Plasma Concentration of the Lipid Peroxidation (LP) Biomarker 4-Ηydroxynonenal (4-HNE) in Benign and Cancer Patients

Abstract

Background/Aim: The present study investigated the plasma concentration of the lipid peroxidation (LP) biomarker 4-hydroxynonenal (4-HNE) in benign and cancer patients having the rectus sheath block (RSB) analgesia after midline laparotomy. Plasma concentrations of catalase (CAT) and malondialdehyde (MDA) were used as a reference. Patients and Methods: This study assessed three LP biomarkers; CAT, MDA and 4-HNE and compared the plasma levels to the patient satisfaction 24 h postoperatively (SFS 24 ; 0=fully unsatisfied; 10=fully satisfied); the overall pain at rest (NRS r ) and when pressing the wound at 20 Newton force (NRS p ) were surveyed and filed on a 11-point numeric rating scale at 24 h following surgery (NRS; 0=no pain; 10=worst pain). There were 56 patients in the study, of whom 12 were excluded due to missing plasma samples. The final study cohort consisted of 15 patients with benign disease and 29 patients with cancer. Results: The RSB analgesia enhanced significantly the SFS 24 scores in the study groups (p=0.001). The plasma 4-HNE decreased immediately after operation (POP1) and the postoperative decrease between the preoperative and the POP1 values in the 4-HNE marker were statistically significant (p<0.001). The individual plasma 4-HNE and MDA concentration correlated significantly in benign and cancer patients (r=0.413, p<0.001). Conclusion: The present study confirms the applicability of the plasma biomarker 4-HNE to cast further light on the postoperative pain in midline laparotomy patients.Failure in antioxidant defenses could lead to formation of reactive oxidative species (ROS) and lipid peroxidation (LP) (1-9). The uncontrolled ROS is called oxidative stress (OS) and is a common feature in cancer cells (1). OS in cancer cells could be demonstrated by an increase in OS markers and ROS in cancer cells can be counteracted by substances known as antioxidants: vitamin E and C, flavonoids and carotenoids (10,11). The most important antioxidative enzymes are catalase (CAT) (12, 13), glutathione peroxidase (GPX1) (4, 14) and superoxide dismutase (SOD1) (15,16). The role of LP in etiology of cancer, neurodegenerative and cardiovascular diseases, has motivated researchers to clarify the mechanism of LP and to develop biomarkers (7,(17)(18)(19). LP proceeds by three mechanisms; (i) free radical oxidation, (ii) free radical independent non-enzymatic oxidation, and (iii) enzymatic oxidation (1, 2). Polyunsaturated fatty acids (PUFAs) and cholesterol are oxidized through enzymatic and non-enzymatic routes. Malondialdehyde (MDA) and 4-Hydroxynonenal (4-HNE) are the ROS that cause OS in cells, targeting the subcellular structures to form covalent protein adducts (1, 2). 4-HNE is an α,β-unsaturated hydroxyalkenal that is produced by LP in cells. 4-HNE has 3 reactive groups: an aldehyde, a double-bond at carbon 2, and a hydroxy group at carbon 4 (1, 2).As far as we know, the differences in the LP stress biomarker 4-HNE plasma concentrations in midline 773 This article is freely accessible online.

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