The role of splenectomy in lipid metabolism and atherosclerosis (AS)

Abstract

The extensive performance of splenectomy worldwide for patients suffered from splenic trauma has given rise to high risks of postoperative complications, which has been attracting increasing attention in recent years. Nowadays the spleen is regarded as a versatile organ of the human body, invested with various excellent properties. The spleen has been recognized to take a great part in lipid metabolism. While removal of the spleen intends to alter lipid values, especially with an elevated LDL, splenic autotransplantation is able to normalize these lipid alterations. What is more, conservative surgical procedures like subtotal or partial splenectomy, could as well, afford a correction of dyslipidemia. At the same time, clinically, splenectomy demonstrates a high rate of atherosclerosis (AS), whereas non-surgical treatment after splenic trauma shows unchanged propagation of AS. Based on the intimate relationship between serum lipids and AS, the lipid changes modulated by splenectomy are believed to be responsible for the development of AS. Therefore, a “splenic factor” is most likely present in the regulation of lipidation and AS. Several theories have been postulated to elucidate the possible mechanism involved, among which most are primarily based on its forceful natural immune function, that is to say, the mononuclear phagocytic system.However, the accurate mechanisms behind this mysterious phenomenon still remain unclear so far. Of importance, lipid fractions should be monitored consecutively in case of inevitable splenectomy.

Contribution of Extramedullary Hematopoiesis to Atherosclerosis. The Spleen as a Neglected Hub of Inflammatory Cells

“…The spleen plays an important role in lipid metabolism: elevated LDL, altered lipid values, and atherosclerosis are common consequences of surgical removal of the organ in animal models and in humans (105)(106)(107)(108). These values become normal when a splenic transplant is performed (109).…”

“…These values become normal when a splenic transplant is performed (109). Conversely, partial splenectomy and conservative procedures reduce these changes in lipid metabolism (105). Therefore, it is proposed that the spleen is an essential regulator of lipid metabolism and the immune-cell function ( Figure 2) and this gives rise to propose what is called`the splenic factor´ (29,105).…”

“…Conversely, partial splenectomy and conservative procedures reduce these changes in lipid metabolism (105). Therefore, it is proposed that the spleen is an essential regulator of lipid metabolism and the immune-cell function ( Figure 2) and this gives rise to propose what is called`the splenic factor´ (29,105). Different studies support this view: higher cholesterol, triglycerides and phospholipid levels, and diminished HDL have been reported after splenectomy in rabbits and other animals; however, some researchers reported conflicting results (105,110).…”

“…Therefore, it is proposed that the spleen is an essential regulator of lipid metabolism and the immune-cell function ( Figure 2) and this gives rise to propose what is called`the splenic factor´ (29,105). Different studies support this view: higher cholesterol, triglycerides and phospholipid levels, and diminished HDL have been reported after splenectomy in rabbits and other animals; however, some researchers reported conflicting results (105,110). In humans, splenectomy was related to increased LDL levels and alterations in serological lipid profiles (105,107,111,112).…”

Elucidating the mechanism by which regulating spleen and lipid method improves the state of hyperlipidaemic rats

“…Traditional Chinese medicine (TCM) theory and related research suggests that the spleen has an important function in metabolising and processing nutritive elements (including lipids) following the injections of food [7]. Further, the importance of spleen in lipid metabolism has been elucidated in a number of preclinical studies [8,9]. Therefore, if the spleen's core functions are dysregulated, systemic metabolism and excretion of lipids is impacted, leading to hyperlipidemia.…”