Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą] / Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text]

En dépit du nombre croissant d’études cliniques sur le canal artériel (CA), des failles méthodologiques entretiennent plusieurs incertitudes concernant l’efficacité et la sécurité des traitements chez les bébés nés prématurés. L’objectif de cette recherche était de comparer les concentrations de prostaglandine E2 (PGE2) et les mesures du flux mésentérique par échographie Doppler chez les enfants nés prématurément et ayant un canal artériel traité à l’ibuprofène par voie intraveineuse ou entérale, en utilisant la méthodologie randomisée contrôlée et à double insu. Dans notre étude pilote, 20 nouveau-nés prématurés de moins de 34 semaines ayant un CA symptomatique confirmé par échocardiographie, furent randomisés au traitement à l’ibuprofène par voie intraveineuse ou entérale. La voie d’administration fut maintenue à l’insu de l’équipe traitante, des cardiologues et des investigateurs. Des dosages des prostaglandines plasmatiques ont été mesurés avant le début du traitement ainsi que 3, 24 et 48 h après le début du traitement. Les mesures du flux mésentérique ont été effectuées avant le traitement à l’ibuprofène ainsi que 1 h et 3 h après le traitement. Nous avons démontré à partir de nos observations que les niveaux plasmatiques de prostaglandines E2 diminuent chez les patients ayant répondu au traitement à l’ibuprofène, indépendamment de la voie d’administration. Nous n’avons pas observé de changement dans l’évolution des dosages de PGE2 chez les patients qui n’ont pas répondu au traitement. Les paramètres mesurés par échographie Doppler au niveau de l’artère mésentérique supérieure n’étaient pas affectés par la voie d’administration du traitement à l’ibuprofène, intraveineuse ou entérale. La présente étude suggère ainsi que le traitement du CA par ibuprofène intraveineux ou entéral n’influe pas sur le flux sanguin mesuré par échographie Doppler. La baisse de la prostaglandine E2 coïncide avec la fermeture du CA, et son dosage pourrait jouer un rôle dans la gestion du traitement. Nous avons démontré la faisabilité d’une étude clinique randomisée à double insu dans le traitement du canal artériel; une méthodologie qui devrait désormait être employé dans la recherche clinique sur les traitements de la persistance du CA. / Despite the growing body of research on the patent ductus arteriosus (PDA), issues with clinical research methodology impairs much of our understanding regarding treatment efficacy and safety in the preterm population. The purpose of this study was to determine plasma prostaglandin E2 (PGE2) concentrations in preterm infants with symptomatic persistence of the ductus arteriosus treated with IV and oral ibuprofen, and measure Doppler flow parameters in the superior mesenteric artery, utilizing randomized controlled and double-blind methodology. Twenty patients age < 34 wks with a symptomatic PDA confirmed by echocardiography randomized to oral vs intravenous ibuprofen regimen. Treating physician, cardiologists and study investigators were blinded to treatment allocation. Plasma PGE2 levels were measured prior to ibuprofen treatment and at 3, 24 and 48 h after treatment. Mesenteric Doppler measurements were taken prior to ibuprofen treatment, and 1 h and 3 h after treatment. Our results showed that plasma PGE2 levels decreased over time in patients that exhibited ductal closure after IV or oral ibuprofen treatment; no time-dependent changes in PGE2 were seen in subjects that failed to respond to ibuprofen. Superior mesenteric artery Doppler flow measurements were not affected by ibuprofen treatment (IV or oral), regardless of efficacy on ductal closure and of PGE2 changes. We conclude that treatment with oral or intravenous ibuprofen does not impact on superior mesenteric artery blood flow measured by Doppler ultrasound. Decreases in plasma PGE2 concentrations coincide with ibuprofen efficacy, and may be more cost-effective to monitor than ultrasound. This study also demonstrated the successful use of double blinded randomized controlled research methodology, which should be more strictly applied in future clinical research on PDA treatment.

