Relationship between the expression of biomarkers in the activated innate immune cell and vital organs injuries during the cardiopulmonary bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIONG Wen ¹ , ZHANG Jinghan ² , DU Lei ³ ,  HU Xiaoling ¹

1. The First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, P. R. China;
2. School of Anaesthesia, Zunyi Medical University, Zunyi, 563000, Guizhou, P. R. China;
3. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

HU Xiaoling, Email: 2469155911@qq.com

Keywords：

Cardiopulmonary bypass; inflammatory response; biomarkers; organ injury; review

DOI：

10.7507/1007-4848.202302089

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Although great progress has been achieved in the techniques and materials of cardiopulmonary bypass (CPB), cardiac surgery under CPB is still one of the surgeries with the highest complication rate. The systemic inflammatory response is an important cause of complications, mainly characterized by activation of innate immune cells and platelets, and up-regulation of inflammatory cytokines. After activation, a variety of molecules on the membrane surface are up-regulated or down-regulated, which can amplify tissue inflammatory damage by releasing cytoplasmic protease and reactive oxygen species, and activate multiple inflammatory signaling pathways in the cell, ultimately leading to organ dysfunction. Therefore, the expression of these cell membrane activation markers is not only a marker of cell activation, but also plays an important role in the process of vital organ injury after surgery. Identification of these specific activation markers is of great significance to elucidate the mechanisms related to organ injury and to find new prevention and treatment methods. This article will review the relationship between these activated biomarkers in the innate immune cells and vital organ injuries under CPB.

Citation： XIONG Wen, ZHANG Jinghan, DU Lei, HU Xiaoling. Relationship between the expression of biomarkers in the activated innate immune cell and vital organs injuries during the cardiopulmonary bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1679-1683. doi: 10.7507/1007-4848.202302089 Copy

1.	Gibbon JH. Application of a mechanical heart and lung apparatus to cardiac surgery. Minnes Med, 1954, 37(3): 171-185.
2.	Zheng XM, Yang Z, Yang GL, et al. Lung injury after cardiopulmonary bypass: Alternative treatment prospects. World J Clin Cases, 2022, 10(3): 753-761.
3.	Hausenloy DJ, Candilio L, Evans R, et al. Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med, 2015, 373(15): 1408-1417.
4.	Eikelboom R, Sanjanwala R, Le ML, et al. Postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(2): 544-554.
5.	Berger M, Terrando N, Smith SK, et al. Neurocognitive function after cardiac surgery: From phenotypes to mechanisms. Anesthesiology, 2018, 129(4): 829-851.
6.	Raffa GM, Agnello F, Occhipinti G, et al. Neurological complications after cardiac surgery: A retrospective case-control study of risk factors and outcome. J Cardiothorac Surg, 2019, 14(1): 23.
7.	Alghamdi BA, Alharthi RA, AlShaikh BA, et al. Risk factors for post-cardiac surgery infections. Cureus, 2022, 14(11): e31198.
8.	Sun C, Chen D, Jin X, et al. Association between acute kidney injury and prognoses of cardiac surgery patients: Analysis of the MIMIC-Ⅲ database. Front Surg, 2023, 9: 1044937.
9.	Hill A, Wendt S, Benstoem C, et al. Vitamin c to improve organ dysfunction in cardiac surgery patients-review and pragmatic approach. Nutrients, 2018, 10(8): 974.
10.	Weber C, Shantsila E, Hristov M, et al. Role and analysis of monocyte subsets in cardiovascular disease. Joint consensus document of the European Society of Cardiology (ESC) Working Groups "Atherosclerosis & Vascular Biology" and "Thrombosis". Thromb Haemost, 2016, 116(4): 626-637.
11.	Gawdat K, Legere S, Wong C, et al. Changes in circulating monocyte subsets (CD16 expression) and neutrophil-to-lymphocyte ratio observed in patients undergoing cardiac surgery. Front Cardiovasc Med, 2017, 4: 12.
12.	Merbecks MB, Ziesenitz VC, Rubner T, et al. Intermediate monocytes exhibit higher levels of TLR2, TLR4 and CD64 early after congenital heart surgery. Cytokine, 2020, 133: 155153.
13.	Mayer D, Altvater M, Schenz J, et al. Monocyte metabolism and function in patients undergoing cardiac surgery. Front Cardiovasc Med, 2022, 9: 853967.
14.	Wu Z, Zhang Z, Lei Z, et al. CD14: Biology and role in the pathogenesis of disease. Cytokine Growth Factor Rev, 2019, 48: 24-31.
15.	O'Neill LA, Golenbock D, Bowie AG. The history of Toll-like receptors: Redefining innate immunity. Nat Rev Immunol, 2013, 13(6): 453-460.
16.	Hadley JS, Wang JE, Michaels LC, et al. Alterations in inflammatory capacity and TLR expression on monocytes and neutrophils after cardiopulmonary bypass. Shock, 2007, 27(5): 466-473.
17.	Flier S, Concepcion AN, Versteeg D, et al. Monocyte hyporesponsiveness and Toll-like receptor expression profiles in coronary artery bypass grafting and its clinical implications for postoperative inflammatory response and pneumonia: An observational cohort study. Eur J Anaesthesiol, 2015, 32(3): 177-188.
18.	Ots HD, Tracz JA, Vinokuroff KE, et al. CD40–CD40L in neurological disease. Int J Mol Sci , 2022, 23(8): 4115.
19.	Perros AJ, Esguerra-Lallen A, Rooks K, et al. Coronary artery bypass grafting is associated with immunoparalysis of monocytes and dendritic cells. J Cell Mol Med, 2020, 24(8): 4791-4803.
20.	Holmannova D, Kolackova M, Kunes P, et al. Impact of cardiac surgery on the expression of CD40, CD80, CD86 and HLA-DR on B cells and monocytes. Perfusion, 2016, 31(5): 391-400.
21.	Zhang J, Ding W, Liu J, et al. Scavenger receptors in myocardial infarction and ischemia/reperfusion injury: The potential for disease evaluation and therapy. J Am Heart Assoc, 2023, 12(2): e027862.
22.	Goldstein JI, Goldstein KA, Wardwell K, et al. Increase in plasma and surface CD163 levels in patients undergoing coronary artery bypass graft surgery. Atherosclerosis, 2003, 170(2): 325-332.
