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Wu JG, Taylor J, Parker M, Kunkel D, Rivera C, Pearce RA, Lennertz R, Sanders RD. Role of interleukin-18 in postoperative delirium: an exploratory analysis. Br J Anaesth 2022; 128:e229-e231. [PMID: 35090723 PMCID: PMC8988177 DOI: 10.1016/j.bja.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Justin G Wu
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Taylor
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maggie Parker
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - David Kunkel
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Cameron Rivera
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Richard Lennertz
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
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2
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Yuhe K, Huey Chew ST, Ang AS, Ge Ng RR, Boonkiangwong N, Liu W, Hao Toh AH, Caleb MG, Man Ho RC, Ti LK. Comparison of postoperative cognitive decline in patients undergoing conventional vs miniaturized cardiopulmonary bypass: A randomized, controlled trial. Ann Card Anaesth 2020; 23:309-314. [PMID: 32687088 PMCID: PMC7559974 DOI: 10.4103/aca.aca_192_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Neurocognitive dysfunction is a common complication of coronary artery bypass grafting (CABG) with incidence of 19–38%. The miniaturized cardiopulmonary bypass (MCPB) system was developed to reduce hemodilution and inflammation and provides better cerebral protection than conventional cardiopulmonary bypass (CCPB). In a meta-analysis, MCPB was associated with a 10-fold reduction in the incidence of strokes. However, its effect on postoperative cognitive decline (POCD) is unknown. We assessed if MCPB decreases POCD after CABG and compared the risk factors. Methods: A total of 71 Asian patients presenting for elective CABG at a tertiary center were enrolled. They were randomly assigned to MCPB (n = 36) or CCPB group (n = 35) and followed up in a single-blinded, prospective, randomized controlled trial. The primary outcome was POCD as measured by the repeatable battery of neuropsychological status (RBANS). Inflammatory markers (tumor necrosis factor-alpha and interleukin-6), hematocrit levels, and neutron-specific enolase (NSE) levels were studied. Results: Overall, the incidence of POCD at 3 months was 50%, and this was not significantly different between both groups (51.4 vs 50.0%, P = 0.90). Having <6 years of formal education [risk ratio (RR) = 3.014, 95% confidence interval (CI) = 1.054–8.618, P = 0.040] was significantly associated with POCD in the CCPB group, while the lowest hematocrit during cardiopulmonary bypass was independently associated with POCD in the MCPB group (RR = 0.931, 95% CI = 0.868–0.998, P = 0.044). The postoperative inflammatory markers and NSE levels were similar between the two groups. Conclusions: This study shows that the MCPB was not superior to CCPB with cell salvage and biocompatible tubing with regard to the neurocognitive outcomes measured by the RBANS.
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Affiliation(s)
- Ke Yuhe
- Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5, Singapore
| | - Sophia Tsong Huey Chew
- Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5; Department of Cardiovascular and Metabolic Disorders, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore
| | - An Shing Ang
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11,, Singapore
| | - Roderica Rui Ge Ng
- Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5; Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore
| | - Nantawan Boonkiangwong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, Singapore
| | - Weiling Liu
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of Anesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore
| | - Anastasia Han Hao Toh
- Department of Psychological Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore
| | - Michael George Caleb
- Department of Anesthesiology, Singapore General Hospital, 20 College Road, Academia, Level 5; Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, 5 Lower Kent Ridge Road, Singapore
| | - Roger Chun Man Ho
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of Psychological Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11; Department of Anesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore
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3
