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Prophylactic treatment with alkaline phosphatase in cardiac surgery induces endogenous alkaline phosphatase release.
MedLine Citation:
PMID:  22395920     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Introduction: Laboratory and clinical data have implicated endotoxin as an important factor in the inflammatory response to cardiopulmonary bypass. We assessed the effects of the administration of bovine intestinal alkaline phosphatase (bIAP), an endotoxin detoxifier, on alkaline phosphatase levels in patients undergoing coronary artery bypass grafting.?Methods: A total of 63 patients undergoing coronary artery bypass grafting were enrolled and prospectively randomized. Bovine intestinal alkaline phosphatase (n=32) or placebo (n=31) was administered as an intravenous bolus followed by continuous infusion for 36 hours. The primary endpoint was to evaluate alkaline phosphatase levels in both groups and to find out if administration of bIAP to patients undergoing CABG would lead to endogenous alkaline phosphatase release.?Results: No significant adverse effects were identified in either group. In all the 32 patients of the bIAP-treated group, we found an initial rise of plasma alkaline phosphatase levels due to bolus administration (464.27±176.17 IU/L). A significant increase of plasma alkaline phosphatase at 4-6 hours postoperatively was observed (354.97±95.00 IU/L) as well. Using LHA inhibition, it was shown that this second peak was caused by the generation of Tissue Non Specific Alkaline Phosphatase (TNSALP-type alkaline phosphatase).?Conclusions: Intravenous bolus administration plus 8 hours continuous infusion of alkaline phosphatase in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass results in endogenous alkaline phosphatase release. This endogenous alkaline phosphatase may play a role in the immune defense system.
Authors:
Suzanne Kats; Ruud Brands; Mohamed A Soliman Hamad; Willem Seinen; Volkher Scharnhorst; Raymond W Wulkan; Jacques P Schönberger; Wim van Oeveren
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-7
Journal Detail:
Title:  The International journal of artificial organs     Volume:  -     ISSN:  1724-6040     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  -    
Other Details:
Languages:  ENG     Pagination:  0     Citation Subset:  -    
Affiliation:
Department of Cardiothoracic Surgery, MUMC, Maastricht - The Netherlands.
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