Early and successful myocardial reperfusion with primary percutaneous coronary intervention (pPCI) is the optimal therapy for patients presenting with ST segment elevation myocardial infarction (STEMI). Despite successful epicardial reopening of the infarct related artery, myocardial perfusion may not be restored in up to 40-50% of patients. This phenomenon, referred to as no-reflow (NR), recognizes several pathogenetic components including distal atherothrombotic embolization, ischaemic injury, reperfusion damage, intramyocardial hemorrhage and individual susceptibility of coronary microcirculation. However the complexity of pathogenesis remains still unclear. Moreover, cause NR plays a crucial role in patients prognosis, accurate detection is critical and multiple novel diagnostic modalities has been recently assessed.The NR phenomenon represents a challenge in the management of STEMI patients and has recently captured a growing interest of both basic scientists and interventional cardiologists. Although relevant efforts to transfer into real world practice new therapeutic strategies, to date there is still weak evidence of clinical improvement in this setting. Several strategies of prevention and treatment of NR have been proposed in the clinical arena including pharmacological and mechanical interventions. Nevertheless, the complexity of the phenomenon makes extremely unlikely for a single therapy to be effective. Understanding the interaction between the components of this pathway, along with exploring newer and more effective agents may enable patients to be treated with the most appropriate therapy.
Citation: Valeria Paradies, Filippo Masi, Francesco Bartolomucci, Alfredo Marchese, Armando Liso, Fabrizio Resta, Stefano Favale, Martino Pepe. No Reflow-phenomenon: from Current State of the Art to Future Perspectives[J]. AIMS Medical Science, 2015, 2(4): 374-395. doi: 10.3934/medsci.2015.4.374
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Early and successful myocardial reperfusion with primary percutaneous coronary intervention (pPCI) is the optimal therapy for patients presenting with ST segment elevation myocardial infarction (STEMI). Despite successful epicardial reopening of the infarct related artery, myocardial perfusion may not be restored in up to 40-50% of patients. This phenomenon, referred to as no-reflow (NR), recognizes several pathogenetic components including distal atherothrombotic embolization, ischaemic injury, reperfusion damage, intramyocardial hemorrhage and individual susceptibility of coronary microcirculation. However the complexity of pathogenesis remains still unclear. Moreover, cause NR plays a crucial role in patients prognosis, accurate detection is critical and multiple novel diagnostic modalities has been recently assessed.The NR phenomenon represents a challenge in the management of STEMI patients and has recently captured a growing interest of both basic scientists and interventional cardiologists. Although relevant efforts to transfer into real world practice new therapeutic strategies, to date there is still weak evidence of clinical improvement in this setting. Several strategies of prevention and treatment of NR have been proposed in the clinical arena including pharmacological and mechanical interventions. Nevertheless, the complexity of the phenomenon makes extremely unlikely for a single therapy to be effective. Understanding the interaction between the components of this pathway, along with exploring newer and more effective agents may enable patients to be treated with the most appropriate therapy.
The brain is an organ with high energy needs. While it represents only 2% of the body weight it grabs at least 20% of its total energy needs [9]. The consumed energy can come from many forms such as glutamate, glucose, oxygen and also lactate [3]. Energy is necessary to support neural activity. Gliomas are the most frequent primary brain tumors (more than 50% of brain cancer cases according to the ICM institute). Like other cancers, they lead to alterations of cells' energy management. In particular, lactate creation, consumption, import and export of a glioma cell seem to play a key role in the cancer development [5]-[11]. Today, neuroimaging techniques allow an indirect and noninvasive measure of cerebral activity. It also enables measurement of various metabolic concentrations such as lactate and measurement of important biological parameters such as the relative cerebral blood volume (allowing relative cerebral blood flow calculations). But because energy management in healthy and tumoral cells and glioma growth can be difficult to observe and explain experimentally, we propose to use mathematical modeling to help to describe and understand cells energy changes.
To the best of our knowledge, only a few mathematical models have been proposed to study lactate fluxes in the brain and the interconnections with energy, see [3] for example. We aim herein at analyzing a model first described in [2].
