inflammatory chemokines such as IL-8, MCP-1 and COX-2 protein expression which could lead to reduced leukocyte recruitment under hypothermia. Underlying mechanisms of this downregulation were found to be reduced ERK 1/2 phosphorylation and incomplete IκB-α degradation resulting in reduced NFκB-dependent proinflammatory gene expression. The upregulation of Bcl-2 protein and the higher IL-6 release after 6 h of mild hypothermia are new and interesting cellular mechanisms of hypothermia in endothelial cell biology. Both factors may play a major role as cell protective mechanisms in hypothermia.     

The radioprotective effect of hypothermia on the immune and hematopoietic systems in mammals

The functional activity of the synthetic apparatus (parameter alpha) in blood lymphocytes, bone marrow hemopoietic cells, and thymus cells, as well as the total number of blood and bone marrow cells in rats after y-irradiation at a dose of 8 Gy in the conditions of normothermia and hypothermia (16-18 degrees C) with hypoxia-hypercapnia were investigated after 2 h and on days 1 and 4. The recovery processes in blood in both groups of rats after acute X-irradiation at a dose of 7 Gy for 36 days were analyzed too. Under hypothermia, on days 1-4 after acute gamma-irradiation, a decrease in the synthetic activity in remaining cells and devastation in the hemopoietic system were pronounced to a lesser degree. After X-irradiation, the restoration of synthetic activity in blood lymphocytes was shown to begin earlier and to finish faster in "hypothermic" rats as compared with the animals irradiated in the state of normothermia. The survival of "hypothermic" rats was 100% as compared with 30% in "normothermic" animals. Thus, the data show that hypothermia exerts a radioprotective effect on the cells of the immune and hemopoietic systems, thus enhancing the resistance of the organism to radiation.     

An integrated model of thermodynamic-hemodynamic-pharmacokinetic system and its application on decoupling control of intracranial temperature and pressure in brain hypothermia treatment

Brain hypothermia treatment (BHT) is an intensive care characterized by simultaneous managements of various vital signs, such as intracranial temperature (ICT) and pressure (ICP), of the severe neuropatient. Medical treatments including therapeutic ambient cooling and diuresis are separately carried out based on the experience of the medical staff involved in the clinical management of various pathophysiological processes, such as thermodynamics, hemodynamics and pharmacokinetics. However, no special attention has been paid to the interactions among these subsystems in therapeutic hypothermia because of the lack of theoretical knowledge. Therefore, quantitative analyses using an integrated model of various physiological processes and their interactions are of pressing need. In the present paper, we propose a general compartmental model to describe the pathophysiological processes of the three aforementioned dynamics, on account of the dynamical analogy of temperature, pressure and concentration. The model is verified by the agreement of model-based simulation results with clinical evidence. Based on responses of the integrated model to various stimuli, a transfer function matrix is identified to linearly approximate the characteristic interrelationships between medical treatments (ambient cooling and diuresis) and the vital signs (ICT and ICP). Then a controller that decouples ambient cooling and diuresis is proposed for efficient management of ICT and ICP, enhancement of hypothermic decompression and reduction of diuretic dosage. Decoupling control simulation indicates that ICT and ICP of the integrated model, representing a patient under BHT, can be simultaneously regulated by a single PID controller for ambient cooling and another for diuresis. The proposed decoupler effectively establishes hypothermic decompression, reduces the dosage of diuretic and improves ICP management. Theoretical analyses of the integrated model and decoupling control of ICT and ICP provide insights into the intensive care of various pathophysiological processes in patients undergoing BHT.     

Subcellular reorganization of cardiomyocytes during and after temporary experimental hypothermic circulatory arrest

Ultrastructure of cardiomyocytes of the left ventricle has been studied in dogs during the experiments, performed with a general external cooling, prolonged circulatory arrest, as well as during long term periods after the operation. In the experiment without cooling it is not possible to restore hemodynamics after 30 min of total ischemia. In cardiomyocytes severe, sometimes irreversible lytic lesions are registered. Opposite to this, by the end of one hour's cardiac arrest under total cooling up to 24-22 degrees C, changes in ultrastructure of cardiomyocytes are minimal. This is proved by a stabilizing action of hypothermia to membranous, fibrillar and even labile granular cellular components. More manifested changes occur in cells after restoration of the cardiac activity and worming, though even at this stage certain morphological signs of partial restoration of synthetic processes are noted. By the third day after the operation ultrastructure of cardiomyocytes is fully normalized at an essential hypertrophy and hyperplasia of protein synthesis organels and lysosomes. Thus, under conditions of aperfusional hypothermia (24-22 degrees C) and cardiac arrest, produced with pharmacological cooling, cardiomyocytes safely survive one hour's total ischemia, presenting their ability to intracellular regeneration in full.     

