Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10.
BACKGROUND
Proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8 play a key role in the inflammatory cascade after cardiopulmonary bypass (CPB) and may induce cardiac and lung dysfunction. Antiinflammatory cytokines such as IL-10 may also significantly limit these complications. Corticosteroid administration before CPB increases blood IL-10 levels and prevents proinflammatory cytokine release. This study examined the association of increased release of IL-10, stimulated by steroid pretreatment, with reduced myocardial and lung injury after CPB.


METHODS
Twenty patients undergoing coronary artery bypass grafting (CABG) received either preoperative steroid (n = 10, protocol group) or no steroid (n = 10, control group). Perioperative care was standardized, and all caregivers were blinded to treatment group. Seven intervals of blood samples were obtained and assayed for TNF-alpha, IL-6, IL-8, and IL-10. Various hemodynamic and pulmonary measurements were obtained perioperatively. Levels of MB isoenzyme creatine kinase (CK-MB) were also measured.


RESULTS
In the protocol group, proinflammatory cytokines were significantly reduced while IL-10 levels were much higher after CPB. The protocol group had a lower alveolar-arterial oxygen gradient and higher ratio of arterial oxygen pressure to fraction of inspired oxygen after CPB. Creatine kinase (CK) and CK-MB were reduced in the patients treated with steroid. Correlations were found between plasma cytokines levels and cardiac index, and CK-MB.


CONCLUSIONS
This study confirms that corticosteroids abolish proinflammatory cytokines release and increase blood IL-10 levels after CPB. Our findings demonstrate a greater release of IL-10 induced by steroid pretreatment, and better heart and lung protection after CPB.
Giomarelli
Pierpaolo
P
Institute of Thoracic and Cardiovascular Surgery, University of Siena, Siena, Italy. giomarelli@unisi.it
Scolletta
Sabino
S
Borrelli
Emma
E
Biagioli
Bonizella
B
D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D016207:Cytokines / Q000032:analysis / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000209:etiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10