Agradecemos Krista den Ouden pelo seu excelente assistência técnica. Esta técnica foi apoiado financeiramente pela Fundação do Rim holandês, concessão C06.2174. MCV é apoiada pela organização Holandesa para Pesquisa Científica (NWO) Vidi-concessão 016.096.359.

Todos os experimentos são executados de acordo com as linhas de orientação éticas animais experimentais da comissão de animal experimental Utrecht. O protocolo é realizada sob a orientação e aprovação dos cuidados com os animais da instituição do autor e da comissão de uso. DRC é induzida em ratos Lewis consanguíneos machos (Charles River, Sulzfeld, Alemanha) com a idade de 8 semanas. Os ratos são alojados sob condições padrão num ambiente, luz, temperatura e humidade controlada. 1. Preparação da cirurgia <ol><li> Esterilizar instrumentos cirúrgicos: <ul><li> Um tecido estudante forceps 1-2 dentes de 12 centímetros </li><li> Um estudante fórceps padrão normal </li><li> 2 Semken forceps </li><li> Uma tesoura de Mayo </li><li> Um estudante tesoura iris </li><li> Um porta-agulha Olsen-Hegar com tesoura </li><li> Cobertor </li></ul></li><li> Confira lista de inventário: <ul><li> Mesa de operação com almofada de aquecimento e lâmpadas </li><li> O <sub&gt; 2, isoflurano </li><li> Tecidos </li><li> Barbeador </li><li> Balança </li><li> Conjunto operacional estéril </li><li> 5x5 gaze estéril e 10x10 </li><li> Álcool a 70% </li><li> Solução de NaCl a 0,9% </li><li> Seringa de 1 ml </li><li> Agulhas (25G) </li><li> Gel almofadas de espuma: Spongostan </li><li> Vicryl 4.0 e 5.0 </li><li> A buprenorfina 0,03 mg / kg (1:10 diluído em salina fisiológica) </li><li> Gaiola limpa para ratos após cirurgia </li></ul></li></ol> 2. Direito uninefrectomia Side <ol><li> Desinfetar a mesa com álcool 70%. </li><li> Lugar rato na caixa de indução e induzir a anestesia com 4% de isoflurano e um fluxo litro de O 2. Nota: dependendo da estirpe de ratos utilizada, pré e peri-operatório analgesia são prescritos, isso precisa ser discutido com o veterinário local. </li><li> Transferir rato para mesa e lugar nariz em cone. O cone de nariz e de rato são colocados numa almofada de aquecimento para manter a temperatura corporal do rato. O rato is ventilados com uma mistura de 2% de isoflurano e 1 litro de O 2. </li><li> Raspar o flanco do rato e desinfecção com álcool. Lavar e desinfectar as mãos e usar luvas cirúrgicas estéreis. Usar uma touca de cabeça e uma máscara. Faça por 1 - 1,5 centímetros incisão paralela às costelas usando uma pinça e tesouras sem corte anatômico. Expor o rim por dissecção romba dos músculos das costas. </li><li> O pólo inferior do rim é visível, use com cuidado as pequenas pinças contundentes para prender o tecido adiposo perirenal. Exteriorizar o rim, puxando suavemente sobre a gordura perirenal com uma pinça. Tome cuidado para não perturbar a glândula adrenal durante este procedimento. A glândula supra-renal pode ser facilmente removido por uma pinça de colocação no local medial e no tecido adiposo e movido suavemente para cima entre a glândula supra-renal e do rim, conforme ilustrado na Figura 2. </li><li> Coloque renal suavemente sobre gaze e clara em torno do tecido adiposo e conjuntivo. Identificar a artéria renal e veia e colocar uma ligadura (5.0vicryl) com um único nó ao redor dos vasos, mas não amarrar o nó. </li><li> Mova o nó frouxo cuidadosamente ao longo dos vasos em direção à aorta por aproximadamente 0,5 cm, para criar espaço entre o rim eo nó. Isto é feito para evitar que a ligadura de escorregar após o corte. </li><li> Amarrar o nó com dois nós de casal. Se a perfusão é interrompida, a cor do rim mudará imediatamente para castanho. Não corte as extremidades da ligadura. </li><li> Cortar os vasos renais próximos do rim e remover o rim. Puxe delicadamente as longas extremidades da ligadura para verificar se há sangramento dos vasos renais. A ligadura deve permanecer no local na embarcação. Corte as extremidades longas da ligadura. Note, os vasos renais remanescentes será recolhido para dentro da cavidade abdominal imediatamente. </li><li> Blot rim retirado secar e pesar. </li><li> Fechar a incisão do músculo esquelético com o funcionamento de suturas com Vicryl 5.0. Injectar 0,10 ml (0,03 mg / kg), a buprenorfina im no membro posterior. Feche apele com Vicryl 4.0 com sutura intradérmica. Isto impede que os ratos de abertura da ferida. Nota: devido à depressão respiratória em ratos Lewis, que só dão analgesia pós-operatória, pouco antes de desligar o isoflurano. </li><li> Abrigar o rato em uma gaiola solitária limpo com fácil acesso à comida e água. Coloque a gaiola metade sobre o aquecimento pad O / N e verifique o rato cuidadosamente no dia seguinte. Quando a ferida é fechada e o rato é activo, que é, normalmente, compreendida entre 6 e 12 horas após a cirurgia, os ratos podem ser colocados de volta no alojamento de grupo. </li></ol> 3. Lado Esquerdo nefrectomia subtotal <ol><li> Sete dias depois, as mesmas preparações são feitas no lado esquerdo como para o lado direito, tal como descrito 2,1-2,5. Antes da cirurgia, é calculada a quantidade de tecido renal, que precisa de ser removido correspondente a aproximadamente 2/3RDS do peso do rim direito. Prepare a pequenos pedaços de espuma de gel (Spongostan, Johnson &amp; Johnson, New Jersey) antes da cirurgia. </li&gt; <li> Coloque uma tesoura afiada em torno do pólo superior do rim esquerdo e ressecar o pólo superior de um acidente vascular cerebral (para localização tesoura, ver Figura 3). Cubra imediatamente com um pedaço de espuma de gel e de exercer uma pressão ligeira com uma gaze estéril. </li><li> Repita com o pólo inferior do rim como em 3.3. </li><li> Elevador rim para impedir a coagulação na pele. Manter a pressão suave em ambos almofadas de espuma de gel com gaze estéril até parar de sangrar. Quando o sangramento persistir, adicionar uma outra almofada de espuma. </li><li> Coloque o restante do rim com almofadas de espuma de gel aderente dentro do abdômen. Feche o músculo ea pele e siga 2,9-2,12. </li></ol> 4. Sham Cirurgia <ol><li> Sham controles operados submetidas ao mesmo procedimento, a fim de expor os rins. Em vez de extirpar o rim ou o corte dos pólos, uma semana depois, ambos os rins estão decapsulated em um intervalo de uma semana, tomando cuidado para não perturbar as glândulas supra-renais. Fechamento da ferida e cuidados pós-operatórios são identical a 2.11 e 2.12. </li></ol>