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Stehouwer MC, de Vroege R, Bruggemans EF, Hofman FN, Molenaar MA, van Oeveren W, de Mol BA, Bruins P. The influence of gaseous microemboli on various biomarkers after minimized cardiopulmonary bypass. Perfusion 2019; 35:202-208. [DOI: 10.1177/0267659119867572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Gaseous microemboli that originate from the cardiopulmonary bypass circuit may contribute to adverse outcome after cardiac surgery. We prospectively evaluated the influence of gaseous microemboli on the release of various biomarkers after use of a minimally invasive extracorporeal technology system. Methods: In 70 patients undergoing coronary artery bypass grafting with minimized cardiopulmonary bypass, gaseous microemboli were measured intraoperatively with a bubble counter. Intra- and postoperative biomarker levels for inflammatory response (interleukin-6, C5b-9), endothelial damage (von Willebrand factor, soluble vascular cell adhesion molecule-1), oxidative stress (malondialdehyde, 8-isoprostane, neuroketal), and neurological injury (neuron-specific enolase, brain-type fatty acid-binding protein) were analyzed using immune assay techniques. The relationship between gaseous microemboli number or volume and the incremental area under the curve (iAUC24h) or peak change for the biomarkers was calculated. Results: All biomarkers except for malondialdehyde increased at least temporarily after coronary artery bypass grafting with a minimally invasive extracorporeal technology system. The median total gaseous microemboli number was 6,174 (interquartile range: 3,507-10,531) and the median total gaseous microemboli volume was 4.31 µL (interquartile range: 2.71-8.50). There were no significant correlations between total gaseous microemboli number or volume and iAUC24h or peak change for any of the biomarkers. After controlling for the variance of possible other predictor variables, multiple linear regression analysis showed no association between gaseous microemboli parameters and release of biomarkers. Conclusion: This study showed no evidence that gaseous microemboli contribute to increased biomarker levels after coronary artery bypass grafting with cardiopulmonary bypass. A reason for the absence of damage by gaseous microemboli may be the relative and considerably small amount of gaseous microemboli entering the patients in this study.
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Affiliation(s)
- Marco C Stehouwer
- Department of Extracorporeal Circulation, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Roel de Vroege
- Department of Extracorporeal Circulation, HAGA Hospital, The Hague, The Netherlands
| | | | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Meyke A Molenaar
- Department of Anaesthesiology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Wim van Oeveren
- Laboratory for Blood Compatibility and Biomarker Detection, HaemoScan, Groningen, The Netherlands
| | - Bastian A de Mol
- Section Cardiovascular Biomechanics, Faculty of Biomedical Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter Bruins
- Department of Anaesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Nieuwegein, The Netherlands
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4
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Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med 2016; 42:1398-407. [DOI: 10.1007/s00134-016-4358-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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5
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Callaway JK, Wood C, Jenkins TA, Royse AG, Royse CF. Isoflurane in the presence or absence of surgery increases hippocampal cytokines associated with memory deficits and responses to brain injury in rats. Behav Brain Res 2016; 303:44-52. [PMID: 26784560 DOI: 10.1016/j.bbr.2016.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/10/2016] [Accepted: 01/14/2016] [Indexed: 11/25/2022]
Abstract
Evidence from experimental animal studies convincingly argues for a role of pro-inflammatory cytokines due to surgical trauma in causing postoperative cognitive dysfunction. However, other studies have shown exposure to 2-4h of isoflurane anesthetic without surgical trauma can also impair cognitive function. We aimed to determine cytokine changes over time following isoflurane exposure in the presence and absence of surgery and examine subsequent cognitive function. Male rats were exposed to isoflurane (1.8%, 4h) with or without laparotomy or control conditions and tested in a contextual fear conditioning paradigm 8 days later. On day 9 rats were perfused, serum and hippocampal samples were collected and 24 cytokines were analysed. Groups of rats exposed as above were killed 6 or 48h after isoflurane exposure to examine early cytokine changes. Isoflurane exposure resulted in significantly less freezing in the contextual fear conditioning test (F(2,31)=6.11, P=0.006) and addition of laparotomy caused no further deficits (P>0.05). At 6h post isoflurane exposure an immunosuppressive response was observed in the serum while hippocampal cytokines were largely unchanged. These finding suggest isoflurane alone causes inflammatory changes and cognitive deficits. The addition of a laparotomy had a negligible effect. Early after isoflurane exposure changes in serum and hippocampal cytokines were divergent but by 9 days were aligned. At this time cytokines associated with memory deficits and brain injury processes were significantly elevated in serum and brain.
