Beta-chemokine secretion patterns in relation to clinical course and outcome in children after cardiopulmonary bypass: continuing the search to abrogate systemic inflammatory response.
BACKGROUND
Surgery involving cardiopulmonary bypass (CPB) is frequently accompanied by a systemic inflammatory response partly triggered by neutrophils and monocyte-macrophages. Certain cytokines that are powerful leukocyte-chemotactic factors have recently been characterized and shown to be important in evoking inflammatory responses: monocyte chemoattractant protein-1 (MCP-1) has monocyte-macrophage chemotactic activity, and regulated-upon-activation normal T-cell expressed and secreted (RANTES) has a potent chemoattractant activity for mononuclear phagocytes. This prospective cohort study investigated possible roles of these chemokines in the inflammatory response to CPB and relationships between the changes in chemokine levels and the clinical course and outcome.


METHODS
Systemic blood of 16 children undergoing CPB was collected after induction of anesthesia (base line); at 15 minutes after bypass onset; at CPB cessation; and at 1, 2, 4, 8, 12, and 24 hours afterward to measure MCP-1 and RANTES.


RESULTS
The significant changes of plasma beta chemokine levels following CPB were associated with patient characteristics, operative variables, and postoperative course. Cardiopulmonary bypass of more than 2 hours, longer surgical times, inotropic support, and reoperation were associated with higher MCP-1 levels and lower RANTES levels.


CONCLUSIONS
Our results suggest a relation between CPB-induced mediators and clinical effects, implying pathogenic roles for chemokines following CPB. These molecules should be considered as possible targets for therapeutic intervention.
Lotan
D
D
Department of Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Zilberman
D
D
Dagan
O
O
Keller
N
N
Ben-Abraham
R
R
Weinbroum
A A
AA
Harel
R
R
Barzilay
Z
Z
Paret
G
G
D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D018932:Chemokine CCL2 / Q000097:blood; D018946:Chemokine CCL5 / Q000378:metabolism; D018925:Chemokines / Q000097:blood / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000378:metabolism / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology*
D018932:Chemokine CCL2; D018946:Chemokine CCL5; D018925:Chemokines