Adenosine A2A receptor hyperexpression in patients with severe SIRS after cardiopulmonary bypass.
OBJECTIVE
Adenosine (ADO) is an endogenous nucleoside, which has been involved in blood pressure failure during severe systemic inflammatory response syndrome (severe SIRS) after cardiac surgery with cardiopulmonary bypass (CPB). Adenosine acts via its receptor subtypes, namely A1, A2A, A2B, or A3. Because A2A receptors are implicated in vascular tone, their expression might contribute to severe SIRS. We compared adenosine plasma levels (APLs) and A2A ADO receptor expression (ie, B, K, and mRNA amount) in patients with or without postoperative SIRS.


METHODS
: This was a prospective comparative observational study. Forty-four patients who underwent cardiac surgery involving CPB. Ten healthy subjects served as controls.


RESULTS
Among the patients, 11 presented operative vasoplegia and postoperative SIRS (named complicated patients) and 33 were without vasoplegia or SIRS (named uncomplicated patients). Adenosine plasma levels, K, B, and mRNA amount (mean +/- SD) were measured on peripheral blood mononuclear cells. Adenosine plasma levels, B, and K were significantly higher in complicated patients than in uncomplicated patients (APLs: 2.7 +/- 1.0 vs 1.0 +/- 0.5 micromol l, P < 0.05; B: 210 +/- 43 vs 65 +/- 26 fmol/mg, P < 0.05; K: 35 +/- 10 vs 2 +/- 1 nM, P < 0.05). In uncomplicated patients, APLs remain higher than in controls (1 +/- 0.5 vs 0.6 +/- 0.25 micromol/L; P < 0.05). Mean arterial pressure was inversely correlated to APLs (R = -0.58; P < 0.001) and B (R = -0.64; P < 0.001) leading to an increased requirement of vasoactive drugs during the postoperative period in vasoplegic patients.


CONCLUSIONS
High expression of A2A ADO receptor and high APLs may be a predictive factor of postoperative severe SIRS after CPB.
Kerbaul
François
F
Pôle d'Anesthésie-Réanimation, Groupe Hospitalier de La Timone, France.
Bénard
Frédéric
F
Giorgi
Roch
R
Youlet
By
B
Carrega
Louis
L
Zouher
Ibrahim
I
Mercier
Laurence
L
Gérolami
Victoria
V
Bénas
Vincent
V
Blayac
Dorothée
D
Gariboldi
Vlad
V
Collart
Frédéric
F
Guieu
Régis
R
D000241:Adenosine / Q000097:blood; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D015870:Gene Expression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012333:RNA, Messenger / Q000097:blood / Q000235:genetics; D043683:Receptors, Adenosine A2 / Q000097:blood / Q000235:genetics*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology* / Q000235:genetics
D012333:RNA, Messenger; D043683:Receptors, Adenosine A2; D000241:Adenosine