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Pollak U, Avniel-Aran A, Binshtok AM, Bar-Yosef O, Bronicki RA, Checchia PA, Finkelstein Y. Exploring the Possible Role of Cannabinoids in Managing Post-cardiac Surgery Complications: A Narrative Review of Preclinical Evidence and a Call for Future Research Directions. J Cardiovasc Pharmacol 2024; 83:537-546. [PMID: 38498618 DOI: 10.1097/fjc.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
ABSTRACT Open-heart surgery with cardiopulmonary bypass often leads to complications including pain, systemic inflammation, and organ damage. Traditionally managed with opioids, these pain relief methods bring potential long-term risks, prompting the exploration of alternative treatments. The legalization of cannabis in various regions has reignited interest in cannabinoids, such as cannabidiol, known for their anti-inflammatory, analgesic, and neuroprotective properties. Historical and ongoing research acknowledges the endocannabinoid system's crucial role in managing physiological processes, suggesting that cannabinoids could offer therapeutic benefits in postsurgical recovery. Specifically, cannabidiol has shown promise in managing pain, moderating immune responses, and mitigating ischemia/reperfusion injury, underscoring its potential in postoperative care. However, the translation of these findings into clinical practice faces challenges, highlighting the need for extensive research to establish effective, safe cannabinoid-based therapies for patients undergoing open-heart surgery. This narrative review advocates for a balanced approach, considering both the therapeutic potential of cannabinoids and the complexities of their integration into clinical settings.
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Affiliation(s)
- Uri Pollak
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Avniel-Aran
- Section of Pediatric Critical Care, Hadassah University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexander M Binshtok
- Department of Medical Neurobiology, Institute for Medical Research Israel-Canada, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Bar-Yosef
- Pediatric Neurology and Child Development, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronald A Bronicki
- Department of Pediatrics, Critical Care Medicine and Cardiology, Baylor College of Medicine, Houston, TX
- Pediatric Cardiovascular Intensive Care Unit, Texas Children's Hospital, Houston, TX
| | - Paul A Checchia
- Department of Pediatrics, Critical Care Medicine and Cardiology, Baylor College of Medicine, Houston, TX
- Pediatric Cardiovascular Intensive Care Unit, Texas Children's Hospital, Houston, TX
| | - Yaron Finkelstein
- Division of Emergency Medicine, Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and
- Division of Clinical Pharmacology and Toxicology, Faculty of Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Mathis BJ, Kato H, Matsuishi Y, Hiramatsu Y. Endogenous and exogenous protection from surgically induced reactive oxygen and nitrogen species. Surg Today 2024; 54:1-13. [PMID: 36348164 DOI: 10.1007/s00595-022-02612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
Surgical intervention creates reactive oxygen species through diverse molecular mechanisms, including direct stimulation of immune-mediated inflammation necessary for wound healing. However, dysregulation of redox homeostasis in surgical patients overwhelms the endogenous defense system, slowing the healing process and damaging organs. We broadly surveyed reactive oxygen species that result from surgical interventions and the endogenous and/or exogenous antioxidants that control them. This study assimilates current reports on surgical sources of reactive oxygen and nitrogen species along with literature reports on the effects of endogenous and exogenous antioxidants in human, animal, and clinical settings. Although exogenous antioxidants are generally beneficial, endogenous antioxidant systems account for over 80% of total activity, varying based on patient age, sex, and health or co-morbidity status, especially in smokers, the diabetic, and the obese. Supplementation of exogenous compounds for support in surgical patients is thus theoretically beneficial, but a lack of persuasive clinical evidence has left this potential patient support strategy without clear guidelines. A more thorough understanding of the mechanisms of exogenous antioxidants in patients with compromised health statuses and pharmacokinetic profiling may increase the utility of such support in both the operating and recovery rooms.
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Affiliation(s)
- Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan.
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yujiro Matsuishi
- Department of Neuroscience Nursing, St. Luke's International University, Tokyo, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JVP, Swann JR, Johnson MJ, Beattie RM. A scoping review: urinary markers of metabolic maturation in infants with CHD and the relationship to growth. Cardiol Young 2023; 33:1879-1888. [PMID: 36325968 DOI: 10.1017/s1047951122003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Growth failure in infants born with CHD is a persistent problem, even in those provided with adequate nutrition. OBJECTIVE To summarise the published data describing the change in urinary metabolites during metabolic maturation in infants with CHD and identify pathways amenable to therapeutic intervention. DESIGN Scoping review. ELIGIBILITY CRITERIA Studies using qualitative or quantitative methods to describe urinary metabolites pre- and post-cardiac surgery and the relationship with growth in infants with CHD. SOURCES OF EVIDENCE NICE Healthcare Databases website was used as a tool for multiple searches. RESULTS 347 records were identified, of which 37 were duplicates. Following the removal of duplicate records, 310 record abstracts and titles were screened for inclusion. The full texts of eight articles were reviewed for eligibility, of which only two related to infants with CHD. The studies included in the scoping review described urinary metabolites in 42 infants. A content analysis identified two overarching themes of metabolic variation predictive of neurodevelopmental abnormalities associated with anaerobic metabolism and metabolic signature associated with the impact on gut microbiota, inflammation, energy, and lipid digestion. CONCLUSION The results of this scoping review suggest that there are considerable gaps in our knowledge relating to metabolic maturation of infants with CHD, especially with respect to growth. Surgery is a key early life feature for CHD infants and has an impact on the developing biochemical phenotype with implications for metabolic pathways involved in immunomodulation, energy, gut microbial, and lipid metabolism. These early life fingerprints may predict those individuals at risk for neurodevelopmental abnormalities.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Health Science, University of Southampton, Southampton, UK
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton, UK
| | - James J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aneurin Young
- Department of Neonatal Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust and NIHR Southampton Biomedical Research Centre, UK
| | - John V P Pappachan
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - John R Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark J Johnson
- Neonatal Medicine, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Ozlu F, Demiray GA, Güneş D, Yıldızdaş HY, Yıldız S. Assessment of antioxidant system status before and after operation in neonates with congenital heart disease. Niger J Clin Pract 2023; 26:1557-1562. [PMID: 37929535 DOI: 10.4103/njcp.njcp_252_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background/Aim Oxidative stress is considered to have a significant role in the development of cardiovascular diseases (CVDs) as well as many other diseases. Therefore, the purpose of the study is to evaluate the antioxidant system status at pre- and post-operative period in newborns with congenital heart disease (CHD) requiring operation. Materials and Methods Fifty CHD patients participated in this research. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and thiobarbituric acid reactive substances (TBARS) levels were studied in blood samples. RACHS-1 score, blood lactate levels, and hypoxic events were also recorded. Comparisons of antioxidant system parameters were conducted at pre- and post-operative periods and also between exitus and discharged groups. Results GPx activity and TBARS levels were significantly higher in the pre-operative period than post-operative period though the other antioxidant enzymes were not altered. In pre-operative period, GPx activity was low in addition to rarer hypoxic events in the discharged group. Also, a negative correlation was found between SOD and GPx activities in pre-operative period. Conclusion The results provide fundamental data showing the lowered GPx activity and TBARS levels considered as sensitive oxidative biomarkers after the operation. It was assumed that antioxidant system parameters might show changes after the operation, and GPx is prominent for resistance to hypoxic conditions. Post-operative reduction of GPx and TBARS levels is significant for evaluating the antioxidant system alterations after the operation. However, further investigations follow long-term duration for post-operative monitoring to estimate how antioxidant system status changes to improve the treatment of the health condition.
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Affiliation(s)
- F Ozlu
- Department of Neonatology, Çukurova University, Adana, Türkiye
| | - G A Demiray
- Biotechnology Center; Vocational School of Imamoglu, Çukurova University, Adana, Türkiye
| | - D Güneş
- Department of Pediatrics, Çukurova University, Adana, Türkiye
| | - H Y Yıldızdaş
- Department of Neonatology, Çukurova University, Adana, Türkiye
| | - S Yıldız
- Biotechnology Center, Çukurova University, Adana, Türkiye
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Brooks BA, Sinha P, Staffa SJ, Jacobs MB, Freishtat RJ, Patregnani JT. Children with single ventricle heart disease have a greater increase in sRAGE after cardiopulmonary bypass. Perfusion 2023:2676591231189357. [PMID: 37465929 DOI: 10.1177/02676591231189357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Reducing cardiopulmonary bypass (CPB) induced inflammatory injury is a potentially important strategy for children undergoing multiple operations for single ventricle palliation. We sought to characterize the soluble receptor for advanced glycation end products (sRAGE), a protein involved in acute lung injury and inflammation, in pediatric patients with congenital heart disease and hypothesized that patients undergoing single ventricle palliation would have higher levels of sRAGE following bypass than those with biventricular physiologies. METHODS This was a prospective, observational study of children undergoing CPB. Plasma samples were obtained before and after bypass. sRAGE levels were measured and compared between those with biventricular and single ventricle heart disease using descriptive statistics and multivariate analysis for risk factors for lung injury. RESULTS sRAGE levels were measured in 40 patients: 19 with biventricular and 21 with single ventricle heart disease. Children undergoing single ventricle palliation had a higher factor and percent increase in sRAGE levels when compared to patients with biventricular circulations (4.6 vs. 2.4, p = 0.002) and (364% vs. 181%, p = 0.014). The factor increase in sRAGE inversely correlated with the patient's preoperative oxygen saturation (Pearson correlation (r) = -0.43, p = 0.005) and was positively associated with red blood cell transfusion (coefficient = 0.011; 95% CI: 0.004, 0.017; p = 0.001). CONCLUSIONS Children with single ventricle physiology have greater increase in sRAGE following CPB as compared to children undergoing biventricular repair. Larger studies delineating the role of sRAGE in children undergoing single ventricle palliation may be beneficial in understanding how to prevent complications in this high-risk population.
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Affiliation(s)
- Bonnie A Brooks
- Division of Pediatric Critical Care Medicine, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Pranava Sinha
- Department of Pediatric Cardiac Surgery, M Health Fairview University of Minnesota, Minneapolis MN, USA
- Division of Cardiovascular Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard University, Boston Children's Hospital, Boston, MA, USA
| | - Marni B Jacobs
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA
| | - Robert J Freishtat
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA
- Departments of Pediatrics, Emergency Medicine, and Genomics & Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jason T Patregnani
- Division of Pediatric Critical Care Medicine, Maine Medical Center, Tufts University School of Medicine, Barbara Bush Children's Hospital, Portland, ME, USA
- Division of Pediatric Cardiac Critical Care, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
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DiLorenzo MP, Grosse-Wortmann L. Myocardial Fibrosis in Congenital Heart Disease and the Role of MRI. Radiol Cardiothorac Imaging 2023; 5:e220255. [PMID: 37404787 PMCID: PMC10316299 DOI: 10.1148/ryct.220255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
Progress in the field of congenital heart surgery over the last century can only be described as revolutionary. Recent improvements in patient outcomes have been achieved through refinements in perioperative care. In the current and future eras, the preservation and restoration of myocardial health, beginning with the monitoring of tissue remodeling, will be central to improving cardiac outcomes. Visualization and quantification of fibrotic myocardial remodeling is one of the greatest assets that cardiac MRI brings to the field of cardiology, and its clinical use within the field of congenital heart disease (CHD) has been an area of particular interest in the last few decades. This review summarizes the physical underpinnings of myocardial tissue characterization in CHD, with an emphasis on T1 parametric mapping and late gadolinium enhancement. It describes methods and suggestions for obtaining images, extracting quantitative and qualitative data, and interpreting the results for children and adults with CHD. The tissue characterization observed in different lesions is used to examine the causes and pathomechanisms of fibrotic remodeling in this population. Similarly, the clinical consequences of elevated imaging biomarkers of fibrosis on patient health and outcomes are explored. Keywords: Pediatrics, MR Imaging, Cardiac, Heart, Congenital, Tissue Characterization, Congenital Heart Disease, Cardiac MRI, Parametric Mapping, Fibrosis, Late Gadolinium Enhancement © RSNA, 2023.
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Vanreusel I, Taeymans J, Van Craenenbroeck E, Segers VFM, Van Berendoncks A, Briedé JJ, Hens W. Elevated oxidative stress in patients with congenital heart disease and the effect of cyanosis: a meta-analysis. Free Radic Res 2023; 57:470-486. [PMID: 38000042 DOI: 10.1080/10715762.2023.2284639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Oxidative stress is an important pathophysiological mechanism in the development of numerous cardiovascular disorders. To improve therapy and preventive strategies, clinicians need a better understanding of the underlying pathophysiological mechanisms of congenital heart diseases (CHD). The objective of this meta-analysis was to determine whether oxidative stress is elevated in patients with CHD compared to healthy controls, and to evaluate whether a difference in oxidative stress parameters can be observed between patients with cyanotic (cCHD) and acyanotic CHD (aCHD). Therefore, 21 studies investigating oxidative stress in peripheral blood of both children and adults with CHD were reviewed. Different methods to assess the oxidant status were compared and divided into three categories: pro-oxidative or anti-oxidative stress markers and the ratio of pro-to-anti oxidative stress markers. This meta-analysis showed elevated oxidative stress levels in patients with CHD, and more specifically in patients with cCHD. Moreover, this indicates that there could be potential in oxidative stress measurements as a new biomarker of disease severity. Further research will be needed to clarify the exact role of oxidative stress and its contributors in CHD in order to get a better and more in-depth understanding of the underlying pathophysiology of CHD, especially the higher susceptibility of the right ventricle (RV) to progress to heart failure (HF). This could facilitate the development of antioxidant treatments and RV-specific HF therapies, which are necessary to improve survival in these patients and could be of particular importance in cCHD.
