Cardiopulmonary Bypass Induces Acute Lung Injury via the High-Mobility Group Box 1/Toll-Like Receptor 4 Pathway

Abstract

During cardiopulmonary bypass (CPB), pulmonary ischemia/reperfusion (I/R) injury can cause acute lung injury (ALI). Our previous research confirmed that abnormal high-mobility group box 1 (HMGB1) release after CPB was closely related to ALI. However, the mechanism underlying the HMGB1-mediated induction of ALI after CPB is unclear. Our previous study found that HMGB1 binds Toll-like receptor 4 (TLR4), leading to lung injury, but direct evidence of a role for these proteins in the mechanism of CPB-induced lung injury has not been shown. We examined the effects of inhibiting HMGB1 or reducing TLR4 expression on CPB-induced lung injury in rats administered anti-HMBG1 antibody or TLR4 short-hairpin RNA (shTLR4), respectively. In these rat lungs, we studied the histologic changes and levels of interleukin- (IL-) 1β, tumour necrosis factor- (TNF-) α, HMGB1, and TLR4 after CPB. After CPB, the lung tissues from untreated rats showed histologic features of injury and significantly elevated levels of IL-1β, TNF-α, HMGB1, and TLR4. Treatment with anti-HMGB1 attenuated the CPB-induced morphological inflammatory response and protein levels of IL-1β, TNF-α, HMGB1, and TLR4 in the lung tissues and eventually alleviated the ALI after CPB. Treatment with shTLR4 attenuated the CPB-induced morphological inflammatory response and protein levels of IL-1β, TNF-α, and TLR4 in the lung tissues and eventually alleviated the ALI after CPB, but could not alleviate the HMGB1 protein levels induced by CPB. In summary, the present study demonstrated that the HMGB1/TLR4 pathway mediated the development of ALI induced by CPB.

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…Persistent hypoxemia often occurs after extubation in patients undergoing cardiac surgery, which affects the prognosis of patients and increases the cost of hospitalization. The reason may be blood contact with foreign matter and organ hypoperfusion during the process of CPB, which leads to an increase in systemic in ammatory mediators and results in lung injury [11][12][13]. During pulmonary ischemiareperfusion, in ammatory cells in ltrate, pulmonary interstitial exudation increases, and microvilli on the surface of type II alveolar epithelial cells decrease in abundance.…”

XueFu ZhuYu Decoction Alleviates Cardiopulmonary Bypass-Induced NLRP3 Inflammasome-Dependent Pyroptosis by Inhibiting IkB-α/NF-κB Pathway in Acute Lung Injury Rats

“…Rats were housed in standard laboratory conditions and had free access to food and tap water. To establish the CPB model, we followed the previous study [ 4 ]. One week after adaptation, rats were randomly divided into the following groups ( n = 6, in each group): sham, CPB, XFZYD, Ac-YVAD-CMK, and Bay-11-7082.…”

“…It is currently believed that ischemia-reperfusion injury and systemic inflammatory response syndrome may be important causes of ALI after CPB [ 3 , 4 ]. During the reperfusion period, diffuse neutrophil-dominated inflammatory cell infiltration and pulmonary edema rapidly in the lung tissues, and the symptoms of severe patients rapidly progressed to the impairment of alveolar epithelial-pulmonary vascular endothelial barrier function, which presents fatal pulmonary edema and severe pulmonary ventilation dysfunction.…”

Management Strategies for COVID-19 in the General Ward of Cardiovascular Surgery: Experience From a Single Tertiary Hospital in China

“…The unique clinical characteristics of patients in the department of cardiovascular surgery bring new challenges for the prevention and control of this epidemic. First, the immunity in patients undergoing cardiac surgery, especially cardiopulmonary bypass, will decline to various degrees, so they are more susceptible to pneumonia [Deng 2020]. Second, patients are unable to take care of themselves in the early postoperative period, so they need assistance to help them buy meals, daily goods, etc.…”