Our paper is organized as follows. We first present the mathematical model proposed to describe the mechanisms of interest. We then investigate its well-posedness and derive bounds on the solutions. Indeed, such an analysis is necessary to justify how a mathematical model is well-adapted to a biological problem. We also analyze the limit model and study its steady state. Bounds on the solutions are important as they are related with the viability domain of the cell. Furthermore, as mentioned in [8], a therapeutic perspective is to have the steady state outside the viability domain where cell necrosis occurs. Additionnally, we present numerical simulations with different values of the small parameter
The present model is reduced in order to follow in a simpler way lacate kinetics between a cell and the capillary network in its neighborhood. It is built in vivo which means that we have to consider loss and input terms for both intracellular and capillary lactate concentrations. We denote by
First, there is a lactate cotransport through the brain blood. It is taken into account by a simplified version of an equation for carrier-mediated symport. This nonlinear term depends on the maximum transport rate between the blood and the cell
Then a cell can equally produce and consume lactate, but also export surplus lactate to neighboring cells. We denote by
Next there is a blood flow contribution to capillary lactate depending on both arterial and venous lactates. We denote by
Finally, we have the following ODE's, for
$
u′ε(t)=J(t,uε(t))−T(uε(t)k+uε(t)−vε(t)k′+vε(t)),
$
|
(2.1) |
$
εv′ε(t)=F(t)(L−vε(t))+T(uε(t)k+uε(t)−vε(t)k′+vε(t)).
$
|
(2.2) |
The initial condition is given by :
$(u_{\varepsilon}(0);v_{\varepsilon}(0)) = (\bar{u}_0;\bar{v}_0) \in \mathbb{R}^+\times \mathbb{R}^+.$ |
The model is biologically described in [2], to which we refer the interested readers for a better understanding of this process.
Well-posedness. Recall that an ODE system
$x \geqslant 0, x_k = 0 \Rightarrow f_k(t, x)\geqslant 0$ |
is verified for all
Since we have for nonnegative
$|{\frac{u_1}{k+u_1}-\frac{u_2}{k+u_2}}| = \frac{k|{u_2-u_1}|}{(k+u_1)(k+u_2)} \leqslant \frac{|{u_2-u_1}|}{k}, $ |
then we can rewrite (2.1)-(2.2), setting
$X(t):=(uε(t);vε(t)), $
|
to have
$X'(t) = H(t, X(t)), ~~~~~~~~~ X(0) = X_0, $ |
where
Bounds on the solution. By means of (2.2), we have
$v_{\varepsilon}'(t) \leqslant -\frac{F_1 v_{\varepsilon}(t)}{\varepsilon}+\frac{F_2L}{\varepsilon}+\frac{T}{\varepsilon}, $ |
which implies, using Gronwall's lemma, that
$v_{\varepsilon}(t) \leqslant \exp (\frac{-F_1 t}{\varepsilon})\bar{v}_0+\int_0^t \exp (\frac{-F_1 (t-s)}{\varepsilon})\frac{T+F_2L}{\varepsilon}ds, $ |
or equivalently,
$v_{\varepsilon}(t) \leqslant \exp (\frac{-F_1 t}{\varepsilon})\bar{v}_0+\frac{T+F_2L}{F_1}(1- \exp (\frac{-F_1 t}{\varepsilon})).$ |
One can see, using the above formula, that we have
$v_{\varepsilon}(t) \leqslant \max(\bar{v}_0, \frac{T+F_2L}{F_1}): = B_v. \label{Bv} $ |
Theorem 3.1. We can exhibit a sufficient, but not necessary, condition to ensure a bound on
$\forall (t, x) \in \mathbb{R}^2, \ J(t, x) \leqslant B_J$ |
and :
$BJ<T(1−Bvk′+Bv)⇔BJ(k′+Bv)<Tk′.(C2.1) $
|
In that case, we have, setting
$
uε(t)⩽max(kz1−z,ˉu0):=Bu.
