Heller A R, Rothermel J, Weigand M A, Plaschke K, Schmeck J, Wendel M, Bardenheuer H J, Koch T
University Hospital Carl Gustav Carus, Harvard Medical International Associated Institution, Department of Anesthesiology and Intensive Care Medicine, Dresden, Germany.
Eur J Anaesthesiol. 2007 Mar;24(3):258-66. doi: 10.1017/S026502150600144X. Epub 2006 Nov 10.
Tissue depletion of adenosine during endotoxaemia has previously been described in the lung. Therapeutic approaches to prevent adenosine depletion and the role of A1 and A2 receptor agonists, however, have not been investigated until now.
In isolated and ventilated rabbit lungs, it was tested whether pretreatment with adenosine A1 agonist 2-chloro-N6-cyclopentyladenosine (CCPA; 10(-7) mol, n = 6) or A2 receptor agonist 5'-(N-cyclopropyl)-carboxyamido adenosine (CPCA; 10(-7) mol, n = 6) prior to injection of lipopolysaccharide (LPS) (500 pg mL-1) influenced pulmonary artery pressure (PAP), pulmonary energy content and oedema formation as compared with controls, solely infused with LPS (n = 6). Release rates of adenosine and uric acid were determined by high-performance liquid chromatography. Pulmonary tissue concentrations of high-energy phosphates were measured and the adenine nucleotide pool, adenosine 5'-triphosphate (ATP)/adenosine 5'-diphosphate (ADP) ratio and adenylate energy charge of the pulmonary tissue were calculated.
Administration of LPS induced increases in PAP within 2 h up to 20.8 +/- 2.9 mmHg (P < 0.01). While pretreatment with the A1 agonist merely decelerated pressure increase (13.8 +/- 1.1 mmHg, P < 0.05), the A2 agonist completely suppressed the pulmonary pressure reaction (9.6 +/- 1.0 mmHg, P < 0.01). Emergence of lung oedema after exclusive injection of LPS up to 12.0 +/- 2.9 g was absent after A1 (0.6 +/- 0.5 g) and A2 (-0.3 +/- 0.2 g) agonists. These observations were paralleled by increased adenosine release rates compared with LPS controls (P < 0.05). Moreover, tissue concentrations of ADP, ATP, guanosine 5'-diphosphate, guanosine 5'-triphosphate, nicotinamide-adenine-dinucleotide and creatine phosphate were significantly reduced after LPS. Consequently, the calculated tissue adenine nucleotide pool and the adenylate energy charge increased after adenosine receptor stimulation (P = 0.001).
Adenosine A1- and A2-receptor agonists reduced LPS-induced vasoconstriction and oedema formation by maintenance of tissue energy content. Thus, adenosine receptor stimulation, in particular of the A2 receptor, might be beneficial during acute lung injury.
此前已有研究描述内毒素血症期间肺组织中腺苷耗竭的情况。然而,迄今为止尚未研究预防腺苷耗竭的治疗方法以及A1和A2受体激动剂的作用。
在离体通气的兔肺中,测试在注射脂多糖(LPS)(500 pg/mL)之前,用腺苷A1激动剂2-氯-N6-环戊基腺苷(CCPA;10⁻⁷ mol,n = 6)或A2受体激动剂5'-(N-环丙基)-羧酰胺腺苷(CPCA;10⁻⁷ mol,n = 6)预处理是否会影响肺动脉压(PAP)、肺能量含量和水肿形成,对照组仅输注LPS(n = 6)。通过高效液相色谱法测定腺苷和尿酸的释放率。测量肺组织中高能磷酸盐的浓度,并计算肺组织的腺嘌呤核苷酸池、腺苷5'-三磷酸(ATP)/腺苷5'-二磷酸(ADP)比值和腺苷酸能荷。
注射LPS后2小时内PAP升高至20.8±2.9 mmHg(P < 0.01)。虽然用A1激动剂预处理仅减缓了压力升高(13.8±1.1 mmHg,P < 0.05),但A2激动剂完全抑制了肺压力反应(9.6±1.0 mmHg,P < 0.01)。单独注射LPS后出现的肺水肿高达12.0±2.9 g,而A1激动剂(0.6±0.5 g)和A2激动剂(-0.3±0.2 g)处理后未出现。与LPS对照组相比,这些观察结果伴随着腺苷释放率的增加(P < 0.05)。此外,LPS处理后,ADP、ATP、鸟苷5'-二磷酸、鸟苷5'-三磷酸、烟酰胺腺嘌呤二核苷酸和磷酸肌酸的组织浓度显著降低。因此,腺苷受体刺激后计算得出的组织腺嘌呤核苷酸池和腺苷酸能荷增加(P = 0.001)。
腺苷A1和A2受体激动剂通过维持组织能量含量减少LPS诱导的血管收缩和水肿形成。因此,腺苷受体刺激,尤其是A2受体的刺激,在急性肺损伤期间可能有益。