Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane)

Marfella, Antonio; Bilancio, Antonio; Polese, Claudio; Iodice, F.; Edmondo, Cesareo; Cerasuolo, Dionigio; Esposito, Giuseppe; Zannoni, Vincenzo; Beneduce, Gerardo

doi:10.1016/s0192-0561(99)00021-1

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Isoflurane has been shown to lower kynurenine production acutely (4–24 h post‐anaesthesia) with a delayed increase seen after 38 h in both plasma and urinary levels (Marfella et al. 1999).…”

Section: Resultsmentioning

confidence: 99%

Kynurenine metabolism predicts cognitive function in patients following cardiac bypass and thoracic surgery

Forrest

Mackay

Oxford

et al. 2011

Journal of Neurochemistry

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Cardiac surgery involving extra-corporeal circulation can lead to cognitive dysfunction. As such surgery is associated with signs of inflammation and pro-inflammatory mediators activate tryptophan oxidation to neuroactive kynurenines which modulate NMDA receptor function and oxidative stress, we have measured blood concentrations of kynurenines and inflammatory markers in 28 patients undergoing coronary arterial graft surgery and, for comparison, 28 patients undergoing non-bypass thoracic surgery. A battery of cognitive tests was completed before and after the operations. The results show increased levels of tryptophan with decreased levels of kynurenine, anthranilic acid and 3-hydroxyanthranilic acid associated with bypass, and a later increase in kynurenic acid. Levels of neopterin and lipid peroxidation products rose after surgery in non-bypass patients whereas tumour necrosis factor-a and S100B levels increased after bypass. Changes of neopterin levels were greater after non-bypass surgery. Cognitive testing showed that the levels of tryptophan, kynurenine, kynurenic acid and the kynurenine/tryptophan ratio, correlated with aspects of post-surgery cognitive function, and were significant predictors of cognitive performance in tasks sensitive to frontal executive function and memory. Thus, anaesthesia and major surgery are associated with inflammatory changes and alterations in tryptophan oxidative metabolism which predict, and may play a role in, post-surgical cognitive function.

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Section: Resultsmentioning

confidence: 99%

Kynurenine metabolism predicts cognitive function in patients following cardiac bypass and thoracic surgery

Forrest

Mackay

Oxford

et al. 2011

Journal of Neurochemistry

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“…KYNA production is also elevated during a bacterial or viral inflammation, an autoimmune disease and after a severe trauma (Forrest et al 2006; Hartai et al 2007; Scott et al 2009; Zeden et al 2010). Increases in plasma tryptophan metabolites have also been observed in patients undergoing elective abdominal or cardiac surgery (Forrest et al 2011; Marfella et al 1999). Perioperative increases in plasma cytokine concentrations following surgery-related inflammatory response may affect plasma KYNA concentration.…”

Section: Introductionmentioning

confidence: 99%

Plasma Kynurenic Acid Concentration in Patients Undergoing Cardiac Surgery: Effect of Anaesthesia

Kotlińska-Hasiec

Nowicka-Stążka

Parada-Turska

et al. 2014

Arch. Immunol. Ther. Exp.

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Increases in plasma kynurenic acid (KYNA) concentration relate to the severity of inflammation. The aim of this study was to analyse changes in plasma KYNA concentration and neutrophil/lymphocyte ratio (NLR) in cardiac surgery patients. Additionally, the effect of anaesthesia was analysed. Adult cardiac surgery patients under intravenous general anaesthesia were studied. Additionally, some patients received sevoflurane (SEV) prior to cardiopulmonary bypass. Plasma KYNA concentration and NLR were measured before anaesthesia, just after surgery and on postoperative days 1, 2 and 3. Patients were assigned to two groups: patients who did not receive SEV (NonSEV group) and patients who received SEV (SEV group). Forty-three patients were studied. Twenty-four of them received SEV. KYNA increased immediately after surgery and remained elevated through postoperative day 3 in the NonSEV group, whereas it was similar to the preoperative concentration in the SEV group. NLR increased immediately after surgery in both groups, and higher values were noted in the NonSEV group than in the SEV group at postoperative days 2 and 3. Plasma KYNA concentration correlated with NLR in the NonSEV group. Cardiac surgery caused an increase in NLR. Plasma KYNA increased in the NonSEV group and correlated with NLR. Administration of SEV inhibited the increase in KYNA, most likely due to its anti-inflammatory properties.

