allopurinol and Coronary-Disease

Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney disease, and coronary heart disease, among others, resulting in renewed interest in uric acid as a potential pathogenic mediator in these clinical conditions. Despite encouraging animal studies showing beneficial roles of allopurinol, clinical studies and randomized controlled trials remain scarce, and, despite available clinical evidence supporting a therapeutic role for allopurinol, multiple issues remain before routine use of allopurinol can be recommended for use in patients with hyperuricemia and hypertension, kidney disease, or coronary heart disease. These include a need for more robust clinical trial data that evaluate efficacy on hard clinical outcomes, optimal dose, duration of treatment, and the potential for serious allergic reactions. In this article we review the current available evidence describing the effects of allopurinol in hypertension, kidney disease, and coronary heart disease, highlighting unresolved issues surrounding allopurinol use for uric acid lowering in individuals without gout.

Topics: Allopurinol; Antihypertensive Agents; Cardiotonic Agents; Chronic Disease; Coronary Disease; Gout Suppressants; Humans; Hypertension, Renal; Randomized Controlled Trials as Topic; Uric Acid

The association of elevated serum uric acid (hyperuricemia, gout) with the presence of classical coronary risk factors and coronary artery disease or myocardial infarction has been analysed in many epidemiological studies. In this paper the urid acid metabolism, the factors influancing on this metabolism, the laboratory hyperurycemia criteria and the mode of hyperuricemia treatment are presented. The hyperuricemia and it's collaboration with the other coronary risk factors are analysed as an independent risk factors. Hyperuricemia is described as an increased concentration of uric acid in blood. The urate concentration is elevated when the upper level of arbitrary accepted value is exceeded. That corresponds to the mean value of urate concentration of particular sex and age plus two standard deviations. In most cases of epidemiologic investigations the upper normal range of concentration equals 6 mg/dl for women and 7 mg/dl for men. An increased level of uric acid leads to urate gout (diathesis urica). An increased level of urate in serum is connected with numerous cardiovascular risk factors such as: arterial hypertension, hyperglycemia, diabetes and male sex. But up today, hyperuricemia is not used as independent direct risk factor, so the reduction of uric acid is not obligatory recommended in guidelines for prevention of cardiovascular diseases and stroke.

Topics: Allopurinol; Coronary Disease; Gout Suppressants; Humans; Hyperuricemia; Risk Factors; Uric Acid

Topics: Animals; Coronary Disease; Disease Models, Animal; Dogs; Free Radicals; Heart Arrest, Induced; Humans; Models, Cardiovascular; Myocardial Reperfusion Injury; Myocardium; Rats; Xanthine Oxidase

Topics: Animals; Chronic Disease; Collateral Circulation; Coronary Disease; False Positive Reactions; Free Radicals; Half-Life; Myocardial Infarction; Myocardial Reperfusion; Oxygen; Superoxide Dismutase; Tetrazolium Salts; Xanthine Oxidase

Oxygen-derived free radicals have been implicated in the pathogenesis of various disease states, including myocardial ischemia and reperfusion. In this article, we review 1) the evidence linking free radical production and myocardial injury during myocardial ischemia and reperfusion and 2) results of studies of the effects of the pharmacological therapies available potentially to prevent free radical-mediated injury. Free radicals can be produced during ischemia and reperfusion by several different biochemical pathways. Of these, the xanthine oxidase reaction and the output of free radicals by neutrophils that have accumulated in damaged tissue have been studied extensively. When produced, free radicals can potentially damage myocytes or endothelial cells through peroxidation of membrane lipids or damage to proteins or nucleic acids. Using electron spin resonance spectroscopy, several studies have shown a 'burst' of oxygen free radicals immediately after reperfusion. Moreover, exogenous generation of intravascular free radicals has been shown to produce marked vascular and myocyte damage, as well as contractile dysfunction. 'Anti-free radical' interventions, such as xanthine oxidase inhibitors and free radical scavengers have been reported to prevent contractile dysfunction and reperfusion-induced arrhythmias after an episode of reversible ischemic injury. However, after more severe episodes of ischemia, such interventions have had conflicting effects on myocardial infarct size. 'Anti-free radical' interventions could be of potential use in situations where reversible ischemic injury occurs. In situations where reperfusion is achieved after irreversible ischemic injury has occurred, the potential beneficial effect of these treatments on infarct size is more doubtful.

Topics: Animals; Coronary Disease; Free Radicals; Myocardial Reperfusion Injury; Myocardium; Oxygen; Xanthine Oxidase

Topics: Allopurinol; Animals; Coronary Disease; Humans; Myocardial Reperfusion Injury

An increasing number of studies in cell cultures, isolated perfused hearts, and intact animal preparations purport to show the significance of free radical production in the pathophysiology of myocardial injury and necrosis of ischemic and reoxygenated or reperfused tissue. Additionally an impressive array of therapeutic approaches has been developed to interfere with the generation of free radicals and to thereby salvage jeopardized myocardium. Based on these data clinical trials are now being conducted or planned. However, a critical examination of the experimental data raises questions that undermine total acceptance of the conclusions of the investigators and the enthusiastic extrapolations to the clinical arena. Issues such as endotoxin contamination of infused free radical scavenger enzymes, incorrect dosing, possibly improper selection of control conditions, species specificity, inadequate consideration of the dependence of infarct size on coronary collateral blood flow, and the possibly transient nature of any benefits of anti-free radical interventions cast doubt on some of the accumulated data and their general applicability to humans. These issues must be satisfactorily addressed before this experimental approach can be fully embraced by the clinical cardiologist. Additionally, uniformity in the experimental model and conditions might eliminate some of the confusion and make it easier to compare the results of different studies. Free radical mechanisms may be important in the heart, but more data are needed to rigorously document an unequivocal effect of therapeutic interventions in experimental models before clinical trials are appropriate.

Topics: Allopurinol; Animals; Catalase; Clinical Trials as Topic; Coronary Disease; Free Radicals; Humans; Models, Chemical; Myocardial Reperfusion Injury; Myocardium; Oxygen; Superoxide Dismutase; Xanthine Oxidase

Topics: Animals; Coronary Disease; Dogs; Free Radicals; Humans; Rabbits; Rats; Species Specificity; Xanthine Oxidase

This article assesses whether oxygen-derived free radicals are one of the molecular causes of life-threatening arrhythmias that arise upon reperfusion of the ischemic myocardium. Evidence supporting this proposition has been obtained from studies of the effects of free radical scavengers and antioxidants, free radical generating systems, inhibition of various sources of free radicals and studies investigating the formation of free radicals and their products during early reperfusion. It has been hypothesized that free radical formation causes localised membrane damage to the sarcolemma that results in focal alterations in transmembrane ionic fluxes, particularly potassium. These changes in ionic fluxes may then lead to electrophysiological abnormalities that culminate in ventricular arrhythmias.

Topics: Animals; Arrhythmias, Cardiac; Catecholamines; Coronary Circulation; Coronary Disease; Free Radicals; Humans; Neutrophils; Oxygen; Spin Labels; Xanthine Oxidase

There is a growing body of evidence for the role of free radicals in mediating myocardial tissue injury during myocardial ischemia and in particular during the phase of myocardial reoxygenation. Associated with myocardial ischemia and reperfusion is the generation of oxygen-derived free radicals from a variety of sources that include the mitochondrial electron transport chain; the biosynthesis of prostaglandins; the enzyme xanthine oxidase; and circulating elements in the blood, with the polymorphonuclear neutrophil assuming a primary focus of attention. Experimental studies have shown that free radical scavengers (e.g., N-[2-mercaptopropionyl]glycine) and enzymes that scavenge or degrade reactive species of oxygen (superoxide dismutase or catalase) can reduce the mass of myocardial tissue that undergoes irreversible injury. Additionally allopurinol, which inhibits the enzyme xanthine oxidase, reduces ultimate infarct size, putatively by reducing the xanthine oxidase generation of superoxide anion. Neutrophils that enter the ischemically injured myocardium under the influence of chemotactic attraction and activation of the complement system generate and release highly reactive and cytotoxic oxygen derivatives that are destructive to the vascular endothelium and to the cardiac myocytes. Studies have documented that neutrophil depletion or suppression of neutrophil function (ibuprofen, nafazatrom, BW 755C, or more recently with prostacyclin or iloprost) results in a significant salvage of myocardial tissue that is subjected to a period of regional ischemia followed by reperfusion. Our current understanding of the events associated with myocardial ischemia suggests that within the ischemic myocardial region or area at risk, there is a population of cells that are reversibly injured and that reperfusion within a specified period (less than 3 hours) of time is capable of restoring the majority of the jeopardized cells to a normal status, but that the act of reperfusion itself will lead to the sudden demise of a fraction of the cells because of the cytotoxic effects of reactive species of oxygen derived from one or more of the sources indicated above. The efforts to minimize the amount of tissue that undergoes cell death as a result of myocardial ischemia demand that early reperfusion be established. However, the reintroduction of molecular oxygen and the circulating elements of the blood will be associated with an "explosive" and self-limited destruction of so

Topics: Antioxidants; Ascorbic Acid; Cell Adhesion; Coronary Disease; Free Radicals; Glycoproteins; Humans; Lysosomes; Myocardial Infarction; Myocardium; Necrosis; Neutrophils; Oxygen; Superoxide Dismutase; Xanthine Oxidase

Considerable attention is being given to the interactions that occur among blood platelets, neutrophils, and the vascular endothelium. There is an increasing awareness that the various blood elements interact in the process of thrombus formation and vascular occlusion. In addition, interactions among these cells can lead to the formation and release of vasoactive substances that have the potential to modulate regional blood flow. This review focuses on the coronary vascular bed and an assessment of how cell-cell interactions, under normal physiological conditions as well as in the presence of myocardial injury, may lead to alterations in coronary vascular resistance and myocardial function. Should related events be operative in human clinical states of disease, the circulating elements of the blood may serve as targets in the development of therapeutic interventions to regulate myocardial blood flow.

Topics: Animals; Blood Cells; Coronary Disease; Coronary Thrombosis; Coronary Vessels; Dogs; Endothelium; Free Radicals; Leukocytes; Oxygen; Platelet Activating Factor; Platelet Aggregation; Rabbits; Thromboxane A2; Thromboxane-A Synthase; Vasoconstriction; Vasodilation; Xanthine Oxidase

Topics: Allopurinol; Animals; Catalase; Coronary Circulation; Coronary Disease; Free Radicals; Glutathione Peroxidase; Humans; Mitochondria, Heart; Myocardial Contraction; Myocardial Infarction; Myocardium; Neutrophils; Oxygen; Perfusion; Superoxide Dismutase; Superoxides

In 1969 McCord and Fridovich discovered superoxide dismutase, which converts the oxygen free radical O(2) (-) to hydrogen peroxide H(2)O(2). In the presence of excess O(2) (-), H(2)O(2) may then undergo further reduction to the highly toxic hydroxyl radical, OH(*). Since the description of this enzymatic process, there has been explosive growth in related biochemical research, which has now percolated through to clinical investigation. The hypoxanthine-xanthine oxidase system originally used as a radical production model has a close counterpart in the ischemia-reperfusion phenomenon purported to cause diseases of heart, brain and gastrointestinal tract, and free radicals are now known to have a critical role in postphagocytic bacterial killing. Prototypic deficiency diseases such as chronic granulomatous disease are now recognized. Some evidence indicates that excess states such as perhaps Batten's disease also occur, and environmental influences such as selenium and vitamin E deficiency may augment free radical levels. Many disorders including microvasculopathies, noncardiogenic pulmonary edema, glomerulopathies and radiation damage may owe part of their proximate pathogenesis to free radicals. Control of tissue free radical levels is now pharmacologically feasible and perhaps justified for specific diseases.

Topics: Animals; Coronary Disease; Free Radicals; Gastrointestinal Diseases; Glomerulonephritis; Granulomatous Disease, Chronic; Humans; Hydrogen Peroxide; Neuronal Ceroid-Lipofuscinoses; Oxygen; Pulmonary Edema; Selenium; Superoxide Dismutase; Xanthine Oxidase

Myocardial ischemia initiates a series of cellular reactions which unless checked will culminate in cell death and tissue necrosis. Although reperfusion provides a means of preventing cell death it is not without hazard. In cases of mild ischemia, where tissue injury is in its reversible phase, reperfusion may precipitate potentially lethal ventricular arrhythmias and in cases of severe injury it may actually accelerate the process of cell death leading to hemorrhage and other forms of severe injury. The identity of mediators of cellular injury, and particularly the critical transition from reversible to irreversible injury, remains controversial. Whereas for a number of years ATP depletion, calcium overload and catecholamines have been considered as key factors in tissue injury, attention has recently been directed towards oxygen-derived free radicals (e.g. superoxide and the hydroxyl radical). In this article we discuss sources of free radicals in the mammalian heart (xanthine oxidase, mitochondria, leucocytes, and catecholamines) and present arguments based on quantitative and temporal considerations that the xanthine oxidase-mediated degradation of hypoxanthine is the most important source of free radicals and as such is the most appropriate target for therapeutic intervention. To support our arguments we present data from two species, the dog and the rat, in which we have shown how allopurinol, the specific inhibitor of xanthine oxidase, can afford a reduction of infarct size in the dog and can dramatically reduce the incidence of potentially lethal reperfusion-induced arrhythmias in the rat. Arising from these and other studies is the proposition that anti-free radical interventions (particularly those directed towards xanthine oxidase inhibition) may provide an important new therapeutic principle in the management of ischemia and reperfusion.

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Catecholamines; Coronary Disease; Free Radicals; Humans; Leukocytes; Mitochondria, Heart; Myocardial Infarction; Oxygen; Perfusion; Xanthine Oxidase

It is now clear that oxygen-derived free radicals play an important part in several models of experimentally induced reperfusion injury. Although there are certainly multiple components to clinical ischemic and reperfusion injury, it appears likely that free-radical production may make a major contribution at certain stages in the progression of the injury. The primary source of superoxide in reperfused reoxygenated tissues appears to be the enzyme xanthine oxidase, released during ischemia by a calcium-triggered proteolytic attack on xanthine dehydrogenase. Reperfused tissues are protected in a variety of laboratory models by scavengers of superoxide radicals or hydroxyl radicals or by allopurinol or other inhibitors of xanthine oxidase. Dysfunction induced by free radicals may thus be a major component of ischemic diseases of the heart, bowel, liver, kidney, and brain.

