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Dexmedetomidine in cardiac surgery: Emphasis on interleukin-18 signaling pathway
Bassim Mohammed Jabbar Hatemi1 , Ayesheh Enayati1 , Ali Movafegh *2 , Ali Jabbari1
1- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
2- Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran , movafegh@sina.tums.ac.ir
Abstract:   (80 Views)

Background: Dexmedetomidine (Dex), a non-opioid anesthetic and highly selective alpha2 (α2) adrenergic receptor agonist, exerts beneficial effects by mitigating inflammation and myocardial injury during cardiac surgery. These protective actions are mediated through its anti-inflammatory, anti-apoptotic, antioxidant, and anti-stress properties, as well as by the activation of the innate immune system. Notably, the immune and adrenergic systems are closely interconnected. Adrenergic receptors are expressed on both innate and adaptive immune cells, enabling them to respond directly to signals from the sympathetic nervous system.
Methods: A systematic literature search was conducted across several prominent academic databases, including PubMed, Scopus, Elsevier, and Google Scholar, from January 2015 to December 2025. To ensure focus and consistency, language restrictions were applied, limiting the included literature to English-language publications where the database functionalities permitted such filtering.
Results: Interleukin-18 (IL-18) is identified as a pro-inflammatory cytokine belonging to the interleukin-1 (IL-1) superfamily. It is produced by a variety of cell types, including macrophages, epithelial cells, T cells, neutrophils, natural killer T (NKT) cells, and B cells. Evidence suggests its involvement in the pathophysiology of several inflammatory diseases, such as ischemia/reperfusion injury, cardiac surgery complications, transplant rejection, and autoimmune disorders.
Conclusion: Dex is posited to enhance postoperative cardiac function by modulating the immune system through the attenuation of IL-18 secretion from immune cells, consequently mitigating inflammatory responses in the context of cardiac surgery. This review aims to investigate the intricate interplay between cardiac pathologies and IL-18, while also elucidating the IL-18 signaling pathways influenced by Dex in the setting of open-heart surgery.
 

Keywords: Dexmedetomidine, Alpha 2 Adrenergic Receptor, Thoracic Surgery, Interleukin-18, Inflammation, Sympatholytics
     
Article Type: Review | Subject: Medicine
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