$
|
(3.1) |
Remark 1. Condition
Proof. Equation (2.1) gives
$u_{\varepsilon}'(t) \leqslant B_J+ T\frac{B_v}{B_v+k'}-T\frac{u_{\varepsilon}(t) }{k+u_{\varepsilon}(t) }.$ |
We set
$1-z = \frac{(k'+B_v)T}{(k'+B_v)T}-\frac{B_v(T+B_J)+k'B_J}{(k'+B_v)T} = \frac{k'T-B_J(k'+B_v)}{(k'+B_v)T} > 0.$ |
Let
$u_{\varepsilon}(t) > \frac{kz}{1-z}.$ |
Then,
$u_{\varepsilon}(t)(1-\frac{B_v}{k'+B_v}-\frac{B_J}{T}) > k(\frac{B_v}{k'+B_v}+\frac{B_J}{T}), $ |
which yields
$B_J+ T\frac{B_v}{B_v+k'}-T\frac{u_{\varepsilon}(t)}{k+u_{\varepsilon}(t)} < 0, $ |
hence
$ u_{\varepsilon}'(t) < 0. $ |
We finally deduce that
$uε(t)⩽max(kz1−z,ˉu0). $
|
Remark 2. This condition on an upper bound on
$J_{test}(s, x) = \underbrace{G_J}_{\text{creation}}-\underbrace{L_J}_{\text{ consumption}}+\underbrace{\frac{C_J}{\varepsilon_J+x}}_{\text{import}}, $ |
for positive constants
We have already proved that
$v_{\varepsilon}'(t) \geqslant -\frac{F_2 v_{\varepsilon}(t)}{\varepsilon}+\frac{F_1L}{\varepsilon}-\frac{T}{\varepsilon}\frac{B_v}{k'+B_v}.$ |
Then, if
$v_{\varepsilon}(t) \leqslant \frac{F_1L-T\frac{B_v}{k'+B_v}}{F_2}, $ |
we have
$vε(t)⩾min(ˉv0,F1L−TBvk′+BvF2). $
|
If
$
vε(t)⩾min(ˉv0,max(F1L−TBvk′+BvF2,0)):=Mv.
$
|
(3.2) |
Similarly,
$u′ε(t)⩾T(Mvk′+Mv−uεk+uε). $
|
Then
$
uε(t)⩾min(ˉu0,Mvkk′):=Mu.
$
|
(3.3) |
Remark 3. The upper bound
$v_{\varepsilon}(t) \leqslant \max( \underset{\varepsilon>0}{\sup{\bar{v}_0}}, \frac{T+F_2L}{F_1}) .$ |
The lower bounds
Stability of the equilibrium. For constant
$
ul:=k(JT+vlk′+vl)1−(JT+vlk′+vl),
$
|
(3.4) |
$
vl:=L+JF.
$
|
(3.5) |
It has also been proven that this unique stationary point is a node, hence a locally stable equilibrium. However, this equilibrium does not always exist. For existence, the parameters need to satisfy :
$
JT+LF+JF(k′+L)+J<1⇔J2+JF(L+k′)−TFk′<0.
$
|
(3.6) |
Remark 4. We have already shown that
$J^2+JF(L+k')-TFk'> T^2+TF(L+k')-TFk' = T(T+FL) > 0.$ |
Therefore, the contraposition leads to:
$J^2+JF(L+k')-TFk'\leqslant 0 \text{ implies } J \leqslant T.$ |
We fix all the parameters but
$\Delta_J = F^2(L+k')^2+4TFk'>0$ |
and there is an equilibrium only when
$Jb:=12(−F(L+k′)−√ΔJ),Jh:=12(−F(L+k′)+√ΔJ). $
|
Knowing that
1.
2.
A therapeutic perspective is to have the steady state outside the viability domain [8]. Therefore playing on cell lactate intake could be worth exploring: a large
We now study the limit system for
$
u′0(t)=J−T(u0(t)k+u0(t)−v0(t)k′+v0(t)),
$
|
(4.1) |
$
0=F(L−v0(t))+T(u0(t)k+u0(t)−v0(t)k′+v0(t)),
$
|
(4.2) |
together with the initial condition :
$u_0(0) = \bar{u}_0 \in \mathbb{R}^+.$ |
We first give some preliminary results and then establish bounds on the solutions and study the well-posedness of the system. We finally compare the original system (with
Preliminaries. The function
We define the function
${\varphi _c}\left\{ ]−c,+∞[→]−∞,T[s↦Tsc+s. \right.$
|
It is easy to see that
$\varphi _c^{ - 1}\left\{ [0,T[→[0,+∞[z↦czT−z. \right.$
|
Furthermore, we introduce the function
${{\psi }_{c}}\left\{ ]−c,+∞[→R s↦Fs+φc(s), \right.$
|
where
$\psi_c'(s) = F+\frac{Tc}{(c+s)^2}.$ |
Employing (4.2), we have :
$\psi_{k'}(v_0(t)) = FL+\varphi_k(u_0(t)).$ |
We rewrite (4.1)-(4.2) as :
$
v0(t)=ψ−1k′(FL+φk(u0(t))):=Ψ(u0(t)),
$
|
(4.3) |
$
u′0(t)=J−T(u0(t)k+u0(t)−Ψ(u0(t))k′+Ψ(u0(t))):=G(t,u0(t)),
$
|
(4.4) |
and set, for
$Ψ−1(y)=φ−1k(ψk′(y)−FL). $
|
A priori bounds on the solutions. Thanks to (4.4), we have :
$G(t, 0) = J+\frac{T\psi_{k'}^{-1}(FL)}{k'+\psi_{k'}^{-1}(FL)}\geqslant J, $ |
and the system is quasipositive : for an initial condition
Using (4.2), we find an upper bound on
$
v0(t)⩽L+TF:=Bv,0.