Topics: Animals; Calcium; Coronary Disease; Free Radicals; Humans; Intestines; Ischemia; Shock; Superoxides; Transplantation; Xanthine Dehydrogenase; Xanthine Oxidase

Cardiac ischemia is characterized by rapid deterioration of cardiac function, which has been linked to the fall in intracellular pH, increased levels of inorganic phosphate and reduction in free energy change of ATP-hydrolysis. Biochemical events responsible for irreversible myocardial injury involve various mechanisms which change the properties of the cardiac cell membrane (disorders in lipid metabolism, free radical formation). Recent evidence suggests that in the heart, xanthine oxidase is a major source of free radical formation. During ischemia, adenine-nucleotide breakdown in the cardiomyocyte proceeds only to the stage of inosine. Due to the localisation of nucleoside phosphorylase and xanthine-oxidase in vascular endothelium, further degradation of inosine to hypoxanthine, xanthine and uric acid occurs predominantly in the vascular space. It is therefore conceivable that the primary site of reperfusion injury in the ischemic heart may be the coronary endothelium damaged by free radicals.

Topics: Adenosine Triphosphate; Animals; Coronary Disease; Free Radicals; Heart; Hydrogen-Ion Concentration; Myocardial Contraction; Myocardium; Oxygen; Sarcolemma; Xanthine Oxidase

Topics: Acrylamides; Animals; Calcium; Cnidarian Venoms; Coronary Disease; Doxorubicin; Egtazic Acid; Electron Spin Resonance Spectroscopy; Free Radicals; Guinea Pigs; Heart; Hypoxia; Isoproterenol; Myocardium; Necrosis; Rabbits; Rats; Xanthine Oxidase

Topics: Acute Disease; Allopurinol; Arthritis; Aspirin; Colchicine; Coronary Disease; Diuretics; Gout; Humans; Hypoxanthine Phosphoribosyltransferase; Indomethacin; Kidney; Kidney Calculi; Kidney Diseases; Lead Poisoning; Lymphoproliferative Disorders; Myeloproliferative Disorders; Phenylbutazone; Platelet Aggregation; Probenecid; Purine-Pyrimidine Metabolism, Inborn Errors; Pyrazinamide; Ribose-Phosphate Pyrophosphokinase; Uric Acid; Uricosuric Agents

The effect of gout on the risk of developing coronary artery disease (CAD) is uncertain. Some studies have found that gout is a risk factor for acute myocardial infarction. This study examined the changes in risk of CAD in gout patients taking allopurinol and/or benzbromarone, and analyzed the dose-response relationship of both drugs with CAD incidence.. The medical records of one million subjects from 2000 to 2011 were provided by the Taiwan National Health Insurance Research Database. Cox proportional hazard ratio was used to compare the risk of CAD in gout patients taking allopurinol or/and benzbromarone with those taking neither drug. Hazard ratios (HR) were adjusted for possible confounding factors, including age, gender, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and relevant medications.. Of 8047 gout patients, 1422 were treated with allopurinol (Group A), 4141 with benzbromarone (Group B), and 2484 with both drugs (Group A/B) during the follow-up period. Our results showed the incidence of CAD after adjusting for covariates for Group A, Group B, and Group A/B did not significantly differ from the comparison group. However, after adjustment for covariates in dose-response analyses, treatment with over 270 defined daily doses (DDDs) of allopurinol, and over 360 DDDs of benzbromarone, was associated with a significantly reduced risk of CAD.. We found that the use of allopurinol and benzbromarone, whether alone or in combination, had a linear dose-response relationship between the numbers of defined daily doses and the risk of CAD, especially in higher DDDs.

Topics: Allopurinol; Benzbromarone; Coronary Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Gout; Gout Suppressants; Humans; Incidence; Male; Middle Aged; Population Surveillance; Risk Factors; Taiwan; Treatment Outcome; Uric Acid; Uricosuric Agents

The effect of reactive oxygen species (ROS) on platelet function in coronary heart disease (CHD) is complex and poorly defined. Platelet aggregation studies in healthy volunteers have demonstrated contrasting results when platelets are exposed to ROS. We investigated the effect of ROS on whole blood aggregation (WBA) and the endothelial cell-platelet interaction in patients with CHD.. ROS generated by xanthine and xanthine oxidase caused a concentration-dependent inhibition of WBA in blood from healthy donors and patients with CHD. In patients with CHD, 100 μM xanthine and 100 mU/ml xanthine oxidase inhibited WBA in response to 3 μg/ml collagen by 28.9% (95% CI 15.9%-41.8%, p<0.001) and in response to 5 μM ADP by 36.0% (95% CI 9.6%-62.4%, p=0.005). Using nitrotyrosine expression, platelets isolated from patients with CHD were found to be susceptible to peroxynitrite damage. The addition of 1 × 10(5) cultured endothelial cells inhibited WBA in response to 3 μg/ml collagen by 31.2% (95% CI 12.2%-50.2%, p<0.05) and in response to 5 μM ADP by 31.6% (95% CI 2.5-60.7%, p<0.05). Addition of xanthine and xanthine oxidase did not alter this effect, however pre-treatment of endothelial cells with a nitric oxide synthase inhibitor (L-NAME) partly reversed the inhibition.. ROS inhibit WBA in blood from patients with CHD. Whilst endothelial cells also inhibit WBA, the effect is attenuated by L-NAME, suggesting that nitric oxide is likely to remain an important protective mechanism against thrombosis in CHD.

Topics: Aged; Blood Platelets; Cell Communication; Coronary Disease; Endothelial Cells; Endothelium, Vascular; Enzyme Inhibitors; Female; Hemostasis; Humans; Male; Middle Aged; NG-Nitroarginine Methyl Ester; Platelet Aggregation; Reactive Oxygen Species; Tyrosine; Xanthine; Xanthine Oxidase

Allopurinol protects the heart against ischaemic events during coronary artery bypass grafting (CABG), possibly because of its antioxidant properties. This double-blind study was designed to investigate whether allopurinol (1 g), given before cardiopulmonary bypass and prior to the opening of cross-clamping, has an antioxidant effect in CABG patients by measuring plasma total peroxyl radical scavenging capacity.. Twenty-seven patients with stabile angina were randomized into allopurinol (n = 14) or placebo (n = 13) groups.. During 10 min reperfusion, plasma hypoxanthine and xanthine concentrations increased only in the allopurinol group, whereas uric acid concentrations decreased. Total peroxyl radical scavenging capacity (TRAP) decreased from the initial value at all measuring points in both groups.. The reducing effect of allopurinol on free radical generation cannot be seen in TRAP values, obviously because the uric acid concentration of plasma decreases markedly. The positive clinical effects of allopurinol in CABG patients may arise from its direct oxygen free radical scavenging function.

Topics: Aged; Allopurinol; Analysis of Variance; Coronary Artery Bypass; Coronary Disease; Double-Blind Method; Free Radical Scavengers; Free Radicals; Humans; Hypoxanthine; Infusions, Intravenous; Intraoperative Period; Male; Middle Aged; Preoperative Care; Probability; Reference Values; Reperfusion; Sensitivity and Specificity; Uric Acid; Xanthine

Allopurinol reduces formation of cytotoxic free radicals during myocardial ischemia/reperfusion in animals. To evaluate the effect of allopurinol on cardiac performance and metabolism after coronary bypass in humans, we divided 33 patients into two groups: 15 patients (controls) received no allopurinol and 18 patients received 200 mg allopurinol intravenously (i.v.) 1 h preoperatively. Hemodynamic measurements were made with a triple-lumen thermodilution pulmonary artery catheter before cardiopulmonary bypass (CPB), 30 min after completion of CPB and 6 h later in the intensive care unit (ICU). A catheter placed into the coronary sinus was used for blood sampling for measurement of lactate and creatine phosphokinase MB. Peripheral blood was obtained for measurement of xanthine oxidase activity (XO), uric acid, and thiol groups. A myocardial biopsy was taken for measurement of thiol group content and XO before CPB and after heparin neutralization with protamin (a few minutes after CPB). Treated patients had better recovery of cardiac output (CO) and left ventricular stroke work (LVSW) 30 min and 6 h after completion of CPB than did controls. Allopurinol significantly reduced plasma XO. Plasma concentrations of uric acid increased significantly in both groups 30 min after completion of CPB, but the increase in controls was greater (p < 0.02) than with allopurinol. Thiol group levels increased (p < 0.05) only in controls. Our results demonstrate improvement of cardiac function in coronary artery bypass surgery with allopurinol that is related to its metabolic effects consistent with protection against XO catalyzed free radical-mediated injury.

Topics: Adult; Aged; Aged, 80 and over; Allopurinol; Blood Pressure; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Female; Free Radicals; Heart; Humans; Injections, Intravenous; Lactates; Lactic Acid; Male; Middle Aged; Oxidative Stress; Stroke Volume; Sulfhydryl Compounds; Uric Acid; Xanthine Oxidase

To examine the cardioprotective efficacy of allopurinol in patients undergoing elective coronary artery surgery.. Prospective randomised trial.. London teaching hospital.. Twenty patients with at least moderately good left ventricular function undergoing elective coronary artery surgery and requiring at least two bypass grafts.. Patients were randomised to receive allopurinol (1200 mg in two divided doses) or to act as controls.. The primary determinant of the efficacy of myocardial protection was serial measurement (preoperatively and subsequently at one, six, 24, and 72 hours after the end of cardiopulmonary bypass) of cardiac troponin T (cTnT) a highly sensitive and specific marker of myocardial damage. Additional evidence was provided by serial measurement of the MB-isoenzyme of creatine kinase (CK-MB) and myoglobin, ECG changes, and clinical outcome.. There was no significant difference in age, ejection fraction, number of grafts, bypass times, or cross clamp times between the two groups. In both groups there was a highly significant (p < 0.01) rise in cTnT, CK-MB, and myoglobin. Peak concentrations were reached between one (CK-MB and myoglobin) and six hours (cTnT) after the end of cardiopulmonary bypass. At 72 hours cTnT concentrations were six times higher than baseline concentrations whereas CK-MB and myoglobin were approximately double baseline concentrations. There was no significant difference in cTnT, CK-MB, or myoglobin between the allopurinol and control groups at any time. There was no diagnostic ECG evidence of perioperative infarction in any patient.. Unlike previous reports this study did not show that allopurinol had a cardioprotective effect in patients with good left ventricular function undergoing elective coronary artery surgery.

Topics: Allopurinol; Cardiomyopathies; Cardiopulmonary Bypass; Coronary Disease; Creatine Kinase; Humans; Isoenzymes; Male; Middle Aged; Myoglobin; Premedication; Treatment Failure; Troponin

A plethora of experimental evidence indicates that allopurinol reduces the formation of cytotoxic free radicals during myocardial ischemia and reperfusion. The purpose of this study was to evaluate the effect of allopurinol on cardiac performance and early mortality after coronary bypass surgery. Allopurinol (n = 89) or placebo (n = 80) was administered to 169 patients before surgery. Randomization produced groups evenly matched for surgical risk factors. Hospital mortality rate in the placebo group was 14 of 80 (18%) in the allopurinol group 4 of 89 (4%), p = 0.014. Cardiac performance, scored by cardiac index and the need for ionotropic or mechanical support, was significantly better in the allopurinol group. More nonfatal complications occurred in the allopurinol group. When either a complication or death is termed an event, the proportion of events was equal in the two groups. No side effects were identified. We now administer allopurinol to all patients who are undergoing bypass surgery unless specifically contraindicated.

Topics: Adult; Aged; Allopurinol; Cause of Death; Coronary Artery Bypass; Coronary Disease; Heart; Humans; Middle Aged; Myocardial Reperfusion Injury; Postoperative Complications; Postoperative Period; Premedication

An increasing number of studies in cell cultures, isolated perfused hearts, and intact animal preparations purport to show the significance of free radical production in the pathophysiology of myocardial injury and necrosis of ischemic and reoxygenated or reperfused tissue. Additionally an impressive array of therapeutic approaches has been developed to interfere with the generation of free radicals and to thereby salvage jeopardized myocardium. Based on these data clinical trials are now being conducted or planned. However, a critical examination of the experimental data raises questions that undermine total acceptance of the conclusions of the investigators and the enthusiastic extrapolations to the clinical arena. Issues such as endotoxin contamination of infused free radical scavenger enzymes, incorrect dosing, possibly improper selection of control conditions, species specificity, inadequate consideration of the dependence of infarct size on coronary collateral blood flow, and the possibly transient nature of any benefits of anti-free radical interventions cast doubt on some of the accumulated data and their general applicability to humans. These issues must be satisfactorily addressed before this experimental approach can be fully embraced by the clinical cardiologist. Additionally, uniformity in the experimental model and conditions might eliminate some of the confusion and make it easier to compare the results of different studies. Free radical mechanisms may be important in the heart, but more data are needed to rigorously document an unequivocal effect of therapeutic interventions in experimental models before clinical trials are appropriate.

Topics: Allopurinol; Animals; Catalase; Clinical Trials as Topic; Coronary Disease; Free Radicals; Humans; Models, Chemical; Myocardial Reperfusion Injury; Myocardium; Oxygen; Superoxide Dismutase; Xanthine Oxidase

The hypothesis tested was that free radicals generated following ischemia and reperfusion in cardiac operations can produce clastogenic factor that results in chromosomal aberration. Fourteen randomized patients undergoing coronary artery bypass grafting were divided into two groups. In Group 1 (7 patients), myocardial protection was achieved using a cardioplegic solution without allopurinol. In Group 2 (7 patients), 100 mg of allopurinol (xanthine oxidase inhibitor) was added to the solution. In both groups, blood samples were taken from the coronary sinus before the aorta was clamped and 20 minutes after myocardial reperfusion was achieved. The blood samples were used to study the patients' chromosomes. The results were given as the percentage of chromosomal aberrations observed in 100 mitoses. There were no significant differences between the preischemic values in both groups and the postischemic values in Group 2. On the other hand, there was a significant difference between the postischemic values in Groups 1 and 2 (p less than 0.01). In conclusion, reperfusion following myocardial ischemia in cardiac operations can produce clastogenic aberrations. This clastogenic activity can be reduced by adding allopurinol to the cardioplegic solution.