Uma elastase-2 foi recentemente descrita como a principal enzima formadora de angiotensina (Ang) II no perfusato do leito arterial mesentérico (LAM) isolado de rato. Investigamos a interação dessa elastase-2 do perfusato do LAM isolado de rato (E-2LAMR) com alguns substratos e inibidores de elastases-2 e de quimases formadoras de Ang II. Os precursores de Ang II, [Pro11-D-Ala12]-Ang I e substrato tetradecapeptídeo de renina (TDP), foram convertidos em Ang II pela E-2LAMR com eficiências catalíticas de 8,6 min-1mM-1 e 5,1 min-1mM-1, respectivamente, enquanto os substratos cromogênicos N-succinil-Ala-Ala-Pro-Leu-p-nitroanilida e N-succinil-Ala-Ala-Pro-Phe-p-nitroanilida foram hidrolisados pela enzima com eficiências catalíticas de 10,6 min-1mM-1 e 7,6 min-1mM-1, respectivamente. O inibidor peptídico CH 5450 inibiu as atividades da E-2LAMR sobre os substratos Ang I (IC50=49 mM) e N-succinil-Ala-Ala-Pro-Phe-p-nitroanilida (IC50=4,8 mM), enquanto Acetil-Ala-Ala-Pro-Leu-clorometilcetona (Ac-AAPL-CK), um efetivo inibidor de elastases-2 pancreáticas, bloqueou eficientemente a atividade formadora de Ang II da E-2LAMR (IC50=4,5 mM). Em conjunto, esses dados confirmaram e estenderam as similaridades enzimológicas entre elastases-2 pancreáticas e a E-2LAMR. Além disso, a interação até então desconhecida da E-2LAMR com [Pro11-D-Ala12]-Ang I e CH 5450, ambos considerados como reagentes seletivos para quimases, sugere que as evidências para a formação de Ang II in vivo por quimases podem ter sido superestimadas em investigações prévias sobre vias geradoras de Ang II. Experimentos realizados com o LAM isolado de rato analisando o efeito vasoconstritor de Ang II, Ang I, TDP e [Pro11-D-Ala12]-Ang I mostraram a existência de uma via geradora de Ang II independente da ECA, a qual é sensível à quimostatina e Ac-AAPL-CK. Entre os possíveis candidatos para essa via alternativa à ECA aparece a E-2LAMR, uma enzima que não é inibida por captopril e que é sensível à quimostatina e Ac-AAPL-CK. Embora quimases, que também são sensíveis à quimostatina, também possam ser candidatos a essa via independente da ECA, com base nos fatos de que a quimase I de rato tem uma atividade predominante de degradação da Ang II e que não existem relatos na literatura de que quimases sejam sensíveis ao inibidor Ac-AAPL-CK, esses dados em conjunto sugerem um possível papel para a E-2LAMR, mas não quimases, como uma via alternativa à ECA para a geração de Ang II no LAM isolado de rato. A clonagem e o seqüenciamento do cDNA para a E-2LAMR foram alcançados pela combinação de transcrição reversa e reação da polimerase em cadeia. A seqüência do cDNA mostrou-se idêntica à do cDNA para a elastase-2 pancreática de rato; o cDNA tem 909 nucleotídeos mais uma cauda poli (A) e codifica uma preproenzima de 271 amino ácidos. A análise dos supostos amino ácidos no sítio de ligação da Ang I revelou características que poderiam explicar a atividade do tipo carboxidipeptidase necessária para a eficiente conversão de Ang I em Ang II. Adicionalmente, a seqüência revela características estruturais que poderiam contribuir para a ausência de atividade dessa enzima sobre a Ang II. O RNAm para a E-2LAMR foi expresso em LAM, pâncreas, pulmão, coração, rim, fígado e baço, mas não em aorta de rato. Células endoteliais do LAM em cultura expressaram o RNAm para a E-2LAMR e sintetizaram a enzima. A localização intravascular dessa enzima e sua habilidade em formar Ang II e não clivar esse peptídeo indicam que ela poderia ter uma participação significativa como um agente formador de Ang II no sistema cardiovascular. Esses resultados também podem indicar que a E-2LAMR é expressa em vasos de resistência, mas não em vasos de condutância. / An elastase-2 has been recently described as the major