23.	Asmussen A, Busch HJ, Helbing T, et al. Monocyte subset distribution and surface expression of HLA-DR and CD14 in patients after cardiopulmonary resuscitation. Sci Rep, 2021, 11(1): 12403.
24.	Radley G, Ali S, Pieper IL, et al. Mechanical shear stress and leukocyte phenotype and function: Implications for ventricular assist device development and use. Int J Artif Organs, 2019, 42(3): 133-142.
25.	Castanheira FVS, Kubes P. Neutrophils and NETs in modulating acute and chronic inflammation. Blood, 2019, 133(20): 2178-2185.
26.	Ivetic A, Hoskins Green HL, Hart SJ. L-selectin: A major regulator of leukocyte adhesion, migration and signaling. Front Immunol, 2019, 10: 1068.
27.	Hambsch J, Osmancik P, Bocsi J, et al. Neutrophil adhesion molecule expression and serum concentration of soluble adhesion molecules during and after pediatric cardiovascular surgery with or without cardiopulmonary bypass. Anesthesiology, 2002, 96(5): 1078-1085.
28.	Zhou H, Liao J, Aloor J, et al. CD11b/CD18 (Mac-1) is a novel surface receptor for extracellular double-stranded RNA to mediate cellular inflammatory responses. J Immunol, 2013, 190(1): 115-125.
29.	Paśnik J, Cywińska-Bernas A, Moll J, et al. Alterations of metalloproteinases and their inhibitors concentrations in peripheral blood in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. Przeglad Lekarski, 2009, 66(7): 359-364.
30.	Shu Q, Zhang XH, Wu LJ, et al. Effect of cardiopulmonary bypass on CD11/CD18 expression of neutrophils in children undergoing cardiac surgery. Zhejiang Da Xue Xue Bao Yi Xue Ban, 2007, 36(1): 66-70.
31.	Rinder CS, Fontes M, Mathew JP, et al. Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury. Ann Thorac Surg, 2003, 75(3): 899-905.
32.	Genschmer KR, Russell DW, Lal C, et al. Activated PMN exosomes: Pathogenic entities causing matrix destruction and disease in the lung. Cell, 2019, 176(1-2): 113-126.
33.	Mizurini DM, Hottz ED, Bozza PT, et al. Fundamentals in COVID-19-associated thrombosis: Molecular and cellular aspects. Front Cardiovasc Med, 2021, 8: 785738.
34.	Dehghani T, Panitch A. Endothelial cells, neutrophils and platelets: Getting to the bottom of an inflammatory triangle. Open Biol, 2020, 10(10): 200161.
35.	Ling L, Zhang J, Li Y, et al. Platelets play a dual role in the pathophysiology of transfusion-related acute lung injury. Respir Physiol Neurobiol, 2023, 309: 104004.
36.	Liu C, Yang Y, Du L, et al. Platelet-leukocyte aggregate is associated with adverse events after surgical intervention for rheumatic heart disease. Sci Rep, 2019, 9(1): 13069.
37.	Yang S, Huang X, Liao J, et al. Platelet-leukocyte aggregates: A predictor for acute kidney injury after cardiac surgery. Ren Fail, 2021, 43(1): 1155-1162.
38.	Sakamaki F, Ishizaka A, Handa M, et al. Soluble form of P-selectin in plasma is elevated in acute lung injury. Am J Respir Crit Care Med, 1995, 151(6): 1821-1826.
39.	Stengel D, Bauwens K, Keh D, et al. Prognostic value of an early soluble L-selectin (sCD62L) assay for risk assessment in blunt multiple trauma: A metaanalysis. Clin Chem, 2005, 51(1): 16-24.
40.	Shantsila E, Ghattas A, Griffiths HR, et al. Mon2 predicts poor outcome in ST-elevation myocardial infarction. J Intern Med, 2019, 285(3): 301-316.
41.	Suzuki A, Fukuzawa K, Yamashita T, et al. Circulating intermediate CD14⁺⁺CD16⁺monocytes are increased in patients with atrial fibrillation and reflect the functional remodelling of the left atrium. Europace, 2017, 19(1): 40-47.
42.	Lukasik M, Dworacki G, Kufel-Grabowska J, et al. Upregulation of CD40 ligand and enhanced monocyte-platelet aggregate formation are associated with worse clinical outcome after ischaemic stroke. Thromb Haemost, 2012, 107(2): 346-355.
43.	Garlichs CD, Kozina S, Fateh-Moghadam S, et al. Upregulation of CD40-CD40 ligand (CD154) in patients with acute cerebral ischemia. Stroke, 2003, 34(6): 1412-1418.

