cyclic-gmp and Peritonitis

The natriuretic effect of atrial natriuretic peptide (ANP) is blunted in certain clinical disorders such as congestive heart failure and liver cirrhosis, despite the elevated plasma ANP levels. These sodium-retaining states are characterized by increased activity of the renal sympathetic nerves. Recent studies have shown higher levels of circulating and urinary catecholamines in cancer patients. We hypothesized that the increased adrenergic activity may be responsible for ascites formation in patients with peritonitis carcinomatosa (PC). The objective of this study was to determine the renal responses to endogenous ANP in patients with PC. Patients, hospitalized at our institute for PC, were examined using renal clearance studies for 2 h. Non-cancer patients were also examined as control subjects. Statistical analysis was performed using Wilcoxon's rank sum test. The results showed that absolute and fractional sodium excretions were markedly lower in patients with PC (54 +/- 16 microEq/min, means +/- SE, p < 0.0005; 0.55 +/- 0.15%, p < 0.005) than in control patients (166 +/- 14 microEql/min; 1.14 +/- 0.09%, respectively). Plasma ANP concentration was increased in patients with PC (34.7 +/- 8.4 pg/ml, p < 0.001) in comparison with control patients (13.3 +/- 2.0 pg/ml). Plasma and urinary levels of norepinephrine were significantly higher in cancer patients (0.36 +/- 0.10 ng/ml, p < 0.05; 125 +/- 20 ng/dl GF, p < 0.05) than in the controls (0.17 +/- 0.02 ng/ml; 73 +/- 13 ng/dl GF). These results suggest that increased renal sympathetic nerve activity may contribute to the attenuation of the natriuretic effect of ANP in patients with PC.

Topics: Adult; Aged; Atrial Natriuretic Factor; Cachexia; Cyclic GMP; Female; Guanosine; Humans; Kidney; Kidney Function Tests; Male; Middle Aged; Natriuresis; Norepinephrine; Peritoneal Neoplasms; Peritonitis; Sodium

One of the clinical characteristics associated with septic shock is heart failure. Several lines of evidence indicate that functional consequences of heart failure in septic shock are linked to the activated NO-cyclic guanosine monophosphate (NO-cGMP) pathway. We have previously shown that the high-affinity cGMP export transporter, multidrug resistance protein 5 (MRP5), is expressed in the heart, which modulates intracellular concentrations and, hence, the effects of cGMP. Thus, modified expression of cardiac MRP5 in septic shock can alter cGMP concentrations and contribute to the development of heart failure. We therefore investigated MRP5 expression in the heart using two established murine models of septic shock (intraperitoneal LPS injection and surgical implantation of a stent into the ascending colon, resulting in a multibacterial peritonitis [CASP, colon ascendens stent peritonitis] in C57BL/6N mice, respectively; n = 38). Cardiac MRP5 was assessed by quantitative polymerase chain reaction and immunofluorescence. The protein was localized in the endothelial wall, smooth muscle, and cardiac myocytes. MRP5 mRNA expression was significantly reduced compared with controls both in the LPS (31.9 +/- 16.8 x 10(-4) vs. 54.1 +/- 14.8 x 10(-4), P = 0.025) and CASP model (18.3 +/- 9.4 x 10(-4) vs. 42.8 +/- 12.1 x 10(-4), P = 0.009; MRP5/glyceraldehyde 3-phosphate dehydrogenase copy numbers, respectively). In parallel, IL-6 plasma levels were significantly increased in both models. Incubation of cultured murine cardiomyocytes (HL1) with 5 ng/mL IL-6 resulted in decreased expression of MRP5 (54% of control), as did incubation of the cells with serum from septic mice (LPS serum, 22% of control; CASP serum, 11% of control). In conclusion, cardiac expression of the cGMP export transporter MRP5 is decreased in two murine models of septic shock, most likely by a transcriptional mechanism. Reduced cGMP export as a consequence of decreased MRP5 expression can attenuate heart failure in sepsis.

Topics: Animals; Cells, Cultured; Colon; Cyclic GMP; Disease Models, Animal; Endothelium; Female; Gene Expression Regulation; Glyceraldehyde-3-Phosphate Dehydrogenases; Heart Failure; Interleukin-6; Lipopolysaccharides; Mice; Multidrug Resistance-Associated Proteins; Myocardium; Myocytes, Cardiac; Myocytes, Smooth Muscle; Nitric Oxide; Peritonitis; Polymerase Chain Reaction; RNA, Messenger; Shock, Septic; Stents

The alterations in peritoneal permeability characteristics during peritonitis can only partly be explained by the increased concentrations of prostaglandins and cytokines in the dialysate. Fifteen patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with 16 peritonitis episodes were examined in the acute phase of the infection by using standard peritoneal permeability analyses (SPAs). In 9 of these patients, a control SPA could be performed. The contribution of nitric oxide (NO), prostaglandins, and the acute phase reactants C-reactive protein (CRP) and secretory phospholipase A2 (sPLA2) were analyzed. The mass transfer area coefficients (MTACs) of low-molecular-weight solutes increased during peritonitis: urea 26%, creatinine 45%, and urate 45%. The MTAC of CO2, calculated to estimate peritoneal blood flow, was 71 mL/min (34 to 254 mL/min) during peritonitis and 55 mL/min (42 to 63 mL/min) after recovery, P < or = .05. The peritoneal protein clearances were also greater during peritonitis, but this increase was not related to the molecular weight of the protein. Therefore the restriction coefficients to macromolecules were not different. The net ultrafiltration in all peritonitis episodes was lower as compared with the control dwells: -97 mL (-196 to 19 mL) versus 25 mL (-132 to 216 mL), P = .03. The prostaglandin concentrations in dialysate were greater during peritonitis than after recovery. The median increase was 199% for prostaglandin E2 (PGE2), 68% for 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha), and 44% for thromboxane B2 (TxB2). Plasma sPLA2 values were 22.7 microg/L (7.3 to 407.6) during peritonitis and 8.9 microg/L (5.5 to 11.5) after recovery, P < .01. The increased plasma sPLA2 during peritonitis correlated with plasma CRP (r = .6; P = .02). The peritoneal clearances of sPLA2 were greater during peritonitis, but this could be attributed completely to the increased peritoneal transport. Both during peritonitis and after recovery, the sPLA2 clearances did not exceed the predicted values based on transport from the circulation to the dialysate. No evidence was found for local production of nitrite or nitrate. However, the MTAC of cyclic guanosine monophosphate (cGMP) was greater during the experiments performed 48 to 72 hours after the onset of peritonitis, which suggests the synthesis of NO. It can be concluded that peritonitis does not induce detectable local release of sPLA2 and that the inflammation-induced increase in th

