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eComment: Carbon monoxide and its vasodilatative properties: another good reason for clinical implication

Department of Anesthesiology and Critical Care Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany

Carbon monoxide induces relaxation of human internal thoracic and radial arterial grafts

We read with great interest the paper by Dr. Achouh and colleagues [1]. In this particular research project, the authors investigated the effect of carbon monoxide as a relaxation-inducing drug on isolated human artery grafts. They conclude that carbon monoxide increases vasodilatation in arterial grafts independent of epithelial function via a cyclic guanosinmonophosphate but not nitric oxide related pathway. The authors should be congratulated on their excellent experimental design and results. We think that the idea of using carbon monoxide as a potential therapeutic agent is tempting. Many other studies have shown antiapoptotic, anti-inflammatory, and antiproliferative effects through carbon monoxide inhalation, carbon monoxide releasing molecules, and heme oxygenase-1 in different organ systems [2–4]. The results of Achouh and colleagues may contribute to enhance protective strategies concerning coronary artery bypass grafting and related vasospasms.

We would like to discuss a few points regarding the application and the time-dependent effects of carbon monoxide. First, in this paper, the authors mentioned that carbon monoxide application was achieved by flushing the organ bath chamber with a flow of 2 l/min. The authors should explain how quantification of carbon monoxide in the Krebs solution was performed and, accordingly, how many parts per million would be necessary to achieve a comparable effect in an in vivo model? Secondly, did the authors analyze the time until full capability of contractility was retrieved? This way, short-term effects could be distinguished from long-lasting effects of significant clinical relevance.

The effects of carbon monoxide releasing molecules such as carbon monoxide releasing molecule [CORM]-2 are well described, although CORM-2 is only soluble in dimethylsulfoxide (DMSO) and, therefore, not applicable for any in vivo study. Recent evidence of CORM-3 – which is water-soluble – suggests that the endothelium plays a major role in vasodilation [5]. We suggest that the authors consider using CORM-3 (or higher) in their future studies in view of potential clinical settings treating arterial spasms. We congratulate the authors for their promising results and suggest that they consider using CORM-3 or a non-toxic dosage of inhalative carbon monoxide for their future research. We are delighted to see that there might be another good reason for low-dose inhalative carbon monoxide in cardiac surgery.

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Top References

 

1. Achouh PE, Simonet S, Fabiani JN, Verbeuren TJ. Carbon monoxide induces relaxation of human internal thoracic and radial arterial grafts. Interact CardioVasc Thorac Surg 2008;7:959–963.[Abstract/Free Full Text]
2. Goebel U, Siepe M, Mecklenburg A, Stein P, Roesslein M, Schwer CI, Schmidt R, Doenst T, Geiger KK, Pahl HL, Schlensak C, Loop T. Carbon monoxide inhalation reduces pulmonary inflammatory response during cardiopulmonary bypass in pigs. Anesthesiology 2008;108:1025–1036.[CrossRef][Medline]
3. Goebel U, Siepe M, Mecklenburg A, Doenst T, Beyersdorf F, Loop T, Schlensak C. Reduced pulmonary inflammatory response during cardiopulmonary bypass: effects of combined pulmonary perfusion and carbon monoxide inhalation. Eur J Cardiothorac Surg, doi:10.1016/j.ejcts.2008.07.031.[Abstract/Free Full Text]
4. Nakao A, Faleo G, Shimizu H, Nakahira K, Kohmoto J, Sugimoto R, Choi AM, McCurry KR, Takahashi T, Murase N. Ex vivo carbon monoxide prevents cytochrome P450 degradation and ischemia/reperfusion injury of kidney grafts. Kidney Int 2008;74:1009–1016.[CrossRef][Medline]
5. Foresti R, Hammad J, Clark JE, Johnson TR, Mann BE, Friebe A, Green CJ, Motterlini R. Vasoactive properties of CORM-3, a novel water-soluble carbon monoxide-releasing molecule. Br J Pharmacol 2004;142:453–460.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Matthias Siepe Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goebel, U. Articles by Siepe, M. Search for Related Content PubMed PubMed Citation Articles by Goebel, U. Articles by Siepe, M. Related Collections Related Article