Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2021; 18 (3): 181-256 ➤ Генетические маркеры риска неврологических осложнений в кардиохирургии. Часть 3

Genetic markers of risk of neurological complications in cardiac surgery. Part 3

Authors: Koksheneva I.V., Zakaraya I.T.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-3-193-200

UDC: 616.831-005.4:616.12-089

Link: Clinical Physiology of Blood Circulaiton. 2021; 3 (18): 193-200

Quote as: Koksheneva I.V., Zakaraya I.T. Genetic markers of risk of neurological complications in cardiac surgery. Part 3. Clinical Physiology of Circulation. 2021; 18 (3): 193–200 (in Russ.). DOI: 10.24022/1814-6910-2021-18-3-193-200

Keywords:  genetic variability genetic variants associated with the risk of neurological complications genetic variability of the regulatory pathways of the inflammatory response genetic variability of the regulatory pathways of hemostasis genetic variability of apolipoprotein E

Received / Accepted:  22.10.2020 / 27.11.2020

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Abstract

Despite the improvement of surgical methods and anesthesia, the incidence of neurological complications after cardiac surgery, varying in severity from cerebral coma to focal stroke, is 1–3%, and cognitive deficit is up to 69%. That has a significant impact on mortality rates, and subsequently on the quality of life of patients. The pathophysiology of perioperative neurological damage is complex, including complex interactions between regulatory pathways of inflammation, hemostasis, lipid metabolism, and others. In each of these pathways, polymorphic genetic variants have been identified. Certain genetic polymorphisms can modulate the risk of neurological complications after cardiac surgery. This review presents the published data on identified genetic variants associated with perioperative neurological damage in patients undergoing cardiac surgery. These data hold promise for clinical use. First, to better predict the risk of neurological complications before cardiac surgery. Secondly, preoperative genetic screening may allow a change in surgical tactics, with the introduction of procedures aimed at reducing this risk. For example, avoid clamping the aorta during surgery. In addition, the use of neuroprotective strategies and/or pharmacological agents, especially in patients at highest risk, may reduce the risks of neurological complications.

