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Neutrophil oxidative metabolism during cariopulmonary by-pass with polypropylene hollow fibre oxygenator
NEUTROPHIL
OXIDATIVE METABOLISM DURING CARIOPULMONARY BY-PASS WITH POLYPROPYLENE HOLLOW FIBRE OXYGENATOR G. Giordano, M.D., M.G. Pignatelli, M.D., P. Costa, M.D., L. Biancardi, M.D., E. Castenetto, M.D., M. Formica, M.D., G. Cavaiii, M.C. Ampiro, D. Roccatello, M.D. 1st Anesthesia Department and Division of Nephrology, Ospedale Maggiore, S. Giovanni, Corso Bramante 88, 10126 Torino, Italy
The mean values of CL emission at various times and slalisticai signiticancc compared to basal lcvcls are summa&cd below:
INTRODUCTION Cardiopulmonary by-pass (CPB) for cardiac surgery is known to produce a generalized inftammatory reaction involving complement, coagulation, kahikrein and tibrinolytic cascades (1). Lie in haemodialysis, sudden neutropenia and rebound neutrophiiia, ah.0 occurs (2). The aim of the present study was to look for CPB related abnormalities in neutrohii oxidative metabolism and their possible relationship with other predictors of compatibility of biomaterials [such as the C3 breakdown product C3d and beta-2 microglobulin (beta;?-m)].
PMA
oz (mvxmin) Basal
METHODS Niie consecutive patients, undergoing CPB with polypropylene hollow tibre oxygenators (OXY41 Sorin Biomedica) for cardiac surgery, were prospcctivcly studied. Informed consent was given by ah the patients undergoing to the procedures of this project. Institutional approval was obtained before the study was begun. Age ranged from 54 to 70 years. All patients received the same premeditation and were anaesthetized with oxygen, fentanyl (40-62 mcg/kg), diazepam and pancuronium. The oxygenator was primed with cristalloid solution and mannitol. During CPB mean perfusion pressure was maintained between 40 and 60 mm Hg and all patients were cooled to an oesophageal temperature of 28-30°C. Blood samples were collected at 10,2O, 30 min of CPB. Cell separation. Neutrophils were isolated from peripheral blood by dextran sedimentation and Ficoll-Hypaque gradient (3). Chemiiuminescence assay (CL). Opsonizcd Zymosan (OZ) and phorbol myristate acetate (PMA)(Sigma) served as stimulus for luminol-enhanced chemiluminescence experiments. The instrumentation equipment included a LKB-Wallac 1251 luminometer coupled to either display unit, potentiometric recorder and computer for data registration. Duplicate samples were measured at 1 min intervals as millivolts (mV) ligth emission. The chemihrminescence response was determined as the integral under the curve (mVxmin)(3). C&h C3d was detcctcd by radial immunodiffusion tcchniquc (4). Results were expressed as percentage of C3d measured after complete activation induced by Inuhn in a pool of normal human serum (%NHS-I). BetaZmicroelobulin measurement. The enzyme immunoessay Enzygnost BetaZmicroglobulin (Bchring) was employed (5). Statistics. The Wilcoxon test and the linear coefticient of regression were used.
1373.7 (5552198)
P
(mvxmin)
P
1649.6 (346-4118)
10 min 1923.7 (676-3472) 0.01 1956.4 (843-5461)
N.S.
24l min 1953.2 (8143321) 0.01 2602 (637-5785)
0.05
30 min 2067.7 (943-3423) 0.01 2412.6 (1265-5771)
0.01
C3d and BetaZm levels were corrected for haemodilution values. A signiticant increase (~~0.02) in C3d lcvcls was found at 10 min (5.3 %NHS-I, range 3.3-8 vs basal 2.7 %NHS-I, range 2-5). Conversely no change in levels of Be@-m was detected during CPB: DISCUSSION The data suggest that the impact of patient blood contact with foreign surfaces in the extracorporeal circuit resulted in activation of phagocyte cells with increased potential in oxygen consumption.This phenomenon could be a major determinant of the inflammatory reactions occuring in most patients undergoing CPB. A possible relationship with complement activation induced by hollow-tibre oxygenator cannot be excluded. REFERENCES 1) Kirkiin JK, Blackstone EH and Kirklin JW. Cardiopulmonary by-pass: studies on its damaging effects. Blood Purif 5: 168-178, 1987. 2) Hammerschmidt DE, Stronceck DF, Bowers TK et al. Complement activation and ncutropenia occuring during cardiopulmonary by-pass. J Thorac Cardiovasc Surg 8: 370-377, 1981. 3) Roccatello D, Mazzucco G, Coppo R et al. Functional changes of monocyte due to dialysis membranes. Kidney Int 35 (1989), in press. 4) Roccatcllo D, Coppo R, Piccoli G et al. Circulating Fc receptor blocking factors in IgA nephropathy. Ciin Nephrol 23: 159-168,198s. 5) Amore A, Coppo R, Roccatello D et ai. Single kidney function: effect of acute protein and water loading on microalbuminuria. Am J Med 84: 711-717,1988.
