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Engels M, Bilgic E, Pinto A, Vasquez E, Wollschläger L, Steinbrenner H, Kellermann K, Akhyari P, Lichtenberg A, Boeken U. A cardiopulmonary bypass with deep hypothermic circulatory arrest rat model for the investigation of the systemic inflammation response and induced organ damage. JOURNAL OF INFLAMMATION-LONDON 2014; 11:26. [PMID: 25400510 PMCID: PMC4231204 DOI: 10.1186/s12950-014-0026-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/23/2014] [Indexed: 02/08/2023]
Abstract
Background Cardiopulmonary bypass (CPB) is a commonly used technique in cardiac surgery. CPB is however associated with a strong induction of systemic inflammatory response syndrome (SIRS) which in conjunction with ischemia and reperfusion may lead to multiple organ failure. The aim of the study was to establish and characterize a CPB rat model incorporating deep hypothermic circulatory arrest with a specific focus on the extent of the inflammatory reactions and organ damage as a groundwork for novel therapeutics against SIRS and I/R induced organ injury. Materials and methods Male Wistar rats (n = 6) were cannulated for CPB, connected to a heart-lung-machine (HLM) and cooled to a temperature of 16°C before they underwent 45 minutes of deep hypothermic circulatory arrest with global ischaemia. Arrest was followed by rewarming and 60 minutes of reperfusion. Haemodynamic and vital parameters were recorded throughout the CPB procedure. Only animals displaying sinus rhythm throughout reperfusion were utilized for analysis. Rats were euthanized and tissue samples were harvested. Blood gas analysis was performed and blood samples were taken. Induction of organ damage was examined by analysis of protein levels and phosphorylation status of kinases and stress proteins. Results were compared to animals (n = 6) which did not undergo CPB. Results CPB induced leucocytosis and an increase of interleukin-6 and TNF-α plasma values indicating an inflammatory response. Markers of tissue damage and dysfunction, such as troponin T, creatinine and AST were elevated. Phosphorylation of STAT3 was induced in all examined organs. Activation of MAPK and induction of heat shock proteins occurred in an organ-specific manner with most pronounced effects in heart, lungs and kidneys. Conclusions The presented CPB rat model shows the induction of SIRS and activation of specific signalling cascades. SIRS seems not to be provoked during DHCA and is elicited mainly during reperfusion. This model might be suitable to test the efficacy of therapeutics applied in major heart surgery with and without DHCA.
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Affiliation(s)
- Melanie Engels
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany ; Institute for Biochemistry and Molecular Biology I, Heinrich Heine University, Duesseldorf, Germany
| | - Esra Bilgic
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany
| | - Antonio Pinto
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany ; Institute for Biochemistry and Molecular Biology I, Heinrich Heine University, Duesseldorf, Germany
| | - Edwin Vasquez
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany ; Institute for Biochemistry and Molecular Biology I, Heinrich Heine University, Duesseldorf, Germany
| | - Lena Wollschläger
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany ; Institute for Biochemistry and Molecular Biology I, Heinrich Heine University, Duesseldorf, Germany
| | - Holger Steinbrenner
- Institute for Biochemistry and Molecular Biology I, Heinrich Heine University, Duesseldorf, Germany
| | - Kristine Kellermann
- Clinic for Anaesthesiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany
| | - Udo Boeken
- Department of Cardiovascular Surgery, Faculty of Medicine, Heinrich Heine University, Moorenstr. 5, Duesseldorf, D - 40225, Germany
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Probing the coagulation pathway with aptamers identifies combinations that synergistically inhibit blood clot formation. ACTA ACUST UNITED AC 2014; 21:935-44. [PMID: 25065530 DOI: 10.1016/j.chembiol.2014.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/03/2014] [Accepted: 05/30/2014] [Indexed: 11/21/2022]
Abstract
Coordinated enzymatic reactions regulate blood clot generation. To explore the contributions of various coagulation enzymes in this process, we utilized a panel of aptamers against factors VIIa, IXa, Xa, and prothrombin. Each aptamer dose-dependently inhibited clot formation, yet none was able to completely impede this process in highly procoagulant settings. However, several combinations of two aptamers synergistically impaired clot formation. One extremely potent aptamer combination was able to maintain human blood fluidity even during extracorporeal circulation, a highly procoagulant setting encountered during cardiopulmonary bypass surgery. Moreover, this aptamer cocktail could be rapidly reversed with antidotes to restore normal hemostasis, indicating that even highly potent aptamer combinations can be rapidly controlled. These studies highlight the potential utility of using sets of aptamers to probe the functions of proteins in molecular pathways for research and therapeutic ends.
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Inflammatory Response in Patients under Coronary Artery Bypass Grafting Surgery and Clinical Implications: A Review of the Relevance of Dexmedetomidine Use. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/905238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite the fact that coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) prolongs life and reduces symptoms in patients with severe coronary artery diseases, these benefits are accompanied by increased risks. Morbidity associated with cardiopulmonary bypass can be attributed to the generalized inflammatory response induced by blood-xenosurfaces interactions during extracorporeal circulation and the ischemia/reperfusion implications, including exacerbated inflammatory response resembling the systemic inflammatory response syndrome (SIRS). The use of specific anesthetic agents with anti-inflammatory activity can modulate the deleterious inflammatory response. Consequently, anti-inflammatory anesthetics may accelerate postoperative recovery and better outcomes than classical anesthetics. It is known that the stress response to surgery can be attenuated by sympatholytic effects caused by activation of central (α-)2-adrenergic receptor, leading to reductions in blood pressure and heart rate, and more recently, that they can have anti-inflammatory properties. This paper discusses the clinical significance of the dexmedetomidine use, a selective (α-)2-adrenergic agonist, as a coadjuvant in general anesthesia. Actually, dexmedetomidine use is not in anesthetic routine, but this drug can be considered a particularly promising agent in perioperative multiple organ protection.
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Li W, Zheng B, Xu H, Deng Y, Wang S, Wang X, Su D. Isoflurane Prevents Neurocognitive Dysfunction After Cardiopulmonary Bypass in Rats. J Cardiothorac Vasc Anesth 2013; 27:502-9. [DOI: 10.1053/j.jvca.2012.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Indexed: 11/11/2022]
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Le Guillou V, Tamion F, Jouet I, Richard V, Mulder P, Bessou JP, Doguet F. Mesenteric endothelial dysfunction in a cardiopulmonary bypass rat model: the effect of diabetes. Diab Vasc Dis Res 2012; 9:270-9. [PMID: 22278737 DOI: 10.1177/1479164111434432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes is a risk factor for perioperative complications after cardiac surgery. We studied its effects on mesenteric endothelial function in a cardiopulmonary bypass (CPB) model. METHODS Forty Wistar rats were divided into four groups: sham (D-CPB-), cardiopulmonary bypass (D-CPB+), diabetic (D+CPB-) and diabetic that have undergone CPB (D+CPB+). Two samples of mesenteric artery were used for nitric oxide synthase (NOS) Western blot analysis, and two others for assessing contractile response and endothelium relaxations. Nitrite products and tumour necrosis factor-alpha (TNF-α) were assessed as markers of inflammatory response. RESULTS We observed an enhanced contractile response to the α-adrenergic agonist associated with impairment of mesenteric vasorelaxation in D+CPB+ rats. Western immunoblot analysis of D+CPB+ highlighted an additive effect of hyper-expression of inducible NOS. A significantly increased inflammatory response was observed after CPB in diabetic animals. CONCLUSIONS This work confirms the potential deleterious impact of diabetes on the mesenteric endothelium during CPB in cardiac surgery.
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Affiliation(s)
- Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, France
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Jungwirth B, de Lange F. Animal models of cardiopulmonary bypass: development, applications, and impact. Semin Cardiothorac Vasc Anesth 2010; 14:136-40. [PMID: 20478954 DOI: 10.1177/1089253210370491] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurologic and neurocognitive complications after cardiac surgery have been reported repeatedly. To better understand its etiology and design protective strategies, small animal models have been developed. This study describes the development of a survival rat cardiopulmonary bypass (CPB) model, along with the introduction of an appropriately sized oxygenator. This model led the way for even more complicated models with CPB, facilitating full cardiac arrest with anterograde cardioplegia administration, air embolization, and deep hypothermic circulatory arrest. In addition, the results of several of those rat CPB studies are summarized and their preclinical relevance is pointed out.