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“…Immune response is a protective phenomenon against any foreign antigen, but due to the nature of the antigen, antibodies produced and patient's susceptibility, it may be deleterious (15,16). Although there are a lot of clinical studies on the effects of widely used anesthetic agents and methods on immune system either in vivo or in vitro (7-14, 26, 27), there is limited number of evidence on neopterin which is an important marker of cellular immunity (20,25). Determination of neopterin concentrations in biological fluids seems to be more useful, non-invasive, cheaper and reliable (15)(16)(17)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, sevoflurane is thought to have a little effect on neutrophil apoptosis, cytokine concentration and neutrophil count, but desflurane seems to cause greater systemic response effects (26,27). Marfella et al reported a marked decrease in neopterin level at 4 hours after anaesthetic induction, however they found an increase in neopterin levels at 24 hours in patients with uterine malignancies operated either halothane or isoflurane (20). In our study sevoflurane, desflurane, and isoflurane resulted in an increase urinary neopterin levels in the postoperative 2nd hour 19.5 %, 16.6 %, and 13.0 %, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, the isolation and measurement of these markers in biological fluids is difficult, variable, and expensive; and their application in clinical practice it is not always feasible. Although blood and/or even urinary neopterin serves as a sensitive and early biomarker of cellular immune system activation, the relationship between neopterin release and exposure to anesthetics has not been assessed in greater detail with only a few exceptions (19,20). Therefore, the main goal of the present study was undertaken to investigate possible effects of inhalation anesthetics, such as desflurane, isoflurane, and sevoflurane on immune system by measuring urinary neopterin in patients who underwent laparoscopic cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Inhalation Anesthetics on the Profile of Urinary Neopterin as an Immune Marker in Patients who Underwent Laparoscopic Cholecystectomy

Capan

Baydar²,

Girgin³

et al. 2011

Pteridines

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It has been claimed that inhalational anesthetics affect many phases of immune response. Although, there are a lot of studies on the effects of widely used anaesthetic agents and methods on the immune system, there are only a few studies to show the effects by evaluation of neopterin concentrations as an important marker of cellular immunity. This study was done to evaluate possible effects of inhalation anesthetics, such as desflurane, isoflurane, and sevoflurane on the immune system by measuring urinary neopterin concentrations in patients who underwent laparoscopic cholecystectomy. The study is randomized, prospective and double blind. Urinary neopterin was measured in patients submitted to general anesthesia with either desflurane (n = 20) or isoflurane (n = 11), or sevoflurane (n = 13) in laparoscopic cholecystectomy. Urine samples were collected preoperatively, at 2nd and 24th hours post-operatively and the neopterin per creatinine concentrations were measured by using high-performance liquid chromatography.The preoperative neopterin levels were similar across the study groups. Variance analysis of repeated measures showed an effect of time (p <0.05): Neopterin concentrations increased over time, but the effect of different anesthetics on neopterin was similar. The mean increases in neopterin concentrations were similar among all the applied anesthetics. In conclusion, this report shows changes of immune response by investigation of neopterin in urine samples during 24 hours in patients exposed to three different inhalational anesthetic agents sevoflurane, desflurane and isoflurane in laparoscopic cholecystectomy.

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Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane)

Cited by 8 publications

References 22 publications

Kynurenine metabolism predicts cognitive function in patients following cardiac bypass and thoracic surgery

Kynurenine metabolism predicts cognitive function in patients following cardiac bypass and thoracic surgery

Plasma Kynurenic Acid Concentration in Patients Undergoing Cardiac Surgery: Effect of Anaesthesia

Effects of Inhalation Anesthetics on the Profile of Urinary Neopterin as an Immune Marker in Patients who Underwent Laparoscopic Cholecystectomy

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