Circulating Proteomic Analysis Identifies Reduced Inflammation After Initiation of Hemodynamic Support with Either Veno-Arterial Extracorporal Membrane Oxygenation or Impella in Patients with Cardiogenic Shock

Abstract

<h3>Purpose</h3> Use of acute mechanical circulatory support (AMCS) for cardiogenic shock (CS) is growing. We sought to determine whether plasma protein profiles are differentially regulated after initiation of veno-arterial extracorporeal membrane oxygenation (ECMO) or Impella in patients with CS. <h3>Methods</h3> Plasma samples were collected before device implantation and 72 hours after initiation of support in 11 CS patients receiving ECMO (n=5) or Impella (n=6). The aptamer-based SOMAscan assay was used to detect 1305 circulating proteins. Ingenuity Pathway Analysis identified cellular pathways and network interactions defined by proteins with a fold change >1.3 or <0.7 and p<0.05 after AMCS initiation. <h3>Results</h3> 67/1305 proteins were changed after ECMO (18 upregulated and 49 downregulated, p<0.05) and 38/1305 after Impella (10 upregulated and 28 downregulated, p<0.05). Only 8 proteins were commonly affected by ECMO and Impella. Despite minimal overlap in individual proteins, both devices were associated with markers of reduced inflammation including regulatory cytokines and increased apoptosis of leukocytes, phagocytes, and antigen-presenting cells (Figures A-B). <h3>Conclusion</h3> Using unbiased proteomic screening we identified that ECMO and Impella are associated with reduced expression of inflammatory markers and increased markers of inflammatory cell death. These circulating proteins may serve as novel targets of therapy or novel biomarkers to tailor AMCS device use and improve patient outcomes.