References

  1. Hogue C.W., Palin C.A., Arrowsmith J.E. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg. 2006; 103 (1): 21–37. DOI: 10.1213/01.ANE.0000220035.82989.79
  2. Selim M. Perioperative stroke. N. Engl. J. Med. 2007; 356 (7): 706–13. DOI: 10.1056/NEJMra062668 3. Selnes O.A., Gottesman R.F. Neuropsychological outcomes after coronary artery bypass grafting. J. Int. Neuropsychol. Soc. 2010; 16 (2): 221–6. DOI: 10.1017/S1355617709991196
  3. Filsoufi F., Rahmanian P.B., Castillo J.G., Bronster D., Adams D.H. Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann. Thorac. Surg. 2008; 85 (3): 862–70. DOI: 10.1016/j.athoracsur. 2007.10.060
  4. Tarakji K.G., Sabik J.F., Bhudia S.K., Batizy L.H., Blackstone E.H. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011; 305 (4): 381–90. DOI: 10.1001/jama.2011.37
  5. Mashour G.A., Shanks A.M., Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology. 2011; 114 (6): 1289–96. DOI: 10.1097/ALN.0b013e318216e7f4
  6. Бузиашвили Ю.И., Кокшенева И.В., Абуков С.Т., Сандухадзе Б.Р Значение генетического полиморфизма медиаторов воспалительного ответа в развитии осложнений после кардиохирургических операций (обзор литературы). Кардиология и сердечно-сосудистая хирургия. 2016; 9 (1): 13–9.
  7. Grocott H.P., White W.D., Morris R.W., Podgoreanu M.V., Mathew J.P., Nielsen D.M. et al.; Perioperative Genetics and Safety Outcomes Study (PEGASUS) Investigative Team. Genetic polymorphisms and the risk of stroke after cardiac surgery. Stroke. 2005; 36 (9): 1854–8. DOI: 10.1161/01.STR. 0000177482.23478.dc
  8. Mathew J.P., Podgoreanu M.V., Grocott H.P., White W.D., Morris R.W., Stafford-Smith M. et al.; PEGASUS Investigative Team. Genetic variants in Pselectin and C-reactive protein influence susceptibility to cognitive decline after cardiac surgery. J. Am. Coll. Cardiol. 2007; 49 (19): 1934–42. DOI: 10.1016/j.jacc. 2007.01.080
  9. Marousi S., Ellul J., Antonacopoulou A., Gogos C., Papathanasopoulos P., Karakantza M. Functional polymorphisms of interleukin 4 and interleukin 10 may predict evolution and functional outcome of an ischaemic stroke. Eur. J. Neurol. 2011; 18 (4): 637–43. DOI: 10.1111/j.1468-1331.2010.03228.x
  10. Marousi S., Antonacopoulou A., Kalofonos H., Papathanasopoulos P., Karakantza M., Ellul J. Functional inflammatory genotypes in ischemic stroke: could we use them to predict age of onset and long-term outcome? Stroke. Res. Treat. 2011; 2011: 792923. DOI: 10.4061/2011/792923
  11. Revilla M., Obach V., Cervera A., Dávalos A., Castillo J., Chamorro A. A -174G/C polymorphism of the interleukin-6 gene in patients with lacunar infarction. Neurosci. Lett. 2002; 324 (1): 29–32. DOI: 10.1016/s0304-3940(02)00169-6
  12. Nepal G., Yadav J.K., Kong Y. Association between K469E polymorphism of ICAM-1 gene and susceptibility of ischemic stroke: an updated meta-analysis. Mol. Genet. Genomic. Med. 2019; 7 (7): e00784. DOI: 10.1002/mgg3.784
  13. Gao H., Zhang X. Associations of intercellular adhesion molecule-1 rs5498 polymorphism with ischemic stroke: a meta-analysis. Mol. Genet. Genomic. Med. 2019; 7 (6): e643. DOI: 10.1002/mgg3.643
  14. Pola R., Flex A., Gaetani E., Flore R., Serricchio M., Pola P. Synergistic effect of -174 G/C polymorphism of the interleukin-6 gene promoter and 469 E/K polymorphism of the intercellular adhesion molecule-1 gene in Italian patients with history of ischemic stroke. Stroke. 2003; 34 (4): 881–5. DOI: 10.1161/01.STR.0000062346.70983.DF
  15. Liu Y., Geng P.L., Yan F.Q., Chen T., Wang W., Tang X.D. et al. C-reactive Protein -717A>G and -286C>T>A gene polymorphism and ischemic stroke. Chin. Med. J. (Engl). 2015; 128 (12): 1666–70. DOI: 10.4103/0366-6999.158371
  16. Brull D.J., Serrano N., Zito F., Jones L., Montgomery H.E., Rumley A. et al. Human CRP gene polymorphism influences CRP levels: implications for the prediction and pathogenesis of coronary heart disease. Arterioscler. Thromb. Vasc. Biol. 2003; 23 (11): 2063–9. DOI: 10.1161/01.ATV.0000084640.21712.9C
  17. Wilson C.J., Finch C.E., Cohen H.J. Cytokines and cognition – the case for a head-to-toe inflammatory paradigm. J. Am. Geriatr. Soc. 2002; 50 (12): 2041–56. DOI: 10.1046/j.1532-5415.2002.50619.x
  18. Reichenberg A., Yirmiya R., Schuld A., Kraus T., Haack M., Morag A., Pollmächer T. Cytokine-associated emotional and cognitive disturbances in humans. Arch. Gen. Psychiatry. 2001; 58 (5): 445–52. DOI: 10.1001/archpsyc.58.5.445
  19. Yaffe K., Lindquist K., Penninx B.W., Simonsick E.M., Pahor M., Kritchevsky S. et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology. 2003; 61 (1): 76–80. DOI: 10.1212/01.wnl.0000073620.42047.d7
  20. Tardiff B.E., Newman M.F., Saunders A.M., Strittmatter W.J., Blumenthal J.A., White W.D. et al. Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center. Ann. Thorac. Surg. 1997; 64 (3): 715–20. DOI: 10.1016/s0003-4975(97)00757-1
  21. Alberts M.J., Graffagnino C., McClenny C., DeLong D., Strittmatter W., Saunders A.M., Roses A.D. ApoE genotype and survival from intracerebral haemorrhage. Lancet. 1995; 346 (8974): 575. DOI: 10.1016/s0140-6736(95)91411-0
  22. Teasdale G.M., Nicoll J.A., Murray G., Fiddes M. Association of apolipoprotein E polymorphism with outcome after head injury. Lancet. 1997; 350 (9084): 1069–71. DOI: 10.1016/S0140-6736(97)04318-3
  23. Slooter A.J., Tang M.X., van Duijn C.M., Stern Y., Ott A., Bell K. et al. Apolipoprotein E epsilon4 and the risk of dementia with stroke. A population-based investigation. JAMA. 1997; 277 (10): 818–21. DOI: 10.1001/jama.277.10.818
  24. Sheng H., Laskowitz D.T., Bennett E., Schmechel D.E., Bart R.D., Saunders A.M et al. Apolipoprotein E isoform-specific differences in outcome from focal ischemia in transgenic mice. J. Cereb. Blood. Flow. Metab. 1998; 18 (4): 361–6. DOI: 10.1097/00004647- 199804000-00003
  25. Leung J.M., Sands L.P., Wang Y., Poon A., Kwok P.Y., Kane J.P., Pullinger C.R. Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery. Anesthesiology. 2007; 107 (3): 406–11. DOI: 10.1097/01.anes.0000278905.07899.df
  26. Heyer E.J., Wilson D.A., Sahlein D.H., Mocco J., Williams S.C., Sciacca R. et al. APOE-epsilon4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology. 2005; 65 (11): 1759–63. DOI: 10.1212/01.wnl.0000184579. 23624.6b
  27. Newman M.F., Laskowitz D.T., White W.D., Kirchner J.L., Grocott H.P., Stafford-Smith M. et al. Apolipoprotein E polymorphisms and age at first coronary artery bypass graft. Anesth. Analg. 2001; 92 (4): 824–9. DOI: 10.1097/00000539-200104000-00006
  28. Ely E.W., Girard T.D., Shintani A.K., Jackson J.C., Gordon S.M., Thomason J.W. et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit. Care. Med. 2007; 35 (1): 112–7. DOI: 10.1097/01.CCM.0000251925.18961.CA
  29. Liu C.C., Kanekiyo T., Xu H., Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nat. Rev. Neurol. 2013; 9 (2): 106–18. DOI: 10.1038/nrneurol.2012.263
  30. Bartels K., Li Y.J., Li Y.W., White W.D., Laskowitz D.T., Kertai M.D. et al. Apolipoprotein epsilon 4 genotype is associated with less improvement in cognitive function five years after cardiac surgery: a retrospective cohort study. Can. J. Anaesth. 2015; 62 (6): 618–26. DOI: 10.1007/s12630-015-0337-8
  31. Weiss E.J., Bray P.F., Tayback M., Schulman S.P., Kickler T.S., Becker L.C. et al. Polymorphism of a platelet glycoprotein receptor as an inherited risk factor for coronary thrombosis. N. Engl. J. Med. 1996; 334 (17): 1090–4. DOI: 10.1056/NEJM199604253341703
  32. Carter A.M., Catto A.J., Bamford J.M., Grant P.J. Platelet GP IIIa PlA and GP Ib variable number tandem repeat polymorphisms and markers of platelet activation in acute stroke. Arterioscler. Thromb. Vasc. Biol. 1998; 18 (7): 1124–31. DOI: 10.1161/01.atv.18.7.1124
  33. Ramlawi B., Otu H., Rudolph J.L., Mieno S., Kohane I.S., Can H. et al. Genomic expression pathways associated with brain injury after cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 2007; 134 (4): 996–1005. DOI: 10.1016/j.jtcvs.2007.01.096
****
  1. Hogue C.W., Palin C.A., Arrowsmith J.E. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg. 2006; 103 (1): 21–37. DOI: 10.1213/01.ANE.0000220035.82989.79
