Remote Ischemic Preconditioning Attenuates Oxidative Stress during Cardiopulmonary Bypass
DOI:
https://doi.org/10.1532/hsf.1590Abstract
Background: Deep hypothermic circulatory arrest (DHCA) is used to overcome the threat of cerebral ischemia during complex surgical operations of the heart and the aortic arch. Remote ischemic preconditioning (RIPC) has been shown to mitigate neurological damage.Methods: We analyzed blood samples in a consecutive series of 52 piglets that underwent a 60-min period of DHCA with RIPC (the RIPC group) or without (the control group), to reveal whether the protective effect to oxidative stress could be seen by measuring serum 8-hydroxydeoxyguanosine (8-OHdG). The piglets were cannulated and cooled to 18°C using a heart-lung machine, for the DHCA. The piglets were then rewarmed to normothermic temperature. Blood sampling was taken at baseline, after 30 minutes of cooling,
2 hours postoperatively, and 8 hours postoperatively, and analyzed. 8-hydroxydeoxyguanosine (8-OHdG) from blood samples was analyzed by using Enzyme Linked Immunosorbent Assay (ELISA).
Results: The serum 8-OHdG concentration was lower in the RIPC group after the cooling phase, 1.84 (1.44-2.17) ng/mL, and at 8 hours after HCA 1.48 (1.39-1.69) ng/mL, when compared with the control group, where the values were
2.14 (1.81-2.56) and 1.84 (1.62-2.44) ng/mL, respectively
(P = .025) and (P = .004).
Conclusion: Remote ischemic preconditioning lowers oxidative stress during cardiopulmonary bypass.
References
Arvola O, Haapanen H, Herajärvi J, et al. 2016. Remote ischemic preconditioning reduces cerebral oxidative stress following hypothermic circulatory arrest in A porcine model. Semin Thorac Cardiovasc Surg [In press].
Birkelund T, Obad DS, Matejec R, Botker HE, Ravn HB. 2015. Remote ischemic preconditioning does not increase circulating or effector organ concentrations of proopiomelanocortin derivates. Scand Cardiovasc J 49:257-63.
Byrne CJ, McCafferty K, Kieswich J, et al. 2012. Ischemic conditioning protects the uremic heart in a rodent model of myocardial infarction. Circulation 125:1256-65.
Chiou CC, Chang PY, Chan EC, Wu TL, Tsao KC, Wu JT. 2003. Urinary 8-hydroxydeoxyguanosine and its analogs as DNA marker of oxidative stress: Development of an ELISA and measurement in both bladder and prostate cancers. Clin Chim Acta 334:87-94.
Franke A, Lante W, Fackeldey V, et al. 2005. Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: Is what we see what we know? Eur J Cardiothorac Surg 28:569-75.
Garcia-Dorado D, Rodriguez-Sinovas A, Ruiz-Meana M, Inserte J, Agullo L, Cabestrero A. 2006. The end-effectors of preconditioning protection against myocardial cell death secondary to ischemia-reperfusion. Cardiovasc Res 70:274-85.
Granger DN, Kvietys PR. 2015. Reperfusion injury and reactive oxygen species: The evolution of a concept. Redox Biol 6:524-51.
Griepp RB. 2001. Cerebral protection during aortic arch surgery. J Thorac Cardiovasc Surg 121:425-7.
Haapanen H, Herajarvi J, Arvola O, et al. 2016. Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model. J Thorac Cardiovasc Surg 151:777-85.
Halestrap AP. 2006. Mitochondria and preconditioning: A connexin connection? Circ Res 99:10-12.
Hamilton ML, Guo Z, Fuller CD, et al. 2001. A reliable assessment of 8-oxo-2-deoxyguanosine levels in nuclear and mitochondrial DNA using the sodium iodide method to isolate DNA. Nucleic Acids Res 29:2117-26.
Hausenloy DJ, Candilio L, Evans R, et al. 2015. Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med 373:1408-17.
Heusch G, Botker HE, Przyklenk K, Redington A, Yellon D. 2015. Remote ischemic conditioning. J Am Coll Cardiol 65:177-95.
Jensen HA, Loukogeorgakis S, Yannopoulos F, et al. 2011. Remote ischemic preconditioning protects the brain against injury after hypothermic circulatory arrest. Circulation 123:714-21.
Li C, Xu M, Wu Y, Li YS, Huang WQ, Liu KX. 2014. Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofol-remifentanil anesthesia: A randomized controlled study. Anesthesiology 121:249-59.
Mazurek A, Berardini M, Fishel R. 2002. Activation of human MutS homologs by 8-oxo-guanine DNA damage. J Biol Chem 277:8260-6.
McCullough JN, Zhang N, Reich DL, et al. 1999. Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg 67:1895-9; discussion 1919-21.
Meybohm P, Bein B, Brosteanu O, et al. 2015. A multicenter trial of remote ischemic preconditioning for heart surgery. N Engl J Med 373:1397-1407.
Raedschelders K, Ansley DM, Chen DD. 2012. The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion. Pharmacol Ther 133:230-55.
Shibutani S, Takeshita M, Grollman AP. 1991. Insertion of specific bases during DNA synthesis past the oxidation-damaged base 8-oxodG. Nature 349:431-4.
Suleiman MS, Zacharowski K, Angelini GD. 2008. Inflammatory response and cardioprotection during open-heart surgery: The importance of anaesthetics. Br J Pharmacol 153:21-33.
Walsh M, Whitlock R, Garg AX, et al. 2016. Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (remote IMPACT): A randomized controlled trial. CMAJ 188:329-36.
Yannopoulos FS, Makela T, Niemela E, et al. 2010. Improved cerebral recovery from hypothermic circulatory arrest after remote ischemic preconditioning. Ann Thorac Surg 90:182-8.
Yannopoulos F, Makela T, Arvola O, et al. 2012. Remote ischemic precondition preserves cerebral oxygen tension during hypothermic circulatory arrest. Scand Cardiovasc J 46:245-50.
Yannopoulos FS, Arvola O, Haapanen H, et al. 2014. Leg ischaemia before circulatory arrest alters brain leucocyte count and respiratory chain redox state. Interact Cardiovasc Thorac Surg 18:272-7.
Yildirim F, Iskesen I, Kurdal AT, et al. 2016. Is “attenuation of oxidative stress” helpful to understand the mechanism of remote ischemic preconditioning in cardiac surgery? J Cardiothorac Vasc Anesth 30:134-40.