$
|
(4.5) |
We can also obtain an upper bound on
We now rewrite (4.2) as :
$v_{0}(t)^2+v_{0}(t)(k'-L+\frac{T}{F}-z)-k'(L+z) = 0, $ |
where
Noting that
$
v0(t)=12(z+L−TF−k′+√(TF+k′−L−z)2+4k′(L+z)).
$
|
(4.6) |
Well-posedness. Equation (4.4) gives :
$u′0(t)=J−T(u0(t)k+u0(t)−Ψ(u0(t))k′+Ψ(u0(t))):=G(t,u0(t)). $
|
Lemma 1. The function
$|{\Psi(u_1)-\Psi(u_2)}| \leqslant K_L |{u_1-u_2}|.$ |
Proof. Let
$Ψ′(u)=1(Ψ−1)′(Ψ(u)) $
|
and :
$|(Ψ−1)′(Ψ(u))|=|(φ−1k)′(ψk′(Ψ(u))−FL)ψk′(Ψ(u)))|=|Tk(T−ψk′(Ψ(u))+FL)2(F+Tk(k+Ψ(u))2)|=|Tk(Tk+F(k+Ψ(u))2)(T+φk(u))2(k+Ψ(u))2|. $
|
It follows from the above that
$0=F(L−v)+T(uk+u−vk′+v)⇒v⩽FL+T=Bv,0,v⩾0. $
|
Therefore,
$|Ψ′(u)|=1|(Ψ−1)′(Ψ(u))|=|(T+φk(u))2(k+Ψ(u))2Tk(Tk+F(k+Ψ(u))2)|⩽(T+Tuk+u)2(k+Ψ(u))2⩽4T2(k+Bv,0)2:=KL. $
|
Consequently,
Stability of the equilibrium. As proved in [3], (4.1)-(4.2) can have at most one equilibrium given under the above parameters condition. The Jacobian of the system at this point gives the eigenvalue :
$\lambda: = -T \frac{k}{(k+u_l)^2} <0.$ |
Therefore,
$Tulk+ul=Tkzl1−zl1−zlk=Tzl=TJT+Tvlk′+vl=F(JF+L−L)+Tvlk′+vl=F(vl−L)+Tvlk′+vl. $
|
Thus :
$Fv_l+T\frac{v_l}{k'+v_l} = FL+T\frac{u_l}{k+u_l} \Leftrightarrow v_l = \Psi(u_l), $ |
and the stationnary point
Comparison between the original and the limit systems. We wish to bound the difference between
$u_{\varepsilon}(0) = u_0(0) = \bar{u}_0.$ |
We set
$
u′(t)=T(k′v(t)(vε(t)+k′)(v0(t)+k′)−ku(t)(uε(t)+k)(u0(t)+k)),
$
|
(4.7) |
$
εv′(t)=−Fv(t)+T(ku(t)(uε(t)+k)(u0(t)+k)−k′v(t)(vε(t)+k′)(v0(t)+k′))−εv′0(t).
$
|
(4.8) |
It follows from the above that,
$u′0(t)=J−T(u0(t)k+u0(t)−v0(t)k′+v0(t))∈[J−T,J+T],v0(t)⩽Bv,0, $
|
Therefore, differentiating (4.2), we find :
$Fv′0(t)=T(ku′0(t)(k+u0(t))2−k′v′0(t)(k′+v0(t))2)⇒v′0(t)(F+k′T(k′+v0(t))2)=Tku′0(t)(k+u0(t))2, $
|
hence
$|{v_{0}'(t)}| \leqslant \frac{kT(J+T)}{(F+\frac{k'T}{(k'+B_{v, 0})^2})}: = \gamma.$ |
Next, multiplying
$
12ddt(u2(t))⩽Tk′|u(t)||v(t)|,
$
|
(4.9) |
$
ε12ddt(v2(t))+Fv2(t)⩽Tk|u(t)||v(t)|+ε|v(t)|γ.
$
|
(4.10) |
Noting that
$Tk|u(t)||v(t)|+ε|v(t)|γ=(Tk|u(t)|2√F)(√F2|v(t)|)+(|v(t)|√F2)(2√Fεγ)⩽F2v2(t)+4T2Fk2u2(t)+4γ2Fε2 $
|
and
$Tk′|u(t)||v(t)|=(Tk′|u(t)|√2√F)(√F√2|v(t)|)⩽F2v2(t)+2T2Fk′2u2(t), $
|
summing (4.9) and (4.10) thus yields,
$ddt(u2(t)+εv2(t))⩽(8T2Fk2+4T2Fk′2)(u2(t)+εv2(t))+8γ2Fε2. $
|
Noting finally that :
$u^2(0) = 0 \text{ and }u^2(0)+\varepsilon v^2(0) = \varepsilon (\bar{v}_0-\Psi(\bar{u}_0))^2, $ |
Gronwall's lemma gives,
$u2(t)+εv2(t)⩽exp(T2tF(8k2+4k′2))(ε(ˉv0−Ψ(ˉu0))2+k2(J+T)2(F+k′T(k′+L+TF)2)22ε2(2k2+1k′2))−k2(J+T)2(F+k′T(k′+L+TF)2)22ε2(2k2+1k′2). $
|
Remark 5. In the particular case
$u2(t)+εv2(t)⩽(exp(T2tmF(8k2+4k′2))−1)2γ2ε2T2(2k2+1k′2) $
|
which yields that, on the finite time interval
$
|u(t)|⩽Ctmε,|v(t)|⩽Ctm√ε.
$
|
(4.11) |
Remark 6. Setting
In this section, we first present several numerical simulations with relevant values of our parameters. We also compare the numerical simulations with different values of
Numerical illustration with nonconstant
$J\left\{ R+→R+ x↦GJ−Lj+Cjx+εj, \right.$
|
containing a creation term, a consumption term and an import term. This function
$F\left\{ \begin{array}{l} {\mathbb{R}^ + } \to {\mathbb{R}^ + }\\ t \mapsto \left\{ \begin{array}{l} {F_0}(1 + {\alpha _f})\;\;\;{\rm{if}}\;\exists N \in\mathbb{N} /(N - 1){t_f} + {t_i}{\rm{ < }}t{\rm{ < }}N{t_f},\\ \;\;\;\;\;\;\;\;\;\;\;\;{F_0}\;\;{\rm{if}}\;\;{\rm{not}} \end{array} \right.
\end{array} \right.$
|
The parameters for these two functions are given in Table 1.
Parameter | Value | Unit |
| 0.012 | s |
| 0.5 | |
| 50 | |
| 100 | |
| 5.7*10 | |
| 0.001 | |
| 0.002 | |
| 0.001 | |
We also consider the parameters given in [2] and [8]. In that case,
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.001 | s |
The solutions
Numerical simulations with different values of
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0057 | mM.s |
| 0.0272 | s |
| 0.1 | s |
Note that, in that case, we have shown the existence of an upper bound on
Using the parameters values given in Table 3, we perform numerical simulations with various values of
While the intracellular lactate trajectories seem not to differ a lot, the capillary lactate trajectories show different initial dynamics. The smaller
Remark 7. An approach based on singular perturbation theory has been made on this model by Lahutte-Auboin et al. [7,8]. There, the authors give a geometrical explanation for the initial lactate dip and prove the existence of a periodic solution of the fast-slow system under a repetitive sequence of identical stimuli. In addition, our approach gives an estimate on the rate of convergence with respect to the parameters, which is usually not the case with singular perturbation theory.
