1
|
Bartoli-Leonard F, Harris AG, Saunders K, Madden J, Cherrington C, Sheehan K, Baquedano M, Parolari G, Bamber A, Caputo M. Altered Inflammatory State and Mitochondrial Function Identified by Transcriptomics in Paediatric Congenital Heart Patients Prior to Surgical Repair. Int J Mol Sci 2024; 25:7487. [PMID: 39000594 PMCID: PMC11242307 DOI: 10.3390/ijms25137487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
Congenital heart disease (CHD) remains the most common birth defect, with surgical intervention required in complex cases. Right ventricle (RV) function is known to be a major predictor of sustained cardiac health in these patients; thus, by elucidating the divergent profiles between CHD and the control through tissue analysis, this study aims to identify new avenues of investigation into the mechanisms surrounding reduced RV function. Transcriptomic profiling, in-silico deconvolution and functional network analysis were conducted on RV biopsies, identifying an increase in the mitochondrial dysfunction genes RPPH1 and RMPR (padj = 4.67 × 10-132, 2.23 × 10-107), the cytotoxic T-cell markers CD8a, LAGE3 and CD49a (p = 0.0006, p < 0.0001, and p = 0.0118) and proinflammatory caspase-1 (p = 0.0055) in CHD. Gene-set enrichment identified mitochondrial dysfunctional pathways, predominately changes within oxidative phosphorylation processes. The negative regulation of mitochondrial functions and metabolism was identified in the network analysis, with dysregulation of the mitochondrial complex formation. A histological analysis confirmed an increase in cellular bodies in the CHD RV tissue and positive staining for both CD45 and CD8, which was absent in the control. The deconvolution of bulk RNAseq data suggests a reduction in CD4+ T cells (p = 0.0067) and an increase in CD8+ T cells (p = 0.0223). The network analysis identified positive regulation of the immune system and cytokine signalling clusters in the inflammation functional network, as there were lymphocyte activation and leukocyte differentiation. Utilising RV tissue from paediatric patients undergoing CHD cardiac surgery, this study identifies dysfunctional mitochondrial pathways and an increase in inflammatory T-cell presence prior to reparative surgery.
Collapse
Affiliation(s)
- Francesca Bartoli-Leonard
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Amy G. Harris
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
| | - Kelly Saunders
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Julie Madden
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Carrie Cherrington
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Karen Sheehan
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Mai Baquedano
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
| | - Giulia Parolari
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Andrew Bamber
- North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
| | - Massimo Caputo
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| |
Collapse
|
2
|
Heo RH, Wang MK, Meyre PB, Birchenough L, Park L, Vuong K, Devereaux PJ, Blum S, Lindahl B, Stone G, Conen D. Associations of Inflammatory Biomarkers With the Risk of Morbidity and Mortality After Cardiac Surgery: A Systematic Review and Meta-analysis. Can J Cardiol 2023; 39:1686-1694. [PMID: 37495205 DOI: 10.1016/j.cjca.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Although inflammatory biomarkers have been associated with cardiovascular events in nonsurgical settings, these associations have not been systematically addressed in patients undergoing cardiac surgery. This review aimed to evaluate the relationships of inflammatory markers with mortality and adverse cardiovascular events in patients undergoing cardiac surgery. METHODS Medline, Embase, and Central databases were systematically searched for studies reporting pre- or postoperative levels of inflammatory biomarkers in patients undergoing cardiac surgery. Outcomes of interest were postoperative mortality, nonfatal myocardial infarction, stroke, congestive heart failure, and major adverse cardiovascular events (MACE). Studies reporting multivariable adjusted risk estimates were included. Risk estimates were pooled with the use of random-effects models and reported as summary odds ratios (ORs). RESULTS Among 14,465 citations identified, 29 studies including 29,401 participants met the eligibility criteria. The average follow-up time after surgery was 31 months. Preoperative C-reactive protein (CRP) levels were associated with an increased risk of all-cause mortality (OR 1.88, 95% CI 1.60-2.20; I2 = 19%; 11 studies) and MACE (OR 1.73, 95% CI 1.34-2.24; I2 = 0%; 3 studies). CRP levels measured on postoperative day 6 (OR 7.4, 95% CI 2.90-18.88, 1 study) and day 10 (OR 11.8, 95% CI 3.50-39.78, 1 study) were associated with a higher risk of all-cause mortality. Less, but overall similar, information was available for other inflammatory biomarkers. CONCLUSIONS In this large meta-analysis, inflammatory biomarkers measured before or after cardiac surgery were associated with mortality and adverse cardiovascular outcomes in patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Rachel Haeeun Heo
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael Ke Wang
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pascal B Meyre
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Lauren Birchenough
