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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 381-385, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Kharazmi, LW Andersen, L Baek, NH Valerius, M Laub and JP Rasmussen
Plasma endotoxin concentrations and oxidative burst response of peripheral
blood polymorphonuclear leukocytes were examined in 12 patients undergoing
coronary artery bypass. The measurements were made just before the
operation, 5 minutes after removal of the aortic crossclamp, and 24 hours
after the operation. Endotoxin was quantitated by a combination of a
sensitive Limulus amebocyte lysate assay and rocket immunoelectrophoresis
measuring picogram amounts of endotoxin. Peripheral blood neutrophils were
purified by a two-step dextran sedimentation and metrizoate sodium Ficoll
(Lymphoprep., Nyegaard, Oslo, Norway) centrifugation. The oxidative burst
response of these cells was measured for their ability to generate
superoxide anion and was determined by a cytochrome c reduction assay.
Preoperatively, all the plasma samples except one were free of endotoxin.
The endotoxin levels reached 100 pg/ml 5 minutes after removal of the
aortic crossclamp, and except in one sample they had decreased 24 hours
after the operation. Studies on the generation of superoxide by neutrophils
showed a decline in the response 5 minutes after removal of the aortic
crossclamp and an enhancement of the response to f-Met-Leu-Phe by cells
obtained from 11 of 12 patients 24 hours postoperatively. In vitro addition
of bacterial lipopolysaccharide to blood from healthy individuals also
enhanced the superoxide response of the neutrophils. We conclude that
during cardiopulmonary bypass the circulating blood is contaminated by
endotoxin and the neutrophils are primed for enhanced generation of oxygen
radicals. The released oxygen radicals may be involved in the tissue damage
observed in these patients.
ARTICLES
Endotoxemia and enhanced generation of oxygen radicals by neutrophils from patients undergoing cardiopulmonary bypass
State Serum Institute, Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
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