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Affiliation(s)
- Jennifer K Callaway
- Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Wood
- Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia
| | - Trisha A Jenkins
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - Alistair G Royse
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiac Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Colin F Royse
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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6
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Silvia A, Claudia M, Cristina B, Manuel SA, Rigillo G, Blom JMC, Nicoletta B, Bruno C, Carmine PM, Fabio T. Interleukin 18 activates MAPKs and STAT3 but not NF-κB in hippocampal HT-22 cells. Brain Behav Immun 2014; 40:85-94. [PMID: 24603356 PMCID: PMC6248908 DOI: 10.1016/j.bbi.2014.02.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/17/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022] Open
Abstract
Interleukin (IL)-18 is a cytokine previously demonstrated to participate in neuroinflammatory processes. Since the components of the IL-18 receptor complex are expressed in neurons throughout the brain, IL-18 is also believed to directly influence neuronal function. Here we tested this hypothesis on mouse hippocampal neurons by measuring the effects of IL-18 on three pathways previously shown to be regulated by this cytokine in non-neuronal cells: the MAPK pathways, p38 and ERK1/2 MAPKs, STAT3 and NF-κB. Experiments were carried out in vitro using the immortalized hippocampal neuronal line HT-22 or in vivo following i.c.v. injection with recombinant mouse IL-18. We showed that IL-18 did not activate NF-κB in HT-22 cells whereas it induced a rapid (within 15min) activation of the MAPK pathways. Moreover, we demonstrated that IL-18 treatment enhanced P-STAT3 (Tyr705)/STAT3 ratio in the nucleus of HT-22 cells after 30-60min of exposure. A similar increase in P-STAT3 (Tyr705)/STAT3 ratio was observed in the whole hippocampus one hour after i.c.v. injection. These data demonstrate that IL-18 can act directly on neuronal cells affecting the STAT3 pathway; therefore, possibly regulating the expression of specific genes within the hippocampus. This effect may help to explain some of the IL-18-induced effects on synaptic plasticity and functionality within the hippocampal system.
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Affiliation(s)
- Alboni Silvia
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Montanari Claudia
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Benatti Cristina
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sanchez-Alavez Manuel
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037, United States
| | - Giovanna Rigillo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Joan MC Blom
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Brunello Nicoletta
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Conti Bruno
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA 92037, United States
| | - Pariante M. Carmine
- Stress, Psychiatry and Immunology Department of Psychological Medicine Institute of Psychiatry, Kings College London, London, UK
| | - Tascedda Fabio
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
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7
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Zhang XY, Tang W, Xiu MH, Chen DC, Yang FD, Tan YL, Wang ZR, Zhang F, Liu J, Liu L, Chen Y, Wen N, Kosten TR. Interleukin 18 and cognitive impairment in first episode and drug naïve schizophrenia versus healthy controls. Brain Behav Immun 2013; 32:105-11. [PMID: 23499732 DOI: 10.1016/j.bbi.2013.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/20/2013] [Accepted: 03/03/2013] [Indexed: 11/16/2022] Open
Abstract
Alterations in the inflammatory and immune systems have been documented to occur from the earliest stages of schizophrenia, and have been associated with neurodevelopmental changes. Cognitive impairment is a core feature in the pathology of schizophrenia, and recent studies showed a significant increase in serum IL-18 in schizophrenia, and a putative role of IL-18 in neuroprogression and thus neurocognitive defects. The purpose of this study was to examine the association of IL-18 with cognitive deficits in schizophrenia. We recruited 77 first episode and drug naïve schizophrenic patients and 75 healthy control subjects and examined the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and serum IL-18 in both groups. Schizophrenic symptoms were assessed using the positive and negative syndrome scale (PANSS). We found that IL-18 levels were non-significantly higher in patients than controls (206.0±92.9 pg/ml vs 193.2±41.8 pg/ml, p=0.28). Cognitive scores on the RBANS and nearly all of its five subscales (all p<0.05) except for the Visuospatial/Constructional index (p>0.05) were significantly lower in schizophrenic patients than normal controls. For the patients, IL-18 was positively associated with the Visuospatial/Constructional domain of cognitive deficits in schizophrenia. Our findings suggest that cognitive deficits occur during the acute stage of a schizophrenic episode, and IL-18 may be involved in Visuospatial/Constructional deficits of these patients.