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Louis Park
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiven Vuong
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Steffen Blum
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Gregg Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
3
|
Tian H, Jiang X, Duan G, Chen J, Liu Q, Zhang Y, Li S, Bao X, Huang H. Preoperative inflammatory markers predict postoperative clinical outcomes in patients undergoing heart valve surgery: A large-sample retrospective study. Front Immunol 2023; 14:1159089. [PMID: 37063874 PMCID: PMC10102463 DOI: 10.3389/fimmu.2023.1159089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionPreoperative inflammation affects the postoperative outcomes of patients undergoing heart valve surgery. This study aimed to explore the role and predictive effects of preoperative inflammation on the primary outcomes after valvular cardiac surgery.MethodsThis retrospective study utilized a medical recording system to screen 5075 patients who underwent heart valve surgery. Data on the C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR) before heart valve surgery were collected from the hospital’s medical system. Postoperative hepatic insufficiency, acute kidney injury, heart failure, and myocardial damage were assessed using blood indicators. Patients with and without prolonged mechanical ventilation, extended intensive care unit stays, prolonged hospital stays, and death within 30 days after surgery (considered the primary outcome in this study) were compared. Group comparisons, receiver operating characteristic (ROC) curve analyses, and logistic analyses were performed to determine the associations between preoperative inflammation and outcomes after heart valve surgery.ResultsA total of 3249 patients were included in the analysis. Significant differences in CRP level, ESR, and NLR were found between patients with and without postoperative adverse outcomes. ROC analysis showed that CRP levels >5 mg/L effectively predicted postoperative heart failure, and NLR >3.5 had a good predictive effect on all-cause mortality within 30 days after surgery. Patients with CRP levels >5 mg/L had a higher incidence of postoperative heart failure than other patients (20.7% vs. 12.6%, P<0.001), with a relative risk of 1.447 (95% confidence interval: 1.155–1.814). Patients with NLR >3.5 had a higher incidence of death within 30 days after surgery (5.3% vs. 1.2%, P<0.001), with a relative risk of 3.236 (95% confidence interval: 1.773–5.906).ConclusionPreoperative inflammation can affect postoperative outcomes in patients undergoing heart valve surgery. CRP level >5 mg/L and NLR >3.5 can effectively predict postoperative heart failure and death within 30 days after surgery, respectively.
Collapse
Affiliation(s)
- Hongni Tian
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xuetao Jiang
- Department of Anesthesiology, Second Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qi Liu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yamei Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shiqi Li
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaohang Bao
- Department of Anesthesiology, Second Affiliated Hospital of Army Military Medical University, Chongqing, China
- *Correspondence: Xiaohang Bao, ; He Huang,
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
- *Correspondence: Xiaohang Bao, ; He Huang,
| |
Collapse
|
4
|
Nguyen M, Stiel L, Guilloteau A, Bahr PA, Masson D, Thomas C, Blot M, Guy J, Fontaine C, Durand B, Bouhemad B, Guinot PG. Leukocyte cell population data in patients with cardiac surgery and cardiopulmonary bypass: A potential readily available tool to monitor immunity. Front Immunol 2023; 13:1101937. [PMID: 36741408 PMCID: PMC9892932 DOI: 10.3389/fimmu.2022.1101937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose Cardiac surgery with cardiopulmonary bypass triggers sterile inflammation that is responsible for post-operative morbidity. Automated flow cytometry devices used for leucocyte count provide cell population data (CPD) regarding fluorescence intensity, size and granularity of leukocytes that have never been studied in the context of sterile inflammation. Our objective was to explore leukocyte cell population data in patients undergoing cardiac surgery with cardiopulmonary bypass in order to determine whether CPD could be used to monitor immune cell activation. Methods This is an ancillary study of a cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. Cell population data (CPD) extracted from a routine automated flow cytometer were analyzed (Fluorescence targeted to nucleic acids). The time points of interest were: pre-operative, postoperative and 5 days after surgery. The variations in those parameters were studied. Data were then compared between patients according to the occurrence of a composite criteria (supra-ventricular arrythmia, stroke, acute renal failure, and/or death). Results Data from 1453 patients were analyzed. The neutrophil count, fluorescence granularity (NE-SCC), intensity (NE-SFL) and size (NE-FSC) increased with surgery. Heterogeneity of neutrophils decreased in terms of fluorescence granularity (NE-WX) and size (NE-WZ) but increased in terms of intensity (NE-WY). The lymphocyte count decreased with surgery. While fluorescence granularity (LY-X) and size increased (LY-Z), Lymphocyte intensity