Rachael L. Ford, BS, Ira M. Mains, BS, Ebony J. Hilton, BS, Scott T

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Endothelin-A Receptor Inhibition After Cardiopulmonary Bypass: Cytokines and Receptor Activation Rachael L. Ford, BS, Ira M. Mains, BS, Ebony J. Hilton, BS, Scott T. Reeves, MD, Robert E. Stroud, MS, Fred A. Crawford, MD, John S. Ikonomidis, MD, PhD, Francis G. Spinale, MD, PhD The Annals of Thoracic Surgery Volume 86, Issue 5, Pages 1576-1583 (November 2008) DOI: 10.1016/j.athoracsur.2008.06.076 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The absolute changes in plasma (A) endothelin, (B) interleukin-6, and (C) interleukin-10 concentrations were computed at 0.5, 6, and 24 hours after infusion of increasing doses of the endothelin-A receptor (ET-AR) antagonist (0.1 to 2.0 mg/kg [black bars]) or vehicle (0 mg/kg [white bars]). At 24 hours after infusion, plasma endothelin levels were increased, except in the high-dose ET-AR group. Plasma interleukin-6 levels were increased at 6 hours after infusion in all of the ET-AR antagonist groups. In contrast, interleukin-10 levels were reduced after infusion of the higher doses of the ET-AR antagonist, and this effect persisted at longer time points. (*p < 0.05 versus immediate postinfusion time point; #p < 0.05 versus respective 0.5-hour time point.) The Annals of Thoracic Surgery 2008 86, 1576-1583DOI: (10.1016/j.athoracsur.2008.06.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The absolute changes in plasma (A) tumor necrosis factor-α (TNF), (B) TNF receptor I, and (C) TNF receptor II concentrations were computed at 0.5, 6, and 24 hours after infusion of increasing doses of the endothelin-A receptor (ET-AR) antagonist (0.1 to 2.0 mg/kg [black bars]) or vehicle (0 mg/kg [white bars]). At 24 hours after infusion, plasma TNF levels were reduced in the higher dose of the ET-AR antagonist when compared with the vehicle group. Plasma TNF receptor I levels decreased immediately after infusion of the higher doses of the ET-AR antagonist, and this effect persisted at longer time points. Similarly, at 24 hours after infusion, plasma TNF receptor II levels were reduced in the higher doses of the ET-AR antagonist when compared with the vehicle group. (*p < 0.05 versus immediate postinfusion time point; #p < 0.05 versus respective vehicle group.) The Annals of Thoracic Surgery 2008 86, 1576-1583DOI: (10.1016/j.athoracsur.2008.06.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Schematic of the potential interaction of the endothelin-A receptor (ET-AR) and the tumor necrosis factor-α (TNF) pathway. Binding of endothelin (ET) to the ET-AR caused the induction of an intracellular cascade which culminates in both pretranscriptional and transcriptional events. Specifically, ET-AR can result in the formation of phosphorylation intermediates, which in turn could cause phosphorylation and mobilization of TNF convertase (TACE) to the cell membrane. In turn, TACE would cause solubilization of membrane-bound TNF and ultimately binding to the TNF receptor complex (TNFR). The binding of TNF to the TNFR will ultimately be proteolytically processed and yield soluble TNFR complexes, which can be quantified in the plasma. Stimulation of both the ET-AR and TNFR will cause binding to transcription factor sites such as nuclear factor κ-B (NFκB) and activating protein 1 (AP-1), which can cause the formation of ET and TNF. Thus, stimulation of the ET-AR and TNFR thereby form an amplification loop. The present study demonstrated that selective ET-AR can directly modify TNFR activation. The Annals of Thoracic Surgery 2008 86, 1576-1583DOI: (10.1016/j.athoracsur.2008.06.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions