Preserving vascular function is crucial for preventing multiorgan failure and death in ischemic and low-pressure states such as
trauma/
hemorrhagic shock (T/HS). It has recently been reported that inhibiting circulating
proteases released from the bowel to the circulation during T/HS may preserve vascular function and improve outcomes following T/HS. This study aimed to evaluate the role of the
serine protease inhibitor gabexate mesilate (GM) in preserving vascular function during T/HS when given enterally. We studied the vascular reactivity of mesenteric arteries from male Wistar rats treated with enteral GM (10 mg/kg) (GM-treated, n = 6) or control (
Shock-control, n = 6) following (T/HS) using pressure myography. Concentration-response curves of endothelial-dependent and endothelial-independent agonists (e.g.,
acetylcholine,
sodium nitroprusside) ranging from 10-10 to 10-5 M were performed. In a second set of experiments, ex-vivo arteries from healthy rats were perfused with plasma from shocked animals from both groups and vascular performance was similarly measured. Arteries from the GM-treated group demonstrated a preserved concentration-response curve to the α1
adrenergic agonist phenylephrine compared to arteries from
Shock-control animals (- logEC50: - 5.73 ± 0.25 vs. - 6.48 ± 0.2,
Shock-control vs. GM-treated, p = 0.04). When perfused with plasma from GM-treated rats, healthy arteries exhibited an even greater constriction and sensitivity to
phenylephrine (- logEC50: - 6.62 ± 0.21 vs. - 7.13 ± 0.21,
Shock-control vs. GM-treated, p = 0.02). Enteral GM also preserved the endothelium-dependent vascular response to agonists following T/HS and limited
syndecan-1 shedding as a marker of glycocalyx compromise (41.84 ± 9 vs. 17.63 ± 3.97 ng/mL,
Shock-control vs. GM-treated, p = 0.02).
Syndecan-1 cleavage was correlated with plasma
trypsin-like activity (r2 = 0.9611). Enteral
gabexate mesilate was able to maintain vascular function in experimental T/HS, which was reflected by improved hemodynamics (mean arterial pressure 50.39 ± 7.91 vs. 64.95 ± 3.43 mmHg,
Shock-control vs. GM treated, p = 0.0001). Enteral
serine protease inhibition may be a potential therapeutic intervention in the treatment of T/HS.