Using the parameters given in Table 3, we now test different values for
There is a limit value of
$J_{lim} = 0.00851 \text{ mM.s$^{-1}$}.$ |
There are two types of dynamics : those with
Experimental data. In this section we compare typical results obtained by using the model (with constant
For each five patients we have four lactate concentration measures (only three for patient 1) separated from each other by more than
We are unable to distinguish between capillary lactate and intracellular lactate using imaging data. Therefore lactate concentration measures are the sum of the capillary lactate and intracellular lactate concentrations.
Because lactate concentrations variations are intrinsic and depend on lactate exchanges, we assume that it is relevant to adjust the initial values (
Parameter | Value | Unit |
| 0.1 | mM.d |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0272 | d |
| 0.1 | d |
The results are given in Figure 7. Fitted values of
Patient | | | |
| | | |
| | | |
| | | |
| | | |
| | | |
Our model (with constant
In this study we analyze a model for lactate kinetics first given in [2]. This model is a first step in view of a better understanding of lactate dynamics in the brain. Lactate has a key role in neuroenergetics. Therefore studying its dynamics in the brain is necessary to better understand the energetic breakdown which is observed, for example in tumors. This model is known to give good results when fitted with experimental data [2], [8]. However, to the best of our knowledge, no mathematical analysis has been made to show the existence and uniqueness of the solution and conditions for bounds on the solution, but also comparisons between the original and limit systems.
In this paper, we study the original and limit systems and obtain existence, uniqueness and bounds on the solutions for the two systems. We also give a condition on
When confronted with imaging data from NMR spectroscopy and perfusion, the model provides good results. Because there are large time variations, we cannot ensure that all the parameters remain constant in time. Therefore constant parameters are not good for explaining hard changes on the lactate concentration dynamics such as shifting from a decreasing concentration to an increasing one. Despite this, they can explain what happens after a lactate spike.
Differences in lactate dynamics suggest that there are several glioma profiles with different typical kinetics. This could indicate that non-agressive low grade gliomas show an increasing lactate concentration and then move to more agressive form (WHO Ⅱ+ to WHO Ⅲ+). At this stage the glioma will exhibit angiogenesis, modified proteins and altered transporters, which leads to fluctuating lactate kinetics [6]. This point should be considered as a critical one because of its therapeutical management consequences. Yet the patient should be referred to more agressive therapeutics such as radiotherapy or chemotherapy. Also the imaging control frequency should be restrained as well.
As already mentioned in [10], an initial dip exists in the brain lactate dynamics. This dip could be mathematically explained by the different initial values of the capillary lactate concentration between the original and limit systems. Therefore the dip can be biologically explained by compartment volume modifications.
It cannot be excluded that
Indeed one perspective is to build more complex and suitable models for brain metabolism. Adding oxygen and glucose dynamics to this model can be the next step in view of a more accurate description of energy dynamics in the brain. It could also be interesting to build a model with different cell types (such as astrocyte and neuron), for a better understanding of the brain fuel substrate fluxes.
The authors wish to thank an anonymous referee for her/his careful reading of the paper and helpful comments.
[1] |
Hamm CW, Bassand JP, Agewall S, et al. (2011) ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation. Eur Heart J 32: 2999-3054. doi: 10.1093/eurheartj/ehr236
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Parameter | Value | Unit |
| 0.012 | s |
| 0.5 | |
| 50 | |
| 100 | |
| 5.7*10 | |
| 0.001 | |
| 0.002 | |
| 0.001 | |
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.001 | s |
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0057 | mM.s |
| 0.0272 | s |
| 0.1 | s |
Parameter | Value | Unit |
| 0.1 | mM.d |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0272 | d |
| 0.1 | d |
Patient | | | |
| | | |
| | | |
| | | |
| | | |
| | | |
Parameter | Value | Unit |
| 0.012 | s |
| 0.5 | |
| 50 | |
| 100 | |
| 5.7*10 | |
| 0.001 | |
| 0.002 | |
| 0.001 | |
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.001 | s |
Parameter | Value | Unit |
| 0.01 | mM.s |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0057 | mM.s |
| 0.0272 | s |
| 0.1 | s |
Parameter | Value | Unit |
| 0.1 | mM.d |
| 3.5 | mM |
| 3.5 | mM |
| 0.3 | mM |
| 0.0272 | d |
| 0.1 | d |
Patient | | | |
| | | |
| | | |
| | | |
| | | |
| | | |