Effects of Low-dose Selenium on the Inflammatory Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial

Sedighinejad, Abbas; Imantalab, Vali; Mirmansouri, Ali; Jouryabi, Ali Mohammadzadeh; Kanani, Gholamreza; Sheikhani, Nassir Nassiri; Haghighi, Mohammad; Atrkarroushan, Zahra; Biazar, Gelareh

doi:10.5812/ircmj.37918

Cited by 20 publications

(26 citation statements)

References 72 publications

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“…In 2017, Mirmansouri et al demonstrated that the administration of 600 μg Se prior to surgery had no effect on the stress response due to surgery . Similar results were obtained in a study conducted in 2016 …”

Section: Interventional Studiesmentioning

confidence: 61%

“…In patients undergoing cardiac surgery, Stevanovic et al demonstrated that higher Se levels were correlated with lower interleukin‐6 (IL‐6) levels, indicating the anti‐inflammatory characteristics of Se and the importance of the patients’ Se status in the modulation of the inflammatory response during cardiac surgery . In the same context, the anti‐inflammatory effects of Se supplementation were investigated in patients receiving one 600‐μg dose of Se intravenously right before surgery . Neither tumor necrosis factor‐α nor IL‐6 levels were affected in this study.…”

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 61%

“…CRP levels were only significant at T1 ( P = 0.039). The lack of a more pronounced anti‐inflammatory effect may be due to either an inadequate dose of Se or the administration of a single dose, which may be insufficient to balance the dysregulated metabolism …”

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 99%

“…Considering the studies performed in the past decades and the different doses administered in these interventions, there is still no consensus about either the adequate dosage or supplementation strategy (eg, bolus vs continuous supplementation, and selenocompound) . The administration of low doses of Se at only a few time points will probably have no significant effects on the circulating Se blood levels, bioavailability, or the patient's clinical outcome . In contrast, a more frequent administration of Se might have more pronounced effects on reducing new infections in critically ill patients .…”

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 99%

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Selenium in Cardiac Surgery

et al. 2019

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Selenium (Se) is an essential trace element that plays a pivotal role in many of the body's regulatory and metabolic functions, especially during times of stress. After uptake, Se is incorporated into several Se-dependent proteins, which have potent antiinflammatory and antioxidant capacities. Several observational clinical studies have demonstrated that Se deficiency can cause chronic cardiovascular diseases and aggravate organ dysfunction after cardiac surgery and that low levels of Se may be independently associated with the development of organ dysfunction after cardiac surgery. Based on these findings, several studies have investigated the effects of a perioperative Se supplementation strategy. Therefore, the present review describes in depth the pathophysiology and harmful stimuli during cardiac surgery, how Se may counteract these injuries, the different types of Se supplementation strategies that have been evaluated, and current evidence of its clinical significance. (Nutr Clin Pract. 2019;34:528-539)

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Section: Interventional Studiesmentioning

confidence: 61%

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 61%

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 99%

Section: The Role Of Se In Cardiac Surgerymentioning

confidence: 99%

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Selenium in Cardiac Surgery

et al. 2019

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“…However, CPB-related complications are still prevalent, such as postoperative cognitive dysfunction (POCD), gastrointestinal injury, and acute lung injury [1, 2]. CPB causes intestinal mucosal barrier damage, releases toxins and proinflammatory cytokines, and produces a systemic inflammatory response, leading to tissue dysfunction in the brain, lung, liver, kidney, and other organs [3-5]. Previous studies have demonstrated that a systemic inflammatory response, myocardial ischemia-reperfusion, and surgical trauma are the major causes of POCD and intestinal mucosal barrier function impairment after CPB [6-8].…”

Section: Introductionmentioning

confidence: 99%

Activated Α7nachr Improves Postoperative Cognitive Dysfunction and Intestinal Injury Induced by Cardiopulmonary Bypass in Rats: Inhibition of the Proinflammatory Response Through the Th17 Immune Response