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Affiliation(s)
- Xiang Yang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
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8
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Wu Y, Bian L, Ni X, Ning M, Zhao Y, Ling R. A mechanistic investigation into non-infarcted brain injury induced by cerebral artery microemboli. Mol Biol Rep 2012; 40:1283-90. [PMID: 23129315 DOI: 10.1007/s11033-012-2171-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 10/08/2012] [Indexed: 11/24/2022]
Abstract
To establish a rat brain injury by non-infarction process model induced by cerebral artery microemboli which would be used to further explore the neural injury mechanisms of cerebral artery microemboli. Seventy-two Sprague-Dawley rats were randomly divided into the microemboli group and the sham group; 100 25-50 μm microemboli in 300 μl or the same amount of saline were injected into the left carotid artery, respectively. The severity of neuron damage was assessed 3 and 7 days after the operation, using haematoxylin-eosin (HE) staining and immunohistochemical staining for caspase-3. Immunohistochemical staining for CD11b and GFAP were used to quantitatively analyse hyperplasia and the activation of microglia and astrocytes. TNF-α expression was detected by using ELISA and the NF-κB expression was detected by employing Western blotting. The results of HE staining had shown that ischaemic infarct foci were not detected in either the microemboli group or sham group. Only a few apoptotic cells and a few cells with the positive expression of CD11b and GFAP were detected in the sham group. And compared with that of the sham group, the number of apoptotic cells and the positive expression of CD11b and GFAP in the microemboli group were significantly increased (P < 0.001). These parameters were also significantly increased 7 days after the operation compared to rats 3 days after surgery (P < 0.001). The expressions of TNF-α and NF-κB were significantly increased in the microemboli group (P < 0.001), and the increase of the expression of TNF-α and NF-κB on the 3 days was more significant compared to that of TNF-α and NF-κB on 7 days (P < 0.001). Injection of 25-50 μm microemboli at a dose of 100 microemboli in 300 μl into the carotid artery of rats did not result in cerebral infarction, but led to neuronal apoptosis, hyperplasia and activation of microglia and astrocytes. This leads us to conclude that TNF-α and NF-κB may play important roles in the pathogenesis of neuronal apoptosis induced by microemboli in the cerebral arteries.
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Affiliation(s)
- Yiying Wu
- Department of Geriatrics, Shanghai First People's Hospital, Shanghai Jiaotong University, No. 100 Haining Road, Shanghai, 200080, China
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9
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Tegla CA, Cudrici C, Patel S, Trippe R, Rus V, Niculescu F, Rus H. Membrane attack by complement: the assembly and biology of terminal complement complexes. Immunol Res 2012; 51:45-60. [PMID: 21850539 DOI: 10.1007/s12026-011-8239-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Complement system activation plays an important role in both innate and acquired immunity. Activation of the complement and the subsequent formation of C5b-9 channels (the membrane attack complex) on the cell membranes lead to cell death. However, when the number of channels assembled on the surface of nucleated cells is limited, sublytic C5b-9 can induce cell cycle progression by activating signal transduction pathways and transcription factors and inhibiting apoptosis. This induction by C5b-9 is dependent upon the activation of the phosphatidylinositol 3-kinase/Akt/FOXO1 and ERK1 pathways in a Gi protein-dependent manner. C5b-9 induces sequential activation of CDK4 and CDK2, enabling the G1/S-phase transition and cellular proliferation. In addition, it induces RGC-32, a novel gene that plays a role in cell cycle activation by interacting with Akt and the cyclin B1-CDC2 complex. C5b-9 also inhibits apoptosis by inducing the phosphorylation of Bad and blocking the activation of FLIP, caspase-8, and Bid cleavage. Thus, sublytic C5b-9 plays an important role in cell activation, proliferation, and differentiation, thereby contributing to the maintenance of cell and tissue homeostasis.