<ol>
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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Healthy+bone+marrow+cells+reduce+progression+of+kidney+failure+better+than+CKD+bone+marrow+cells+in+rats+with+established+chronic+kidney+disease.">Healthy bone marrow cells reduce progression of kidney failure better than CKD bone marrow cells in rats with established chronic kidney disease.</a> Cell Transplant. , (2012).</li><li>Baylis, C., Corman, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+aging+kidney:+insights+from+experimental+studies.">The aging kidney: insights from experimental studies.</a> J. Am. Soc. Nephrol. 9 (4), 699-709 (1998).</li><li>Szabo, A. J., Muller, V., Chen, G. F., Samsell, L. 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Res. 8 (10), 1318-1322 (1991).</li><li>Levey, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+renal+function+in+chronic+renal+disease.">Measurement of renal function in chronic renal disease.</a> Kidney Int. 38 (1), 167-184 (1990).</li><li>Myers, G. L., Miller, W. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recommendations+for+improving+serum+creatinine+measurement:+a+report+from+the+Laboratory+Working+Group+of+the+National+Kidney+Disease+Education+Program.">Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program.</a> Clin. Chem. 52 (1), 5-18 (2006).</li><li>Hostetter, T. H., Meyer, T. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+development+of+clearance+methods+for+measurement+of+glomerular+filtration+and+tubular+reabsorption.">The development of clearance methods for measurement of glomerular filtration and tubular reabsorption.</a> Am. J. Physiol. Renal Physiol. 287 (5), F868-F870 (2004).</li><li>Koeners, M. P., Racasan, S., Koomans, H. A., Joles, J. A., Braam, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nitric+oxide,+superoxide+and+renal+blood+flow+autoregulation+in+SHR+after+perinatal+L-arginine+and+antioxidants.">Nitric oxide, superoxide and renal blood flow autoregulation in SHR after perinatal L-arginine and antioxidants.</a> Acta. Physiol. (Oxf). 190 (4), 329-338 (2007).</li><li>van den Brandt, J., Wang, D., Kwon, S. H., Heinkelein, M., Reichardt, H. 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Os autores não têm nada a revelar.

A remoção cirúrgica do 5/6th da massa renal em ratos Lewis, combinada com uma dieta rica em sal e inibição temporária NOS leva a um modelo de doença renal crônica que se assemelha CKD humana e permite o estudo dos mecanismos causais e eficácia de intervenções terapêuticas em CKD. O modelo de nefrectomia 5/6th é um modelo bem conhecido e descrito extensivamente para DRC. No entanto, a simples remoção 5/6th da massa renal não levar à insuficiência renal imediato em todas as c...

Devido ao seu caráter progressivo, resultante final da doença renal em estágio, e morbidade cardiovascular e mortalidade associadas, DRC é um problema crescente de saúde pública 1. Retardar a progressão da doença renal crônica é, portanto, uma prioridade de saúde. Desde DRC é caracterizada por desarranjos complexos de homeostase, os modelos animais integrativos são necessárias para estudar o desenvolvimento e progressão de DRC. O rim é composto de uma ampla gama de diferentes tipos de células que interagem uns com os outros. Esta complexidade não pode ser mimetizado in vitro. Para estudar as intervenções terapêuticas em CKD, usamos o modelo 5/6th nefrectomia ablação, um modelo experimental bem conhecido de doença renal progressiva, assemelhando-se vários aspectos da CKD humano 2,3. A redução bruta da massa renal provoca glomerular progressiva e lesão túbulo-intersticial, perda de néfrons remanescentes e desenvolvimento de hipertensão arterial sistêmica e glomerular. Ela está associada com progrperda essive intrarenal capilar 4, inflamação e glomeruloesclerose. Fatores de risco para DRC invariavelmente impacto sobre a função endotelial 5. Usamos uma estirpe de rato (Lewis) que é relativamente resistente ao desenvolvimento de DRC e, portanto, a remoção combinada de 5/6th da massa renal com óxido nítrico (NO) depleção 6, 7, 8 e uma dieta rica em sal 9. Após a chegada e de aclimatação, os animais recebem um inibidor da NO-sintase (L-NNA), suplementado com a água de beber (20 mg / L) durante um período de 4 semanas, seguido de uninefrectomia lado direito (UNX), com continuação da L-NNA após dois dias . Uma semana depois, a nefrectomia subtotal (SNX), ou seja remoção de 2/3rds de massa renal é realizado no lado esquerdo. Após SNX, os animais são deixados a recuperar durante 2 dias, seguido novamente por 20 mg / L na água de beber LNNA por um período de 4 semanas. Uma dieta rica em sal (6%), complementado em terra de comida (veja linha do tempo Figura 1), continua durante todo o experimento. Tele razão para realizar o UNX no lado direito e a SNX no lado esquerdo é que os vasos renais são mais longos no lado esquerdo, que torna mais fácil o acesso ao rim sem esticar os vasos muito quando o rim é exposto fora do corpo . Na literatura, os modelos são descritos em que os pólos do rim esquerdo são removidos em primeiro lugar, seguido por UNX do rim direito, uma semana depois 10,11,12. Nas nossas mãos este modelo mostrou um desenvolvimento muito mais rápido de insuficiência renal, mas também uma variação muito maior na perda da função renal. A progressão da insuficiência renal é seguida ao longo do tempo medindo a ureia plasmática, pressão arterial sistólica e proteinúria. Por seis semanas após SNX, insuficiência renal desenvolveu, caracterizada pela diminuição acentuada na taxa de filtração glomerular (69%) e do fluxo plasmático renal eficaz (62%) 13 de hipertensão (pressão sanguínea sistólica&gt; 150 mm Hg), a proteinúria (&gt; 50 mg/24 hr) e leve uremia (&gt; 10 mM). Características histológicas incluem Tubuldanos o-reflectida pela inflamação intersticial, atrofia tubular e fibrose e glomeruloesclerose focal conduzindo a enorme redução dos glomérulos saudáveis ​​na população remanescente (&lt;10%). Follow-up até 12 semanas após SNX mostra a progressão da DRC, proporcionando uma janela de oportunidade para a avaliação de intervenções terapêuticas.

<table border="1">
	<tbody>
		<tr>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Reagent</td>
		</tr>
		<tr>
			<td>L-NNA</td>
			<td>Sigma-aldrich</td>
			<td>N5501</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Spongostan dental: gel foam pads 1x1x1 cm</td>
			<td>Johnson&amp;Johnson</td>
			<td>Ms0005</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Ethicon Vicryl FS-2S naald 4/0 V392H p/36</td>
			<td>Ethicon</td>
			<td>V303H</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Ethicon Vicryl RB-1+ naald 5/0 V303H p/36</td>
			<td>Ethicon</td>
			<td>V392H</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Buprenorphine (0.3 mg/ml)</td>
			<td>Via local pharmacist ordered by Reckitt Benckiser pharmaceuticals</td>
			<td>unknown</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>Equipment</td>
		</tr>
		<tr>
			<td>Student Tissue Forceps - 1x2 Teeth 12 cm</td>
			<td>Fine Science Tools (FST)</td>
			<td>91121-12</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Student Standard Pattern Forceps</td>
			<td>FST</td>
			<td>91100-12</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Mayo Scissors</td>
			<td>FST</td>
			<td>14010-15</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>2X Semken Forceps</td>
			<td>FST</td>
			<td>11008-13</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Student Iris Scissors</td>
			<td>FST</td>
			<td>91460-11</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Olsen-Hegar Needle Holder</td>
			<td>FST</td>
			<td>12002-14</td>
			<td>&nbsp;</td>
		</tr>
	</tbody>
</table>

5/6th nephrectomy in combination with high salt diet and nitric oxide synthase inhibition to induce chronic kidney disease in the lewis rat

A doença renal crônica (DRC) é um problema global. Retardar a progressão da doença renal crônica é uma das principais prioridades de saúde. Desde DRC é caracterizada por desarranjos complexos de homeostase, os modelos animais integrativos são necessárias para estudar o desenvolvimento e progressão de DRC. Para estudar o desenvolvimento de intervenções terapêuticas com DRC e romance em CKD, usamos o modelo de ablação nefrectomia 5/6th, um modelo experimental bem conhecido de doença renal progressiva, assemelhando-se vários aspectos da CKD humano. A redução bruta da massa renal provoca glomerular progressiva e lesão túbulo-intersticial, perda de néfrons remanescentes e desenvolvimento de hipertensão arterial sistêmica e glomerular. Também está associada com a perda progressiva intra capilar, inflamação e glomeruloesclerose. Fatores de risco para DRC invariavelmente impacto sobre a função endotelial. Para simular isso, nós combinamos remoção de 5/6th da massa renal com o óxido nítrico (NO) exaustão e uma dieta rica em sal. Após a chegada e aclimatação, os animais receber um inibidor da sintase de NO (NG-nitro-L-arginina) (L-NNA), suplementado com a água de beber (20 mg / L) durante um período de 4 semanas, seguido de uninefrectomia no lado direito. Uma semana mais tarde, uma nefrectomia subtotal (SNX) é realizada no lado esquerdo. Após SNX, os animais são deixados a recuperar durante dois dias seguidos por LNNA na água de beber (20 mg / L) por um período adicional de 4 semanas. Uma dieta rica em sal (6%), complementado em terra de comida (veja linha do tempo Figura 1), continua durante todo o experimento. A progressão da insuficiência renal é seguida ao longo do tempo medindo a ureia plasmática, pressão arterial sistólica e proteinúria. Por seis semanas após SNX, insuficiência renal desenvolveu. A função renal é medida usando inulina &quot;padrão ouro&quot; e ácido para-amino hipúrico (PAH), tecnologia de apuramento. Este modelo de DRC é caracterizada por uma redução na taxa de filtração glomerular (TFG) e do fluxo plasmático renal eficaz (FPER), hipertensão (pressão sanguínea sistólica&gt; 150 mm Hg), a proteinúria (&gt; 50 mg/24 hr) E uremia leve (&gt; 10 mM). As características histológicas incluem danos túbulo-intersticial reflectida pela inflamação, atrofia tubular, e fibrose e glomeruloesclerose focal conduzindo a enorme redução dos glomérulos saudáveis ​​na população remanescente (&lt;10%). Follow-up até 12 semanas após SNX mostra a progressão da DRC.

Após a nefrectomia subtotal, aproximadamente 1/6th da massa renal total é para a esquerda. Figura 4 mostra o peso da parte removida do rim direito com média e desvio padrão, em duas experiências anteriores. Deve-se ter em mente que, durante a semana depois da UNX, hipertrofia do rim esquerdo ocorre, indicando que o peso que deve ser removido calculado com base no peso do rim direito sempre resulta em menos do que a remoção 5/6th. No entanto, uma vez que não é possível determinar o peso do rim ...

Watch this Scientific Journal Video about 5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat at JoVE.com

5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat

Um método de duas fases para estabelecer a doença renal crónica (IRC) em ratos Lewis por remoção cirúrgica da massa renal 5/6th é descrito. Combinação do procedimento cirúrgico, NOS-inibição e uma dieta rica em sal leva a um modelo semelhante CKD humano, permitindo estudo dos mecanismos causais e desenvolvimento de intervenções terapêuticas.

5/6th Nephrectomy em combinação com uma dieta alta de sal e Óxido Nítrico Sintase inibição para induzir o Doença Renal Crônica no Rato Lewis

Chronic kidney disease (CKD) is a global problem. Slowing CKD progression is a major health priority. Since CKD is characterized by complex derangements ...

56th-nephrectomy-combination-with-high-salt-diet-nitric-oxide

Research

JoVE Journal

Medicine

23.4K visualizações.  University Medical Center Utrecht. Um método de duas fases para estabelecer a doença renal crónica (IRC) em ratos Lewis por remoção cirúrgica da massa renal 5/6th é descrito. Combinação do procedimento cirúrgico, NOS-inibição e uma dieta rica em sal leva a um modelo semelhante CKD humano, permitindo estudo dos mecanismos causais e desenvolvimento de intervenções terapêuticas.

Vídeo: 5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat

Analytical Techniques for Assaying Nitric Oxide Bioactivity

Nitric oxide (NO) is a diatomic free radical that is extremely short lived in biological systems (less than 1 second in circulating blood)1. NO may be considered one of the most important signaling molecules produced in our body, regulating essential functions including but not limited to regulation of blood pressure, immune response and neural communication. Therefore its accurate detection and quantification in biological matrices is critical to understanding the role of NO in health and disease. With such a short physiological half life of NO, alternative strategies for the detection of reaction products of NO biochemistry have been developed. The quantification of relevant NO metabolites in multiple biological compartments provides valuable information with regards to in vivo NO production, bioavailability and metabolism. Simply sampling a single compartment such as blood or plasma may not always provide an accurate assessment of whole body NO status, particularly in tissues. The ability to compare blood with select tissues in experimental animals will help bridge the gap between basic science and clinical medicine as far as diagnostic and prognostic utility of NO biomarkers in health and disease. Therefore, extrapolation of plasma or blood NO status to specific tissues of interest is no longer a valid approach. As a result, methods continue to be developed and validated which allow the detection and quantification of NO and NO-related products/metabolites in multiple compartments of experimental animals in vivo. The established paradigm of NO biochemistry from production by NO synthases to activation of soluble guanylyl cyclase (sGC) to eventual oxidation to nitrite (NO2-) and nitrate (NO3-) may only represent part of NO's effects in vivo. The interaction of NO and NO-derived metabolites with protein thiols, secondary amines, and metals to form S-nitrosothiols (RSNOs), N-nitrosamines (RNNOs), and nitrosyl-heme respectively represent cGMP-independent effects of NO and are likely just as important physiologically as activation of sGC by NO. A true understanding of NO in physiology is derived from in vivo experiments sampling multiple compartments simultaneously. Nitric oxide (NO) methodology is a complex and often confusing science and the focus of many debates and discussion concerning NO biochemistry. The elucidation of new mechanisms and signaling pathways involving NO hinges on our ability to specifically, selectively and sensitively detect and quantify NO and all relevant NO products and metabolites in complex biological matrices. Here, we present a method for the rapid and sensitive analysis of nitrite and nitrate by HPLC as well as detection of free NO in biological samples using in vitro ozone based chemiluminescence with chemical derivitazation to determine molecular source of NO as well as ex vivo with organ bath myography.

The endogenous production of nitric oxide (NO) regulates a wide variety of biological functions. It is becoming increasingly clear that disruption or dysregulation of NO based signaling is involved in many human diseases. Methods to quantify relevant NO metabolites may provide novel diagnostic or prognostic biomarkers for human disease.

Técnicas Analíticas para ensaiar Bioatividade Óxido Nítrico

Nitric oxide (NO) is a diatomic free radical that is extremely short lived in biological systems (less than 1 second in circulating blood)1. NO may be ...

Medicina

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

Ablação por cateter em combinação com o fechamento do apêndice atrial esquerdo para Fibrilação Atrial

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

Spectral Karyotyping to Study Chromosome Abnormalities in Humans and Mice with Polycystic Kidney Disease

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being analyzed 1, 2. This classical banding technique, however, is not reliable in identifying complex chromosomal aberrations such as those associated with cancer. To overcome the limitations of the banding technique, Spectral Karyotyping (SKY) is introduced to provide much reliable information on chromosome abnormalities.
SKY is a multicolor fluorescence in-situ hybridization (FISH) technique to detect metaphase chromosomes with spectral microscope 3, 4. SKY has been proven to be a valuable tool for the cytogenetic analysis of a broad range of chromosome abnormalities associated with a large number of genetic diseases and malignancies 5, 6. SKY involves the use of multicolor fluorescently-labelled DNA probes prepared from the degenerate oligonucleotide primers by PCR. Thus, every chromosome has a unique spectral color after in-situ hybridization with probes, which are differentially labelled with a mixture of fluorescent dyes (Rhodamine, Texas Red, Cy5, FITC and Cy5.5). The probes used for SKY consist of up to 55 chromosome specific probes 7-10.
The procedure for SKY involves several steps (Figure 1). SKY requires the availability of cells with high mitotic index from normal or diseased tissue or blood. The chromosomes of a single cell from either a freshly isolated primary cell or a cell line are spread on a glass slide. This chromosome spread is labeled with a different combination of fluorescent dyes specific for each chromosome. For probe detection and image acquisition,the spectral imaging system consists of sagnac interferometer and a CCD camera. This allows measurement of the visible light spectrum emitted from the sample and to acquire a spectral image from individual chromosomes. HiSKY, the software used to analyze the results of the captured images, provides an easy identification of chromosome anomalies. The end result is a metaphase and a karyotype classification image, in which each pair of chromosomes has a distinct color (Figure 2). This allows easy identification of chromosome identities and translocations. For more details, please visit Applied Spectral Imaging website (<a href="http://www.spectral-imaging.com/" target="_blank">http://www.spectral-imaging.com/</a>).
SKY was recently used for an identification of chromosome segregation defects and chromosome abnormalities in humans and mice with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a genetic disease characterized by dysfunction in primary cilia 11-13. Using this technique, we demonstrated the presence of abnormal chromosome segregation and chromosomal defects in ADPKD patients and mouse models 14. Further analyses using SKY not only allowed us to identify chromosomal number and identity, but also to accurately detect very complex chromosomal aberrations such as chromosome deletions and translocations (Figure 2).

Spectral Karyotyping (SKY) is an advanced cytogenetics technique to identify genomic and chromosomal aberrations. This technique takes advantage of chromosome painting probes, which allow classification of all chromosomes. SKY can also identify complex chromosome aberrations and segregation defects in mice and humans with various diseases, including polycystic kidney disease.

Cariotipagem espectral para o Estudo de Anomalias cromossômicas em humanos e camundongos com doença renal policística

Conventional method to identify and classify individual chromosomes depends on the unique banding pattern of each chromosome in a specific species being ...

A Model of Chronic Nutrient Infusion in the Rat

Chronic exposure to excessive levels of nutrients is postulated to affect the function of several organs and tissues and to contribute to the development of the many complications associated with obesity and the metabolic syndrome, including type 2 diabetes. To study the mechanisms by which excessive levels of glucose and fatty acids affect the pancreatic beta-cell and the secretion of insulin, we have established a chronic nutrient infusion model in the rat. The procedure consists of catheterizing the right jugular vein and left carotid artery under general anesthesia; allowing a 7-day recuperation period; connecting the catheters to the pumps using a swivel and counterweight system that enables the animal to move freely in the cage; and infusing glucose and/or Intralipid (a soybean oil emulsion which generates a mixture of approximately 80% unsaturated/20% saturated fatty acids when infused with heparin) for 72 hr. This model offers several advantages, including the possibility to finely modulate the target levels of circulating glucose and fatty acids; the option to co-infuse pharmacological compounds; and the relatively short time frame as opposed to dietary models. It can be used to examine the mechanisms of nutrient-induced dysfunction in a variety of organs and to test the effectiveness of drugs in this context.

A protocol for chronic infusions of glucose and Intralipid in rats is described. This model can be used to study the impact of nutrient excess on organ function and physiological parameters.

Um Modelo de Infusão Crónica de nutrientes no Rato

Chronic exposure to excessive levels of nutrients is postulated to  affect the function of several organs and tissues and to contribute to the  ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

Avaliação da função vascular em pacientes com doença renal crônica

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Slow-release Drug Delivery through Elvax 40W to the Rat Retina: Implications for the Treatment of Chronic Conditions

Diseases of the retina are difficult to treat as the retina lies deep within the eye. Invasive methods of drug delivery are often needed to treat these diseases. Chronic retinal diseases such as retinal oedema or neovascularization usually require multiple intraocular injections to effectively treat the condition. However, the risks associated with these injections increase with repeated delivery of the drug. Therefore, alternative delivery methods need to be established in order to minimize the risks of reinjection. Several other investigations have developed methods to deliver drugs over extended time, through materials capable of releasing chemicals slowly into the eye. In this investigation, we outline the use of Elvax 40W, a copolymer resin, to act as a vehicle for drug delivery to the adult rat retina. The resin is made and loaded with the drug. The drug-resin complex is then implanted into the vitreous cavity, where it will slowly release the drug over time. This method was tested using 2-amino-4-phosphonobutyrate (APB), a glutamate analogue that blocks the light response of the retina. It was demonstrated that the APB was slowly released from the resin, and was able to block the retinal response by 7 days after implantation. This indicates that slow-release drug delivery using this copolymer resin is effective for treating the retina, and could be used therapeutically with further testing.

This paper details how Elvax 40W can be used as a slow-release method for drug delivery to the adult rat retina. The protocol for preparing, loading, and delivering the drug-resin complex to the eye is described.

De liberação lenta Drug Delivery através Elvax 40W para o Rat Retina: implicações para o tratamento de condições crônicas

Diseases of the retina are difficult to treat as the retina lies deep within the eye. Invasive methods of drug delivery are often needed to treat these ...

Busulfan as a Myelosuppressive Agent for Generating Stable High-level Bone Marrow Chimerism in Mice

Bone marrow transplantation (BMT) is often used to replace the bone marrow (BM) compartment of recipient mice with BM cells expressing a distinct biomarker isolated from donor mice. This technique allows for identification of donor-derived hematopoietic cells within the recipient mice, and can be used to isolate and characterize donor cells using various biochemical techniques. BMT typically relies on myeloablative conditioning with total body irradiation to generate niche space within the BM compartment of recipient mice for donor cell engraftment. The protocol we describe here uses myelosuppressive conditioning with the chemotherapeutic agent busulfan. Unlike irradiation, which requires the use of specialized facilities, busulfan conditioning is performed using intraperitoneal injections of 20 mg/kg busulfan until a total dose of 60-100 mg/kg has been administered. Moreover, myeloablative irradiation can have toxic side effects and requires successful engraftment of donor cells for survival of recipient mice. In contrast, busulfan conditioning using these doses is generally well tolerated and mice survive without donor cell support. Donor BM cells are isolated from the femurs and tibiae of mice ubiquitously expressing green fluorescent protein (GFP), and injected into the lateral tail vein of conditioned recipient mice. BM chimerism is estimated by quantifying the number of GFP+ cells within the peripheral blood following BMT. Levels of chimerism&nbsp;>80% are typically observed in the peripheral blood 3-4 weeks post-transplant and remain established for at least 1 year. As with irradiation, conditioning with busulfan and BMT allows for the accumulation of donor BM-derived cells within the central nervous system (CNS), particularly in mouse models of neurodegeneration. This busulfan-mediated CNS accumulation may be more physiological than total body irradiation, as the busulfan treatment is less toxic and CNS inflammation appears to be less extensive. We hypothesize that these cells can be genetically engineered to deliver therapeutics to the CNS.

We describe a protocol whereby busulfan conditioning permits the bone marrow of a recipient mouse to be replaced with bone marrow cells from donor mice ubiquitously expressing green fluorescent protein, in the absence of irradiation. This technique is useful to study bone marrow cell accumulation in the central nervous system.

Busulfan como Agente mielosupressores para a geração estável de alto nível de Medula Óssea quimerismo em Ratos

Bone marrow transplantation (BMT) is often used to replace the bone marrow (BM) compartment of recipient mice with BM cells expressing a distinct ...

