allopurinol and Respiratory-Insufficiency

The effect of allopurinol to inhibit purine metabolism via the xanthine oxidase pathway in neonates with severe, progressive hypoxemia during rescue and reperfusion with extracorporeal membrane oxygenation (ECMO) was examined. Twenty-five term infants meeting ECMO criteria were randomized in a double-blinded, placebo-controlled trial. Fourteen did not receive allopurinol, whereas 11 were treated with 10 mg/kg after meeting criteria and before cannulation, in addition to a 20-mg/kg priming dose to the ECMO circuit. Infant plasma samples before cannulation, and at 15, 30, 60, and 90 min, and 3, 6, 9, and 12 h on bypass were analyzed (HPLC) for allopurinol, oxypurinol, hypoxanthine, xanthine, and uric acid concentrations. Urine samples were similarly evaluated for purine excretion. Hypoxanthine concentrations in isolated blood-primed ECMO circuits were separately measured. Hypoxanthine, xanthine, and uric acid levels were similar in both groups before ECMO. Hypoxanthine was higher in allopurinol-treated infants during the time of bypass studied (p = 0.022). Xanthine was also elevated (p < 0.001), and uric acid was decreased (p = 0.005) in infants receiving allopurinol. Similarly, urinary elimination of xanthine increased (p < 0.001), and of uric acid decreased (p = 0.04) in treated infants. No allopurinol toxicity was observed. Hypoxanthine concentrations were significantly higher in isolated ECMO circuits and increased over time during bypass (p < 0.001). This study demonstrates that allopurinol given before cannulation for and during ECMO significantly inhibits purine degradation and uric acid production, and may reduce the production of oxygen free radicals during reoxygenation and reperfusion of hypoxic neonates recovered on bypass.

Topics: Allopurinol; Blood Gas Analysis; Double-Blind Method; Enzyme Inhibitors; Extracorporeal Membrane Oxygenation; Humans; Hypertension, Pulmonary; Hypoxanthine; Hypoxia; Infant, Newborn; Purines; Respiratory Insufficiency; Xanthine Oxidase

We have recently reported that in an anesthetized rat model, generation of oxygen free radicals (OFR) via i.v. administration of Xanthine plus Xanthine Oxidase [X + XO] resulted in death of about 90% of the animals within a 120-min observation period. Pretreatment of the rats with endogenous scavengers Superoxide Dismutase and Catalase, or with felodipine, a dihydropyridine calcium channel blocker, and/or with dopexamine, an agonist of beta 2 adrenoceptors as well as dopamine (DA-1) receptors significantly enhanced the survival rate to over 70%. The present study was designed to investigate whether lipid peroxidation and ensuing respiratory depression contributed to the lethal toxicity of the free radicals. In the control group, the death of the rats administered [X + XO] was proceeded by significant increases in the plasma lipid peroxides (PLP) and by a severe hypertensive response characteristic of an intense ischemic state, which was confirmed by the presence of hypercapnia, hypoxemia, and acidosis. Placement of the animals on the positive pressure ventilation prior to the administration of [X + XO] did not prevent increases in PLP but, prevented any adverse alterations in the respiratory markers and significantly enhanced survival rate up to 70%. In contrast, both felodipine as well as dopexamine prevented any increases in PLP, normalized blood gas profile, and significantly increased survival rate to 80 to 90%. These observations suggest that the lethal toxicity produced by oxygen free radical was due to respiratory distress. The relationship between increases in the PLP and respiratory depression and the mechanisms via which two pharmacologically distinct agents, felodipine and dopexamine, facilitated the salutary effects cannot be conclusively stated at this time. It is further suggested that although the doses of these two drugs employed in the present studies are not adequate to function as antioxidants, such a possibility cannot be entirely ruled out.

Topics: Anesthesia; Animals; Carbon Dioxide; Dopamine; Felodipine; Hemodynamics; Hydrogen-Ion Concentration; Kinetics; Lipid Peroxidation; Male; Oxygen; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Respiratory Insufficiency; Vasodilator Agents; Xanthine; Xanthine Oxidase; Xanthines

Topics: Aged; Allopurinol; Cytarabine; Drug Therapy, Combination; Humans; Hydroxyurea; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukocytosis; Male; Positive-Pressure Respiration; Postoperative Complications; Respiratory Insufficiency

Topics: Animals; Free Radicals; Guinea Pigs; Lung Compliance; Oxygen; Pulmonary Surfactants; Rabbits; Respiratory Distress Syndrome; Respiratory Insufficiency; Superoxide Dismutase; Xanthine Oxidase

Topics: Animals; Free Radicals; Guinea Pigs; Oxygen; Pulmonary Surfactants; Rabbits; Respiratory Insufficiency; Xanthine Oxidase