Perioperative changes in the plasma metabolome of patients receiving general anesthesia for pancreatic cancer surgery
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Johanna Mock-Ohnesorge1, Andreas Mock2,3,4, Thilo Hackert5, Stefan Fröhling3,4, Judith Schenz1, Gernot Poschet6, Dirk Jäger2,4, Markus W. Büchler5, Florian Uhle1 and Markus A. Weigand1
1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
2 Department of Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
3 Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
4 German Cancer Consortium (DKTK), Heidelberg, Germany
5 Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
6 Centre for Organismal Studies (COS), University of Heidelberg, Heidelberg, Germany
Keywords: metabolomics; anesthesia; plasma; tumor; longitudinal
Received: February 25, 2021 Accepted: April 19, 2021 Published: May 11, 2021
Background: Modern anesthesia strives to offer personalized concepts to meet the patient’s individual needs in sight of clinical outcome. Still, little is known about the impact of anesthesia on the plasma metabolome, although many metabolites have been shown to modulate the function of various immune cells, making it particularly interesting in the context of oncological surgery. In this study longitudinal dynamics in the plasma metabolome during general anesthesia in patients undergoing pancreatic surgery were analyzed.
Materials and Methods: Prospective, observational study with 10 patients diagnosed with pancreatic (pre-) malignancy and subjected to elective resection surgery under general anesthesia. Plasma metabolites (n = 630) were quantified at eight consecutive perioperative timepoints using mass spectrometry-based targeted metabolomics.
Results: 39 metabolites significantly changed during the perioperative period. Tryptophan concentrations decreased by 45% with the maximum decrease after anesthesia induction (p = 6.24E-07), while taurine synthesis increased (p = 1.46E-04). Triacylglycerides and lysophosphatidylcholines were significantly reduced with increased liberation of free monounsaturated fatty acids (p = 0.03). Carnitine levels decreased significantly (p = 9.30E-04).
Conclusions: The major finding of this study was perioperative tryptophan depletion and increased taurine synthesis. Both are essential for immune cell function and are therefore of significant interest for perioperative management. Further studies are needed to identify influencing anesthetic factors.
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