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Gourlay T, Modine T. The Influence of Cannulation Technique on Blood Flow to the Brain in Rats Undergoing Cardiopulmonary Bypass: A Cautionary “Tail”. Artif Organs 2010; 34:498-503. [DOI: 10.1111/j.1525-1594.2009.00917.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kellermann K, Gordan ML, Nollert G, Blobner M, Kochs EF, Jungwirth B. Long-term assessment of NFkappaB expression in the brain and neurologic outcome following deep hypothermic circulatory arrest in rats. Perfusion 2010; 24:429-36. [PMID: 20093339 DOI: 10.1177/0267659109358655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Inflammatory response is discussed as a contributor to neurologic deficits following cardiac surgery using deep hypothermic circulatory arrest (DHCA). Nuclear Factor Kappa B (NFkappaB) presents a central transcription factor whose expression pattern and subsequent role very much depend on the type and manner of cerebral injury. This study was designed to assess the time course of cerebral NFkappaB expression in relation to neurologic performance over 28 days following 45min of DHCA in rats. METHODS With Institutional Review Board approval, 30 rats were subjected to cardiopulmonary bypass (CPB) with 45min of DHCA (rectal temperature 15-18 degrees Celsius) and randomly assigned to 1, 3, 7, 14 and 28 days of postoperative survival. Untreated animals served as control (n=6). Cerebral NFkappaB expression was analyzed immunohistochemically, cyclooxygenase-2 (COX-2) and inhibitor of kappa B-alpha (IkappaBalpha) using Western Blot and the number of eosinophilic neurons with hematoxylin and eosin (HE) staining. Neurologic outcome was assessed pre- and postoperatively. RESULTS Neuronal expression of NFkappaB in the hippocampus peaked at day one, remaining elevated in the motor cortex until day 28. Rats showed neurologic deficits on postoperative day one. Cerebral COX-2 was increased during the first postoperative week and IkappaBalpha peaked on day 14. Histologic damage in the motor cortex and hippocampus persisted until day 28. No systemic inflammation was detectable postoperatively. CONCLUSIONS Postoperative day one presents with the highest NFkappaB-expression in the ischemia-sensitive hippocampus, accompanied by neurologic dysfunction and histologic damage following 45min of DHCA in rats.
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Affiliation(s)
- Kristine Kellermann
- Klinik für Anesthesiologie, Technische Universität München, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 München, Germany.
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Jungwirth B, Eckel B, Blobner M, Kellermann K, Kochs EF, Mackensen GB. The impact of cardiopulmonary bypass on systemic interleukin-6 release, cerebral nuclear factor-kappa B expression, and neurocognitive outcome in rats. Anesth Analg 2009; 110:312-20. [PMID: 19861361 DOI: 10.1213/ane.0b013e3181bbc42e] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neurocognitive deficits after cardiac surgery with cardiopulmonary bypass (CPB) continue to affect patients' quality of life, and an inflammatory reaction may be one of the contributors. We designed this experiment to study perioperative systemic interleukin-6 (IL-6) concentrations, cerebral expression of nuclear factor-kappa B (NF-kappaB), and neurocognitive outcome after CPB in young rats. The impact of oxygenator size on these outcomes was also assessed. METHODS Rats were randomly assigned to 1 of 4 groups: control (n = 7, nonanesthetized), sham-operated rats (n = 10, anesthetized, cannulated, and not connected to CPB), and 2 CPB groups, anesthetized, cannulated, and subjected to 90 min of CPB, using either a small-volume rat oxygenator (CPB/rat oxygenator, n = 10) or a neonate oxygenator (CPB/neonate oxygenator, n = 10). Systemic IL-6 was determined before, at the end of, and 2 h after CPB or at equivalent times. Hippocampal NF-kappaB expression was assessed on postoperative day 21 using immunohistochemistry. Neurocognitive performance was assessed with the modified hole-board test at baseline and for 21 postoperative days. RESULTS Both CPB groups had increased systemic IL-6 levels compared with sham, with the neonate oxygenator causing a substantially larger increase at 2 h after CPB compared with the rat oxygenator group (CPB/rat oxygenator: 220 pg/mL [16-415]; CPB/neonate oxygenator: 1400 pg/mL [592-5812]) (P < 0.05). Hippocampal NF-kappaB was increased in experimental groups compared with controls (10 +/- 4). CPB resulted in more NF-kappaB-positive neurons (271 +/- 57 CPB/neonate oxygenator and 269 +/- 72 CPB/rat oxygenator) compared with sham operation (173 +/- 24). Neurocognitive and behavioral performances were unaltered and comparable among all groups. CONCLUSIONS Pronounced systemic inflammatory responses to experimental CPB associated with increased hippocampal expression of NF-kappaB were not accompanied by neurocognitive impairment. This suggests that other factors beyond CPB and inflammatory responses might contribute to adverse neurocognitive outcomes after cardiac surgery.
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Affiliation(s)
- Bettina Jungwirth
- Klinik für Anaesthesiologie der Technischen Universität München, D-81675 Munich, Germany.