Chen

Sun

Dong

et al. 2018

Cell Physiol Biochem

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Backgrund/Aims: To investigate the effects of activated α7 nicotinic acetylcholine receptor (α7nAChR) on postoperative cognitive dysfunction (POCD) and intestinal injury induced by cardiopulmonary bypass (CPB) and its relationship with the Th17 response in order to provide a theoretical basis for organ protection and targeted drug therapy during the perioperative period. Methods: Sprague-Dawley rat models of CPB were established. Rat intestinal and brain injuries were observed after CPB using hematoxylin and eosin staining. Cell apoptosis was determined using terminal deoxynucleotidyl transferase dUTP nick end labeling. Inflammatory factors and markers of brain injury in rat serum were measured using enzyme-linked immunosorbent assay. The expression levels of Bcl-2, Bax, caspase-3, ZO-1, occludin, AQP4, RORγT, and α7nAchR were examined using western blotting. Transcription factor RORγT expression was determined using real-time fluorescent quantitative polymerase chain reaction. Th17 cells in the peripheral blood and spleen were determined using flow cytometry. α7nAchR knockout rats were established. The Th17 response in the peripheral blood and spleen of α7nAchR knockout rats was further verified using flow cytometry. Results: CPB can induce POCD and intestinal injury in rats. α7nAchR activation markedly reduced intestinal injury, POCD, neuronal apoptosis, proinflammatory factor expression, and number of CD4⁺IL-17⁺ cells. α7nAchR knockout significantly increased serum D-lactic acid, FABP2, S-100β, NSE, TNF-α, IL-6, and IL-17 secretion. The number of CD4⁺IL-17⁺ cells was also significantly increased. Conclusion: α7nAchR activation markedly ameliorates the intestinal injury and POCD induced by CPB. Inhibition of the Th17 immune response can reduce the proinflammatory response, which could provide a new method for clinical perioperative organ protection and targeted drug therapy.

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Effect of High-Dose Selenium on Postoperative Organ Dysfunction and Mortality in Cardiac Surgery Patients

et al. 2023

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ImportanceSelenium contributes to antioxidative, anti-inflammatory, and immunomodulatory pathways, which may improve outcomes in patients at high risk of organ dysfunctions after cardiac surgery.ObjectiveTo assess the ability of high-dose intravenous sodium selenite treatment to reduce postoperative organ dysfunction and mortality in cardiac surgery patients.Design, Setting, and ParticipantsThis multicenter, randomized, double-blind, placebo-controlled trial took place at 23 sites in Germany and Canada from January 2015 to January 2021. Adult cardiac surgery patients with a European System for Cardiac Operative Risk Evaluation II score–predicted mortality of 5% or more or planned combined surgical procedures were randomized.InterventionsPatients were randomly assigned (1:1) by a web-based system to receive either perioperative intravenous high-dose selenium supplementation of 2000 μg/L of sodium selenite prior to cardiopulmonary bypass, 2000 μg/L immediately postoperatively, and 1000 μg/L each day in intensive care for a maximum of 10 days or placebo.Main Outcomes and MeasuresThe primary end point was a composite of the numbers of days alive and free from organ dysfunction during the first 30 days following cardiac surgery.ResultsA total of 1416 adult cardiac surgery patients were analyzed (mean [SD] age, 68.2 [10.4] years; 1043 [74.8%] male). The median (IQR) predicted 30-day mortality by European System for Cardiac Operative Risk Evaluation II score was 8.7% (5.6%-14.9%), and most patients had combined coronary revascularization and valvular procedures. Selenium did not increase the number of persistent organ dysfunction–free and alive days over the first 30 postoperative days (median [IQR], 29 [28-30] vs 29 [28-30]; P = .45). The 30-day mortality rates were 4.2% in the selenium and 5.0% in the placebo group (odds ratio, 0.82; 95% CI, 0.50-1.36; P = .44). Safety outcomes did not differ between the groups.Conclusions and RelevanceIn high-risk cardiac surgery patients, perioperative administration of high-dose intravenous sodium selenite did not reduce morbidity or mortality. The present data do not support the routine perioperative use of selenium for patients undergoing cardiac surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT02002247

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Effects of Low-dose Selenium on the Inflammatory Response in Coronary Artery Bypass Graft Surgery: A Clinical Trial

Cited by 20 publications

References 72 publications

Selenium in Cardiac Surgery

Selenium in Cardiac Surgery

Activated Α7nachr Improves Postoperative Cognitive Dysfunction and Intestinal Injury Induced by Cardiopulmonary Bypass in Rats: Inhibition of the Proinflammatory Response Through the Th17 Immune Response

Effect of High-Dose Selenium on Postoperative Organ Dysfunction and Mortality in Cardiac Surgery Patients

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