angiotensin (Ang) II-forming enzyme of the rat mesenteric arterial bed (MAB) perfusate. Here, we have investigated the interaction of affinity-purified rat MAB elastase-2 with some substrates and inhibitors of both pancreatic elastases-2 and Ang II-forming chymases. The Ang II precursors [Pro11-D-Ala12]-Ang I and renin substrate tetradecaptide (TDP) were converted into Ang II by the rat MAB elastase-2 with catalytic efficiencies of 8.6 min-1mM-1 and 5.1 min-1mM-1, respectively, and the chromogenic substrates N-succinyl-Ala-Ala-Pro-Leu-p-nitroanilide and N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide were hydrolyzed by the enzyme with catalytic efficiencies of 10.6 min-1mM-1 and 7.6 min-1mM-1, respectively. The noncleavable peptide inhibitor CH 5450 inhibited the rat MAB elastase-2 activities toward the substrates Ang I (IC50=49 mM) and N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide (IC50=4.8 mM), whereas N-acetyl-Ala-Ala-Pro-Leu-chloromethylketone (Ac-AAPL-CK), an effective active site-directed inhibitor of pancreatic elastases-2, efficiently blocked the Ang II-generating activity of the rat MAB enzyme (IC50=4.5 mM). Altogether, these data confirm and extend the enzymological similarities between pancreatic elastases-2 and their rat MAB counterpart. Moreover, the thus far unrealized interaction of rat MAB elastase-2 with [Pro11-D-Ala12]-Ang I and CH 5450, both regarded as selective for chymases, suggests that evidence for the in vivo formation of Ang II by chymases may have been overestimated in previous investigations of Ang II-forming pathways. Experiments carried out in the isolated rat MAB analyzing the vasoconstrictor effect of Ang II, Ang I, TDP, and [Pro11-D-Ala12]-Ang I showed the existence of an ACE-independent pathway for Ang II generation, which is sensitive to chymostatin and Ac-AAPL-CK. Among the possible candidates for this ACE-independent pathway is rat MAB elastase-2, an enzyme that is not inhibited by captopril, and that is sensitive to chymostatin and Ac-AAPL-CK. Although chymases, which are also chymostatin-sensitive enzymes, might also be other possible candidates for this ACE-independent pathway, based on the fact that rat chymase I has a predominant Ang II-degrading activity, and because there are no reports in the literature that chymases are sensitive to Ac-AAPL-CK, altogether these data suggest a possible role for rat MAB elastase-2, but not chymases, as an alternative pathway to ACE for Ang II generation in the isolated rat MAB. The cloning and sequencing of the cDNA for the rat MAB elastase-2 was accomplished by reverse transcription-polymerase chain reaction. The sequence of this cDNA was found identical to the sequence of the rat pancreatic elastase-2; the cDNA is 909 nucleotides in length plus a poly (A) tail and encodes a preproenzyme of 271 amino acids. Analysis of the putative amino acids in the extended Ang I binding site of the rat MAB elastase-2 reveals features that could explain the dipeptidyl carboxypeptidase-like activity required for efficient Ang I to Ang II conversion. Additionally, the sequence reveals structural features that could contribute to the lack of activity of this enzyme toward Ang II. Rat MAB elastase-2 mRNA was expressed in rat mesenteric arteries, pancreas, lung, heart, kidney, liver, and spleen but not in aorta. Cultured mesenteric endothelial cells expressed the mRNA for rat MAB elastase-2 and synthesized the enzyme itself. The intravascular localization of this enzyme and its ability to generate Ang II and not destroy this peptide indicate that it might play a role in the rat cardiovascular system as an Ang II-forming agent. These results may also indicate that rat MAB elastase-2 is expressed in resistance vessels but not in conduit vessels.

