title: Direct evidence of endothelial injury during cardiopulmonary bypass by demonstration of circulating endothelial cells.
abstract: Endothelial activation is considered a key process in the development of a whole body inflammatory response secondary to cardiopulmonary bypass (CPB). Increased levels of a multitude of soluble mediators have been described as being released during and after cardiac surgery. Circulating endothelial cells have recently been established as a novel marker of endothelial damage in a variety of vascular disorders. Blood samples from 20 patients undergoing elective coronary artery bypass surgery were obtained preoperatively and 1, 6, 12, 24, and 48 h after termination of CPB. Control samples were obtained from ten healthy volunteers. Circulating endothelial cells (CEC) were isolated with immunomagnetic anti-CD146-coated Dynabeads, and counted in a Nageotte chamber. Low numbers of CEC were observed in healthy control volunteers (12 +/- 6 cells/mL; median: 9 cells/mL). CEC numbers were already significantly elevated in all patients before CPB, and there was a further significant increase after weaning from CPB (maximum increase at 6 h after CPB: 73 +/- 30 cells/mL; range: 30-153 cells/mL, p < 0.001). The number of CEC provides further and direct evidence that CPB is associated with a pronounced endothelial injury and/or damage. CEC appear to be most useful markers for vascular endothelial activation because they are specific, stable, and circulating components of injured vessel wall.
authors.affiliation: Departament of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Regensburg, Germany. fx.schmid@klinik.uni-regensburg.de
authors.forename: Franz-Xaver
authors.initials: FX
authors.lastname: Schmid
authors.forename: Bernhard
authors.initials: B
authors.lastname: Floerchinger
authors.forename: Nalini Kumar
authors.initials: NK
authors.lastname: Vudattu
authors.forename: Günther
authors.initials: G
authors.lastname: Eissner
authors.forename: Marion
authors.initials: M
authors.lastname: Haubitz
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.forename: Reinhard
authors.initials: R
authors.lastname: Andreesen
authors.forename: Dietrich E
authors.initials: DE
authors.lastname: Birnbaum
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002469:Cell Separation; D017558:Elective Surgical Procedures / Q000009:adverse effects; D042783:Endothelial Cells / Q000473:pathology; D004730:Endothelium, Vascular / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged