Adenosine A2A receptor agonist improves cardiac dysfunction from pulmonary ischemia-reperfusion injury.
BACKGROUND
Ischemia-reperfusion (IR) injury negatively impacts patient outcome in lung transplantation. Clinically, we observed that lung transplant patients with ischemia-reperfusion injury tend to have cardiac dysfunction. Previous studies have shown that ATL-146e (4-{3-[6-amino-9-(5-ethylcarbamoyl-3,4-dihydroxy-tetrahydro-furan-2-yl)-9H-purin-2-yl]-prop-2-ynyl}-cyclohexanecarboxylic acid methyl ester), a selective adenosine A2A receptor agonist, reduces lung inflammation after ischemia-reperfusion. We hypothesized that pulmonary ischemia-reperfusion causes secondary heart dysfunction and ATL-146e will improve this dysfunction.


METHODS
We utilized an in vivo rabbit lung ischemia-reperfusion model. The Sham group underwent 120 minutes single lung ventilation. The IR and ATL groups underwent 90 minutes right lung ischemia with 30 minutes right lung reperfusion. The ATL-146e was given intravenously to the ATL group during reperfusion. Cardiac output and arterial blood gases were monitored, and neutrophil sequestration was measured by myeloperoxidase activity.


RESULTS
Upon reperfusion, cardiac output (mL/min) significantly dropped in the IR and ATL groups. By 15 minutes reperfusion, cardiac output in the ATL group improved significantly over the IR group and remained significant thereafter. Lung myeloperoxidase activity was significantly reduced by ATL-146e. Although never hypoxemic, arterial oxygenation was lower in the IR and ATL groups while central venous pressures and mean arterial pressures were similar among groups. A separate experiment demonstrated that reperfusion with the antioxidant N-(2-mercaptopropionyl)glycine prevented cardiac dysfunction.


CONCLUSIONS
Pulmonary ischemia-reperfusion causes cardiac dysfunction independent of preload, afterload, and oxygenation. The ATL-146e improves this dysfunction presumably by the antiinflammatory effects of adenosine A2A receptor activation on neutrophils. One likely mechanism involves the release of oxidants from the ischemic lung upon reperfusion, which has immediate negative effects on the heart.
Reece
T Brett
TB
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA. tbr5q@virginia.edu
Laubach
Victor E
VE
Tribble
Curtis G
CG
Maxey
Thomas S
TS
Ellman
Peter I
PI
Warren
Patrick S
PS
Schulman
Andrew M
AM
Linden
Joel
J
Kern
John A
JA
Kron
Irving L
IL
D058908:Adenosine A2 Receptor Agonists; D000818:Animals; D000975:Antioxidants / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D003509:Cyclohexanecarboxylic Acids / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D008168:Lung / Q000098:blood supply*; D018375:Neutrophil Activation; D010100:Oxygen / Q000097:blood; D009195:Peroxidase / Q000378:metabolism; D011687:Purines / Q000494:pharmacology*; D011817:Rabbits; D017382:Reactive Oxygen Species / Q000378:metabolism; D015427:Reperfusion Injury / Q000503:physiopathology*
C431129:ATL 146e; D058908:Adenosine A2 Receptor Agonists; D000975:Antioxidants; D003509:Cyclohexanecarboxylic Acids; D011687:Purines; D017382:Reactive Oxygen Species; D009195:Peroxidase; D010100:Oxygen