Topics: Allopurinol; Cardioplegic Solutions; Chromosome Aberrations; Coronary Artery Bypass; Coronary Disease; Free Radicals; Humans; Myocardial Reperfusion Injury; Random Allocation

Xanthine oxidase (XO), a major source of superoxide, has been implicated in endothelial dysfunction in atherosclerosis. Mechanisms, however, leading to endothelial XO activation remain poorly defined. We tested the effect of angiotensin II (Ang II) on endothelial XO and its relevance for endothelial dysfunction in patients with coronary disease.. XO protein levels and XO-dependent superoxide production were determined in cultured endothelial cells in response to Ang II. In patients with coronary disease, endothelium-bound XO activity as determined by ESR spectroscopy and endothelium-dependent vasodilation were analyzed before and after 4 weeks of treatment with the AT1-receptor blocker losartan, the XO inhibitor allopurinol, or placebo. Ang II substantially increased endothelial XO protein levels and XO-dependent superoxide production in cultured endothelial cells, which was prevented by NAD(P)H-oxidase inhibition. In vivo, endothelium-bound XO activity was reduced by losartan and allopurinol, but not placebo therapy in patients with coronary disease. XO inhibition with oxypurinol improved endothelium-dependent vasodilation before, but not after losartan or allopurinol therapy.. These findings suggest a novel mechanism whereby Ang II promotes endothelial oxidant stress, ie, by redox-sensitive XO activation. In patients with coronary disease, losartan therapy reduces endothelium-bound XO activity likely contributing to improved endothelial function.

Topics: Aged; Allopurinol; Angiotensin II; Angiotensin II Type 1 Receptor Blockers; Animals; Cattle; Cells, Cultured; Coronary Circulation; Coronary Disease; Endothelial Cells; Endothelium, Vascular; Enzyme Activation; Enzyme Inhibitors; Female; Humans; Losartan; Male; Middle Aged; NADPH Oxidases; Oxypurinol; Superoxides; Vasodilation; Xanthine Oxidase

Topics: Allopurinol; Colchicine; Coronary Disease; Gout; Gout Suppressants; Humans; Kidney Failure, Chronic; Patient Care Planning; Uric Acid

In an attempt to avoid the deleterious effect of cardiopulmonary bypass, off-pump coronary artery bypass grafting has been rediscovered and spread. We often accomplish the ischemic preconditioning (IP) in off-pump CABG. IP is the phenomenon in which sublethal episode of myocardial ischemia result in increased tolerance to a later, potentially lethal, episode of ischemia. To evaluate the cardioprotective effect of IP and an ATP-sensitive potassium channel (KATP) opener, oxidative radical scavenger, 43 clinical cases were examined. The myocardial tissue oxygen saturation was measured by near-infra red spectroscopy during IP. Twelve cases were subjected to accomplish simple IP (5 min x twice), and 29 cases received pharmacological IP (administrated allopurinol preoperatively and nicorandil intraoperatively; 3 min x once). The result showed that the tissue oxygen of pharmacological IP group is superior to that of simple IP group. The concomitant use of IP and KATP opener, oxidative radical scavenger both ameliorated cardiac dysfunction during the ischemia in anastomotic occlusion of the coronary artery, and improved the postischemic functional recovery. These results suggest that we would be able to decrease both duration and the number of times of IP by using KATP opener and oxidative radical scavenger.

Topics: Allopurinol; Coronary Artery Bypass; Coronary Disease; Humans; Ischemic Preconditioning, Myocardial; Minimally Invasive Surgical Procedures; Myocardium; Nicorandil

University of Wisconsin solution (UW) has been shown to be an effective preservative for the cardiac allograft. Recently, the high potassium content of UW has been implicated in causing coronary endothelial damage, allegedly contributing to development of cardiac allograft vasculopathy (CAV) and eventually to poorer survival.. We examined our experience using UW for preservation of cardiac allografts between 1990 and 1994 (n = 94), and compared these to hearts preserved with the lower potassium-containing Stanford solution used at our center between 1986 and 1990 (n = 65). Indices of graft function, ischemic injury, CAV incidence, CAV severity, and survival were evaluated.. The 2 groups were similar in age, gender, diagnosis, donor inotropic support, donor-recipient weight ratio, incidence of acute graft failure, and cytomegalovirus seroconversion. UW-preserved hearts came from older donors (30.5 vs 24.1 years, p < .001), and were transplanted into more status 1 recipients (56% vs 22%, p < .001), consistent with current trends. Mean ischemic time of UW-preserved hearts was significantly longer (184 vs 155 minutes, p < .005) although time required to wean from bypass was less (45.5 vs 73.8 minutes, p < .001) and there was a trend towards less inotropic requirement. CPK-MB release was less with UW preservation (63 vs 87 microg/ dL, p = .001). Three years after transplantation, both groups were similar in the incidence of CAV (UW, 27.3%; STNF, 37.5%; p = 0.27), and also the severity of CAV (p = 0.78). Deaths attributed to CAV were equal in each group (UW, 11.4% vs STNF, 10.7%; p = 0.79). Kaplan-Meier survival analysis revealed equivalent survival curves (p = 0.26).. We conclude that UW is a safe and effective myocardial preservative, allowing longer ischemic times with equivalent graft function. Our data suggest that when UW is used for cardiac allograft preservation, both CAV and survival are comparable to the experience with other preservatives containing lower concentrations of potassium.

Topics: Adenosine; Allopurinol; Cardioplegic Solutions; Coronary Disease; Coronary Vessels; Glutathione; Graft Survival; Heart Transplantation; Humans; Insulin; Organ Preservation; Organ Preservation Solutions; Postoperative Complications; Raffinose; Retrospective Studies; Transplantation, Homologous

Chronic heart failure is associated with hyperuricaemia and elevations in circulating markers of inflammation. Activation of xanthine oxidase, through free radical release, causes leukocyte and endothelial cell activation. Associations could therefore be expected between serum uric acid level, as a marker of increased xanthine oxidase activity, and markers of inflammation. We have explored these associations in patients with chronic heart failure, taking into account the hyperuricaemic effects of diuretic therapy and insulin resistance.. Circulating uric acid and markers of inflammation were measured in 39 male patients with chronic heart failure and 16 healthy controls. All patients underwent a metabolic assessment, which provided a measure of insulin sensitivity (intravenous glucose tolerance tests and minimal modelling analysis). Compared to controls, patients with chronic heart failure had significantly higher levels of circulating uric acid, interleukin-6, soluble tumour necrosis factor receptor (sTNFR)-1, soluble intercellular adhesion molecule-1 (ICAM-1, all P<0.001), E-selectin and sTNFR2 (both P<0.05). In patients with chronic heart failure, serum uric acid concentrations correlated with circulating levels of sTNFR1 (r=0.74), interleukin-6 (r=0.66), sTNFR2 (r=0.63), TNFa (r=0.60) (all P<0.001), and ICAM-1 (r=0.41, P<0.01). In stepwise regression analyses, serum uric acid emerged as the strongest predictor of ICAM-1, interleukin-6, TNF, sTNFR1 and sTNFR2, independent of diuretic dose, age, body mass index, alcohol intake, serum creatinine, plasma insulin and glucose, and insulin sensitivity.. Serum uric acid is strongly related to circulating markers of inflammation in patients with chronic heart failure. This is consistent with a role for increased xanthine oxidase activity in the inflammatory response in patients with chronic heart failure.

Topics: Cardiomyopathy, Dilated; Case-Control Studies; Coronary Disease; Cytokines; Glucose Tolerance Test; Heart Failure; Humans; Linear Models; Male; Middle Aged; Uric Acid; Xanthine Oxidase

Ventricular arrhythmias were studied in rat isolated hearts subjected to coronary artery occlusion and reperfusion. Free radicals in the perfusate were detected by continuous flow luminol-enhanced chemiluminescence. Administration of purine (2.3 mM) and xanthine oxidase (0.12 U ml-1 min-1) did not significantly modify the severity of reperfusion-induced arrhythmias but did generate free radicals. No free radical generation was detected during the period of coronary artery occlusion or reperfusion. Superoxide dismutase (SOD) 20-80 U ml-1 did not alter the severity of reperfusion arrhythmias but, in the presence of 80 U ml-1 SOD, occlusion-induced arrhythmias were augmented. SOD did not produce any effect on haemodynamics at the concentrations tested. Ventricular arrhythmias and cardiac haemodynamics were also not significantly changed by the combination of scavengers, SOD (10 U ml-1), catalase (100 U ml-1) and mannitol (20 mM). These data suggest that the superoxide free radical is unlikely to be the primary cause of reperfusion induced arrhythmias in rat isolated hearts subjected to regional ischaemia.

Topics: Animals; Arrhythmias, Cardiac; Catalase; Coronary Disease; Free Radical Scavengers; Free Radicals; In Vitro Techniques; Luminescent Measurements; Male; Mannitol; Oxygen Compounds; Purines; Rats; Rats, Wistar; Reperfusion Injury; Superoxide Dismutase; Xanthine Oxidase

Morin hydrate is a bioactive pigment found in yellow Brazil wood. Recently, we reported that morin hydrate prolongs the survival of three types of cells from the human circulatory system against oxyradicals generated in vitro. The protection excels that given by equimolar concentrations of ascorbate, mannitol, and Trolox. Here, we demonstrate that, in vivo, morin hydrate at 5 mumol/kg actually reduced by > 50% the tissue necrosis in post-ischemic and reperfused rabbit hearts. Mechanistically, morin hydrate not only scavenges oxyradicals, but also moderately inhibits xanthine oxidase, a free-radical generating enzyme from the ischemic endothelium. Among other possibilities, morin hydrate appears to chelate some metal ions (e.g. Fe2+) in oxyradical formation, although this needs to be examined further. Nuclear magnetic resonance (at 500 mHz) and electron-impact mass spectrometry also supported a molecular formula of C15H10O7 for morin hydrate. Only by X-ray crystallography was it clearly revealed that there are two water molecules attached by intermolecular hydrogen bonds to a morin molecule. Also, the three rings of morin hydrate approach coplanarity. This conformation favours a delocalization of electrons after oxyradical reduction, making morin an effective antioxidant. Thus, we have documented some of the molecular properties and myocardial salvage effects of morin hydrate.

Topics: Animals; Antioxidants; Coronary Disease; Crystallography, X-Ray; Flavonoids; Heart; Magnetic Resonance Spectroscopy; Mass Spectrometry; Myocardial Reperfusion; Myocardium; Necrosis; Rabbits; Xanthine Oxidase

1. Anaesthetized, open-chest dogs were subjected to 60 min of left circumflex coronary artery occlusion followed by 90 min of reperfusion. Endothelium-dependent and -independent relaxant responses of the isolated coronary arterial rings were then investigated. 2. The endothelium-dependent, acetylcholine-induced relaxation of ischaemic/reperfused arterial rings was significantly attenuated in comparison to control rings (1.9 fold rightward shift, ischaemic/reperfused maximum relaxation = 57 +/- 13% of control maximum relaxation; P less than 0.05). In contrast, glyceryl trinitrate produced similar relaxant responses in control and ischaemic rings. 3. Pretreatment of dogs with either amlodipine (3 micrograms kg-1 min-1, i.v.) or propranolol (1 mg kg-1, i.v.) completely prevented the postischaemic impairment of endothelium-dependent relaxant responses (100 +/- 3% and 90 +/- 5% of control maximum relaxation, respectively). 4. Allopurinol pretreatment (25 mg kg-1, p.o. 24 h previously, plus 50 mg kg-1 i.v. 5 min before arterial occlusion) partially protected against endothelial dysfunction by preventing the ischaemia-induced rightward shift of the acetylcholine relaxation curve and increasing the maximum relaxation response (83 +/- 7% of control rings). 5. These results confirm that endothelium-dependent coronary vascular relaxation is impaired by ischaemia and reperfusion, and that the ischaemia-induced impairment is reduced by pretreatment with amlodipine, propranolol or allopurinol.

Topics: Acetylcholine; Allopurinol; Amlodipine; Animals; Calcium Channel Blockers; Coronary Disease; Coronary Vessels; Dogs; Endothelium, Vascular; Female; In Vitro Techniques; Male; Muscle Relaxation; Muscle, Smooth, Vascular; Myocardial Reperfusion Injury; Nifedipine; Nitroglycerin; Propranolol

Electrophysiological effects of allopurinol on arrhythmias were studied in isolated segments of guinea pig right ventricular free walls paced from endocardium. A high-gain electrocardiogram as well as transmembrane electrical activity from endo- and epicardium were recorded. Tissues were exposed to simulated ischemia for 15 min and then were reperfused with normal Tyrode solution. Sustained or nonsustained ventricular tachycardia, bigeminy, and trigeminy with characteristics of transmural reentry occurred in early reperfusion in 75% of 20 control preparations. Arrhythmias were associated with prolongation of transmural conduction time and abbreviation of endocardial effective refractory period (ERP). Allopurinol strongly reduced the incidence of reperfusion arrhythmias (20-33%) between 10 and 100 microM, whereas either lower or higher concentrations (5 or 500 microM) were less effective (43 and 50%). Antiarrhythmic efficacy correlated with significant attenuation of reperfusion-induced transmural conduction delay (P less than 0.05 or 0.01). Allopurinol did not affect endocardial conduction times nor did it significantly alter endocardial action potential duration or ERP. Our results indicate that allopurinol exerts antiarrhythmic efficacy during reperfusion by selectively attenuating defects related to anisotropic tissue properties.