Nos transplantes intervivos de fígado em adultos, o enxerto possui apenas uma artéria segmentar, cujo calibre e extensão são geralmente pequenos. Assim, a distância entre essa artéria do enxerto e a artéria hepática do receptor geralmente é grande e os calibres desproporcionais, tornando tecnicamente difícil a reconstrução arterial hepática. Nestes casos, pode-se utilizar um autoenxerto vascular de interposição para facilitar o procedimento, evitando-se assim complicações cirúrgicas. Objetivo: O presente trabalho se propôs a comparar a artéria mesentérica inferior (AMI), artéria esplênica (AE), artéria epigástrica inferior (AEI), ramo descendente da artéria circunflexa femoral lateral (ACFL) e artéria hepática própria (AHP) como opções de autoenxerto de interposição em transplantes de fígado intervivos em adultos. Método: Foram dissecados 16 cadáveres frescos e coletados as referidas artérias de cada um deles. As variáveis estudadas foram diâmetro do orifício proximal, do distal e comprimento. O diâmetro proximal da AHP e os diâmetros distais AE, AMI, AEI e ramo descendente da ACFL foram comparados ao diâmetro distal da AHD. Os diâmetros proximais e distais da AE, AEI e ramo descendente da ACFL foram comparados entre si para avaliar ganho de calibre. Resultados: Todas as artérias, exceto a AMI, apresentaram diferença estatisticamente significante em relação à AHD quanto à diâmetro. Em termos de ganho de calibre, as artérias apresentaram diferença estatisticamente significante. Todas as artérias, exceto a AHP, apresentaram comprimento de 3 cm. Conclusão: A AMI apresentou a melhor compatibilidade de diâmetro com a AHD e comprimento suficiente para uso como autoenxerto. A AHP, AE, AEI e o ramo descendente da ACFL apresentam calibre estatisticamente diferente da AHD. Destas, somente a AHP não apresentou média de comprimento suficiente para uso em transplante de fígado intervivos / In living donor liver transplantation, the graft presents only a segmental artery, which usually has small diameter and short extension. In these cases, an interpositional arterial autograft can be used in order to obtain vascular extension and better diameter compatibility, making the procedure easier and avoiding surgical complications. Aim: We compared the inferior mesenteric artery (IMA), the splenic artery (SA), the inferior epigastric artery (IEA), the descending branch of the lateral circumflex femoral artery (LCFA) and the proper hepatic artery (PHA) as options of interpositional autograft in living donor liver transplantation. Method: Segments of at least 3 cm of all five arteries were harvested from 16 fresh adult cadavers from both genders through standardized dissection. The analyzed measures were proximal and distal diameter and length. The proximal diameter of RHA and the distal diameter of SA, IMA, IEA and the LCFA were compared to the distal diameter of the RHA. The proximal and distal diameters of the SA, IEA and the LCFA were compared to study caliber gain of each artery. Results: All arteries, except the IMA, showed statistical significant difference in relation to the RHA in terms of diameter. Regarding caliber gain, the arteries demonstrated statistical significant difference. All arteries, except PHA, presented length equal to 3 cm. Conclusion: The IMA demonstrated the best compatibility with the RHA in terms of diameter and has shown sufficient length to be employed as interpositional graft. The PHA, the SA, the IEA and the LCFA presented statistically significant different diameters when compared to the RHA. Among these vessels, only the PHA did not show sufficient mean length

O diabetes mellitus tipo 2 (DM2), uma doença que afeta milhões de pessoas em todo o mundo, é marcado pela presença de complicações micro e macrovasculares, as quais estão associadas à disfunção endotelial, inflamação e fibrose. A aldosterona, cujos níveis plasmáticos estão elevados em pacientes e modelos experimentais de DM2, aumenta a geração de espécies reativas de oxigênio (ERO) e a expressão de marcadores inflamatórios. As citocinas IL-1? e IL-18 são liberadas principalmente após ativação de plataformas moleculares denominadas inflamassomas, as quais incluem os receptores NLRP3. Recentemente, demonstramos que o receptor NLRP3 contribui para a disfunção vascular induzida pela aldosterona. Considerando a existência de evidências que a aldosterona, via receptor mineralocorticoide (MR) e NLRP3, induz a produção de mediadores inflamatórios e, consequentemente, ativação do inflamassoma, podendo assim contribuir para o processo inflamatório no diabetes, nós hipotetizamos que o bloqueio de receptores MR e NLRP3 previne a ativação do inflamassoma e reduz o desenvolvimento das alterações vasculares funcionais associadas ao DM2. Observamos que artérias mesentéricas de animais diabéticos apresentam aumento da expressão/ativação de caspase-1 e IL-11?, aumento dos níveis plasmáticos de IL-1?, aumento da atividade da caspase- 1 em macrófagos do lavado peritoneal e prejuízo no relaxamento dependente de endotélio, comparativamente a artérias do grupo controle. Os tratamentos com espironolactona (antagonista MR) e MCC950 (inibidor de receptor NLRP3) atenuam a disfunção vascular, reduzem a expressão e a atividade da caspase-1 e diminuem os níveis plasmáticos de IL-1?. Células de músculo liso vascular e macrófagos derivados da medula estimulados com aldosterona também apresentam aumento da expressão dos componentes do inflamassoma, o que poderia contribuir para as alterações observadas em animais diabéticos. Pacientes com DM2 apresentam correlação positiva entre os níveis de aldosterona e de IL-1? e/ou glicemia. Em conclusão, nosso estudo demonstra que a aldosterona induz disfunção vascular e processo inflamatório no diabetes tipo 2 através da ativação de MR e do inflamassoma NLRP3. / Type 2 diabetes mellitus (T2DM), a disease that affects millions of people around the world, is marked by the presence of micro and macrovascular complications, which are associated with endothelial dysfunction, inflammation and fibrosis. Aldosterone excess aggravates endothelial dysfunction in diabetes by promoting insulin resistance, fibrosis, oxidative stress and inflammation. Aldosterone activates the molecular platform inflammasome in cells of the immune system, an event that contributes to vascular dysfunction induced by the mineralocorticoid hormone. However, it is unclear whether activation of the inflammasome contributes to the effects of aldosterone in diabetes-associated vascular abnormalities. In the present study we tested the hypothesis that aldosterone induces vascular dysfunction in T2DM via activation of mineralocorticoid receptors (MR) and assembly of the NLRP3 inflammasome. To determine whether aldosterone activates the NLRP3 inflammasome and NLRP3 activation contributes to diabetes-associated vascular dysfunction, mesenteric arteries from control mice (db/m) and mice with type 2 diabetes (db/db), treated with vehicle, spironolactone (MR antagonist) or the NLRP3 antagonist MCC950, were used. Db/db mice exhibited increased vascular expression/activation of caspase-1 and IL-1?, increased plasma IL-1? levels, increased number of caspase-1-positive macrophages in the peritoneal lavage as well as reduced acetylcholine (ACh) vasodilation, compared to control db/m mice. Treatment of db/db mice with spironolactone and MCC950 reduced vascular caspase-1, decreased plasma IL-1? levels and partly restored ACh responses. Spironolactone treatment also reduced the number of caspase-1-positive-macrophages in db/db mice. Vascular smooth muscle cells and bone marrow-derived macrophages stimulated with aldosterone also exhibited increased expression of inflammatory components, which may contribute to diabetes-associated vascular changes. Patients with T2DM exhibited a correlation between aldosterone and IL-1? levels and/or glycemia. In conclusion, our study demonstrates that aldosterone induces vascular dysfunction and inflammatory process in type 2 diabetes through MR receptor activation and NLRP3 inflammation.

