Müller-Schweinitzer E, Stulz P, Striffeler H, Haefeli W E
Department of Internal Medicine, Kantonsspital, University Hospital Basel, Switzerland.
J Vasc Surg. 1998 Mar;27(3):528-37. doi: 10.1016/s0741-5214(98)70328-3.
Cryopreserved human blood vessels are important tools in bypass surgery. However, several in vitro studies have demonstrated diminished postthaw functional activity. Therefore the aim of this study was to investigate the consequences of various freezing/thawing protocols and the role of protein kinase C in the postthaw functional activity of cryopreserved human arteries.
In vitro responses of frozen/thawed human internal mammary arteries (IMA) were used to investigate the functional activity after thawing at 15 degrees, 30 degrees, and 100 degrees C/min and after different prefreezing equilibration times (10, 60, 120, 240 minutes) with the cryomedium (Krebs-Henseleit solution containing 1.8 mol/L dimethyl sulfoxide and 0.1 mol/L sucrose) at room temperature followed by cryostorage at -196 degrees C.
Prefreezing equilibration for 10 to 120 minutes diminished maximal alpha-adrenoceptor-mediated responses to noradrenaline to approximately 60%, and equilibration for 240 minutes attenuated noradrenaline effects to less than 25% of that produced by unfrozen controls. Contractile responses were slightly better when thawing was performed at 15 degrees C/min compared with 100 degrees C/min. The postthaw sensitivity to direct activation of protein kinase C by phorbol 12,13-dibutyrate was enhanced. Compared with unfrozen tissues (pD2 = 7.36 +/- 0.07, n = 32) maximal sensitization to phorbol 12,13-dibutyrate was observed in IMA that had been frozen after 60 minutes of equilibration with the cryomedium (pD2 = 8.31 +/- 0.09, n = 30). Responses to phorbol 12,13-dibutyrate of cryopreserved IMA were highly susceptible to blockade of calcium influx by nifedipine, whereas those of unfrozen IMA were resistant to nifedipine. Against noradrenaline nifedipine was equipotent in cryopreserved (pD'2 = 7.75 +/- 0.15, n = 8) and unfrozen IMA (pD'2 = 7.70 +/- 0.10, n = 6). Endothelium-dependent relaxant responses to acetylcholine were significantly attenuated after cryopreservation (Emax = 26% +/- 5%, n = 4) compared with unfrozen IMA (Emax = 71% +/- 4%, n = 4, p < 0.001); endothelium-independent relaxant responses to sodium nitroprusside were unchanged.
Cryopreservation of human IMA under the conditions applied in this study (1) attenuated endothelial cell function and (2) induced an activation of protein kinase C, thereby increasing calcium influx through dihydropyridine-sensitive calcium channels. These experimental data suggest that postoperative administration of calcium channel blockers alone or combined with long-acting nitrates should effectively prevent the development of spasms in arterial grafts.
冷冻保存的人体血管是搭桥手术中的重要工具。然而,多项体外研究表明,解冻后的功能活性会降低。因此,本研究旨在探讨不同冷冻/解冻方案的影响以及蛋白激酶C在冷冻保存的人体动脉解冻后功能活性中的作用。
利用冷冻/解冻后的人乳内动脉(IMA)的体外反应,研究在15℃、30℃和100℃/分钟解冻后以及在室温下与冷冻介质(含有1.8 mol/L二甲基亚砜和0.1 mol/L蔗糖的Krebs-Henseleit溶液)进行不同的预冷冻平衡时间(10、60、120、240分钟)后再在-196℃冷冻保存后的功能活性。
预冷冻平衡10至120分钟会使最大α-肾上腺素能受体介导的对去甲肾上腺素的反应降低至约60%,而平衡240分钟会使去甲肾上腺素的作用减弱至未冷冻对照产生作用的不到25%。与100℃/分钟解冻相比,以15℃/分钟解冻时收缩反应稍好。解冻后对佛波醇12,13 -二丁酸酯直接激活蛋白激酶C的敏感性增强。与未冷冻组织(pD2 = 7.36±0.07,n = 32)相比,在与冷冻介质平衡60分钟后冷冻的IMA中观察到对佛波醇12,13 -二丁酸酯的最大致敏作用(pD2 = 8.31±0.09,n = 30)。冷冻保存的IMA对佛波醇12,13 -二丁酸酯的反应对硝苯地平阻断钙内流高度敏感,而未冷冻的IMA对硝苯地平有抗性。针对去甲肾上腺素,硝苯地平在冷冻保存的IMA(pD'2 = 7.75±0.15,n = 8)和未冷冻的IMA(pD'2 = 7.70±0.10,n = 6)中效力相当。与未冷冻的IMA(Emax = 71%±4%,n = 4)相比,冷冻保存后对乙酰胆碱的内皮依赖性舒张反应显著减弱(Emax = 26%±5%,n = 4,p < 0.001);对硝普钠的非内皮依赖性舒张反应未改变。
在本研究应用的条件下冷冻保存人IMA(1)减弱了内皮细胞功能,(2)诱导了蛋白激酶C的激活,从而增加了通过二氢吡啶敏感性钙通道的钙内流。这些实验数据表明,术后单独给予钙通道阻滞剂或与长效硝酸盐联合应用应能有效预防动脉移植物痉挛的发生。