Topics: Action Potentials; Allopurinol; Animals; Arrhythmias, Cardiac; Coronary Disease; Electrophysiology; Guinea Pigs; Heart; Heart Conduction System; In Vitro Techniques; Male; Myocardial Reperfusion Injury; Pericardium; Reaction Time; Refractory Period, Electrophysiological; Reperfusion

1. We assessed the effect of polyethylene glycol conjugated superoxide dismutase (PEG-SOD) on myocardial stunning in the rabbit heart in which xanthine oxidase level is extremely low. 2. In open-chest anaesthetized rabbits, the left marginal branch of the coronary artery was occluded for 10 min and then reperfused for 30 min. A group of rabbits (PEG-SOD group) received 1000 units/kg of PED-SOD and another group (control group) was given saline 15 min before the coronary occlusion. 3. Regional systolic thickening fraction (TF) was similarly reduced to approximately -25% of baseline value during ischaemia in both groups. However recovery of TF after reperfusion was significantly better in the PEG-SOD group (n = 9) and TF at 30 min after reperfusion was 70.1 +/- 3.9% of baseline value compared with 44.9 +/- 3.4% in the control group (n = 9; P less than 0.05). Rate-pressure products, left ventricular pressure, and LV dP/dt max were not significantly different between the PEG-SOD treated and untreated control rabbits at any time during the experiment. PEG-SOD did not modify the regional myocardial blood flow (coloured microsphere method) during ischaemia/reperfusion, which was assessed by using separate groups of rabbits. 4. These findings indicate that oxygen free radicals are important in the pathogenesis of myocardial stunning in xanthine oxidase deficient hearts.

Topics: Animals; Coronary Circulation; Coronary Disease; Coronary Vessels; Free Radical Scavengers; Hemodynamics; Male; Myocardial Contraction; Myocardial Reperfusion; Myocardium; Polyethylene Glycols; Rabbits; Superoxide Dismutase; Xanthine Oxidase

A high-performance liquid chromatographic method is described for the separation and quantitation of several purine compounds, including hypoxanthine. The isocratic separation of a standard mixture of nine compounds is achieved within 20 min on a reversed-phase Nucleosil 100-5C18 column, with a mobile phase of KH2PO4 (300 mM, pH 4.0)-methanol-acetonitrile-tetrahydrofuran (97.9:1:1:0.1, v/v). Uric acid, guanine, hypoxanthine, uridine, xanthine, allopurinol, inosine, guanosine and 7-methylxanthine were almost completely baseline-separated, with detection limits in the range 0.5-1.2 pmol per injection. The influence of the concentrations of buffer and tetrahydrofuran on the quality of separation are described. The within-day and the day-to-day precision were satisfactory (e.g. coefficients of variation of less than 1.5 and ca. 6.0%, respectively, for peak heights). The recovery of [3H]hypoxanthine added to samples was 86 +/- 1%. Hypoxanthine was quantified in human plasma samples obtained at various times during coronary artery bypass grafting. The hypoxanthine levels measured immediately after release of the aortic cross-clamp were significantly higher than those determined under control conditions (18.8 +/- 7.0 and 3.4 +/- 1.0 microM, respectively).

Topics: Allopurinol; Chromatography, High Pressure Liquid; Coronary Disease; Guanosine; Humans; Hypoxanthine; Hypoxanthines; Inosine; Uridine; Xanthine; Xanthines

Reperfusion after reversible ischemia has been shown to result in prolonged depression of contractile function ("myocardial stunning"). Recent studies suggest that oxygen free radicals may mediate postischemic dysfunction. Since heart sarcolemmal membranes, which contain several types of enzymes, ion channels and receptors play important roles to maintain cell functions, the present study was undertaken to examine the effects of oxygen free radicals on heart sarcolemmal membrane functions in vitro. In the presence of a superoxide anion radical-generating system (2mM xanthine plus 0.03 U/ml xanthine oxidase), sarcolemmal Ca(2+)-stimulated ATPase activity and ATP-dependent Ca2+ accumulation were inhibited in an incubating time-dependent manner. Both lipid peroxidation (r = 0.82) and sulfhydryl group content (r = 0.95) showed significant correlations with Ca(2+)-stimulated ATPase activity. ATP-independent Ca2+ bindings were increased upon treating the membranes with xanthine plus xanthine oxidase. Voltage-dependent Ca(2+)-channels were also affected by oxygen free radicals. The maximal number of binding sites (Bmax) for [3H]-nitrendipine binding was depressed without any changes in dissociation constant (Kd). The effects of oxygen free radicals on adrenergic receptors were more complex. Bmax for [3H]-dihydroalprenolol (DHA) binding (beta-receptor) was increased whereas Bmax for [3H]-prazosin binding [alpha 1-receptor) was decreased after incubating the membrane with xanthine plus xanthine oxidase. Kd for [3H]-DHA or [3H]-prazosin binding was increased. Superoxide dismutase showed protective effects on the changes in these membrane functions due to xanthine plus xanthine oxidase. It is suggested that oxygen free radicals damage heart sarcolemmal membrane functions which may lead to cardiac dysfunction in the stunned myocardium.

Topics: Adenosine Triphosphatases; Animals; Calcium; Catalase; Cell Membrane; Coronary Disease; Free Radicals; Homeostasis; Lipid Peroxidation; Male; Myocardial Contraction; Myocardium; Prazosin; Rats; Rats, Inbred Strains; Superoxide Dismutase; Xanthine; Xanthine Oxidase; Xanthines

Oxygen-derived free radicals are thought to injure the ischemic heart during coronary microvascular embolization.. To test this idea, microspheres (15 microns in diameter) were repetitively administered into the left anterior descending coronary artery to cause microvascular embolization in dogs. Myocardial contractile and metabolic dysfunctions were significantly attenuated after treatments with recombinant human superoxide dismutase, an acyl derivative of ascorbic acid (CV3611, 2-O-octadecylascorbic acid), and xanthine oxidase inhibitor (allopurinol). The free radical scavengers and inhibitor enhanced the coronary hyperemic flow response during embolization, and the total number of microspheres causing maximal embolization was increased by these drugs. When 8-phenyltheophylline was additionally administered with superoxide dismutase, these beneficial effects were abolished, indicating that coronary effects of these drugs may be due to increased release of adenosine during coronary microvascular embolization.. We conclude that oxygen radicals worsen the ischemic injury in coronary microembolization.

Topics: Allopurinol; Animals; Ascorbic Acid; Body Water; Cardiomyopathies; Coronary Disease; Dogs; Edema; Embolism; Free Radical Scavengers; Free Radicals; Microcirculation; Microspheres; Oxygen; Superoxide Dismutase; Theophylline

Using a highly specific assay that minimizes enzyme inactivation in vitro, we found that rabbit myocardial tissue contained low levels of xanthine oxidase (XO) and xanthine dehydrogenase (XD) activity that were effectively inhibited by pretreatment of hearts with allopurinol. In parallel, allopurinol treatment also improved ventricular developed pressure, peak systolic pressure, and coronary flow in isolated hearts subjected to 30 min of normothermic global ischemia and 30 min of reperfusion. Although function was protected by allopurinol treatment, creatine kinase (CK) release was not altered by allopurinol. Inhibition of myocardial XO with allopurinol did not increase myocardial ATP or phosphocreatine. In addition, allopurinol did not scavenge superoxide anion or hydrogen peroxide in vitro. The results support the possibility that relatively low amounts of XO activity, similar to levels reported in human myocardium, may contribute to cardiac ischemia-reperfusion injury.

Topics: Allopurinol; Animals; Coronary Disease; Creatine Kinase; Free Radical Scavengers; Heart; Hydrogen Peroxide; Myocardial Reperfusion Injury; Myocardium; Oxygen; Rabbits; Ventricular Function; Xanthine Oxidase

Xanthine oxidase is the pathological form of xanthine oxidoreductase, which generates free oxygen radicals, when it converts (hypo)xanthine to urate. We studied 1. developmental changes in rat heart, 2. urate production in catheterized patients, and 3. species differences of cardiac xanthine oxidase. First, we measured the activity of the enzyme at various ages. In rat-heart homogenate, xanthine oxidoreductase increased from 0.5 mU/g (newborn) to 25 mU/g (15 weeks, P less than 0.001). In the second part of the study, we demonstrated that patients undergoing coronary angioplasty showed some cardiac urate production. In the last part of our investigations we showed that in explanted human hearts perfused with hypoxanthine, the enzymatic activity was low, contrasting findings in some other species. The apparent xanthine oxidoreductase activity (mU/g) was: 33 (mouse), 28 (rat), 14 (guinea pig), 0.59 (rabbit), less than 0.1 (pig), 0.31 (man) and 3.7 (cow). We conclude that in several species, cardiac damage due to xanthine oxidase cannot be excluded; however in man it is unlikely to occur.

Topics: Aging; Animals; Cattle; Coronary Disease; Guinea Pigs; Humans; In Vitro Techniques; Mice; Myocardium; Rabbits; Rats; Species Specificity; Swine; Uric Acid; Xanthine Oxidase

The pathogenesis of post-ischaemic depression of contractility in myocardium was examined in isovolumic rat heart. 31P-NMR was used to monitor changes in ATP, creatine phosphate (CrP), inorganic phosphate (Pi), and [H+] during brief periods of ischaemia and reperfusion with and without allopurinol treatment. During 5, 10, or 15 min of total global ischaemia, the decline in function (rate-pressure product) correlated inversely with [Pi] (r = 0.92, P less than 0.01). Cardiac function exhibited a slow progressive recovery during 20 min of reperfusion, ultimately reaching only 85%, 78%, and 69% of its pre-ischaemic value following 5, 10, and 15 min of global ischaemia respectively. Following each ischaemic period [ATP], [CrP], [Pi], and [H+] all recovered to control levels within 5-10 min of initiating reperfusion. Allopurinol (2 mM) treatment of hearts made ischaemic for 15 min significantly improved contractile recovery to 89 +/- 7%. Allopurinol also exhibited significant anti-arrhythmic activity during the reperfusion period, decreasing the incidence of premature contractions and the duration of tachy-arrhythmias. Allopurinol had no effect on the final repletion of [ATP] and [CrP], or the recovery of [Pi] and [H+], although the rate of ATP repletion was elevated in the initial 5 min of reperfusion. These results show that neither depletion of the cytosolic high-energy phosphate pool, nor sustained elevations in [Pi] or [H+] are important in the production of post-ischaemic contractile impairment. The beneficial action of allopurinol suggests that xanthine oxidase derived oxygen free-radicals may be involved in the sustained contractile dysfunction following brief ischaemic episodes.

Topics: Adenosine Triphosphate; Allopurinol; Animals; Arrhythmias, Cardiac; Coronary Disease; Energy Metabolism; In Vitro Techniques; Male; Myocardial Contraction; Myocardial Reperfusion Injury; Myocardium; Phosphocreatine; Rats; Rats, Inbred Strains

We assessed the effect of hypoxia/reoxygenation on 14C-albumin flux across endothelial monolayers. Cultured bovine pulmonary artery endothelial cells were grown to confluence on nitrocellulose filters (pore size 12 microns). The endothelialized filters were mounted in Ussing-type chambers which were filled with cell culture medium (M 199). Equimolar amounts (33 nM) of 14C-labeled and unlabeled albumin were added to the "hot" and "cold" chambers, respectively. The monolayers were then exposed to successive periods (90 min) of normoxia (pO2 145 mmHg), hypoxia (pO2 20 mmHg), and reoxygenation (pO2 145 mmHg). A gas bubbling system was used to control media pO2 and to ensure adequate mixing. Four aliquots of culture media were taken during each period in order to calculate the 14C-albumin permeability across the endothelialized filter. In some experiments, either the xanthine oxidase inhibitor, oxypurinol (10 microM), or superoxide dismutase (600 U/mL), was added to the media immediately prior to the experiments. As compared to the normoxic control period, albumin permeability was 1.5 times higher during hypoxia (p less than 0.01) and 2.3 times higher during reoxygenation (p less than 0.01). The reoxygenation-induced increase in albumin permeability was prevented by either oxypurinol or superoxide dismutase. These data indicate that xanthine oxidase-derived oxygen radicals contribute to the hypoxia/reoxygenation-induced endothelial cell dysfunction. The altered endothelial barrier function induced by hypoxia/reoxygenation is consistent with the microvascular dysfunction observed following reperfusion of ischemic tissues.

