Benjamin F. Dickens

Magnesium-deficiency elevates circulating levels of inflammatory cytokines and endothelin

SummaryWe have developed two rodent models of diet-induced magnesium-deficiency in which histologically defined cardiac lesions can be induced within two to three weeks. During the development of these lesions, the magnesium-deficient animals exhibit circulating cytokine levels which are indicative of a generalized inflammatory state. Dramatic elevations of the macrophage-derived cytokines, IL-1, IL-6, and TNF-α together with signigicantly elevated levels of the endothelial cell-derived cytokine, endothelin, were detected in the plasma of these animals. We believe that the pathophysiological effects caused by the action of these cytokines may play a role in the promotion of cardiovascular pathology associated with magnesium deficiency.

Neonatal Cytokines and Cerebral Palsy in Very Preterm Infants

To examine the relationship of cytokines in blood of very preterm neonates with later diagnosis of spastic cerebral palsy (CP) compared with infants of similar gestational age without CP, we measured concentrations of inflammatory cytokines and other substances in archived neonatal blood by recycling immunoaffinity chromatography. Subjects were surviving children born before 32 wk gestational age (GA) to women without preeclampsia, 64 with later diagnoses of CP and 107 control children. The initial analyses were augmented by measurement of 11 cytokines by a bead-based flow analytic system (Luminex) in an additional 37 children with CP and 34 control children from the same cohort. Concentrations of examined substances did not differ by presence of indicators of infection in mother, infant, or placenta. On ANOVA, concentrations of a number of cytokines were significantly related to neonatal ultrasound abnormalities (periventricular leukomalacia, ventricular enlargement, or moderate or severe germinal matrix hemorrhage). None of the substances measured either by immunoaffinity chromatography or flow analytic methods, including IL-1, -6, and -8 and tumor necrosis factor-α, was related to later diagnosis of CP or its subtypes. Inflammatory cytokines in neonatal blood of very premature infants did not distinguish those with later diagnoses of CP from control children.

Role of free radicals and substance P in magnesium deficiency

In the United States the literature contains only sporadic references to clinical disorders of Mg-deficiency, compared to more recent interest in the benefits of magnesium infusion in myocardial infarction and other acute clinical conditions [1,2]. In Europe the clinical interest in Mg-deficiency was pioneered by Durlach in his book entitled Le Magnesium en Prutique Clinique; the English edition was entitled Magnesium in Clinical Practice [3]. In the conclusion of his book, Durlach stated: “This ion which is present in all the cells is involved in many different pathologies. Integrating a search for the disorders of magnesium metabolism in daily diagnostic processes allows determination of the indications and precise methods of magnesium therapy.” In the United States, Seelig authored a text in 1980 entitled Magnesium Dejicicncy in the Parhogerzesis sf Disease [4] and reviewed the literature concerning magnesium requirements in human nutrition and the association of magnesium deficiency with cardiovascular disease [s]. That same year Wacker published an excellent book entitled Mugnesium und Mm in which he emphasized the clinical relevance of magnesium 161. Six decades ago MacCollum [7l studied the effects of Mg-deficiency on development, reproduction, neuromuscular and humoral abnormalities in animals. In 1959 Bajusz and Selye published a paper describing the influence of electrolytes in the process of myocardial injury [8]. More recently, Lehr focused attention on magnesium and the process of cardiac necrosis [9], or cardiomyopathic lesions which had been described earlier [lo]. B.T. Altura and B.M. Altura published a series of papers which postulated

Neurogenic peptides and the cardiomyopathy of magnesium-deficiency: Effects of substance P-receptor inhibition

Dietary deficiency of magnesium (Mg) in rodents results in cardiomyopathic lesion formation. In our rat model, these lesions develop after 3 weeks on the Mg-deficient diet; significant elevation of several cytokines, IL-1, IL-6 and TNFα also occurs. In probing the mechanisms of lesion formation, we obtained data supporting the participation of free radicals (Freedman AMet al.: Bioch Biophys Res Commun 1990; 170: 1102). Recently, we identified an early elevation of circulating substance P and proposed a role of neurogenic peptides during Mg-deficiency (Weglicki WB, Phillips TM: Am J Phys 1992; 262: R734). The present study was designed to evaluate the contribution of neurogenic peptides to the pathogenesis of Mg-deficiency. In the blood, substance-P and calcitonin gene related peptide (CGRP) are elevated during the first week on the diet. During the second week, circulating histamine, PGE2 and TBAR-materials were elevated and red cell glutathione was reduced, all prior to the elevation of the inflammatory cytokines during the third week. When the rats were treated with the substance P-receptor blocker [CP-96,345], the levels of substance P and CGRP remained elevated; however, increases in histamine, PGE2, TBAR-materials, and the decrease in red cell glutathione were inhibited; also, the development of cardiac lesions was inhibited significantly. These data support a central role for neurogenic peptides, especially substance P, in the development of cardiomyopathic lesions during Mg-deficiency.

