Prolonged Cardiopulmonary Bypass Time-Induced Endothelial Dysfunction via Glypican-1 Shedding, Inflammation, and
Shiyi Li1, Katherine V Nordick1, Iván Murrieta-Álvarez1
1Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Prolonged cardiopulmonary bypass (CPB) triggers inflammation and activates matrix metallopeptidase 9 (MMP9), leading to glypican-1 shedding and endothelial dysfunction. This impacts outcomes in cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Biomarkers
- Endothelial Function
Background:
- Extended cardiopulmonary bypass (CPB) duration (>180 min) is associated with adverse outcomes in cardiac surgery.
- Endothelial dysfunction is a key factor in post-CPB complications.
- The roles of glypican-1, MMP9, and IL-1β in prolonged CPB-induced endothelial dysfunction require further investigation.
Purpose of the Study:
- To investigate the association between prolonged CPB and plasma levels of glypican-1, MMP9, and IL-1β.
- To determine if these markers contribute to endothelial dysfunction following on-pump cardiac surgery.
Main Methods:
- A cohort of 51 cardiac surgery patients was divided into normal (<180 min) and prolonged (>180 min) CPB groups.
- Plasma levels of glypican-1, MMP9, and IL-1β were measured preoperatively, intraoperatively, and postoperatively.
- Statistical analysis was used to compare marker levels and assess correlations with CPB duration.
Main Results:
- Preoperative levels of glypican-1, MMP9, and IL-1β were similar between groups.
- Postoperative levels of all three markers were significantly elevated in the prolonged CPB group.
- Significant positive correlations were found between MMP9, IL-1β, glypican-1 levels, and CPB duration.
Conclusions:
- Prolonged CPB induces a systemic inflammatory response.
- Activation of MMP9 by prolonged CPB leads to glypican-1 shedding.
- These processes contribute to endothelial dysfunction after extended cardiopulmonary bypass.
Objectives:
A prolonged cardiopulmonary bypass (CPB) time of over 180 min is linked to poorer outcomes and higher mortality in cardiac surgery. This study examines how glypican-1 shedding, matrix metallopeptidase 9 (MMP9), and the pro-inflammatory cytokine IL-1β may contribute to endothelial dysfunction in patients undergoing on-pump surgery with an extended CPB.
Methods:
Fifty-one patients undergoing cardiac surgical procedures were divided into two groups based on the intraoperative CPB duration: (i) normal CPB (<180 min, n = 23) and (ii) prolonged CPB (>180 min, n = 28). The preoperative, intraoperative, and postoperative plasma levels of glypican-1, MMP9, and IL-1β were measured.
Results:
Before surgery, the plasma levels of glypican-1, MMP9, and IL-1β were comparable between the normal CPB and the prolonged CPB groups. However, after the end of the CPB, all three markers showed significant elevation in the prolonged CPB group compared to the normal CPB group. Significant correlations were observed between the intraoperative and postoperative levels of MMP9, IL-1β, and glypican-1. A strong positive correlation was also observed between the intraoperative and postoperative levels of glypican-1 and the duration of the CPB.
Conclusions:
A prolonged CPB triggers a systemic inflammatory response and activates MMP9, leading to glypican-1 shedding and endothelial dysfunction.
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