Adenosine A2A Receptor Hyperexpression in Patients With Severe SIRS After Cardiopulmonary Bypass

• Published in: Journal of investigative medicine Vol. 56; no. 6; pp. 864 - 871
• Main Authors: Kerbaul, François, Bénard, Frédéric, Giorgi, Roch, Youlet, By, Carrega, Louis, Zouher, Ibrahim, Mercier, Laurence, Gérolami, Victoria, Bénas, Vincent, Blayac, Dorothée, Gariboldi, Vlad, Collart, Frédéric, Guieu, Régis
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.08.2008; Sage Publications Ltd
• Subjects: Adenosine; Adenosine - blood; Adult; Aged; Blood pressure; Cardiopulmonary Bypass - adverse effects; Case-Control Studies; Female; Gene Expression; Heart surgery; Hemodialysis; Hemodynamics; Humans; Inflammatory diseases; Laboratories; Male; Middle Aged; Neutrophils; Prospective Studies; Pulmonary hypertension; Receptors, Adenosine A2 - blood; Receptors, Adenosine A2 - genetics; RNA, Messenger - blood; RNA, Messenger - genetics; Sepsis; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - etiology; Systemic Inflammatory Response Syndrome - genetics; Transplants & implants; France; adenosine; cardiopulmonary bypass; SIRS; A2A receptors; hemodynamics
• ISSN: 1081-5589; 1708-8267
• DOI: 10.2310/JIM.0b013e3181788d02

ObjectiveAdenosine (ADO) is an endogenous nucleoside, which has been involved in blood pressure failure during severe systemic inflammatory response syndrome (severe SIRS) after cardiac surgery with cardiopulmonary bypass (CPB). Adenosine acts via its receptor subtypes, namely A1, A2A, A2B, or A3. Because A2A receptors are implicated in vascular tone, their expression might contribute to severe SIRS. We compared adenosine plasma levels (APLs) and A2A ADO receptor expression (ie, B, K, and mRNA amount) in patients with or without postoperative SIRS.PatientsThis was a prospective comparative observational study. Forty-four patients who underwent cardiac surgery involving CPB. Ten healthy subjects served as controls.Measurements and ResultsAmong the patients, 11 presented operative vasoplegia and postoperative SIRS (named complicated patients) and 33 were without vasoplegia or SIRS (named uncomplicated patients). Adenosine plasma levels, K, B, and mRNA amount (mean ± SD) were measured on peripheral blood mononuclear cells. Adenosine plasma levels, B, and K were significantly higher in complicated patients than in uncomplicated patients (APLs: 2.7 ± 1.0 vs 1.0 ± 0.5 μmol l−1, P < 0.05; B: 210 ± 43 vs 65 ± 26 fmol/mg, P < 0.05; K: 35 ± 10 vs 2 ± 1 nM, P < 0.05). In uncomplicated patients, APLs remain higher than in controls (1 ± 0.5 vs 0.6 ± 0.25 μmol/L; P < 0.05).Mean arterial pressure was inversely correlated to APLs (R = −0.58; P < 0.001) and B (R = −0.64; P < 0.001) leading to an increased requirement of vasoactive drugs during the postoperative period in vasoplegic patients.ConclusionsHigh expression of A2A ADO receptor and high APLs may be a predictive factor of postoperative severe SIRS after CPB.