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Heat shock proteins HSP70 and HSP27 in the cerebral spinal fluid of patients undergoing thoracic aneurysm repair correlate with the probability of postoperative paralysis

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Cell Stress and Chaperones Aims and scope

Abstract

An understanding of the time course and correlation with injury of heat shock proteins (HSPs) released during brain and/or spinal cord cellular stress (ischemia) is critical in understanding the role of the HSPs in cellular survival, and may provide a clinically useful biomarker of severe cellular stress. We have analyzed the levels of HSPs in the cerebrospinal fluid (CSF) from patients who are undergoing thoracic aneurysm repair. Blood and CSF samples were collected at regular intervals, and CSF was analyzed by enzyme-linked immunosorbent assay for HSP70 and HSP27. These results were correlated with intraoperative somatosensory-evoked potentials measurements and postoperative paralysis. We find that the levels of these proteins in many patients are elevated and that the degree of elevation correlates with the risk of permanent paralysis. We hypothesize that sequential measurement intraoperatively of the levels of the heat shock proteins HSP70 and HSP27 in the CSF can predict those patients who are at greatest risk for paralysis during thoracic aneurysm surgery and will allow us to develop means of preventing or attenuating this severe and often fatal complication.

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Abbreviations

TAA:

thoracic aortic aneurysm

TAAA:

thoraco-abdominal aortic aneurysm

DHCA:

deep hypothermic circulatory arrest

LA/FA:

left atrial femoral artery bypass

CABG:

coronary artery bypass graft

HSP:

heat shock protein

SSEP:

somato sensory-evoked potentials

MEP:

motor-evoked potential, EEG

TEVAR:

thoracic aortic endovascular repair

MAP:

mean arterial pressure

CNS:

central nervous system

CSF:

cerebral spinal fluid

ICP:

intracerebral pressure

ASIA:

American Spinal Injury Association

NIHSS:

NIH Stroke Scale

RSE:

residual squared error

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Acknowledgments

We would like to express our gratitude for the valuable expertise of, skillful intraoperative management by, and discussions with our cardiac anesthesia colleagues, Drs. Augostides, Cheung, Floyd, Hanson, Horak, Levy, Savino, and Weiss. We also gratefully acknowledge the cooperation of the Aortic Surgery Group of Drs. Acker, Bavaria, Pochettino, Szeto, and Woo. We also thank Dr. Andrew Ochroch for preliminary statistical analysis.

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Correspondence to James G. Hecker.

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M.L. McGarvey and J.G. Hecker contributed equally to this work.

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Hecker, J.G., Sundram, H., Zou, S. et al. Heat shock proteins HSP70 and HSP27 in the cerebral spinal fluid of patients undergoing thoracic aneurysm repair correlate with the probability of postoperative paralysis. Cell Stress and Chaperones 13, 435–446 (2008). https://doi.org/10.1007/s12192-008-0039-z

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  • DOI: https://doi.org/10.1007/s12192-008-0039-z

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