Expression of CD200/CD200R regulatory molecules on granulocytes and monocytes is modulated by cardiac surgical operation

Perfusion ◽  
2010 ◽  
Vol 25 (6) ◽  
pp. 389-397 ◽  
Author(s):  
Jan Krejsek ◽  
Martina Kolackova ◽  
Jiri Mandak ◽  
Pavel Kunes ◽  
Karolina Jankovicova ◽  
...  

Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory response. Both humoral and cellular regulatory mechanisms are operating to maintain body homeostasis. We followed the changes in the expression of CD200/CD200R regulatory molecules on monocytes and granulocyte of cardiac surgical patients operated on using either standard (OP) or modified “mini-invasive” cardiopulmonary bypass (MOP). Methods: Expression of CD200/CD200R regulatory molecules was determined by flow cytometry. Results: The expression of CD200R on granulocytes was increased after surgery in both groups of patients, but the increase was statistically significant only in OP patients (p<0.01). At this time point, there was a significant difference in CD200R expression on granulocytes when comparing OP to MOP patients, being higher in the former group (p<0.01). The expression of CD200R on monocytes was diminished after surgery and during an early postoperative period in both groups of patients. The expression of CD200 on monocytes was significantly diminished after surgery in both groups (p<0.01). Nonetheless, we observed an increase in CD200 expression in OP patients at the 3rd postoperative day. There was a statistically significantly increased CD200 expression on monocytes of OP patients (p<0.001) at the 3rd postoperative day when we compared OP and MOP groups. The expression of CD200 on granulocytes was significantly higher after surgery and at the 3rd postoperative day in OP when compared to MOP patients. Conclusions: CD200R expression on granulocytes was significantly increased, while CD200 and CD200R expression on monocytes was decreased after cardiac surgery.

Perfusion ◽  
2010 ◽  
Vol 25 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Pavel Kunes ◽  
Jiri Mandak ◽  
Jan Harrer ◽  
Martina Kolackova ◽  
Ctirad Andrys ◽  
...  

Aims: In a group of patients undergoing cardiac surgery performed both with (“on-pump”) and without the use (“offpump”) of cardiopulmonary bypass (CPB), we studied the changes of neutrophil membrane apoptosis-inducing complex Apo/Fas. Methods: Expression of Apo/Fas (CD95) on leukocytes was evaluated by flow cytometry. Results: In “on-pump” patients, we found an increase in the expression of CD95 median intensity fluorescence (MFI) on granulocytes from a baseline level median=56, (Q 1=45.5, Q3=64) to a median=88, (Q1=62, Q 3=109.5; p<0.01) at the 3rd postoperative day and median=74, (Q1=63, Q3=84.5; p<0.01) at the 7th postoperative day. In “off-pump” patients, granulocyte CD95 MFI was median=55, (Q1=51, Q3=84) before surgery. The significant increase was found on the 3rd postoperative day only; median=90, (Q 1=66; Q3=98; p<0.05). A similar pattern in the CD95 expression was also found if percentage changes of granulocyte CD95 MFI were followed. Moreover, the significantly increased Apo/Fas expression expressed as a percentage change of CD95 MFI was found in “on-pump” patients compared to “off-pump” patients, both at the 3rd postoperative day (p<0.05) and at the 7th postoperative day (p<0.01). Conclusions: This is the first direct evidence of increasing densities of the Apo/Fas complex on neutrophils in cardiac surgical patients.


2009 ◽  
Vol 52 (4) ◽  
pp. 149-153 ◽  
Author(s):  
Jan Krejsek ◽  
Martina Koláčková ◽  
Vladimír Lonský ◽  
Manuela Trojáčková Kudlová ◽  
Jiří Manďák ◽  
...  

Background: Cardiac surgery provokes a systemic inflammatory response in any patient. This complex body reaction involves also RANK/RANKL molecules which have been recently identified as principal regulators of bone metabolism. Aims: To follow the changes in the expression of RANK/RANKL molecules on innate immune cells of cardiac surgical patients. Patients and Methods: Twenty-six patients undergoing cardiac surgical were assigned to undergo coronary artery bypass grafting using either cardiopulmonary bypass (“on-pump”) or modified “miniinvasive on-pump”. The expression of RANK/RANKL was performed by flow cytometry. Results: Significantly increased expression of RANK on monocytes of “miniinvasive on-pump” patients was found at the 1st, the 3nd, and 7th postoperative days. The similar pattern was found also for monocyte RANKL expression. In addition, RANKL expression was significantly increased at the 3rd postoperative day in “on-pump” patient. No significant differences between “miniinvasive on-pump” and “on-pump” cardiac surgical patients were found. Conclusion: The expression of both RANK and RANKL molecules is significantly enhanced on monocytes of “miniinvasive on-pump” cardiac surgical patients.


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.


Cytometry ◽  
2001 ◽  
Vol 46 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Attila T�rnok ◽  
J�zsef Bocsi ◽  
Heike R�ssler ◽  
Veronika Schlykow ◽  
Peter Schneider ◽  
...  

1998 ◽  
Vol 80 (07) ◽  
pp. 58-64 ◽  
Author(s):  
P. Ferroni ◽  
G. Speziale ◽  
G. Ruvolo ◽  
A. Giovannelli ◽  
F. M. Pulcinelli ◽  
...  