Topics: Animals; Biological Transport; Carbon Radioisotopes; Cattle; Cells, Cultured; Coronary Disease; Endothelium; Free Radicals; Oxygen; Oxypurinol; Serum Albumin; Superoxide Dismutase; Xanthine Oxidase

This study was designed to demonstrate the concentration-dependent effects of an exogenous free-radical-generating system on the functional characteristics of isolated perfused guinea pig hearts under normal conditions and in response to conditions associated with ischemia followed by reperfusion. Purine (0.0115-0.23 mM) and xanthine oxidase (0.05-1.0 U/L) were added to normal Tyrode's solution and perfused for 40 min. Purine (0.0575-0.23 mM)/xanthine oxidase (0.25-1.0 U/L) produced a decline in contractile force that ranged from 59 to 44% of initial values (p less than 0.05). Although all concentrations of the free-radical-generating system enhanced resting tension when compared to control, this increase was only significant in the presence of purine (0.0115 and 0.0575 mM)/xanthine oxidase (0.05 and 0.25 U/L), following a 20-40 min perfusion period (p less than 0.05). Significant correlations were found between the concentration of the free-radical-generating system and the depression in contractile force (p less than 0.05), as well as between the loss of force and the enhancement of resting tension (p less than 0.002) in the presence of all concentrations of purine/xanthine oxidase examined. Furthermore, purine/xanthine oxidase was a potent stimulus for release of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). While this release was correlated significantly with the concentration of purine/xanthine oxidase (p less than 0.001), there was no significant relationship between the decline in contractile force and the release of 6-keto-PGF1 alpha per se.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 6-Ketoprostaglandin F1 alpha; Animals; Blood Pressure; Coronary Disease; Dose-Response Relationship, Drug; Free Radicals; Guinea Pigs; Heart Rate; Male; Myocardial Contraction; Myocardial Reperfusion; Xanthine Oxidase

Isolated rat hearts (n = 15 per group) were subjected to regional ischemia (10 min) and reperfusion. Superoxide dismutase (SOD; 8 X 10(3), 2 X 10(4), 4 X 10(4), 6 X 10(4), 8 X 10(4), 1.2 X 10(5), or 1.6 X 10(5) IU/l) given early (i.e., throughout the experiment) reduced the incidence of reperfusion-induced ventricular fibrillation (VF), the dose-response characteristics describing an asymmetric U-shaped curve. The optimal dose of SOD (8 X 10(4) IU/l) reduced VF incidence from its control value of 87 to 27% (P less than 0.05). Given late (i.e., 2 min before reperfusion), this dose of SOD exerted a reduced but nonetheless significant antifibrillatory effect. Early administration of catalase (1 X 10(3), 1 X 10(4), 2.5 X 10(4), 5 X 10(4), 1 X 10(5), 1.5 X 10(5), or 1 X 10(6) IU/l) reduced VF incidence in a linear dose-dependent manner, from its control value of 87 to 7% with 1 X 10(6) IU/l (P less than 0.05). Late administration of this dose reduced VF incidence from its control value of 87 to 27% (P less than 0.05). Allopurinol (0.07, 0.15, 0.37, 0.73, 1.10, or 1.47 mM added to the perfusate throughout the experiment) significantly reduced VF incidence over a wide range of doses, but low and high doses were ineffective. Pretreatment with allopurinol (0, 0.01, 0.02, 0.05, 0.10, 0.20, or 0.50 g.kg-1.day-1 per os 48, 24, and 1 h before study) reduced VF incidence from its control value of 93 to less than 50% at several doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allopurinol; Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Catalase; Coronary Disease; Dose-Response Relationship, Drug; Free Radicals; Male; Myocardial Contraction; Myocardial Reperfusion Injury; Rats; Superoxide Dismutase; Time Factors

The calcium-channel inhibiting agent, diltiazem, has been shown to enhance salvage of reperfused myocardium independent of effects on coronary blood flow or myocardial work. Because lipid peroxidation may be a mediator of reperfusion injury and modifiable by calcium-sensitive pathways, we evaluated the effects of diltiazem on the formation of malondialdehyde (MDA), a product of lipid peroxidation, in isolated rabbit hearts perfused with buffer under control conditions or after 60 minutes of ischemia with or without 3 minutes of reperfusion. Diltiazem (5 x 10(-7)M) reduced tissue MDA content in seven reperfused hearts compared with levels measured in 14 hearts reperfused without drug (1.54 +/- 1.09 [SD] compared with 3.57 +/- 1.88 nmol/g, p less than 0.05). Superoxide dismutase and catalase were ineffective in reducing tissue MDA content in reperfused hearts (n = 8; MDA concentration, 3.88 +/- 2.82 nmol/g) although they were effective in preventing lipid peroxidation in separate studies in which oxygen-centered free radicals were generated directly by an infusion of xanthine oxidase and hypoxanthine. These results suggest that the salutary effects of diltiazem in the setting of reperfusion may be mediated by reduction of lipid peroxidation at a locus not accessible to scavengers of oxygen-centered free radicals or by a mechanism not mediated by free radical pathways.

Topics: Animals; Coronary Disease; Diltiazem; Heart; Hypoxanthine; Hypoxanthines; In Vitro Techniques; Kinetics; Lipid Peroxidation; Male; Malonates; Malondialdehyde; Myocardial Reperfusion; Myocardium; Rabbits; Xanthine Oxidase

Complete cessation of flow in isolated rat hearts for 90 min resulted in a gradual breakdown of ATP and concomitant accumulation of degradation products, such as adenosine, inosine (major break-down product), hypoxanthine, and, to a lesser extent, xanthine. After 45 min of ischemia, the content and relative composition of purines hardly changed, whereas the AMP content continued to rise. This finding points to constraints on AMP degradation and flux through the degradation pathway from adenosine to uric acid in the ischemic heart. In myocardial preparations, the cells of which were deliberately disrupted by freezing and thawing before anoxic incubation, AMP did not accumulate and was finally converted to hypoxanthine. These results indicate that compartmentalization of substrates and enzymes is responsible for the observed preferential accumulation of AMP and inosine in the ischemic heart. Inhibition of hypoxanthine degradation is explained by the absence of oxygen. Restoration of flow and oxygen supply abolished the inhibition of metabolic flux. Accumulated purines were released into the coronary effluent and, concomitantly, further metabolized. Comparison of tissue levels of hypoxanthine, xanthine, and uric acid before reperfusion and the amounts released during reperfusion indicates that in rat myocardium substantial amounts of potentially hazardous xanthine oxidase-derived reactive oxygen species are likely to be formed during the early reperfusion phase.

Topics: Adenine Nucleotides; Animals; Coronary Disease; Hemodynamics; In Vitro Techniques; Male; Myocardial Reperfusion; Myocardium; Oxygen; Rats; Rats, Inbred Lew; Xanthine Oxidase

Recent evidence suggests that free oxygen radicals are produced by ischaemic tissues, accounting for at least part of the damage that results. These free oxygen radicals are produced by xanthine oxidase, amongst others, and removed by scavenger enzymes (catalase, superoxide dismutase and glutathione peroxidase) and anti-oxidants. As mitochondria are oxygen-utilising organelles, they are capable of producing free oxygen radicals. Our results indicate that the removal of free oxygen radicals are not diminished during ischaemia, but the activity of the free oxygen radical generator, xanthine oxidase, is increased. This could lead to an increased superoxide anion concentration.

Topics: Animals; Antioxidants; Catalase; Coronary Disease; Glutathione Peroxidase; Male; Mitochondria, Heart; Myocardium; Perfusion; Rats; Rats, Inbred Strains; Superoxide Dismutase; Superoxides; Xanthine Oxidase

The electron transport chain of the mitochondria is highly sensitive to myocardial ischemia. As free oxygen radicals take part in the damage that occurred during ischemia, this study was undertaken to determine if allopurinol and deferrioxamine had any beneficial effect on mitochondrial function. Our results showed that perfusion with allopurinol did not improve the mitochondrial function, but that reperfusion with allopurinol and deferrioxamine had a beneficial effect. We came to the conclusion that xanthine oxidase, as a generator of superoxide anions, is of minor importance in comparison with the hydroxyl radicals, which are probably formed in the presence of iron in the cell.

Topics: Adenosine Diphosphate; Allopurinol; Animals; Coronary Disease; Deferoxamine; Heart Arrest; In Vitro Techniques; Male; Mitochondria, Heart; Myocardial Reperfusion; Oxidative Phosphorylation; Rats; Rats, Inbred Strains; Superoxides

Pre-treatment with allopurinol is able markedly to attenuate the deterioration in blood viscosity (BV) and whole blood filterability (WBF) that occurs after ischaemia during exercise. It also reduces the exercise-induced increase in serum oxidase activity, although this action is slightly less effective in peripheral obliterative arterial disease (POAD) patients. Conversely, allopurinol is completely ineffective in modifying haemorheological parameters in vitro, and it does not affect superoxide anion generation or enzyme release from neutrophils stimulated in vitro with formyl-methionyl-leucyl-phenylalanine (FMLP). It is suggested that allopurinol may attenuate changes in BV and WBF by affecting xanthine-oxidase-dependent free radical formation in tissues.

Topics: Aged; Allopurinol; Arterial Occlusive Diseases; Blood Viscosity; Coronary Disease; Female; Glucuronidase; Humans; In Vitro Techniques; Male; Middle Aged; Neutrophils; Physical Exertion; Rheology; Superoxides

Topics: Animals; Catalase; Cattle; Coronary Disease; Creatine Kinase; Deferoxamine; Disease Models, Animal; Male; Myocardial Reperfusion Injury; Myocardium; Rats; Rats, Inbred Strains; Superoxide Dismutase; Superoxides; Xanthine Oxidase

Three lines of investigation indicated that hydrogen peroxide (H2O2) from xanthine oxidase (XO) contributes to cardiac dysfunction during reperfusion after ischemia. First, addition of dimethylthiourea (DMTU), a highly permeant O2 metabolite scavenger (but not urea) simultaneously with reperfusion improved recovery of ventricular function as assessed by ventricular developed pressure (DP), contractility (+dP/dt), and relaxation rate (-dP/dt) in isolated Krebs-Henseleit-perfused rat hearts subjected to global normothermic ischemia. Second, hearts from rats fed tungsten or treated with allopurinol had negligible XO activities (less than 0.5 mU/g wet myocardium compared with greater than 6.0 mU/g in control hearts) and increased ventricular function after ischemia and reperfusion. Third, myocardial H2O2-dependent inactivation of catalase occurred after reperfusion following ischemia, but not after ischemia without reperfusion or perfusion without ischemia. In contrast, myocardial catalase did not decrease during reperfusion of ischemic hearts treated with DMTU, tungsten, or allopurinol.

Topics: Allopurinol; Amitrole; Catalase; Coronary Disease; Hydrogen Peroxide; In Vitro Techniques; Myocardium; Perfusion; Thiourea; Tungsten; Urea; Xanthine Oxidase

Age-dependent differences in the effects of ischemia and reperfusion on ATP breakdown were studied in perfused adult and newborn (10 days old) rat hearts. No-flow ischemia (15 min at 37, 30, or 23 degrees C) was applied and reperfusion (20 min at 37 degrees C) was studied after ischemia at 23 or 37 degrees C. Hypothermia during ischemia protected both age groups to a similar degree against ATP decline, which was linear with temperature. Reperfusion after normothermic ischemia resulted in higher ATP levels in newborn hearts with less release of ATP catabolites (purines). We found no age-related differences in lactate release but large differences in purine release. During normoxia, adult hearts released mainly urate (80% of total) and inosine (7%), but newborns released hypoxanthine (64%) and inosine (15%). Early during reperfusion adult hearts released inosine (58%) and adenosine (18%), but newborns released inosine (53%) and hypoxanthine (38%). These data suggested a lower activity of the potentially deleterious enzyme xanthine oxidoreductase in newborn hearts, which was confirmed by enzymatic assay. ATP-catabolite release during reperfusion was less in newborn than adult hearts, and this coincided with lower xanthine oxidase activity.

Topics: Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Aging; Animals; Animals, Newborn; Coronary Disease; Female; Heart; In Vitro Techniques; Kinetics; Male; Myocardium; Perfusion; Rats; Rats, Inbred Strains; Xanthine Dehydrogenase; Xanthine Oxidase

Topics: Arachidonic Acids; Calcium; Catecholamines; Coronary Disease; Free Radicals; Humans; Leukocytes; Mitochondria; Myocardial Reperfusion Injury; Xanthine Oxidase

Topics: Administration, Oral; Adult; Allopurinol; Coronary Artery Bypass; Coronary Disease; Heart Arrest, Induced; Humans; Intraoperative Complications; Male; Middle Aged; Myocardial Infarction; Premedication

Topics: Allopurinol; Biological Factors; Chromosome Aberrations; Coronary Artery Bypass; Coronary Disease; DNA Damage; Heart Arrest, Induced; Humans; Myocardial Reperfusion Injury; Reference Values

Allopurinol, a competitive inhibitor of xanthine oxidase, has been shown to have a protective effect on ischemic myocardium, but its mechanism of action remains controversial. We used an isolated rat heart preparation to test the hypothesis that allopurinol could restore adenosine triphosphate (ATP) levels and improve the recovery of left ventricular function after global myocardial ischemia. Hearts were equilibrated for 30 min, subjected to 10 min of global, normothermic (37 degrees C) ischemia, and reperfused for 15, 30, and 60 min. Hearts treated with allopurinol (100 microM) exhibited greater ATP levels and improved function during reperfusion than did untreated control hearts. Hearts treated with hypoxanthine (100 microM), the substrate for xanthine oxidase, also showed increased ATP and functional recovery compared with controls. These results suggest that allopurinol may protect the globally ischemic myocardium by enhancing the salvage of hypoxanthine for reincorporation into adenine nucleotides.

Topics: Adenine Nucleotides; Adenosine Diphosphate; Adenosine Triphosphate; Allopurinol; Animals; Coronary Disease; Free Radicals; Hypoxanthine; Hypoxanthines; Male; Myocardial Revascularization; Myocardium; Oxygen; Rats; Rats, Inbred Strains

We have assessed whether oxygen-derived free radicals produced by xanthine oxidase may be an important trigger mechanism in the genesis of reperfusion-induced arrhythmias. We have examined (i) the effects of inhibition of xanthine oxidase by both folic acid solution and amflutizole; (ii) the effects of the inhibitor of xanthine dehydrogenase to xanthine oxidase conversion, soybean trypsin inhibitor; (iii) the effects of administration of superoxide dismutase and catalase, both singly and in combination and (iv) in an isolated rat heart preparation we have investigated the ability of free radical scavengers to reduce reperfusion arrhythmias caused by the infusion of xanthine oxidase and hypoxanthine. The prior administration of folic acid solution, amflutizole, superoxide dismutase, catalase, and superoxide dismutase plus catalase all reduced the incidence of reperfusion-induced arrhythmias and resultant mortality, caused by reperfusion after a transient period of coronary artery occlusion in the anaesthetised rat. Prior administration of soybean trypsin inhibitor significantly reduced mortality. In an isolated, perfused rat heart preparation with temporary coronary artery occlusion, addition of xanthine oxidase-hypoxanthine to the perfusion medium increased the incidence of reperfusion arrhythmias and decreased the total duration of sinus rhythm during reperfusion. Further addition of superoxide dismutase or L-methionine increased significantly the total duration of sinus rhythm. These results suggest that in the rat heart xanthine oxidase may be involved in the genesis of reperfusion-induced arrhythmias.

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Catalase; Coronary Disease; Folic Acid; Free Radicals; Heart; Hypoxanthines; Male; Perfusion; Rats; Rats, Inbred Strains; Superoxide Dismutase; Thiazoles; Trypsin Inhibitors; Xanthine Oxidase

Xanthine oxidase (XO) has been hypothesized to be a potential source of oxygen-derived free radicals during reperfusion of ischemic myocardium based on the fact that allopurinol, a XO-inhibitor, can reduce reperfusion injury. In this communication we report that both allopurinol and oxypurinol, the principle metabolite of allopurinol, prevent the reperfusion injury in isolated pig heart. However, we found that neither pig heart nor pig blood contain any XO activity. Our study showed a direct free radical scavenging action of these XO-inhibitors during ischemia and reperfusion, as judged by the reduction of free radical signals when compared using an Electron Paramagnetic Resonance Spectrometer. Using a Luminometer, we also confirmed that both allopurinol and oxypurinol can scavenge ClO2, HOCl, and significantly inhibit free radical signals generated by activated neutrophils. These XO-inhibitors, however, failed to scavenge O2. and OH. radicals. Our results suggest that these XO-inhibitors salvaged the ischemic-reperfused myocardium by scavenging free radicals, and not by inhibiting XO in the pig heart.