A ouabaína (OUA) promoveu hipertensão arterial (HA) após 5, 10 e 20 semanas de tratamento e modificou a função vascular de artérias mesentéricas de resistência (AMR). O tratamento por 5 semanas com OUA aumentou o óxido nítrico (NO) e a expressão protéica da isoforma neuronal de óxido nítrico (nNOS), ao passo que diminuiu os prostanóides vasoconstritores. Além disso, reduziu a expressão protéica da Cu-Zn superóxido dismutase (SOD) e aumentou a atividade funcional da Na+K+-ATPase. Já o tratamento por 10 semanas com OUA aumentou NO e prostanóides vasodilatadores, enquanto diminuiu a expressão protéica da nNOS e da COX-2. O tratamento por 20 semanas reduziu o NO e a expressão protéica da nNOS. Porém, aumentou o ânion superóxido, o tromboxano A2 e a expressão protéica de ambas: a SOD e a COX-2. Em conclusão, o tratamento com OUA promoveu HA e alterações funcionais em AMR, sendo estas dependentes do tempo analisado, pois no tratamento durante 5 e 10 semanas estas alterações não contribuem para a manutenção da HA, enquanto que o tratamento durante 20 semanas contribui. / Ouabain treatment (OUA) developed hypertension after 5, 10 and 20 weeks and modified the vascular function in mesenteric resistance arteries (MRA). 5-weeks treatment with OUA increased nitric oxide (NO) and neuronal isoform of nitric oxide (nNOS) protein expression. On the other side, this treatment reduced vasoconstrictors prostanoids. Besides decreased Cu-Zn superoxide dismutase (SOD) protein expression and increased functional activity of Na+K+-ATPase. 10-weeks treatment enhance NO and vasodilators prostanoids but reduced both nNOS and COX-2 protein expression. 20-weeks treatment reduced NO and nNOS protein expression. Nevertheless increased anion superoxide, tromboxan A2 and both SOD and COX-2 protein expression. In conclusion, OUA treatment induced HA and functional alterations in MRA that are time-dependents, because in 5 and 10 weeks of treatment these alterations are not likely to maintenance of HA, but the changes observed in the treatment during 20 weeks contributes.

Uma elastase-2 foi recentemente descrita como a principal enzima formadora de angiotensina (Ang) II no perfusato do leito arterial mesentérico (LAM) isolado de rato. Investigamos a interação dessa elastase-2 do perfusato do LAM isolado de rato (E-2LAMR) com alguns substratos e inibidores de elastases-2 e de quimases formadoras de Ang II. Os precursores de Ang II, [Pro11-D-Ala12]-Ang I e substrato tetradecapeptídeo de renina (TDP), foram convertidos em Ang II pela E-2LAMR com eficiências catalíticas de 8,6 min-1mM-1 e 5,1 min-1mM-1, respectivamente, enquanto os substratos cromogênicos N-succinil-Ala-Ala-Pro-Leu-p-nitroanilida e N-succinil-Ala-Ala-Pro-Phe-p-nitroanilida foram hidrolisados pela enzima com eficiências catalíticas de 10,6 min-1mM-1 e 7,6 min-1mM-1, respectivamente. O inibidor peptídico CH 5450 inibiu as atividades da E-2LAMR sobre os substratos Ang I (IC50=49 mM) e N-succinil-Ala-Ala-Pro-Phe-p-nitroanilida (IC50=4,8 mM), enquanto Acetil-Ala-Ala-Pro-Leu-clorometilcetona (Ac-AAPL-CK), um efetivo inibidor de elastases-2 pancreáticas, bloqueou eficientemente a atividade formadora de Ang II da E-2LAMR (IC50=4,5 mM). Em conjunto, esses dados confirmaram e estenderam as similaridades enzimológicas entre elastases-2 pancreáticas e a E-2LAMR. Além disso, a interação até então desconhecida da E-2LAMR com [Pro11-D-Ala12]-Ang I e CH 5450, ambos considerados como reagentes seletivos para quimases, sugere que as evidências para a formação de Ang II in vivo por quimases podem ter sido superestimadas em investigações prévias sobre vias geradoras de Ang II. Experimentos realizados com o LAM isolado de rato analisando o efeito vasoconstritor de Ang II, Ang I, TDP e [Pro11-D-Ala12]-Ang I mostraram a existência de uma via geradora de Ang II independente da ECA, a qual é sensível à quimostatina e Ac-AAPL-CK. Entre os possíveis candidatos para essa via alternativa à ECA aparece a E-2LAMR, uma enzima que não é inibida por captopril e que é sensível à quimostatina e Ac-AAPL-CK. Embora quimases, que também são sensíveis à quimostatina, também possam ser candidatos a essa via independente da ECA, com base nos fatos de que a quimase I de rato tem uma atividade predominante de degradação da Ang II e que não existem relatos na literatura de que quimases sejam sensíveis ao inibidor Ac-AAPL-CK, esses dados em conjunto sugerem um possível papel para a E-2LAMR, mas não quimases, como uma via alternativa à ECA para a geração de Ang II no LAM isolado de rato. A clonagem e o seqüenciamento do cDNA para a E-2LAMR foram alcançados pela combinação de transcrição reversa e reação da polimerase em cadeia. A seqüência do cDNA mostrou-se idêntica à do cDNA para a elastase-2 pancreática de rato; o cDNA tem 909 nucleotídeos mais uma