Cytokines, Neuropeptides, and Reperfusion Injury during Magnesium Deficiency a

In summary, hypomagnesemia enhances reperfusion injury. We postulate that neurogenic inflammation, which occurs very early during hypomagnesemia, predisposes the myocardium to reperfusion injury by depleting endogenous antioxidants and recruiting inflammatory cells, which can participate in enhanced free radical production during postischemic reperfusion. Vitamin E supplements can prevent the occurrence of this enhanced injury possibly through the restoration of endogenous antioxidant defenses.

Activation of the neutrophil and loss of plasma glutathione during Mg-deficiency — modulation by nitric oxide synthase inhibition

Sprague-Dawley rats (200 g) were fed either a Mg-deficient or Mg-sufficient diet for 3 weeks. An enriched neutrophil fraction (>85%) was isolated from the blood by sodium metrizoate/dextran gradient centrifugation. Using the superoxide dismutase (SOD)-inhibitable cytochrome c reduction assay, the basal activity of neutrophils isolated from the Mg-deficient rats were found elevated 5 fold after two weeks, and up to ∼7 fold after three weeks on the diet. Upon challenge by phorbol myristate acetate (PMA), unlike the Mg-sufficient cells, the Mg-deficient cells exhibited no significant activation. Treatment of the Mg-deficient rats with the nitric oxide (NO)-synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) in the drinking water, significantly attenuated the basal superoxide producing activity of the neutrophils and partially restored its response to PMA challenge. In association with the neutrophil activation. Mg-deficiency resulted in 70% decrease in plasma glutathione and 220% increase in Fe-promoted, thiobarbituric acid reactive substance (TBARS) levels; both changes were significantly attenuated by L-NAME treatment. The results suggest that neutrophils from Mg-deficient rats are activated endogenously to generate oxy-radicals which might directly mediate the in vivo peroxidative indices during Mg-deficiency. Furthermore, the neutrophil activity was lowered by NO-synthase inhibition suggesting that NO overproduction during Mg-deficiency participates in the neutrophil activation process.

Lysosomal lipolytic enzymes, lipid peroxidation, and injury.

SummaryWe have used highly purified lysosomes to investigate three models of hydrolytic injury by lysosomal phospholipases. Lysosomes, enriched up to 70-fold in marker enzyme activities, can be isolated from homogenized hepatic tissue by differential centrifugation and subsequent free flow electrophoresis. These organelles remain latent and can also be utilized to obtain ‘lysosol’, the soluble fraction of the lysosomes tissue containing acid active phospholipases. The first model investigated the effect of lysosol on non-lysosomal membranes. When this soluble fraction was incubated with plasmalemma (sarcolemma) from cardiac cells, selective hydrolysis of the phospholipids was observed: phosphatidylcholine, phosphatidylethanolamine, and sphingomyelin were the preferred substrates, and only lysophosphatidylcholine and lysophosphatidylethanolamine accumulated in significant amounts. Hydrolysis of sphingomyelin was enhanced significantly by Triton-X-100. In the second model, when intact lysosomes were incubated at acid pH, hydrolysis of phospholipids by the endogenous lipases was observed. Once again this lipolysis was specific for phosphatidylcholine, phosphatidylethanolamine, and sphingomyelin: significant amounts of lysophospholipids also accumulated in this model. Concurrent with these lipid changes, an increase in lysosomal permeability also occurred and pH 5.0 was optimal for this lipolytic activity. However, no phospholipase activity was detected when lysosomes were incubated at pH ranges found in acidotic tissue (pH 6.0 or higher). In the third model, lysosomes were incubated at pH 6.0 in the presence of exogenously generated free radicals (dihydroxyfumarate-FeADP). A rapid loss of membrane phospholipids was observed, and most of this loss could be contributed to peroxidation of membrane phospholipids; the production of malondialdehyde preceded loss of N-acetylglucosaminidase from the lysosome. However, significant accumulation of lysophospholipids, from 2% at control time to 6.6 and 8.7% at 10 and 20 minutes, suggested that lysosomal phospholipase were hydrolyzing lysosomal phospholipids. Thus, we hypothesize that this ‘free radical-induced lipolysis’ is a result of peroxidized phospholipids serving as preferred substrate for phospholipases at pH 6.0.