Topics: Adult; Biological Transport; Blood Flow Velocity; C-Reactive Protein; Cyclic GMP; Dinoprostone; Female; Humans; Kidney Diseases; Male; Middle Aged; Nitric Oxide; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Permeability; Phospholipases A; Phospholipases A2; Splanchnic Circulation

The hemodynamic effects of sepsis have been attributed in part to increased nitric oxide (NO) production and activation of guanylate cyclase, resulting in increased cGMP and relaxation of vascular smooth muscle. Heme oxygenase-1 (HO-1), a heat shock protein, has been shown to increase intracellular cGMP levels by formation of carbon monoxide (CO). We hypothesized that HO may be an important mediator of the hepatic response to infection. Male Swiss Webster mice underwent standard cecal ligation and puncture (CLP, 18 gauge 2X) or sham operation, and received either normal saline (NS) or Zn protoporphyrin IX (ZN PP IX), a competitive HO inhibitor (n = 6-8/group). Hepatic tissue samples were collected at 3, 6, 12, and 24 hr from separate mice. Serum was collected at 3 and 24 hr. A semiquantitative reverse transcriptase polymerase chain reaction method was used to measure HO-1 mRNA levels. Hepatic cGMP levels were measured by ELISA. Groups were repeated (n = 10/group) to assess mortality. Serum was collected at 3 and 24 hr to measure serum aspartate aminotransferase (AST) levels. HO-1 mRNA expression increased significantly by 3 hr after CLP and with HO inhibition alone (P < 0.05 vs sham + NS). HO-1 mRNA remained elevated through 24 hr. CLP animals with HO inhibition showed a significant reduction of hepatic cGMP following CLP compared with CLP + saline at 24 hr (P < 0.05). Mortality was significantly increased in the CLP + ZN PP group at 24 hr (P < 0.05 CLP NS vs CLP ZN PP). CLP caused a marked increase in AST activity, which was increased further with HO inhibition. HO-1 mRNA expression was induced by CLP. AST levels following CLP were markedly increased with HO inhibition. HO-1 function appeared to contribute to elevation of hepatic cGMP during peritonitis and may be an important hepatic adaptive response to infection.

Topics: Animals; Carbon Monoxide; Cyclic GMP; Enzyme Induction; Heme Oxygenase (Decyclizing); Liver; Male; Mice; Peritonitis; Sepsis; Time Factors

Topics: Animals; Ascitic Fluid; Cadmium Poisoning; Cyclic AMP; Cyclic GMP; Glucuronidase; Histamine; L-Lactate Dehydrogenase; Leukocytes; Peritonitis; Prostaglandins; Rats

Topics: Cyclic AMP; Cyclic GMP; Humans; Peritonitis; Practolol; Syndrome

Following intraperitoneal injection of actinomycin D rats show a decrease in number of cells present in the peritoneal cavity, reaching the lowest point after 24 hr. At the same time a highly significant increase of free beta-glucoronidase and of the intracellular concentrations of both cyclic AMP and cyclic GMP has been observed. No exudate was present at this time. Measurable quantities of exudate were present 48-72 hr after actinomycin injection concomitantly with an intense cellular immigration, the dominant cell being mononuclears. In this second phase of the reaction the free beta-glucuronidase decreases towards normal values and both the cyclic nucleotides are significantly below the control values. It is suggested that the increase of intracellular cAMP--concomitant with the maximum release of lysosomal enzymes--is a feedback mechanism preventing further release of inflammatory mediators.

Topics: Animals; Cyclic AMP; Cyclic GMP; Dactinomycin; Disease Models, Animal; Glucuronidase; Peritoneal Cavity; Peritonitis; Prostaglandins E; Rats

The injection of 50 microgram i.p. of actinomycin D produces, in rats, a biphasic inflammatory reaction. The first short lasting phase (approximately 24 h) is characterized by the decrease of the peritoneal cells number, by the increase of the levels of both cAMP and cGMP in the peritoneal cells and by the increased synthesis and release of lysosomal enzymes from these cells. The second long lasting phase (greater than 120 h) is characterized by the exudate formation, intense cellular immigration, continuous release of lysosomal enzymes, return to or below the normal values of the intracellular levels of cyclic nucleotides. The treatment of rats with a steroidal drug reduces the beta-glucuronidase release and, concomitantly, the intracellular cyclic nucleotides levels. Indomethacin is ineffective.

Topics: Animals; Cell Movement; Cyclic AMP; Cyclic GMP; Dactinomycin; Disease Models, Animal; Female; Fluprednisolone; Glucuronidase; Indomethacin; L-Lactate Dehydrogenase; Leukocytes; Peritonitis; Prostaglandins E; Prostaglandins F; Rats