Difference in onset of warm ischemia and reperfusion injury between parenchymal and endothelial cells of the liver. Evaluation by purine nucleoside phosphorylase and hyaluronic acid.
The onset of warm ischemia and reperfusion injury in the liver was investigated in a canine model through changes in parenchymal markers [isozyme class V of lactate dehydrogenase (LDH) and alanine aminotransferase (ALT)], endothelial markers [purine nucleoside phosphorylase (PNP) and hyaluronic acid clearance], and the liver metabolism (ketone body ratio) in warm ischemia induced by inflow occlusion using Pringle's maneuver and subsequent reperfusion. In this in vivo model, a PNP assay system and a model were designed so as to exclude the influence of wide localization of PNP possibly originating in erythrocytes or the intestine, and to discriminate between PNP of endothelial cells and that of parenchymal cells in the liver. After 45 min of warm ischemia, reperfusion resulted in damage only to endothelial cells, as seen by significant increase in PNP alone (3.6 +/- 0.1 U/liter at the end of warm ischemia to 6.8 +/- 0.5 U/liter at 5 min after reperfusion, P < 0.01) and significant decrease in hyaluronic acid clearance compared to the 30-min warm ischemia group in which no increase in either marker for parenchymal and endothelial cells was noted. By contrast, after 60 min of warm ischemia, reperfusion resulted in damage to parenchymal cells along with damage to endothelial cells, as seen by significant increases in LDH(V) and ALT (93 +/- 4 U/liter and 32 +/- 2 IU/liter at the end of warm ischemia to 239 +/- 17 U/liter and 165 +/- 27 IU/liter at 5 min after reperfusion, respectively), as well as a marked increase in PNP and deterioration of hyaluronic acid clearance compared to the 45-min warm ischemia group. Reperfusion after 120 min of warm ischemia did not show recovery of metabolic function of the liver as evaluated by hepatic mitochondrial redox state. It is suggested that a time lag occurs in the onset of injury between parenchymal cells and endothelial cells and that endothelial cells are temporally earlier in failing than parenchymal cells when the liver is exposed to short-term warm ischemia and subsequent reperfusion.
Nakagami
M
M
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Morimoto
T
T
Mitsuyoshi
A
A
Mashima
S
S
Shimabukuro
T
T
Yamaoka
Y
Y
D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D004285:Dogs; D004730:Endothelium, Vascular / Q000378:metabolism*; D005260:Female; D006503:Hepatic Veins; D006358:Hot Temperature; D006820:Hyaluronic Acid / Q000097:blood*; D007511:Ischemia / Q000097:blood*; D007527:Isoenzymes; D007657:Ketone Bodies / Q000097:blood; D007700:Kinetics; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008099:Liver / Q000098:blood supply*; D008297:Male; D011683:Purine-Nucleoside Phosphorylase / Q000097:blood*; D015427:Reperfusion Injury / Q000097:blood*
D007527:Isoenzymes; D007657:Ketone Bodies; D006820:Hyaluronic Acid; D007770:L-Lactate Dehydrogenase; D011683:Purine-Nucleoside Phosphorylase; D000410:Alanine Transaminase