Alkaline phosphatase and infant cardiopulmonary bypass

Abstract

Alkaline phosphatase (AP) is an endogenous enzyme associated with inflammatory processes, and shown both in vitro and in vivo to be beneficial, as a therapy, in inflammation and organ injury. Cardio pulmonary bypass is widely used for repair of congenital heart defects in children, however, it may result in global inflammation and organ injury/dysfunction. Gaps of knowledge exist in the understanding of AP activity after infant cardiothoracic surgery and its association with major cardiovascular events and organ injury. In this volume of The Journal, Davidson et al describe AP activity in infants who underwent cardiopulmonary bypass. The study showed that persistently low AP activity, considered a biomarker or organ injury, through repeated measurements over 72 hours was independently associated with occurrence of major cardiac events: cardiac arrests, mechanical circulatory support, and death. The authors also showed that the kinetics of AP activity and serum concentration of AP were strongly correlated. Overall, this study is important in that the findings suggest that monitoring AP activity is of importance in predicting outcomes, as well as potential for considering AP as a target for modifying operative outcomes in infants. Article page 49 ▶ Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and Relationship to Organ Injury and Major Cardiovascular EventsThe Journal of PediatricsVol. 190PreviewTo determine the kinetics of alkaline phosphatase (AP) activity and concentration after infant cardiopulmonary bypass, including isoform-specific changes, and to measure the association between postoperative AP activity and major postoperative cardiovascular events, organ injury/dysfunction, and postoperative support requirements Full-Text PDF