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Affiliation(s)
- Inne Vanreusel
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Jan Taeymans
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Emeline Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Vincent F M Segers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - An Van Berendoncks
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Jacob J Briedé
- Department of Toxicogenomics, School of Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands
| | - Wendy Hens
- Cardiac Rehabilitation Centre, Antwerp University Hospital, Edegem, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT Research Group, University of Antwerp, Antwerp, Belgium
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Long DA, Gibbons KS, Stocker C, Ranger M, Alphonso N, Le Marsney R, Dow B, Schults JA, Graydon C, Shehabi Y, Schibler A. Perioperative dexmedetomidine compared to midazolam in children undergoing open-heart surgery: A pilot randomised controlled trial. CRIT CARE RESUSC 2023; 25:33-42. [PMID: 37876986 PMCID: PMC10581262 DOI: 10.1016/j.ccrj.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective There is a need for evidence on the best sedative agents in children undergoing open heart surgery for congenital heart disease. This study aimed to evaluate the feasibility and safety of dexmedetomidine in this group compared with midazolam. Design Double blinded, pilot randomized controlled trial. Setting Cardiac operating theatre and paediatric intensive care unit in Brisbane, Australia. Participants Infants (≤12 months of age) undergoing their first surgical repair of a congenital heart defect. Interventions Dexmedetomidine (up to 1.0mcg/kg/hr) versus midazolam (up to 80mcg/kg/hr), commenced in the cardiac operating theatre prior to surgery. Main outcome measures The primary outcome was the time spent in light sedation (Sedation Behavior Scale [SBS] -1 to +1); Co-primary feasibility outcome was recruitment, retention and protocol adherence. Secondary outcomes were use of supplemental sedatives, ventilator free days, delirium, vasoactive drug support, and adverse events. Neurodevelopment and health-related quality of life (HRQoL) were assessed at 12 months post-surgery. Results Sixty-six participants were recruited. The number of SBS scores in the light sedation range were greater in the dexmedetomidine group at 24 hours, 48 hours, and overall study duration (0-14 days) versus the midazolam group (24hr: 76/170 [45%] vs 60/178 [34%], aOR 4.14 [95% CI 0.48, 35.92]; 48hr: 154/298 [52%] vs 122/314 [39%], aOR 6.95 [95% CI 0.77, 63.13]; 0-14 days: 597/831 [72%] vs 527/939 [56%], aOR 3.93 [95% CI 0.62, 25.03]). Feasibility was established with no withdrawals or loss to follow-up at 14 days and minimal protocol deviations. There were no differences between the groups relating to clinical, safety, neurodevelopment or HRQoL outcomes. Conclusions The use of dexmedetomidine was associated with more time spent in light sedation when compared with midazolam. The feasibility of conducting a blinded RCT of midazolam and dexmedetomidine in children undergoing open heart surgery was also established. The findings justify further investigation in a larger trial. Clinical trial registration ACTRN12615001304527.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Kristen S. Gibbons
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Christian Stocker
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
| | - Michael Ranger
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Australia
| | - Nelson Alphonso
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
- Department of Cardiac Surgery, Queensland Children's Hospital, Australia
| | - Renate Le Marsney
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Belinda Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Australia
| | - Jessica A. Schults
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Cameron Graydon
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Australia
| | - Yahya Shehabi
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Andreas Schibler
- Wesley Medical Research Institute, Australia
- Critical Care Research Group, St. Andrew's War Memorial Hospital, Australia
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Blood Biomarkers in Patients with Parkinson's Disease: A Review in Context of Anesthetic Care. Diagnostics (Basel) 2023; 13:diagnostics13040693. [PMID: 36832181 PMCID: PMC9955162 DOI: 10.3390/diagnostics13040693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Parkinson's disease (PD) is the second most common inflammatory neurodegenerative disorder after dementia. Preclinical and epidemiological data strongly suggest that chronic neuroinflammation slowly induces neuronal dysfunction. Activated microglia secrete several neurotoxic substances, such as chemokines and proinflammatory cytokines, which may promote blood-brain barrier (BBB) permeabilization. CD4+ T cells comprise proinflammatory cells such as T helper (Th) 1 and Th17 cells, as well as anti-inflammatory cells such as Th2 and T regulatory cells (Tregs). Th1 and Th17 cells can be detrimental to dopamine neurons, whereas Th2 and Tregs are neuroprotective. The results of studies on the serum levels of cytokines such as IFN-γ and TNF-α secreted by Th1 T cells, IL-8 and IL-10 secreted by Th2 T cells, and IL-17 secreted by Th17 cells in PD patients are not uniform. In addition, the relationships between serum cytokine levels and motor and non-motor symptoms of PD are controversial. Surgical stress and anesthesia induce inflammatory responses by disturbing the balance between pro- and anti-inflammatory cytokines, which may exacerbate the neuroinflammatory response in PD patients. Here we review studies on blood inflammatory biomarkers in PD patients and discuss the roles of surgery and anesthesia in PD progression.
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Karacaer F, Biricik E, Ilgınel M, Tunay DL, Döğüş Y, Öztürk ÖG, Güzel Y, Benli O, Güneş Y. The Anti-Inflammatory and Antioxidant Effects of Propofol and Sevoflurane in Children With Cyanotic Congenital Heart Disease. J Cardiothorac Vasc Anesth 2023; 37:65-72. [PMID: 36307353 DOI: 10.1053/j.jvca.2022.09.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/25/2022] [Accepted: 09/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The authors aimed to compare the anti-inflammatory and antioxidant effects of propofol and sevoflurane in children with cyanotic congenital heart disease (CCHD) undergoing cardiac surgery with cardiopulmonary bypass. DESIGN Prospective, randomized, double-blind study. SETTING Single center, university hospital. PARTICIPANTS Children ages 1-10 years with CCHD undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Children were randomized to receive general anesthesia with either sevoflurane (group S) or propofol (group P). Systemic inflammatory response syndrome (SIRS) occurrence was assessed at the end of the surgery and at the sixth, 12th, and 24th postoperative hours. Blood samples were obtained at 4 times: after anesthesia induction (T0), after release of the aortic cross-clamp (T1), at the end of the surgery (T2), and at the postoperative 24th hour (T3). The serum levels of interleukin 6 and tumor necrosis factor alpha, and the total antioxidant status (TAS) and total oxidant status, were analyzed. RESULTS SIRS was more common in group S than in group P at all times (p = 0.020, p = 0.036, p = 0.004, p = 0.008). There were no significant differences between the groups in the mean tumor necrosis factor alpha and interleukin 6 levels at any time. The TAS level at T2 was higher in group P than group S (p = 0.036). The serum TAS level increased at T2 compared with T0 in group P, but it decreased in group S (p = 0.041). CONCLUSION The results showed that propofol provided a greater antioxidant effect and reduced SIRS postoperatively more than sevoflurane in children with CCHD undergoing cardiac surgery.
