Hydrogen peroxide pretreatment of perfused canine vessels induces ICAM-1 and CD18-dependent neutrophil adherence

Background. Cytotoxic products of neutrophils (polymorphonuclear leukocytes, PMNs) contribute to ischemia-reperfusion injury of several tissues. Hydrogen peroxide (H2O2), one of the cytotoxic products of PMNs, also promotes the adherence of PMNs to cultured vascular endothelial cells in vitro. The present study was undertaken to determine if H2O2 also augmented adhesion of PMNs to intact vessels perfused ex vivo and to determine if H2O2-induced PMN adherence to intact canine carotid arteries and external jugular veins or to cultured canine venous endothelium is mediated by specific adherence ligands on the neutrophil and/or the endothelium. Methods and Results. Vessels were perfused for 20 minutes with oxygenated Krebs-Henseleit bicarbonate buffer with and without H2O2, washed with buffer alone, and then exposed to 111In-labeled isolated PMNs (107 cells/vessel) under static conditions for up to 20 minutes before being washed again. Residual radioactivity retained by the washed vessel was counted as an index of PMN retention. The adherence of unlabeled PMNs to cultured endothelial cells was determined by a visual assay method after pretreatment of the endothelium with H2O2 for brief periods followed by washing. Perfusion of vessels with H2O2 produced a transient, concentration-dependent increase in PMN adhesion to both canine carotid arteries and external jugular veins that was two to four times that of control values at 1 mmol/l and declined at higher H2O2 concentrations. Peak retention of PMNs by canine carotid arteries occurred 10 minutes after exposure to 1 mmol/l H2O2 and then rapidly declined to control values; this effect was replicated by a second 20-minute exposure of canine carotid arteries to 1 mmol/l H2O2 60 minutes after the first exposure. Scanning and transmission electron microscopy revealed not only adherence of PMNs to but migration through the vascular endothelium of the carotid artery after H2O2 perfusion. The endothelium was intact in H2O2-treated arteries not exposed to PMNs. H2O2-induced PMN retention was completely inhibited by addition of catalase or the hydroxyl radical scavenger dimethylthiourea to the perfusate by incubation of the PMN with a monoclonal antibody (Mab) against CD18 (R15.7) or by perfusion of the H22O2-treated vessel with CE18/6, a Mab against canine ICAM-1 (intercellular adhesion molecule-1). Similar effects of Mabs on PMN adhesion to H2O2-pretreated cultured endothelium were noted. The retention of PMNs by vessels mechanically denuded of endothelial cells was markedly increased. H2O2 pretreatment of these vessels did not further augment PMN adherence, and no inhibitory effect of R15.7 was noted. Incubation of carotid arteries and PMNs with a specific platelet-activating factor antagonist, WEB2086, completely inhibited the H2O2-induced increased PMN retention by these vessels. Conclusions. These results indicate that H2O2, in the absence of evidence for permanent endothelial cell injury, can induce a transient, reversible, platelet-activating factor-dependent adherence of PMNs to vessels by mechanisms that depend on an intact endothelium and involve CD18 on the PMN and ICAM-1 on the endothelium

Acceptability of geothermal installations: A geoethical concept for GeoLaB

International audienceThe growing demand for energy, natural resources and urban expansion during the last two centuries increased human interference with the geosphere far beyond geothermal usage. The increasing number of large-scale projects intervening the area of life of communities raised public concerns related to their environmental and social impact. Integration of public concerns into such projects should therefore go beyond outreach and communication measures. It requires an open approach to inclusive governance structures with respect to designing research and development processes and to modify technological options. Geoethical concepts emphasize that geoscientific knowledge may assist society in decision making as well as in dealing with risks, user conflicts and environmental threats on local, regional and global scale in order to support more sustainable practices at the intersection of human beings and the geosphere.In the present article, we analyse the social response to recent geothermal development and identify the precondition for public acceptability of geothermal projects. On this basis, the potential contribution of a GeoLaB, a Geothermal Laboratory in the crystalline Basement, to a geoethic approach in geothermal research and technology development is discussed. The underground research laboratory is planned as an infrastructure to answer scientific challenges and to offer the necessary transparency to interact with the public. The GeoLaB approach aims on transparent, tangible science and can serve to enhance mutual understanding of stakeholder groups. It may increase public awareness on geothermal research and potentially enhance the opportunity for public approval of planned activities. As a generic site, GeoLaB can develop scientific-technological solutions for a responsible exploitation of geothermal energy accompanied by sociological studies. The underground research laboratory will serve as a platform for science communication, participation and dialogue of stakeholders from industry, politics, administration and society. This complies with the comprehension of responsible research in a geoethical sense

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)