lactoferrin and Aortic-Aneurysm--Thoracic

Complement activation contributes to ischemia-reperfusion injury. Patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair suffer extensive ischemia-reperfusion and considerable systemic inflammation.. The degree and mechanism of complement activation and its role in inflammation were investigated in 19 patients undergoing TAAA repair. Patients undergoing open infrarenal aortic surgery (n=5) or endovascular descending aortic aneurysm repair (n=6) served as control subjects. Substantial complement activation was seen in TAAA patients but not in controls. C1rs-C1-inhibitor complexes increased moderately, whereas C4bc, C3bBbP, C3bc, and the terminal SC5b-9 complex (TCC) increased markedly after reperfusion, reaching a maximum 8 hours after reperfusion. Interleukin (IL)-1beta, tumor necrosis factor alpha (TNF-alpha), and IL-8 increased significantly in TAAA patients but not in controls, peaking at 24 hours postoperatively and correlating closely with the degree of complement activation. IL-6 and IL-10 increased to a maximum 8 hours after reperfusion in the TAAA patients, were not correlated with complement activation, and increased moderately in the control subjects. Myeloperoxidase and lactoferrin increased markedly before reperfusion in all groups, whereas sICAM-1, sP-selectin, and sE-selectin were unchanged. No increase was observed in complement activation products, IL-1beta, TNF-alpha, or IL-8 in a mannose-binding lectin (MBL)-deficient TAAA patient, whereas IL-6, IL-10, myeloperoxidase, and lactoferrin increased as in the controls. Two other MBL-deficient TAAA patients receiving plasma attained significant MBL levels and showed complement and cytokine patterns identical to the MBL-sufficient TAAA patients.. The data suggest that complement activation during TAAA repair is MBL mediated, amplified through the alternative pathway, and responsible in part for the inflammatory response.

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Cell Adhesion Molecules; Chemokines; Complement Activation; Cytokines; Female; Humans; Inflammation; Lactoferrin; Male; Mannose-Binding Lectin; Middle Aged; Neutrophil Activation; Peroxidase; Plasma; Prospective Studies; Reperfusion Injury; Vascular Surgical Procedures

The aim of this study was to evaluate the inflammatory reactions in patients with thoracic aortic aneurysms before, during and after stent graft treatment and to relate markers of leukocyte activation to the use of radiographic contrast media.. Blood samples were drawn from 7 patients undergoing elective stent graft treatment for thoracic aneurysms. The samples were analyzed for leukocyte and platelet counts and the concentrations of iohexol (radiographic contrast medium), myeloperoxidase, lactoferrin, neutrophil activating peptide-2 (NAP-2), soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1 (sVCAM-1), the complement activation products C3bc and the terminal complement complex (TCC). The preoperative results were compared with 10 healthy blood donors of similar age.. Preoperatively, the aneurysm patients had significantly elevated concentrations of myeloperoxidase, neopterin and complement activation products compared to controls. Myeloperoxidase and lactoferrin increased after the first contrast dose and peaked at 8 h postoperatively. Platelet counts decreased, while NAP-2, sVCAM-1 and TCC increased from 8 h postoperatively.. We conclude that patients with thoracic aneurysms have a low-grade inflammation prior to intervention. Stent graft treatment induces further activation, and markers of endothelial, platelet, and complement activation were increased for several days after the procedure. Radiographic contrast media could be an important contributor to the activation of neutrophil leukocytes.

Topics: Aged; Aged, 80 and over; Angiography; Aortic Aneurysm, Thoracic; Aortitis; Biomarkers; Blood Vessel Prosthesis Implantation; Complement System Proteins; Female; Follow-Up Studies; Humans; Lactoferrin; Male; Middle Aged; Peroxidase; Platelet Count; Prognosis; Retrospective Studies; Stents