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Affiliation(s)
- Feride Karacaer
- Balcalı Hospital, Çukurova University, Anesthesiology and Reanimation Department, Adana, Turkey.
| | - Ebru Biricik
- Balcalı Hospital, Çukurova University, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Murat Ilgınel
- Balcalı Hospital, Çukurova University, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Demet Laflı Tunay
- Balcalı Hospital, Çukurova University, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Yusuf Döğüş
- Balcalı Hospital, Çukurova University, Biochemistry Department, Adana, Turkey
| | | | - Yasin Güzel
- Balcalı Hospital, Çukurova University, Cardiovascular Surgery Department, Adana, Turkey
| | - Onur Benli
- Ministry of Health University, Adana City Training and Research Hospital, Cardiovascular Surgery Department, Adana, Turkey
| | - Yasemin Güneş
- Balcalı Hospital, Çukurova University, Anesthesiology and Reanimation Department, Adana, Turkey
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Cañizo Vázquez D, Hadley SM, Pérez Ordóñez M, Lopez-Abad M, Valls A, Viñals ML, Moscoso BA, Benito Fernandez S, Camprubí-Camprubí M, Sanchez-de-Toledo J. Oxidative Stress and Indicators of Brain Damage Following Pediatric Heart Surgery. Antioxidants (Basel) 2022; 11:antiox11030489. [PMID: 35326139 PMCID: PMC8944849 DOI: 10.3390/antiox11030489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 01/27/2023] Open
Abstract
Pediatric cardiac surgery induces an increased oxidative stress (OS) response. Increased OS is associated with poor neurologic outcomes in neonatal populations with similar patterns of brain injury. We investigated OS and brain injury in infants undergoing heart surgery. Patients 6 months or younger, undergoing cardiac surgery with or without cardiopulmonary bypass (CPB), were included in this prospective, observational study. Patients were divided into infant (30 days−6 months) and neonatal (<30 days) groups for analysis. Urine OS biomarker 8-iso-prostaglandin F2α (8-iso-PGF2α) was quantified pre-surgery and at 0 and 24 h post-surgery. A serum brain damage biomarker S100B protein was also measured pre-surgery and at 0 and 72 h post-surgery. Amplitude-integrated electroencephalography during surgery was analyzed. Neuropsychological evaluation using the Bayley III or Vineland test was performed in all patients at 24 months of age. Sixty-two patients were included, 44 of whom underwent follow-up neurologic evaluation. 8-iso-PGF2α and S100B levels were increased after surgery. Postoperative levels of S100B were positively correlated with 8-iso-PGF2α levels 24 h after surgery (rho = 0.5224; p = 0.0261). There was also a correlation between immediate post-surgery levels of 8-iso-PGF2α and intra-surgery seizure burden (rho = 0.4285, p = 0.0205). Patients with an abnormal neurological evaluation had increased levels of S100B 72 h after surgery (p = 0.048). 8-iso-PGF2α levels 24 h after surgery were also related to abnormal neurologic outcomes. Levels of 8-iso-PGF2α following pediatric cardiac surgery are associated with several indicators of brain injury including brain damage biomarkers, intra-operative seizures, and abnormal neurological evaluation at follow-up, suggesting the importance of oxidative stress response in the origin of brain damage in this population.
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Affiliation(s)
- Débora Cañizo Vázquez
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain; (D.C.V.); (M.L.-A.)
| | - Stephanie M. Hadley
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marta Pérez Ordóñez
- Pediatric Cardiology Department, Sant Joan de Déu Hospital, Cardiovascular Research Group, Sant Joan de Deu Research Institute, 08950 Barcelona, Spain;
| | - Miriam Lopez-Abad
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain; (D.C.V.); (M.L.-A.)
| | - Anna Valls
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Marta López Viñals
- Department of Anesthesia, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Bosco A. Moscoso
- Department of Cardiothoracic Surgery, Hospital Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Sergio Benito Fernandez
- Department of Pediatric Critical Care, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Marta Camprubí-Camprubí
- Cardiovascular Research Group, Sant Joan de Deu Research Institute, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu-Hospital Clinic, University of Barcelona, 08950 Barcelona, Spain
- Correspondence:
| | - Joan Sanchez-de-Toledo
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
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Kobayashi K, Liu C, Jonas RA, Ishibashi N. The Current Status of Neuroprotection in Congenital Heart Disease. CHILDREN 2021; 8:children8121116. [PMID: 34943311 PMCID: PMC8700367 DOI: 10.3390/children8121116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
Neurological deficits are a serious and common sequelae of congenital heart disease (CHD). While their underlying mechanisms have not been fully characterized, their manifestations are well-known and understood to persist through adulthood. Development of therapies to address or prevent these deficits are critical to attenuate future morbidity and improve quality of life. In this review, we aim to summarize the current status of neuroprotective therapy in CHD. Through an exploration of present research in the pre-operative, intra-operative, and post-operative phases of patient management, we will describe existing clinical and bench efforts as well as current endeavors underway within this research area.
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Affiliation(s)
- Kei Kobayashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Christopher Liu
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Richard A. Jonas
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (K.K.); (C.L.); (R.A.J.)
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC 20010, USA
- School of Medicine and Health Science, George Washington University, Washington, DC 20052, USA
- Correspondence:
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Hadley S, Cañizo Vazquez D, Lopez Abad M, Congiu S, Lushchencov D, Camprubí Camprubí M, Sanchez-de-Toledo J. Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes. PLoS One 2021; 16:e0250124. [PMID: 34228731 PMCID: PMC8259993 DOI: 10.1371/journal.pone.0250124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2α, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes. METHODS Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (<30 days) or infants (30 days-6 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2α levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated. RESULTS Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2α levels 24 hours after surgery (8.04 [6.4-10.3] ng/mg Cr) were higher than pre-operative levels (5.7 [4.65-7.58] ng/mg Cr) (p<0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2α levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2α levels. 8-iso-PGF2α clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036). CONCLUSIONS Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.