  2. Selim M. Perioperative stroke. N. Engl. J. Med. 2007; 356 (7): 706–13. DOI: 10.1056/NEJMra062668 3. Selnes O.A., Gottesman R.F. Neuropsychological outcomes after coronary artery bypass grafting. J. Int. Neuropsychol. Soc. 2010; 16 (2): 221–6. DOI: 10.1017/S1355617709991196
  3. Filsoufi F., Rahmanian P.B., Castillo J.G., Bronster D., Adams D.H. Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann. Thorac. Surg. 2008; 85 (3): 862–70. DOI: 10.1016/j.athoracsur. 2007.10.060
  4. Tarakji K.G., Sabik J.F., Bhudia S.K., Batizy L.H., Blackstone E.H. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011; 305 (4): 381–90. DOI: 10.1001/jama.2011.37
  5. Mashour G.A., Shanks A.M., Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology. 2011; 114 (6): 1289–96. DOI: 10.1097/ALN.0b013e318216e7f4
  6. Buziashvili Yu.I., Koksheneva I.V., Abukov S.T., Sandukhadze B.R. The value of genetic polymorphism of inflammatory response mediators in the development of complications after cardiac surgery (literature review). Cardiology and Cardiovascular Surgery. 2016; 9 (1): 13–9 (in Russ.).
  7. Alam A., Hana Z., Jin Zh., Suen K.Ch., Ma D. Surgery, neuroinflammation and cognitive impairment. E. Bio. Medicine. 2018; 37: 547–56. DOI: 10.1016/j.ebiom.2018.10.021
  8. Grocott H.P., White W.D., Morris R.W., Podgoreanu M.V., Mathew J.P., Nielsen D.M. et al.; Perioperative Genetics and Safety Outcomes Study (PEGASUS) Investigative Team. Genetic polymorphisms and the risk of stroke after cardiac surgery. Stroke. 2005; 36 (9): 1854–8. DOI: 10.1161/01.STR. 0000177482.23478.dc
  9. Mathew J.P., Podgoreanu M.V., Grocott H.P., White W.D., Morris R.W., Stafford-Smith M. et al.; PEGASUS Investigative Team. Genetic variants in Pselectin and C-reactive protein influence susceptibility to cognitive decline after cardiac surgery. J. Am. Coll. Cardiol. 2007; 49 (19): 1934–42. DOI: 10.1016/j.jacc. 2007.01.080
  10. Marousi S., Ellul J., Antonacopoulou A., Gogos C., Papathanasopoulos P., Karakantza M. Functional polymorphisms of interleukin 4 and interleukin 10 may predict evolution and functional outcome of an ischaemic stroke. Eur. J. Neurol. 2011; 18 (4): 637–43. DOI: 10.1111/j.1468-1331.2010.03228.x
  11. Marousi S., Antonacopoulou A., Kalofonos H., Papathanasopoulos P., Karakantza M., Ellul J. Functional inflammatory genotypes in ischemic stroke: could we use them to predict age of onset and long-term outcome? Stroke. Res. Treat. 2011; 2011: 792923. DOI: 10.4061/2011/792923
  12. Revilla M., Obach V., Cervera A., Dávalos A., Castillo J., Chamorro A. A -174G/C polymorphism of the interleukin-6 gene in patients with lacunar infarction. Neurosci. Lett. 2002; 324 (1): 29–32. DOI: 10.1016/s0304-3940(02)00169-6
  13. Nepal G., Yadav J.K., Kong Y. Association between K469E polymorphism of ICAM-1 gene and susceptibility of ischemic stroke: an updated meta-analysis. Mol. Genet. Genomic. Med. 2019; 7 (7): e00784. DOI: 10.1002/mgg3.784
  14. Gao H., Zhang X. Associations of intercellular adhesion molecule-1 rs5498 polymorphism with ischemic stroke: a meta-analysis. Mol. Genet. Genomic. Med. 2019; 7 (6): e643. DOI: 10.1002/mgg3.643
  15. Pola R., Flex A., Gaetani E., Flore R., Serricchio M., Pola P. Synergistic effect of -174 G/C polymorphism of the interleukin-6 gene promoter and 469 E/K polymorphism of the intercellular adhesion molecule-1 gene in Italian patients with history of ischemic stroke. Stroke. 2003; 34 (4): 881–5. DOI: 10.1161/01.STR.0000062346.70983.DF
  16. Liu Y., Geng P.L., Yan F.Q., Chen T., Wang W., Tang X.D. et al. C-reactive Protein -717A>G and -286C>T>A gene polymorphism and ischemic stroke. Chin. Med. J. (Engl). 2015; 128 (12): 1666–70. DOI: 10.4103/0366-6999.158371
  17. Brull D.J., Serrano N., Zito F., Jones L., Montgomery H.E., Rumley A. et al. Human CRP gene polymorphism influences CRP levels: implications for the prediction and pathogenesis of coronary heart disease. Arterioscler. Thromb. Vasc. Biol. 2003; 23 (11): 2063–9. DOI: 10.1161/01.ATV.0000084640.21712.9C
  18. Wilson C.J., Finch C.E., Cohen H.J. Cytokines and cognition – the case for a head-to-toe inflammatory paradigm. J. Am. Geriatr. Soc. 2002; 50 (12): 2041–56. DOI: 10.1046/j.1532-5415.2002.50619.x