cauda poli (A) e codifica uma preproenzima de 271 amino ácidos. A análise dos supostos amino ácidos no sítio de ligação da Ang I revelou características que poderiam explicar a atividade do tipo carboxidipeptidase necessária para a eficiente conversão de Ang I em Ang II. Adicionalmente, a seqüência revela características estruturais que poderiam contribuir para a ausência de atividade dessa enzima sobre a Ang II. O RNAm para a E-2LAMR foi expresso em LAM, pâncreas, pulmão, coração, rim, fígado e baço, mas não em aorta de rato. Células endoteliais do LAM em cultura expressaram o RNAm para a E-2LAMR e sintetizaram a enzima. A localização intravascular dessa enzima e sua habilidade em formar Ang II e não clivar esse peptídeo indicam que ela poderia ter uma participação significativa como um agente formador de Ang II no sistema cardiovascular. Esses resultados também podem indicar que a E-2LAMR é expressa em vasos de resistência, mas não em vasos de condutância. / An elastase-2 has been recently described as the major angiotensin (Ang) II-forming enzyme of the rat mesenteric arterial bed (MAB) perfusate. Here, we have investigated the interaction of affinity-purified rat MAB elastase-2 with some substrates and inhibitors of both pancreatic elastases-2 and Ang II-forming chymases. The Ang II precursors [Pro11-D-Ala12]-Ang I and renin substrate tetradecaptide (TDP) were converted into Ang II by the rat MAB elastase-2 with catalytic efficiencies of 8.6 min-1mM-1 and 5.1 min-1mM-1, respectively, and the chromogenic substrates N-succinyl-Ala-Ala-Pro-Leu-p-nitroanilide and N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide were hydrolyzed by the enzyme with catalytic efficiencies of 10.6 min-1mM-1 and 7.6 min-1mM-1, respectively. The noncleavable peptide inhibitor CH 5450 inhibited the rat MAB elastase-2 activities toward the substrates Ang I (IC50=49 mM) and N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide (IC50=4.8 mM), whereas N-acetyl-Ala-Ala-Pro-Leu-chloromethylketone (Ac-AAPL-CK), an effective active site-directed inhibitor of pancreatic elastases-2, efficiently blocked the Ang II-generating activity of the rat MAB enzyme (IC50=4.5 mM). Altogether, these data confirm and extend the enzymological similarities between pancreatic elastases-2 and their rat MAB counterpart. Moreover, the thus far unrealized interaction of rat MAB elastase-2 with [Pro11-D-Ala12]-Ang I and CH 5450, both regarded as selective for chymases, suggests that evidence for the in vivo formation of Ang II by chymases may have been overestimated in previous investigations of Ang II-forming pathways. Experiments carried out in the isolated rat MAB analyzing the vasoconstrictor effect of Ang II, Ang I, TDP, and [Pro11-D-Ala12]-Ang I showed the existence of an ACE-independent pathway for Ang II generation, which is sensitive to chymostatin and Ac-AAPL-CK. Among the possible candidates for this ACE-independent pathway is rat MAB elastase-2, an enzyme that is not inhibited by captopril, and that is sensitive to chymostatin and Ac-AAPL-CK. Although chymases, which are also chymostatin-sensitive enzymes, might also be other possible candidates for this ACE-independent pathway, based on the fact that rat chymase I has a predominant Ang II-degrading activity, and because there are no reports in the literature that chymases are sensitive to Ac-AAPL-CK, altogether these data suggest a possible role for rat MAB elastase-2, but not chymases, as an alternative pathway to ACE for Ang II generation in the isolated rat MAB. The cloning and sequencing of the cDNA for the rat MAB elastase-2 was accomplished by reverse transcription-polymerase chain reaction. The sequence of this cDNA was found identical to the sequence of the rat pancreatic elastase-2; the cDNA is 909 nucleotides in length plus a poly (A) tail and encodes a preproenzyme of 271 amino acids. Analysis of the putative amino acids in the extended Ang I binding site of the rat MAB elastase-2 reveals features that could explain the dipeptidyl carboxypeptidase-like activity required for efficient Ang I to Ang II conversion. Additionally, the sequence reveals structural features that could contribute to the lack of activity of this enzyme toward Ang II. Rat MAB elastase-2 mRNA was expressed in rat mesenteric arteries, pancreas, lung, heart, kidney, liver, and spleen but not in aorta. Cultured mesenteric endothelial cells expressed the mRNA for rat MAB elastase-2 and synthesized the enzyme itself. The intravascular localization of this enzyme and its ability to generate Ang II and not destroy this peptide indicate that it might play a role in the rat cardiovascular system as an Ang II-forming agent. These results may also indicate that rat MAB elastase-2 is expressed in resistance vessels but not in conduit vessels.

