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-Adrenergic blockade restores normal fluid transport
capacity of alveolar epithelium after hemorrhagic shock
Departments of Anesthesia and Medicine and Cardiovascular Research Institute, University of California, San Francisco, California 94143
Activation of
-adrenergic receptors in the
lung is an important mechanism that can prevent alveolar flooding after
brief but severe hemorrhagic shock. However, a neutrophil-dependent oxidant injury to the alveolar epithelium prevents the normal upregulation of alveolar fluid clearance by catecholamines after prolonged hemorrhagic shock. Because hemorrhage increases
proinflammatory cytokine expression in the lung partly through the
activation of
-adrenergic receptors, the objective of this study was
to determine whether
-adrenergic blockade would restore the normal fluid transport capacity of the alveolar epithelium after hemorrhagic shock. Hemorrhagic shock was associated with a significant increase of
interleukin-1
(IL-1
) concentration in the lung and a failure of
the alveolar epithelium to respond to
-adrenergic agonists, with the
upregulation of vectorial fluid transport despite intra-alveolar administration of exogenous catecholamines. In contrast,
catecholamine-mediated upregulation of alveolar liquid clearance was
restored by pretreatment with phentolamine, an
-adrenergic-receptor
antagonist. Phentolamine pretreatment also significantly attenuated the
shock-mediated increase of IL-1
concentration in the lung.
Additional experiments demonstrated that the inhibition of IL-1
binding to its receptor by the administration of IL-1-receptor
antagonist restored the normal fluid transport capacity of the alveolar
epithelium after hemorrhagic shock. In summary, the results of these
studies indicate that the activation of
-adrenergic receptors after
hemorrhagic shock prevents the
-adrenergic-dependent upregulation of
alveolar fluid clearance by modulating the severity of the pulmonary
inflammatory response.
-adrenergic-receptor antagonist; alveolar liquid clearance; oxidative injury; interleukin-1; interleukin-1-receptor
antagonist
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