11-Oxoaerothionin isolated from the marine sponge Aplysina fistularis shows anti-inflammatory activity in LPS-stimulated macrophages

Marine sponges of the order Verongida are a rich source of biologically active bromotyrosine-derived secondary metabolites. However, none of these compounds are known to display anti-inflammatory activity. In the present investigation, we report the anti-inflammatory effects of 11-oxoaerothionin isolated from the Verongida sponge Aplysina fistularis. When RAW264.7 cells and primary macrophages were preincubated with 11-oxoaerothionin and stimulated with LPS (lipopolysaccharide), a concentration-dependent inhibition of iNOS (inducible nitric oxide synthase) protein and NO2- (Nitrite) production were observed. The same effect was observed when proinflammatory cytokines and PGE(2) (Prostaglandin E2) production was evaluated. In summary, we demonstrated that in the presence of LPS, 11-oxoaerothionin suppresses NO2 and iNOS expression as well as inflammatory cytokines and PGE(2).

PTEN Directly Activates the Actin Depolymerization Factor Cofilin-1 During PGE(2)-Mediated Inhibition of Phagocytosis of Fungi

Macrophage ingestion of the yeast Candida albicans requires its recognition by multiple receptors and the activation of diverse signaling programs. Synthesis of the lipid mediator prostaglandin E-2 (PGE(2)) and generation of cyclic adenosine monophosphate (cAMP) also accompany this process. Here, we characterized the mechanisms underlying PGE(2)-mediated inhibition of phagocytosis and filamentous actin (F-actin) polymerization in response to ingestion of C. albicans by alveolar macrophages. PGE(2) suppressed phagocytosis and F-actin formation through the PGE(2) receptors EP2 and EP4, cAMP, and activation of types I and II protein kinase A. Dephosphorylation and activation of the actin depolymerizing factor cofilin-1 were necessary for these inhibitory effects of PGE(2). PGE(2)-dependent activation of cofilin-1 was mediated by the protein phosphatase activity of PTEN (phosphatase and tensin homolog deleted on chromosome 10), with which it directly associated. Because enhanced production of PGE(2) accompanies many immunosuppressed states, the PTEN-dependent pathway described here may contribute to impaired antifungal defenses.

Temporal relationships of a pulse of prolactin (PRL) to a pulse of a metabolite of PGF2 alpha in mares

Hourly blood samples were collected from 10 mares during 24 h of each of the preluteolytic, luteolytic, and postluteolytic periods. The autocorrelation function of the R program was used to detect pulse rhythmicity, and the intra-assay CV was used to locate and characterize pulses of prolactin (PRL) and a metabolite of prostaglandin F2 alpha (PGFM). Rhythmicity of PRL and PGFM concentrations was detected in 67% and 89% of mares, respectively. Combined for the three periods (no difference among periods), the PRL pulses were 5.2 +/- 0.4 h (mean +/- SEM) at the base, 7.5 +/- 1.5 h between nadirs of adjacent pulses, and 12.3 +/- 1.5 h from peak to peak. The peaks of PRL pulses were greater (P < 0.05) during the luteolytic period (46 +/- 14 ng/mL) and postluteolytic period (52 15 ng/mL) than during the preluteolytic period (17 3 ng/mL). Concentrations of PRL during hours of a PGFM pulse were different (P < 0.003) within the luteolytic period and postluteolytic period and were greatest at the PGFM peak; PRL concentrations during a PGFM pulse were not different during the preluteolytic period. The frequency of the peak of PRL and PGFM pulses occurring at the same hour (synchrony) was greater for the luteolytic period (65%, P < 0.01) and postluteolytic period (50%, P < 0.001) than for the preluteolytic period (17%). This is the first report in mares on characterization and rhythmicity of PRL pulses, synchrony between PRL and PGFM pulses, and greater PRL activity during the luteolytic and postluteolytic periods than during the preluteolytic period. (C) 2012 Elsevier Inc. All rights reserved.