Prior work using a contractility bioassay determined that the serotonin (5-HT) receptor subtype 5-HT2A is present in bovine lateral saphenous veins and plays a role in ergot alkaloid-induced vascular contraction in steers grazing endophyte-infected (Epichloë coenophiala) tall fescue (Lolium arundinaceum). A study was conducted to determine what 5-HT receptors are involved in vasoconstriction of bovine gut vasculature. The findings of this study indicate that 5-HT2A is present and may play a role in ergot alkaloid induced vasoconstriction. A second study was conducted to determine if ergot alkaloids were transported in the small intestine. The active transporter, peptide transporter 1 (PepT1), was evaluated for its role in the transport of various concentrations of ergot alkaloids across Caco-2 cell monolayers. Results indicate that CEPH, ERT, EXT, and LSA do move across Caco-2 cell monolayers, but appear to utilize PepT1 at larger concentrations. Overall, the demonstrated presence of 5-HT2A receptors in the bovine gut vasculature established a potential for vascular interference by ergot alkaloids entering the bloodstream through transepithelial absorption.

<p>Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods. </p><p>Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease.</p><p>Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor.</p><p>A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions.</p><p>Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated from clinical series. The patients were often nursed in non-surgical wards.</p>

<p>One of the main obstacles to maintaining patients with short bowel syndrome on parenteral nutrition, or successfully transplanting these patients with a small bowel graft, is the many severe infections that occur. Evidence is accumulating that translocating bacteria from the patient’s bowel causes a significant part of these infections. In this thesis bacterial translocation is studied in a Thiry-Vella loop of defunctionalised small bowel in the rat. </p><p>Bacterial translocation to the mesenteric lymph nodes (MLNs) occurs in almost 100% of the rats after three days. No systemic spread of bacteria is observed unless there is additional immunosupression with depletion of Kupffer cells in the liver. However, blocking the function of α/β T cells does not increase the translocation. Removal of MLNs does not either aggravate bacterial translocation in the Thiry-Vella loop model. Conversely, after small bowel transplantation translocating bacteria spread systemically if the MLNs are removed. </p><p>The Thiry-Vella loop should also be a suitable model for the testing of potentially translocation-inhibiting substances. Reinforcement of the intestinal barrier with glutamine or phosphatidylcholine proved insufficient in decreasing bacterial translocation. Even selective bowel decontamination with tobramycin failed to abolish bacterial translocation. Thus, it seems that the driving force for translocation in this model is strong regardless of the relatively small trauma of intestinal defunctionalisation.</p><p>Flow cytometric studies of the immune cells in the spleen MLNs showed a decrease in MHC class II positive T cells in the MLNs of the Thiry-Vella loop. Concurrently the number of macrophages increased with time as observed by immunohistochemistry. The fraction of MHC class II negative macrophages increased in the spleens of rats treated with glutamine. </p><p>In conclusion, the Thiry-Vella loop model offers possibilities of immunological as well as mechanistic studies on bacterial translocation from small intestine.</p>