Ischemic preconditioning attenuates portal venous plasma concentrations of purines following warm liver ischemia in man
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vor 19 Jahren
Background/Aims: Degradation of adenine nucleotides to adenosine
has been suggested to play a critical role in ischemic
preconditioning (IPC). Thus, we questioned in patients undergoing
partial hepatectomy whether (i) IPC will increase plasma purine
catabolites and whether (ii) formation of purines in response to
vascular clamping (Pringle maneuver) can be attenuated by prior
IPC. Methods: 75 patients were randomly assigned to three groups:
group I underwent hepatectomy without vascular clamping; group II
was subjected to the Pringle maneuver during resection, and group
III was preconditioned (10 min ischemia and 10 min reperfusion)
prior to the Pringle maneuver for resection. Central, portal venous
and arterial plasma concentrations of adenosine, inosine,
hypoxanthine and xanthine were determined by high-performance
liquid chromatography. Results: Duration of the Pringle maneuver
did not differ between patients with or without IPC. Surgery
without vascular clamping had only a minor effect on plasma purine
transiently increased. After the Pringle maneuver alone, purine
plasma concentrations were most increased. This strong rise in
plasma purines caused by the Pringle maneuver, however, was
significantly attenuated by IPC. When portal venous minus arterial
concentration difference was calculated for inosine or
hypoxanthine, the respective differences became positive in
patients subjected to the Pringle maneuver and were completely
prevented by preconditioning. Conclusion: These data demonstrate
that (i) IPC increases formation of adenosine, and that (ii) the
unwanted degradation of adenine nucleotides to purines caused by
the Pringle maneuver can be attenuated by IPC. Because IPC also
induces a decrease of portal venous minus arterial purine plasma
concentration differences, IPC might possibly decrease disturbances
in the energy metabolism in the intestine as well. Copyright (C)
2005 S. Karger AG, Basel.
has been suggested to play a critical role in ischemic
preconditioning (IPC). Thus, we questioned in patients undergoing
partial hepatectomy whether (i) IPC will increase plasma purine
catabolites and whether (ii) formation of purines in response to
vascular clamping (Pringle maneuver) can be attenuated by prior
IPC. Methods: 75 patients were randomly assigned to three groups:
group I underwent hepatectomy without vascular clamping; group II
was subjected to the Pringle maneuver during resection, and group
III was preconditioned (10 min ischemia and 10 min reperfusion)
prior to the Pringle maneuver for resection. Central, portal venous
and arterial plasma concentrations of adenosine, inosine,
hypoxanthine and xanthine were determined by high-performance
liquid chromatography. Results: Duration of the Pringle maneuver
did not differ between patients with or without IPC. Surgery
without vascular clamping had only a minor effect on plasma purine
transiently increased. After the Pringle maneuver alone, purine
plasma concentrations were most increased. This strong rise in
plasma purines caused by the Pringle maneuver, however, was
significantly attenuated by IPC. When portal venous minus arterial
concentration difference was calculated for inosine or
hypoxanthine, the respective differences became positive in
patients subjected to the Pringle maneuver and were completely
prevented by preconditioning. Conclusion: These data demonstrate
that (i) IPC increases formation of adenosine, and that (ii) the
unwanted degradation of adenine nucleotides to purines caused by
the Pringle maneuver can be attenuated by IPC. Because IPC also
induces a decrease of portal venous minus arterial purine plasma
concentration differences, IPC might possibly decrease disturbances
in the energy metabolism in the intestine as well. Copyright (C)
2005 S. Karger AG, Basel.
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