title: Stress induced IL-10 does not seem to be essential for early monocyte deactivation following cardiac surgery.
abstract: An increase in circulating levels of IL-10 is believed to contribute to immunosuppression caused by major surgery. Cortisol and catecholamines have been shown to be important costimulatory factors for IL-10 secretion in humans. As thoracic epidural block (TEB) should blunt the perioperative increases in cortisol and catecholamines we investigated whether IL-10 secretion is influenced by TEB. Twenty-six patients undergoing coronary artery bypass graft surgery using cardiopulmonary bypass were randomized to receive either general anesthesia (GA) or GA plus TEB. Sensory and pain levels were measured to demonstrate clinical effectiveness. Plasma concentrations of epinephrine, norepinephrine, cortisol, IL-6 and IL-10 as well as monocyte surface expression of HLA-DR and their ex vivo capacity to release TNF-alpha after LPS stimulation were measured perioperatively. TEB was clinically effective and patients receiving TEB showed decreased circulating levels of IL-10. However, this decrease was independent of decreased levels of cortisol or epinephrine. No influence of TEB on IL-6 levels, monocyte capacity to ex vivo release TNF-alpha upon LPS stimulation or their expression of HLA-DR was found. In conclusion, high TEB reduces antiinflammatory immune suppressing mediators including IL-10 and stress mediators. At least in cardiac surgery patients the monocyte functional depression is not related to systemic release of IL-10 and the influence of cortisol or epinephrine is less important for early monocyte deactivation than what in vitro and animal models have suggested.
authors: Department of Anaesthesiology and Intensive Therapy, University Hospital Charité, Schumannstrasse 20/21, 10117 Berlin, Germany. thomas.volk@charite.de
authors: Thomas
authors: T
authors: Volk
authors: Ulrich R
authors: UR
authors: Döpfmer
authors: Martin
authors: M
authors: Schmutzler
authors: Sebastian
authors: S
authors: Rimpau
authors: Hero
authors: H
authors: Schnitzler
authors: Wolfgang
authors: W
authors: Konertz
authors: Conny
authors: C
authors: Hoeflich
authors: Wolf D
authors: WD
authors: Döcke
authors: Claudia D
authors: CD
authors: Spies
authors: Hans D
authors: HD
authors: Volk
authors: Wolfgang J
authors: WJ
authors: Kox
mesh_terms: D000767:Anesthesia, Epidural; D006348:Cardiac Surgical Procedures; D002395:Catecholamines / Q000097:blood; D005260:Female; D006684:HLA-DR Antigens / Q000096:biosynthesis / Q000235:genetics; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D002395:Catecholamines; D006684:HLA-DR Antigens; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D006854:Hydrocortisone