Abstract
Systemic inflammatory response can be associated with clinically significant and, at times, refractory hypotension. Despite the lack of uniform definitions, this condition is frequently called vasoplegia or vasoplegic syndrome (VS), and is thought to be due to dysregulation of endothelial homeostasis and subsequent endothelial dysfunction secondary to direct and indirect effects of multiple inflammatory mediators. Vasoplegia has been observed in all age groups and in various clinical settings, such as anaphylaxis (including protamine reaction), sepsis, hemorrhagic shock, hemodialysis, and cardiac surgery. Among mechanisms thought to be contributory to VS, the nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway appears to play a prominent role. In search of effective treatment for vasoplegia, methylene blue (MB), an inhibitor of nitric oxide synthase (NOS) and guanylate cyclase (GC), has been found to improve the refractory hypotension associated with endothelial dysfunction of VS. There is evidence that MB may indeed be effective in improving systemic hemodynamics in the setting of vasoplegia, with reportedly few side effects. This review describes the current state of clinical and experimental knowledge relating to MB use in the setting of VS, highlighting the potential risks and benefits of therapeutic MB administration in refractory hypotensive states.
Keywords: ACE inhibitors, cGMP-mediated vasodilation, inducible Nitric oxide, cardio-pulmonary bypass, anaphylactic shock
Mini-Reviews in Medicinal Chemistry
Title: Methylene Blue and Vasoplegia: Who, When, and How?
Volume: 8 Issue: 5
Author(s): S. Peter Stawicki, Carrie Sims, Babak Sarani, Michael D. Grossman and Vicente H. Gracias
Affiliation:
Keywords: ACE inhibitors, cGMP-mediated vasodilation, inducible Nitric oxide, cardio-pulmonary bypass, anaphylactic shock
Abstract: Systemic inflammatory response can be associated with clinically significant and, at times, refractory hypotension. Despite the lack of uniform definitions, this condition is frequently called vasoplegia or vasoplegic syndrome (VS), and is thought to be due to dysregulation of endothelial homeostasis and subsequent endothelial dysfunction secondary to direct and indirect effects of multiple inflammatory mediators. Vasoplegia has been observed in all age groups and in various clinical settings, such as anaphylaxis (including protamine reaction), sepsis, hemorrhagic shock, hemodialysis, and cardiac surgery. Among mechanisms thought to be contributory to VS, the nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway appears to play a prominent role. In search of effective treatment for vasoplegia, methylene blue (MB), an inhibitor of nitric oxide synthase (NOS) and guanylate cyclase (GC), has been found to improve the refractory hypotension associated with endothelial dysfunction of VS. There is evidence that MB may indeed be effective in improving systemic hemodynamics in the setting of vasoplegia, with reportedly few side effects. This review describes the current state of clinical and experimental knowledge relating to MB use in the setting of VS, highlighting the potential risks and benefits of therapeutic MB administration in refractory hypotensive states.