decreased (LY-Y). Lymphocytes were less heterogeneous in terms of their granularity, size and intensity after surgery (LY-WX, LY-WY, LY-WZ). Patients who developed the composite complication criteria had a higher pre-operative neutrophil count (5.08 [3.89;6.95] vs 4.76 [3.60;6.13], p = 0.02; AUC = 0.56 [0.51;0.60]), and more heterogeneous neutrophils in terms of fluorescence granularity (NE-WX, AUC = 0.57 [0.52;0.62]) and intensity (NE-WY, AUC 0.61 [0.56;0.65]). Those patients also had lower pre-operative lymphocyte count (1.49 [1.10;1.14] vs 1.81 [1.39;2.39], p<0.01, AUC = 0.61 [0.57;0.66]) and fluorescence granularity (LY-X, AUC = 0.57 [0.53;0.62]). NE-WX, NE-WY and LY-X were associated with post-operative complications after adjustment on the EuroSCORE 2 (adjusted odd ratio of 1.01 [1.00;1.02]; 1.01 [1.00;1.01] and 1.08 [1.02;1.15] respectively). Conclusion Cardiac surgery with cardiopulmonary bypass was associated with substantial alterations of CPD probably reflecting leukocytes activation in sterile inflammation. Pre-operative NE-WX, NE-WY and LY-X biomarkers levels were associated with post-operative complications, independently of the EuroSCORE 2. Such routine, unexploited and low cost parameters might represent useful tools likely to monitor immune function and predict outcomes for patients undergoing cardiac surgery. Our findings requires validation on a larger external cohort.
Collapse
Affiliation(s)
- Maxime Nguyen
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,*Correspondence: Maxime Nguyen,
| | - Laure Stiel
- INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,Service de Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France
| | - Adrien Guilloteau
- Clinical Research Support Unit, Dijon University Hospital, Dijon, France
| | - Pierre-Alain Bahr
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - David Masson
- University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
| | - Charles Thomas
- University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
| | - Mathieu Blot
- University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,Department of Infectiology, Dijon University Hospital, Dijon, France
| | - Julien Guy
- Cytometry Core Facility, University of Burgundy Franche-Comté, Dijon, France
| | - Cécile Fontaine
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Bastien Durand
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
| |
Collapse
|
5
|
Charitos IA, Ballini A, Bottalico L, Cantore S, Passarelli PC, Inchingolo F, D'Addona A, Santacroce L. Special features of SARS-CoV-2 in daily practice. World J Clin Cases 2020; 8:3920-3933. [PMID: 33024749 PMCID: PMC7520789 DOI: 10.12998/wjcc.v8.i18.3920] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
The severe acute respiratory syndrome-coronavirus-2 (commonly known as SARS-CoV-2) is a novel coronavirus (designated as 2019-nCoV), which was isolated for the first time after the Chinese health authorities reported a cluster of pneumonia cases in Wuhan, China in December 2019. Optimal management of the Coronavirus Disease-2019 disease is evolving quickly and treatment guidelines, based on scientific evidence and experts' opinions with clinical experience, are constantly being updated. On January 30, 2020, the World Health Organization declared the SARS-CoV-2 outbreak as a "Public Health Emergency of International Concern". The total lack of immune protection brought about a severe spread of the contagion all over the world. For this reason, diagnostic tools, patient management and therapeutic approaches have been tested along the way, in the desperate race to break free from the widespread infection and its fatal respiratory complications. Current medical knowledge and research on severe and critical patients' management and experimental treatments are still evolving, but several protocols on minimizing risk of infection among the general population, patients and healthcare workers have been approved and diffused by International Health Authorities.
Collapse
Affiliation(s)
- Ioannis A Charitos
- Department of Emergency and Urgency, National Poisoning Centre, Riuniti University Hospital of Foggia, Foggia 71122, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University Campus "E. Quagliariello", University of Bari “Aldo Moro”, Bari 70125, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Lucrezia Bottalico
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (CEDICLO), University of Bari, Bari 70121, Italy
| | - Stefania Cantore
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari 70124, Italy
- Sorriso & Benessere - Ricerca e Clinica S.R.L, Bari 70129, Italy
| | - Pier Carmine Passarelli
- Department of Head, Neck and Sense Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, Bari 70124, Italy
| | - Antonio D'Addona
- Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS — Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Luigi Santacroce
- Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies (CEDICLO), University of Bari, Bari 70121, Italy
- Ionian Department, Microbiology and Virology Laboratory, Policlinico University Hospital, University of Bari “Aldo Moro”, Bari 70124, Italy
| |
Collapse
|
6
|
Santacroce L, Charitos IA, Del Prete R. COVID-19 in Italy: An Overview from the First Case to Date. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7926] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|