Redox Imbalance in Coronary Artery Bypass Grafting: The Clinical Significance of Aminothiols

Coronary artery bypass grafting (CABG) is a vital intervention for severe coronary artery disease, yet it induces significant oxidative stress, contributing to postoperative complications and long-term cardiovascular risks. Aminothiols, including glutathione, homocysteine, cysteine, and cysteinylglycine, are key regulators of redox homeostasis, making them promising biomarkers for assessing oxidative stress in CABG patients. This narrative review explores their biochemical roles, measurement techniques, and associations with clinical outcomes. Glutathione mitigates reactive oxygen species (ROS) through the glutathione redox cycle, while elevated homocysteine promotes oxidative damage and inflammation, linked to complications like atrial fibrillation and acute kidney injury. Cysteine and cysteinylglycine further support redox balance, with their dysregulation reflecting perioperative stress. Studies demonstrate that altered aminothiol levels pre- and post-CABG correlate with adverse outcomes, including myocardial injury, graft restenosis, and major adverse cardiovascular events. Advanced analytical methods like high-performance liquid chromatography and liquid chromatography-mass spectrometry enable precise aminothiol quantification, although variability and lack of standardization pose challenges. Therapeutic interventions, such as N-acetylcysteine and folate supplementation, show potential to modulate aminothiol levels and reduce oxidative stress. Despite these insights, gaps in longitudinal data and assay standardization limit clinical adoption. Future research should focus on standardized protocols, large-scale studies, and metabolomics to integrate aminothiols into personalized medicine, enhancing risk stratification and therapeutic strategies for improved CABG outcomes. Overall, this narrative review synthesizes available data on aminothiols and oxidative stress in CABG, with the objective of identifying knowledge gaps and potential pathways for translational and clinical application.

• Publication year

  2025

• Venue

  Cureus

• Publication date

  2025-11-01

• Fields of study

  Medicine, Chemistry

• Identifiers
  DOI 10.7759/cureus.96384PMID 41367470PMCID 12685385
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Pharmacological Cardioprotection against Ischemia Reperfusion Injury—The Search for a Clinical Effective Therapy

  2023cited by this paper
• Oxidative Stress in Patients before and after On-Pump and Off-Pump Coronary Artery Bypass Grafting: Relationship with Syntax Score

  2021cited by this paper
• Stroke After Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention: Incidence, Pathogenesis, and Outcomes

  2019cited by this paper
• Homocysteine Modification in Protein Structure/Function and Human Disease.

  2019cited by this paper
• Oxidative stress and cardiovascular disease: new insights.

  2018cited by this paper
• A robust and versatile mass spectrometry platform for comprehensive assessment of the thiol redox metabolome

  2018cited by this paper
• Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting

  2017influential reference
• Emerging applications of metabolomics in drug discovery and precision medicine

  2016cited by this paper
• Metabolomics enables precision medicine: “A White Paper, Community Perspective”

  2016cited by this paper
• Metabolomics: beyond biomarkers and towards mechanisms

  2016cited by this paper
• The Role of Oxidative Stress in Myocardial Ischemia and Reperfusion Injury and Remodeling: Revisited

  2016cited by this paper
• Novel Biomarker of Oxidative Stress Is Associated With Risk of Death in Patients With Coronary Artery Disease

  2016influential reference
• Cardiopulmonary Bypass and Oxidative Stress

  2015influential reference
• Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery.

  2015cited by this paper
• Role of homocysteine in the development of cardiovascular disease

  2015influential reference
• Plasma Levels of Homocysteine and Cysteine Increased in Pediatric NAFLD and Strongly Correlated with Severity of Liver Damage

  2014influential reference
• Glutathione synthesis.

  2013influential reference
• A new LC-MS/MS method for the clinical determination of reduced and oxidized glutathione from whole blood.

  2013cited by this paper
• Analysis of GSH and GSSG after derivatization with N-ethylmaleimide

  2013cited by this paper
• A randomized controlled trial to prevent post-operative atrial fibrillation by antioxidant reinforcement.