Topics: Adenosine Triphosphate; Allopurinol; Animals; Coronary Disease; Female; Free Radicals; Heart; Hydroxides; Hydroxyl Radical; Hypoxanthine; Hypoxanthines; Male; Myocardium; Oxypurinol; Phosphocreatine; Pyrimidines; Swine; Xanthine; Xanthine Oxidase; Xanthines

Topics: Animals; Arrhythmias, Cardiac; Coronary Circulation; Coronary Disease; Free Radicals; Hydroxides; Hydroxyl Radical; Superoxides; Xanthine Oxidase

To determine the site of reperfusion damage after ischaemia the leakage of xanthine dehydrogenase and xanthine oxidase was assessed in vascular and interstitial effluents. Contractile function was reduced during hypoperfusion but improved after the addition of superoxide dismutase and vasoxin to the perfusion medium. Both interstitial fluid and coronary effluent showed dehydrogenase and oxidase activity after no flow ischaemia. Furthermore, the ratio of lactate dehydrogenase to creatine kinase in coronary effluents was reduced. These findings indicate that the myocardial interstitium may be a site of ischaemic membrane damage since this space contains hypoxanthine and xanthine oxidase. The protective effect of superoxide dismustase also indicates the possibility of damage due to oxygen derived radicals in the cardiac interstitium during low flow perfusion.

Topics: Adrenergic alpha-Agonists; Animals; Coronary Disease; Endothelium, Vascular; Extracellular Space; Exudates and Transudates; Male; Methoxamine; Myocardial Contraction; Rats; Rats, Inbred Strains; Superoxide Dismutase; Xanthine Dehydrogenase; Xanthine Oxidase

The effects of allopurinol pretreatment (1 mg/ml in the drinking water for 7 days at an estimated daily dose of 75 mg/kg) on biochemical and chemical changes occurring following left circumflex coronary artery ligation (40 min) and reperfusion (60 min) were examined in pentobarbital-anesthetized rabbits. During the ischemic phase, allopurinol pretreatment provided significant preservation of cellular ATP levels and of mitochondrial ATP generation as compared with untreated animals (P less than 0.05). During the reperfusion phase, allopurinol pretreatment significantly prevented the decrease in left ventricular pressure, sodium and calcium accumulation and decreases in sarcolemmal Na+,K+-stimulated and sarcoplasmic reticulum K+,Ca2+-stimulated ATPase activities as compared with untreated animals (P less than 0.05). In contrast, the decrease in mitochondrial (azide-sensitive) ATPase during ischemia and the partial recovery during reperfusion were unaffected by allopurinol pretreatment. Our results indicate that the myocardial protective effects of allopurinol may differ mechanistically in the ischemic and reperfusion phases of injury. The fact that rabbit hearts do not contain detectable xanthine oxidase activity would seem to preclude an obligatory role of this enzyme both in the generation of myocardial ischemic/reperfusion injury and in the protective actions of allopurinol.

Topics: Adenosine Triphosphatases; Adenosine Triphosphate; Allopurinol; Animals; Calcium; Coronary Disease; Coronary Vessels; Ligation; Lysosomes; Male; Mitochondria, Heart; Myocardium; Rabbits; Sarcolemma; Sarcoplasmic Reticulum; Sodium; Sodium-Potassium-Exchanging ATPase

Standard microelectrode techniques were used to study the effects of a free radical generating system on action potentials recorded from guinea pig ventricular myocardium. Free radicals were generated by mixing xanthine oxidase (0.02-0.04 mu/ml) with the superfusate-modified Locke's solution containing purine 2.3 mM. The system was validated by demonstrating that it could reduce cytochrome C at a rate of 15.9 +/- 1.5 mol/l/min. This rate was decreased to 3.0 +/- 0.3 (p less than 0.001) in the presence of superoxide dismutase (12 mg/100 ml), and the reaction was absent if xanthine oxidase and purine were premixed for 60 minutes prior to adding cytochrome C. Superfusion of guinea pig ventricular strips with the free radical generating system (20-30 minutes) resulted in a highly significant reduction in resting potential from -79.3 +/- 1.8 mV to -70.9 +/- 1.4 mV (p less than 0.0001, n = 6) and in action potential amplitude from 110.9 +/- 2.2 mV to 101.7 +/- 4.0 mV (p less than 0.0001). There was an accompanying fall in maximum rate of depolarization (Vmax) from 254.1 +/- 17.7 V/sec to 207.1 +/- 18.6 V/sec (p less than 0.01) and no significant change in action potential duration. These changes were accompanied by spontaneous activity in 3 of 6 preparations and reversed after 20-30 minutes washing in Locke's solution. They were largely abolished by adding superoxide dismutase (12 mg/100 ml) to the superfusate and completely absent if the xanthine oxidase and purine were premixed for 60 minutes before superfusing the myocardium. We conclude that the phenomena observed may contribute to the genesis of reperfusion arrhythmias.

Topics: Action Potentials; Animals; Arrhythmias, Cardiac; Coronary Circulation; Coronary Disease; Female; Free Radicals; Guinea Pigs; Heart; Isotonic Solutions; Male; Membrane Potentials; Oxygen; Purines; Superoxides; Xanthine Oxidase

The effects of in vitro generated oxygen free radicals on transmembrane potentials in guinea pig papillary muscles were investigated. Superfusion of the muscle with the oxygen free radical generating medium (1 mM xanthine + 10 U/l xanthine oxidase) for 40 min altered significantly neither the resting nor the action potentials characteristics. We propose that electrophysiological changes leading to the reperfusion-induced arrhythmias may be secondary to an inhomogenous change in the coronary myocardial perfusion produced by the radicals.

Topics: Animals; Arrhythmias, Cardiac; Coronary Disease; Female; Free Radicals; Guinea Pigs; In Vitro Techniques; Male; Membrane Potentials; Oxygen; Papillary Muscles; Xanthine; Xanthine Oxidase; Xanthines

The xanthine oxidase pathway has been proposed as a source of oxygen-derived free radicals in ischemic and reperfused myocardium. A spectrophotometric assay was employed to measure the xanthine oxidase activity of rat and rabbit hearts exposed to varying durations of global ischemia. In the rat 24.6 +/- 4.8 mIU/g wet wt of xanthine dehydrogenase + xanthine oxidase activity were detected in both ischemic and normally perfused myocardium. In the non-ischemic state only 6% of this activity was associated with the free radical-producing oxidase form. After 5 min of ischemia however about 25% of the enzyme was in the oxidase form, a value which remained unchanged over the following 25 min. Neither xanthine dehydrogenase nor xanthine oxidase could be detected in the rabbit heart. Failure of allopurinol, an inhibitor of xanthine oxidase, to limit infarct size in a rabbit model of ischemia/reperfusion provides further evidence that this species has insignificant amounts of xanthine oxidase in its heart. Anesthetized rabbits were subjected to coronary artery ligation for 45 min and 3 h of reperfusion. The volume of the zone of underperfusion was assessed with fluorescent microspheres and infarct size was assessed by tetrazolium staining. In control animals 67.5 +/- 3.8% of the zone of underperfusion became necrotic. In rabbits given superoxide dismutase (15000 IU/kg) + catalase (50,000 IU/kg) for 90 min starting 15 min before occlusion, infarct size was only 35.4 +/- 3.3% of the zone of underperfusion. However, in rabbits pretreated with allopurinol (75 mg p.o. 24 h before study + 30 mg/kg 5 min before occlusion) infarct size was 65.8 +/- 8.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allopurinol; Animals; Antioxidants; Catalase; Coronary Disease; Free Radicals; Ketone Oxidoreductases; Myocardial Infarction; Myocardium; Perfusion; Rabbits; Rats; Rats, Inbred Strains; Xanthine Dehydrogenase; Xanthine Oxidase

Topics: Adult; Aged; Allopurinol; Arthritis; Colchicine; Coronary Disease; Gout; Humans; Hypertension; Middle Aged; Probenecid; Uric Acid; Urinary Calculi

The possible role of free radicals in the genesis of occlusion and reperfusion-induced arrhythmias was studied by determining the effects of the xanthine oxidase inhibitor allopurinol (400 mg p.o. 24 h before experimentation +25 mg kg-1 i.v.) and the free radical scavenger N-t-butyl-alpha-phenyl nitrone (PBN; 50 mg kg-1 i.v.) on these arrhythmias in chloralose anaesthetized greyhounds. Neither of the drugs had any major effects on haemodynamic variables, although allopurinol caused a significant increase in heart rate. The mean number of extrasystoles observed during ischaemia in dogs given allopurinol or PBN was not significantly different from those seen in controls. Further, the incidence of ventricular fibrillation during either occlusion or reperfusion was unchanged by either drug and there was thus no improvement in survival. These results suggest that, in this model of myocardial ischaemia and reperfusion, free radicals may not play a major role in the genesis of life-threatening arrhythmias.

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Blood Gas Analysis; Coronary Circulation; Coronary Disease; Cyclic N-Oxides; Dogs; Female; Free Radicals; Hemodynamics; Hydrogen-Ion Concentration; Lactates; Male; Nitrogen Oxides

Allopurinol is thought to protect hearts against damage due to hypoxia or ischemia by inhibiting xanthine oxidase and oxygen radical generation. We subjected isolated rabbit hearts, equilibrated by perfusion at 37 degrees C, to 1 h of global ischemia at 27 or 37 degrees C with or without brief pretreatment with 100 microM allopurinol. The total absence of xanthine or uric acid in the coronary effluent following ischemia, the presence of hypoxanthine (25 +/- 4 microM peak concentration), and the failure of allopurinol to alter purine washout profiles or postischemic cardiac function suggest that rabbit myocardium lacks xanthine oxidase or dehydrogenase. Data obtained with a similar rat heart preparation showed appreciable formation of xanthine (12 +/- 2 microM peak) and uric acid (10 +/- 3 microM). Allopurinol pretreatment inhibited xanthine and uric acid formation and significantly improved key indicators of postischemic left ventricular function. We conclude that there is species dependency in the myocardial activity of xanthine oxidase or dehydrogenase, that when present it can be inhibited by acute allopurinol pretreatment, and that xanthine oxidase activity and its ability to generate oxygen radicals are not universal contributors to cardiac ischemic damage.

Topics: Allopurinol; Animals; Chromatography, High Pressure Liquid; Coronary Disease; In Vitro Techniques; Osmolar Concentration; Purines; Rabbits; Rats; Rats, Inbred Strains

Recent evidence suggests that postischemic myocardial dysfunction (or myocardial "stunning") may be mediated by oxygen free radicals, but the mechanism for their production remains unknown. To explore the role of xanthine oxidase as a potential source of free radicals, open-chest dogs undergoing a 15-min occlusion of the left anterior descending coronary artery (LAD) followed by 4 h of reperfusion (REP) received intravenously either allopurinol (50 mg/kg 48 h, 20 h, and 30 min before occlusion, 10 mg/kg 1 min before REP, and 6.25 mg X kg-1 X h-1 throughout REP, n = 13) or saline (n = 14). The two groups were similar with respect to occluded bed size (postmortem perfusion) and collateral flow (radioactive microspheres). In controls, the transcardiac difference in plasma uric acid (great cardiac vein - arterial concentration) increased 199 +/- 70% (means +/- SE) during ischemia (P less than 0.02) and remained elevated for 5 min after REP; no increase was observed in treated dogs. Regional myocardial function was assessed by measuring systolic wall thickening with an epicardial Doppler probe. The two groups exhibited comparable systolic thickening under base-line conditions and similar degrees of dyskinesis during ischemia. Following REP, however, recovery of contractile function (expressed as percent of preocclusion values) was considerably greater in allopurinol-treated as compared with control dogs: 57 +/- 14 vs. -22 +/- 16 (P less than 0.01) at 1 h, 70 +/- 13 vs. -15 +/- 15 (P less than 0.001) at 2 h, 65 +/- 14 vs. -28 +/- 13 (P less than 0.001) at 3 h, and 68 +/- 13 vs. -17 +/- 14 (P less than 0.001) at 4 h. These differences could not be ascribed to hemodynamic factors. The results suggest that xanthine oxidase is a source of the oxygen free radicals responsible for myocardial stunning following a brief episode of reversible regional ischemia.

Topics: Allopurinol; Animals; Blood Gas Analysis; Body Temperature; Coronary Circulation; Coronary Disease; Dogs; Half-Life; Hematocrit; Hemodynamics; Kinetics; Myocardium; Oxypurinol; Potassium; Regional Blood Flow; Uric Acid; Xanthine; Xanthine Oxidase; Xanthines

The effect of the xanthine oxidase inhibitor, allopurinol, on myocardial ultrastructure after left circumflex coronary artery occlusion (40 min) with or without reperfusion (60 min) was examined in rabbits. Pretreatment of rabbits for 7 days with allopurinol (0.1% in the drinking water) resulted in a lower incidence of ventricular fibrillation in both ischemic and reperfusion phases. However, the number of Q waves, ST-segment elevation and premature ventricular contractions were similar in both groups of animals. Examination of hearts from allopurinol-treated animals revealed a distinct decrease in ultrastructural alterations following ischemia and reperfusion. Among the subcellular organelles studied, allopurinol had a preferential protective effect on the mitochondria both during the ischemic and reperfusion phases. In the allopurinol-treated animals, most mitochondria were intact and the cristae network preserved. Our study suggests that the preservation of mitochondrial structural and functional integrity by allopurinol may be an important determinant of its protective actions in myocardial ischemic/reperfusion injury.

