TY - JOUR A1 - Asch, Silke A1 - Kaufmann, Tobias Peter A1 - Walter, Michaela A1 - Leistner, Marcus A1 - Danner, Bernd C. A1 - Perl, Thorsten A1 - Kutschka, Ingo A1 - Niehaus, Heidi T1 - The effect of perioperative hemadsorption in patients operated for acute infective endocarditis—A randomized controlled study JF - Artificial Organs N2 - Patients operated for infective endocarditis (IE) are at high risk of developing an excessive systemic hyperinflammatory state, resulting in systemic inflammatory response syndrome and septic shock. Hemoadsorption (HA) by cytokine adsorbers has been successfully applied to remove inflammatory mediators. This randomized controlled trial investigates the effect of perioperative HA therapy on inflammatory parameters and hemodynamic status in patients operated for IE. A total of 20 patients were randomly assigned to either HA therapy or the control group. HA therapy was initiated intraoperatively and continued for 24 hours postoperatively. Cytokine levels (IL‐6, IL‐1b, TNF‐α), leukocytes, C‐reactive protein (CRP), and Procalcitonin (PCT) as well as catecholamine support, and volume requirement were compared between both groups. Operative procedures included aortic (n = 7), mitral (n = 6), and multiple valve surgery (n = 7). All patients survived to discharge. No significant differences concerning median cytokine levels (IL‐6 and TNF‐α) were observed between both groups. CRP and PCT baseline levels were significantly higher in the HA group (59.5 vs. 26.3 mg/dL, P = .029 and 0.17 vs. 0.05 µg/L, P = .015) equalizing after surgery. Patients in the HA group required significantly higher doses of vasopressors (0.093 vs. 0.025 µg/kg/min norepinephrine, P = .029) at 12 hours postoperatively as well as significantly more overall volume replacement (7217 vs. 4185 mL at 12 hours, P = .015; 12 021 vs. 4850 mL at 48 hours, P = .015). HA therapy did neither result in a reduction of inflammatory parameters nor result in an improvement of hemodynamic parameters in patients operated for IE. For a more targeted use of HA therapy, appropriate selection criteria are required. KW - cytokines KW - endocarditis KW - hemadsorption KW - sepsis KW - SIRS Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262681 VL - 45 IS - 11 SP - 1328 EP - 1337 ER - TY - JOUR A1 - Leistner, Marcus A1 - Sommer, Stefanie A1 - Kanofsky, Peer A1 - Leyh, Rainer A1 - Sommer, Sebastian-Patrick T1 - Ischemia time impacts on respiratory chain functions and Ca\(^{2+}\)-handling of cardiac subsarcolemmal mitochondria subjected to ischemia reperfusion injury JF - Journal of Cardiothoracic Surgery N2 - Background Mitochondrial impairment can result from myocardial ischemia reperfusion injury (IR). Despite cardioplegic arrest, IR-associated cardiodepression is a major problem in heart surgery. We determined the effect of increasing ischemia time on the respiratory chain (RC) function, the inner membrane polarization and Ca\(^{2+}\) homeostasis of rat cardiac subsarcolemmal mitochondria (SSM). Methods Wistar rat hearts were divided into 4 groups of stop-flow induced warm global IR using a pressure-controlled Langendorff system: 0, 15, 30 and 40 min of ischemia with 30 min of reperfusion, respectively. Myocardial contractility was determined from left ventricular pressure records (dP/dt, dPmax) with an intraventricular balloon. Following reperfusion, SSM were isolated and analyzed regarding electron transport chain (ETC) coupling by polarography (Clark-Type electrode), membrane polarization (JC1 fluorescence) and Ca2+-handling in terms of Ca\(^{2+}\)-induced swelling and Ca\(^{2+}\)-uptake/release (Calcium Green-5 N® fluorescence). Results LV contractility and systolic pressure during reperfusion were impaired by increasing ischemic times. Ischemia reduced ETC oxygen consumption in IR40/30 compared to IR0/30 at complex I-V (8.1 ± 1.2 vs. 18.2 ± 2.0 nmol/min) and II-IV/V (16.4 ± 2.6/14.8 ± 2.3 vs. 2.3 ± 0.6 nmol/min) in state 3 respiration (p < 0.01). Relative membrane potential revealed a distinct hyperpolarization in IR30/30 and IR40/30 (171.5 ± 17.4% and 170.9 ± 13.5%) compared to IR0/30 (p < 0.01), wearing off swiftly after CCCP-induced uncoupling. Excess mitochondrial permeability transition pore (mPTP)-gated Ca\(^{2+}\)-induced swelling was recorded in all groups and was most pronounced in IR40/30. Pyruvate addition for mPTP blocking strongly reduced SSM swelling in IR40/30 (relative AUC, ± pyruvate; IR0/30: 1.00 vs. 0.61, IR15/30: 1.68 vs. 1.00, IR30/30: 1.42 vs. 0.75, IR40/30: 1.97 vs. 0.85; p < 0.01). Ca2+-uptake remained unaffected by previous IR. Though Ca\(^{2+}\)-release was delayed for ≥30 min of ischemia (p < 0.01), Ca\(^{2+}\) retention was highest in IR15/30 (RFU; IR0/30: 6.3 ± 3.6, IR 15/30 42.9 ± 5.0, IR30/30 15.9 ± 3.8, IR40/30 11.5 ± 6.6; p ≤ 0.01 for IR15/30 against all other groups). Conclusions Ischemia prolongation in IR injury gradually