<p>Advances in life science require knowledge of active molecules in complex biological systems. These molecules are often only present for a certain time and at limited concentrations. Integrated micro-analytical tools for sampling, separation and mass spectrometric (MS) detection would meet these requests and are therefore continuously gaining interest. An on-line coupling of analytical functions provides shorter analysis time and less manual sample handling. In this thesis, improved compatibility of microdialysis sampling and multidimensional separations coupled to MS detection are developed and discussed.</p><p>Microdialysis was used <i>in vitro</i> for determination of the non-protein bound fraction of the drug ropivacaine. The sampling unit was coupled on-line to capillary column liquid chromatography (LC) followed by ultraviolet or MS detection. For MS detection, the system was extended with a desalting step and an addition of internal standard. A method for MS screening of microdialysates, collected <i>in vivo,</i> was also developed. The method involved sampling and measurements of the chemical pattern of molecules that generally are ignored in clinical investigations. Chemometric tools were used to extract the relevant information and to compare samples from stimulated and control tissues.</p><p>Complex samples often require separation in more than one dimension. On-line interfaces for sample transfer between LC and capillary electrophoresis (CE) were developed in soft poly(dimethylsiloxane) (PDMS). MS detection in the LC-CE system was optimised on frequent sampling of the CE peak or on high resolution in mass spectra using time-of-flight (TOF)MS or Fourier transform ion cyclotron resonance (FTICR)MS, respectively. Aspects on electrode positioning in the LC-CE interface led to development of an on-column CE electrode. A successful method for deactivation of the PDMS surface using a polyamine polymer was also developed. The systems were evaluated using peptides and proteins, molecules that are gaining increased attention in bioscience, and consequently also in chemical analysis. </p>

Background and aims: Lung recruitment maneuvers (brief episodes of high airway pressure) are a modern treatment alternative to achieve open lung conditions under mechanical ventilation of patients with acute lung injury. It is well known that positive pressure ventilation with high airway pressures cause negative circulatory effects, and that the effects on regional vascular beds can be even more pronounced than the systemic effects. Hypoperfusion of the mesenteric vascular bed can lead to tissue ischemia and local inflammation. This intestinal inflammation has been associated with subsequent development of multiple organ dysfunction syndrome, a syndrome that still carries a high mortality and is a leading cause of death for intensive care patients. The aim of this thesis was therefore to investigate whether lung recruitment maneuvers would cause negative effects on mesenteric circulation, oxygenation or metabolism. Methods and results: In an initial study on ten patients with acute lung injury, we could demonstrate a trend towards a decreased gastric mucosal perfusion during three repeated lung recruitment maneuvers. To more closely examine this finding, we set up an oleic acid lung injury model in pigs, and in our second study we established that this model was devoid of inherent intestinal effects and was adequate for subsequent studies of intestinal effects of lung recrutiment maneuvers. In the acute lung injury model, we also tested the effect of an infusion of a vasodilating agent concurrent with the recruitment maneuvers, the hypothesis being that a vasodilating agent would prevent intestinal vasoconstriction and hypoperfusion. We could show that three repeated lung recruitment maneuvers induced short term negative effects on mesenteric oxygenation and metabolism, but that these findings were transient and short lasting. Further, the effects of prostacyclin were minor and opposing. These findings of relative little impact on the intestines of lung recruitment maneuvers, lead us to investigate the hypothesis that repeated recruitment maneuvers maybe could elicite a protective intestinal preconditioning response, a phenomenon previously described both in the rat and in the dog. However, in our fourth study, using both classical ischemic preconditioning with brief periods of intestinal ischemia or repeated lung recrutiment maneuvers, we could not demonstrate the phenomenon of intestinal preconditioning in the pig. Conclusions: We conclude, that from a mesenteric point of view, lung recruitment maneuvers are safe, and only induce transient and short lasting negative effects. We also conclude that the cause of the minor effects of lung recruitment maneuvers is not dependent on intestinal preconditioning.

