Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1983 Feb;197(2):220–225. doi: 10.1097/00000658-198302000-00016

Therapeutic benefits of 5-hydroxytryptamine inhibition following pulmonary embolism.

W V Huval, M A Mathieson, L I Stemp, B M Dunham, A G Jones, D Shepro, H B Hechtman
PMCID: PMC1353113  PMID: 6824376

Abstract

The smooth muscle-constricting, platelet amine, serotonin (5-hydroxytryptamine; 5-HT) is theorized to play an important role in the cardiopulmonary dysfunction that accompanies embolization. The present study was designed to examine this hypothesis. Autologous clot, 0.75 g/kg, was injected IV into 14 dogs. After 30 minutes, one half of the animals were randomly assigned to the treatment group and received a bolus infusion of 0.15 mg/kg ketanserin, a quinazoline derivative known to be a selective 5-HT receptor antagonist. Five minutes after embolization there were increases in mean pulmonary arterial pressure (MPAP) from 12 mm to 48 mmHg (p less than 0.001); pulmonary vascular resistance (PVR) from 2.2 mm to 12.2 mmHg X min/L (p less than 0.001); physiologic shunt (QS/QT) from 12% to 44% (p less than 0.01); and physiologic dead space (VD/VT), calculated from end tidal and arterial PCO2, from 8% to 39% (p less than 0.001). Within 15 minutes platelet counts decreased from 186,000/mm3 to 134,800/mm3 (p less than 0.05); 5-HT contained in circulating platelets fell from 1.71 micrograms/ to 1.44 micrograms/10(9) platelets (p less than 0.05). Five minutes after ketanserin, MPAP declined to 27 mmHg and was lower than the control value of 41 mmHg (p less than 0.05); PVR decreased to 6.2 mmHg X min/L, lower than 12 mmHg X min/L in controls (p less than 0.01); QS/QT fell to 26% in contrast to 47% in controls (p less than 0.05); and VD/VT declined moderately to 32% (p less than 0.05), although this value was not different from 38% in control animals. Cardiopulmonary function continued to improve in treated animals until termination of the experiment at four hours when pulmonary angiograms and perfusion scans demonstrated vascular recruitment compared with untreated embolized control dogs. These data demonstrate that the cardiopulmonary consequences of experimental embolization are primarily determined by the vasoconstrictive and bronchoconstrictive actions of 5-HT.