Intravascular Delivery of Biologics to the Rat Kidney

The renal microvascular compartment plays an important role in the progression of kidney disease and hypertension, leading to the development of End Stage Renal Disease with high risk of death for cardiovascular events. Moreover, recent clinical studies have shown that renovascular structure and function may have a great impact on functional renal recovery after surgery. Here, we describe a protocol for the delivery of drugs into the renal artery of rats. This procedure offers significant advantages over the frequently used systemic administration as it may allow a more localized therapeutic effect. In addition, the use of rodents in pharmacodynamic analysis of preclinical studies may be cost effective, paving the way for the design of translational experiments in larger animal models. Using this technique, infusion of rat recombinant Vascular Endothelial Growth Factor (VEGF) protein in rats has induced activation of VEGF signaling as shown by increased expression of FLK1, pAKT/AKT, pERK/ERK. In summary, we established a protocol for the intrarenal delivery of drugs in rats, which is simple and highly reproducible.

The administration of drugs for recovery of kidney function requires control of the localization and distribution of the therapeutic compound. Here, we describe in detail a simple technique for intrarenal delivery of drugs in rats. This procedure may be easily performed with no mortality and high reproducibility.

Entrega intravascular de Biologics para o rim de rato

The renal microvascular compartment plays an important role in the progression of kidney disease and hypertension, leading to the development of End Stage ...

Assessment of Kidney Function in Mouse Models of Glomerular Disease

The use of murine models to mimic human kidney disease is becoming increasingly common. Our research is focused on the assessment of glomerular function in diabetic nephropathy and podocyte-specific VEGF-A knock-out mice; therefore, this protocol describes the full kidney work-up used in our lab to assess these mouse models of glomerular disease, enabling a vast amount of information regarding kidney and glomerular function to be obtained from a single mouse. In comparison to alternative methods presented in the literature to assess glomerular function, the use of the method outlined in this paper enables the glomerular phenotype to be fully evaluated from multiple aspects. By using this method, the researcher can determine the kidney phenotype of the model and assess the mechanism as to why the phenotype develops. This vital information on the mechanism of disease is required when examining potential therapeutic avenues in these models. The methods allow for detailed functional assessment of the glomerular filtration barrier through measurement of the urinary albumin creatinine ratio and individual glomerular water permeability, as well as both structural and ultra-structural examination using the Periodic Acid Schiff stain and electron microscopy. Furthermore, analysis of the genes dysregulated at the mRNA and protein level enables mechanistic analysis of glomerular function. This protocol outlines the generic but adaptable methods that can be applied to all mouse models of glomerular disease.

This protocol describes a full kidney work-up that should be carried out in mouse models of glomerular disease. The methods allow for detailed functional, structural, and mechanistic analysis of glomerular function, which can be applied to all mouse models of glomerular disease.

Avaliação da função renal em modelos do rato da doença Glomerular

The use of murine models to mimic human kidney disease is becoming increasingly common. Our research is focused on the assessment of glomerular function ...

Platelet-based Detection of Nitric Oxide in Blood by Measuring VASP Phosphorylation

Platelets are the blood components responsible for proper blood clotting. Their function is highly regulated by various pathways. One of the most potent vasoactive agents, nitric oxide (NO), can also act as a powerful inhibitor of platelet aggregation. Direct NO detection in blood is very challenging due to its high reactivity with cell-free hemoglobin that limits NO half-life to the millisecond range. Currently, NO changes after interventions are only estimated based on measured changes of nitrite and nitrate (members of the nitrate-nitrite-NO metabolic pathway). However precise, these measurements are rather difficult to interpret vis a vis actual NO changes, due to the naturally high baseline nitrite and nitrate levels that are several orders of magnitude higher than expected changes of NO itself. Therefore, the development of direct and simple methods that would allow one to detect NO directly is long overdue. This protocol addresses a potential use of platelets as a highly sensitive NO sensor in blood. It describes initial platelet rich plasma (PRP) and washed platelet preparations and the use of nitrite and deoxygenated red blood cells as NO generators. Phosphorylation of VASP at serine 239 (P-VASPSer239) is used to detect the presence of NO. The fact that VASP protein is highly expressed in platelets and that it is rapidly phosphorylated when NO is present leads to a unique opportunity to use this pathway to directly detect NO presence in blood.

Here, we present a protocol to address the potential use of platelets as a highly sensitive nitric oxide sensor in blood. It describes initial platelet preparation and the use of nitrite and deoxygenated red blood cells as nitric oxide generators.

Detecção baseada em plaquetas de óxido nítrico no sangue, medindo-se a fosforilação VASP

Platelets are the blood components responsible for proper blood clotting. Their function is highly regulated by various pathways. One of the most potent ...