The antiendotoxin agent taurolidine potentially reduces ischemia/reperfusion injury through its metabolite taurine.
BACKGROUND
Cardiopulmonary bypass results in ischemia/reperfusion (I/R)-induced endotoxemia. We conducted a prospective randomized trial to investigate the effect of taurolidine, an antiendotoxin agent with antioxidant and membrane-stabilizing properties, on patients undergoing coronary artery bypass grafting (CABG).


METHODS
A total of 60 patients undergoing CABG were randomized into 4 groups. St Thomas' Hospital cold crystalloid cardioplegia was used in groups A and B, and cold blood cardioplegia in groups C and D. Groups A and C received a placebo infusion of normal saline, whereas groups B and D were administered intravenous taurolidine. Arrhythmias induced by pro- and anti-inflammatory cytokines (interleukin [IL]-6 and IL-10), and I/R were assessed perioperatively.


RESULTS
Administration of taurolidine in crystalloid cardioplegia patients resulted in a significant decrease in serum IL-6 and an increase in serum IL-10 at 24 hours postaortic unclamping compared to placebo (P < .0001). Although not statistically significant, this trend in serum IL-6 decrease was mirrored in the blood cardioplegia patients (P = .068). Taurolidine treatment also significantly decreased I/R-induced arrhythmias compared to placebo in the crystalloid cardioplegia patients (P < .003). There were fewer I/R-induced arrhythmias compared to placebo in the blood cardioplegia patients; the difference, however, was marginal and not statistically significant (P = .583).


CONCLUSIONS
This study demonstrates that administration of taurolidine in CABG patients induces a potent anti-inflammatory response that is associated with a significant decrease in arrhythmias.
Doddakula
Kishore K
KK
Department of Cardiac Surgery, University College Cork, Cork University Hospital, Cork, Ireland.
Neary
Peter M
PM
Wang
Jiang H
JH
Sookhai
Shastri
S
O'Donnell
Aongus
A
Aherne
Tom
T
Bouchier-Hayes
David J
DJ
Redmond
Henry P
HP
D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000379:methods; D003250:Constriction; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D004731:Endotoxins / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010587:Phagocytosis / Q000502:physiology; D010919:Placebos; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D016897:Respiratory Burst / Q000502:physiology; D013654:Taurine / Q000031:analogs & derivatives* / Q000378:metabolism* / Q000627:therapeutic use
D000975:Antioxidants; D004731:Endotoxins; D015850:Interleukin-6; D010919:Placebos; D016753:Interleukin-10; D013654:Taurine