Abstract
Changes in granulocyte elastase (GLE) andβ-gluculonidase (β-gl) were observed during open heart surgeries which were performed under deep hypothermia with surface cooling. In addition, the effect of urinary trypsin inhibitor, urinastatin, on the activities of these enzymes was studied. The patients were divided into three groups, namely group U-I with intravenous injection of 6000 u·kg−1 of urinastatin before cooling, group U-II administered with an additional 6000 u·kg−1 after warming to 30°C, and an untreated group (Group C). The plasma level of GLE increased significantly in the three groups compared with the level before cooling respectively. In the group U-II, the GLE level after the warming was lower than that in the control group. The serum level ofβ-gl increased significantly in the three groups at the end of rewarming (36°C). The release of GLE from lysosomes in granulocytes was inhibited in the group U-II. The insufficient inhibition of GLE release in the group U-I is probably due to relatively short half-life of urinastatin. Therefore double administration of 6000 u·kg−1, before and after the cooling, may be required to achieve the therapeutic effect. Consequently, urinastatin appears to be useful in open heart surgery under deep hypothermia with surface cooling.
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References
Chiba K: Changes of Lysosomal Enzyme Activity during deep hypothermia. Masui (Jpn J Anesthesiol) 31:1190–1203, 1982
Wakusawa R, Shibata S, Okada K: Simple deep hypothermia for open heart surgery in infancy. Canad Anaesth Soc J 24:491–503, 1977
Neumann S, Gunzer G, Hennrich N, et al: “PMN-elastase assay”: Enzyme immunoassay for human polymorphonuclear elastase complexed withα 1-protease inhibitor. J Clin Chern Clin Biochem 22:693–697, 1984
Kato K, Yoshida K, Tsukamoto H, et al: Synthesis ofβ-Nitrophenyl-D-Glucopyranosiduronic Acid and Its Utilization as a Substrate for the Assay ofβ-Glucuronidase Activity. Chern Pharmaceut Bull 8:239–242, 1960
Baggiolini M, Schnyder J, Bretz U: Lysosomal enzymes and neutral proteinases as mediators of inflammation. Advances in inflammation Research, Vol. 1 Raven Press, New York, 263, 1979
Seitz R, Wolf M, Egbring R, et al: Neutrophil elastase, thrombin and plasmin in septic shock. Adv Exp Med BioI 240:481–484, 1988
Antonsen S, Brandslund I, Clemensen S, et al: Neutrophil lysosomal enzyme release and complement activation during cardiopulmonary bypass. Scand J Thorac Cardiovasc Surg 21:47–52, 1987
Riegal W, Spillner G, Schlosser V, et al: Plasma levels of main granulocyte components during cardiopulmonary bypass. J Thorac Cardiovasc Surg 95:1014–1019, 1985
Horl WH, Steinhauer HB, Schallmeyer P: Plasma levels of granulocyte elastase during hemodialysis: Effects of different dialyzer membranes. Kidney Int 28:791–796, 1985
Harg WM, Schollmeyer P, Horl WH: Granulocyte activation during haemodialysis in the absence of complement activation: inhibition by calcium channel blockers. J Clin Invest 18:380–385, 1972
Shimai S, Takano T, Ohya C, et al: Clinical implication of plasma PMN elastase (α 1-proteinase inhibitor-elastase compelx) in patients with early stage of scute myocardial infarction. J Jap Soc I Med 76:383–390, 1987
Idell S, Kucich U, Fein A, et al: Neutrophil elastase-releasing factors in Bronchoalvealar lavage from patient with adult respiratory distress syndrome. Am Rev Respir Dis 132:1098–1105, 1985
Doi H, Okutsu Y, Kitamura S, et al: Changes in serum activities of granulocyte elastase, pancreatic secretory trypsin inhibitor (PSTI) and (β-glucuronidase in patients undergoing cardiopulmonary bypass. Masui (Jpn J Anesthesiol) 37:344–351, 1988
Glenn TM, Lefer AM, Beardsley AC, et al: Circulatory responses to splanchnic lysosomal hydrolases in the dog. Ann Surg 176:120–127, 1972
Bitensky L, Chayen J, Cunningham GJ: Behavior of lysosomes in hemorrhagic shock. Nature 199:493–494, 1963
Clermont HG, Williams JS, Adams JT: Steroid effect on the release of the lysosomal enzyme acid phosphatase in shock. Ann Surg 179:917–921, 1974
Muramatsu M, Mori S, Matsuzawa Y, et al: Purification and characterization of urinary trypsin in hibitor, UT 168, from normal humor urine, and its cleavage by human uropepsin. J Biochem 88:1317–1329, 1980
Ohnishi H, Suzuki K, Niho T, et al: Protective effects of urinary trypsin inhibitor in experimental shock. Jap J Pharmacol 39:137–144, 1985
Nabuchi A, Kumon K, Tanaka K, et al: The effect of Urinastatin on the release of granulocyte elastase at cardiopulmonay bypass. Jap Intensive Care Med 12:201–209, 1988
Matsunaga H, Matsumoto H, Yagyu K, et al: Effect of retreatment with urinastatin on circulatory dynamics and endocrinal functions during extracorporeal circulation. Jap J Artif Organs 16:530–533, 1987
Doi H, Andoh T, Okutzu Y: Effects of Urinastatin on the serum activities of granulocyte elastase,β-glucuronidase and pancreatic secretory tripsin inhibitor in patient having open cardiac surgery. Masui (Jpn J Anesthesiol) 37:975–980, 1988
Miyahara T: Effect of urinary trypsin inhibitor, MR-20 on Hemorrhagic shock in dogs. Masui (Jpn J Anesthesiol) 32:943–995, 1983
Tanifuji Y, Shima H, Mishima K, et al: The effect of Urinastatin on renal blood flow and urine volume in deliberate hypotension anesthesia. Masui (Jpn J Anesthesiol) 37:577–582, 1988
Sanaka T: New approach to the management of ischemic acute renal failure, protective effect of protease inhibitor on ischemic acute renal failure, Textbook for the group training course in coun termeasures against renal failure. J Int Coup Ag 17:1, 1986
Almqvist PM, Ekstrom B, Kuenzing M, et al: Increased survival of endotoxin-injected dogs treated with methylpredonisolone, naloxone and ibuprofen. Circ Shock 14:129–136, 1984
Sielaff TD, Sugerman HJ, Tatum JL, et al: Successful treatment of adult respiratory distress syndrome by histamine and prostaglandin blockade in a procine pseudomonas model. Surgery 102:350–357, 1987
Sielaff TD, Sugerman HJ, Tatum JL, et al: Treatment of porcine pseudomonas ARDS with combination drug therapy. Trauma 27:1313–1322, 1987
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Kawamura, T., Shimoda, Y. & Wakusawa, R. The effects of urinastatin on the plasma levels of granulocyte elastase during open heart surgery under simple deep hypothermia. J Anesth 6, 269–276 (1992). https://doi.org/10.1007/s0054020060269
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DOI: https://doi.org/10.1007/s0054020060269