  2013influential reference
• Glutathione catalysis and the reaction mechanisms of glutathione-dependent enzymes.

  2013cited by this paper
• The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion.

  2012cited by this paper
• Postoperative acute kidney injury is associated with hemoglobinemia and an enhanced oxidative stress response.

  2011cited by this paper
• 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

  2011cited by this paper
• Atorvastatin Inhibits gp91phox Circulating Levels in Patients With Hypercholesterolemia

  2010cited by this paper
• Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.

  2009cited by this paper
• Glutathione: overview of its protective roles, measurement, and biosynthesis.

  2009influential reference
• The treatment of hyperhomocysteinemia.

  2009cited by this paper
• Determination of glutathione and glutathione disulfide in biological samples: an in-depth review.

  2009cited by this paper
• Hyperhomocysteinemia Promotes Inflammatory Monocyte Generation and Accelerates Atherosclerosis in Transgenic Cystathionine &bgr;-Synthase–Deficient Mice

  2009cited by this paper
• N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study.

  2008cited by this paper
• Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials.

  2008influential reference
• The Pathophysiology of Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI)

  2008cited by this paper
• Simultaneous determination of total homocysteine, cysteine, cysteinylglycine, and glutathione in human plasma by high-performance liquid chromatography: application to studies of oxidative stress.

  2007cited by this paper
• Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery.

  2006cited by this paper
• The role of oxidants and free radicals in reperfusion injury.

  2006cited by this paper
• The sulfur-containing amino acids: an overview.

  2006cited by this paper
• Writing narrative literature reviews for peer-reviewed journals: secrets of the trade.

  2006cited by this paper
• Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis of randomized controlled trials.

  2006influential reference
• Redox modifications of protein-thiols: emerging roles in cell signaling.

  2006influential reference
• Balancing the strengths of systematic and narrative reviews.

  2005cited by this paper
• Early postoperative function of the heart after coronary artery bypass grafting is not predicted by myocardial necrosis and glutathione-associated oxidative stress.

  2005influential reference
• Facts and recommendations about total homocysteine determinations: an expert opinion.

  2004cited by this paper
• Extracellular thiols and thiol/disulfide redox in metabolism.

  2004influential reference
• Role of the endothelium in modulating neointimal formation: vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions.

  2004cited by this paper
• Cardiopulmonary bypass as a cause of free radical-induced oxidative stress and enhanced blood-borne isoprostanes in humans.

  2003influential reference
• Oxidative stress and acute lung injury.

  2003cited by this paper
• Redox potential of GSH/GSSG couple: assay and biological significance.

  2002cited by this paper
• Systemic Free Radical Activation Is a Major Event Involved In Myocardial Oxidative Stress Related to Cardiopulmonary Bypass

  2002cited by this paper
• Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis

  2002cited by this paper
• Decreased rate of coronary restenosis after lowering of plasma homocysteine levels.

  2001cited by this paper
• Measurement of homocysteine and other aminothiols in plasma: advantages of using tris(2-carboxyethyl)phosphine as reductant compared with tri-n-butylphosphine.

  2001cited by this paper
• Homocysteine and atherothrombosis.

  1998influential reference
• The Pathophysiology of Vasomotor Dysfunction

  1997cited by this paper
• Oxidative stress: oxidants and antioxidants

  1997cited by this paper
• Homocysteine and vascular disease

  1996cited by this paper
• The role of nitric oxide and cell adhesion molecules on the microcirculation in ischaemia-reperfusion.

  1996cited by this paper
• Endothelial cell injury in cardiovascular surgery: the pathophysiology of vasomotor dysfunction.

  1996cited by this paper
• Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years.

  1996cited by this paper
• Reduced, oxidized and protein-bound forms of homocysteine and other aminothiols in plasma comprise the redox thiol status--a possible element of the extracellular antioxidant defense system.

  1996cited by this paper

• No citing papers are available for this paper.