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Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q

Arnaud Vanlander (UGent) , Juergen Guenther Okun, Annik de Jaeger (UGent) , Joél Smet (UGent) , Elien De Latter (UGent) , Boel De Paepe (UGent) , Georges Dacremont, Brigitte Wuyts (UGent) , Bert Vanheel (UGent) , Peter De Paepe (UGent) , et al.
(2015) ANESTHESIOLOGY. 122(2). p.343-352
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Abstract
BACKGROUND: Propofol is a short-acting intravenous anesthetic agent. In rare conditions, a life-threatening complication known as propofol infusion syndrome can occur. The pathophysiologic mechanism is still unknown. Some studies suggested that propofol acts as uncoupling agent, others suggested that it inhibits complex I or complex IV, or causes increased oxidation of cytochrome c and cytochrome aa3, or inhibits mitochondrial fatty acid metabolism. Although the exact site of interaction is not known, most hypotheses point to the direction of the mitochondria. METHODS: Eight rats were ventilated and sedated with propofol up to 20 h. Sequential biopsy specimens were taken from liver and skeletal muscle and used for determination of respiratory chain activities and propofol concentration. Activities were also measured in skeletal muscle from a patient who died of propofol infusion syndrome. RESULTS: In rats, authors detected a decrease in complex II+III activity starting at low tissue concentration of propofol (20 to 25 µM), further declining at higher concentrations. Before starting anesthesia, the complex II+III/citrate synthase activity ratio in liver was 0.46 (0.25) and in skeletal muscle 0.23 (0.05) (mean [SD]). After 20 h of anesthesia, the ratios declined to 0.17 (0.03) and 0.12 (0.02), respectively. When measured individually, the activities of complexes II and III remained normal. Skeletal muscle from one patient taken in the acute phase of propofol infusion syndrome also shows a selective decrease in complex II+III activity (z-score: -2.96). CONCLUSION: Propofol impedes the electron flow through the respiratory chain and coenzyme Q is the main site of interaction with propofol.
Keywords
6-DIISOPROPYLPHENOL, GENERAL ANESTHETIC 2, RAT-LIVER MITOCHONDRIA, RESPIRATORY-CHAIN, COMPLEX I, DEHYDROGENASE COMPLEX, SEDATED RABBITS, BINDING DOMAIN, DEFECT, DEFICIENCIES, FIBROBLASTS

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Chicago
Vanlander, Arnaud, Juergen Guenther Okun, Annik de Jaeger, Joél Smet, Elien De Latter, Boel De Paepe, Georges Dacremont, et al. 2015. “Possible Pathogenic Mechanism of Propofol Infusion Syndrome Involves Coenzyme Q.” Anesthesiology 122 (2): 343–352.
APA
Vanlander, Arnaud, Okun, J. G., de Jaeger, A., Smet, J., De Latter, E., De Paepe, B., Dacremont, G., et al. (2015). Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q. ANESTHESIOLOGY, 122(2), 343–352.
Vancouver
1.
Vanlander A, Okun JG, de Jaeger A, Smet J, De Latter E, De Paepe B, et al. Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q. ANESTHESIOLOGY. 2015;122(2):343–52.
MLA
Vanlander, Arnaud, Juergen Guenther Okun, Annik de Jaeger, et al. “Possible Pathogenic Mechanism of Propofol Infusion Syndrome Involves Coenzyme Q.” ANESTHESIOLOGY 122.2 (2015): 343–352. Print.
@article{5745836,
  abstract     = {BACKGROUND: Propofol is a short-acting intravenous anesthetic agent. In rare conditions, a life-threatening complication known as propofol infusion syndrome can occur. The pathophysiologic mechanism is still unknown. Some studies suggested that propofol acts as uncoupling agent, others suggested that it inhibits complex I or complex IV, or causes increased oxidation of cytochrome c and cytochrome aa3, or inhibits mitochondrial fatty acid metabolism. Although the exact site of interaction is not known, most hypotheses point to the direction of the mitochondria.
METHODS: Eight rats were ventilated and sedated with propofol up to 20 h. Sequential biopsy specimens were taken from liver and skeletal muscle and used for determination of respiratory chain activities and propofol concentration. Activities were also measured in skeletal muscle from a patient who died of propofol infusion syndrome.
RESULTS: In rats, authors detected a decrease in complex II+III activity starting at low tissue concentration of propofol (20 to 25 {\textmu}M), further declining at higher concentrations. Before starting anesthesia, the complex II+III/citrate synthase activity ratio in liver was 0.46 (0.25) and in skeletal muscle 0.23 (0.05) (mean [SD]). After 20 h of anesthesia, the ratios declined to 0.17 (0.03) and 0.12 (0.02), respectively. When measured individually, the activities of complexes II and III remained normal. Skeletal muscle from one patient taken in the acute phase of propofol infusion syndrome also shows a selective decrease in complex II+III activity (z-score: -2.96).
CONCLUSION: Propofol impedes the electron flow through the respiratory chain and coenzyme Q is the main site of interaction with propofol.},
  author       = {Vanlander, Arnaud and Okun, Juergen Guenther and de Jaeger, Annik and Smet, Jo{\'e}l and De Latter, Elien and De Paepe, Boel and Dacremont, Georges and Wuyts, Brigitte and Vanheel, Bert and De Paepe, Peter and Jorens, P and Van Regenmortel, N and Van Coster, Rudy},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  language     = {eng},
  number       = {2},
  pages        = {343--352},
  title        = {Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q},
  url          = {http://dx.doi.org/10.1097/ALN.0000000000000484},
  volume       = {122},
  year         = {2015},
}

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