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Am J Physiol Heart Circ Physiol 281: H84-H92, 2001;
0363-6135/01 $5.00
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Vol. 281, Issue 1, H84-H92, July 2001

Hemorrhage-induced alpha -adrenergic signaling results in myocardial TNF-alpha expression and contractile dysfunction

Rohan Shahani, Lazar V. Klein, John G. Marshall, Sherwin Nicholson, Barry B. Rubin, Paul M. Walker, and Thomas F. Lindsay

Division of Vascular Surgery, University Health Network and Department of Surgery, University of Toronto, Toronto, Ontario, Canada M5G 2C4

Hemorrhagic shock (HS), secondary to major blood loss, frequently precedes multiple organ dysfunction and is accompanied by a surge in circulating catecholamine levels. Expression of the cardiodepressant cytokine, tumor necrosis factor-alpha (TNF-alpha ), has been observed in the heart after HS and resuscitation (HS/R) and alpha 1-adrenergic blockade prevented translocation of the nuclear transcription factor, NF-kappa B, to the nucleus. We hypothesized that alpha 1-adrenergic stimulation induces myocardial TNF-alpha expression, which results in depressed cardiac function after HS/R. The role of alpha 1-adrenergic stimulation in myocardial TNF-alpha expression and depressed cardiac function after HS/R was assessed by treatment with the alpha 1-adrenergic inhibitor, prazosin hydrochloride (1 mg/kg ip), for 1 h before the onset of hemorrhage. In addition, TNF-alpha was neutralized with a specific antibody (600 µl/kg iv) 5 min before hemorrhage. HS was induced by the withdrawal of blood to a mean blood pressure of 50 mmHg for 1 h. Contractile function was measured with the use of a Langendorff apparatus 2 h after the end of HS. HS/R led to significant decreases in left ventricular developed tension and in the maximal rate of pressure increase over time during both contraction and relaxation. Myocardial expression of TNF-alpha measured by enzyme-linked immunosorbent assay increased significantly after 30 min of hemorrhage and peaked after 60 min of HS and 45 min of resuscitation. Depression in cardiac function after HS/R was reversed by 85% in hearts from rats treated with a TNF-alpha neutralizing antibody and by 90% in hearts from rats treated with prazosin hydrochloride. We conclude that HS activates a alpha 1-adrenergic pathway, resulting in TNF-alpha expression in the heart and depressed myocardial contractile function.

hemorrhagic shock; left ventricular function; cytokines; adrenergic stimulation; tumor necrosis factor-alpha


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