Abstract 13587: Remote Ischemic Preconditioning Modifies the Plasma Proteome in Children Undergoing Repair of Tetralogy of Fallot: a Randomized Controlled Trial
Introduction: Remote ischemic preconditioning (RIPC) has been applied in paediatric cardiac surgery. We have demonstrated that RIPC stimulus induced proteomic response in plasma of healthy volunteers. Herein we tested the hypothesis that RIPC modifies the plasma proteomic response in children undergoing repair of Tetralogy of Fallot (TOF).
Methods: Children (n=40) undergoing TOF repair were double-blind randomized to RIPC (n=20) and control (n=20) groups. Blood samples were taken at baseline, at the end of CPB and at 6, 12 and 24 hours post-CPB. Plasma samples were fractionated and analysed by liquid chromatography mass spectrometry (MS) in a label free, untargeted approach. Data were analyzed using Genedata software. Peptides that demonstrated differential expression (p<0.01) were selected as targets for tandem MS. Corresponding proteins were identified using the NCBI human protein database.
Results: There was no difference in mean age (7.3±3.5 vs 6.8±3.6 months) (p=0.89), weight (7.7±1.8 vs 7.5±1.9 kg) (p=0.71), CPB time (104±7 vs 94±7 min) (p=0.98) or aortic cross-clamp time (83±22 vs 75±20 min) (p=0.36) between the groups. There were no differences in clinical outcomes. No peptides were differentially expressed between 2 groups at baseline or at the end of CPB. There were 48 peptides with higher expression levels in the RIPC group 6 hours post-CPB. This was no longer evident in the RIPC group at 12 or 24 hours, with only 1 peptide down-regulated at each of these time points. The proteins identified from the 48 peptides of interest included: inter-alpha (globulin) inhibitor (42.0 ± 11.8 vs 820.8 ± 181.1, p=0.006), fibrinogen preproprotein (59.3 ± 11.2 vs 1192.6 ± 278.3, p=0.007), complement C3 precursor (391.2 ± 160.9 vs 5385.1 ± 689.4, p=0.0005), complement C4B (151.5 ± 17.8 vs 4587.8 ± 799.2, p=0.003), apolipoprotein B100 (53.4 ± 8.3 vs 1364.5 ± 278.2, p=0.005) and urinary proteinase inhibitor (358.6 ± 74.9 vs 5758.1 ± 1343.1, p=0.009). These proteins are involved in metabolism, haemostasis, immunity and inflammation.
Conclusion: We provided the first comprehensive analysis of RIPC-induced proteomic changes in children undergoing heart surgery. The proteomic changes peak at 6 hours post-CPB and return to baseline within the first 24 hours of surgery.
- © 2013 by American Heart Association, Inc.