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Title: Associations Between Systemic and Cerebral Inflammation in an Ovine Model of Cardiopulmonary Bypass.
Austin Authors: Elsaafien, Khalid;Sloan, Jasmine M;Evans, Roger G;Cochrane, Andrew D;Marino, Bruno;McCall, Peter R ;Hood, Sally G;Yao, Song T;Korim, Willian S;Bailey, Simon R;Jufar, Alemayehu H;Peiris, Rachel M;Bellomo, Rinaldo ;Miles, Lachlan F ;May, Clive N;Lankadeva, Yugeesh R
Affiliation: Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health.
Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia.
Cellsaving and Perfusion Resources, Melbourne, Victoria, Australia.
Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia.
Faculty of Veterinary Science, University of Melbourne, Melbourne, Victoria, Australia.
Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australia
Issue Date: 1-Apr-2023
Date: 2023
Publication information: Anesthesia and Analgesia 2023; 136(4): 802-813
Abstract: Intraoperative inflammation may contribute to postoperative neurocognitive disorders after cardiac surgery requiring cardiopulmonary bypass (CPB). However, the relative contributions of general anesthesia (GA), surgical site injury, and CPB are unclear. In adult female sheep, we investigated (1) the temporal profile of proinflammatory and anti-inflammatory cytokines and (2) the extent of microglia activation across major cerebral cortical regions during GA and surgical trauma with and without CPB (N = 5/group). Sheep were studied while conscious, during GA and surgical trauma, with and without CPB. Plasma tumor necrosis factor-alpha (mean [95% confidence intervals], 3.7 [2.5-4.9] vs 1.6 [0.8-2.3] ng/mL; P = .0004) and interleukin-6 levels (4.4 [3.0-5.8] vs 1.6 [0.8-2.3] ng/mL; P = .029) were significantly higher at 1.5 hours, with a further increase in interleukin-6 at 3 hours (7.0 [3.7-10.3] vs 1.8 [1.1-2.6] ng/mL; P < .0001) in animals undergoing CPB compared with those that did not. Although cerebral oxygen saturation was preserved throughout CPB, there was pronounced neuroinflammation as characterized by greater microglia circularity within the frontal cortex of sheep that underwent CPB compared with those that did not (0.34 [0.32-0.37] vs 0.30 [0.29-0.32]; P = .029). Moreover, microglia had fewer branches within the parietal (7.7 [6.5-8.9] vs 10.9 [9.4-12.5]; P = .001) and temporal (7.8 [7.2-8.3] vs 9.9 [8.2-11.7]; P = .020) cortices in sheep that underwent CPB compared with those that did not. CPB enhanced the release of proinflammatory cytokines beyond that initiated by GA and surgical trauma. This systemic inflammation was associated with microglial activation across 3 major cerebral cortical regions, with a phagocytic microglia phenotype within the frontal cortex, and an inflammatory microglia phenotype within the parietal and temporal cortices. These data provide direct histopathological evidence of CPB-induced neuroinflammation in a large animal model and provide further mechanistic data on how CPB-induced cerebral inflammation might drive postoperative neurocognitive disorders in humans.
DOI: 10.1213/ANE.0000000000006379
Journal: Anesthesia and Analgesia
Start page: 802
End page: 813
PubMed URL: 36928157
ISSN: 1526-7598
Type: Journal Article
Subjects: Cardiopulmonary Bypass/adverse effects
Appears in Collections:Journal articles

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