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Coronary Disease; Electrocardiography; Male; Microscopy, Electron; Mitochondria, Heart; Myocardium; Rabbits

Tiron (1,2-dihydroxybenzene-3,5-disulfonate) is oxidized to an EPR-visible semiquinone by superoxide radicals produced by xanthine oxidase. The steady-state level of the Tiron radicals increases with an increased xanthine oxidase concentration. A calibration plot has been obtained relating the steady-state concentration of the Tiron semiquinone determined by EPR-spectroscopy to the rate of 0.2 production as measured by the superoxide dismutase-sensitive cytochrome c reduction. This approach allows for a simple and sensitive assay of 0.2 generation rate in biological systems in the range of ca.0.1-4.0 microM/min using Tiron as a spin trap. The rate of 0.2 generation by antimycin-inhibited ischemic rat heart mitochondria has been measured by this method.

Topics: 1,2-Dihydroxybenzene-3,5-Disulfonic Acid Disodium Salt; Animals; Benzenesulfonates; Cattle; Coronary Disease; Cytochrome c Group; Electron Spin Resonance Spectroscopy; Kinetics; Milk; Mitochondria, Heart; Oxidation-Reduction; Rats; Superoxides; Xanthine Oxidase

Milk consumption is related to arteriosclerosis. Recent landmark studies confirm a previously suspected close correlation between milk intake and arteriosclerotic heart disease. Support is therefore provided for a recently proposed novel hypothesis that arteriosclerosis is a chronic infectious disease caused by blue-green bacteria and that milk is a carrier vehicle for these contaminant organisms. A revisionist view of diet and milk in the causation of arteriosclerosis is developed. Previous hypotheses relating milk consumption to arteriosclerosis and advances in pasteurization techniques are discussed and integrated with this infection theory.

Topics: Animals; Arteriosclerosis; Coronary Disease; Cyanobacteria; Dietary Fats; Feeding Behavior; Female; Hot Temperature; Humans; Lactose; Male; Milk; Sex Factors; Sterilization; Xanthine Oxidase

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Coronary Circulation; Coronary Disease; Free Radicals; Oxygen; Rats; Ventricular Fibrillation; Xanthine Oxidase

We evaluated whether supplemental pharmacologic interventions that altered formation or degradation of reactive oxygen metabolites, when added to hypothermic crystalloid cardioplegic solution (procaine-free St. Thomas' Hospital solution), alter postischemic function of isolated rabbit hearts. Hypoxic, substrate-free cardioplegic solutions cooled to 27 degrees C were perfused through isolated rabbit hearts for 5 minutes before and after an uninterrupted 2 hour period of global ischemia at 27 degrees C. Hearts were then reperfused with standard buffer for 1 hour at 37 degrees C. In some experiments, the cardioplegic solution was supplemented with the following: superoxide dismutase (30 micrograms/ml; degrades superoxide anion); catalase (1.7 micrograms/ml; degrades hydrogen peroxide); allopurinol (1 mmol/L; inhibits xanthine oxidase); or deferoxamine (Desferal, 0.5 mmol/L; selectively chelates ferric iron). Postreperfusion contractile parameters of supplemented hearts, including left ventricular pressure development and its first derivative, left ventricular compliance, spontaneous heart rate, and coronary vascular resistance, were statistically compared to data obtained from hearts arrested with unsupplemented cardioplegic solution. Catalase supplementation provided statistically significant improvement of most functional parameters; somewhat less protection was obtained with allopurinol. Deferoxamine provided little added protection except for the ability to prevent ischemia-induced increases of coronary vascular resistance. There was no evidence of added protection by superoxide dismutase. The data suggest that an important component of ischemia-induced cardiac cell damage in an asanguineous setting is hydrogen peroxide-dependent, and interventions that either inhibit production of superoxide anion or degrade hydrogen peroxide offer best protection. They may be clinically efficacious additives to crystalloid cardioplegic solutions.

Topics: Allopurinol; Animals; Bicarbonates; Blood Pressure; Calcium Chloride; Catalase; Coronary Circulation; Coronary Disease; Deferoxamine; Diastole; Edema; Heart Arrest, Induced; Heart Rate; Magnesium; Myocardial Contraction; Myocardial Revascularization; Myocardium; Potassium Chloride; Rabbits; Sodium Chloride; Superoxide Dismutase

Recent studies have established a major role for oxygen-derived free radicals in post ischemic tissue injury to the intestine. During ischemia, there appears to be a calcium-triggered, protease-dependent conversion of the native xanthine dehydrogenase to a superoxide-producing xanthine oxidase. The catabolic degradation of ATP during ischemia provides an oxidizable substrate, hypoxanthine. On reperfusion, molecular oxygen is resupplied and a burst of superoxide production ensues, resulting in extensive tissue damage. The same mechanism appears to occur in myocardial ischemia. Xanthine dehydrogenase rapidly converts to the oxidase during nonperfusion in the rat heart. In the isolated perfused working rat heart model, 40 min of anoxia followed by reoxygenation results in substantial release of creatine kinase. The release of creatine kinase is blocked almost completely by pretreatment of the rats with allopurinol, a specific inhibitor of xanthine oxidase.

Topics: Allopurinol; Animals; Coronary Disease; Creatine Kinase; Free Radicals; Heart; Intestines; Ketone Oxidoreductases; Kidney; Liver; Male; Myocardium; Rats; Rats, Inbred Strains; Superoxides; Xanthine Dehydrogenase; Xanthine Oxidase

Growing evidence supports the concept that oxygen free radicals are an important cause of myocardial ischemic and reperfusion injury. This study was designed to determine if toxic oxygen metabolites may exacerbate ischemic injury upon reoxygenation. Left ventricular function was studied in a group of seven dogs receiving intermittent, 4 degrees C, hyperosmolar, hyperkalemic (KCI 25 mEq/L) saline cardioplegic solution. This group was compared to a group (n = 7) receiving a hyperkalemic (KCI 25 mEq/L) cardioplegic solution designed to scavenge superoxide anion and hydroxyl radical: superoxide dismutase (3,000 U/ml) and mannitol (325 mOsm/L). A third group of five animals received allopurinol pretreatment (50 mg/kg/day) for 72 hours and hyperkalemic saline cardioplegic solution. After 60 minutes of ischemia (10 degrees to 15 degrees C) and 45 minutes of reperfusion, left ventricular mechanical function was better in the groups receiving free radical scavengers and allopurinol pretreatment than in the group receiving only hyperkalemic saline cardioplegic solution. Free radical scavengers preserved myocardial function in this model of hypothermic global ischemia and reperfusion. Our data support the concept that injury occurs primarily during reperfusion with the generation of oxygen free radicals via the hypoxanthine-xanthine oxidase reaction. Allopurinol has potential clinical application in the prevention of reperfusion injury.

Topics: Allopurinol; Animals; Blood Pressure; Coronary Disease; Dogs; Free Radicals; Heart Arrest, Induced; Hydrogen-Ion Concentration; Hydroxides; Hydroxyl Radical; Hypertonic Solutions; Mannitol; Myocardium; Oxidation-Reduction; Oxygen; Perfusion; Potassium; Potassium Compounds; Superoxide Dismutase; Superoxides

The pathogenic mechanisms responsible for heart damage following temporary coronary artery occlusion are unknown. Some damage may be mediated by a normal cellular enzyme, xanthine dehydrogenase, which converts to xanthine oxidase during myocardial ischemia. Reperfusion, with restoration of oxygen supply, may then lead to formation of superoxide by xanthine oxidase, possibly initiating a cascade of oxidative events. In support of this, reperfusion of transiently ischemic canine myocardium leads to a rapid loss of cellular glutathione and a decrease in catalase activity, both indicative of enhanced generation of activated oxygen. Allopurinol--an inhibitor of xanthine oxidase--ameliorates both biochemical damage and functional deficits ordinarily triggered by ischemia and reperfusion, suggesting one possible mode of pharmacologic intervention following acute myocardial infarction.

Topics: Allopurinol; Animals; Catalase; Coronary Disease; Dogs; Glutathione; Myocardium; Oxygen; Perfusion; Time Factors; Xanthine Oxidase

During the acute phase of myocardial ischemia, adenine nucleotides are degraded to nucleosides and bases, especially inosine and hypoxanthine. Simultaneously, xanthine dehydrogenase is converted to xanthine oxidase, an enzyme that converts hypoxanthine to xanthine, and xanthine to uric acid, producing a superoxide anion for each molecule of hypoxanthine or xanthine oxidized. To determine if free radicals via this enzymatic source contribute to cell death in myocardial ischemia, we determined whether allopurinol, an inhibitor of xanthine oxidase, could limit infarct size in a reperfusion preparation of myocardial infarction. The circumflex coronary artery of each of 34 dogs was occluded for 40 min, followed by reperfusion for 4 days. Infarct size then was measured by histologic methods and was related to major baseline predictors of infarct size, including anatomic area at risk and collateral blood flow. Infarct size was larger (NS) in the allopurinol (n = 8) than in the control (n = 11) group, a trend that was related to slightly higher (NS) collateral blood flow in the control group. We conclude that allopurinol has no beneficial effect in this preparation of experimental myocardial infarction. The results oppose the hypothesis that free radicals, produced via the xanthine oxidase reaction, are an important contributing factor in myocardial ischemic cell death.

Topics: Allopurinol; Animals; Cell Survival; Coronary Disease; Dogs; Female; Hemodynamics; Male; Myocardial Infarction; Perfusion; Postoperative Period; Xanthine Oxidase

Experiments were performed to determine if xanthine oxidase is a source of free radicals during myocardial ischemia. Open chest dogs were subjected to 1 h of total occlusion of the left anterior descending coronary artery followed by 4 h of reperfusion. Directly after coronary artery occlusion, Ce141 microspheres were injected into the left atrium to mark the ischemic bed. At the end of reperfusion, the hearts were removed and sectioned. Autoradiography determined the ischemic myocardium at risk, and the necrotic zone was determined by triphenyl-tetrazolium staining. Animals were divided into three groups: control, allopurinol (24-h oral pretreatment 400 mg, then 50 mg/kg IV bolus on occlusion); and superoxide dismutase starting with occlusion (15 000 U/kg). The size of the infarct as a percentage of the tissue at risk was: 23.1 +/- 4.1 for the control; 8.7 +/- 1.2 for the allopurinol group; and 5.4 +/- 1.2 for the superoxide dismutase group. The infarcts in the allopurinol and superoxide dismutase groups were significantly smaller than those in the control groups. In a second series of experiments we determined the xanthine oxidase/xanthine dehydrogenase content of dog myocardium. The left anterior descending branch was ligated for 30 min and then biopsies were removed from both the normal and the ischemic regions. Total enzyme content did not differ between the two regions averaging 0.259 U/g protein for the ischemic tissue and 0.225 U/g protein for the normal region. Only 9.8% of the enzyme was in the oxidase form in the normal region while 32.8% was in the oxidase form in the ischemic zone.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allopurinol; Animals; Coronary Circulation; Coronary Disease; Dogs; Female; Free Radicals; Male; Myocardium; Necrosis; Superoxide Dismutase; Xanthine Oxidase

Topics: Allopurinol; Animals; Chemistry; Coronary Disease; Gout; History, 20th Century; Humans; Hypertension; Leukemia, Myeloid; National Institutes of Health (U.S.); Nephritis, Interstitial; Purines; United States; Uric Acid; Urinary Calculi; Xanthine Oxidase

Topics: Allopurinol; Animals; Antioxidants; Coronary Disease; Deferoxamine; Dogs; Free Radicals; Iron; Mannitol; Myocardium; Neutrophils; Oxygen; Peroxides; Superoxide Dismutase; Xanthine Oxidase

The objective of this study was to test the hypothesis that cytotoxic oxygen metabolites participate in lytic cardiac cell damage, detected as creatine kinase release, upon reoxygenation of hypoxic, isolated buffer-perfused hearts (oxygen paradox). Perfusate additives included: superoxide dismutase (30 mg/l); catalase (2 mg/l); deferoxamine (0.5 mM); and allopurinol (1 mM). Creatine kinase release upon reoxygenation was reduced, to levels not significantly different from nonhypoxic controls, by adding either catalase, allopurinol or deferoxamine to the buffer during hypoxia. Reduced creatine kinase leakage was not accompanied by parallel preservation of ventricular function or coronary vascular resistance. Administration of catalase during hypoxia was superior to administering it only during reoxygenation. Treatment with catalase during both hypoxia and reoxygenation provided no more protection than administration only during hypoxia. The data suggest that an important component of hypoxia-induced cardiac cell damage is due primarily to hydrogen peroxide, which may then form hydroxyl radical. Superoxide anion plays an important role as a precursor of these species, but added superoxide dismutase alone did not significantly reduce creatine kinase loss. The data also suggest that damage resulting in creatine kinase release upon reoxygenation occurs during oxygen deprivation, and it is mediated in part by cytotoxic oxygen metabolites.