SummaryCardiopulmonary bypass (CPB) is associated with impaired platelet function and a systemic inflammatory response. The present study was designed to evaluate whether any correlation between platelet activation and inflammatory response during CPB exists. The results obtained from 8 patients undergoing hypothermic CPB for cardiac surgery showed the occurrence of a moderate degree of platelet activation during CPB, demonstrated by an increase of platelet CD62P expression in correlation with an increase of β-thromboglobulin levels, with a concomitant decrease of in vitro platelet response. Plasma IL-1β levels significantly increased during CPB, with a peak between 1 and 4 h after CPB. Similarly, IL-6 levels were elevated 30 min from CPB starting, peaked at 4 h, and remained elevated after 24 h. A direct correlation was found between plasma IL-1β and IL-6 levels. A significant correlation between plasma IL-1β and β-thromboglobulin levels was also found. In turn, plasma β-thromboglobulin levels correlated with CD62P expression on activated platelets. An inverse correlation was found between in vitro platelet aggregation and plasma IL-1β or IL-6 levels. From the present results it may be speculated that platelet activation during CPB may contribute, through the release of IL-1β, to activation of endothelial cells and subsequent release of other cytokines with chemotactic and pro-inflammatory properties, thus playing an important role in the inflammatory response associated with CPB.


2005 ◽  
Vol 13 (4) ◽  
pp. 382-395 ◽  
Author(s):  
Shahzad G Raja ◽  
Gilles D Dreyfus

Cardiac surgery and cardiopulmonary bypass initiate a systemic inflammatory response largely determined by blood contact with foreign surfaces and the activation of complement. It is generally accepted that cardiopulmonary bypass initiates a whole-body inflammatory reaction. The magnitude of this inflammatory reaction varies, but the persistence of any degree of inflammation may be considered potentially harmful to the cardiac patient. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques including maintenance of hemodynamic stability, minimization of exposure to cardiopulmonary bypass circuitry, and pharmacologic and immunomodulatory agents have been examined in clinical studies. This article briefly reviews the current concepts of the systemic inflammatory response following cardiac surgery, and the various therapeutic strategies being used to modulate this response.


2020 ◽  
Vol 48 (1) ◽  
pp. 43-52
Author(s):  
Qi Wong ◽  
Kelly P Byrne ◽  
Scott C Robinson

TEG6s® is a new device introduced by the Haemonetics Corporation and designed to provide the same information as TEG® 5000 (Haemonetics Corporation, Braintree, MA, USA) but with much greater ease of use. We tested whether using citrated TEG6s gave reaction time, maximum amplitude and percentage of clot that had lysed at 30 minutes values similar to a non-citrated TEG5000, to allow clinical interchangeability using our current thrombelastography management algorithm for cardiac surgery. We also examined the agreement between the alpha-angle and functional fibrinogen maximum amplitude in our cardiac surgical patients.  In total, 243 paired arterial blood samples in 99 patients were tested, using TEG5000 (non-citrated) and TEG6s (citrated) after induction of anaesthesia (prior to heparin administration), following protamine administration at the end of the cardiac bypass and whenever a TEG5000 was requested after this by the attending anaesthetist. Bland–Altman plots and Lin’s concordance coefficient were used to compare agreement whereas modified Bland–Altman plots and McNemar’s test were used to illustrate the differences in management recommendations between the two thrombelastography devices.  All 243 samples were compared for reaction time and alpha-angle; 239 samples were compared for maximum amplitude; 136 samples were compared for the percentage of clot that had lysed at 30 minutes; 16 samples were compared for functional fibrinogen maximum amplitude. Lin’s concordance coefficient for these parameters was: reaction time 0.63, alpha-angle 0.39, maximum amplitude 0.5, percentage of clot that had lysed at 30 minutes 0.09 and functional fibrinogen maximum amplitude 0.31. Differences between the two devices became more marked at more abnormal values. Significant differences in median values, suggesting a fixed bias, were found for maximum amplitude and functional fibrinogen maximum amplitude. Differences in treatment recommendation could only be calculated for reaction time and maximum amplitude. Maximum amplitude was found to have a significant difference in treatment recommendation between the two devices using our current thrombelastography management algorithm for cardiac surgery with TEG6s recommending treatment in 11.5% more patients than TEG5000.  Using the TEG6s with our current TEG5000–based thrombelastography management algorithm for cardiac surgery would result in a change in treatment recommendation in at least 10% of our cardiac surgical patients. Agreement between the two thrombelastography devices appears to decrease with increasing patient coagulopathy. New algorithms will need to be developed and tested to validate TEG6s for cardiac surgical patients in our institution.


Perfusion ◽  
2008 ◽  
Vol 23 (6) ◽  
pp. 323-327 ◽  
Author(s):  
E Sirvinskas ◽  
J Andrejaitiene ◽  
L Raliene ◽  
L Nasvytis ◽  
A Karbonskiene ◽  
...  

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.


2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
Author(s):  
Judith A. Hudetz ◽  
Alison J. Byrne ◽  
Kathleen M. Patterson ◽  
Paul S. Pagel ◽  
David C. Warltier

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.


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