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Affiliation(s)
- Stephanie Hadley
- Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Debora Cañizo Vazquez
- BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Stefano Congiu
- Department of Cardiothoracic Surgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Marta Camprubí Camprubí
- BCNatal, Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clinic, University of Barcelona, Barcelona, Spain
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Gibbison B, Villalobos Lizardi JC, Avilés Martínez KI, Fudulu DP, Medina Andrade MA, Pérez-Gaxiola G, Schadenberg AW, Stoica SC, Lightman SL, Angelini GD, Reeves BC. Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass. Cochrane Database Syst Rev 2020; 10:CD013101. [PMID: 33045104 PMCID: PMC8095004 DOI: 10.1002/14651858.cd013101.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Corticosteroids are routinely given to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) in an attempt to ameliorate the inflammatory response. Their use is still controversial and the decision to administer the intervention can vary by centre and/or by individual doctors within that centre. OBJECTIVES This review is designed to assess the benefits and harms of prophylactic corticosteroids in children between birth and 18 years of age undergoing cardiac surgery with CPB. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and Conference Proceedings Citation Index-Science in June 2020. We also searched four clinical trials registers and conducted backward and forward citation searching of relevant articles. SELECTION CRITERIA We included studies of prophylactic administration of corticosteroids, including single and multiple doses, and all types of corticosteroids administered via any route and at any time-point in the perioperative period. We excluded studies if steroids were administered therapeutically. We included individually randomised controlled trials (RCTs), with two or more groups (e.g. multi-drug or dose comparisons with a control group) but not 'head-to-head' trials without a placebo or a group that did not receive corticosteroids. We included studies in children, from birth up to 18 years of age, including preterm infants, undergoing cardiac surgery with the use of CPB. We also excluded studies in patients undergoing heart or lung transplantation, or both; studies in patients already receiving corticosteroids; in patients with abnormalities of the hypothalamic-pituitary-adrenal axis; and in patients given steroids at the time of cardiac surgery for indications other than cardiac surgery. DATA COLLECTION AND ANALYSIS We used the Covidence systematic review manager to extract and manage data for the review. Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We resolved disagreements by consensus or by consultation with a third review author. We assessed the certainty of evidence with GRADE. MAIN RESULTS We found 3748 studies, of which 888 were duplicate records. Two studies had the same clinical trial registration number, but reported different populations and interventions. We therefore included them as separate studies. We screened titles and abstracts of 2868 records and reviewed full text reports for 84 studies to determine eligibility. We extracted data for 13 studies. Pooled analyses are based on eight studies. We reported the remaining five studies narratively due to zero events for both intervention and placebo in the outcomes of interest. Therefore, the final meta-analysis included eight studies with a combined population of 478 participants. There was a low or unclear risk of bias across the domains. There was moderate certainty of evidence that corticosteroids do not change the risk of in-hospital mortality (five RCTs; 313 participants; risk ratio (RR) 0.83, 95% confidence interval (CI) 0.33 to 2.07) for children undergoing cardiac surgery with CPB. There was high certainty of evidence that corticosteroids reduce the duration of mechanical ventilation (six RCTs; 421 participants; mean difference (MD) 11.37 hours lower, 95% CI -20.29 to -2.45) after the surgery. There was high-certainty evidence that the intervention probably made little to no difference to the length of postoperative intensive care unit (ICU) stay (six RCTs; 421 participants; MD 0.28 days lower, 95% CI -0.79 to 0.24) and moderate-certainty evidence that the intervention probably made little to no difference to the length of the postoperative hospital stay (one RCT; 176 participants; mean length of stay 22 days; MD -0.70 days, 95% CI -2.62 to 1.22). There was moderate certainty of evidence for no effect of the intervention on all-cause mortality at the longest follow-up (five RCTs; 313 participants; RR 0.83, 95% CI 0.33 to 2.07) or cardiovascular mortality at the longest follow-up (three RCTs; 109 participants; RR 0.40, 95% CI 0.07 to 2.46). There was low certainty of evidence that corticosteroids probably make little to no difference to children separating from CPB (one RCT; 40 participants; RR 0.20, 95% CI 0.01 to 3.92). We were unable to report information regarding adverse events of the intervention due to the heterogeneity of reporting of outcomes. We downgraded the certainty of evidence for several reasons, including imprecision due to small sample sizes, a single study providing data for an individual outcome, the inclusion of both appreciable benefit and harm in the confidence interval, and publication bias. AUTHORS' CONCLUSIONS Corticosteroids probably do not change the risk of mortality for children having heart surgery using CPB at any time point. They probably reduce the duration of postoperative ventilation in this context, but have little or no effect on the total length of postoperative ICU stay or total postoperative hospital stay. There was inconsistency in the adverse event outcomes reported which, consequently, could not be pooled. It is therefore impossible to provide any implications and policy-makers will be unable to make any recommendations for practice without evidence about adverse effects. The review highlighted the need for well-conducted RCTs powered for clinical outcomes to confirm or refute the effect of corticosteroids versus placebo in children having cardiac surgery with CPB. A core outcome set for adverse event reporting in the paediatric major surgery and intensive care setting is required.
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Affiliation(s)
- Ben Gibbison
- Department of Cardiac Anaesthesia and Intensive Care, Bristol Heart Institute/University Hospitals Bristol NHS FT, Bristol, UK
| | | | - Karla Isis Avilés Martínez
- Emergency Pediatric Department, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico
| | - Daniel P Fudulu
- Department of Cardiac Surgery, University Hospital Bristol NHS Trust, Bristol, UK
| | - Miguel Angel Medina Andrade
- Thoracic and Cardiovascular Department, Hospital Civil Fray Antonio Alcalde de Guadalajara, Guadalajara, Mexico
| | | | - Alvin Wl Schadenberg
- Department of Paediatric Intensive Care, University Hospital Bristol NHS Trust, Bristol, UK
| | - Serban C Stoica
- Department of Paediatric Cardiac Surgery, University Hospital Bristol NHS Trust, Bristol, UK
| | - Stafford L Lightman
- Henry Wellcome Laboratories for Integrative Metabolism and Neuroscience, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, University Hospital Bristol NHS Trust, Bristol, UK
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15
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Fujii Y. Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model. BIOLOGY 2020; 9:biology9040081. [PMID: 32326072 PMCID: PMC7236599 DOI: 10.3390/biology9040081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/20/2023]
Abstract
Extracorporeal circulation (ECC) methods are being increasingly used for mechanical support of respiratory and cardio-circulatory failure. Especially, cardiopulmonary bypass (CPB) during cardiovascular surgery, sustenance of the patient’s life by providing an appropriate blood flow and oxygen supply to principal organs. On the other hand, systemic inflammatory responses in patients undergoing cardiovascular surgery supported by CPB contribute significantly to CPB-associated mortality and morbidity. Our previous research showed that CPB causes a systemic inflammatory response and organ damage in a small animal CPB model. We have been studying the effects of hyperoxia and blood plasma substitute on CPB. In this review, we present a study focusing on the systemic inflammatory response during CPB, along with our findings.
