Ringer's ethyl pyruvate solution: a novel resuscitation fluid

Reactive oxygen species (ROS) have been implicated in the pathogenesis of the structural and functional alterations to tissues that are associated with a variety of pathological processes, including: sepsis and septic shock, thermal injury, doxorubicin-induced cardiomyopathy, hemorrhagic shock, and mesenteric ischemia/reperfusion (I/R) injury. Pyruvate (CH3COCOO-), a small molecule that is normally regarded as a key intermediate in the oxidative or anaerobic metabolism of glucose, is also a potent and effective ROS scavenger. Unfortunately, the usefulness of pyruvate as a therapeutic agent is abrogated by its very poor stability in solution. In an effort to take advantage of the ability of pyruvate to scavenge ROS while avoiding the problems associated with the instability of pyruvate in solution, we have developed a novel resuscitation fluid, which consists of a simple derivative of pyruvic acid, ethyl pyruvate, dissolved in a calcium-containing balanced salt solution. We call this solution Ringer's Ethyl Pyruvate Solution (REPS), and have shown in preliminary studies that treatment with REPS can improve outcome in a variety of animal models of critical illness.