Vitamin C supplementation attenuates oxidative stress and improves erythrocyte deformability in cardiac surgery with cardiopulmonary bypass

• Published in: Chinese journal of physiology Vol. 65; no. 5; pp. 241 - 249
• Main Authors: Tai, Ying-Hsuan, Wu, Hsiang-Ling, Chu, You-Hsiang, Huang, Cheng-Hsiung, Ho, Shung-Tai, Lin, Tso-Chou, Lu, Chih-Cherng
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.09.2022; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: antioxidant; ascorbic acid; Coronary artery bypass; Ethylenediaminetetraacetic acid; non-muscle myosin iia; Oxidative stress; reactive oxygen species; Surgery; Vitamin C; United Kingdom; Taiwan; ascorbic acid; non-muscle myosin IIA; Antioxidant; reactive oxygen species
• ISSN: 0304-4920; 2666-0059
• DOI: 10.4103/0304-4920.358234

Cardiopulmonary bypass (CPB) depletes endogenous Vitamin C and generates oxidative stress in cardiac surgery. This study aimed to clarify whether Vitamin C supplementation reduces oxidant production and improves erythrocyte deformability in cardiac surgery with CPB. In a randomized and controlled design, 30 eligible patients undergoing cardiac surgery with hypothermic CPB were equally assigned to the Vitamin C group and control group. Subjects of the Vitamin C group and control group received an intravenous infusion of Vitamin C 20 mg·kg-1 and a placebo during rewarming period of CPB, respectively. We measured the plasma level of reactive oxygen species (ROS) and phosphorylation levels of non-muscle myosin IIA (NMIIA) in erythrocyte membrane, as an index of erythrocyte deformability, before and after CPB. Vitamin C supplementation attenuated the surge in plasma ROS after CPB, mean 1.661 ± standard deviation 0.801 folds in the Vitamin C group and 2.743 ± 1.802 in the control group. The tyrosine phosphorylation level of NMIIA after CPB was upregulated in the Vitamin C group compared to the control group, 2.159 ± 0.887 folds and 1.384 ± 0.445 (P = 0.0237). In addition, the phosphorylation of vasodilator-stimulated phosphoprotein (VASP) and focal adhesion kinase (FAK) in erythrocytes was concurrently enhanced in the Vitamin C group after CPB. The phosphorylation level of endothelial nitric oxide synthase in erythrocytes was significantly increased in the Vitamin C group (1.734 ± 0.371 folds) compared to control group (1.102 ± 0.249; P = 0.0061). Patients receiving Vitamin C had lower intraoperative blood loss and higher systemic vascular resistance after CPB compared to controls. Vitamin C supplementation attenuates oxidative stress and improves erythrocyte deformability via VASP/FAK signaling pathway in erythrocytes during CPB.