TY - JOUR
T1 - Oxidative stress and nerve function after cardiopulmonary bypass in patients with diabetes
AU - Matyal, Robina
AU - Sakamuri, Sruthi
AU - Huang, Thomas
AU - Owais, Khurram
AU - Parikh, Samir
AU - Khabbaz, Kamal
AU - Wang, Angela
AU - Sellke, Frank
AU - Mahmood, Feroze
N1 - Publisher Copyright:
© 2014 by The Society of Thoracic Surgeons.
PY - 2014
Y1 - 2014
N2 - Background. Chronic hyperglycemia has been associated with increased oxidative stress in skeletal muscle and sympathetic nerve dysfunction. We investigated the effect of chronic hyperglycemia on the myocardium of patients with uncontrolled diabetes (UD) compared with patients with well-controlled diabetes (CD) and patients without diabetes (ND) after cardioplegic cardiopulmonary bypass (CP/CPB) with acute intraoperative glycemic control. Methods. Atrial tissue and serum were collected from 47 patients (ND = 18 with glycated hemoglobin [HbA1c] of 5.8 ± 0.2; CD = 8 with HbA1c of 6.1 ± 0.1; with UD = 21 with HbA1c = 9.6 ± 0.5) before and after CP/CPB for immunoblotting, protein oxidation assays, immunohistochemical evaluation, and microarray analysis. Results. The uncontrolled group had increased total protein oxidation (p < 0.05) and decreased levels of antioxidative enzyme manganese superoxide dismutase (MnSOD) (p < 0.05) after CP/CPB compared with the controlled group. Collagen staining revealed increased fibrosis in patients with UD (p < 0.05) compared with patients with CD and patients without diabetes. The uncontrolled group also showed a decrease in the neurogenic and angiogenic markers nerve growth factor (NGF) (p < 0.05), neurotrophin (NT)-3 (p < 0.05), and platelet-derived growth factor (PDGF)-β (p < 0.05) compared with the other groups after CP/CPB. Atrial and serum microarray analysis showed increased oxidative stress and sympathetic nerve damage, increased fibrosis, and a decrease in angiogenesis in patients with UD (p < 0.03) compared with patients without diabetes. Conclusions. CP/CPB led to higher oxidative stress in patients with UD before surgical intervention, even after normal glucose levels were maintained intraoperatively. Thus, controlled HbA1C in addition to acute intraoperative glucose control may be a more suitable end point for patients with diabetes undergoing cardiac operations.
AB - Background. Chronic hyperglycemia has been associated with increased oxidative stress in skeletal muscle and sympathetic nerve dysfunction. We investigated the effect of chronic hyperglycemia on the myocardium of patients with uncontrolled diabetes (UD) compared with patients with well-controlled diabetes (CD) and patients without diabetes (ND) after cardioplegic cardiopulmonary bypass (CP/CPB) with acute intraoperative glycemic control. Methods. Atrial tissue and serum were collected from 47 patients (ND = 18 with glycated hemoglobin [HbA1c] of 5.8 ± 0.2; CD = 8 with HbA1c of 6.1 ± 0.1; with UD = 21 with HbA1c = 9.6 ± 0.5) before and after CP/CPB for immunoblotting, protein oxidation assays, immunohistochemical evaluation, and microarray analysis. Results. The uncontrolled group had increased total protein oxidation (p < 0.05) and decreased levels of antioxidative enzyme manganese superoxide dismutase (MnSOD) (p < 0.05) after CP/CPB compared with the controlled group. Collagen staining revealed increased fibrosis in patients with UD (p < 0.05) compared with patients with CD and patients without diabetes. The uncontrolled group also showed a decrease in the neurogenic and angiogenic markers nerve growth factor (NGF) (p < 0.05), neurotrophin (NT)-3 (p < 0.05), and platelet-derived growth factor (PDGF)-β (p < 0.05) compared with the other groups after CP/CPB. Atrial and serum microarray analysis showed increased oxidative stress and sympathetic nerve damage, increased fibrosis, and a decrease in angiogenesis in patients with UD (p < 0.03) compared with patients without diabetes. Conclusions. CP/CPB led to higher oxidative stress in patients with UD before surgical intervention, even after normal glucose levels were maintained intraoperatively. Thus, controlled HbA1C in addition to acute intraoperative glucose control may be a more suitable end point for patients with diabetes undergoing cardiac operations.
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U2 - 10.1016/j.athoracsur.2014.06.041
DO - 10.1016/j.athoracsur.2014.06.041
M3 - Article
C2 - 25258156
AN - SCOPUS:84922352969
SN - 0003-4975
VL - 98
SP - 1635
EP - 1644
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -