PMID- 34211011 OWN - NLM STAT- MEDLINE DCOM- 20211103 LR - 20240226 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 11 IP - 1 DP - 2021 Jul 1 TI - Focal intra-colon cooling reduces organ injury and systemic inflammation after REBOA management of lethal hemorrhage in rats. PG - 13696 LID - 10.1038/s41598-021-93064-4 [doi] LID - 13696 AB - Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving maneuver for the management of lethal torso hemorrhage. However, its prolonged use leads to distal organ ischemia-reperfusion injury (IRI) and systemic inflammatory response syndrome (SIRS). The objective of this study is to investigate the blood-based biomarkers of IRI and SIRS and the efficacy of direct intestinal cooling in the prevention of IRI and SIRS. A rat lethal hemorrhage model was produced by bleeding 50% of the total blood volume. A balloon catheter was inserted into the aorta for the implementation of REBOA. A novel TransRectal Intra-Colon (TRIC) device was placed in the descending colon and activated from 10 min after the bleeding to maintain the intra-colon temperature at 37 degrees C (TRIC37 degrees C group) or 12 degrees C (TRIC12 degrees C group) for 270 min. The upper body temperature was maintained at as close to 37 degrees C as possible in both groups. Blood samples were collected before hemorrhage and after REBOA. The organ injury biomarkers and inflammatory cytokines were evaluated by ELISA method. Blood based organ injury biomarkers (endotoxin, creatinine, AST, FABP1/L-FABP, cardiac troponin I, and FABP2/I-FABP) were all drastically increased in TRIC37 degrees C group after REBOA. TRIC12 degrees C significantly downregulated these increased organ injury biomarkers. Plasma levels of pro-inflammatory cytokines TNF-alpha, IL-1b, and IL-17F were also drastically increased in TRIC37 degrees C group after REBOA. TRIC12 degrees C significantly downregulated the pro-inflammatory cytokines. In contrast, TRIC12 degrees C significantly upregulated the levels of anti-inflammatory cytokines IL-4 and IL-10 after REBOA. Amazingly, the mortality rate was 100% in TRIC37 degrees C group whereas 0% in TRIC12 degrees C group after REBOA. Directly cooling the intestine offered exceptional protection of the abdominal organs from IRI and SIRS, switched from a harmful pro-inflammatory to a reparative anti-inflammatory response, and mitigated mortality in the rat model of REBOA management of lethal hemorrhage. FAU - Arya, Awadhesh K AU - Arya AK AD - Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA. FAU - Hu, Kurt AU - Hu K AD - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. FAU - Subedi, Lalita AU - Subedi L AD - Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA. FAU - Li, Tieluo AU - Li T AD - Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA. FAU - Hu, Bingren AU - Hu B AD - Departments of Anesthesiology, Shock, Trauma and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, MD, USA. bhu@som.umaryland.edu. AD - Veterans Affairs Maryland Health Center System, 10 North Greene Street, Baltimore, MD, USA. bhu@som.umaryland.edu. LA - eng GR - R01 NS097875/NS/NINDS NIH HHS/United States GR - R21 AG052734/AG/NIA NIH HHS/United States GR - P41 RR004050/RR/NCRR NIH HHS/United States GR - R01 NS102815/NS/NINDS NIH HHS/United States GR - I01 BX003926/BX/BLRD VA/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20210701 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 SB - IM MH - Animals MH - Balloon Occlusion/adverse effects/instrumentation/*methods MH - Cold Temperature MH - Hemorrhage/pathology/*therapy MH - Inflammation/etiology/pathology MH - Intestines/injuries MH - Male MH - Rats, Sprague-Dawley MH - Resuscitation/adverse effects/instrumentation/methods MH - Rats PMC - PMC8249469 COIS- The authors declare no competing interests. EDAT- 2021/07/03 06:00 MHDA- 2021/11/04 06:00 PMCR- 2021/07/01 CRDT- 2021/07/02 06:08 PHST- 2020/12/29 00:00 [received] PHST- 2021/06/14 00:00 [accepted] PHST- 2021/07/02 06:08 [entrez] PHST- 2021/07/03 06:00 [pubmed] PHST- 2021/11/04 06:00 [medline] PHST- 2021/07/01 00:00 [pmc-release] AID - 10.1038/s41598-021-93064-4 [pii] AID - 93064 [pii] AID - 10.1038/s41598-021-93064-4 [doi] PST - epublish SO - Sci Rep. 2021 Jul 1;11(1):13696. doi: 10.1038/s41598-021-93064-4.