Platelet-activating factor receptor (PAF-R)-dependent pathways control tumour growth and tumour response to chemotherapy

Abstract Background Phagocytosis of apoptotic cells by macrophages induces a suppressor phenotype. Previous data from our group suggested that this occurs via Platelet-activating factor receptor (PAF-R)-mediated pathways. In the present study, we investigated the impact of apoptotic cell inoculation or induction by a chemotherapeutic agent (dacarbazine, DTIC) on tumour growth, microenvironmental parameters and survival, and the effect of treatment with a PAF-R antagonist (WEB2170). These studies were performed in murine tumours: Ehrlich Ascitis Tumour (EAT) and B16F10 melanoma. Methods Tumour growth was assessed by direct counting of EAT cells in the ascitis or by measuring the volume of the solid tumour. Parameters of the tumour microenvironment, such as the frequency of cells expressing cyclo-oxygenase-2 (COX-2), caspase-3 and galectin-3, and microvascular density, were determined by immunohistochemistry. Levels of vascular endothelium growth factor (VEGF) and prostaglandin E2 (PGE2) were determined by ELISA, and levels of nitric oxide (NO) by Griess reaction. PAF-R expression was analysed by immunohistochemistry and flow cytometry. Results Inoculation of apoptotic cells before EAT implantation stimulated tumour growth. This effect was reversed by in vivo pre-treatment with WEB2170. This treatment also reduced tumour growth and modified the microenvironment by reducing PGE2, VEGF and NO production. In B16F10 melanoma, WEB2170 alone or in association with DTIC significantly reduced tumour volume. Survival of the tumour-bearing mice was not affected by WEB2170 treatment but was significantly improved by the combination of DTIC with WEB2170. Tumour microenvironment elements were among the targets of the combination therapy since the relative frequency of COX-2 and galectin-3 positive cells and the microvascular density within the tumour mass were significantly reduced by treatment with WEB2170 or DTIC alone or in combination. Antibodies to PAF-R stained the cells from inside the tumour, but not the tumour cells grown in vitro. At the tissue level, a few cells (probably macrophages) stained positively with antibodies to PAF-R. Conclusions We suggest that PAF-R-dependent pathways are activated during experimental tumour growth, modifying the microenvironment and the phenotype of the tumour macrophages in such a way as to favour tumour growth. Combination therapy with a PAF-R antagonist and a chemotherapeutic drug may represent a new and promising strategy for the treatment of some tumours.

Activation of PAF-receptor induces regulatory dendritic cells through PGE2 and IL-10

Activation of the platelet-activating factor receptor (PAFR) in macrophages is associated with suppressor phenotype. Here, we investigated the PAFR in murine dendritic cells (DC). Bone marrow-derived dendritic cells (BALB/c) were cultured with GM-CSF and maturation was induced by LPS. The PAFR antagonists (WEB2086, WEB2170, PCA4248) and the prostaglandin (PG) synthesis inhibitors (indomethacin, nimesulide and NS-398) were added before LPS. Mature and immature DCs expressed PAFR. LPS increased MHCII, CD40, CD80, CD86, CCR7 and induced IL-10, IL-12, COX-2 and PGE2 expression. IL-10, COX-2 and PGE2 levels were reduced by PAFR antagonists and increased by cPAF. The IL-10 production was independent of PGs. Mature DCs induced antigen-specific lymphocyte proliferation. PAFR antagonists or PG-synthesis inhibitors significantly increased lymphocyte proliferation. It is proposed that PAF has a central role in regulatory DC differentiation through potentiation of IL-10 and PGE2 production.

Formaldehyde inhalation reduces respiratory mechanics in a rat model with allergic lung inflammation by altering the nitric oxide/cyclooxygenase-derived products relationship

Bronchial hyperresponsiveness is a hallmark of asthma and many factors modulate bronchoconstriction episodes. A potential correlation of formaldehyde (FA) inhalation and asthma has been observed; however, the exact role of FA remains controversial. We investigated the effects of FA inhalation on Ovalbumin (OVA) sensitisation using a parameter of respiratory mechanics. The involvement of nitric oxide (NO) and cyclooxygenase-derived products were also evaluated. The rats were submitted, or not, to FA inhalation (1%, 90 min/day, 3 days) and were OVA-sensitised and challenged 14 days later. Our data showed that previous FA exposure in allergic rats reduced bronchial responsiveness, respiratory resistance (Rrs) and elastance (Ers) to methacholine. FA exposure in allergic rats also increased the iNOS gene expression and reduced COX-1. L-NAME treatment exacerbated the bronchial hyporesponsiveness and did not modify the Ers and Rrs, while Indomethacin partially reversed all of the parameters studied. The L-NAME and Indomethacin treatments reduced leukotriene B4 levels while they increased thromboxane B2 and prostaglandin E2. In conclusion, FA exposure prior to OVA sensitisation reduces the respiratory mechanics and the interaction of NO and PGE2 may be representing a compensatory mechanism in order to protect the lung from bronchoconstriction effects.

Efeitos da Prostaglandina E1 na gênese de capilares sanguíneos em músculo esquelético isquêmico de ratos: estudo histológico e ultra-estrutural

Objetivo: o objetivo deste trabalho foi estudar os aspectos morfológicos e ultra-estruturais na gênese de capilares sanguíneos em músculo esquelético do membro caudal de ratos submetidos à isquemia sob a ação da Prostaglandina E1 (PGE1), administrada por via intramuscular ou endovenosa. Métodos: foram utilizados 60 ratos (Rattus norvegicus albinus), linhagem Wistar-UEM, distribuídos aleatoriamente em três grupos de 20, redistribuídos igualmente em dois subgrupos, observados no 7o e 14o dias, sendo um grupo controle onde apenas foi provocada a isquemia no membro, outro com a isquemia e a injeção da PGE1 via intramuscular (IM), e outro com a isquemia e a injeção da PGE1 endovenosa (EV). Para análise dos resultados, foram realizadas a coloração com hematoxilina & eosina (HE), a imuno-histoquímica e a microscopia eletrônica de transmissão (MET). Resultados: constatou-se um aumento estatisticamente significante no número de capilares nos subgrupos com o uso da PGE1 IM e EV, através da contagem nos cortes corados com HE. Houve marcação de capilares e vasos de maior calibre nestes mesmos subgrupos, porém, esta reação não foi eficiente para a quantificação dos capilares. Na MET encontraram-se evidências de formação de novos capilares. Conclusões: a PGE1, administrada por via IM ou EV, promoveu, após 14 dias de observação, um aumento no número de capilares no músculo esquelético de ratos submetido à isquemia, identificáveis histologicamente com a coloração em HE. Na análise ultra-estrutural encontraram-se alterações que sugerem, nos animais sob a ação da PGE1, que a neoformação vascular possa ter ocorrido por angiogênese e vasculogênese. A imuno-coloração, apesar da marcação de capilares e vasos maiores, não permitiu estabelecer uma correlação com o aumento de vasos encontrados na coloração com HE.

Die Regulation des Interleukin-12 p40 Promotors in Monozyten und Makrophagen

Interleukin-12 ist ein Schlüsselregulator zellvermittelter Immunantworten. In der vorliegenden Dissertation wurde die Regulation des IL-12 p40 Promotors in Monozyten und Makrophagen untersucht. Mit Hilfe von 'In Vivo Footprinting'-, Bandshift- und Transfektionsexperimenten konnte eine wichtige Funktion der Transkriptionsfaktoren NF-kappaB, C/EBP-beta und PU.1 bei der Aktivierung des Promotors gezeigt werden. 'In Vivo Footprinting'-Experimente führten auch zur Identifikation eines bisher nicht beschriebenen regulatorischen Elementes im IL-12 p40 Promotor. Dieses GA-12 genannte Motiv war in unstimulierten primären Monozyten protektiert, nicht jedoch in Zellen, die mit LPS oder LPS/ Interferon-gamma stimuliert wurden. Eine genauere Charakterisierung ergab, daß dieses Motiv eine repressorische Funktion auf den Promotor ausübt und in unstimulierten, nicht jedoch in stimulierten Monozyten und Makrophagen von einem spezifischen GATA-ähnlichen Komplex (GAP-12) erkannt wird. Zudem führte die Behandlung von Monozyten mit Interleukin-4 und Prostaglandin-E2, Inhibitoren der IL-12 Produktion, zu einer Verstärkung der Komplexbildung am GA-12 Motiv. Zur Analyse der Promotorregulation im nukleosomalen Umfeld wurden außerdem IL-12 p40 Promotor/ Luziferase transgene Mäuse hergestellt. Die Analyse dieser Mäuse zeigte, daß der proximale Promotor ausreichend Sequenzinformation beinhaltet, um in vivo die stimulations- und gewebespezifische Regulation des Gens zu gewährleisten. Anhand der erhobenen Daten konnte ein Modell der Regulation des IL-12 p40 Promotors in Monozyten und Makrophagen entworfen werden.