impaired SSM in terms of respiratory chain function and Ca\(^{2+}\)-homeostasis. Membrane hyperpolarization appears to be responsible for impaired Ca2+-cycling and ETC function. Ischemia time should be considered an important factor influencing IR experimental data on subsarcolemmal mitochondria. Periods of warm global ischemia should be minimized during cardiac surgery to avoid excessive damage to SSMs. KW - subsarcolemmal mitochondria KW - ischemia reperfusion injury KW - ischemia time Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236455 VL - 14 ER - TY - JOUR A1 - Hamouda, Khaled A1 - Oezkur, Mehmet A1 - Sinha, Bhanu A1 - Hain, Johannes A1 - Menkel, Hannah A1 - Leistner, Marcus A1 - Leyh, Rainer A1 - Schimmer, Christoph T1 - Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study JF - Journal of Cardiothoracic Surgery N2 - Background All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients’ characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results 615/1096 patients (56,1%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4%), 5/283 (1,7%), and 1/283 (0,3%) in group I versus 6/332 (1,8%), 9/332 (2,7%), and 3/332 (0,9%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05). Conclusions Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs. KW - nosocomial infection KW - cardiac surgery KW - antibiotic prophylaxis Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124977 VL - 10 IS - 25 ER - TY - THES A1 - Leistner, Marcus Heinz Martin T1 - Transportrelevante Substratinteraktionen des organischen Kationentransporters 1 der Ratte (rOCT1) T1 - Substrate interactions of rat organic cation transporter 1 (rOCT1) relevant for transport N2 - Im Rahmen der vorliegenden Arbeit wurde das mechanistische Funktionsprinzip des Rat Organic Cation Transporter 1, stellvertretend für die Gruppe der organischen Kationentransporter, im Hinblick auf die Beteiligung einzelner Aminosäuren der mutmaßlichen Bindungstasche am Transportprozess (Tyr222, Asp475) untersucht. Hierbei stand insbesondere die Frage nach einer gleichzeitigen oder sequentiellen Interaktion der o. g. Aminosäuren mit dem jeweils gewählten Transportliganden im Vordergrund. Bei Mutation der untersuchten Interaktionsstellen (Einzelmutanten Y222F, D475E, Doppelmutante Y222F/D475E) konnten Km-Änderungen für die zelluläre Aufnahme von MPP und TEA sowie IC50-Änderungen für die Hemmung des MPP-Transportes durch TEA bzw. TBuA im Xenopus-laevis-Oozytenmodell mittels radioaktiver Aufnahmemessungen erzielt werden. Trotz eines signifikant additiven Effektes der Doppelmutation auf die TEA-Affinität des Transporters im Vergleich zu den Einzelmutanten erschien ein sequentieller Transportmechanismus aufgrund der nicht additiven IC50(TEA)-Verminderung für den MPP-Transport und der Sicherung der Lokalisation von Tyr222 und Asp475 auf unterschiedlichen Seiten der Plasmamembran durch TBuA-Inhibitionsversuche der MPP-Aufnahme wahrscheinlich. Gestützt wurden diese Ergebnisse durch die analoge Modellierung dreidimensionaler Darstellungen des doppelmutierten rOCT1(Y222F/D475E) anhand bereits kristallographisch vermessener Prokaryotentransporter. Diese Modelle bestätigten eine interaktionsrelevante räumliche Position der modifizierten Aminosäurereste innerhalb der Bindungstasche, welche eine metachrone Substrat- bzw. Inhibitorbindung nahelegte. Demnach interagiert in Kongruenz beider Untersuchungsansätze zunächst Tyr222 auf extrazellulärer Seite mit dem Liganden, während der intramembranären Konformationsänderung des Transporters erfolgt dann eine Transposition des Substrates respektive Inhibitors auf Asp475 auf der Zytosolseite. N2 - The involvement of two amino acids (Y222, D475) of the innermost cavity of rat organic cation transporter 1 (rOCT1) in the transport process was investigated. The study aimed at characterizing the interaction between substrates and the amino acid residues as a synchronous or sequential process. Mutations of the above mentioned amino acids (Y222F, D475E, Y222F/D475E) showed a significantly additive effect on TEA affinity in contrast to MPP for the double mutant on one hand. On the other hand there was no additive decrease in IC50(TEA) values for MPP transport. Additionally, the accessibility of Y222 and D475 on different sides of the plasma membrane during transport was verified by TBuA inhibition of MPP translocation. Taken together these findings strongly suggest a sequential transport mechanism. This interpretation of the experimental data was also supported by computer based three dimensional modelling of the Y222F/D475E double mutant with substrates/inhibitors bound to the innermost cavitiy, which showed the positions of the two amino acids within the tertiary structure of rOCT1 to be suitable for metachronous substrate interactions. KW - Organischer Kationentransporter KW - Organic cation transporter Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-65849 ER -