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Affiliation(s)
- Cosmin A Tegla
- Department of Neurology, School of Medicine, University of Maryland, 655 W. Baltimore Street, BRB 12-033, Baltimore, MD 21201, USA
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10
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Umstead TM, Lu CJK, Freeman WM, Myers JL, Clark JB, Thomas NJ, Icitovic N, Chinchilli VM, Ündar A, Phelps DS. The Kinetics of Cardiopulmonary Bypass: A Dual-Platform Proteomics Study of Plasma Biomarkers in Pediatric Patients Undergoing Cardiopulmonary Bypass. Artif Organs 2012; 36:E1-20. [DOI: 10.1111/j.1525-1594.2011.01412.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Wu HY, Li F, Tang QF. Immunological effects of laparoscopic and open cholecystectomy. J Int Med Res 2011; 38:2077-83. [PMID: 21227013 DOI: 10.1177/147323001003800623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This prospective, randomized, controlled study evaluated plasma levels of interleukin-18 (IL-18) and monocyte chemotactic protein-1 (MCP-l) in patients undergoing cholecystectomy. Forty patients were randomized to undergo laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). Plasma concentrations of IL-18 and MCP-1 were measured before anaesthesia (T(0)), before operation (T(1)), 30 min after the start of the operation (T(2)) and at the end of the operation (T(3)). Compared with T(0), the IL-18 concentration was significantly increased at T(2) and T(3) in both groups. In addition, the MCP-1 concentration was significantly increased at T(3) compared with T(0) in the LC group. Both the IL-18 and MCP-1 concentrations were significantly lower in the OC group than in the LC group at T(3). It is suggested that carbon dioxide pneumoperitoneum may cause immunodepression, that epidural anaesthesia can attenuate the stress response, and that IL-18 and MCP-1 are sensitive markers for evaluating the patient's immune function.
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Affiliation(s)
- H Y Wu
- Department of Anaesthesiology, Kunshan Fourth People's Hospital, Kunshan, China
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12
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Cann C, Wilkes AR, Hall JE, Kumar RA. Are we using our brains? Diagnosis of postoperative cognitive dysfunction. Anaesthesia 2010; 65:1166-9. [DOI: 10.1111/j.1365-2044.2010.06531.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Alboni S, Cervia D, Sugama S, Conti B. Interleukin 18 in the CNS. J Neuroinflammation 2010; 7:9. [PMID: 20113500 PMCID: PMC2830964 DOI: 10.1186/1742-2094-7-9] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 01/29/2010] [Indexed: 12/16/2022] Open
Abstract
Interleukin (IL)-18 is a cytokine isolated as an important modulator of immune responses and subsequently shown to be pleiotropic. IL-18 and its receptors are expressed in the central nervous system (CNS) where they participate in neuroinflammatory/neurodegenerative processes but also influence homeostasis and behavior. Work on IL-18 null mice, the localization of the IL-18 receptor complex in neurons and the neuronal expression of decoy isoforms of the receptor subunits are beginning to reveal the complexity and the significance of the IL-18 system in the CNS. This review summarizes current knowledge on the central role of IL-18 in health and disease.
