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Markers for endothelial activation during open heart surgery.
Hilde Eikemo1, Olav F M Sellevold, Vibeke Videm
1Department of Immunology and Transfusion Medicine, Trondheim, Norway.
The Annals of Thoracic Surgery
|January 17, 2004
Summary
Cardiopulmonary bypass activates endothelial cells, increasing soluble adhesion molecules like sICAM-1 and sVCAM-1. Soluble VCAM-1 (sVCAM-1) is the most promising marker for endothelial activation during surgery.
Area of Science:
- Cardiovascular Surgery
- Biomarkers
- Endothelial Biology
Background:
- Endothelial activation is a critical factor in assessing the biocompatibility of cardiopulmonary bypass (CPB).
- Reliable markers are needed to quantify this activation during CPB procedures.
Purpose of the Study:
- To evaluate soluble adhesion molecules as markers of endothelial activation during CPB.
- To compare the kinetics and clinical relevance of sICAM-1, sVCAM-1, and sE-selectin.
Main Methods:
- Blood samples were collected from 21 patients undergoing CPB surgery at three time points: pre-anesthesia, post-CPB, and post-operative day 1.
- Concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble E-selectin (sE-selectin) were measured.
- Patient sera were used to stimulate human umbilical vein endothelial cells (HUVEC) in vitro to assess membrane-bound marker expression (mICAM-1, mVCAM-1).
Main Results:
- Concentrations of sICAM-1 and sVCAM-1 significantly increased from pre-anesthesia to post-operative measurements.
- sE-selectin levels also rose during the study period.
- Both membrane-bound ICAM-1 and VCAM-1 increased on HUVECs stimulated with patient sera, indicating endothelial activation.
- In vivo soluble marker levels did not correlate with in vitro activation but were associated with operative variables like age and CPB time.
Conclusions:
- Endothelial cells are activated during cardiopulmonary bypass.
- The soluble adhesion molecules sICAM-1, sVCAM-1, and sE-selectin exhibit distinct kinetic profiles.
- Soluble VCAM-1 (sVCAM-1) appears to be the most suitable clinical marker for endothelial activation, correlating with aortic cross-clamping and medication doses.