The effect of X-rays and artificial hypotermia on lipids in rat neocortex

Lipid content of tissue and of fraction of microsomes in neocortex of Wistar rats was studies under artificial hypothermia, after X-ray irradiation in dose 8 Gy under conditions of normothermia and artificial hypothermia in 48 h. The condition of artificial hypothermia get by cooling of rats to 15-18 degrees C. It was shown, that in fraction of microsomes of hypothermia rats the content of phosphatidylinositol was decreased, and in 48 h after cooling of rats the amount of protein, total and individual phospholipids was increased. The lipid content in tissue and in fraction of microsomes of rats, which were irradiated in normotermia, had no changes after 48 h. In fraction of microsomes of rats, which were irradiated after hypothermia, the amount of protein, total phospholipids, sphingomyelin, phosphatidylcholine and phosphatidylserine is increased trustworthy. Thus, we think, that radioprotective effect of hypotermia may be connected with the accumulation of proteins and of phospholipids in the endoplasmic reticulum membranes of neocortex.     

Glial proteome changes in response to moderate hypothermia

Reactive glia plays a central role in neuroinflammation associated with secondary damage after brain injury. In order to understand the global effects of therapeutic hypothermia on glial activation and neuroinflammation, we performed proteomic profiling of glial cultures following inflammatory stimulation and hypothermic exposure. Primary mixed glial cultures prepared from mouse brains were stimulated with lipopolysaccharide and interferon-γ under normothermic (37°C) or moderate hypothermic (29°C) conditions, and their proteome profiles were compared by LC-ESI-MS/MS. Differentially expressed proteins were determined by high-throughput label-free quantification. Under hypothermic conditions, 64 and 16 proteins were upregulated (≥1.5-fold) and downregulated (≤ 0.7-fold), respectively, compared to normothermic conditions. More importantly, hypothermia altered the abundance of 143 proteins that were either increased or decreased by inflammatory stimulation. The results were validated for several proteins (ICAM-1, STAT-1, YWHAB, and IFIT-3) by Western blot analysis. Pathway and network analysis indicate that hypothermia influences various biological functions of glia such as molecular transport, cell movement, immune response, cell death, and stress response. In conclusion, moderate hypothermia seems to have a significant effect on the protein expression profiles of brain glia and possibly ensuing neuroinflammation. These proteins may be involved in the protective mechanism of hypothermia against brain injuries.     

Dynamics of free amino acids in rat brain tissue during hypothermia

A comparative study is conducted for the effect of one-, three- and six-hour artificial deep (20-19 degrees C) hypothermia on the content of free amino acids in the blood serum, tissue, nuclei and mitochondria of the rat brain. It is found out that the content is the highest in the blood serum after a three-hour cooling. In the brain tissue the amount of amino acids lowers, especially under conditions of a six-hour hypothermia. In nuclei a three-hour effect of hypothermia decreases sharply the content of free amino acids and the six-hour one increases the amount of most of them. Under hypothermia the content of nearly all amino acids in the brain mitochondria is higher than in the intact animals.     

Facultative hypothermic responses in an Afrotropical arid-zone passerine,the red-headed finch (<Emphasis Type="Italic">Amadina erythrocephala</Emphasis>)

We investigated thermoregulation and facultative hypothermic responses to food deprivation in the red-headed finch (Amadina erythrocephala), a 22-g passerine endemic to the arid regions of southern Africa. We predicted that, like most other passerines investigated, A. erythrocephala exhibits shallow rest-phase hypothermia, but not torpor. We observed significant reductions in rest-phase energy expenditure and body temperature (Tb) in response to restricted feeding. The maximum extent of Tb reduction (ca. 5 degrees C) and energy savings (ca. 10%) were consistent with those reported for a number of other passerine species. The lowest Tb we observed in a bird able to arouse spontaneously was 34.8 degrees C. The parameters of facultative hypothermic responses in A. erythrocephala were indicative of shallow rest-phase hypothermia, but not torpor. The limited available data on hypothermic responses in passerines suggest that many species do not possess the capacity for torpor. In passerines, torpor appears to be restricted to a few nectarivores and aerial insectarivores, and may have evolved independently of the torpor observed in non-passerine taxa such as the Trochiliformes and Caprimulgidae. The basal metabolic rate (BMR) of A. erythrocephala was 30-46% lower than predicted by various allometric equations, but was similar to the predicted BMR for a 22-g desert bird.     