Untersuchung der zellulären Antwort von Tumor und Endothelium auf radioaktive Bestrahlung in vitro und in vivo

Tumore des Kopf-Hals Bereiches sprechen aufgrund schneller Resistenzbildung häufig schlecht auf die derzeit praktizierten Bestrahlungstherapien an. Der Erfolg dieser Behandlung wird dabei maßgeblich durch die Strahlenresistenz des malignen Gewebes limitiert. Das Verständnis der zugrunde liegenden zellulären und molekularen Mechanismen ist diesbezüglich unvollständig. Die Resistenzzunahme während der klinischen Behandlung könnte durch die Selektion strahlenresistenter Einzelzellen verursacht werden oder durch die Aktivierung von Resistenzmechanismen. Im Rahmen dieser Arbeit wurde die bestrahlungsvermittelte Freisetzung möglicherweise protektiv wirkender Faktoren durch Tumorzelllinien des Kopf-Hals Bereiches untersucht. Durch Bestrahlung erfolgte eine Induktion von VEGF (vascular endothelial growth factor) und FGF-2 (fibroblast growth factor 2), IL-8 (Interleukin-8) und PGE2 (Prostaglandin E2). Die Untersuchung von VEGF und FGF-2 zeigte weiterhin ein zytoprotektives Potential dieser Faktoren, d.h. die T

Entwicklung und Optimierung eines Mikroarray zur Erfassung der genetischen Prädisposition von Atherosklerose

Die Entstehung der Atherosklerose ist ein komplexer Vorgang, der sich durch Ablagerung von Lipiden an der Gefäßwand sowie durch immunologische und inflammatorische Prozesse auszeichnet. Neben konventionellen Risikofaktoren wie Alter, Geschlecht, Rauchen, HDL-Cholesterin, Diabetes mellitus und einer positiven Familienanamnese werden zur Bestimmung des atherosklerotischen Risikos neue Biomarker der inflammatorischen Reaktion untersucht. Ziel dieser Arbeit war die Entwicklung einer Methode zur Diagnostik des Atheroskleroserisikos. Es wurde eine neuartige Chip-Technologie eingesetzt, um das Risiko für eine potentiell drohende atherosklerotische Erkrankung abzuschätzen. Dabei wurde ausgenutzt, dass molekulare Veränderungen in Genen bestimmte Krankheitsbilder auslösen können. rnEs wurde ein molekularbiologischer Test entwickelt, welcher die Untersuchung von genetischen Variationen aus genomischer DNA ermöglicht. Dafür fand die Entwicklung einer Multiplex-PCR statt, deren Produkt mit der Chip-Technologie untersucht werden kann. Dazu wurden auf einem Mikroarray Sonden immobilisiert, mit deren Hilfe genspezifische Mutationen nachgewiesen werden können. So wurden mehrere Gene mit einem geringen Aufwand gleichzeitig getestet. rnDie Auswahl der entsprechenden Marker erfolgte anhand einer Literaturrecherche von randomisierten und kontrollierten klinischen Studien. Der Mikroarray konnte für zwölf Variationen in den acht Genen Prostaglandinsynthase-1 (PTGS1), Endotheliale NO-Synthase (eNOS), Faktor V (F5), 5,10-Methylentetrahydrofolsäure-Reduktase (MTHFR), Cholesterinester-Transferprotein (CETP), Apolipoprotein E (ApoE), Prothrombin (F2) und Lipoproteinlipase (LPL) erfolgreich etabliert werden. Die Präzision des Biochips wurde anhand der Echtzeit-PCR und der Sequenzierung nachgewiesen. rnDer innovative Mikroarray ermöglicht eine einfache, schnelle und kosteneffektive Genotypisierung von wichtigen Allelen. Viele klinisch relevante Variationen für Atherosklerose können nun in nur einem Test überprüft werden. Zukünftige Studien müssen zeigen, ob die Methode eine Vorhersage über den Ausbruch der Erkrankung und eine gezielte Therapie ermöglicht. Dies wäre ein erster Schritt in Richtung präventive und personalisierter Medizin für Atherosklerose.rn

Differentiation and extracellular matrix interactions of chondrocytes in response to signaling molecules and biomaterials for cartilage repair = Differenzierung und Interaktionen von Chondrozyten mit der extrazellulären Matrix als Reaktion auf Signalmoleküle und Biomaterialien für die Wiederinstandsetzung von Knorpel

Chondrocytes live isolated in the voluminous extracellular matrix of cartilage, which they secrete and is neither vascularized nor innervated. Nutrient and waste exchanges occur through diffusion leading to low oxygen tension around the cells. Consequently even normal cartilage under normal physiological conditions suffers from a poor reparative potential that predisposes to degenerative conditions, such as osteoarthritis of the joints, with significant clinical effects.rnOne of the key challenges in medicine is the structural and functional replacement of lost or damaged tissues. Current therapeutical approaches are to transplant cells, implant bioartificial tissues, and chemically induce regeneration at the site of the injury. None of them reproduces well the biological and biomechanical properties of hyaline cartilage.rnThis thesis investigates the re-differentiation of chondrocytes and the repair of cartilage mediated by signaling molecules, biomaterials, and factors provided in mixed cellular cultures (co-culture systems). As signaling molecules we have applied prostaglandin E2 (PGE2) and bone morphogenetic protein 1 (BMP-1) and we have transfected chondrocytes with BMP-1 expressing vectors. Our biomaterials have been hydrogels of type-I collagen and gelatin-based scaffolds designed to mimic the architecture and biochemistry of native cartilage and provide a suitable three-dimensional environment for the cells. We have brought chondrocytes to interact with osteosarcoma Cal 72 cells or with murine preosteoblastic KS483 cells, either in a cell-to-cell or in a paracrine manner.rnExogenous stimulation with PGE2 or BMP-1 did not improve the differentiation or the proliferation of human articular chondrocytes. BMP-1 induced chondrocytic de-differentiation in a dose-dependent manner. Prostaglandin stimulation from gelatin-based scaffolds (three-dimensional culture) showed a certain degree of chondrocyte re-differentiaton. Murine preosteoblastic KS483 cells had no beneficial effect on human articular chondrocytes jointly cultivated with them in hydrogels of type I collagen. Although the hydrogels provided the chondrocytes with a proper matrix in which the cells adopted their native morphology; additionally, the expression of chondrocytic proteoglycan increased in the co-cultures after two weeks. The co-culture of chondrocytes with osteoblast-like cells (in transwell systems) resulted in suppression of the regular de-differentiation program that passaged chondrocytes undergo when cultured in monolayers. Under these conditions, the extracellular matrix of the chondrocytes, rich in type-II collagen and aggrecan, was not transformed into the extracellular matrix characteristic of de-differentiated human articular chondrocytes, which is rich in type-I collagen and versican.rnThis thesis suggests novel strategies of tissue engineering for clinical attempts to improve cartilage repair. Since implants are prepared in vitro (ex-vivo) by expanding human articular chondrocytes (autologous or allogeneic), we conclude that it will be convenient to provide a proper three-dimensional support to the chondrocytes in culture, to supplement the culture medium with PGE2, and to stimulate chondrocytes with osteoblastic factors by cultivating them with osteoblasts.rn

Einfluss der Phosphorylierung durch die Casein Kinase II auf den HSP90-Chaperone-Zyklus in humanen Zellen

In der vorliegenden Arbeit wurde eine Analysenmethode auf Basis der Massenbestimmung über Elektrospray-Ionisation qualifiziert, mit der es möglich ist, den Gehalt beider in humanen Zellen vorliegenden isoformen Chaperone HSP90-alpha und HSP90-beta sowie deren Phosphorylierungsstatus in der sog. „charged linker“-Region (CLR) getrennt voneinander zu bestimmen. Die Quantifizierung dieser posttranslationalen Modifikation von HSP90 in der noch wenig untersuchten Region des Chaperons stellte eine besondere Herausforderung an das analytische Messsystem dar, da diese sich fast ausschließlich aus geladenen Aminosäuren zusammensetzt und eine hohe Sequenzhomologie der beiden Isoformen in humanen Zellen vorliegt. Mit dieser Methode ist es gelungen, sowohl die stärkere Expression beider Isoformen in Tumor-Zelllinien im Vergleich zu Nicht-Tumor-Zelllinien als auch signifikant höhere Level beider phosphorylierten Varianten in den Tumor-Zelllinien nachzuweisen. Des Weiteren konnte durch gezielte Arretierung der Tumor-Zelllinie HCT116 in der G0/G1-Phase des Zellzyklus der Nachweis erbracht werden, dass nur HSP90-alpha in diesem Ruhestadium der Zellteilung in der phosphorylierten Form vorliegt. rnDa die Phosphorylierung der CLR von HSP90 als ein Marker für die Substrataktivierung herangezogen werden kann, besteht jetzt die Möglichkeit, Auswirkungen von z. B. HSP90-Inhibitoren auf beide HSP90-Isoformen hinsichtlich ihrer Expression und Phosphorylierung durch die Casein Kinase II (CK II) im zellulären Umfeld zu testen.rnIn-vitro konnte die Phosphorylierung der CLR von HSP90-alpha und -beta mit der CK II an den rekombinant hergestellten Proteinen nachgestellt werden. Dieses typische Phosphorylierungs-Motiv (S-X-X-E/D) findet man bei sehr vielen Co-Chaperonen wie auch bei der Prostaglandin E Synthase p23, das ebenfalls durch eine in-vitro Kinase-Reaktion mit der CK II an drei Positionen phosphoryliert wurde. Durch ein Binde-Assay zeigte sich, dass p23 nur in dieser modifizierten Form an HSP90-alpha bindet. Das Bindeverhalten von p23 an die beta-Isoform wird durch diese Phosphorylierung jedoch nicht beeinflusst. Diese Erkenntnisse erweitern das Verständnis des bis dato beschriebenen Chaperon-Zyklus von HSP90 und zeigen deutliche Unterschiede in den Aktivierungszyklen beider Isoformen auf. Da die Casein Kinase II hier entscheidend in den durch HSP90 vermittelten Aktivierungsprozess eingreift, eröffnet sich ein weites Feld an Möglichkeiten, diese Prozesse an weiteren Co-Chaperonen und Substratproteinen zu studieren.rn

Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial

Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke or other cardiovascular events. We compared the selective thromboxane-prostaglandin receptor antagonist terutroban with aspirin in the prevention of cerebral and cardiovascular ischaemic events in patients with a recent non-cardioembolic cerebral ischaemic event.

Lowered microvascular vessel wall oxygen consumption augments tissue pO2 during PgE1-induced vasodilation

Continuous infusion of intravenous prostaglandin E1 (PgE1, 2.5 mug/kg/min) was used to determine how vasodilation affects oxygen consumption of the microvascular wall and tissue pO(2) in the hamster window chamber model. While systemic measurements (mean arterial pressure and heart rate) and central blood gas measurements were not affected, PgE1 treatment caused arteriolar (64.6 +/- 25.1 microm) and venular diameter (71.9 +/- 29.5 microm) to rise to 1.15 +/- 0.21 and 1.06 +/- 0.19, respectively, relative to baseline. Arteriolar (3.2 x 10(-2) +/- 4.3 x 10(-2) nl/s) and venular flow (7.8 x 10(-3) +/- 1.1 x 10(-2)/s) increased to 1.65 +/- 0.93 and 1.32 +/- 0.72 relative to baseline. Interstitial tissue pO(2) was increased significantly from baseline (21 +/- 8 to 28 +/- 7 mmHg; P < 0.001). The arteriolar vessel wall gradient, a measure of oxygen consumption by the microvascular wall decreased from 20 +/- 6 to 16 +/- 3 mmHg (P < 0.001). The arteriolar vessel wall gradient, a measure of oxygen consumption by the vascular wall, decreased from 20 +/- 6 to 16 +/- 3 mmHg (P < 0.001). This reduction reflects a 20% decrease in oxygen consumption by the vessel wall and up to 50% when cylindrical geometry is considered. The venular vessel wall gradient decreased from 12 +/- 4 to 9 +/- 4 mmHg (P < 0.001). Thus PgE1-mediated vasodilation has a positive microvascular effect: enhancement of tissue perfusion by increasing flow and then augmentation of tissue oxygenation by reducing oxygen consumption by the microvascular wall.

The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association

OBJECTIVES: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. METHODS: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. RESULTS: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. CONCLUSIONS: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.