Traumatic brain injury (TBI) is a major cause of mortality and disability. As common sequelae in survivors of TBI are disabling functional, emotional and cognitive disturbances, improved treatment of TBI patients is urgently needed. At present, no neuroprotective pharmacological treatment exists. The formation of oxygen-centered free radicals, reactive oxygen species (ROS), is considered an important event in the pathophysiology of TBI. In the present thesis, the fluid percussion (FPI) and controlled cortical contusion injury models of TBI in rats were used. Two nitrone radical scavengers, α-Phenyl-N-tert -butyl nitrone (PBN) and the sulfonated analogue of PBN, 2-sulfophenyl-N-tert-butyl nitrone (S-PBN), were used as tools to study the role of ROS in TBI. Pre-treatment with PBN (30 mg/kg) improved morphological and cognitive outcome after severe controlled cortical contusion injury. Treatment with equimolar doses of PBN and S-PBN administered 30 min after FPI followed by a 24 h intravenous infusion improved morphological outcome. Only S-PBN improved cognitive outcome as assessed in the Morris Water Maze. Surprisingly, pre-treatment with PBN increased the number of apoptotic neurons at 24 hours after injury despite a reduced lesion volume. FPI resulted in an early increase in glucose uptake and a reduction in regional cerebral blood flow (rCBF) assessed by fluoro-2-deoxyglucose (FDG) and hexamethylpropylene amine oxime (HMPAO) autoradiography. At 12 h, a marked reduction in glucose uptake and rCBF ensued. These TBI-induced changes were attenuated by PBN and S-PBN pre-treatment. A method for ROS detection using 4-hydroxybenzoate in conjunction with microdialysis was evaluated. The results showed a marked increase in ROS formation as assessed by an increase in the single adduct 3,4-DHBA, lasting 90 min after injury. In a separate study, PBN and S-PBN equally reduced 3,4-DHBA formation despite no detectable brain concentrations of S-PBN at 30 or 60 min post-injury. In conclusion, ROS play an important role in the injury process after TBI. We report a method for ROS detection with potential clinical utility. Nitrones increased ROS elimination and improved functional and morphological outcome. Nitrone treatment may have a clinical potential as a neuroprotective concept in TBI.

The analysis of low abundant biological molecules is often challenging due to their chemical properties, low concentration and limited sample volumes. Neuropeptides are one group of molecules that fits these criteria. Neuropeptides also play an important role in biological functions, which makes them extra interesting to analyze. A classic chemical analysis involves sampling, sample preparation, separation and detection. In this thesis, an enhanced solid supported microdialysis method was developed and used as a combined sampling- and preparation technique. In general, significantly increased extraction efficiency was obtained for all studied peptides. To be able to control the small sample volumes and to minimize the loss of neuropeptides because of unwanted adsorption onto surfaces, the subsequent analysis steps were miniaturized to a micro total analysis system (µ-TAS), which allowed sample pre-treatment, injection, separation, manipulation and detection. In order to incorporate these analysis functions to a microchip, a novel microfabrication protocol was developed. This method facilitated three-dimensional structures to be fabricated without the need of clean room facilities. The sample pre-treatment step was carried out by solid phase extraction from beads packed in the microchip. Femtomole levels of neuropeptides were detected from samples possessing the same properties as microdialysates. The developed injection system made it possible to conduct injections from a liquid chromatographic separation into a capillary electrophoresis channel, which facilitated for advanced multidimensional separations. An electrochemical sample manipulation system was also developed. In the last part, different electrospray emitter tip designs made directly from the edge of the microchip substrate were developed and evaluated. The emitters were proven to be comparable with conventional, capillary based emitters in stability, durability and dynamic flow range. Although additional developments remain, the analysis steps described in this thesis open a door to an integrated, on-line µ-TAS for neuropeptides analysis in complex biological samples.

Advances in life science require knowledge of active molecules in complex biological systems. These molecules are often only present for a certain time and at limited concentrations. Integrated micro-analytical tools for sampling, separation and mass spectrometric (MS) detection would meet these requests and are therefore continuously gaining interest. An on-line coupling of analytical functions provides shorter analysis time and less manual sample handling. In this thesis, improved compatibility of microdialysis sampling and multidimensional separations coupled to MS detection are developed and discussed. Microdialysis was used in vitro for determination of the non-protein bound fraction of the drug ropivacaine. The sampling unit was coupled on-line to capillary column liquid chromatography (LC) followed by ultraviolet or MS detection. For MS detection, the system was extended with a desalting step and an addition of internal standard. A method for MS screening of microdialysates, collected in vivo, was also developed. The method involved sampling and measurements of the chemical pattern of molecules that generally are ignored in clinical investigations. Chemometric tools were used to extract the relevant information and to compare samples from stimulated and control tissues. Complex samples often require separation in more than one dimension. On-line interfaces for sample transfer between LC and capillary electrophoresis (CE) were developed in soft poly(dimethylsiloxane) (PDMS). MS detection in the LC-CE system was optimised on frequent sampling of the CE peak or on high resolution in mass spectra using time-of-flight (TOF)MS or Fourier transform ion cyclotron resonance (FTICR)MS, respectively. Aspects on electrode positioning in the LC-CE interface led to development of an on-column CE electrode. A successful method for deactivation of the PDMS surface using a polyamine polymer was also developed. The systems were evaluated using peptides and proteins, molecules that are gaining increased attention in bioscience, and consequently also in chemical analysis.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