Export Options
About this article
Cite this article as:
Stawicki Peter S., Sims Carrie, Sarani Babak, Grossman D. Michael and Gracias H. Vicente, Methylene Blue and Vasoplegia: Who, When, and How?, Mini-Reviews in Medicinal Chemistry 2008; 8 (5) . https://dx.doi.org/10.2174/138955708784223477
DOI https://dx.doi.org/10.2174/138955708784223477 |
Print ISSN 1389-5575 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5607 |
Call for Papers in Thematic Issues
Bioprospecting of Natural Products as Sources of New Multitarget Therapies
According to the Convention on Biological Diversity, bioprospecting is the exploration of biodiversity and indigenous knowledge to develop commercially valuable products for pharmaceutical and other applications. Bioprospecting involves searching for useful organic compounds in plants, fungi, marine organisms, and microorganisms. Natural products traditionally constituted the primary source of more than ...read more
Computational Frontiers in Medicinal Chemistry
The thematic issue "Computational Frontiers in Medicinal Chemistry" provides a robust platform for delving into state-of-the-art computational methodologies and technologies that significantly propel advancements in medicinal chemistry. This edition seeks to amalgamate top-tier reviews spotlighting the latest trends and breakthroughs in the fusion of computational approaches, including artificial intelligence (AI) ...read more
Mitochondria as a Therapeutic Target in Metabolic Disorders
Mitochondria are the primary site of adenosine triphosphate (ATP) production in mammalian cells. Moreover, these organelles are an important source of reactive oxygen and nitrogen species in virtually any nucleated cell type. The modulation of a myriad of cellular signaling pathways depends on the mitochondrial physiology. Mitochondrial dysfunction is observed ...read more
Natural Products and Dietary Supplements in Alleviation of Metabolic, Cardiovascular, and Neurological Disorders
Metabolic disorders like diabetes, obesity, inflammation, oxidative stress, cancer etc, cardiovascular disorders like angina, myocardial infarction, congestive heart failure etc as well as neurological disorders like Alzheimer?s, Parkinson?s, Epilepsy, Depression, etc are the global burden. They covered the major segment of the diseases and disorders from which the human community ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Supramolecular Chiro-Biomedical Aspect of β-Blockers in Drug Development
Current Drug Targets Progress in the Discovery of Treatments for C. difficile Infection: A Clinical and Medicinal Chemistry Review
Current Topics in Medicinal Chemistry Biochemical and Structural Investigations of Bothropstoxin-II, a Myotoxic Asp49 Phospholipase A2 from Bothrops jararacussu Venom
Protein & Peptide Letters The Perils, Pitfalls and Opportunities of Using High Sensitivity Cardiac Troponin
Current Medicinal Chemistry Recent Advances in the Synthesis of 1,3-Azoles
Current Topics in Medicinal Chemistry Docking, Synthesis and Anti-Diabetic Activity of Novel Sulfonylhydrazone Derivatives Designed as PPAR-Gamma Agonists
Current Topics in Medicinal Chemistry Relationship Between the Pharmacokinetics of Levosimendan and Its Effects on Cardiovascular System
Current Drug Metabolism Low Doses of G-CSF Prevent Cerebral Infarction and Maintain Muscle Strength in an Experimental Model of Global Ischemic Stroke
Current Pharmaceutical Biotechnology Radial vs Femoral Approach in Acute Coronary Syndromes: A Meta- Analysis of Randomized Trials
Current Vascular Pharmacology The Pharmacological Effects of Novokinin; a Designed Peptide Agonist of the Angiotensin AT<sab>2</sab> Receptor
Current Pharmaceutical Design Glutamate mGlu5-Adenosine A2A-Dopamine D2 Receptor Interactions in the Striatum. Implications for Drug Therapy in Neuro-psychiatric Disorders and Drug Abuse
Current Medicinal Chemistry - Central Nervous System Agents The Role of Niacin in Lipid-lowering Treatment: Are we Aiming Too High?
Current Pharmaceutical Design Role of Microglia in the Pathogenesis of Sepsis-Associated Encephalopathy
CNS & Neurological Disorders - Drug Targets Vascular effects of flavonoids
Current Medicinal Chemistry Attacking HIV Provirus: Therapeutic Strategies to Disrupt Persistent Infection
Infectious Disorders - Drug Targets Recent Advances in Protein and Peptide Drug Delivery: A Special Emphasis on Polymeric Nanoparticles
Protein & Peptide Letters Bacterial Toxins: Potential Weapons Against HIV Infection
Current Pharmaceutical Design Metabolite Identification and Profiling in Drug Design: Current Practice and Future Directions
Current Pharmaceutical Design Drugs for AIDS
Mini-Reviews in Medicinal Chemistry Myocardial Infarction. Pathological Relevance and Relationship with Coronary Risk Factors
Current Pharmaceutical Design