Yanuarso Piprim B, Djer Mulyadi M, Hendarto Aryono, Pudjiadi Antonius H, Rachmadi Lisnawati, Wibowo Heri, Advani Najib, Murni Indah K, Kekalih Aria, Sukardi Rubiana, Dilawar Ismail, Susanti Dhama S, Supriatna Novianti
Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Narra J. 2025 Apr;5(1):e2138. doi: 10.52225/narra.v5i1.2138. Epub 2025 Mar 24.
Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-ιβ (IL-ιβ), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-ιβ, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n = 22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n = 22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p = 0.015), caspase-1 protein expression (p = 0.001), and IL-10 levels between after intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between after intervention and 48 hours post-surgery (p = 0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-ιβ levels indicate alternative regulatory mechanisms.
法洛四联症（TOF）矫正手术中的体外循环通过激活NLRP3、半胱天冬酶 -1和白细胞介素 -ιβ（IL -ιβ）引发炎症反应增强，随后触发白细胞介素 -10（IL -10）反应。尽管改良阿特金斯饮食（MAD）具有已知的代谢和抗炎作用，但在小儿心脏手术中的影响仍未得到探索，尚无关于其在接受心脏直视手术的TOF患者中应用的研究。本研究的目的是评估MAD对接受心脏直视手术的TOF患者中NLRP3、半胱天冬酶 -1、IL -ιβ和IL -10表达的影响。对44例TOF患者进行了双臂随机对照试验。治疗组（n = 22）接受MAD，即术前至少14天采用低碳水化合物、高脂肪饮食方案，脂肪和蛋白质摄入量不受限制，而对照组（n = 22）遵循无碳水化合物限制的标准饮食。收集血浆和漏斗部心脏组织进行分析。在干预前使用翼形输液针采集全血样本，干预14天后使用Abbocath输液针采集，在心脏手术矫正后6、24和48小时，对接受心脏直视手术的患者使用连接动脉管路的无针注射器采集。在心脏直视手术期间收集漏斗部心脏组织。本研究表明，与对照组相比，MAD组干预后与术后6、24和48小时之间，NLRP3蛋白表达（p = 0.015）、半胱天冬酶 -1蛋白表达（p = 0.001）和IL -10水平存在显著差异。相比之下，对照组干预后与术后48小时之间IL -10水平未观察到显著差异（p = 0.654）。总之，MAD可能通过下调NLRP3和半胱天冬酶 -1表达同时维持IL -10水平来调节接受心脏直视手术的TOF患者围手术期的炎症反应。尽管NLRP3和半胱天冬酶 -1表达降低，但IL -ιβ水平未变表明存在其他调节机制。