Kinetic characteristics of acetylcholinesterase and structural-functional state of rat erythrocyte membranes at moderate hypothermia

Artificial hypothermic state of homeothermic animals contributes to the stimulation of free radical processes in red blood cells. In order to understand what are the consequences of oxidative damage of erythrocyte membrane, we examined the dependence of the kinetic characteristics of integral membrane enzyme acetylcholinesterase (AChE) and structural and functional state of the membrane on the duration of mild hypothermia. For this purpose we reduced body temperature of adult Wistar rats by external cooling to 30°C (short-term moderate hypothermia) and then prolonged hypothermia up to 1.5 and 3 h. A short-term hypothermia was followed with an increase in V _max and a decrease in K _m, promoting an increase in the catalysis effectiveness.The optimum point on the graph of the concentration dependence was shifted to the area of lower concentrations, and the character of enzyme–substrate interactions at high concentrations of the enzyme changed. Upon prolongation of hypothermia, changes in the AChE kinetic characteristics favored normalization of the enzyme activity and concentration dependence. To test the hypothesis of a possible influence of the lipid matrix on the kinetic characteristics of AchE, we studied structural properties of the erythrocyte membranes using fluorescent probe pyrene. The observed changes in the structural and dynamic characteristics of erythrocyte membranes after a 1.5-h hypothermia suggested a reduction in microviscosity of both total and annular lipids. Prolongation of hypothermia up to 3 h favored normalization of this parameter. It was found that the indicators of the structural state of erythrocyte membranes at different durations of hypothermia correlate with certain kinetic characteristics of AChE. The data indicate that the prolongation of mild hypothermia up to 3 h triggers adaptive mechanisms directed to normalization of the erythrocytes membrane functioning.     

Effects of insulin and beta-adrenergic blockade on certain indicators of carbohydrate metabolism in the blood and tissues of rats during short-lasting hypothermia

Administration of insulin 1 i.u./100 g of body weight to hypothermic rats causes a fall of glucose and lactate levels in the serum and a rise in myocardial glycogen level in relation to the group of control rats kept at room temperature and to the group of rats subjected only to hypothermia. Beta-adrenergic blockade (propranolol 0.6-1 mg/kg) caused no changes in the levels of carbohydrate metabolites in the serum of hypothermic rats but raised the myocardial glycogen level by 42% in relation to the animals subjected only to hypothermia. Simultaneous administration of both these agents during hypothermia produces a fall of the serum levels of glucose and pyruvate with a rise in the level of lactate, and raises the glycogen level in the myocardium (by about 161%) and in the skeletal muscle (by 54%) in relation to the rats subjected to hypothermia alone. Insulin and/or propranolol fail to prevent glycogen reserve exhaustion in the liver of hypothermic rats which could be due to activation of non-blocked alpha-adrenergic receptors or to the action of yet another glycogenolytic agent, e.g. glucagon, during hypothermia.     

Afterdrop of body temperature during rewarming: an alternative explanation

Afterdrop, the continued fall of deep body temperatures during rewarming after hypothermia, is thought to endanger the heart by further cooling from cold blood presumed to be returning from the periphery. However, afterdrop is not always observed, depending on the circumstances. To explore this phenomenon, mild hypothermia was induced quantitatively with a suit calorimeter, using several patterns of cooling and rewarming. When cooling was rapid and followed immediately by rewarming, there were typical afterdrops in the temperatures measured in the rectum, auditory canal, and esophagus. However, when rewarming was delayed, or when cooling had been slow and prolonged, afterdrop was not seen. Afterdrops were then observed in two physical models that had no circulation: a bag of gelatin and a leg of beef. Central layers continued to give up heat as long as the surrounding layer was cooler. These results, together with recent findings by others that peripheral blood flow is low until afterdrop is complete, make this circulatory explanation of afterdrop improbable. Alternatively, afterdrop can be explained by the way heat moves through a mass of tissue.