title: Effect of Insulin Therapy using Hyper-insulinemic Normoglycemic Clamp on Inflammatory Response in Brain Dead Organ Donors.
abstract: BACKGROUND
  Brain death is a major stress that is associated with a massive inflammatory response and systemic hyperglycemia. Severe inflammation leads to increased graft immunogenicity and risk of graft dysfunction; while acute hyperglycemia aggravates the inflammatory response and increases the risk of morbidity and mortality. Insulin therapy not only controls hyperglycemia but also suppresses inflammation. The present study is to investigate the anti-inflammatory properties and the normoglycemia maintenance of high dose insulin on brain dead organ donors.
  
  
  METHODS
  15 brain dead organ donors were divided into 2 groups, insulin treated (n=6) and controls (n=9). Insulin was provided for a minimum of 6 h using the hyperinsulinemic normoglycemic clamp technique. The changes of serum cytokines, including IL-6, IL-10, IL-1β, IL-8, TNFα, TGFα and MCP-1, were measured by suspension bead array immunoassay and glucose by a glucose monitor.
  
  
  RESULTS
  Compared to controls, insulin treated donors had a significant lower blood glucose 4.8 (4-6.9) vs. 9 (5.6-11.7) mmol/L, p<0.01); the net decreases of pro-inflammatory cytokines, such as IL-6 and MCP-1, and the net increase of anti-inflammatory cytokine, such as IL-10, reached significant level in insulin treated donors compared with those in controls.
  
  
  CONCLUSIONS
  High dose insulin therapy decreases the concentrations of inflammatory cytokines in brain dead donors and preserves normoglycemia. High dose of insulin may have anti-inflammatory effects in brain dead organ donors and therefore, improve the quality of donor organs and potentially improve outcomes.
authors.affiliation: Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Aljiffry
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Hassanain
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Schricker
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Shaheen
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: T
authors.initials: T
authors.lastname: Nouh
authors.affiliation: Department of Anesthesia, McGill University Health Centre, Montreal, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Lattermann
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Salman
authors.affiliation: School of Dietetic and Human Nutrition, McGill University, Montreal, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Wykes
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Metrakos
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death / Q000097:blood*; D016207:Cytokines / Q000097:blood* / Q000187:drug effects; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000188:drug therapy; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000379:methods*; D014019:Tissue Donors
chemical_list: D016207:Cytokines; D007328:Insulin