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Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery

BACKGROUND: Hypothermic circulatory arrest (HCA) in aortic arch surgery has a significant risk of neurological injury despite the newest protective techniques and strategies. Nitric oxide (NO) could exert a protective role, reduce infarct area and increase cerebral perfusion. This study aims to inve...

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Autores principales: Linardi, Daniele, Mani, Romel, Murari, Angela, Dolci, Sissi, Mannino, Loris, Decimo, Ilaria, Tessari, Maddalena, Martinazzi, Sara, Gottin, Leonardo, Luciani, Giovanni B., Faggian, Giuseppe, Rungatscher, Alessio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795629/
https://www.ncbi.nlm.nih.gov/pubmed/35096996
http://dx.doi.org/10.3389/fcvm.2021.772065
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author Linardi, Daniele
Mani, Romel
Murari, Angela
Dolci, Sissi
Mannino, Loris
Decimo, Ilaria
Tessari, Maddalena
Martinazzi, Sara
Gottin, Leonardo
Luciani, Giovanni B.
Faggian, Giuseppe
Rungatscher, Alessio
author_facet Linardi, Daniele
Mani, Romel
Murari, Angela
Dolci, Sissi
Mannino, Loris
Decimo, Ilaria
Tessari, Maddalena
Martinazzi, Sara
Gottin, Leonardo
Luciani, Giovanni B.
Faggian, Giuseppe
Rungatscher, Alessio
author_sort Linardi, Daniele
collection PubMed
description BACKGROUND: Hypothermic circulatory arrest (HCA) in aortic arch surgery has a significant risk of neurological injury despite the newest protective techniques and strategies. Nitric oxide (NO) could exert a protective role, reduce infarct area and increase cerebral perfusion. This study aims to investigate the possible neuroprotective effects of NO administered in the oxygenator of selective antegrade cerebral perfusion (SCP) during HCA. METHODS: Thirty male SD adult rats (450–550 g) underwent cardiopulmonary bypass (CPB), cooling to 22°C body core temperature followed by 30 min of HCA. Rats were randomized to receive SCP or SCP added with NO (20 ppm) administered through the oxygenator (SCP-NO). All animals underwent CPB-assisted rewarming to a target temperature of 35°C in 60 min. At the end of the experiment, rats were sacrificed, and brain collected. Immunofluorescence analysis was performed in blind conditions. RESULTS: Neuroinflammation assessed by allograft inflammatory factor 1 or ionized calcium-binding adapter molecule 1 expression, a microglia activation marker was lower in SCP-NO compared to SCP (4.11 ± 0.59 vs. 6.02 ± 0.18%; p < 0.05). Oxidative stress measured by 8oxodG, was reduced in SCP-NO (0.37 ± 0.01 vs. 1.03 ± 0.16%; p < 0.05). Brain hypoxic area extent, analyzed by thiols oxidation was attenuated in SCP-NO (1.85 ± 0.10 vs. 2.74 ± 0.19%; p < 0.05). Furthermore, the apoptotic marker caspases 3 was significantly reduced in SCP-NO (10.64 ± 0.37 vs. 12.61 ± 0.88%; p < 0.05). CONCLUSIONS: Nitric oxide administration in the oxygenator during SCP and HCA improves neuroprotection by decreasing neuroinflammation, optimizing oxygen delivery by reducing oxidative stress and hypoxic areas, finally decreasing apoptosis.
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spelling pubmed-87956292022-01-29 Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery Linardi, Daniele Mani, Romel Murari, Angela Dolci, Sissi Mannino, Loris Decimo, Ilaria Tessari, Maddalena Martinazzi, Sara Gottin, Leonardo Luciani, Giovanni B. Faggian, Giuseppe Rungatscher, Alessio Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Hypothermic circulatory arrest (HCA) in aortic arch surgery has a significant risk of neurological injury despite the newest protective techniques and strategies. Nitric oxide (NO) could exert a protective role, reduce infarct area and increase cerebral perfusion. This study aims to investigate the possible neuroprotective effects of NO administered in the oxygenator of selective antegrade cerebral perfusion (SCP) during HCA. METHODS: Thirty male SD adult rats (450–550 g) underwent cardiopulmonary bypass (CPB), cooling to 22°C body core temperature followed by 30 min of HCA. Rats were randomized to receive SCP or SCP added with NO (20 ppm) administered through the oxygenator (SCP-NO). All animals underwent CPB-assisted rewarming to a target temperature of 35°C in 60 min. At the end of the experiment, rats were sacrificed, and brain collected. Immunofluorescence analysis was performed in blind conditions. RESULTS: Neuroinflammation assessed by allograft inflammatory factor 1 or ionized calcium-binding adapter molecule 1 expression, a microglia activation marker was lower in SCP-NO compared to SCP (4.11 ± 0.59 vs. 6.02 ± 0.18%; p < 0.05). Oxidative stress measured by 8oxodG, was reduced in SCP-NO (0.37 ± 0.01 vs. 1.03 ± 0.16%; p < 0.05). Brain hypoxic area extent, analyzed by thiols oxidation was attenuated in SCP-NO (1.85 ± 0.10 vs. 2.74 ± 0.19%; p < 0.05). Furthermore, the apoptotic marker caspases 3 was significantly reduced in SCP-NO (10.64 ± 0.37 vs. 12.61 ± 0.88%; p < 0.05). CONCLUSIONS: Nitric oxide administration in the oxygenator during SCP and HCA improves neuroprotection by decreasing neuroinflammation, optimizing oxygen delivery by reducing oxidative stress and hypoxic areas, finally decreasing apoptosis. Frontiers Media S.A. 2022-01-14 /pmc/articles/PMC8795629/ /pubmed/35096996 http://dx.doi.org/10.3389/fcvm.2021.772065 Text en Copyright © 2022 Linardi, Mani, Murari, Dolci, Mannino, Decimo, Tessari, Martinazzi, Gottin, Luciani, Faggian and Rungatscher. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Linardi, Daniele
Mani, Romel
Murari, Angela
Dolci, Sissi
Mannino, Loris
Decimo, Ilaria
Tessari, Maddalena
Martinazzi, Sara
Gottin, Leonardo
Luciani, Giovanni B.
Faggian, Giuseppe
Rungatscher, Alessio
Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title_full Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title_fullStr Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title_full_unstemmed Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title_short Nitric Oxide in Selective Cerebral Perfusion Could Enhance Neuroprotection During Aortic Arch Surgery
title_sort nitric oxide in selective cerebral perfusion could enhance neuroprotection during aortic arch surgery
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795629/
https://www.ncbi.nlm.nih.gov/pubmed/35096996
http://dx.doi.org/10.3389/fcvm.2021.772065
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