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Oxidative stress and abnormal cholesterol metabolism in patients with post-cardiac arrest syndrome
Midori Nagase1, Atsushi Sakurai2, Atsunori Sugita2
1School of Bioscience and Biotechnology, Tokyo University of Technology, 1404-1 Katakura-cho, Hachioji, Tokyo 192-0982, Japan.
Insights
Post-cardiac arrest syndrome (PCAS) patients exhibit increased oxidative stress and liver dysfunction, impacting survival. Therapeutic hypothermia may improve coenzyme Q10 levels in PCAS patients.
Area of Science:
- Biochemistry
- Cardiology
- Critical Care Medicine
Background:
- Post-cardiac arrest syndrome (PCAS) involves whole-body ischemia/reperfusion injury.
- Oxidative stress and tissue damage are significant concerns in PCAS patients.
Purpose of the Study:
- To investigate biochemical markers of oxidative stress and liver function in PCAS patients.
- To correlate these markers with patient outcomes and the effects of therapeutic hypothermia.
Main Methods:
- Assessed coenzyme Q10 oxidation, plasma free fatty acids (FFA), and cholesterol metabolism (free cholesterol/cholesterol esters ratio).
- Compared biochemical parameters in PCAS patients (n=40) versus healthy controls (n=55).
- Analyzed time-course changes in relation to patient survival and therapeutic hypothermia.
Main Results:
- PCAS patients showed increased oxidized coenzyme Q10, elevated FFA, and altered polyunsaturated fatty acid levels.
- A significantly increased free cholesterol/cholesterol esters ratio suggested impaired lecithin-cholesterol acyltransferase activity.
- Rapid declines in cholesterol esters were observed in non-survivors, indicating liver dysfunction's role in mortality.
- Therapeutic hypothermia enhanced the plasma coenzyme Q10 to total cholesterol ratio.
Conclusions:
- Liver function is a critical determinant of survival in post-cardiac arrest syndrome.
- Biochemical markers like coenzyme Q10 and cholesterol metabolism reflect disease severity and prognosis.
- Therapeutic hypothermia shows potential benefits in improving metabolic profiles in PCAS patients.
Abstract:
Patients with post-cardiac arrest syndrome (PCAS) suffer from whole body ischemia/reperfusion injury similar to that experienced by newborn babies. Increased oxidative stress was confirmed in PCAS patients (n = 40) at the time of hospitalization by a significant increase in the percentage of the oxidized form of coenzyme Q10 in total coenzyme Q10 compared to age-matched healthy controls (n = 55). Tissue oxidative damage in patients was suggested by the significant increase in plasma levels of free fatty acids (FFA) and the significant decrease in polyunsaturated fatty acid contents in total FFA. A greater decrease in free cholesterol (FC) compared to cholesterol esters (CE) was observed. Therefore, the FC/CE ratio significantly increased, suggesting deficiency of lecithin-cholesterol acyltransferase secreted from the liver. Time course changes of the above parameters were compared among 6 groups of patients divided according to outcome severity. Rapid declines of FC and CE were observed in patients who died within a day, while levels remained unchanged in patients discharged in a week. These data suggest that liver function is one of the key factors determining the survival of patients. Interestingly, therapeutic hypothermia treatment enhanced the increment of plasma ratio of coenzyme Q10 to total cholesterol at the end of rewarming.
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