WO1995034301A1 - Substrats energetiques - Google Patents
Substrats energetiques Download PDFInfo
- Publication number
- WO1995034301A1 WO1995034301A1 PCT/SE1995/000698 SE9500698W WO9534301A1 WO 1995034301 A1 WO1995034301 A1 WO 1995034301A1 SE 9500698 W SE9500698 W SE 9500698W WO 9534301 A1 WO9534301 A1 WO 9534301A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- alpha
- ketoglutarate
- organs
- solution
- providing
- Prior art date
Links
- 239000000758 substrate Substances 0.000 title abstract description 15
- KPGXRSRHYNQIFN-UHFFFAOYSA-L 2-oxoglutarate(2-) Chemical compound [O-]C(=O)CCC(=O)C([O-])=O KPGXRSRHYNQIFN-UHFFFAOYSA-L 0.000 claims abstract description 53
- 210000000056 organ Anatomy 0.000 claims abstract description 37
- 230000000302 ischemic effect Effects 0.000 claims abstract description 24
- 230000017531 blood circulation Effects 0.000 claims abstract description 13
- 238000011084 recovery Methods 0.000 claims abstract description 12
- 238000002360 preparation method Methods 0.000 claims abstract description 8
- 239000000243 solution Substances 0.000 claims description 34
- 239000000203 mixture Substances 0.000 claims description 24
- 230000002107 myocardial effect Effects 0.000 claims description 20
- 150000001413 amino acids Chemical class 0.000 claims description 18
- 239000008148 cardioplegic solution Substances 0.000 claims description 13
- 230000004060 metabolic process Effects 0.000 claims description 12
- 230000000747 cardiac effect Effects 0.000 claims description 8
- 238000001802 infusion Methods 0.000 claims description 8
- 239000000126 substance Substances 0.000 claims description 7
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- 150000002500 ions Chemical class 0.000 claims description 5
- 238000004321 preservation Methods 0.000 claims description 5
- LENZDBCJOHFCAS-UHFFFAOYSA-N tris Chemical compound OCC(N)(CO)CO LENZDBCJOHFCAS-UHFFFAOYSA-N 0.000 claims description 5
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- 150000001720 carbohydrates Chemical class 0.000 claims description 4
- 235000014633 carbohydrates Nutrition 0.000 claims description 4
- 239000000969 carrier Substances 0.000 claims description 4
- 229960002885 histidine Drugs 0.000 claims description 4
- HNDVDQJCIGZPNO-UHFFFAOYSA-N histidine Natural products OC(=O)C(N)CC1=CN=CN1 HNDVDQJCIGZPNO-UHFFFAOYSA-N 0.000 claims description 4
- 238000000034 method Methods 0.000 claims description 4
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- 150000003077 polyols Chemical class 0.000 claims description 4
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- 238000003860 storage Methods 0.000 claims description 3
- 229960000281 trometamol Drugs 0.000 claims description 3
- 239000004475 Arginine Substances 0.000 claims description 2
- AHLPHDHHMVZTML-BYPYZUCNSA-N L-Ornithine Chemical compound NCCC[C@H](N)C(O)=O AHLPHDHHMVZTML-BYPYZUCNSA-N 0.000 claims description 2
- ODKSFYDXXFIFQN-BYPYZUCNSA-P L-argininium(2+) Chemical compound NC(=[NH2+])NCCC[C@H]([NH3+])C(O)=O ODKSFYDXXFIFQN-BYPYZUCNSA-P 0.000 claims description 2
- KDXKERNSBIXSRK-YFKPBYRVSA-N L-lysine Chemical compound NCCCC[C@H](N)C(O)=O KDXKERNSBIXSRK-YFKPBYRVSA-N 0.000 claims description 2
- KDXKERNSBIXSRK-UHFFFAOYSA-N Lysine Natural products NCCCCC(N)C(O)=O KDXKERNSBIXSRK-UHFFFAOYSA-N 0.000 claims description 2
- 239000004472 Lysine Substances 0.000 claims description 2
- AHLPHDHHMVZTML-UHFFFAOYSA-N Orn-delta-NH2 Natural products NCCCC(N)C(O)=O AHLPHDHHMVZTML-UHFFFAOYSA-N 0.000 claims description 2
- UTJLXEIPEHZYQJ-UHFFFAOYSA-N Ornithine Natural products OC(=O)C(C)CCCN UTJLXEIPEHZYQJ-UHFFFAOYSA-N 0.000 claims description 2
- ODKSFYDXXFIFQN-UHFFFAOYSA-N arginine Natural products OC(=O)C(N)CCCNC(N)=N ODKSFYDXXFIFQN-UHFFFAOYSA-N 0.000 claims description 2
- 229960003121 arginine Drugs 0.000 claims description 2
- 229960003646 lysine Drugs 0.000 claims description 2
- 229960003104 ornithine Drugs 0.000 claims description 2
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- 235000013619 trace mineral Nutrition 0.000 claims description 2
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- 230000006872 improvement Effects 0.000 abstract description 2
- 239000008280 blood Substances 0.000 description 30
- 210000004369 blood Anatomy 0.000 description 30
- 229940024606 amino acid Drugs 0.000 description 17
- JVTAAEKCZFNVCJ-UHFFFAOYSA-M Lactate Chemical compound CC(O)C([O-])=O JVTAAEKCZFNVCJ-UHFFFAOYSA-M 0.000 description 10
- 238000007675 cardiac surgery Methods 0.000 description 10
- 230000010410 reperfusion Effects 0.000 description 10
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 9
- 230000006378 damage Effects 0.000 description 9
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- 229910052760 oxygen Inorganic materials 0.000 description 9
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- WHUUTDBJXJRKMK-VKHMYHEASA-N L-glutamic acid Chemical compound OC(=O)[C@@H](N)CCC(O)=O WHUUTDBJXJRKMK-VKHMYHEASA-N 0.000 description 6
- ZDXPYRJPNDTMRX-VKHMYHEASA-N L-glutamine Chemical compound OC(=O)[C@@H](N)CCC(N)=O ZDXPYRJPNDTMRX-VKHMYHEASA-N 0.000 description 6
- 229930195712 glutamate Natural products 0.000 description 6
- 229940049906 glutamate Drugs 0.000 description 6
- ZDXPYRJPNDTMRX-UHFFFAOYSA-N glutamine Natural products OC(=O)C(N)CCC(N)=O ZDXPYRJPNDTMRX-UHFFFAOYSA-N 0.000 description 6
- 229960002743 glutamine Drugs 0.000 description 6
- 210000001519 tissue Anatomy 0.000 description 6
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Natural products OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 description 5
- WQZGKKKJIJFFOK-VFUOTHLCSA-N beta-D-glucose Chemical compound OC[C@H]1O[C@@H](O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-VFUOTHLCSA-N 0.000 description 5
- 230000036770 blood supply Effects 0.000 description 5
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- 210000002027 skeletal muscle Anatomy 0.000 description 4
- 208000028399 Critical Illness Diseases 0.000 description 3
- CKLJMWTZIZZHCS-REOHCLBHSA-N L-aspartic acid Chemical compound OC(=O)[C@@H](N)CC(O)=O CKLJMWTZIZZHCS-REOHCLBHSA-N 0.000 description 3
- 229940009098 aspartate Drugs 0.000 description 3
- 150000005693 branched-chain amino acids Chemical class 0.000 description 3
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- 239000003550 marker Substances 0.000 description 3
- 210000004165 myocardium Anatomy 0.000 description 3
- 230000003647 oxidation Effects 0.000 description 3
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- 238000011282 treatment Methods 0.000 description 3
- 230000004102 tricarboxylic acid cycle Effects 0.000 description 3
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 2
- BHPQYMZQTOCNFJ-UHFFFAOYSA-N Calcium cation Chemical compound [Ca+2] BHPQYMZQTOCNFJ-UHFFFAOYSA-N 0.000 description 2
- 102000004420 Creatine Kinase Human genes 0.000 description 2
- 108010042126 Creatine kinase Proteins 0.000 description 2
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 description 2
- QIVBCDIJIAJPQS-VIFPVBQESA-N L-tryptophane Chemical compound C1=CC=C2C(C[C@H](N)C(O)=O)=CNC2=C1 QIVBCDIJIAJPQS-VIFPVBQESA-N 0.000 description 2
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- 108091005804 Peptidases Proteins 0.000 description 2
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- QIVBCDIJIAJPQS-UHFFFAOYSA-N Tryptophan Natural products C1=CC=C2C(CC(N)C(O)=O)=CNC2=C1 QIVBCDIJIAJPQS-UHFFFAOYSA-N 0.000 description 2
- 239000006035 Tryptophane Substances 0.000 description 2
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- 239000007864 aqueous solution Substances 0.000 description 2
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- 238000006731 degradation reaction Methods 0.000 description 2
- VTYGSWGUBDXCRA-UHFFFAOYSA-L dipotassium;2-oxopentanedioate Chemical compound [K+].[K+].[O-]C(=O)CCC(=O)C([O-])=O VTYGSWGUBDXCRA-UHFFFAOYSA-L 0.000 description 2
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- 239000000543 intermediate Substances 0.000 description 2
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- 239000012528 membrane Substances 0.000 description 2
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- 230000002093 peripheral effect Effects 0.000 description 2
- 239000002243 precursor Substances 0.000 description 2
- 229940024999 proteolytic enzymes for treatment of wounds and ulcers Drugs 0.000 description 2
- 229910001415 sodium ion Inorganic materials 0.000 description 2
- 239000003381 stabilizer Substances 0.000 description 2
- 238000012360 testing method Methods 0.000 description 2
- 230000000472 traumatic effect Effects 0.000 description 2
- 229960004799 tryptophan Drugs 0.000 description 2
- KPGXRSRHYNQIFN-UHFFFAOYSA-N 2-oxoglutaric acid Chemical group OC(=O)CCC(=O)C(O)=O KPGXRSRHYNQIFN-UHFFFAOYSA-N 0.000 description 1
- QTBSBXVTEAMEQO-UHFFFAOYSA-M Acetate Chemical compound CC([O-])=O QTBSBXVTEAMEQO-UHFFFAOYSA-M 0.000 description 1
- BVKZGUZCCUSVTD-UHFFFAOYSA-M Bicarbonate Chemical class OC([O-])=O BVKZGUZCCUSVTD-UHFFFAOYSA-M 0.000 description 1
- 239000002126 C01EB10 - Adenosine Substances 0.000 description 1
- 241000282472 Canis lupus familiaris Species 0.000 description 1
- KRKNYBCHXYNGOX-UHFFFAOYSA-K Citrate Chemical compound [O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O KRKNYBCHXYNGOX-UHFFFAOYSA-K 0.000 description 1
- FBPFZTCFMRRESA-KVTDHHQDSA-N D-Mannitol Chemical compound OC[C@@H](O)[C@@H](O)[C@H](O)[C@H](O)CO FBPFZTCFMRRESA-KVTDHHQDSA-N 0.000 description 1
- HMFHBZSHGGEWLO-SOOFDHNKSA-N D-ribofuranose Chemical compound OC[C@H]1OC(O)[C@H](O)[C@@H]1O HMFHBZSHGGEWLO-SOOFDHNKSA-N 0.000 description 1
- 229930091371 Fructose Natural products 0.000 description 1
- RFSUNEUAIZKAJO-ARQDHWQXSA-N Fructose Chemical compound OC[C@H]1O[C@](O)(CO)[C@@H](O)[C@@H]1O RFSUNEUAIZKAJO-ARQDHWQXSA-N 0.000 description 1
- 239000005715 Fructose Substances 0.000 description 1
- 102000009127 Glutaminase Human genes 0.000 description 1
- 108010073324 Glutaminase Proteins 0.000 description 1
- 108010024636 Glutathione Proteins 0.000 description 1
- 229920002527 Glycogen Polymers 0.000 description 1
- 208000010496 Heart Arrest Diseases 0.000 description 1
- 206010061216 Infarction Diseases 0.000 description 1
- 102000004877 Insulin Human genes 0.000 description 1
- 108090001061 Insulin Proteins 0.000 description 1
- 206010022489 Insulin Resistance Diseases 0.000 description 1
- 108010044467 Isoenzymes Proteins 0.000 description 1
- 229930195725 Mannitol Natural products 0.000 description 1
- 208000034486 Multi-organ failure Diseases 0.000 description 1
- 208000010718 Multiple Organ Failure Diseases 0.000 description 1
- 229910019142 PO4 Inorganic materials 0.000 description 1
- ZLMJMSJWJFRBEC-UHFFFAOYSA-N Potassium Chemical compound [K] ZLMJMSJWJFRBEC-UHFFFAOYSA-N 0.000 description 1
- 208000001647 Renal Insufficiency Diseases 0.000 description 1
- PYMYPHUHKUWMLA-LMVFSUKVSA-N Ribose Natural products OC[C@@H](O)[C@@H](O)[C@@H](O)C=O PYMYPHUHKUWMLA-LMVFSUKVSA-N 0.000 description 1
- 206010040047 Sepsis Diseases 0.000 description 1
- 239000007983 Tris buffer Substances 0.000 description 1
- 239000000654 additive Substances 0.000 description 1
- 229960005305 adenosine Drugs 0.000 description 1
- 230000002411 adverse Effects 0.000 description 1
- 150000004716 alpha keto acids Chemical class 0.000 description 1
- HMFHBZSHGGEWLO-UHFFFAOYSA-N alpha-D-Furanose-Ribose Natural products OCC1OC(O)C(O)C1O HMFHBZSHGGEWLO-UHFFFAOYSA-N 0.000 description 1
- 230000037354 amino acid metabolism Effects 0.000 description 1
- 239000003242 anti bacterial agent Substances 0.000 description 1
- 229940088710 antibiotic agent Drugs 0.000 description 1
- 210000000709 aorta Anatomy 0.000 description 1
- 150000007514 bases Chemical class 0.000 description 1
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- 230000000975 bioactive effect Effects 0.000 description 1
- 230000037396 body weight Effects 0.000 description 1
- 239000000872 buffer Substances 0.000 description 1
- 230000003293 cardioprotective effect Effects 0.000 description 1
- 230000005779 cell damage Effects 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 230000007012 clinical effect Effects 0.000 description 1
- 210000003748 coronary sinus Anatomy 0.000 description 1
- 230000002596 correlated effect Effects 0.000 description 1
- 230000000875 corresponding effect Effects 0.000 description 1
- 239000008121 dextrose Substances 0.000 description 1
- 238000005265 energy consumption Methods 0.000 description 1
- 230000002255 enzymatic effect Effects 0.000 description 1
- 239000003797 essential amino acid Substances 0.000 description 1
- 235000020776 essential amino acid Nutrition 0.000 description 1
- 238000004108 freeze drying Methods 0.000 description 1
- 229960003180 glutathione Drugs 0.000 description 1
- 229940096919 glycogen Drugs 0.000 description 1
- 238000005534 hematocrit Methods 0.000 description 1
- 230000007574 infarction Effects 0.000 description 1
- 239000003978 infusion fluid Substances 0.000 description 1
- 230000002401 inhibitory effect Effects 0.000 description 1
- 229940125396 insulin Drugs 0.000 description 1
- 230000003993 interaction Effects 0.000 description 1
- 210000000936 intestine Anatomy 0.000 description 1
- 230000003834 intracellular effect Effects 0.000 description 1
- 208000037906 ischaemic injury Diseases 0.000 description 1
- 201000006370 kidney failure Diseases 0.000 description 1
- 230000000670 limiting effect Effects 0.000 description 1
- 210000004185 liver Anatomy 0.000 description 1
- 229910001629 magnesium chloride Inorganic materials 0.000 description 1
- 239000000594 mannitol Substances 0.000 description 1
- 235000010355 mannitol Nutrition 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 230000002503 metabolic effect Effects 0.000 description 1
- 230000037323 metabolic rate Effects 0.000 description 1
- 239000002207 metabolite Substances 0.000 description 1
- 208000029744 multiple organ dysfunction syndrome Diseases 0.000 description 1
- 208000031225 myocardial ischemia Diseases 0.000 description 1
- 229910052757 nitrogen Inorganic materials 0.000 description 1
- 235000015097 nutrients Nutrition 0.000 description 1
- 230000036284 oxygen consumption Effects 0.000 description 1
- 230000000144 pharmacologic effect Effects 0.000 description 1
- 235000021317 phosphate Nutrition 0.000 description 1
- 150000003013 phosphoric acid derivatives Chemical class 0.000 description 1
- 239000001103 potassium chloride Substances 0.000 description 1
- WCUXLLCKKVVCTQ-UHFFFAOYSA-M potassium chloride Inorganic materials [Cl-].[K+] WCUXLLCKKVVCTQ-UHFFFAOYSA-M 0.000 description 1
- 235000011164 potassium chloride Nutrition 0.000 description 1
- 229910001414 potassium ion Inorganic materials 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 238000001243 protein synthesis Methods 0.000 description 1
- 102000004169 proteins and genes Human genes 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 230000017854 proteolysis Effects 0.000 description 1
- 230000009467 reduction Effects 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
- 235000017557 sodium bicarbonate Nutrition 0.000 description 1
- 229910000030 sodium bicarbonate Inorganic materials 0.000 description 1
- FAPWRFPIFSIZLT-UHFFFAOYSA-M sodium chloride Inorganic materials [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 238000001694 spray drying Methods 0.000 description 1
- 239000013589 supplement Substances 0.000 description 1
- 235000021476 total parenteral nutrition Nutrition 0.000 description 1
- 230000014616 translation Effects 0.000 description 1
- 238000002054 transplantation Methods 0.000 description 1
- 208000001072 type 2 diabetes mellitus Diseases 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
- A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
- A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/205—Amine addition salts of organic acids; Inner quaternary ammonium salts, e.g. betaine, carnitine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
- A61K31/4164—1,3-Diazoles
- A61K31/4172—Imidazole-alkanecarboxylic acids, e.g. histidine
Definitions
- the present invention is directed to alpha-ketoglutarate containing infusible energy substrate preparations and the uses thereof.
- the preparations are advantageous by their capacity in improving the ischemic tolerance of organs interrupted from their regular blood flow and in the improvement of the recovery of such organs.
- Amino acid enriched cardioplegic solutions are described by e.g. the U.S. patent 4,988,515 wherein an improved glutamate/aspartate containing cardioplegic solution is described.
- This document shows how a cardioplegic solution with a specific calcium ion concentration range and osmolality range improves cardiac recovery from ischemia after interrupting the blood flow to dogs' hearts.
- Concentrated aqueous solutions of the amino acids, calcium ion and glucose are mixed with other standard additives and a cardioplegia compatible diluent or carrier, such as blood, stroma free haemoglobin, oxygenated plasma, crystalloids and fluorocarbons.
- a cardioplegia compatible diluent or carrier such as blood, stroma free haemoglobin, oxygenated plasma, crystalloids and fluorocarbons.
- HTK -s olution histidine-tryptophane-ketoglutarate
- the HTK- solution is intended to be used clinically, immediately after aortic cross clamping when a cold solution (4 to 8°C) is infused into the coronary system for 6 to 10 min.