Title: Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis Objective: Eating disorders, such as bulimia nervosa (BN) and anorexia nervosa (AN), are characterized by abnormal eating behavior. The main features of BN are binge-eating and inappropriate compensatory methods to prevent weight gain. The appetite-modulating peptide ghrelin is secreted by the stomach and shows a strong release of growth hormone (GH). A potential GH-ghrelin feedback loop between stomach and the pituitary has been recently reported. Acipimox (Aci), an analogue of nicotinic acid, inhibits lipolysis in adipose tissue (AT) and reduces plasma glycerol and free fatty acids (FFA) levels. Exercise and Aci are stimulators of GH secretion. We suppose that a negative feedback from increased GH levels during exercise may play a role in reducing plasma ghrelin levels. We surmised that altered baseline activity and exercise-induced activation of the sympathetic nervous system (SNS) results in excessive stimulation of lipolysis associated with negative energy balance and may lead to abnormal AT metabolism in patients with BN. Disruption of the gut-brain-AT axis might be involved in the pathogenesis of BN. The...

Early administration of broad-spectrum antibiotics is the first goal in sepsis treatment. Besides from bacteriostatic/bactericidal effects, some antibiotics may also modify the host´s response to infection. The novel antibiotic tigecycline may exert such properties; however, this property has not been evaluated in large-animal trials. We compared tigecycline with doxycycline and placebo in relation to anti-inflammatory, circulatory and organ dysfunction effects in a sterile pig model of sepsis. Doxycycline, but not tigecycline, reduced the inflammatory response as manifested by tumor necrosis factor alpha levels in plasma. Tigecycline, however, had a stabilizing effect on the circulation not exerted by doxycycline or placebo. To achieve rapid restoration of the circulating blood volume - another major goal in sepsis treatment - fluid bolus administration of is some-times practiced. In addition to crystalloids, albumin-containing solutions are suggested. Yet, some animal-experimental data suggests that rapid bolus administration of albumin reduces albumin’s plasma-expanding effect. We compared a rapid intravenous bolus of radiolabeled albumin with a slow infusion in a sterile pig model of sepsis. Rapid bolus of administration did not reduce plasma levels of albumin following administration and did not increase the amount of albumin that left the circulation. Inadequate oxygen delivery (DO2) by the circulation to the tissues may cause increased plasma lactate, which is the most striking effect of sepsis on the metabolism. However, experimental data and clinical trials refute this link, instead, suggesting other mechanisms, including impaired oxygen extraction, mitochondrial dysfunction and accelerated aerobic glycolysis. We investigated the impact of DO2, oxygen consumption (VO2), hemodynamic parameters and inflammatory response on plasma lactate and organ dysfunction in two experimental sepsis models. In the most severe cases of shock, with DO2, there was an increase in plasma lactate, but without a decrease in VO2, invalidating the assumption that the increase in lactate is due to anaerobic metabolism. To identify critical steps in the sepsis-induced increase in lactate, we inhibited the major energy-producing step in the electron transport chain (ETC). The combination of sepsis and ETC inhibition led to a cellular energy crisis. This finding suggests that early sepsis induces a partial mitochondrial dysfunction.

L'intérêt du suivi du métabolisme énergétique cérébral dans la prise en charge des patients victimes d'hémorragie sous-arachnoïdienne anévrismale (aSAH) grave reste actuellement controversé en raison de l'absence de valeurs seuils décisionnelles applicables en pratique. Ce travail avait pour objectif de réévaluer l'intérêt des paramètres biochimiques de trois techniques, la microdialyse intracérébrale (cMD), la mesure de la pression tissulaire cérébrale en oxygène (PbtO2) et le cathéter rétrograde jugulaire, pour prédire l’issue fonctionnelle de ces patients et diagnostiquer la survenue d'un infarctus. Il parait évident que ce suivi peut permettre de prédire à l'échelon individuel l'issue fonctionnelle à long terme. Le metabolic ratio (MR) ou l'association de ce MR avec des paramètres des deux autres techniques (ratio Lactate/Pyruvate >40, lactates hypoxiques) représentent des potentiels biomarqueurs pronostiques. Il est en revanche difficile de conclure sur l'intérêt de ce suivi pour diagnostiquer les complications ischémiques secondaires. Bien qu'il ait été montré que le MR peut être considéré comme un biomarqueur, il n'est pas possible de conclure actuellement sur les deux approches locales (cMD et PbtO2). Des règles d'implantation ont tout de même pu être identifiées et validées permettant leur application rapide en pratique courante. Au final, le suivi du métabolisme énergétique cérébral doit être envisagé dans la prise en charge des patients aSAH graves notamment pour prédire l'issue fonctionnelle à long terme car des valeurs seuils décisionnelles ont été identifiées et faciliteront ainsi l'utilisation de ce type de monitoring / The interest of cerebral energy metabolism monitoring in the care of patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) currently remains controversial because of the absence of decision making thresholds applicable in practice. This work aimed to reassess the value of biochemical parameters from three techniques, intracerebral microdialysis (cMD), the measurement of brain tissue oxygen pressure (PbtO2), the retrograde jugular catheter to predict the functional outcome and diagnose the occurrence of secondary ischemia.It seems obvious that this monitoring can predict at the individual level the functional long-term outcome. The metabolic ratio (MR) or association of MR with the parameters of the two other techniques (lactate/pyruvate >40, hypoxic lactate) represent potential prognostic biomarkers.It is however difficult to conclude on the interest of such monitoring to diagnose secondary ischemic complications. Although it has been shown that the MR can be considered as a biomarker, it is currently not possible to conclude on the two local approaches (cMD and PbtO2). Nevertheless, implantation rules have been identified and validated for their rapid application in clinical practice.Finally, the monitoring of brain energy metabolism remains a reference technique in the care of serious aSAH patients, especially to predict functional long-term outcome because decision thresholds have been identified and thus will facilitate the use of this kind of monitoring

