Rapid tissue destruction in group A streptococcal (GAS) necrotizing fasciitis/myonecrosis often necessitates extensive debridement to ensure survival. The mechanisms responsible for this fulminant process remain unknown; we hypothesized that toxin-induced ischemia contributes to necrosis. In a rat model, Doppler flowmetry was used to measure local blood flow at the site of the intramuscular injection of exotoxins from an invasive M-type 1 GAS, which caused a rapid, dose-dependent decrease in perfusion that was irreversible at the highest toxin concentration tested. Videomicroscopic results revealed that blood flow was impeded by occlusive intravascular cellular aggregates. Flow-cytometric results confirmed that GAS toxins induced the coaggregation of platelets and neutrophils, that this activity was attributable to streptolysin O, and that platelet/neutrophil complex formation was largely mediated by platelet P-selectin (CD62P). Strategies that target platelet adherence molecules may prevent vascular occlusion, maintain tissue viability, and reduce the need for amputation in necrotizing GAS infections.

Mechanisms responsible for the rapid tissue destruction in gas gangrene are not well understood. To examine the early effects of Clostridium perfringens exotoxins on tissue perfusion, a rat model of muscle blood flow was developed. Intramuscular injection of a clostridial toxin preparation containing both phospholipase C (PLC) and theta-toxin caused a rapid (1-2 min) and irreversible decrease in blood flow that paralleled formation of activated platelet aggregates in venules and arterioles. Later (20-40 min), aggregates contained fibrin and leukocytes, and neutrophils accumulated along vascular walls. Flow cytometry confirmed that these clostridial toxins or recombinant PLC induced formation of P-selectin-positive platelet aggregates. Neutralization of PLC activity in the clostridial toxin preparation completely abrogated human platelet responses and reduced perfusion deficits. It is concluded that tissue destruction in gas gangrene is related to profound attenuation of blood flow initiated by activation of platelet responses by PLC.

Clostridium perfringens gas gangrene is a fulminant infection, and radical amputation remains the single best treatment. It has been hypothesized that rapid tissue destruction is related to tissue hypoxia secondary to toxin-induced vascular obstruction, and previous studies demonstrated that phospholipase C (PLC) caused a rapid and irreversible decrease in skeletal muscle blood flow that paralleled the formation of intravascular aggregates of activated platelets, fibrin, and leukocytes. In this study, flow cytometry demonstrated that PLC stimulated platelet/neutrophil aggregation in a gpIIbIIIa-dependent fashion. Pretreatment of animals with heparin or depletion of leukocytes reduced blood-flow deficits, and aggregate formation caused by PLC. It is concluded that fulminant tissue destruction in gas gangrene results from profound attenuation of blood flow caused by PLC-induced, gpIIbIIIa-mediated formation of heterotypic platelet/polymorphonuclear leukocyte aggregates. Therapeutic strategies that target gpIIbIIIa may prevent vascular occlusion, maintain tissue viability, and provide an alternative to radical amputation for patients with this infection.

Mechanisms mediating the increase in gastric mucosal blood flow (GMBF) induced by the stable thyrotropin-releasing hormone (TRH) analog RX-77368 injected intracisternally at a gastric acid secretory dose (30 ng) were investigated using hydrogen gas clearance in urethan-anesthetized rats. The histamine H1 receptor antagonist pyrilamine (intravenously), capsaicin (subcutaneously, -10 days), and N G-nitro-l-arginine methyl ester (l-NAME, intracisternally) failed to impair the 150% rise in GMBF induced by intracisternal injection of RX-77368. By contrast, atropine (subcutaneously) and N G-monomethyl-l-arginine (intravenously) completely inhibited the increase in GMBF evoked by intracisternal RX-77368. l-NAME (intravenously) blocked the intracisternal RX-77368-induced increase in GMBF in capsaicin-pretreated rats, and thel-NAME effect was reversed by intravenous l- but notd-arginine. These findings indicate that vagal efferent activation induced by TRH analog injected intracisternally at a gastric acid secretory dose increases GMBF through atropine-sensitive mechanisms stimulatingl-arginine-nitric oxide pathways, whereas H1 receptors and capsaicin-sensitive afferent fibers do not play a role.

The thyrotropin-releasing hormone (TRH) analog, RX 77368, (p-Glu-His-(3,3'-dimethyl)-Pro-NH2) injected intracisternally (i.c.) at low doses increases gastric mucosal blood flow through vagal cholinergic and calcitonin gene-related peptide dependent pathways. The influence of the mast cell stabilizer, ketotifen, on i.c. injection of RX 77368 (1.5 ng)-induced changes in gastric mucosal blood flow (hydrogen gas-clearance technique), gastric acid secretion and mean arterial pressure was studied in urethane-anesthetized rats. RX 77368 increased gastric blood flow by 131% and systemic arterial pressure by 11 mm Hg and decreased gastric mucosal vascular resistance by 54% whereas acid secretion was not altered within the 30 min period post injection. Ketotifen had no effect on these basal parameters but abolished i.c. RX 77368-induced increased gastric mucosal blood flow and decreased gastric vascular resistance. These data suggest that mast cells may be part of the peripheral mechanisms involved in vagal gastric hyperemia induced by TRH analog injected i.c. at a low dose.

