Download PDF
Thorac Cardiovasc Surg 2003; 51(3): 130-137
DOI: 10.1055/s-2003-40318
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

Nitric Oxide and Inflammatory Response in Simulated Extracorporeal Circulation

M.  Lahtinen1 , V.  Melki1 , B.  Adamik2 , H.  Khamis1 , J.  W.  Borowiec1
  • 1Department of Cardiothoracic Surgery, Uppsala University Hospital, Sweden
  • 2Department of Anestesiology & Intensive Care, University Hospital Wroclaw, Poland
Further Information

Publication History

Received: January 5, 2003

Publication Date:
30 June 2003 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Simulated extracorporeal circulation (SECC) induces inflammatory reaction. Nitric oxide (NO) has pro-and anti-inflammatory properties. NO role in SECC-related inflammatory response is unclear. The aim of this study was to clarify if NO affects the foreign-surface induced leukocyte activation during SECC. Methods: Human blood was circulated through SECC during 3 hours. Control group C was ventilated with oxygen/air mixture and the study group with oxygen/air mixture and NO. Leukocyte activation was measured as serum levels of myeloperoxidase (MPO), human neutrophil lipocalin (HNL), lactoferrin (LF), interleukin-1-beta (IL-1β) and interleukin-10 (IL-10). Oxygen free radical production capacity was evaluated with chemiluminescence. NO metabolites nitrite/nitrate were estimated in serum. Results: Leukocyte granule release increased over time. Addition of NO significantly increased MPO, HNL and LF release. The average difference increased with SECC duration. NO addition did not significantly affect measured interleukins concentration or oxygen free radical production capacity. NO metabolites increased significantly in the NO circuits. Conclusions: Results indicate that NO addition during SECC is pro-inflammatory and has no effect on oxygen free radical production and interleukin release.

Key words

Extracorporeal circulation - inflammatory reaction - NO - oxygen free radicals - interleukins

References

  • 1 Edmunds H L. Inflammatory response to cardiopulmonary bypass.  Ann Thorac Surg. 1998;  6615 312-316
    PubMedGoogle Scholar
  • 2 Bauer P, Rozsa Z, Granger D N. Nitric oxide and the gastrointestinal circulation. In: Kadowitz PJ, McNamara DB, eds Nitric oxide and the regulation of the peripheral circulation. Boston, Basel, Berlin; Birkhäuser 2000: 259-269
    Google Scholar
  • 3 Ignarro L J. Nitric oxide in the regulation of blood flow: A historical overview. In: Kadowitz PJ, McNamara DB, eds Nitric oxide and the regulation of the peripheral circulation. Boston, Basel, Berlin; Birkhäuser 2000: 1-12
    Google Scholar
  • 4 Lahtinen M, Borowiec J, Venge P, Henze A, Stiernström H. Nitric oxide increases leukocyte granule release during simulated extracorporeal circulation.  Thor Cardiov Surg. 2000;  48 151-156
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Shinde U A, Mehta A A, Goyal R K. Nitric oxide: a molecule of the millenium.  Indian J Exp Biol. 2000;  38 (3) 201-210
    PubMedGoogle Scholar
  • 6 World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Postgrad Med 2002 48 3 206-208
    Google Scholar
  • 7 Wilkinson P. Chemotaxis and inflammation. Edinburgh, London, Melbourne, New York; Churchill Livingstone 1974
    Google Scholar
  • 8 Hayashi Y, Sawa Y, Nishimura M. et al . Nitric oxide gas infusor to the oxygenator enhances the biocompatibility of heparin coated extracorporeal bypass circuits.  ASAIO Journal. 1998;  44 M456-M461
    CrossrefPubMedGoogle Scholar
  • 9 Grisham M. et al . Quantitation of nitrate and nitrite in extracellular fluids.  Methods Enzymol. 1996;  268 237-246
    PubMedGoogle Scholar
  • 10 Nielsen H, Reimert C, Pedersen A. et al . Time-dependent, spontaneous release of white cell- and platelet derived bioactive substances from stored human blood.  Transfusion. 1996;  36 960-965
    CrossrefPubMedGoogle Scholar
  • 11 Weisbach V, Wanke C, Zingsem J. et al . Cytokine generation in whole blood, leukocyte-depleted and temporarily warmed red blood cell concentrates.  Vox Sang. 1999;  76 100-106
    CrossrefPubMedGoogle Scholar
  • 12 Kooy N, Royall J, Ye Y, Kelly D, Beckman J. Evidence for in vivo peroxynitrite production in human lung injury.  Am J Respir Crit Care Med. 1995;  151 1250-1254
    PubMedGoogle Scholar
  • 13 Asimakopoulos G. Mechanism of the systemic inflammatory response.  Perfusion. 1999;  14 (4) 269-277
    PubMedGoogle Scholar
  • 14 Borowiec J W, Lahtinen M, Venge P, Henze A, Stiernström H. Inflammatory response during simulated extracorporeal circulation with addition of nitric oxide.  J Cardiovasc Surg. 2000;  41 207-213
    PubMedGoogle Scholar
  • 15 Mellgren K, Friberg L, Mellgren G, Hedner T, Wennmalm Å, Wadenvik H. Nitric oxide in the sweep gas reduces platelet activation during experimental perfusion.  Ann Thorac Surg. 1996;  61 1856-1864
    CrossrefPubMedGoogle Scholar
  • 16 Konishi R, Shimizu R, Firestone L. et al . Nitric oxide prevents human platelet adhesion to fiber membranes in whole blood.  ASAIO J. 1996;  42 M850-M853
    PubMedGoogle Scholar
  • 17 Tabet J Y, Lopes M E, Champagne S, Su J B, Merlet P, Hittinger L. Inflammation, cytokines and anti-inflammatory therapies in heart failure.  Arch Mal Coeur Vaiss. 2002;  95 (3) 204-212
    PubMedGoogle Scholar
  • 18 McBride W T, Armstrong M A, Crockard A D, McMurray T J, Rea J M. Cytokine balance and immunosuppressive changes at cardiac surgery: contrasting results between patients and isolated CPB circuits.  Br J Anesth. 1995;  75 724-733
    PubMedGoogle Scholar
  • 19 Hanada T, Yoshimura A. Regulation of cytokine signaling and inflammation.  Cytokine Growth Factor Rev. 2002;  13 (4 - 5) 413-421
    CrossrefPubMedGoogle Scholar
  • 20 Bogdan C, Vodovotz Y, Nathan C. Macrophage deactivation by interleukine 10.  J Exp Med. 1991;  174 1549-1555
    CrossrefPubMedGoogle Scholar

Jan W. Borowiec

Department of Cardiothoracic Surgery, Uppsala University Hospital

75185 Uppsala, Sweden

Phone: +46 18 611 4055

Fax: +46 18 611 3926

Email: jan.borowiec@surgsci.uu.se

      >