Full text

PDF
220

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. COMROE J. H., Jr, VAN LINGEN B., STROUD R. C., RONCORONI A. Reflex and direct cardiopulmonary effects of 5-OH-tryptamine (serotonin); their possible role in pulmonary embolism and coronary thrombosis. Am J Physiol. 1953 Jun;173(3):379–386. doi: 10.1152/ajplegacy.1953.173.3.379. [DOI] [PubMed] [Google Scholar]
  2. Colebatch H. J., Olsen C. R., Nadel J. A. Effect of histamine, serotonin, and acetylcholine on the peripheral airways. J Appl Physiol. 1966 Jan;21(1):217–226. doi: 10.1152/jappl.1966.21.1.217. [DOI] [PubMed] [Google Scholar]
  3. Gaudet R. J., Alam I., Levine L. Accumulation of cyclooxygenase products of arachidonic acid metabolism in gerbil brain during reperfusion after bilateral common carotid artery occlusion. J Neurochem. 1980 Sep;35(3):653–658. doi: 10.1111/j.1471-4159.1980.tb03704.x. [DOI] [PubMed] [Google Scholar]
  4. Hechtman H. B., Lonergan E. A., Shepro D. Platelet and leukocyte lung interactions in patients with respiratory failure. Surgery. 1978 Feb;83(2):155–163. [PubMed] [Google Scholar]
  5. Levine L., Alam I., Langone J. J. The use of immobilized ligands and [125I]protein a for immunoassays of thromboxane B2, prostaglandin D2, 13,14-dihydro-prostaglandin E2, 5,6-dihydro-prostaglandin I2, 6-keto-prostaglandin F1 alpha, 15-hydroxy-9 alpha, 11 alpha(epoxymethano)prosta-5,13-dienoic acid and 15-hydroxy-11 alpha,9 alpha(epoxymethano)prosta-5,13-dienoic acid. Prostaglandins Med. 1979 Mar;2(3):177–189. doi: 10.1016/0161-4630(79)90035-1. [DOI] [PubMed] [Google Scholar]
  6. Leysen J. E., Awouters F., Kennis L., Laduron P. M., Vandenberk J., Janssen P. A. Receptor binding profile of R 41 468, a novel antagonist at 5-HT2 receptors. Life Sci. 1981 Mar 2;28(9):1015–1022. doi: 10.1016/0024-3205(81)90747-5. [DOI] [PubMed] [Google Scholar]
  7. Leysen J. E., Niemegeers C. J., Tollenaere J. P., Laduron P. M. Serotonergic component of neuroleptic receptors. Nature. 1978 Mar 9;272(5649):168–171. doi: 10.1038/272168a0. [DOI] [PubMed] [Google Scholar]
  8. Mlczoch J., Tucker A., Weir E. K., Reeves J. T., Grover R. F. Platelet-mediated pulmonary hypertension and hypoxia during pulmonary microembolism: reduction by platelet inhibition. Chest. 1978 Dec;74(6):648–653. doi: 10.1378/chest.74.6.648. [DOI] [PubMed] [Google Scholar]
  9. Puckett C. L., Gervin A. S., Rhodes G. R., Silver D. Role of platelets and serotonin in acute massive pulmonary embolism. Surg Gynecol Obstet. 1973 Oct;137(4):618–622. [PubMed] [Google Scholar]
  10. Rosoff C. B., Salzman E. W., Gurewich V. Reduction of platelet serotonin and the response to pulmonary emboli. Surgery. 1971 Jul;70(1):12–19. [PubMed] [Google Scholar]
  11. Spannhake E. W., Levin J. L., Mellion B. T., Gruetter C. A., Hyman A. L., Kadowitz P. J. Reversal of 5HT-induced bronchoconstriction by PGI2: distribution of central and peripheral actions. J Appl Physiol Respir Environ Exerc Physiol. 1980 Sep;49(3):521–527. doi: 10.1152/jappl.1980.49.3.521. [DOI] [PubMed] [Google Scholar]
  12. Utsonomiya T., Krausz M. M., Levine L., Shepro D., Hechtman H. B. Thromboxane mediation of cardiopulmonary effects of embolism. J Clin Invest. 1982 Aug;70(2):361–368. doi: 10.1172/JCI110625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Utsunomiya T., Krausz M. K., Dunham B., Levine L., Shepro D., Hechtman H. B. Circulating negative inotropic agent(s) following pulmonary embolism. Surgery. 1982 Apr;91(4):402–408. [PubMed] [Google Scholar]
  14. Utsunomiya T., Krausz M. M., Shepro D., Hechtman H. B. Prostaglandin control of plasma and platelet 5-hydroxytryptamine in normal and embolized animals. Am J Physiol. 1981 Nov;241(5):H766–H771. doi: 10.1152/ajpheart.1981.241.5.H766. [DOI] [PubMed] [Google Scholar]
  15. Utsunomiya T., Krausz M. M., Valeri C. R., Levine L., Shepro D., Hechtman H. B. Treatment of pulmonary embolism with positive end-expiratory pressure and prostaglandin E1. Surg Gynecol Obstet. 1981 Aug;153(2):161–168. [PubMed] [Google Scholar]
  16. Utsunomiya T., Krausz M. M., Valeri C. R., Shepro D., Hechtman H. B. Treatment of pulmonary embolism with prostacyclin. Surgery. 1980 Jul;88(1):25–30. [PubMed] [Google Scholar]
  17. Woolverton W. C., Hyman A. L. The pulmonary hemodynamic effects of lung thromboemboli in dogs. Surgery. 1973 Apr;73(4):572–578. [PubMed] [Google Scholar]
  18. ZUCKER M. B., BORRELLI J. Quantity, assay and release of serotonin in human platelets. J Appl Physiol. 1955 Jan;7(4):425–431. doi: 10.1152/jappl.1955.7.4.425. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES