lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed and are posted here as part of a 12-month trial. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Cardiac Surgery is Associated with Neuronal Damage

31 Pages Posted: 19 Sep 2018

See all articles by Marek Alifier

Marek Alifier

Medical University of Bialystok

Bob Olsson

Göteborg University - Department of Psychiatry and Neurochemistry; Göteborg University - Clinical Neurochemistry Laboratory

Ulf Andresson

Göteborg University - Sahlgrenska University Hospital

Nicholas C. Cullen

Göteborg University; University of Pennsylvania

Jolanta Czyzewska

Medical University of Bialystok

Piotr Jakubow

Medical University of Bialystok

Andrzej Sieskiewicz

Medical University of Bialystok

Anna Stasiak-Barmuta

Medical University of Bialystok

Tomasz Hirnle

Medical University of Bialystok

Johannes Kornhuber

University of Erlangen-Nuremberg-Friedrich Alexander Universität Erlangen Nürnberg

Henrik Zetterberg

Göteborg University; Göteborg University - Sahlgrenska University Hospital; University College London

Piotr Lewczuk

University of Erlangen-Nuremberg-Friedrich Alexander Universität Erlangen Nürnberg; Medical University of Bialystok

Kaj Blennow

Göteborg University - Institute of Neuroscience and Physiology; Göteborg University - Sahlgrenska University Hospital

More...

Abstract

Background: Post-operative cognitive (POCD) decline is common in cardiac surgery and may be caused by neuronal damage. Plasma concentrations of the neuronal proteins tau and neurofilament light (NFL) are established biomarkers for acute neuronal injury. Our objective was to investigate if cardiac surgery is associated with neuronal injury reflected by changes in these plasma biomarkers.    

Methods: We performed a single centre case-control study of 25 patients undergoing cardiac surgery and 26 patients undergoing otolaryngeal surgery. The cohorts were sampled at several time-points before, during and after surgery and plasma concentrations of tau, NFL, and betaamyloid (Aβ40 and Aβ42) were measured.    

Findings: s Tau levels increased greatly by 1700% during cardiac surgery compared to baseline and normalized seven days post-surgery. NFL levels rose sharply seven days post-surgery (1100%). No changes were observed in patients undergoing otolaryngeal surgery. Furthermore, cardiac surgery patients on extracorporeal circulation (on-pump) had higher levels of tau (up to 2200%) and NFL (up to 430%) compared to cardiac surgery patients off-pump. However, the levels of tau and NFL were still significantly elevated in the cardiac surgery patients off-pump compared to the patients undergoing otolaryngeal surgery. Only minor fluctuations were observed for Aβ40 and Aβ42. 

Interpretation: Cardiac surgery, but not otolaryngeal surgery, is associated with massive release of neuronal-specific proteins indicating neuronal injury, which is aggravated by extracorporeal circulation. Thus, neuronal damage may contribute to the increased frequency of POCD in cardiac surgery. Analyses of NFL and tau may help to improve surgical procedures to minimize neuronal damage and possibly POCD.    

Funding Statement: This study was funded by grants no. N/ST/ZB/14/001/1128, 143-28594L, 133-28785L, N/ST/ZB/16/001/1128 from Medical University of Bialystok Clinical Hospital, Poland, the Swedish Research Council, Swedish State Support for Clinical Research, Alzheimer’s Association, the Knut and Alice Wallenberg Foundation, the Torsten Söderberg Foundation, the Alzheimer Foundation (Sweden), the European Research Council (grant number 681712), the Innovative Medicines Initiative Joint Undertaking under EMIF grant agreement n° 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies.

Declaration of Interests: PL received consultation and/or lecture honoraria from IBL International, Fujirebio Europe, AJ Roboscreen, and Roche. KB has served as a consultant or at advisory boards for Alzheon, BioArctic, Biogen, Eli Lilly, Fujirebio Europe, IBL International, Merck, Novartis, Pfizer and Roche Diagnostics. HZ has served on scientific advisory boards for Eli Lilly, Roche 17 Diagnostics, Wave, Samumed and CogRx, and has received travel support from Teva. None of the other authors declares competing interests.

Ethics Approval Statement: The study was approved by the Ethical Committee, Medical University of Bialystok Clinical Hospital, Poland. All patients gave written informed consent.

Keywords: cardiac surgery, extracorporeal circulation, NFL, tau, plasma

Suggested Citation

Alifier, Marek and Olsson, Bob and Andresson, Ulf and Cullen, Nicholas C. and Czyzewska, Jolanta and Jakubow, Piotr and Sieskiewicz, Andrzej and Stasiak-Barmuta, Anna and Hirnle, Tomasz and Kornhuber, Johannes and Zetterberg, Henrik and Lewczuk, Piotr and Blennow, Kaj, Cardiac Surgery is Associated with Neuronal Damage (August 22, 2018). Available at SSRN: https://ssrn.com/abstract=3237019

Marek Alifier

Medical University of Bialystok

Białystok
Poland

Bob Olsson (Contact Author)

Göteborg University - Department of Psychiatry and Neurochemistry ( email )

Göteborg, SE413 45
Sweden

Göteborg University - Clinical Neurochemistry Laboratory ( email )

Sweden

Ulf Andresson

Göteborg University - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

Nicholas C. Cullen

Göteborg University

Viktoriagatan 30
Göteborg, 405 30
Sweden

University of Pennsylvania

Philadelphia, PA 19104
United States

Jolanta Czyzewska

Medical University of Bialystok

Białystok
Poland

Piotr Jakubow

Medical University of Bialystok

Białystok
Poland

Andrzej Sieskiewicz

Medical University of Bialystok

Białystok
Poland

Anna Stasiak-Barmuta

Medical University of Bialystok

Białystok
Poland

Tomasz Hirnle

Medical University of Bialystok

Białystok
Poland

Johannes Kornhuber

University of Erlangen-Nuremberg-Friedrich Alexander Universität Erlangen Nürnberg

Schloßplatz 4
Erlangen, Bavaria 91054
Germany

Henrik Zetterberg

Göteborg University

Viktoriagatan 30
Göteborg, 405 30
Sweden

Göteborg University - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

University College London

Gower Street
London, WC1E 6BT
United Kingdom

Piotr Lewczuk

University of Erlangen-Nuremberg-Friedrich Alexander Universität Erlangen Nürnberg

Schloßplatz 4
Erlangen, Bavaria 91054
Germany

Medical University of Bialystok

Białystok
Poland

Kaj Blennow

Göteborg University - Institute of Neuroscience and Physiology

PO Box 430
Göteborg, SE405 30
Sweden

Göteborg University - Sahlgrenska University Hospital

PO Box 400
Göteborg, SE405 30
Sweden

Click here to go to TheLancet.com

Go to TheLancet.com

Paper statistics

Abstract Views
87
Downloads
11