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Affiliation(s)
- Yutaka Fujii
- Department of Clinical Engineering and Medical Technology, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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16
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Kura B, Szeiffova Bacova B, Kalocayova B, Sykora M, Slezak J. Oxidative Stress-Responsive MicroRNAs in Heart Injury. Int J Mol Sci 2020; 21:E358. [PMID: 31948131 PMCID: PMC6981696 DOI: 10.3390/ijms21010358] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023] Open
Abstract
Reactive oxygen species (ROS) are important molecules in the living organisms as a part of many signaling pathways. However, if overproduced, they also play a significant role in the development of cardiovascular diseases, such as arrhythmia, cardiomyopathy, ischemia/reperfusion injury (e.g., myocardial infarction and heart transplantation), and heart failure. As a result of oxidative stress action, apoptosis, hypertrophy, and fibrosis may occur. MicroRNAs (miRNAs) represent important endogenous nucleotides that regulate many biological processes, including those involved in heart damage caused by oxidative stress. Oxidative stress can alter the expression level of many miRNAs. These changes in miRNA expression occur mainly via modulation of nuclear factor erythroid 2-related factor 2 (Nrf2), sirtuins, calcineurin/nuclear factor of activated T cell (NFAT), or nuclear factor kappa B (NF-κB) pathways. Up until now, several circulating miRNAs have been reported to be potential biomarkers of ROS-related cardiac diseases, including myocardial infarction, hypertrophy, ischemia/reperfusion, and heart failure, such as miRNA-499, miRNA-199, miRNA-21, miRNA-144, miRNA-208a, miRNA-34a, etc. On the other hand, a lot of studies are aimed at using miRNAs for therapeutic purposes. This review points to the need for studying the role of redox-sensitive miRNAs, to identify more effective biomarkers and develop better therapeutic targets for oxidative-stress-related heart diseases.
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Affiliation(s)
- Branislav Kura
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (B.K.); (B.S.B.); (B.K.); (M.S.)
| | - Barbara Szeiffova Bacova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (B.K.); (B.S.B.); (B.K.); (M.S.)
| | - Barbora Kalocayova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (B.K.); (B.S.B.); (B.K.); (M.S.)
| | - Matus Sykora
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (B.K.); (B.S.B.); (B.K.); (M.S.)
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, 842 15 Bratislava, Slovakia
| | - Jan Slezak
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (B.K.); (B.S.B.); (B.K.); (M.S.)
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18
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Hydrogen Sulfide Attenuates Hydrogen Peroxide-Induced Injury in Human Lung Epithelial A549 Cells. Int J Mol Sci 2019; 20:ijms20163975. [PMID: 31443288 PMCID: PMC6720512 DOI: 10.3390/ijms20163975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Abstract
Lung tissues are frequently exposed to a hyperoxia environment, which leads to oxidative stress injuries. Hydrogen sulfide (H2S) is widely implicated in physiological and pathological processes and its antioxidant effect has attracted much attention. Therefore, in this study, we used hydrogen peroxide (H2O2) as an oxidative damage model to investigate the protective mechanism of H2S in lung injury. Cell death induced by H2O2 treatment could be significantly attenuated by the pre-treatment of H2S, resulting in a decrease in the Bax/Bcl-2 ratio and the inhibition of caspase-3 activity in human lung epithelial cell line A549 cells. Additionally, the results showed that H2S decreased reactive oxygen species (ROS), as well as neutralized the damaging effects of H2O2 in mitochondria energy-producing and cell metabolism. Pre-treatment of H2S also decreased H2O2-induced suppression of endogenous H2S production enzymes, cystathionine-beta-synthase (CBS), cystathionine-gamma-lyase (CSE), and 3-mercapto-pyruvate sulfurtransferase (MPST). Furthermore, the administration of H2S attenuated [Ca2+] overload and endoplasmic reticulum (ER) stress through the mitogen-activated protein kinase (MAPK) signaling pathway. Therefore, H2S might be a potential therapeutic agent for reducing ROS and ER stress-associated apoptosis against H2O2-induced lung injury.
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Abstract
Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. However, not only bacteria might evoke an immune response but also other noninfectious stimuli like the surgical trauma or mechanical ventilation may induce an inflammatory response of varying degree. In these cases, the immune system activation is not always beneficial for the patients and might carry the risk of concomitant, harmful effects on host cells, tissues, or even whole organ systems. Research over the past decades has contributed substantial information in which ways surgical patients may be affected by inflammatory reactions. Modulations of the patient's immune system may be evoked by the use of anesthetic agents, the nature of surgical trauma and the use of any supportive therapy during the perioperative period. The effects on the patient may be manifold, including various proinflammatory effects. This review focuses on the causes and effects of inflammation in the perioperative period. In addition, we also highlight possible approaches by which inflammation in the perioperative may be modulated in the future.
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Affiliation(s)
- Jan Rossaint
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
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20
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Raffaeli G, Ghirardello S, Passera S, Mosca F, Cavallaro G. Oxidative Stress and Neonatal Respiratory Extracorporeal Membrane Oxygenation. Front Physiol 2018; 9:1739. [PMID: 30564143 PMCID: PMC6288438 DOI: 10.3389/fphys.2018.01739] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
Oxidative stress is a frequent condition in critically ill patients, especially if exposed to extracorporeal circulation, and it is associated with worse outcomes and increased mortality. The inflammation triggered by the contact of blood with a non-endogenous surface, the use of high volumes of packed red blood cells and platelets transfusion, the risk of hyperoxia and the impairment of antioxidation systems contribute to the increase of reactive oxygen species and the imbalance of the redox system. This is responsible for the increased production of superoxide anion, hydrogen peroxide, hydroxyl radicals, and peroxynitrite resulting in increased lipid peroxidation, protein oxidation, and DNA damage. The understanding of the pathophysiologic mechanisms leading to redox imbalance would pave the way for the future development of preventive approaches. This review provides an overview of the clinical impact of the oxidative stress during neonatal extracorporeal support and concludes with a brief perspective on the current antioxidant strategies, with the aim to focus on the potential oxidative stress-mediated cell damage that has been implicated in both short and long-term outcomes.
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Affiliation(s)
- Genny Raffaeli
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sofia Passera
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Gibbison B, Villalobos Lizardi JC, Avilés Martínez KI, Fudulu DP, Medina Andrade MA, Pérez-Gaxiola G, Schadenberg AWL, Stoica SC, Lightman SL, Angelini GD, Reeves BC. Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass. Hippokratia 2018. [DOI: 10.1002/14651858.cd013101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ben Gibbison
- Bristol Heart Institute/University Hospitals Bristol NHS FT; Department of Cardiac Anaesthesia and Intensive Care; 7th Floor Queens Building Bristol Royal Infirmary Bristol UK BS2 8HW
| | - José Carlos Villalobos Lizardi
- Hospital Civil de Guadalajara "Fray Antonio Alcalde"; Emergency Pediatric Department; Hospital 278. El Retiro Guadalajara Jalisco Mexico 44280
| | - Karla Isis Avilés Martínez
- Hospital Civil de Guadalajara "Fray Antonio Alcalde"; Emergency Pediatric Department; Hospital 278. El Retiro Guadalajara Jalisco Mexico 44280
| | - Daniel P Fudulu
- University Hospital Bristol NHS Trust; Department of Cardiac Surgery; Bristol UK
| | - Miguel Angel Medina Andrade
- Hospital Civil Fray Antonio Alcalde de Guadalajara; Thoracic and Cardiovascular Department; Guadalajara Mexico
| | - Giordano Pérez-Gaxiola
- Hospital Pediátrico de Sinaloa; Evidence-Based Medicine Department; Blvd. Constitución s/n, Col. Almada. 80200 Culiacán Sinaloa Mexico 80200
| | - Alvin WL Schadenberg
- University Hospital Bristol NHS Trust; Department of Paediatric Intensive Care; Bristol UK
| | - Serban C Stoica
- University Hospital Bristol NHS Trust; Department of Paediatric Cardiac Surgery; Bristol UK
| | - Stafford L Lightman
- University of Bristol; Henry Wellcome Laboratories for Integrative Metabolism and Neuroscience; Whitson Street Bristol UK BS1 3NY
| | - Gianni D Angelini
- University Hospital Bristol NHS Trust; Department of Cardiac Surgery; Bristol UK
| | - Barnaby C Reeves
- University of Bristol; School of Clinical Sciences; Level 7, Bristol Royal Infirmary Marlborough Street Bristol UK BS2 8HW
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22
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Fudulu DP, Gibbison B, Upton T, Stoica SC, Caputo M, Lightman S, Angelini GD. Corticosteroids in Pediatric Heart Surgery: Myth or Reality. Front Pediatr 2018; 6:112. [PMID: 29732365 PMCID: PMC5920028 DOI: 10.3389/fped.2018.00112] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Corticosteroids have been administered prophylactically for more than 60 years in pediatric heart surgery, however, their use remains a matter of debate. There are three main indications for corticosteroid use in pediatric heart surgery with the use of cardiopulmonary bypass (CPB): (1) to blunt the systemic inflammatory response (SIRS) induced by the extracorporeal circuit; (2) to provide perioperative supplementation for presumed relative adrenal insufficiency; (3) for the presumed neuroprotective effect during deep hypothermic circulatory arrest operations. This review discusses the current evidence behind the use of corticosteroids in these three overlapping areas. Materials and Methods: We conducted a structured research of the literature using PubMed and MEDLINE databases to November 2017 and additional articles were identified by cross-referencing. Results: The evidence suggests that there is no correlation between the effect of corticosteroids on inflammation and their effect on clinical outcome. Due to the limitations of the available evidence, it remains unclear if corticosteroids have an impact on early post-operative outcomes or if there are any long-term effects. There is a limited understanding of the hypothalamic-pituitary-adrenal axis function during cardiac surgery in children. The neuroprotective effect of corticosteroids during deep hypothermic circulatory arrest surgery is controversial. Conclusions: The utility of steroid administration for pediatric heart surgery with the use of CPB remains a matter of debate. The effect on early and late outcomes requires clarification with a large multicenter randomized trial. More research into the understanding of the adrenal response to surgery in children and the effect of corticosteroids on brain injury is warranted.
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Affiliation(s)
- Daniel P. Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
- Henry Welcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Ben Gibbison
- Cardiac Anesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Thomas Upton
- Henry Welcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Serban C. Stoica
- Department of Congenital Cardiac Surgery, Bristol Royal Hospital for Children - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Massimo Caputo
- Department of Congenital Cardiac Surgery, Bristol Royal Hospital for Children - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Stafford Lightman
- Henry Welcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Gianni D. Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
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Jungner Å, Vallius S, Bruschettini M, Romantsik O, Gram M, Ley D. Cardiopulmonary bypass in the newborn: effects of circulatory cell-free hemoglobin and hyperoxia evaluated in a novel rat pup model. Intensive Care Med Exp 2017; 5:45. [PMID: 28980221 PMCID: PMC5628085 DOI: 10.1186/s40635-017-0153-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Infants with congenital heart defects (CHD) are at risk for white matter brain injury. This novel rat pup model characterizes the systemic effects of intravasal cell-free hemoglobin and hyperoxia, hypothesizing that immature endogenous scavenging systems relate to increased vulnerability to conditions present during cardiopulmonary bypass (CPB). METHODS Plasma pharmacokinetics of cell-free human hemoglobin (Hb) was determined after intraperitoneal (i.p.) administration in postnatal day 6 (P6) rat pups. Cell-free hemoglobin degradation, scavenger- and oxidative stress responses in altered oxygen environments were evaluated in P6 rat pups exposed to i.p. cell-free Hb or vehicle and subjected to hyperoxia or normoxia for 24 h. Plasma and liver were analyzed for free heme, haptoglobin, hemopexin, heme-oxygenase 1, and 8-OHdG at 3-120 h post-injection. Baseline scavenging properties were evaluated in P0-P12 rat pups. RESULTS Cell-free Hb displayed peak plasma concentrations of 3.6 ± 0.5 mg/mL (mean ± SD) at 3 h post-administration. Animals exposed to cell-free Hb demonstrated a 30-fold increase in plasma haptoglobin and a decrease in plasma hemopexin to 1/6 of concentrations observed in pups exposed to vehicle. Exposure to cell-free Hb and hyperoxia mediated increased plasma concentrations of free heme (72.7 ± 19.5 μM, mean ± SD) compared to exposure to cell-free Hb and normoxia (49.3 ± 13.1 μM) at 3 h, and an elevated hepatic mRNA expression of heme-oxygenase 1. mRNA expression of haptoglobin and hemopexin was increased in animals exposed to hemoglobin with a mitigated response in pups exposed to hemoglobin and hyperoxia. Animals exposed to hyperoxia displayed an increase in hepatic transcription of scavenger proteins at 24 h. Combined exposure to cell-free Hb and hyperoxia mediated an increased DNA-oxidation at 6 h, whereas all insults conveyed a decrease in DNA-oxidation at 120 h. CONCLUSIONS In this study, we present a novel rat pup model with scavenging characteristics and brain maturation similar to newborns with CHD. We have confirmed a distinct scavenger response after exposure to systemic cell-free hemoglobin. We have indications of an accelerated metabolism of cell-free Hb and of an altered transcription of scavenger proteins in a hyperoxic environment. We believe that this model will prove valuable in future delineation of inflammatory and oxidative end-organ damage following CPB.
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Affiliation(s)
- Åsa Jungner
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
- Pediatric Intensive Care Unit (BIVA), Skane University Hospital, Lund, Sweden
| | - Suvi Vallius
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Olga Romantsik
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Magnus Gram
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Infection Medicine, Lund University, Lund, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Pediatrics, Skane University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
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Ziyaeifard M, Ziyaeifard P. "Effects of Selenium on Stress Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial Study". Anesth Pain Med 2017; 7:e45461. [PMID: 28824865 PMCID: PMC5559665 DOI: 10.5812/aapm.45461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/21/2017] [Accepted: 02/15/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mohsen Ziyaeifard, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2123922152; +98-9128245876, E-mail:
| | - Parisa Ziyaeifard
- Medical Student, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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25
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Mirmansouri A, Imantalab V, Mohammadzadeh Jouryabi A, Kanani G, Naderi Nabi B, Farzi F, Biazar G, Ghazanfar Tehran S, Tarbiat M. Effect of Selenium on Stress Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial. Anesth Pain Med 2017; 7:e43864. [PMID: 28920049 PMCID: PMC5554419 DOI: 10.5812/aapm.43864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/25/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022] Open
Abstract
Background In spite of significant improvements in surgical and anesthetic techniques, acute stress response to surgery remains a main cause of mortality and morbidity in coronary artery bypass graft (CABG) surgery patients. Therefore, doing research to find safe and effective modalities with more cardio protective properties seems necessary. Objectives In this study, we sought to determine whether intravenous injection of 600 μg Selenium (Se) prior to surgery would limit stress response measured by blood sugar. Methods This double blind clinical trial was conducted at a referral center of cardiac surgery affiliated to Guilan University of Medical Sciences (GUMS) from June 2015 to October 2015. 73 eligible patients candidate for elective isolated CABG surgery were enrolled in the trial. They were randomly allocated to either Se group (n = 36) receiving 600 μg Se prior to surgery or control group (n = 37). Our evaluation was based on blood sugar (BS) which was measured at four point times, including before induction of anesthesia (T0), at the end of CPB (T1), 24 hours (T2) and 48 hours (T3) after surgery. Results The data obtained from 73 patients in group S (n = 36) and group C (n = 37) were analyzed. There was no significant difference between the two groups regarding the baseline characteristics. In both groups, a sharp rise in BS levels was observed following CPB (P = 0.0001). Although the trend of BS changes was remarkable in both groups (P = 0.0001), there was no statistically significant difference between the groups at all point times including T0 (P = 0.45), T1 (P = 0.48), T2 (P = 0.92), and T3 (P = 0.42). Within the study time, our patients were monitored for any adverse effect but nothing was observed. Conclusions This investigation showed that intravenous single dose of 600 μg Se was safe in CABG patients, but had no positive effect on stress response to surgery.
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Affiliation(s)
- Ali Mirmansouri
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Vali Imantalab
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ali Mohammadzadeh Jouryabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Gholamreza Kanani
- Department of Cardaic Surgery, Assistant Professor of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia and Pain (FIPP), Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Gelareh Biazar
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Corresponding author: Gelareh Biazar, Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran, E-mail:
| | - Samaneh Ghazanfar Tehran
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Masoud Tarbiat
- Assistant Professor of Anesthesiology, Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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26
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Paediatric cardiopulmonary bypass surgery: the challenges of heterogeneity and identifying a meaningful endpoint for clinical trials. Intensive Care Med 2016; 43:113-115. [DOI: 10.1007/s00134-016-4622-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022]
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27
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Sedighinejad A, Imantalab V, Mirmansouri A, Mohammadzadeh Jouryabi A, Kanani G, Nassiri Sheikhani N, Haghighi M, Atrkarroushan Z, Biazar G. Effects of Low-dose Selenium on the Inflammatory Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e37918. [PMID: 27795837 PMCID: PMC5070486 DOI: 10.5812/ircmj.37918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/16/2016] [Accepted: 06/18/2016] [Indexed: 01/06/2023]
Abstract
Background Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is suggested that selenium (Se), an essential trace element, has a protective role against oxidative stress. Decreased intraoperative Se levels might be an independent predictive factor for postoperative multiorgan failure. In spite of its proposed advantages, however, the optimal timing and dosage are not well known. Objectives To determine whether 600 µg of intravenous Se administration before induction of anesthesia for CABG surgery could attenuate inflammatory reactions in an Iranian population. Methods This randomized triple-blind clinical trial took place in the department of cardiac surgery of an academic hospital affiliated with Guilan University of Medical Sciences (GUMS) from May 2015 to September 2015. Eighty-eight eligible patients scheduled for elective on-pump CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either an intravenous bolus of 600 µg Se before induction of anesthesia, or normal saline as a placebo. We had four measurement time-points: just before induction of anesthesia (T0), immediately after the end of CPB (T1), 24 hours after surgery (T2), and 48 hours after surgery (T3). Interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) serum levels were measured using the enzyme-linked immunosorbent assay (ELISA). Results Data from a total of 81 patients were analyzed: group S (n = 41) and group C (n = 40). There was no significant difference between the two groups with regard to baseline characteristics. In both groups, CPB caused markedly increased IL-6, TNF-α, and CRP plasma concentrations compared with baseline (P = 0.0001). However, the pattern of changes was not significantly different between group S (P = 0.068) and group C (P = 0.26). The IL-6 and TNF-α change trends were significant in each group (P=0.0001). However, comparing the two groups showed no significant difference. With regard to IL-6, there was no significant difference between the two groups at the time-points of T1 (P = 0.34), T2 (P = 0.17), and T3 (P = 0.056), and the same was found for TNF-α at T1 (P = 0.34), T2 (P = 0.17), and T3 (P = 0.056). With regard to CRP, the trend of the changes was significant in each group (P = 0.0001). However, comparing two groups showed a borderline significant difference between them at T1 (P = 0.039), but not at T2 (P = 0.075) or T3 (P = 0.11). Conclusions This study revealed that the administration of 600 μg of intravenous Se immediately before induction of anesthesia was safe, but when compared to a placebo, no predominant clinical effects or modifications in the systemic inflammatory response induced by on-pump CABG were observed.
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Affiliation(s)
- Abbas Sedighinejad
- MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Vali Imantalab
- MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
- Corresponding Author: Vali Imantalab, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran. Tel: +98-9111316138, E-mail:
| | - Ali Mirmansouri
- MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Ali Mohammadzadeh Jouryabi
- MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Gholamreza Kanani
- MD, Assistant Professor of Cardiac Surgery, Department of Cardaic Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Nassir Nassiri Sheikhani
- MD, Assistant Professor of Cardiac Surgery, Department of Cardaic Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Mohammad Haghighi
- MD, Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
| | - Zahra Atrkarroushan
- PhD, Assistant Professor of Biostatistic, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
| | - Gelareh Biazar
- MD, Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, IR Iran
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