  19. Reichenberg A., Yirmiya R., Schuld A., Kraus T., Haack M., Morag A., Pollmächer T. Cytokine-associated emotional and cognitive disturbances in humans. Arch. Gen. Psychiatry. 2001; 58 (5): 445–52. DOI: 10.1001/archpsyc.58.5.445
  20. Yaffe K., Lindquist K., Penninx B.W., Simonsick E.M., Pahor M., Kritchevsky S. et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology. 2003; 61 (1): 76–80. DOI: 10.1212/01.wnl.0000073620.42047.d7
  21. Tardiff B.E., Newman M.F., Saunders A.M., Strittmatter W.J., Blumenthal J.A., White W.D. et al. Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center. Ann. Thorac. Surg. 1997; 64 (3): 715–20. DOI: 10.1016/s0003-4975(97)00757-1
  22. Alberts M.J., Graffagnino C., McClenny C., DeLong D., Strittmatter W., Saunders A.M., Roses A.D. ApoE genotype and survival from intracerebral haemorrhage. Lancet. 1995; 346 (8974): 575. DOI: 10.1016/s0140-6736(95)91411-0
  23. Teasdale G.M., Nicoll J.A., Murray G., Fiddes M. Association of apolipoprotein E polymorphism with outcome after head injury. Lancet. 1997; 350 (9084): 1069–71. DOI: 10.1016/S0140-6736(97)04318-3
  24. Slooter A.J., Tang M.X., van Duijn C.M., Stern Y., Ott A., Bell K. et al. Apolipoprotein E epsilon4 and the risk of dementia with stroke. A population-based investigation. JAMA. 1997; 277 (10): 818–21. DOI: 10.1001/jama.277.10.818
  25. Sheng H., Laskowitz D.T., Bennett E., Schmechel D.E., Bart R.D., Saunders A.M et al. Apolipoprotein E isoform-specific differences in outcome from focal ischemia in transgenic mice. J. Cereb. Blood. Flow. Metab. 1998; 18 (4): 361–6. DOI: 10.1097/00004647- 199804000-00003
  26. Leung J.M., Sands L.P., Wang Y., Poon A., Kwok P.Y., Kane J.P., Pullinger C.R. Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery. Anesthesiology. 2007; 107 (3): 406–11. DOI: 10.1097/01.anes.0000278905.07899.df
  27. Heyer E.J., Wilson D.A., Sahlein D.H., Mocco J., Williams S.C., Sciacca R. et al. APOE-epsilon4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology. 2005; 65 (11): 1759–63. DOI: 10.1212/01.wnl.0000184579. 23624.6b
  28. Newman M.F., Laskowitz D.T., White W.D., Kirchner J.L., Grocott H.P., Stafford-Smith M. et al. Apolipoprotein E polymorphisms and age at first coronary artery bypass graft. Anesth. Analg. 2001; 92 (4): 824–9. DOI: 10.1097/00000539-200104000-00006
  29. Ely E.W., Girard T.D., Shintani A.K., Jackson J.C., Gordon S.M., Thomason J.W. et al. Apolipoprotein E4 polymorphism as a genetic predisposition to delirium in critically ill patients. Crit. Care. Med. 2007; 35 (1): 112–7. DOI: 10.1097/01.CCM.0000251925.18961.CA
  30. Liu C.C., Kanekiyo T., Xu H., Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy. Nat. Rev. Neurol. 2013; 9 (2): 106–18. DOI: 10.1038/nrneurol.2012.263
  31. Bartels K., Li Y.J., Li Y.W., White W.D., Laskowitz D.T., Kertai M.D. et al. Apolipoprotein epsilon 4 genotype is associated with less improvement in cognitive function five years after cardiac surgery: a retrospective cohort study. Can. J. Anaesth. 2015; 62 (6): 618–26. DOI: 10.1007/s12630-015-0337-8
  32. Weiss E.J., Bray P.F., Tayback M., Schulman S.P., Kickler T.S., Becker L.C. et al. Polymorphism of a platelet glycoprotein receptor as an inherited risk factor for coronary thrombosis. N. Engl. J. Med. 1996; 334 (17): 1090–4. DOI: 10.1056/NEJM199604253341703
  33. Carter A.M., Catto A.J., Bamford J.M., Grant P.J. Platelet GP IIIa PlA and GP Ib variable number tandem repeat polymorphisms and markers of platelet activation in acute stroke. Arterioscler. Thromb. Vasc. Biol. 1998; 18 (7): 1124–31. DOI: 10.1161/01.atv.18.7.1124
  34. Ramlawi B., Otu H., Rudolph J.L., Mieno S., Kohane I.S., Can H. et al. Genomic expression pathways associated with brain injury after cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 2007; 134 (4): 996–1005. DOI: 10.1016/j.jtcvs.2007.01.096

About Authors

  • Inna V. Koksheneva, Dr. Med. Sci., Senior Researcher; ORCID
  • Irakliy T. Zakaraya, Junior Researcher

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