Lipid peroxidation in cardiac surgery: towards consensus on biomonitoring, diagnostic tools and therapeutic implementation

Abstract

This review focuses on oxidative stress and more specifically lipid peroxidation in cardiac surgery, one of the fundamental theories of perioperative complications. We present the molecular pathways leading to lipid peroxidation and integrate analytical methods that allow detection of lipid peroxidation markers in the fluid phase with those focusing on volatile compounds in exhaled breath. In order to explore the accumulated data in the literature, we present a systematic review of quantitative analysis of malondialdehyde, a widely used lipid peroxidation product at various stages of cardiac surgery. This exploration reveals major limitations of existing studies in terms of variability of reported values and significant gaps due to discrete and variable sampling times during surgery. We also appraise methodologies that allow real-time and continuous monitoring of oxidative stress. Complimentary techniques highlight that beyond the widely acclaimed contribution of the cardiopulmonary bypass technology and myocardial reperfusion injury, the use of diathermy contributes significantly to intraoperative lipid peroxidation. We conclude that there is an urgent need to implement the theory of oxidative stress towards a paradigm change in the clinical practice. Firstly, we need to acquire definite and irrefutable information on the link between lipid peroxidation and post-operative complications by building international consensus on best analytical approaches towards generating qualitatively and quantitatively comparable datasets in coordinated multicentre studies. Secondly, we should move away from routine low-risk surgeries towards higher risk interventions where there is major unmet clinical need for improving patient journey and outcomes. There is also need for consensus on best therapeutic interventions which could be tested in convincing large scale clinical trials. As future directions, we propose combination of fluid phase platforms and 'metabography', an extended form of capnography-including real-time analysis of lipid peroxidation and volatile footprints of metabolism-for better patient phenotyping prior to and during high risk surgery towards molecular prediction, stratification and monitoring of the patient's journey.

Ketamine ameliorates oxidative stress-induced apoptosis in experimental traumatic brain injury via the Nrf2 pathway

“…In addition, both SOD and GPx are antioxidant enzymes that catalyze the reduction of glutathione. 30 , 31 The conversion of MDA and the activities of SOD and GPx in the cortex of mice with TBI indicate that oxidative stress occurs following TBI. Apart from that, the results of this study also showed that the treatment with ketamine partly relieves this impact, suggesting that ketamine could attenuate TBI-induced oxidative stress.…”

Laser spectroscopy for breath analysis: towards clinical implementation

“…This innovative approach has irrefutably demonstrated the significant contribution of diathermy to overall oxidative stress and identified increased ethylene associated with regional myocardial ischemia on an individual basis. It can be concluded that sensitive, totally noninvasive, and real-time analysis of lipid peroxidation using breath ethylene is feasible in the clinical and perioperative setting [68]. Mid-infrared OPOs are considered amongst the most useful tools for sensitive LPAS gas sensing, due to their high power (Watt level), wide tuning range, and ease of tunability.…”

Oxidative Stress and Neonatal Respiratory Extracorporeal Membrane Oxygenation

“…Lipid peroxidation, caused by increased ROS and RNS, is linked to many acute and chronic diseases of adulthood such as MOF, hemorrhagic and septic shock, ARDS, acute lung injury, cardiovascular pathology requiring surgery, aging, atherosclerosis, Parkinson, Alzheimer, diabetes mellitus, cataracts and rheumatoid arthritis, and several diseases of the neonatal period (Takeda et al, 1984; Hammond and Hess, 1985; Bertrand et al, 1989; Richard et al, 1990; Quinlan et al, 1996; Carpenter et al, 1998; Lamb et al, 1999; Motoyama et al, 2003; Comporti et al, 2004; Quinlan et al, 2004; Fläring et al, 2005; Laplace et al, 2005; Niki et al, 2005; Saugstad, 2005; Huet et al, 2007; Signorini et al, 2008; Giustarini et al, 2009; Briones and Touyz, 2010; Giacco and Brownlee, 2010; Khaper et al, 2010; Romano et al, 2010; Barrera et al, 2018; Maiorino et al, 2018; Mátyás and Zaharie, 2018; Moore et al, 2018; Orban and Singer, 2018; Perrone et al, 2018; Romano et al, 2018).…”