Gastric hyperemic and acid responses to the stable thyrotropin-releasing hormone (TRH) analog RX-77368 injected intracisternally at a cytoprotective dose were investigated, as well as the underlying mechanisms of the responses. Gastric acid secretion (GAS), mucosal blood flow (GMBF; measured by the hydrogen gas clearance technique), and mucosal vascular resistance (GMVR) and mean arterial pressure (MAP) were assessed simultaneously for 30 min before and after RX-77368 (1.5 ng) administration in urethan-anesthetized rats. RX-77368 increased GMBF from 46.8 +/- 5.3 to 100.6 +/- 20.9 ml.min-1.100 g-1 and MAP from 70.3 +/- 2.1 to 84.3 +/- 5.9 mmHg and decreased GMVR from 1.50 +/- 0.33 to 0.84 +/- 0.08 mmHg.ml-1.min.100 g, whereas GAS was not significantly altered (1.8 +/- 0.4 vs. 4.7 +/- 1.7 mumol/30 min) in vehicle-pretreated rats. The GMBF, MAP, and GMVR responses to RX-77368 were not modified by indomethacin (5 mg/kg ip), whereas GAS was increased. In rats pretreated with capsaicin (125 mg/kg sc) or calcitonin gene-related peptide (CGRP) antagonist hCGRP-(8-37), intracisternal RX-77368 did not increase GMBF or decrease GMVR but did stimulate GAS. These data show that vagal stimulation by the TRH analog RX-77368 injected intracisternally at a nonacid secretory dose increases GMBF. Gastric hyperemia is mediated by CGRP contained in capsaicin-sensitive afferent fibers, whereas acid secretion is under the inhibitory influence of prostaglandins and CGRP.

Cold water immersion restraint (CWIR) is associated with gastric hypercontractility and gastric corpus erosions in the rat. Because the gastric blood flow response to CWIR has not been well defined, we performed the following study. Rats were implanted with force transducers, subjected to CWIR for 2 hr, and then blood flow was determined by the iodo[14C]antipyrine autoradiographic (IAP) technique. When compared to control animals, the CWIR-treated animals displayed foci of gastric corpus hyperemia with a marked and significant increase in blood flow in all layers of the gastric corpus. There was approximately a 100% increase in the mucosa and a 50% increase in the muscularis externa. The hyperemia was not uniform, but rather alternated every 2.1±0.2 mm with regions of low blood flow. Blood flow in the antrum and duodenum was unaffected by CWIR. We conclude that CWIR is associated with alternating regions of high and low blood flow only in the gastric corpus. Reduction of corpus mucosal blood flow might be due to the powerful gastric contractions associated with CWIR.

Because of the contradictory findings in clinical studies, and the complete lack of animal studies, the purpose of this investigation was to characterize the changes in gastric mucosal blood flow (GMBF) and acid secretion in an animal model of chronic renal failure. Rats with chronic renal failure induced by partial kidney infarction had a significantly higher basal GMBF and lower gastric vascular resistance than control rats. The gastric acid secretory and mucosal hyperemic response to pentagastrin were markedly enhanced in renal failure rats. Because endothelial-derived nitric oxide (NO) is an endogenous vasodilator that regulates gastric vascular tone, we hypothesized that NO mediates the gastric hyperemia of renal failure rats. The administration of N omega-nitro-L-arginine methyl ester (L-NAME), a specific inhibitor of NO formation, produced a significantly greater decrease in GMBF in renal failure rats than in control rats, including a low dose inhibiting the basal hyperemia in renal failure rats but having no effect in control rats. It also attenuated pentagastrin-stimulated GMBF in both groups. In contrast, L-NAME produced a similar decrease in basal skeletal muscle blood flow in both renal failure and control rats. We conclude that in the renal failure rat 1) there is an increased basal GMBF and pentagastrin-stimulated acid output and GMBF, and 2) this gastric mucosal hyperemia is mediated by NO.

The current state of our knowledge concerning mediator(s) of the increase in gastric mucosal blood flow that occurs during pentagastrin- and histamine-stimulated acid secretion is reviewed. Evidence for a role for adenosine, prostaglandin, and histamine is presented and discussed. The dose relationship between the acid-stimulatory and the vascular permeability effects of histamine is also presented.

