Continuous Renal Replacement Therapy (CRRT) Attenuates Myocardial Inflammation and Mitochondrial Injury Induced by Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) in a Healthy Piglet Model
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In this study, we investigated the myocardial inflammation and mitochondrial function during venovenous extracorporeal membrane oxygenation (VV ECMO) and further evaluated the effects of continuous renal replacement therapy (CRRT) on them. Eighteen piglets were assigned to the control group, ECMO group, and ECMO+CRRT group. Myocardial inflammation was assessed by the activity of myeloperoxidase (MPO), myocardial concentrations, and mRNA expression of TNF-α, IL-1β, and IL-6; mitochondrial function was assessed by activities of mitochondrial complexes I–V. VV ECMO elicited a general activation of serum and myocardial inflammation and significantly decreased the activities of mitochondrial complexes I and IV. After being combined with CRRT, serum and myocardial concentrations of IL-1β and IL-6, myocardial mRNA expression of IL-6, and the activity of MPO were decreased significantly; the activities of mitochondrial complexes were increased. We conclude that myocardial inflammation was activated during ECMO therapy, inducing mitochondrial injury; moreover, CRRT reduced myocardial inflammation and partially ameliorated mitochondrial function.
KEY WORDSvenovenous extracorporeal membrane oxygenation (VV ECMO) myocardial inflammation mitochondrial function continuous renal replacement therapy (CRRT)
This study was supported by 12th five-year Major Program of Army Grants (no. AWS11J03; no. AWS12J001); Jiangsu Province’s Special Project of Science and Technology in Medicine (BL2012006); and Jiangsu Province’s Key Medical Talent Program (RC2011128). We thank Prof. Dehua Gong, Prof. Daxi Ji, Prof. Zhihong Liu, and other physicians, perfusionists, and nurses of Research Institute of Nephrology in Jinling Hospital for helping us perform hemofiltration.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 3.Peek, G.J., M. Mugford, R. Tiruvoipati, A. Wilson, E. Allen, M.M. Thalanany, et al. 2009. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. The Lancet 374: 1351–1363.CrossRefGoogle Scholar
- 4.Noah, M.A., G.J. Peek, S.J. Finney, M.J. Griffiths, D.A. Harrison, R. Grieve, et al. 2011. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA: The Journal of the American Medical Association 306: 1659–1668.CrossRefGoogle Scholar
- 16.Schetz M. 1999. Non-renal indications for continuous renal replacement therapy. Kidney International. Supplement 72:S88–94.Google Scholar
- 20.Naran, N., M. Sagy, and K.R. Bock. 2010. Continuous renal replacement therapy results in respiratory and hemodynamic beneficial effects in pediatric patients with severe systemic inflammatory response syndrome and multiorgan system dysfunction. Pediatric Critical Care Medicine 11: 737–740.PubMedCrossRefGoogle Scholar
- 24.Poderoso, J.J., M.C. Carreras, C. Lisdero, N. Riobo, F. Schopfer, and A. Boveris. 1996. Nitric oxide inhibits electron transfer and increases superoxide radical production in rat heart mitochondria and submitochondrial particles. Archives of Biochemistry and Biophysics 328: 85–92.PubMedCrossRefGoogle Scholar