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Die Effekte der Herz-Lungen-Maschine auf das intestinale Mikrobiom und die Relation zum postoperativen SIRS

The effects of the cardiopulmonary bypass on the gut microbiome and its contribution to postoperative SIRS

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Herz-Lungen-Maschine (HLM) ist der Grundbaustein der Herzchirurgie. Ihre Anwendung bleibt heutzutage weiterhin bei der Mehrzahl an kardiochirurgischen Operationen unentbehrlich. Trotz ihrer fast 70-jährigen Existenz und zahlreichen technischen Designverbesserungen repräsentiert sie eine invasive Intervention in die physiologische Integrität des menschlichen Körpers. Diese Nebeneffekte zeigen sich in der Form des systemisch inflammatorischen Response-Syndroms (SIRS), das in seiner schwersten Form mit einer Inzidenz von 10–20 % in eine überschießende Immunantwort mit nahezu unkontrollierbarer hämodynamischer Instabilität münden kann und letale und komplikationsträchtige Therapieergebnisse für das kardiochirurgische Patientenkollektiv bringt. Interessanterweise sind die Veränderungen des intestinalen Mikrobioms unter HLM-Anwendung trotz ihrer fundamentalen immunregulatorischen Rolle noch nicht ausreichend untersucht worden. Unser Projekt zielt darauf ab zu identifizieren, wie sich Mikrobiom, Metagenom und Metabolom post-HLM verändern, und diese Erkenntnisse mit der Aktivierung verschiedener Inflammationsmechanismen und dem postoperativen Verlauf der Patienten zu korrelieren. Die Aufklärung eines Zusammenhangs zwischen Mikrobiomveränderung und SIRS-Mechanismen kann in innovative translationale Therapieansätze für die SIRS-Bewältigung durch Mikrobiommodulation resultieren. Darüber hinaus kann die Identifizierung von SIRS-suszeptiblen Ausgangsmikrobiomkompositionen ein Instrument zur präoperativen Risikostratifizierung bieten.

Abstract

Cardiopulmonary bypass (CPB) made cardiac surgery possible. Despite its almost 70 years of existence and countless design improvements, it still represents one of the most invasive interventions on the human body’s physiological integrity. The adverse effects of CPB present as systemic inflammatory response syndrome (SIRS), which in its most severe form with an incidence between 10% and 20% causes metabolic and immunological mayhem, accounting in many cases for uncontrollable hemodynamic, respiratory, and coagulative instability that may result in high rates of morbidity and mortality. Interestingly, the alterations of the intestinal microbiome during CPB and their role in immune regulation have not been thoroughly investigated. Our scientific efforts aim to identify compositional and metabolic shifts in the microbiome after CPB using metagenomics and metabolomics, to correlate these findings to the postoperative clinical outcomes of the patients, and to reveal a possible mechanistic link to the etiology SIRS. This could generate novel translational and therapeutic approaches for amelioration of SIRS after CPB-assisted cardiac surgery based on microbiome modulation. Furthermore, the detection of specific baseline microbiome compositions prone to SIRS susceptibility may provide a tool for risk stratification.

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Authors and Affiliations

  1. Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353, Berlin, Deutschland

    Hristian Hinkov, Timo Z. Nazari-Shafti, Sebastian Neuber, Heike Meyborg, Katrin Krüger, Volkmar Falk & Maximilian Y. Emmert

  2. Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Hristian Hinkov, Lajos Markó, Timo Z. Nazari-Shafti, Sebastian Neuber, Heike Meyborg, Katrin Krüger, Sofia K. Forslund, Dominik N. Müller, Volkmar Falk & Maximilian Y. Emmert

  3. Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, Berlin, Deutschland

    Hristian Hinkov, Lajos Markó, Timo Z. Nazari-Shafti, Sebastian Neuber, Sofia K. Forslund, Dominik N. Müller, Volkmar Falk & Maximilian Y. Emmert

  4. Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft, Berlin, Deutschland

    Lajos Markó, Sofia K. Forslund & Dominik N. Müller

  5. Experimental and Clinical Research Center, A Joint Cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    Lajos Markó, Sofia K. Forslund & Dominik N. Müller

  6. Berliner Institut für Gesundheitsforschung in der Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Timo Z. Nazari-Shafti & Sebastian Neuber

  7. European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Deutschland

    Sofia K. Forslund

  8. Klinik für Herzchirurgie, Universitätsspital Zürich, Zürich, Schweiz

    Héctor Rodriguez

  9. Klinik für Herzchirurgie, Stadtspital Triemli, Zürich, Schweiz

    Héctor Rodriguez

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  1. Hristian Hinkov
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Correspondence to Hristian Hinkov.

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Interessenkonflikt

H. Hinkov, L. Markó, T.Z. Nazari-Shafti, S. Neuber, H. Meyborg, K. Krüger, S.K. Forslund, D.N. Müller, V. Falk, M.Y. Emmert und H. Rodriguez geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Das dargestellte Projektvorhaben ist mit dem Dr. Rusche-Forschungspreis der Deutschen Stiftung für Herzforschung (DSHF) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) für das Jahr 2023 ausgezeichnet.

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Hinkov, H., Markó, L., Nazari-Shafti, T.Z. et al. Die Effekte der Herz-Lungen-Maschine auf das intestinale Mikrobiom und die Relation zum postoperativen SIRS. Z Herz- Thorax- Gefäßchir 37, 315–323 (2023). https://doi.org/10.1007/s00398-023-00590-6

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