RESULTS A remarkable increase in CL emission was detected by using both OZ and PMA in 7 out of 9 patients.
76
OXIDATIVE METABOLISM DURING CARIOPULMONARY BY-PASS WITH POLYPROPYLENE HOLLOW FIBRE OXYGENATOR G. Giordano, M.D., M.G. Pignatelli, M.D., P. Costa, M.D., L. Biancardi, M.D., E. Castenetto, M.D., M. Formica, M.D., G. Cavaiii, M.C. Ampiro, D. Roccatello, M.D. 1st Anesthesia Department and Division of Nephrology, Ospedale Maggiore, S. Giovanni, Corso Bramante 88, 10126 Torino, Italy
The mean values of CL emission at various times and slalisticai signiticancc compared to basal lcvcls are summa&cd below:
INTRODUCTION Cardiopulmonary by-pass (CPB) for cardiac surgery is known to produce a generalized inftammatory reaction involving complement, coagulation, kahikrein and tibrinolytic cascades (1). Lie in haemodialysis, sudden neutropenia and rebound neutrophiiia, ah.0 occurs (2). The aim of the present study was to look for CPB related abnormalities in neutrohii oxidative metabolism and their possible relationship with other predictors of compatibility of biomaterials [such as the C3 breakdown product C3d and beta-2 microglobulin (beta;?-m)].
PMA
oz (mvxmin) Basal
METHODS Niie consecutive patients, undergoing CPB with polypropylene hollow tibre oxygenators (OXY41 Sorin Biomedica) for cardiac surgery, were prospcctivcly studied. Informed consent was given by ah the patients undergoing to the procedures of this project. Institutional approval was obtained before the study was begun. Age ranged from 54 to 70 years. All patients received the same premeditation and were anaesthetized with oxygen, fentanyl (40-62 mcg/kg), diazepam and pancuronium. The oxygenator was primed with cristalloid solution and mannitol. During CPB mean perfusion pressure was maintained between 40 and 60 mm Hg and all patients were cooled to an oesophageal temperature of 28-30°C. Blood samples were collected at 10,2O, 30 min of CPB. Cell separation. Neutrophils were isolated from peripheral blood by dextran sedimentation and Ficoll-Hypaque gradient (3). Chemiiuminescence assay (CL). Opsonizcd Zymosan (OZ) and phorbol myristate acetate (PMA)(Sigma) served as stimulus for luminol-enhanced chemiluminescence experiments. The instrumentation equipment included a LKB-Wallac 1251 luminometer coupled to either display unit, potentiometric recorder and computer for data registration. Duplicate samples were measured at 1 min intervals as millivolts (mV) ligth emission. The chemihrminescence response was determined as the integral under the curve (mVxmin)(3). C&h C3d was detcctcd by radial immunodiffusion tcchniquc (4). Results were expressed as percentage of C3d measured after complete activation induced by Inuhn in a pool of normal human serum (%NHS-I). BetaZmicroelobulin measurement. The enzyme immunoessay Enzygnost BetaZmicroglobulin (Bchring) was employed (5). Statistics. The Wilcoxon test and the linear coefticient of regression were used.
1373.7 (5552198)
P
(mvxmin)
P
1649.6 (346-4118)
10 min 1923.7 (676-3472) 0.01 1956.4 (843-5461)
N.S.
24l min 1953.2 (8143321) 0.01 2602 (637-5785)
0.05
30 min 2067.7 (943-3423) 0.01 2412.6 (1265-5771)
0.01
C3d and BetaZm levels were corrected for haemodilution values. A signiticant increase (~~0.02) in C3d lcvcls was found at 10 min (5.3 %NHS-I, range 3.3-8 vs basal 2.7 %NHS-I, range 2-5). Conversely no change in levels of Be@-m was detected during CPB: DISCUSSION The data suggest that the impact of patient blood contact with foreign surfaces in the extracorporeal circuit resulted in activation of phagocyte cells with increased potential in oxygen consumption.This phenomenon could be a major determinant of the inflammatory reactions occuring in most patients undergoing CPB. A possible relationship with complement activation induced by hollow-tibre oxygenator cannot be excluded. REFERENCES 1) Kirkiin JK, Blackstone EH and Kirklin JW. Cardiopulmonary by-pass: studies on its damaging effects. Blood Purif 5: 168-178, 1987. 2) Hammerschmidt DE, Stronceck DF, Bowers TK et al. Complement activation and ncutropenia occuring during cardiopulmonary by-pass. J Thorac Cardiovasc Surg 8: 370-377, 1981. 3) Roccatello D, Mazzucco G, Coppo R et al. Functional changes of monocyte due to dialysis membranes. Kidney Int 35 (1989), in press. 4) Roccatcllo D, Coppo R, Piccoli G et al. Circulating Fc receptor blocking factors in IgA nephropathy. Ciin Nephrol 23: 159-168,198s. 5) Amore A, Coppo R, Roccatello D et ai. Single kidney function: effect of acute protein and water loading on microalbuminuria. Am J Med 84: 711-717,1988.
RESULTS A remarkable increase in CL emission was detected by using both OZ and PMA in 7 out of 9 patients.
76