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Carboxypeptidase N concentration during cardiopulmonary bypass in humans

Canadian Journal of Anaesthesia volume 39, pages 54–59 (1992)Cite this article

Abstract

Carboxypeptidase N (CPN) is an inactivator of anaphylatoxins and kinins, peptides implicated in the pathogenesis of complications in extracorporeal circulation. To investigate whether the level of CPN is altered during cardiopulmonary bypass (CPB) we studied 15 patients undergoing cardiac surgery utilizing CPB. The concentration of CPN decreased to about 48% of the initial value upon initiation of CPB and remained low throughout the procedure. A similar decrease was observed in the level of alkaline phosphatase, an enzyme that was measured to assess the degree of haemodilution. When the data were normalized for dilution, no difference in the concentration of CPN was observed during CPB. Moreover, no changes in the concentration of CPN were observed when protamine was given to neutralize heparin and none of the 15 patients experienced any side-effects of protamine administration. We conclude that the decrease in CPN during CPB was due primarily to dilution and not to changes in CPN synthesis or catabolism. Protamine administration is not associated with significant changes in the level of CPN in patients who have an asymptomatic reversal of heparin anti-coagulation.

Résumé

La carboxypeptidase N (CPN) est un inactivateur des anaphylatoxines et des kinines impliqué dans la pathogénèse des complications lors d’une circulation extracorporelle. Afin d’investiguer si le niveau de CPN est altéré durant la CEC, on a étudié 15 patients devant subir une chirurgie cardiaque sous CEC. La concentration de CPN a diminué jusqu’à 48% de la valeur initiale au début de la CEC et est demeurée basse durant la procédure. Une diminution similaire fut observée au niveau des phosphatases alcalines, un enzyme qui s’est mesuré afin d’évaluer le degré d’hémodilution. Quand les données furent normalisées pour la dilution, aucune différence dans la concentration de CPM ne fut observée durant la CEC. De plus, aucun changement dans la concentration de CPN ne fut observé quand la protamine fut administrée afin de neutraliser l’héparine et aucun des 15 patients n ’a démontré des effets secondaires lors de l’administration de la protamine. On conclut que la diminution du CPN lors de la CEC était due principalement à la dilution et non aux changements de la synthèse de la CPN ou son catabolisme. L’administration de protamine n’est pas associée aux changements significatifs dans le niveau de CPN aux patients chez qui on a renversé l’anticoagulation due à l’héparine sans incident.

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Author information

Affiliations

  1. Department of Anesthesiology, University of Illinois College of Medicine at Chicago and Humana Hospital-Michael Reese, Chicago, Illinois

    Sara F. Rabito & William Soden

  2. Department of Pharmacology, University of Illinois College of Medicine at Chicago and Humana Hospital-Michael Reese, Chicago, Illinois

    Robert Anders & Randal A. Skidgel

Authors
  1. Sara F. Rabito
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  2. Robert Anders
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  3. William Soden
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  4. Randal A. Skidgel
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Additional information

These studies were supported in part by National Institutes of Health grants DK 41431 and HL 36473.

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Rabito, S.F., Anders, R., Soden, W. et al. Carboxypeptidase N concentration during cardiopulmonary bypass in humans. Can J Anaesth 39, 54–59 (1992). https://doi.org/10.1007/BF03008673

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Key words

  • Anaesthesia: cardiac
  • Blood: coagulation, protamine
  • Enzymes: carboxypeptidase N
  • Polypeptides: anaphylatoxin, kinins