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Affiliation(s)
- Silvia Alboni
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Italy
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14
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Demir T, Demir H, Tansel T, Kalko Y, Tireli E, Dayioglu E, Barlas S, Onursal E. Influence of Methylprednisolone on Levels of Neuron-Specific Enolase in Cardiac Surgery: A Corticosteroid Derivative to Decrease Possible Neuronal Damage. J Card Surg 2009; 24:397-403. [DOI: 10.1111/j.1540-8191.2009.00842.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Platis A, Yu Q, Moore D, Khojeini E, Tsau P, Larson D. The effect of daily administration of IL-18 on cardiac structure and function. Perfusion 2009; 23:237-42. [PMID: 19181757 DOI: 10.1177/0267659108101511] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, the cytokine Interleukin-18 (IL-18) has been shown to be increased as a result of cardiac surgery. Elevated IL-18 has been associated with neurological dysfunction, systemic inflammatory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS) post open-heart surgery. The intent of the study contained herein was to determine the effect of IL-18 administration on cardiac function and structure. Eight C57BL/6 female mice were treated daily with 0.5microg/mouse of recombinant IL-18 for 7 days. Long axis echocardiography (ECHO) measurements of the anatomical and hemodynamic function of the heart for all mice were studied 24h after the last dose. The left ventricular wet weights increased from 84 +/- 1 to 93 +/- 3 mg when comparing the placebo (n = 8) with the IL-18 groups, respectively (p = 0.01). With ECHO analysis, IL-18 significantly increased left ventricular (LV) mass, the left atrium dimensions (LA), and the left ventricular posterior wall thickness (LVPW) over the 8-day time period (p < 0.01). There was a 5-fold increase in interstitial cardiac collagen content and a 30% increase in myocyte size in the IL-18 compared with the control groups (p < 0.01). Administration of IL-18 appears to induce interstitial fibrosis and myocyte hypertrophy, resulting in increased ventricular stiffness. Thus, increased IL-18 during and post open-heart surgical procedures may induce left ventricular diastolic dysfunction and affect post-operative outcomes.
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Affiliation(s)
- A Platis
- Circulatory Sciences Graduate Perfusion Program, College of Medicine, The University of Arizona, Tucson, AZ, USA
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16
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Wu PL, Lin GH, Kang XD, Yuan H, Shen YL. Complement activation by carotenoid derived aldehydes in cultured human vein epithelial cells. Phytother Res 2009; 23:1696-700. [DOI: 10.1002/ptr.2814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery--a randomized controlled trial. Crit Care Med 2009; 37:1762-8. [PMID: 19325490 DOI: 10.1097/ccm.0b013e31819da780] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cardiac surgery is frequently followed by postoperative delirium, which is associated with increased 1-year mortality, late cognitive deficits, and higher costs. Currently, there are no recommendations for pharmacologic prevention of postoperative delirium. Impaired cholinergic transmission is believed to play an important role in the development of delirium. We tested the hypothesis that prophylactic short-term administration of oral rivastigmine, a cholinesterase inhibitor, reduces the incidence of delirium in elderly patients during the first 6 days after elective cardiac surgery. DESIGN : Double-blind, randomized, placebo-controlled trial. SETTING One Swiss University Hospital. PATIENTS One hundred twenty patients aged 65 or older undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTION Patients were randomly assigned to receive either placebo or 3 doses of 1.5 mg of oral rivastigmine per day starting the evening before surgery and continuing until the evening of the sixth postoperative day. MEASUREMENTS AND MAIN RESULTS The primary predefined outcome was delirium diagnosed with the Confusion Assessment Method within 6 days postoperatively. Secondary outcome measures were the results of daily Mini-Mental State Examinations and clock drawing tests, and the use of a rescue treatment consisting of haloperidol and/or lorazepam in patients with delirium. Delirium developed in 17 of 57 (30%) and 18 of 56 (32%) patients in the placebo and rivastigmine groups, respectively (p = 0.8). There was no treatment effect on the time course of Mini-Mental State Examinations and clock drawing tests (p = 0.4 and p = 0.8, respectively). There was no significant difference in the number of patients receiving haloperidol (18 of 57 and 17 of 56, p = 0.9) or lorazepam (38 of 57 and 35 of 56, p = 0.6) in the placebo and rivastigmine groups, respectively. CONCLUSION This negative or, because of methodologic issues, possibly failed trial does not support short-term prophylactic administration of oral rivastigmine to prevent postoperative delirium in elderly patients undergoing elective cardiac surgery with cardiopulmonary bypass.
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Cann C, Wilkes AR, Hall JE, Kumar RA. Postoperative neurocognitive dysfunction after cardiac surgery: problems in defining the incidence. Anaesthesia 2008. [DOI: 10.1111/j.1365-2044.2008.05644_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alston RP. IL-18 and SC5b-9 for predicting neurocognitive dysfunction after cardiopulmonary bypass. Br J Anaesth 2007; 99:444-5; author reply 444-5. [PMID: 17702828 DOI: 10.1093/bja/aem221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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