PHOSPHOLIPID HYDROPEROXIDES ARE PRECURSORS OF LIPID ALKOXYL RADICALS PRODUCED FROM ANOXIA/REOXYGENATED ENDOTHELIAL CELLS

Endothelial cells have been shown to generate primary oxygen-centered free radicals (hydroxyl, superoxide anion) during post-anoxic reoxygenation, but little evidence is available concerning subsequent initiation of lipid peroxidative injury in this model. Electron spin resonance (ESR) spectroscopy with alpha-phenyl-N-tert-butylnitrone (PBN) spin trapping was used to monitor lipid peroxidation (LPO)-derived free radicals formed by cultured bovine aortic endothelial cell suspensions exposed (37 degrees C) to anoxia (A, 45 min, N2 gas) and reoxygenation (R, 15 min, 95% O2/5% CO2). In some studies, superoxide dismutase (SOD, 10 micrograms/ml) was introduced just prior to R to assess the effects of this primary free radical scavenger on LPO-derived free radical production. At various times, aliquots were removed and PBN was introduced to either the cell suspension aliquot (8 mM PBN final, 1 min), or to the corresponding cell-free filtrate (60 mM PBN final), prior to extraction with toluene and ESR spectroscopy. A LPO-derived alkoxyl radical adduct of PBN (PBN/RO., hyperfine splitting alpha N = 13.63 G and alpha H = 1.94-1.98 G) was observed during R using both trapping procedures, with maximal production at 4-5 min and a second minor peak at 10 min. SOD effectively reduced PBN/RO. production and improved viability of A/R cells. In parallel studies, lipid hydroperoxide production was assessed in lipid extracts of A/R cells by high-performance liquid chromatography. Their separation profiles revealed a peak of oxidized lipid occurring between phosphatidylethanolamine (PE) and phosphatidylcholine (PC) in samples taken at 4-5 min and 10 min of R. Resolubilizing cell lipid extracts in oxygen-free benzene containing cobalt (II) acetylacetonate and PBN led to alkoxyl radical production, but only in the oxidized lipid samples, confirming the presence of hydroperoxides. These results suggest that A/R leads to primary free radical induced-lipid peroxidative injury to endothelial cells, as indicated by alkoxyl radical production originating from oxidized membrane phospholipids.

Uncoupling of mitochondrial oxidative phosphorylation alters lipid peroxidation-derived free radical production but not recovery of postischemic rat hearts and post-hypoxic endothelial cells

The contribution of mitochondrial free radical production towards the initiation of lipid peroxidation (LPO) and functional injury in the post-ischemic heart is unclear. Using the isolated rat heart model, the effects of the uncoupler of mitochondrial oxidative phosphorylation dinitrophenol (DNP, 50 µM final) on post-ischemic lipid peroxidation-derived free radical production and functional recovery were assessed. Hearts were subjected to 30 min total global ischemia followed by 15 min of reperfusion in the presence of DNP. As expected, DNP enhanced oxygen consumption before (11.3 ± 0.9 jimol/min, p < 0.001) and during reperfusion (at 10 min: 7.9 ± 0.7 µumol/min), compared to the heart with control treatment (8.2 ± 0.5 and 6.7 ± 0.3, respectively). This effect was only associated with a higher incidence of ventricular tachycardia during reperfusion (80 vs. 50% for control treatment, p < 0.05). Electron spin resonance spectroscopy (ESR) and spin trapping with α-phenyl-tert-butylnitrone (PBN, 3 mM final) were used to monitor free radical generation during reperfusion. The vascular concentration of PBN-radical adducts (untreated: 6.4 ± 1.0 nM, at 10 min) decreased in the presence of DNP (1.7 ± 0.4 nM, p < 0.01). The radical concentration inversely correlated with myocardial oxygen consumption. Total liberation of free radical adducts during the initial 10 min of reperfusion was reduced by DNP (0.59 ± 0.09 nmol, p < 0.01) compared to the respective control treatment (1.26 ± 0.16 nmol). Similar effects, prevention of PBN adduct formation and unchanged viability in the presence of DNP, were obtained with endothelial cells during post-hypoxic reoxygenation. Since inhibition of mitochondrial phosphorylation can inhibit the formation of LPO-derived free radicals after an ischemic/hypoxic interval, mitochondria may represent an important source of free radicals capable of initiating lipid peroxidative injury during reperfusion/reoxygenation. (Mol Cell Biochem 160/161:167–177, 1996)

Inhibition of tumor necrosis factor-alpha by thalidomide in magnesium deficiency.

The effect of thalidomide on circulating cytokines and myocardial lesion formation was investigated in Mg-deficient rats. After two weeks on a Mg-deficient diet, rats show an increase in circulating levels of tumor necrosis factor-alpha and interleukin 1. Thalidomide (1 mg/day) caused a complete inhibition of the increase in circulating tumor necrosis factor-alpha levels, without having an effect on interleukin 1. However, a marked increase in cardiomyopathic lesion formation was observed in Mg-deficient animals treated with thalidomide; possible mechanisms for thalidomides enhancement of myocardial injury are discussed. (Mol Cell Biochem129: 195–200, 1993)