1. Gibbon JH. Application of a mechanical heart and lung apparatus to cardiac surgery. Minnes Med, 1954, 37(3): 171-185.
2. Zheng XM, Yang Z, Yang GL, et al. Lung injury after cardiopulmonary bypass: Alternative treatment prospects. World J Clin Cases, 2022, 10(3): 753-761.
3. Hausenloy DJ, Candilio L, Evans R, et al. Remote ischemic preconditioning and outcomes of cardiac surgery. N Engl J Med, 2015, 373(15): 1408-1417.
4. Eikelboom R, Sanjanwala R, Le ML, et al. Postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(2): 544-554.
5. Berger M, Terrando N, Smith SK, et al. Neurocognitive function after cardiac surgery: From phenotypes to mechanisms. Anesthesiology, 2018, 129(4): 829-851.
6. Raffa GM, Agnello F, Occhipinti G, et al. Neurological complications after cardiac surgery: A retrospective case-control study of risk factors and outcome. J Cardiothorac Surg, 2019, 14(1): 23.
7. Alghamdi BA, Alharthi RA, AlShaikh BA, et al. Risk factors for post-cardiac surgery infections. Cureus, 2022, 14(11): e31198.
8. Sun C, Chen D, Jin X, et al. Association between acute kidney injury and prognoses of cardiac surgery patients: Analysis of the MIMIC-Ⅲ database. Front Surg, 2023, 9: 1044937.
9. Hill A, Wendt S, Benstoem C, et al. Vitamin c to improve organ dysfunction in cardiac surgery patients-review and pragmatic approach. Nutrients, 2018, 10(8): 974.
10. Weber C, Shantsila E, Hristov M, et al. Role and analysis of monocyte subsets in cardiovascular disease. Joint consensus document of the European Society of Cardiology (ESC) Working Groups "Atherosclerosis & Vascular Biology" and "Thrombosis". Thromb Haemost, 2016, 116(4): 626-637.
11. Gawdat K, Legere S, Wong C, et al. Changes in circulating monocyte subsets (CD16 expression) and neutrophil-to-lymphocyte ratio observed in patients undergoing cardiac surgery. Front Cardiovasc Med, 2017, 4: 12.
12. Merbecks MB, Ziesenitz VC, Rubner T, et al. Intermediate monocytes exhibit higher levels of TLR2, TLR4 and CD64 early after congenital heart surgery. Cytokine, 2020, 133: 155153.
13. Mayer D, Altvater M, Schenz J, et al. Monocyte metabolism and function in patients undergoing cardiac surgery. Front Cardiovasc Med, 2022, 9: 853967.
14. Wu Z, Zhang Z, Lei Z, et al. CD14: Biology and role in the pathogenesis of disease. Cytokine Growth Factor Rev, 2019, 48: 24-31.
15. O'Neill LA, Golenbock D, Bowie AG. The history of Toll-like receptors: Redefining innate immunity. Nat Rev Immunol, 2013, 13(6): 453-460.
16. Hadley JS, Wang JE, Michaels LC, et al. Alterations in inflammatory capacity and TLR expression on monocytes and neutrophils after cardiopulmonary bypass. Shock, 2007, 27(5): 466-473.
17. Flier S, Concepcion AN, Versteeg D, et al. Monocyte hyporesponsiveness and Toll-like receptor expression profiles in coronary artery bypass grafting and its clinical implications for postoperative inflammatory response and pneumonia: An observational cohort study. Eur J Anaesthesiol, 2015, 32(3): 177-188.
18. Ots HD, Tracz JA, Vinokuroff KE, et al. CD40–CD40L in neurological disease. Int J Mol Sci , 2022, 23(8): 4115.
19. Perros AJ, Esguerra-Lallen A, Rooks K, et al. Coronary artery bypass grafting is associated with immunoparalysis of monocytes and dendritic cells. J Cell Mol Med, 2020, 24(8): 4791-4803.
20. Holmannova D, Kolackova M, Kunes P, et al. Impact of cardiac surgery on the expression of CD40, CD80, CD86 and HLA-DR on B cells and monocytes. Perfusion, 2016, 31(5): 391-400.
21. Zhang J, Ding W, Liu J, et al. Scavenger receptors in myocardial infarction and ischemia/reperfusion injury: The potential for disease evaluation and therapy. J Am Heart Assoc, 2023, 12(2): e027862.
22. Goldstein JI, Goldstein KA, Wardwell K, et al. Increase in plasma and surface CD163 levels in patients undergoing coronary artery bypass graft surgery. Atherosclerosis, 2003, 170(2): 325-332.
23. Asmussen A, Busch HJ, Helbing T, et al. Monocyte subset distribution and surface expression of HLA-DR and CD14 in patients after cardiopulmonary resuscitation. Sci Rep, 2021, 11(1): 12403.