Le ratio métabolique (MR) est un marqueur du métabolisme cérébral. Dans notre travail, nous avons démontré sa valeur pronostique chez 68 patients victimes d’une hémorragie sous-arachnoïdienne anévrysmale grave. En effet, une diminution du MR sous le seuil de 3,35 traduit un phénomène d’hyperglycolyse relative, dont le nombre d’événement est prédictive d’un pronostic défavorable avec une excellente sensibilité et spécificité. L’obtention de ces résultats est rendue possible, notamment après une phase de validation dans un modèle animal de procédures permettant de limiter les effets de facteurs pré-analytiques critiques. Ces résultats permettent d’envisager une étude pour savoir si l’intégration de ce marqueur dans la stratégie de prise en charge du patient, permet de modifier son devenir fonctionnel. Après avoir validé analytiquement les mesures de pyruvate, glucose et lactate impliquant la technique de microdialyse, nous avons étudié sur une cohorte de patients graves aSAH, modeste (n=18 patients) s’il existait des phénomènes d’hyperglycolyse et leur corrélation avec le pronostic. Dans notre série, à la différence de l’approche globale (cathétérisme de la veine jugulaire), un phénomène d’hyperglycolyse conduirait vers un bon pronostic. En fait, l’approche par microdialyse donne une information sur le métabolisme énergétique localisé à l’implantation de la sonde, alors que le MR donne une information globale, ce qui est probablement le facteur le plus important expliquant la différence d’interprétation entre les 2 approches. En l’absence d’outils de traitement de données et d’algorithmes de décision clinique validés, la microdialyse ne donne pas à l’heure actuelle, une valeur individuelle diagnostique ou pronostique. Un des résultats très prometteurs de ce travail, est la mise en évidence d’un phénomène d’hyperglycolyse relative globale lors du vasospasme, rapidement réversible chez les patients ayant bien évolué, alors qu’il perdure de nombreuses heures après le vasospasme chez les patients ayant évolué de manière péjorative. Ces résultats nécessitent d’être reproduits sur un nombre plus significatifs de patients, ce qui permettrait une confirmation radiologique du vasospasme de manière plus précoce afin de confirmer son importance, sa localisation et l’éventualité de le traiter rapidement / The metabolic ratio (MR) is an index of the brain energetic metabolism. In our study, we have demonstrated its prognostic value for 68 poor grade patients aneurysmal subarachnoid hemorrhage (aSAH): a MR below the threshold value of 3.35 reflects a phenomenon of global cerebral hyperglycolysis which, if repeated, is predictive of a bad outcome. These results were made possible after validation step in an animal mode which allowed to control the critical pre-analytical factors. Our results pave the way for a clinical study aiming to determine if taking into account the MR will help to improve the functional outcome of the aSAH patients. In another approach, based on the use of cerebral microdialysis, we have studied, in an 18 patients cohort, and after an analytical validation of a new biochemical analysis, if such cerebral hyperglycolysis phenomenon was a encountered in this cohort, if these was a correlation with the patients’ outcome. In contrast with the previous 68 aSAH patients, this hyperglycolysis phenomenon appears linked to a good outcome. This apparent discrepancy may be due the difference in the anatomical giving a more localized information on the brain metabolism than the jugular approach used for the MR determination. The most interesting of our results is the correlation found between hyperglycolysis and cerebral vasospasm. If conformed with a larger cohort of aSAH patients, the use of MR could allow an earlier detection and treatment of cerebral vasospasm