Ahmed Asfari, M.D., with a patient in the Pediatric & Congenital Heart Center of Alabama at Children’s of Alabama.
Nearly all children who undergo cardiac surgery suffer lung injury afterward, and its treatment can determine whether the injury is short-lived or will follow a child for a lifetime. That’s why the discovery at Children’s of Alabama of a new biomarker to predict which patients are at higher risk of this complication—steering the use of respiratory support—is being heralded as a groundbreaking development that may reap benefits for children far and wide.
Using samples from a Children’s biorepository, heart specialists revealed that blood levels of a protein called proteoglycan 4, commonly known as lubricin, significantly differ between children undergoing long- and short-term mechanical ventilation after cardiac surgery. Until now, physicians haven’t been able to predict which patients stood at higher risk of lung injury in this care setting.
It’s the first time the finding has been reported in the United States, said Ahmed Asfari, M.D., a cardiac intensivist at the Pediatric & Congenital Heart Center of Alabama at Children’s.
“There’s been nothing like this in regards to acute lung injury, especially for our patient population with congenital heart surgery,” said Asfari, who’s also an assistant professor in the Department of Pediatrics and Division of Cardiology at the University of Alabama at Birmingham (UAB). “When we tested the blood of patients with very long mechanical ventilation duration and compared them to patients with short duration, we found the level of this marker goes down, especially within two days of surgery.”
The discovery wouldn’t have been possible without the Children’s biorepository (left), which houses samples dating back over a decade. All patients under age 8 admitted for heart surgery had blood collected at several points in care, including before and after heart and lung bypass treatment, contributing to this research. The findings were validated at the Dr. Tannin Schmidt Lab at the University of Connecticut and published in Translational Pediatrics.
Asfari said the breakthrough likely will change the landscape for children’s care in the future. “Having the ability to have a serum biomarker that we can use to grade the level of acute lung injury will be extremely helpful,” he said.
The next stage of research will also expand insight into how widely the biomarker may be used. Blood testing now includes larger numbers of patients, along with those in different age groups and with varying cardiac physiology and anatomy, as well as those undergoing other types of surgery, and those both on and off bypass.
“The next step of our research will be doing it prospectively, looking at the patients, healthy children, and also patients with acute lung injury with different physiology—not just heart disease—and over a longer period,” Asfari said.
If the results hold, he predicts the new biomarker might one day become a gold-standard test to predict patients’ odds of suffering acute lung injury.
“It has very good potential to be used at bedside,” Asfari said. “This kind of study and research is very important to adjust the care we’ll provide for each individual patient and shines a light on the role of customized medicine for the future.”
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