Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function
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Journal of Translational Medicine Open Access
RESEARCH
Influence of hemoadsorption during cardiopulmonary bypass on blood vesicle count and function Lukas Wisgrill1, Christian Lamm2, Lena Hell3, Johannes Thaler3, Angelika Berger1, Rene Weiss4, Viktoria Weber4, Harald Rinoesl5, Michael J. Hiesmayr6, Andreas Spittler2,7 and Martin H. Bernardi6*
Abstract Background: Extracorporeal circulation during major cardiac surgery triggers a systemic inflammatory response affecting the clinical course and outcome. Recently, extracellular vesicle (EV) research has shed light onto a novel cellular communication network during inflammation. Hemoadsorption (HA) systems have shown divergent results in modulating the systemic inflammatory response during cardiopulmonary bypass (CPB) surgery. To date, the effect of HA on circulating microvesicles (MVs) in patients undergoing CPB surgery is unknown. Methods: Count and function of MVs, as part of the extracellular vesicle fraction, were assessed in a subcohort of a single-center, blinded, controlled study investigating the effect of the CytoSorb device during CPB. A total of 18 patients undergoing elective CPB surgery with (n = 9) and without (n = 9) HA device were included in the study. MV phenotyping and counting was conducted via flow cytometry and procoagulatory potential was measured by tissue factor-dependent MV assays. Results: Both study groups exhibited comparable counts and post-operative kinetics in MV subsets. Tissue factordependent procoagulatory potential was not detectable in plasma at any timepoint. Post-operative course and laboratory parameters showed no correlation with MV counts in patients undergoing CPB surgery. Conclusion: Additional artificial surfaces to the CPB-circuit introduced by the use of the HA device showed no effect on circulating MV count and function in these patients. Larger studies are needed to assess and clarify the effect of HA on circulating vesicle counts and function. Trial registration ClinicalTrials.Gov Identifier: NCT01879176; registration date: June 17, 2013; https://clinicaltrials.gov/ ct2/show/NCT01879176 Keywords: Blood vesicle, Cardiopulmonary bypass, Extracellular vesicles, Hemoadsorption, Microvesicles Background Cardiopulmonary bypass (CPB) surgery appears to influence the host immune response leading to a systemic inflammatory response with increased pro- and *Correspondence: [email protected] 6 Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18‑20, 1090 Vienna, Austria Full list of author information is available at the end of the article
anti-inflammatory cytokines [1, 2]. Thus, systemic inflammation might negatively influence the postoperative course of this high-risk patient group [3]. The novel hemoadsorption (HA) device CytoSorb (CytoSorbents Europe GmbH, Berlin, Germany) was designed to adsorb mid-molecular weight hydrophobic molecules, including cytokines, through size exclusion and nonspecific surface adsorption in
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