Under in vivo microscopic observation, intragastric ethanol instillation has been seen to cause a prompt, marked constriction of submucosal venules, followed by congestion in mucosal capillaries and severe gross mucosal lesion formation. This study was designed to test the hypothesis that the venoconstriction is mediated by leukotrienes and that inhibition of the venoconstriction would protect against ethanol injury. Intragastric application of the leukotriene receptor antagonist MK-571 inhibited both venoconstriction and gross lesion formation. However, although local submucosal application of MK-571 inhibited venoconstriction, it did not protect the overlying gastric mucosa against ethanol injury. We conclude that leukotrienes play a significant pathogenetic role in ethanol-induced gastric mucosal injury, but while the venoconstriction, mediated by leukotrienes, is one of the factors that promote lesion formation, it is not an essential one.

The flow dynamics of leukocytes in the rat liver microcirculation was studied in the sinusoids in the three zones of the liver acinus (zone 1, periportal; zone 2, mid; and zone 3, pericentral) by means of in vivo fluorescence microscopy. Leukocytes were labeled in vivo with acridine orange. The microscopic image was videotaped and on playback of the videotapes, leukocyte velocity, leukocyte flux, erythrocyte velocity, sinusoid diameter, and sinusoid tortuosity were measured. Blood flow and flow resistance were calculated from these data. The leukocyte velocity, erythrocyte velocity, sinusoid diameter, and blood flow in the liver sinusoids in zone 3 were significantly greater than those in zone 2, which in turn were also significantly greater than those in zone 1. There were significant positive correlations between leukocyte and erythrocyte velocity, between leukocyte velocity and sinusoid diameter, and between leukocyte velocity and blood flow. Sinusoid tortuosity in zone 1 was significantly larger than that in zone 2 and zone 3. Flow resistance in zone 1 was significantly greater than that in zone 2, which was also significantly greater than that in zone 3. These results provide evidence for a "zonal gradient" of leukocyte velocity in the liver sinusoids, with increasing velocity from zone 1 to zone 3. The morphological (narrow diameter and tortuous path) and resistance factors appear to contribute to the slow velocity in zone 1.

With the use of an in vivo microscopy technique in anesthetized-laparotomized rats, the effect of L660,711, a cysteinyl-leukotriene (LT) receptor antagonist, on the gastric submucosal microvascular response to leukotrienes was studied. The direct application of 50-400 nM LTC4 onto the exposed submucosal vasculature caused constriction of both arterioles (maximum constriction: 24 +/- 3%) and venules (26 +/- 3%), whereas LTD4 had no significant effect. Pretreatment with 5 mg/kg L660,711 intragastrically significantly attenuated the LTC4-induced vasoconstriction. The submucosal application of 2 x 10(-7) to 2 x 10(-2) M L660,711 dose dependently inhibited the 400 nM LTC4-induced vasoconstriction. The IC50 of L660,711, preapplied to the gastric submucosa for 15 min, was 4.4 x 10(-4) M in arterioles and 3.9 x 10(-4) M in venules, and 3.6 x 10(-5) M and 3.2 x 10(-5) M, respectively, when it was applied simultaneously with LTC4. Schild plot analysis revealed that L660,711 was not a pure competitive receptor antagonist. L660,711 had no significant effects on epinephrine- or vasopressin-induced arteriolar constriction. In conclusion, L660,711 significantly antagonizes the gastric microvascular effects of LTC4, but not those of other vasoconstrictors, and appears to be a useful new tool for studying LTC4 effects.

Calcitonin gene-related peptide (CGRP) is a 37-residue peptide present in the central and peripheral nervous system. Based on previous reports of its localization in fibers associated with vascular smooth muscles of vessels and its potent inhibitory effect on acid secretion, we studied the influence of intravenous infusion of rat CGRP on gastric mucosal blood flow. The hydrogen gas-clearance technique was used to measure mucosal blood flow in urethan-anesthetized rats. CGRP infused intravenously in doses of 1 or 10 micrograms X kg-1 X h-1 did not significantly modify basal gastric corpus mucosal blood flow or mean-arterial blood pressure. Gastric acid secretion stimulated by pentagastrin infusion (20 micrograms X kg-1 X h-1) was suppressed by CGRP administration (10 micrograms X kg-1 X h-1), whereas neither gastric corpus mucosal blood flow nor mean arterial blood pressure were significantly changed. These results indicate that CGRP must exert its inhibitory action on gastric acid secretion by a mechanism other than decreasing gastric mucosal blood flow.

The effect of pretreatment with intragastric sucralfate on aspirin acid-induced gastric mucosal lesions in the rat was studied. The finding by others that sucralfate is cytoprotective and that this cytoprotective effect probably is mediated, at least in part, by stimulation of endogenous prostaglandin synthesis was confirmed. In addition, a time course study revealed that the maximum cytoprotective effect was present 1 min after sucralfate administration and persisted for at least 6 hr. Microscopic evaluation of histologic sections revealed that sucralfate significantly decreased aspirin-induced deep mucosal erosions (those extending into the parietal cell area) but not superficial mucosal damage. Superficial mucosal damage (surface cell injury and erosions involving the mucous neck cell area) could not be detected grossly. The lesions seen grossly were deeper erosions involving the parietal cell area of the mucosa.