- a cold solution (4 to 8°C)
- the heart muscle will be arrested, the myocardial temperature decreases from 37°C to 10°C and the ⁇ 2-consumption decreases from about 7 to 0.1 ml/min/100 g.
- the low content of alpha-ketoglutarate comprised in the HTK-solutions might be regarded as attempts to recreate the original intracellular conditions in the heart after it has been interrupted from its normal blood supply.
- the German patent application DE 39 43424 teaches a parenteral composition of alpha-ketoacid analogues to certain essential amino acids to be used as a nutrient supply for patients with renal insufficiency that cannot tolerate amino acids.
- the solutions can contain 15 g/1 of alpha-ketoglutarate.
- a nutritional composition containing 5 to 25 g/litre of alpha-ketoglutarate is disclosed to improve the negative nitrogen balance and protein catabolism that occurs in postoperative and post traumatic states.
- the International patent application WO 93/23027 discloses an infusible composition providing more than 0.25 g/kg body weight/ day of alpha-ketoglutarate to critically ill patients in order to improve the protein synthesis capacity and to maintain the energy level in skeletal muscle tissue.
- the alpha-ketoglutarate amount exceeds 17.5 g/1, preferably more than 25 g/1 in a 1 1 amino acid solution per day dose, which for a 70 kg patient will correspond to more than 0.25 g/kg bw and day when administered with conventional total parenteral nutrition constituents.
- This disclosure is generally directed to the treatment of such critically ill patients having more than a 50% depletion of their glutamine pool in the skeletal muscles, who suffer from severe complications like sepsis and multiple organ failure. It does, accordingly, not reveal anything about the specific energy substrate requirements in the post-traumatic heart or any other vital organs subjected to ischemia, for example, during bypass surgery or during preservation of organs for transplantation.
- the heart metabolism is altered so that its substrate uptake is insufficient with respect to its oxygen consumption.
- This condition seems to lead to a catabolic status where the myocardial tissue utilizes endogenous substrates such as glycogen and also, to a large extent amino acids rather than free fatty acids (FFA), glucose or lactate which are the normal substrates in the energy production of the heart.
- FFA free fatty acids
- glucose or lactate which are the normal substrates in the energy production of the heart.
- the change in metabolism is most expressed during the first hours after the trauma, whereupon the metabolism is gradually normalised for about eight hours.
- the present invention is directed to new highly concentrated alpha-ketoglutarate containing energy substrates, uses thereof as well as methods involving said compositions.
- the preparations are especially useful for preventing the myocardial tissue from ischemic damages during cardiac surgery, thereby reducing the postoperative morbidity and the need for postoperative intensive care.
- the present invention is related to compositions providing a total parenterally infused dosage of 5 to 250 gram alpha-ketoglutarate for improving the ischemic tolerance of vital organs interrupted from their regular blood flow and for improving the recovery and /or normal metabolism of such organs.
- the compositions shall provide the patient with total amounts of between 5 to 50 g alpha-ketoglutarate, and more preferably from 10 to 30 g alpha-ketoglutarate.
- compositions are intended to be used as energy substrates, useful for preventing organs from damages during surgery, or other critical conditions when the blood supply to a vital organ is interrupted, such as the first phase after a myocardial infarction or for perfusion and preservation of organs that shall be transplanted.
- compositions of the according invention shall preferably be capable of providing an alpha-ketoglutarate level of about 5 to 100 mM in the fluid passing through the organ interrupted from its normal blood flow and more preferably about 10 to 50 mM. Uses of the compositions and methods of their clinical applications also are apparent from the appended claims.
- compositions will preferably be in a dry powdered form, prepared by methods like lyophilisation or spray drying, that can be readily reconstituted to an administerable solution, just prior to the use. It is advantageous to provide such preparations in sterilizable multi-compartment packages or kits, wherein the solid alpha-ketoglutarate and the reconstitution solution are kept apart during the storage.
- the person skilled in the art is familiar with numerous solutions to this type of technical problems which therefore not will be discussed in more detail.
- the reconstitution solution will consist of a carrier or diluent that is suitable for a composition of the intended type of administration, that can be, for example, a cardioplegical solution, a solution to be administered to the heart just after a myocardial infarction, an infusion solution to be administered to other vital organs subjected to an insufficient blood flow, a solution to be used in connection with a surgical procedure of a vital organ, e.g. for peri- or postoperative administration and a solution useful in the storage and perfusion of organs to be transplanted.
- a carrier or diluent that is suitable for a composition of the intended type of administration, that can be, for example, a cardioplegical solution, a solution to be administered to the heart just after a myocardial infarction, an infusion solution to be administered to other vital organs subjected to an insufficient blood flow, a solution to be used in connection with a surgical procedure of a vital organ, e.g. for peri- or postoperative
- Each suitable carrier or diluent can further contain other specifically adapted, but conventional constituents in the form of energy substrates, such as carbohydrates, amino acids, polyols, buffering agents, electrolytes, stabilizers and certain trace elements, as will be disclosed in more detail below. It would also, of course, if necessary due to stability reasons, be possible to incorporate such constituents also in dry, reconstitutible form, either together with the alpha-ketoglutarate, or separately.
- Suitable counter ions are tromethamine (2-amino-2- hydroxymethyl-l,3-propanediol or THAM), ornithine, lysine, histidine and arginine.
- suitable conventionally used vehicles such as extracorporeal blood from the patient in blood cardioplegia, crystalloid solutions, oxygenated plasma and transfusion emulsions containing synthetic oxygen carriers.
- the parenteral infusion rate of a solution containing a total dosage of 5 to 250 g alpha-ketoglutarate intended to prevent ischemic damages in an organ will vary considerably due to the condition it shall be used for and the desired length of the dosage.
- the infusion rates will vary between 0.5 g/h and 100 g/h.
- Solutions infused to patients subjected to cardiac surgery or during the first phase after a myocardial infarction shall supply a total amount of alpha-ketoglutarate of at least 5 to 250 g, preferably between 5 to 50 g, and more preferably from 10 to 30 g, either during intermittent or continuous administration.
- a suitable solution for cardioplegic use can contain totally about 20 to 30 of alpha ketoglutarate and be diluted with extracorporeal blood and intermittently infused to the heart by the aorta during cardiac surgery.
- the alpha-ketoglutarate containing solutions, for administration to organs interrupted from their regular blood flow, can, added to their carriers or diluents, contain suitable amounts of electrolytes such as sodium, potassium, and magnesium chloride, bicarbonates and phosphates; suitable carbohydrates, such as glucose, fructose, dextrose, ribose, mannitol and other polyols; amino acids, such as aspartate, glutamate, glutamine, histidine, tryptophane and branch chained amino acids can be included in the solution; as well as suitable buffering agents, such as citrate, acetate and tromethamine (tris buffer); and also certain other bioactive constituents, such as insulin, glutathione, adenosine and antibiotics, if desirable for a specific clinical application.
- electrolytes such as sodium, potassium, and magnesium chloride, bicarbonates and phosphates
- suitable carbohydrates such as glucose, fructose, dextrose, ribose,
- Alpha-ketoglutarate containing solutions useful for perfusion and preservation of organs shall preferably comprise carriers suitable for such fluids like oxygen carrying emulsions. In addition they may comprise other suitable energy substrates, amino acids, electrolytes, carbohydrates, buffering agents, and stabilizers.
- alpha-ketoglutarate has a surprisingly high capacity in making vital organs, like the heart, to withstand ischemic conditions, which can not only be explained by its property as an energy substrate, but must also be explained by an influence on the activity of the induced proteolysis and /or degradation of contractile elements in the damaged tissues.
- Patients in the control group received blood cardioplegia comprising blood from the extracorporeal circuit (hematocrit 25%) and Plegisol ® (from Abbott) containing 15 mmol KC1/500 ml and 5 ml sodium bicarbonate 8.4%.
- Blood and Plegisol® were mixed at a 4:1 ratio and delivered with a pump and a heat exchanger.
- 1000 ml of the cardioplegic solution was delivered through a cannula in the aortic root at a rate of 260 ml/min.
- Another dose of 500 ml blood cardioplegia was infused after the completion of each peripheral anastomosis.
- the temperature of the blood cardioplegia was 8°C.
- the final cardioplegia dose was given with the blood cardioplegia rewarmed to 30°C.
- the terminal warm dose was given with at least 500 ml, or more, until the septal temperature reached 25°C.
- the aortic cross-clamp was thereafter released so that the heart was reperfused in a normal manner.
- alpha-ketoglutarate allocated patients, 30 grams of alpha- ketoglutarate were added to 500 ml Plegisol®, and delivered with the blood cardioplegia, which was delivered exactly as described with the control patients. Depending on the duration of the cardioplegic ischemia, this regimen resulted in that a total dose of 15 to 30 grams of alpha-ketoglutarate was delivered.
- Figure 1 shows myocardial oxygen extraction (aerobic capacity) during cold (4 to 8) and warm (9) cardioplegia and after blood cardioplegia
- FIG. 1 shows myocardial lactate release (mean ⁇ SEM) in control patients and in patients treated with alpha-ketoglutarate, during cold (4 to 8) and warm (9) cardioplegia and after blood cardioplegia (during reperfusion 10 to 12). The release of lactate, reflecting anaerobic oxidation, was greater in the alpha-ketoglutarate treated patients, as signified by a more negative value.
- Figure 3 gives the blood concentration in arterial blood of ischemic marker CK-MB (representing myocardial dysfunction and membrane leak), means ⁇ SEM of the two study groups, during blood cardioplegia (2 to 9) and during 4 hours reperfusion (10 to 15).
