Enhanced brain release of erythropoietin, cytokines and NO during carotid clamping.
Although effective and safe, carotid endarterectomy (CEA) implies a reduced blood flow to the brain and likely an ischemia/reperfusion event. The high rate of uneventful outcomes associated with CEA suggests the activation of brain endogenous protection mechanisms aimed at limiting the possible ischemia/reperfusion damage. This study aims at assessing whether CEA triggers protective mechanisms such as brain release of erythropoietin and nitric oxide. CEA was performed in 12 patients; blood samples were withdrawn simultaneously from the surgically exposed ipsilateral jugular and leg veins before, during (2 and 40 min) and after clamp removal (2 min). Plasma antioxidant capacity, carbonylated proteins, erythropoietin, nitrates and nitrites (NOx) were determined. No changes in intraoperative EEG, peripheral and transcranial blood oxygen saturation were detectable, and no patients showed any neurologic sign after the intervention. Antioxidant capacity and protein carbonylation in plasma were unaffected. Differently, erythropoietin, VEGF, TNF-α and NOx increased during clamping in the jugular blood (2 and 40 min), while no changes were observed in the peripheral circulation. These results show that blood erythropoietin, VEGF, TNF-α, and NOx increased in the brain during uncomplicated CEA. This may represent an endogenous self-activated neuroprotective mechanism aimed at the prevention of ischemia/reperfusion damage.
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy. stephana.carelli@guest.unimi.it.
Stephana
S
Carelli
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Giorgio
G
Ghilardi
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Paola
P
Bianciardi
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Elisa
E
Latorre
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Federico
F
Rubino
AO San Paolo, via Antonio Di Rudinì 8, 20142, Milan, Italy.
Marina
M
Bissi
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Anna Maria
AM
Di Giulio
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Michele
M
Samaja
Department of Health Sciences, University of Milan, via A. Di Rudinì, 8, 20142, Milan, Italy.
Alfredo
A
Gorio
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D009569:Nitric Oxide
Carotid endarterectomy; Erythropoietin; Neuroprotection; Nitric oxide