Tumor necrosis factor-alpha and interleukin-10 gene expression in peripheral blood mononuclear cells after cardiac surgery.
OBJECTIVE
Cytokine response after cardiac surgery may be genetically influenced. A study was carried out to investigate the relation between cytokine gene expression in peripheral blood mononuclear cells, genotype, and clinical events after cardiac surgery.


METHODS
A case-control study was performed.


METHODS
Cardiac intensive care unit in a university hospital.


METHODS
A total of 82 patients having elective cardiac surgery were divided into those having uncomplicated recovery (n = 48) or recovery complicated by hyperlactatemia or requirement for inotropic support (n = 34).


METHODS
The relative change in peripheral blood mononuclear cell tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) messenger RNA 1 and 6 hrs after cardiopulmonary bypass was compared with a baseline preoperative level using quantitative reverse transcriptase polymerase chain reaction. DNA was analyzed for carriage of TNF-alpha and IL-10 polymorphic alleles.


RESULTS
Cardiopulmonary bypass was longer in duration in the complicated group. TNF-alpha gene expression decreased and IL-10 gene expression increased in peripheral blood mononuclear cells after surgery when compared with preoperative levels. One hour after cardiopulmonary bypass, the complicated group had more TNF-alpha and less IL-10 messenger RNA production than the uncomplicated group. The IL-10/TNF-alpha ratio was greater in uncomplicated than in complicated recovery patients. An IL-10 haplotype was identified that was less frequent in the complicated group. There was no difference between groups in TNF-alpha genotype. On multivariate analysis, cardiopulmonary bypass time and the IL-10/TNF-alpha messenger RNA ratio were independent predictors of outcome.


CONCLUSIONS
There is a predominant anti-inflammatory cytokine response after uneventful cardiac surgery. IL-10 may have a protective role after cardiac surgery.
Duggan
Edel
E
Department of Anaesthesia, St James's Hospital, Dublin, Ireland.
Caraher
Emma
E
Gately
Kathy
K
O'Dwyer
Michael
M
McGovern
Eilis
E
Kelleher
Dermot
D
McManus
Ross
R
Ryan
Thomas
T
D000328:Adult; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D015870:Gene Expression; D006239:Haplotypes; D006801:Humans; D007362:Intensive Care Units; D016753:Interleukin-10 / Q000235:genetics*; D019344:Lactic Acid / Q000097:blood; D007963:Leukocytes, Mononuclear / Q000378:metabolism*; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D012333:RNA, Messenger / Q000378:metabolism; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*
D002316:Cardiotonic Agents; D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D019344:Lactic Acid