- CK-MB is used as a marker for myocardial ischemia.
- the lower concentrations in the alpha-ketoglutarate group indicates that alpha-ketoglutarate protects the heart from ischemia to a higher degree.
- Figure 4 gives similar data for troponine-t during blood cardioplegia and reperfusion.
- Troponine-t is a highly cardiospecific substance signifying myocardial ischemic injury.
- alpha ketoglutarate in the infused doses of totally 15 to 25 gram leads to a doubled myocardial aerobic capacity during blood cardioplegia and increased with 70% during the early reperfusion period.
- the anaerobic metabolic capacity, represented by myocardial release of lactate is demonstrated to be doubled during cardioplegia and tripled during the early reperfusion if an alpha-ketoglutarate containing solution is infused.
- the myocardial release of lactate had ceased within 1 hour when alpha- ketoglutarate in pharmacological doses had been added to the blood cardioplegia, while it was maintained in the control patients. This implies that aerobic metabolism was normalized quicker with alpha-ketoglutarate.
- the r-values represent the correlation coefficients for the oxygen extraction and the lactate release of the myocardium, 5 minutes after reperfusion, when correlated to the arterial level 4 hours later.
- troponine-t can be regarded as a marker of the induced activity of proteolytic enzymes during the ischemic events. This suggests that alpha- keto glutarate not only is active as an energy substrate for the myocardium, but also is active in inhibiting the catabolism during the ischemia by reducing the degradation of contractile elements in the myocardial tissue and /or inhibit proteolytic enzymes.
- an alpha-ketoglutarate containing cardioplegic solution provides an improved myocardial protection during cardiac surgery and enhances the recovery of the heart, which is an important finding, since cardiac dysfunction is one of the major problems in cardiac surgery.
- the invention is therefore likely to have significant clinical effects.
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Abstract
Préparations infusibles sous forme de substrats énergétiques renfermant de l'alpha-cétoglutarate, et leurs applications. Ces préparations sont avantageuses en ce qu'elles peuvent améliorer la tolérance ischémique des organes dans lesquels le débit sanguin normal a été interrompu, et le rétablissement de ces organes.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU27584/95A AU2758495A (en) | 1994-06-10 | 1995-06-09 | Energy substrates |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
SE9402027-8 | 1994-06-10 | ||
SE9402027A SE9402027D0 (sv) | 1994-06-10 | 1994-06-10 | Energy substrates |
Publications (1)
Publication Number | Publication Date |
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WO1995034301A1 true WO1995034301A1 (fr) | 1995-12-21 |
Family
ID=20394327
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/SE1995/000698 WO1995034301A1 (fr) | 1994-06-10 | 1995-06-09 | Substrats energetiques |
Country Status (4)
Country | Link |
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AU (1) | AU2758495A (fr) |
SE (1) | SE9402027D0 (fr) |
WO (1) | WO1995034301A1 (fr) |
ZA (1) | ZA954775B (fr) |
Cited By (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5880098A (en) * | 1996-04-12 | 1999-03-09 | Pharmacia & Upjohn Aktiebolag | Therapeutic treatment |
US6207658B1 (en) | 1996-01-11 | 2001-03-27 | University Of Florida Research Foundation, Inc. | Preservation of tissue during removal storage and implantation |
WO2006016828A2 (fr) * | 2004-08-12 | 2006-02-16 | Sgp & Sons Ab | Nouvelle utilisation de composes chimiques connus pharmaceutiquement actifs |
WO2006127902A1 (fr) * | 2005-05-26 | 2006-11-30 | Ben O'mar Arrington | Solution de preservation d'organes et de tissus biologiques |
WO2007122190A1 (fr) * | 2006-04-21 | 2007-11-01 | Sgp & Sons Ab | Nouveaux procedes et leur utilisation |
WO2009005464A1 (fr) * | 2007-07-02 | 2009-01-08 | Entress Ab | Nouvelle utilisation de composés chimiques pharmacologiquement actifs connus |
WO2017192413A1 (fr) | 2016-05-01 | 2017-11-09 | The Regents Of The University Of California | Composés glutarate pour le traitement de lésions d'ischémie-reperfusion |
US11998564B2 (en) | 2018-12-14 | 2024-06-04 | National Taiwan University | Stable cardioplegic solution for cardiac surgery |
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US4415556A (en) * | 1980-12-23 | 1983-11-15 | Dr. Franz Kohler Chemie Gmbh | Protective solution for heart and kidney and process for its preparation |
WO1988001861A1 (fr) * | 1986-09-17 | 1988-03-24 | Baxter Travenol Laboratories, Inc. | Apport nutritionnel ou therapie pour personnes susceptibles de souffrir de maladies atherosclereuses, vasculaires, cardiovasculaires et/ou thrombotiques ou en traitement pour ces maladies |
WO1989003688A1 (fr) * | 1987-10-29 | 1989-05-05 | Ab Erik Vinnars | Composition d'amino acide destinee au soutien nutritionnel parenteral et son utilisation |
US4988515A (en) * | 1988-01-28 | 1991-01-29 | The Regents Of The Univ. Of Calif. | Cardioplegic solution |
DE3943424A1 (de) * | 1989-12-30 | 1991-07-04 | Nephro Medica Pharma | Infusions- und injektionsloesung zur intravenoesen verabreichung |
WO1993023027A1 (fr) * | 1992-05-20 | 1993-11-25 | Ab Erik Vinnars | Utilisation de l'alpha-cetoglutarate |
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1994
- 1994-06-10 SE SE9402027A patent/SE9402027D0/xx unknown
-
1995
- 1995-06-09 ZA ZA954775A patent/ZA954775B/xx unknown
- 1995-06-09 WO PCT/SE1995/000698 patent/WO1995034301A1/fr active Application Filing
- 1995-06-09 AU AU27584/95A patent/AU2758495A/en not_active Abandoned
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US4415556A (en) * | 1980-12-23 | 1983-11-15 | Dr. Franz Kohler Chemie Gmbh | Protective solution for heart and kidney and process for its preparation |
WO1988001861A1 (fr) * | 1986-09-17 | 1988-03-24 | Baxter Travenol Laboratories, Inc. | Apport nutritionnel ou therapie pour personnes susceptibles de souffrir de maladies atherosclereuses, vasculaires, cardiovasculaires et/ou thrombotiques ou en traitement pour ces maladies |
WO1989003688A1 (fr) * | 1987-10-29 | 1989-05-05 | Ab Erik Vinnars | Composition d'amino acide destinee au soutien nutritionnel parenteral et son utilisation |
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DE3943424A1 (de) * | 1989-12-30 | 1991-07-04 | Nephro Medica Pharma | Infusions- und injektionsloesung zur intravenoesen verabreichung |
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Cited By (16)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6207658B1 (en) | 1996-01-11 | 2001-03-27 | University Of Florida Research Foundation, Inc. | Preservation of tissue during removal storage and implantation |
US5880098A (en) * | 1996-04-12 | 1999-03-09 | Pharmacia & Upjohn Aktiebolag | Therapeutic treatment |
WO2006016828A2 (fr) * | 2004-08-12 | 2006-02-16 | Sgp & Sons Ab | Nouvelle utilisation de composes chimiques connus pharmaceutiquement actifs |
WO2006016828A3 (fr) * | 2004-08-12 | 2006-06-08 | Sgp & Sons Ab | Nouvelle utilisation de composes chimiques connus pharmaceutiquement actifs |
EP1887862A4 (fr) * | 2005-05-26 | 2012-06-06 | Ben O'mar Arrington | Solution de preservation d'organes et de tissus biologiques |
EP1887862A1 (fr) * | 2005-05-26 | 2008-02-20 | Arrington, Ben O'Mar | Solution de preservation d'organes et de tissus biologiques |
WO2006127902A1 (fr) * | 2005-05-26 | 2006-11-30 | Ben O'mar Arrington | Solution de preservation d'organes et de tissus biologiques |
WO2007122190A1 (fr) * | 2006-04-21 | 2007-11-01 | Sgp & Sons Ab | Nouveaux procedes et leur utilisation |
WO2009005464A1 (fr) * | 2007-07-02 | 2009-01-08 | Entress Ab | Nouvelle utilisation de composés chimiques pharmacologiquement actifs connus |
WO2017192413A1 (fr) | 2016-05-01 | 2017-11-09 | The Regents Of The University Of California | Composés glutarate pour le traitement de lésions d'ischémie-reperfusion |
CN109417016A (zh) * | 2016-05-01 | 2019-03-01 | 加州大学董事会 | 用于治疗缺血-再灌注损伤的戊二酸化合物 |
US10285962B2 (en) | 2016-05-01 | 2019-05-14 | The Regents Of The University Of California | Glutarate compounds for treating ischemia-reperfusion injuries |
US10500177B2 (en) | 2016-05-01 | 2019-12-10 | The Regents Of The University Of California | Glutarate compounds for treating ischemia-reperfusion injuries |
EP3453046A4 (fr) * | 2016-05-01 | 2020-01-08 | The Regents of the University of California | Composés glutarate pour le traitement de lésions d'ischémie-reperfusion |
US11007163B2 (en) | 2016-05-01 | 2021-05-18 | The Regents Of The University Of California | Glutarate compounds for treating ischemia-reperfusion injuries |
US11998564B2 (en) | 2018-12-14 | 2024-06-04 | National Taiwan University | Stable cardioplegic solution for cardiac surgery |
Also Published As
Publication number | Publication date |
---|---|
ZA954775B (en) | 1996-02-08 |
AU2758495A (en) | 1996-01-05 |
SE9402027D0 (sv) | 1994-06-10 |
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