Abstract
BackgroudCardiac surgery with cardiopulmonary bypass (CPB) may cause inflammatory responses, which can deteriorate the outcomes. Inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6,–8 and -10, can act as both the effector and the predictor for post-operative inflammatory responses. Plasma mitochondrial DNA (mtDNA) was found as a pro-inflammatory agent recently, which was released when cells were insulted.MethodsIn the present study, we included 38 patients undergoing coronary artery bypass graft (CABG) to analyze their perioperative plasma mtDNA and levels of inflammatory cytokines. Blood samples were collected before aortic cross-clamping (T1), at the end of CPB (T2), 6 h post-CPB (T3), 12 h post-CPB (T4), and 24 h post-CPB (T5). Rt-PCR and specific ELISA kits were used to quantify the plasma mtDNA and inflammatory cytokines, respectively. Bivariate correlations analysis was used to check the correlations between plasma mtDNA and inflammatory cytokines respectively.ResultsResults shown that plasma mtDNA elevated significantly at T2 and peaked at T4. Furthermore, plasma TNF-α, IL-6 and IL-8 levels significantly increased at T2 and peaked at T3 while IL-10 elevated and peaked at T2. Bivariate correlations analysis showed that the peak plasma mtDNA were positively correlated with the peak TNF-α (r = 0.677, P < 0.001), the peak IL-6 (r = 0.706, P < 0.001), the peak IL-8 (r = 0.584, P < 0.001) and the peak IL-10 (r = 0.565, P < 0.001).ConclusionWe found that plasma mtDNA might play a key role in CPB-induced post-operative inflammatory responses.
Highlights
The first case of extracorporeal circulation (ECC) was reported by Gibbon JH in 1954 to successfully save a patient with atrial septal defect (ASD) [1]
It is well known that most of postoperative complications are related to the systemic inflammatory response syndrome (SIRS) and many studies demonstrated that inflammatory mediators, like tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL8 and IL-10, increased significantly after cardiac surgery with cardiopulmonary bypass (CPB) [4,5,6,7]
Our study demonstrated that plasma mitochondrial DNA (mtDNA) was released during cardiac surgery with CPB
Summary
The first case of extracorporeal circulation (ECC) was reported by Gibbon JH in 1954 to successfully save a patient with atrial septal defect (ASD) [1]. In 1955, Kirklin et al combined the ECC with the oxygenator in intracardiac surgery and since the technique of cardiopulmonary bypass (CPB) was developed to be the key process in modern cardiothoracic surgery [2]. While the CPB helping to bypass circulation out of the heart and lung during the operation, the abnormal status of circulation and the ischemia/reperfusion injury (I/R injury) may cause inflammatory responses [3]. MtDNA was released into circulation and trigger inflammatory responses when cells were dealing with harmful insults [11]. Plasma mtDNA was elevated remarkably in trauma patients, comparing to volunteers [13]. A study based on multiple cohorts showed that mtDNA can improve risk prediction and there is a tight relationship between elevated plasma mtDNA level and 28-day mortality [14]
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