The antiendotoxin agent taurolidine potentially reduces ischemia/reperfusion injury through its metabolite taurine

Doddakula, Kishore K.; Neary, Peter M.; Wang, Jiang H.; Sookhai, Shastri; O'Donnell, Aongus; Aherne, Tom; Bouchier-Hayes, David J.; Redmond, Henry P.

doi:10.1016/j.surg.2010.01.006

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Volume 148, Issue 3 , Pages 567-572, September 2010

The antiendotoxin agent taurolidine potentially reduces ischemia/reperfusion injury through its metabolite taurine

Kishore K. Doddakula, Mch
- Department of Cardiac Surgery, University College Cork, Cork University Hospital, Cork, Ireland
Peter M. Neary, MB
- Academic Department of Surgery, University College Cork, Cork University Hospital, Cork, Ireland
Jiang H. Wang, PhD
- Academic Department of Surgery, University College Cork, Cork University Hospital, Cork, Ireland
Shastri Sookhai, MD, FRCSI
- Academic Department of Surgery, University College Cork, Cork University Hospital, Cork, Ireland
Aongus O'Donnell, MD, FRCSI(CTh)
- Department of Cardiac Surgery, University College Cork, Cork University Hospital, Cork, Ireland
Tom Aherne, MB, FRCSI
- Department of Cardiac Surgery, University College Cork, Cork University Hospital, Cork, Ireland
David J. Bouchier-Hayes, MD, FRCS
- Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
Henry P. Redmond, Mch, FRCSI
- Academic Department of Surgery, University College Cork, Cork University Hospital, Cork, Ireland
- Reprint requests: Henry P. Redmond, Mch, FRCSI, Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland.

Accepted 14 January 2010. published online 12 March 2010.

Background

Cardiopulmonary bypass results in ischemia/reperfusion (I/R)-induced endotoxemia. We conducted a prospective randomized trial to investigate the effect of taurolidine, an antiendotoxin agent with antioxidant and membrane-stabilizing properties, on patients undergoing coronary artery bypass grafting (CABG).

Methods

A total of 60 patients undergoing CABG were randomized into 4 groups. St Thomas' Hospital cold crystalloid cardioplegia was used in groups A and B, and cold blood cardioplegia in groups C and D. Groups A and C received a placebo infusion of normal saline, whereas groups B and D were administered intravenous taurolidine. Arrhythmias induced by pro- and anti-inflammatory cytokines (interleukin [IL]-6 and IL-10), and I/R were assessed perioperatively.

Results

Administration of taurolidine in crystalloid cardioplegia patients resulted in a significant decrease in serum IL-6 and an increase in serum IL-10 at 24 hours postaortic unclamping compared to placebo (P < .0001). Although not statistically significant, this trend in serum IL-6 decrease was mirrored in the blood cardioplegia patients (P = .068). Taurolidine treatment also significantly decreased I/R-induced arrhythmias compared to placebo in the crystalloid cardioplegia patients (P < .003). There were fewer I/R-induced arrhythmias compared to placebo in the blood cardioplegia patients; the difference, however, was marginal and not statistically significant (P = .583).

Conclusion

This study demonstrates that administration of taurolidine in CABG patients induces a potent anti-inflammatory response that is associated with a significant decrease in arrhythmias.