24. Radley G, Ali S, Pieper IL, et al. Mechanical shear stress and leukocyte phenotype and function: Implications for ventricular assist device development and use. Int J Artif Organs, 2019, 42(3): 133-142.
25. Castanheira FVS, Kubes P. Neutrophils and NETs in modulating acute and chronic inflammation. Blood, 2019, 133(20): 2178-2185.
26. Ivetic A, Hoskins Green HL, Hart SJ. L-selectin: A major regulator of leukocyte adhesion, migration and signaling. Front Immunol, 2019, 10: 1068.
27. Hambsch J, Osmancik P, Bocsi J, et al. Neutrophil adhesion molecule expression and serum concentration of soluble adhesion molecules during and after pediatric cardiovascular surgery with or without cardiopulmonary bypass. Anesthesiology, 2002, 96(5): 1078-1085.
28. Zhou H, Liao J, Aloor J, et al. CD11b/CD18 (Mac-1) is a novel surface receptor for extracellular double-stranded RNA to mediate cellular inflammatory responses. J Immunol, 2013, 190(1): 115-125.
29. Paśnik J, Cywińska-Bernas A, Moll J, et al. Alterations of metalloproteinases and their inhibitors concentrations in peripheral blood in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. Przeglad Lekarski, 2009, 66(7): 359-364.
30. Shu Q, Zhang XH, Wu LJ, et al. Effect of cardiopulmonary bypass on CD11/CD18 expression of neutrophils in children undergoing cardiac surgery. Zhejiang Da Xue Xue Bao Yi Xue Ban, 2007, 36(1): 66-70.
31. Rinder CS, Fontes M, Mathew JP, et al. Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury. Ann Thorac Surg, 2003, 75(3): 899-905.
32. Genschmer KR, Russell DW, Lal C, et al. Activated PMN exosomes: Pathogenic entities causing matrix destruction and disease in the lung. Cell, 2019, 176(1-2): 113-126.
33. Mizurini DM, Hottz ED, Bozza PT, et al. Fundamentals in COVID-19-associated thrombosis: Molecular and cellular aspects. Front Cardiovasc Med, 2021, 8: 785738.
34. Dehghani T, Panitch A. Endothelial cells, neutrophils and platelets: Getting to the bottom of an inflammatory triangle. Open Biol, 2020, 10(10): 200161.
35. Ling L, Zhang J, Li Y, et al. Platelets play a dual role in the pathophysiology of transfusion-related acute lung injury. Respir Physiol Neurobiol, 2023, 309: 104004.
36. Liu C, Yang Y, Du L, et al. Platelet-leukocyte aggregate is associated with adverse events after surgical intervention for rheumatic heart disease. Sci Rep, 2019, 9(1): 13069.
37. Yang S, Huang X, Liao J, et al. Platelet-leukocyte aggregates: A predictor for acute kidney injury after cardiac surgery. Ren Fail, 2021, 43(1): 1155-1162.
38. Sakamaki F, Ishizaka A, Handa M, et al. Soluble form of P-selectin in plasma is elevated in acute lung injury. Am J Respir Crit Care Med, 1995, 151(6): 1821-1826.
39. Stengel D, Bauwens K, Keh D, et al. Prognostic value of an early soluble L-selectin (sCD62L) assay for risk assessment in blunt multiple trauma: A metaanalysis. Clin Chem, 2005, 51(1): 16-24.
40. Shantsila E, Ghattas A, Griffiths HR, et al. Mon2 predicts poor outcome in ST-elevation myocardial infarction. J Intern Med, 2019, 285(3): 301-316.
41. Suzuki A, Fukuzawa K, Yamashita T, et al. Circulating intermediate CD14⁺⁺CD16⁺monocytes are increased in patients with atrial fibrillation and reflect the functional remodelling of the left atrium. Europace, 2017, 19(1): 40-47.
42. Lukasik M, Dworacki G, Kufel-Grabowska J, et al. Upregulation of CD40 ligand and enhanced monocyte-platelet aggregate formation are associated with worse clinical outcome after ischaemic stroke. Thromb Haemost, 2012, 107(2): 346-355.
43. Garlichs CD, Kozina S, Fateh-Moghadam S, et al. Upregulation of CD40-CD40 ligand (CD154) in patients with acute cerebral ischemia. Stroke, 2003, 34(6): 1412-1418.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between the expression of biomarkers in the activated innate immune cell and vital organs injuries during the cardiopulmonary bypass

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content