Cellular energetics in hemorrhagic shock: restoring adenosine triphosphate to the cells.
BACKGROUND
This is a review of studies with two agents, glutamine and crocetin, which have been found to enhance recovery of cellular adenosine triphosphate (ATP) and adenosine diphosphate after hemorrhagic shock.


METHODS
The studies used a sublethal (30 minutes) reservoir shock model in 300- to 350-g, male, Sprague-Dawley rats, using either ketamine-xylazine or isoflurane anesthesia. Glutamine was given as a 3% (21 mmol/L) solution in Ringer's lactate (630 mg/kg). Crocetin was given as a 500 nmol/L solution in Ringer's lactate (2 mg/kg).


RESULTS
Both glutamine and crocetin caused recovery of ATP to baseline levels (9.0 micromol/g) within 60 to 120 minutes after resuscitation. Xanthine levels returned more rapidly to baseline (0.1 micromol/g). Both agents prevented the elevation in apoptosis seen in controls at 24 and 48 hours.


CONCLUSIONS
Glutamine is a metabolic substrate and a precursor of ATP synthesis. Crocetin enhances oxygen diffusivity in plasma. Both agents restore cellular energy stores to normal after hemorrhagic shock and produce a marked diminution in the extent of apoptosis postshock. Their mechanism of action probably involves prevention of mitochondrial damage.
Van Way
Charles W
CW
Department of Surgery, University of Missouri-Kansas City School of Medicine, USA. charles.vanway@tmcmed.org
Dhar
Animesh
A
Morrison
David C
DC
Longorio
Mario A
MA
Maxfield
Daniel M
DM
D000244:Adenosine Diphosphate / Q000032:analysis* / Q000378:metabolism; D000251:Adenosine Triphosphatases / Q000032:analysis* / Q000378:metabolism; D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D002338:Carotenoids / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004734:Energy Metabolism / Q000187:drug effects*; D005440:Fluid Therapy; D005973:Glutamine / Q000627:therapeutic use*; D007421:Intestine, Small / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology*; D008099:Liver / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D014801:Vitamin A / Q000031:analogs & derivatives
D000975:Antioxidants; C487773:trans-sodium crocetinate; D005973:Glutamine; D014801:Vitamin A; D002338:Carotenoids; D000244:Adenosine Diphosphate; D000251:Adenosine Triphosphatases