SAFER SURGERY: CU med school team looks at ways to decrease organ damage during surgical procedures

CU Med School researcher points to possibility of a drug that could help prevent damage to internal organs during surgeries

BY SARA CASTELLANOS, Staff Writer

AURORA | Surgery might be a bit less frightening for patients five years from now.

That’s because doctors at the University of Colorado School of Medicine have discovered a group of molecules that could ultimately prevent damage to the body’s organs during surgeries that require anesthesia.

Dr. Almut Grenz (left) and Dr. Holger Eltzschig (right) pose in their laboratory, Jan. 28 at Anschutz Medical Campus. Grenz and Eltzchig have been involved in a research study that identified a group of molecules that has the potential for decreasing damage to organs during procedures that require anesthesia.  (Marla R. Keown/Aurora Sentinel)
Dr. Almut Grenz (left) and Dr. Holger Eltzschig (right) pose in their laboratory, Jan. 28 at Anschutz Medical Campus. Grenz and Eltzchig have been involved in a research study that identified a group of molecules that has the potential for decreasing damage to organs during procedures that require anesthesia. (Marla R. Keown/Aurora Sentinel)

The study is important because “acute,” or severe, organ injury is one of the leading causes of death in patients who have had surgeries.

The study, published in the New England Journal of Medicine in December 2012, marks the first step in the path toward identifying a possible drug that patients could take before or during surgery to lessen harm to organs.

But that’s still about five years away, said Dr. Holger Eltzschig, an anesthesiologist and professor of anesthesiology at the University of Colorado School of Medicine who led the research study.

Eltzschig and his team at the University of Colorado School of Medicine have been researching ways to make surgery safer for more than a decade.

“We’re looking for new drugs that we can give a patient to protect the kidneys, heart or lungs during a surgical intervention,” Eltzschig said.

Finding ways to prevent harm to organs during surgeries that require anesthesia is important, Eltzschig said.

“In today’s world, probably the biggest fear for a patient who is going to have a surgery is that one of the organs is going to fail,” he said. “This can happen even in a perfectly well-done operation.”

For example, if an overweight person with diabetes goes through an intense operation like open-heart surgery, the chances of harm to other organs, namely the kidneys, increases drastically, he said.

Severe kidney injury can occur in up to 20 percent of cases where the patients have a pre-existing renal disease before they undergo any type of surgery, he said.

However, in perfectly healthy surgery patients, the risk of harm to organs is less than 1 percent, he said.

It’s not the anesthesia that leads to severe organ injury in surgeries, Eltzschig said. In fact, anesthesia has become increasingly safe over the past five decades. “Fifty years ago you really had to be nervous about undergoing anesthesia,” Eltzschig said. Back then, there were higher chances of a surgery going awry or the anesthetic threatening a person’s life. Even though anesthesia has become safer over the past 50 years, the mortality rate in surgical patients hasn’t dramatically changed. Doctors think that organs can be harmed during a surgery because of the actual act of surgery itself, rather than the anesthesia.

Eltzschig and his team discovered that many acute organ injuries during surgery were due to a lack of oxygen, or in medical terms, the organ injuries resulted from hypoxia.

Eltzschig helped identify a group of molecules called purines that could help counteract the effects of hypoxia and increase oxygen levels in red blood cells. One of those molecules is called adenosine, but that molecule alone doesn’t have a strong ability to successfully prevent organ injury.

Eltzschig says a man-made, artificial drug that acts like adenosine could have better chances at increasing oxygen levels and preventing injury to organs.

Eltzschig’s study results show that when mice are given an artificial adenosine-like drug, acute kidney injury is prevented. The hope is that humans will benefit from an adenosine-like drug as well.

The next step in the study is to determine how safe adenosine-like drugs are for humans, and to apply for federal grant funding to start clinical trials. “It’s going to take a combination of help from the pharmaceutical industry and the NIH (National Institutes of Health) to fund clinical trials that are going to take these basic research observations from the bench to the bedside,” Eltzschig said.

Dr. Almut Grenz, an assistant professor of anesthesiology who helped Eltzschig in the research, said the results of the study are exciting.

“It would be great if we can get that (adenosine-like) compound in the clinic and give it to the patient before surgery and during surgery and see if it’s protective,” she said.

For Eltzschig and Grenz, both of whom are German-born scientists, the idea of making a positive impact in the lives of surgery patients is thrilling.

“I love nothing else more than doing research,” she said. “I see the need for treatment to prevent diseases, and it’s a wonderful challenge.”

Reach reporter Sara Castellanos at 720-449-9036 or sara@aurorasentinel.com.

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