Levosimendan: Studies on its mechanisms of action and beyond

Acute heart failure syndrome represents a prominent and growing health problem all around the world. Ideally, medical treatment for patients admitted to hospital because of this syndrome, in addition to alleviating the acute symptoms, should also prevent myocardial damage, modulate neurohumoral and inflammatory activation, and preserve or even improve renal function. Levosimendan is a cardiac enhancer having both inotropic and vasodilatory effects. It is approved for the short-term treatment of acutely decompensated chronic heart failure, but it has been shown to have beneficial clinical effects also in ischemic heart disease and septic shock as well as in perioperative cardiac support. In the present study, the mechanisms of action of levosimendan were studied in isolated guinea-pig heart preparations: Langendorff-perfused heart, papillary muscle and permeabilized cardiomyocytes as well as in purified phosphodiesterase isoenzyme preparations. Levosimendan was shown to be a potent inotropic agent in isolated Langendorff-perfused heart and right ventricle papillary muscle. In permeabilized cardiomyocytes, it was demonstrated to be a potent calcium sensitizer in contrast to its enantiomer, dextrosimendan. It was additionally shown to be a very selective phosphodiesterase (PDE) type-3 inhibitor, the selectivity factor for PDE3 over PDE4 being 10000 for levosimendan. Irrespective of this very selective PDE3 inhibitory property in purified enzyme preparations, the inotropic effect of levosimendan was demonstrated to be mediated mainly through calcium sensitization in the isolated heart as well as the papillary muscle preparations at clinically relevant concentrations. In the isolated Lagendorff-perfused heart, glibenclamide antagonized the levosimendan-induced increase in coronary flow (CF). Therefore, the main vasodilatory mechanism in coronary veins is believed to be the opening of the ATP-sensitive potassium (KATP) channels. In the paced hearts, CF did not increase in parallel with oxygen consumption (MVO2), thus indicating that levosimendan had a direct vasodilatory effect on coronary veins. The pharmacology of levosimendan was clearly different from that of milrinone, which induced an increase in CF in parallel with MVO2. In conclusion, levosimendan was demonstrated to increase cardiac contractility by binding to cardiac troponin C and sensitizing the myofilament contractile proteins to calcium, and further to induce coronary vasodilatation by opening KATP channels in vascular smooth muscle. In addition, the efficiency of the cardiac contraction was shown to be more advantageous when the heart was perfused with levosimendan in comparison to milrinone perfusion.

Ammonia emissions from pig and cattle slurry in the field and utilization of slurry nitrogen in crop production

Volatilization of ammonia (NH3) from animal manure is a major pathway for nitrogen (N) losses that cause eutrophication, acidification, and other environmental hazards. In this study, the effect of alternative techniques of manure treatment (aeration, separation, addition of peat) and application (broadcast spreading, band spreading, injection, incorporation by harrowing) on ammonia emissions in the field and on nitrogen uptake by ley or cereals was studied. The effect of a mixture of slurry and peat on soil properties was also investigated. The aim of this study was to find ways to improve the utilization of manure nitrogen and reduce its release to the environment. Injection into the soil or incorporation by harrowing clearly reduced ammonia volatilization from slurry more than did the surface application onto a smaller area by band spreading or reduction of the dry matter of slurry by aeration or separation. Surface application showed low ammonia volatilization, when pig slurry was applied to tilled bare clay soil or to spring wheat stands in early growth stages. Apparently, the properties of both slurry and soil enabled the rapid infiltration and absorption of slurry and its ammoniacal nitrogen by the soil. On ley, however, surface-applied cattle slurry lost about half of its ammoniacal nitrogen. The volatilization of ammonia from surface-applied peat manure was slow, but proceeded over a long period of time. After rain or irrigation, the peat manure layer on the soil surface retarded evaporation. Incorporation was less important for the fertilizer effect of peat manure than for pig slurry, but both manures were more effective when incorporated. Peat manure applications increase soil organic matter content and aggregate stability. Stubble mulch tillage hastens the effect in surface soil compared with ploughing. The apparent recovery of ammoniacal manure nitrogen in crop yield was higher with injection and incorporation than with surface applications. This was the case for leys as well as for spring cereals, even though ammonia losses from manures applied to cereals were relatively low with surface applications as well. The ammoniacal nitrogen of surface-applied slurry was obviously adsorbed by the very surface soil and remained mostly unavailable to plant roots in the dry soil. Supplementing manures with inorganic fertilizer nitrogen, which adds plant-available nitrogen to the soil at the start of growth, increased the overall recovery of applied nitrogen in crop yields.