Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery.
OBJECTIVE
To investigate whether ulinastatin pretreatment (6000 U.kg-1 before CPB and before declamping of aorta) influenced the production of cytokines and adhesion molecules in the peripheral circulation.


METHODS
This prospective randomized study was performed in 22 patients undergoing cardiac surgery. They were divided into two groups. Patients in Group I were untreated and in Group II treated with ulinastatin. The soluble intercellular adhesion molecule-1 (S-ICAM-1), soluble endothelial leukocyte adhesion molecule-1 (S-ELAM-1), interleukin 8 and 6 (IL- 8, 6) were measured using ELISA kits.


RESULTS
Serum S-ICAM-1 concentration in Group I increased from the preoperative value of 297 +/- 27 ng.kg-1 to 418 +/- 106 ng.kg-1 at 60 min after declamping of the aorta (P < 0.01) but did not change in Group II. Serum S-ELAM-1 concentration did not change in either group. Serum concentration of IL-8 and IL-6 in Group I (37 +/- 44 pg.kg-1, and 59 +/- 59 pg.kg-1, preoperatively) increased to 169 +/- 86 pg.kg-1 and 436 +/- 143 pg.kg-1 at 60 min after declamping of the aorta (P < 0.001, P < 0.001). The increases were greater than those from 25 +/- 6 pg.kg-1 and 30 +/- 26 pg.kg-1 to 56 +/- 36 pg.kg-1 and 132 +/- 78 pg.kg-1 in Group II (P < 0.001, P < 0.001). The levels of S-ICAM-1 correlated with those of IL-8 (r = 0.5, P < 0.001).


CONCLUSIONS
These results suggest that ulinastatin may suppress the increase in IL-8 production and the expression of ICAM-1 during cardiac surgery.
Kawamura
T
T
Department of Anaesthesia, School of Medicine, Iwate Medical University, Japan.
Inada
K
K
Akasaka
N
N
Wakusawa
R
R
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D019040:E-Selectin / Q000097:blood*; D006023:Glycoproteins / Q000494:pharmacology*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D014361:Trypsin Inhibitors / Q000494:pharmacology*
D019040:E-Selectin; D006023:Glycoproteins; D015850:Interleukin-6; D016209:Interleukin-8; D014361:Trypsin Inhibitors; D018799:Intercellular Adhesion Molecule-1; C028665:urinastatin