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Cerebral tumor necrosis factor alpha expression and long-term neurocognitive performance after cardiopulmonary bypass in rats. J Thorac Cardiovasc Surg 2009; 138:1002-7. [PMID: 19660347 DOI: 10.1016/j.jtcvs.2009.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 05/20/2009] [Accepted: 06/20/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Cerebral inflammatory reaction is discussed as a contributor to adverse cerebral outcome after cardiac surgery with cardiopulmonary bypass. This study was designed to determine the effect of cardiopulmonary bypass on both cerebral expression of tumor necrosis factor alpha and neurocognitive outcome in rats. METHODS With institutional review board approval, 50 rats were randomly assigned to one of 3 groups: rats of the cardiopulmonary bypass group were subjected to 75 minutes of normothermic cardiopulmonary bypass. Sham-operated animals underwent identical preparation but were not connected to cardiopulmonary bypass, whereas rats of the control group were neither anesthetized nor cannulated. Ten rats per group survived 4 hours after cardiopulmonary bypass or the sham operation for immediate postoperative determination of tumor necrosis factor alpha-expressing cells (immunohistochemistry) and cerebral tumor necrosis factor alpha mRNA levels (polymerase chain reaction). The remaining animals survived 10 days for neurocognitive assessment by using the modified hole-board test and for analysis of cerebral tumor necrosis factor alpha activation in the late postoperative period. RESULTS Expression of tumor necrosis factor alpha mRNA was increased 4 hours after cardiopulmonary bypass and the sham operation, with higher expression in the cardiopulmonary bypass group (chi(2) [2] = 25.08, P < .001). Both experimental groups demonstrated larger numbers of tumor necrosis factor alpha-positive cells in the early and late postoperative periods (F [1] = 13.08, P < or = .001) and an impaired neurocognitive performance on the first postoperative days compared with that seen in the control group (F [2, 24] = 4.26, P = .02). CONCLUSIONS Cerebral tumor necrosis factor alpha activation in both experimental groups during the early postoperative period was accompanied by transient neurocognitive impairment. Therefore cardiopulmonary bypass alone demonstrated no effect on cerebral inflammation and neurocognitive outcome.
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Hardman JG, Moppett IK, Mahajan RP. Validity, credibility, and applicability: the rise and rise of the surrogate. Br J Anaesth 2008; 101:595-6. [PMID: 18854383 DOI: 10.1093/bja/aen292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Lange F, Yoshitani K, Podgoreanu MV, Grocott HP, Mackensen GB. A novel survival model of cardioplegic arrest and cardiopulmonary bypass in rats: a methodology paper. J Cardiothorac Surg 2008; 3:51. [PMID: 18713467 PMCID: PMC2553064 DOI: 10.1186/1749-8090-3-51] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 08/19/2008] [Indexed: 11/18/2022] Open
Abstract
Background Given the growing population of cardiac surgery patients with impaired preoperative cardiac function and rapidly expanding surgical techniques, continued efforts to improve myocardial protection strategies are warranted. Prior research is mostly limited to either large animal models or ex vivo preparations. We developed a new in vivo survival model that combines administration of antegrade cardioplegia with endoaortic crossclamping during cardiopulmonary bypass (CPB) in the rat. Methods Sprague-Dawley rats were cannulated for CPB (n = 10). With ultrasound guidance, a 3.5 mm balloon angioplasty catheter was positioned via the right common carotid artery with its tip proximal to the aortic valve. To initiate cardioplegic arrest, the balloon was inflated and cardioplegia solution injected. After 30 min of cardioplegic arrest, the balloon was deflated, ventilation resumed, and rats were weaned from CPB and recovered. To rule out any evidence of cerebral ischemia due to right carotid artery ligation, animals were neurologically tested on postoperative day 14, and their brains histologically assessed. Results Thirty minutes of cardioplegic arrest was successfully established in all animals. Functional assessment revealed no neurologic deficits, and histology demonstrated no gross neuronal damage. Conclusion This novel small animal CPB model with cardioplegic arrest allows for both the study of myocardial ischemia-reperfusion injury as well as new cardioprotective strategies. Major advantages of this model include its overall feasibility and cost effectiveness. In future experiments long-term echocardiographic outcomes as well as enzymatic, genetic, and histologic characterization of myocardial injury can be assessed. In the field of myocardial protection, rodent models will be an important avenue of research.
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Affiliation(s)
- Fellery de Lange
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
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de Lange F, Yoshitani K, Proia AD, Mackensen GB, Grocott HP. Perfluorocarbon Administration During Cardiopulmonary Bypass in Rats: An Inflammatory Link to Adverse Outcome? Anesth Analg 2008; 106:24-31, table of contents. [DOI: 10.1213/01.ane.0000297439.90773.c7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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