Circulating endothelial microparticles: a promising biomarker of acute kidney injury after cardiac surgery with cardiopulmonary bypass

Abstract

Background: Current diagnostic strategies for acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB) are nonspecific and limited. Previously, we demonstrated that circulating microparticles (MPs) in patients with valve heart disease (VHD) and congenital heart diseases (CHD) induce endothelial dysfunction and neutrophil chemotaxis, which may result in kidney injury. We also found that circulating MPs increase after cardiac surgery with CPB and are related to cardiac function. However, the relationship between circulating MPs and AKI after CPB is unknown.Methods: Eighty-five patients undergoing cardiac surgery with CPB were enrolled. Patients were divided into AKI and non-AKI groups based on the serum creatinine levels at 12 h and 3 d post-CPB. Circulating MPs were isolated from plasma, and their levels including its subtypes were detected by flow cytometer. Independent risk factors for the CPB-associated AKI (CPB-AKI) were determined by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to measure the prognostic potential of CPB-AKI.Results: The morbidity of AKI at 12 h and 3 d after cardiac surgery with CPB was 40% and 31.76%, respectively. The concentrations of total MPs and platelet-derived MPs (PMP) remained unchanged at 12 h and then increased at 3 d post-CPB, while that of endothelial-derived MPs (EMP) increased at both time points. In patients with AKI, PMP and EMP were elevated compared with the patients without AKI. However, no significant change was detected on monocyte-derived MPs (MMP) at 12 h and 3 d post-CPB.The logistic regression analysis showed that EMP was the independent risk factor for AKI both at 12 h and 3 d post-CPB. The area under ROC for the concentrations of EMP at 12 h and 3 d post-CPB was 0.86 and

Circulating small extracellular vesicle-encapsulated SEMA5A-IT1 attenuates myocardial ischemia–reperfusion injury after cardiac surgery with cardiopulmonary bypass

“…Ma et al. [ 26 ] revealed that the concentration of endothelial microparticles could predict CPB-related acute kidney injury at 12 h and 3 days post-CPB with high specificities. EVs mediate cell-to-cell communication by delivering biologically active molecules, including noncoding RNAs, mRNAs, and proteins.…”

“…Furthermore, we cannot exclude the possibility that complications, medication, and other factors may also affect the abundance of SEMA5A-IT1 after CPB, which also needs to be further investigated. In addition, previous studies showed that circulating EV cardiac surgery also affected renal function [ 26 , 41 ]. Our study does not explore the effects of these EVs on renal function, and these questions must be addressed in future studies.…”

“…Further logistic regression analysis indicated that the concentration of microparticles at 12 h after surgery was an independent risk factor for AHF. Ma et al [26] revealed that the concentration of endothelial microparticles could predict CPB-related acute kidney injury at 12 h and 3 days post-CPB with high specificities. EVs mediate cell-to-cell communication by delivering biologically active molecules, including noncoding RNAs, mRNAs, and proteins.…”

Extracorporeal organ support and the kidney

“…Positive end-expiratory pressure may increase intrathoracic pressure, reducing venous return and cardiac output, augmenting right ventricular afterload, systemic venous pressure, venous congestion, and ultimately diminishing renal perfusion. Also, permissive hypoxia and hypercapnia might ensue and decrease renal blood flow (32)(33)(34)(35) Not surprisingly, risk factors for AKI during ECMO include post cardiotomy shock, late ECMO initiation, reduced left ventricle ejection fraction, intraoperative transfusion, high lactate, elevated neutrophil to lymphocyte ratio, and elevated inotropic equivalents (32)(33)(34) and Table 1.…”

Size Distribution of Microparticles: A New Parameter to Predict Acute Lung Injury After Cardiac Surgery With Cardiopulmonary Bypass

“…upon activation or apoptosis. We and other researchers have demonstrated that circulating MPs are elevated in cardiovascular diseases including valve heart disease, acute coronary syndromes, congenital heart disease, and cardiac surgery (8)(9)(10)(11)(12)(13)(14)(15). MPs have been proved to have important physiological and pathophysiological functions and have been suggested as a promising biomarker to diagnose and predict different stages of diseases (11,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”