title: H2S during circulatory shock: some unresolved questions.
abstract: Numerous papers have been published on the role of H2S during circulatory shock. Consequently, knowledge about vascular sulfide concentrations may assume major importance, in particular in the context of "acute on chronic disease", i.e., during circulatory shock in animals with pre-existing chronic disease. This review addresses the questions (i) of the "real" sulfide levels during circulatory shock, and (ii) to which extent injury and pre-existing co-morbidity may affect the expression of H2S producing enzymes under these conditions. In the literature there is a huge range on sulfide blood levels during circulatory shock, in part as a result of the different analytical methods used, but also due to the variable of the models and species studied. Clearly, some of the very high levels reported should be questioned in the context of the well-known H2S toxicity. As long as "real" sulfide levels during circulatory shock are unknown and/or undetectable "on line" due to the lack of appropriate techniques, it appears to be premature to correlate the measured blood levels of hydrogen sulfide with the severity of shock or the H2S therapy-related biological outcomes. The available data on the tissue expression of the H2S-releasing enzymes during circulatory shock suggest that a "constitutive" CSE expression may play a crucial role of for the maintenance of organ function, at least in the kidney. The data also indicate that increased CBS and CSE expression, in particular in the lung and the liver, represents an adaptive response to stress states.
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany.
authors.forename: Oscar
authors.initials: O
authors.lastname: McCook
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany. Electronic address: peter.radermacher@uni-ulm.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany.
authors.forename: Chiara
authors.initials: C
authors.lastname: Volani
authors.affiliation: Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, Cedex 9, 49933 Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.affiliation: Institut für Unfallchirurgische Forschung und Biomechanik, Universitätsklinikum, Helmholtzstrasse 14, 89081 Ulm, Germany.
authors.forename: Anita
authors.initials: A
authors.lastname: Ignatius
authors.affiliation: Institut für Unfallchirurgische Forschung und Biomechanik, Universitätsklinikum, Helmholtzstrasse 14, 89081 Ulm, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Kemmler
authors.affiliation: Institut für Pathologie, Universitätsklinikum, Albert-Einstein-Allee 20-23, 89081 Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Möller
authors.affiliation: Department of Anesthesiology, University of Texas Medical Branch, 601 Harborside Drive, Galveston, TX 77555, USA.
authors.forename: Csaba
authors.initials: C
authors.lastname: Szabó
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Whiteman
authors.affiliation: Department of Biosciences, College of Life and Environmental Sciences, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Wood
authors.affiliation: Department of Biology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Georgieff
authors.affiliation: Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Helmholtzstrasse 8-1, 89081 Ulm, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wachter
mesh_terms: D000818:Animals; D019963:Clinical Chemistry Tests; D006801:Humans; D006862:Hydrogen Sulfide; D051379:Mice; D051381:Rats; D012769:Shock / Q000097:blood / Q000378:metabolism / Q000503:physiopathology; D013440:Sulfides; D013552:Swine
chemical_list: D013440:Sulfides; C025451:sodium bisulfide; C033479:sodium sulfide; D006862:Hydrogen Sulfide
keywords: Cystathione-β-synthase; Cystathionine-γ-lyase; GYY4137; H(2)S; Na(2)S; NaSH