Ascorbic acid improves thrombotic function of platelets during living donor liver transplantation by modulating the function of the E3 ubiquitin ligases c-Cbl and Cbl-b

Abstract

Objective To investigate the effect of ascorbic acid (AA) on hemostatic function during living donor liver transplantation (LDLT). Methods Blood samples from 21 LDLT recipients were taken within 30 minutes after induction and at 120 minutes after reperfusion. Rotational thromboelastography (TEG) and western blot analysis were used to analyze for fibrinolysis and functional changes in c-Cbl and Cbl-b, respectively. TEG test samples were prepared as one of three groups: C group (0.36 mL of blood), N group (0.324 mL of blood + 0.036 mL of 0.9% normal saline), and A group (0.324 mL of blood + 0.036 mL of 200 µmol/L-AA dissolved in 0.9% normal saline). Results AA decreased fibrinolysis and increased clot rigidity at baseline and 120 minutes after reperfusion. Cbl-b expression was significantly increased at baseline and 120 minutes after reperfusion in the A group compared with the C and N groups. However, c-Cbl phosphorylation was most significantly decreased in the A group at baseline and 120 minutes after reperfusion. Conclusion AA can significantly decrease fibrinolysis and improve clot rigidity in LT recipients during LDLT, and functional changes in Cbl-b and c-Cbl might represent the underlying mechanism. AA may be considered for use during LDLT to decrease hyperfibrinolysis.

The Role of Vitamin Deficiency in Liver Disease: To Supplement or Not Supplement?

“…Finally, it was recently found that ascorbic acid is able to reduce fibrinolysis and improve clot rigidity in liver transplantation recipients, and therefore, it can be considered as a strategy during transplantation [189]. However, further and larger studies are needed to confirm the role of vitamin supplementation in liver transplantation candidates.…”

Combating Ischemia-Reperfusion Injury with Micronutrients and Natural Compounds during Solid Organ Transplantation: Data of Clinical Trials and Lessons of Preclinical Findings

“…In a South Korean study, blood samples of recipients of living donor liver grafts were investigated. The authors found vitamin C to be supportive for prevention of hyperfibrinolysis by improving clot rigidity [ 260 ]. In contrast, numerous animal studies addressing the prevention and/or reduction of IRI by the use of vitamin C are availablein respect to the local hepatic damage, as well as remote organ injury caused by liver reperfusion.…”

“…Transplantation [260] -Varying concentrations AA [260] blood circulation improved hyperfibrinolysis by improvement of clot rigidity [260] Vitamin C Heart CABG [265,266,[274][275][276][277][278] percutaneous coronary intervention [269,270] cardiac surgery [267,273] PAD [271] valve replacement surgery [274,278] pump circulation during surgery [265] i.v. [266,267,270,271,273,274,277] p.o.…”