Inhibition of neutrophil activity improves cardiac function after cardiopulmonary bypass

Abdel-Rahman, Ulf; Margraf, Stefan; Aybek, Tayfun; Lögters, Tim; Bitu-Moreno, José; Francischetti, Ieda; Tilmann, Kranert; Grünwald, Frank; Windolf, Joachim; Moritz, Anton; Scholz, Martin

doi:10.1186/1476-9255-4-21

Cited by 15 publications

(13 citation statements)

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“…Should patients with persistent elevations in ON counts trend towards a worse outcome then early intervention (e.g. implementing a low tidal ventilation strategy) could decrease the pro-inflammatory cytokine response leading to end-organ failure [ 36 , 37 ]. It is important to note that there appears to be two patient populations based on the oral neutrophil levels.…”

Section: Discussionmentioning

confidence: 99%

Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass

et al. 2014

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BackgroundCardiopulmonary bypass (CPB) is an immuno-reactive state where neutrophils are activated and accumulate in different tissues. Edema and tissue necrosis are the most common sequelae observed, predominantly in the lungs, kidneys, and heart, heralding significant risk for postoperative complications. No method exists to noninvasively assess in vivo neutrophil activity. The objective of this study was to determine if neutrophil recruitment to the oral cavity would correlate with specific biomarkers after coronary bypass surgery (CPB).MethodsWe conducted a single site prospective observational study including non-consecutive adult patients undergoing elective, on-pump CPB. Blood and either oral cavity rinses or swabs were collected pre- and post-CPB. Absolute neutrophil counts from oral samples and serum biomarkers were measured. The association between neutrophil recruitment to the oral cavity, biomarkers and outcomes after CPB were analyzed.ResultsCPB was associated with statistically significant increases in oral and blood neutrophil counts, as well as an increase in certain biomarkers over preoperative baseline. Peripheral blood neutrophil count were increased at all time points however statistically significant differences in median oral neutrophil counts were observed only at the time point immediately postoperative, and in what seems to be two unique patient populations (p < 0.001; group 1, median: 1.6×105, Interquartile range [IQR], 1.1×105 - 4.8×105, and group 2, median: 1.9×106, IQR, 8.7×105 - 4.0×106).ConclusionsCPB is associated with a transient increase in oral neutrophils that may correlate with the systemic inflammatory response; oral neutrophils may have the ability to discriminate and identify unique patient populations based on their tissue migration.

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Section: Discussionmentioning

confidence: 99%

Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass

et al. 2014

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“…The ability of the mouse-anti-human agonistic anti-Fas IgM used in this study to induce porcine neutrophil apoptosis and to impair the effector functions was shown in earlier studies [22,25]. In previous experiments and in experiments that were done to establish this model, mini circuits without antibody coating were run to exclude effects mediated by the circuit itself.…”

Section: Discussionmentioning

confidence: 96%

Extracorporeal immune therapy with immobilized agonistic anti-Fas antibodies leads to transient reduction of circulating neutrophil numbers and limits tissue damage after hemorrhagic shock/resuscitation in a porcine model

Lögters

Altrichter

Paunel-Görgülü

et al. 2010

Journal of Inflammation

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BackgroundHemorrhagic shock/resuscitation is associated with aberrant neutrophil activation and organ failure. This experimental porcine study was done to evaluate the effects of Fas-directed extracorporeal immune therapy with a leukocyte inhibition module (LIM) on hemodynamics, neutrophil tissue infiltration, and tissue damage after hemorrhagic shock/resuscitation.MethodsIn a prospective controlled double-armed animal trial 24 Munich Mini Pigs (30.3 ± 3.3 kg) were rapidly haemorrhaged to reach a mean arterial pressure (MAP) of 35 ± 5 mmHg, maintained hypotensive for 45 minutes, and then were resuscitated with Ringer' solution to baseline MAP. With beginning of resuscitation 12 pigs underwent extracorporeal immune therapy for 3 hours (LIM group) and 12 pigs were resuscitated according to standard medical care (SMC). Haemodynamics, haematologic, metabolic, and organ specific damage parameters were monitored. Neutrophil infiltration was analyzed histologically after 48 and 72 hours. Lipid peroxidation and apoptosis were specifically determined in lung, bowel, and liver.ResultsIn the LIM group, neutrophil counts were reduced versus SMC during extracorporeal immune therapy. After 72 hours, the haemodynamic parameters MAP and cardiac output (CO) were significantly better in the LIM group. Histological analyses showed reduction of shock-related neutrophil tissue infiltration in the LIM group, especially in the lungs. Lower amounts of apoptotic cells and lipid peroxidation were found in organs after LIM treatment.ConclusionsTransient Fas-directed extracorporeal immune therapy may protect from posthemorrhagic neutrophil tissue infiltration and tissue damage.

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“…The pathognomic pathologic sign of CCE that was not seen in our patient was neddle shaped cleft in arteriole wall (5). Some studies found that however, various treatment strategies have been tested to reduce the severity of the systemic inflammation induced by CPB and to improve the treatment, including anti-inflammatory drugs, novel components of the CPB, and new surgical techniques, or anesthetic drugs or technique but no single strategy has been proven effective yet some of these drugs were evaluated in presiding studies (6)(7)(8). Production of humoral inflammatory mediators and priming of neutrophils by exposure to the CPB apparatus enables a 'post-pump' syndrome characterized by a systemic Sabzi and Faraji 5 inflammatory response syndrome and its anti-inflammatory counterpart, termed the compensatory anti-inflammatory response syndrome (9) IL-18 plays a central role in regulating and balancing these responses.…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled Systemic Inflammatory Response Syndrome by Cardiopulmonary Bypass

Sabzi¹,

Faraji²

2016

West Indian Med J

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It is known that the use of a cardiopulmonary bypass (CPB) during cardiac surgery leads to leukocyte activation and may, among other causes, induce organ dysfunction due to increased leukocyte recruitment into different organs. In our patients pathophysiologically severs SIRS, uncontrolled CPB induced inflammation, chylomicrons and very low density lipoproteins (VLDL) or immune complex have been shown to develop immune dependent agglutination by C-reactive proteins in cardiopulmonary bypass, which could result in vascular occlusion and resultant infarction.

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Inhibition of neutrophil activity improves cardiac function after cardiopulmonary bypass

Abstract: Background: The arterial in line application of the leukocyte inhibition module (LIM) in the cardiopulmonary bypass (CPB) limits overshooting leukocyte activity during cardiac surgery. We studied in a porcine model whether LIM may have beneficial effects on cardiac function after CPB.

Cited by 15 publications

References 30 publications

Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass

Oral neutrophils are an independent marker of the systemic inflammatory response after cardiac bypass

Extracorporeal immune therapy with immobilized agonistic anti-Fas antibodies leads to transient reduction of circulating neutrophil numbers and limits tissue damage after hemorrhagic shock/resuscitation in a porcine model

Uncontrolled Systemic Inflammatory Response Syndrome by Cardiopulmonary Bypass

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