BJA Advance Access originally published online on October 14, 2005
British Journal of Anaesthesia 2005 95(6):737-745; doi:10.1093/bja/aei255
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CARDIOVASCULAR |
Effects of prophylactic or therapeutic application of bovine haemoglobin HBOC-200 on ischaemia–reperfusion injury following acute coronary ligature in rats
Department of Anaesthesia, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
* Corresponding author. E-mail: burmeister{at}uke.uni-hamburg.de
Background. Haemoglobin-based oxygen carriers (HBOCs) are assessed as blood substitutes in patients with perioperative anaemia including patients at risk for perioperative cardiac ischaemia. There is controversy as to whether HBOCs are beneficial or deleterious during ischaemia–reperfusion (I–R). Therefore the effects of HBOC-200 on I–R injury were evaluated in a randomized placebo-controlled animal trial.
Methods. Animals were randomized to receive either placebo i.v. without I–R (sham group, n=9), placebo i.v. with I–R (control group, n=10), HBOC-200 0.4 g kg–1 i.v. prior to I–R (prophylaxis group, n=12) or HBOC-200 0.4 g kg–1 i.v. during I–R (therapy group, n=15). I–R consisted of 25 min of acute ligature of the left coronary artery followed by 120 min of reperfusion. Measurements included assessment of the area at risk and infarct size using triphenyl tetrazolium chloride (TTC) stain, DNA single-strand breaks (in situ nick translation with autoradiography/densitometry) and cardiac arrhythmias.
Results. Infarct size within the area at risk was 62 (SD 15)% (control), 46 (10)% (prophylaxis, P<0.025 vs control) and 61 (9)% (therapy, P<0.85 vs control). The frequency of DNA single-strand breaks was reduced vs control in the sham (P<0.01) and prophylaxis (P<0.04) groups and was almost the same in the therapy group (P<0.75). The severity of cardiac arrhythmias during ischaemia was lower compared with control in the sham (P<0.001) and prophylaxis (P<0.039) groups, but there was no difference in the therapy group.
Conclusion. This study demonstrates that neither prophylactic nor therapeutic application of the cell-free haemoglobin solution HBOC-200 aggravates cardiac I–R injury. Furthermore, the prophylactic approach may offer a new opportunity for pretreatment of patients at risk for perioperative ischaemic cardiac events.
The results were presented in part at the Congress of the European Society of Anaesthesia, Glasgow, UK, June 2003 (‘Best Abstract Award’), and at the Annual Meeting of the American Society of Anesthesiologists, San Francisco, CA, USA, October 2003.
Declaration of interest. T. G. Standl has received lecture honoraria and travel fees from Biopure Corporation, Boston, MA, the manufacturer of HBOC. The Department of Anaesthesiology, University Hospital, Hamburg-Eppendorf, received restricted grants from Biopure Corporation, Boston, MA, between 1994 and 1998 for animal and clinical phase II and III trials. M.A. Burmeister is Vice President Research and Development, Hospital Care Division, B. Braun Melsungen AG, Melsungen, Germany. B. Braun, a global health care supplier, cooperated with Biopure Corporation, Boston, MA, on HBOC development until 1996. The work presented in this paper was done independently of and without any support from B. Braun.