Topics: Allopurinol; Animals; Blood Pressure; Catalase; Coronary Circulation; Coronary Disease; Creatine Kinase; Deferoxamine; Disease Models, Animal; Free Radicals; Hydrogen Peroxide; Hydroxides; Myocardial Contraction; Oxygen; Rabbits; Superoxide Dismutase

We have investigated the possibility that xanthine oxidase-linked free radical production has a role in the genesis of arrhythmias during ischemia and reperfusion. In this study, rats were treated with allopurinol (20 mg/kg, orally, 24 hours before study, plus 20 mg/kg, iv, 15 minutes prior to study). Using an anesthetized open-chest preparation with either coronary artery occlusion for 30 minutes, or 5 minutes followed by 10 minutes reperfusion, we monitored and compared the rhythm disturbances in experimental vs. placebo-treated rats (n = 18 in each group). Allopurinol treatment reduced the incidence of ventricular tachycardia during ischemia from 88% to 50% (P less than 0.05) and the number of premature ventricular complexes from 471 +/- 120 to 116 +/- 46 (P less than 0.02), but the treatment had no effect upon the incidence or duration of ventricular fibrillation or upon mortality. In contrast, far more dramatic protection was observed during reperfusion after 5 minutes of ischemia. Allopurinol treatment reduced the incidence of ventricular fibrillation from 67% to 11% (P less than 0.01), reduced the mean duration of fibrillation from 230 +/- 70 to 14 +/- 1 seconds (P less than 0.05), and reduced mortality by half (10/18 to 4/18), although this did not reach a level of statistical significance. In addition, the mean duration of tachycardia was reduced from 83 +/- 26 to 38 +/- 8 seconds (P less than 0.05). Allopurinol pretreatment thus affords some protection against ischemia-induced arrhythmias, but a higher degree of protection against reperfusion-induced arrhythmias. Allopurinol inhibits xanthine oxidase activity, and, in turn, this inhibits superoxide radical production.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Allopurinol; Animals; Arrhythmias, Cardiac; Arteries; Coronary Disease; Coronary Vessels; Free Radicals; Hemodynamics; Ligation; Male; Perfusion; Rats; Rats, Inbred Strains; Xanthine Oxidase

Topics: Adult; Aged; Allopurinol; Arteriosclerosis; Coronary Disease; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Hypolipidemic Agents; Lipids; Male; Middle Aged; Uric Acid

Acute myocardial ischemia results in a decrease in developed tension and an increase in resting tension. A breakdown of the excitation-contraction coupling system can explain the behavior of the ischemic muscle at a subcellular level. We have identified a specific defect in the sarcoplasmic reticulum (SR) from the ischemic myocardium; i.e., the uncoupling of calcium transport from ATP hydrolysis. The mediators of this excitation-contraction uncoupling process have not been identified. It is now established that the intracellular pH of the ischemic myocardium is in the range of 6.4 but the role of protons and potential role of free radicals have not been identified. We have hypothesized that protons and free radicals may interact to produce the excitation-contraction uncoupling of the ischemic myocardium. Cardiac SR was isolated from the wall of canine left ventricle and calcium uptake velocity and Ca2+ stimulated-Mg2+ dependent ATPase activity determined. Increasing proton concentration between pH 7.0 and 6.4 significantly reduced calcium uptake rates (pH 7.0 = 0.95 +/- 0.02; 6.4 = 0.50 +/- 0.02 mumoles Ca2+/mg-min; p less than 0.01) with no effect on ATPase activity. Calculated coupling ratios (mumoles Ca2+/mumoles Pi) decreased from 0.87 +/- 0.06 at pH 7.0 to 0.51 +/- 0.05 at pH 6.4. At pH 7.0, the generation of exogenous free radicals from the xanthine-xanthine oxidase system significantly depressed both calcium uptake rates (Control = 0.95 +/- 0.02; X+XO = 0.15 +/- 0.02) and ATPase activity (Control = 1.05 +/- 0.02; X+XO + 0.30 +/- 0.01 mumoles Pi/mg-min; p less than 0.01). The decreases in calcium uptake and in ATPase activity were completely reversible with superoxide dismutase (SOD). At pH 6.4 in the presence of xanthine and xanthine oxidase, there is a further depression of calcium uptake rates (Control = 0.50 +/- 0.02; X+XO = 0.11 +/- 0.01; p less than 0.05) but there is no SOD reversible component. The addition of SOD + 20mM mannitol normalized calcium transport at pH 6.4. The calculated coupling ratio at pH 6.4 in the presence of free radicals was 0.13. In contrast sarcoplasmic reticulum isolated from ischemic myocardium demonstrated a significant depression of calcium uptake rates at pH 7.1 which was further accentuated at pH 6.4. Ca2+-ATPase was significantly depressed at pH 7.1 but there was no accentuation at pH 6.4. It is concluded that no single species of free radical can explain the intracellular excitation-contraction uncoupling of the

Topics: Adenosine Triphosphatases; Animals; Calcium; Coronary Disease; Dogs; Free Radicals; Hydrogen-Ion Concentration; Ion Channels; Mannitol; Oxygen Consumption; Sarcoplasmic Reticulum; Superoxide Dismutase; Xanthine Oxidase; Xanthines

High-energy phosphates in heart muscle deprived of oxygen are rapidly broken down to purine nucleosides and oxypurines. We studied the role of xanthine oxidase/dehydrogenase (EC 1.2.3.2/EC 1.2.1.37) in this process with novel high-pressure liquid chromatographic techniques. Under various conditions, including ischemia and anoxia, the isolated perfused rat heart released adenosine, inosine and hypoxanthine, and also substantial amounts of xanthine and urate. Allopurinol, an inhibitor of xanthine oxidase, greatly enhanced the release of hypoxanthine. From the purine release we calculated that the rat heart contained about 18 mU xanthine oxidase per g wet weight. Subsequently, we measured a xanthine oxidase activity of 9 mU/g wet wt. in rat-heart homogenate. When endogenous low molecular weight inhibitors were removed by gel-filtration, the activity increased to 31 mU/g wet wt. Rat myocardial xanthine oxidase seems to be present mainly in the dehydrogenase form, which upon storage at -20 degrees C is converted to the oxidase form.

Topics: Animals; Coronary Disease; Coronary Vessels; Heart; Ketone Oxidoreductases; Male; Myocardium; Perfusion; Purine Nucleosides; Purines; Rats; Rats, Inbred Strains; Xanthine Dehydrogenase; Xanthine Oxidase

Topics: Acidosis; Animals; Calcium; Calcium-Transporting ATPases; Coronary Disease; Dogs; Free Radicals; Hydrogen-Ion Concentration; Mannitol; Sarcoplasmic Reticulum; Superoxide Dismutase; Xanthine Oxidase

In accordance with previous results obtained in healthy volunteers 1H-pyrazolo[3,4-d]pyrimidin-4-ol (allopurinol) showed an inhibiting effect on the adrenergically induced mobilization of free fatty acids in normal rabbits. The effect of allopurinol was nearly equal to that of prostaglandin E1 but less than that of pyridyl carbinol. Similarly like in patients with coronary heart disease, this effect was not found in rabbits with cardiac damage following isoprenaline pretreatment. Allopurinol at higher dosage diminished the noradrenaline-induced decrease of heart rate and increase of blood pressure.

Topics: Allopurinol; Animals; Blood Pressure; Coronary Disease; Fatty Acids, Nonesterified; Female; Heart Rate; Isoproterenol; Lipid Mobilization; Male; Nicotinyl Alcohol; Norepinephrine; Prostaglandins E; Rabbits

Topics: Allopurinol; Animals; Cardiac Output; Coronary Angiography; Coronary Disease; Dogs; Female; Fluoresceins; Heart; Heart Rate; Hemodynamics; Injections, Intravenous; Male; Time Factors; Vascular Resistance

Topics: Adult; Aged; Allopurinol; Anabolic Agents; Coronary Disease; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Purines; Uric Acid

Topics: Animals; Cattle; Cholesterol, Dietary; Coronary Disease; Humans; Milk; Xanthine Oxidase

Topics: Alcohol Drinking; Allopurinol; Blood Proteins; Body Weight; Coronary Disease; Diabetes Complications; Female; Gout; Humans; Hypertension; Lead Poisoning; Male; Protein Binding; Risk; Uric Acid; Urinary Calculi

The effects of prolonged intravenous administration of bovine milk xanthine oxidase (EC 1.2.3.2.) on blood lipids and arterial integrity were measured to determine if the administration of this enzyme produces metabolic changes conducive to plaque formation. New Zealand White rabbits were injected intravenously with bovine milk xanthine oxidase at 4-day intervals during a 13-week test period. At the end of the test period, the rabbits were killed and blood, heart, aorta, liver, and kidneys were collected and evaluated. Rabbits injected with phosphate buffer or acid-denatured xanthine oxidase for the same length of time served as negative controls. Additional rabbits fed a diet containing 3% added cholesterol for the same time period served as positive controls. The administration of xanthine oxidase in large amounts over a prolonged period did not alter serum cholesterol or triglyceride levels and did not reduce plasmalogen levels in the aorta or heart. Xanthine oxidase administration did not induce arterial plaque formation. Cholesterol feeding over the same time period increased serum cholesterol levels, reduced liver xanthine oxidase activity levels and resulted in a marked development of arterial plaques. Althouth xanthine oxidase activity was found in liver from all rabbits, enzyme activity was not detectable in aorta, heart or kidneys from any rabbit. Free or complexed bovine milk xanthine oxidase could not be demonstrated in heart, aorta, liver or kidneys from any of the rabbits with immunodiffusion or with immunofluorescent techniques. The study showed that when large intravenous doses of bovine milk xanthine oxidase were given to rabbits, the enzyme was not deposited in heart, aorta, liver or kidneys. The study also showed that large intravenous doses of xanthine oxidase over prolonged periods did not deplete arterial or coronary tissue plasmalogens, and did not induce arterial plaque formation.

Topics: Animals; Aorta; Cattle; Cholesterol; Cholesterol, Dietary; Coronary Disease; Lipids; Male; Milk; Myocardium; Organ Specificity; Plasmalogens; Rabbits; Triglycerides; Xanthine Oxidase

With use of a canine model of occlusion of the left anterior descending coronary artery and an intracellular lactic dehydrogenase stain to measure infarct size directly, the effects of allopurinol, methylprednisolone sodium succinate and propranolol were studied. Allopurinol did not influence the extent of myocardial necrosis, whereas both methylprednisolone and propranolol significantly reduced myocardial infarct size. Possible mechanisms of action and clinical applicability of these agents are discussed.

Topics: Allopurinol; Animals; Blood; Coronary Disease; Disease Models, Animal; Dogs; Heart; Hemodynamics; Hydrogen-Ion Concentration; Methylprednisolone; Myocardial Infarction; Myocardium; Oxygen; Propranolol

The effects of allopurinol on the myocardial oxygen metabolism were studied in dogs with acute coronary artery occlusion. Upon occlusion of the contributory branch of the coronary artery, myocardial pO2, as measured with an improved polarographic technique, decreased to various lower values depending on the site of the electrode inserted. In the slightly ischemic myocardium, where myocardial pO2 decreased less than 50% of the control by the coronary occlusion, administration of allopurinol brought about a further diminution in myocardial pO2. In the severly ischemic myocardium, where myocardial pO2 decreased more than 50% of the control upon the coronary occlusion, no significant change was observed following allopurinol infusion. Theoretical beneficial effects of allopurinol on the ischemic myocardium by preserving functional purine bases might be offset by the aggravation of the negative oxygen balance in the ischemic but still viable myocardium following administration of allopurinol.

Topics: Allopurinol; Animals; Coronary Circulation; Coronary Disease; Disease Models, Animal; Dogs; Myocardium; Oxygen Consumption; Polarography

Asymptomatic hyperuricemia should be treated only if the plasma uric acid levels are around 10 mg/100 ml or more on several determinations. In addition, patients on a purine-free diet who excrete more than 600 mg uric acid per 24 h should be treated. In both cases, treatment is intended to be prophylactic against gouty nephropathy. At present there is no evidence that primary hyperuricemia alone is a risk factor for early atherosclerosis and especially coronary artery disease. However, more attention should be paid to the accompanying risk factors such as obesity, hyperlipoproteinemia, diabetes mellitus and hypertension.

Topics: Allopurinol; Benzbromarone; Citrates; Coronary Disease; Gout; Humans; Hyperlipidemias; Hypertension; Hypoxanthine Phosphoribosyltransferase; Kidney Diseases; Lesch-Nyhan Syndrome; Obesity; Uric Acid

In a control group of 32 patients undergoing open-heart operation, erythrocyte 2,3-diphosphoglycerate (2,3-DPG) declined progressively during the course of perfusion from a prebypass mean of 17.00 to 11.29 mu M per gram of hemoglobin at the end of bypass. The decrease was greater than that attributable merely to dilution of the patients' cells with the 2,3-DPG-deficient donor cells used to prime the pump oxygenator circuit. Administration of 300 mg of allopurinol, to prevent the conversion of inosine to uric acid, every 8 hours during the 24 hours prior to operation in 11 patients did not prevent the 2,3-DPG decrease during heart-lung bypass: prebypass, 18.31; postbypass, 13.56 mu M/gm Hgb. The mean P50 for both these groups combined decreased from a prebypass mean of 25.7 to a postbypass level of 21.9 torr. A solution of 0.1 M inosine, 0.1 M pyruvate, and 0.066 M phosphate (IPP) in a dosage of 7.5 ml per kologram of body weight prevented the 2,3-DPG decrease: prebypass, 15.74; postbypass, 14.85. Administration of 15 ml per kilogram of IPP in 15 patients preserved 2,3-DPG: prebypass, 18.09; postbypass, 18.52. The P50 remained unchanged in this last group. The method of providing for myocardial oxygen requirements during bypass was not standardized, and therefore the protective effect of IPP against ischemic damage in patients undergoing aortic valve replacement or myocardial revascularization could not be evaluated. No deleterious effects of IPP were noted.

Topics: Adult; Allopurinol; Cardiopulmonary Bypass; Child; Coronary Disease; Diphosphoglyceric Acids; Erythrocytes; Extracorporeal Circulation; Half-Life; Hemoglobins; Humans; Inosine Nucleotides; Oxygen; Oxyhemoglobins; Postoperative Complications; Protein Binding; Pyruvates; Rheumatic Heart Disease

Topics: Aged; Animals; Arteriosclerosis; Cell Membrane; Coronary Disease; Humans; Intestinal Absorption; Middle Aged; Milk; Myocardium; Plasmalogens; Xanthine Oxidase

Topics: Adult; Aged; Amines; Aortic Diseases; Arteriosclerosis; Autopsy; Coronary Disease; Humans; Male; Middle Aged; Myocardium; Pteridines; Xanthine Oxidase

Topics: Adult; Allopurinol; Animals; Blood Glucose; Blood Pressure; Cardiac Output; Cardiac Volume; Coronary Disease; Dogs; Fatty Acids, Unsaturated; Heart Rate; Hemodynamics; Humans; Lipoproteins; Male; Oxygen Consumption; Uric Acid

Topics: Allopurinol; Animals; Blood Pressure; Cardiac Catheterization; Cardiac Output; Coronary Disease; Coronary Vessels; Dogs; Dye Dilution Technique; Electrocardiography; Heart Rate; Ischemia; Myocardium; Phosphorus; Potassium; Sheep; Sodium; Uric Acid; Vascular Resistance; Venous Pressure; Xanthine Oxidase