title: Effects of insulin therapy on inflammatory mediators in infants undergoing cardiac surgery with cardiopulmonary bypass.
abstract: To determine whether insulin administration modulates the systemic inflammatory response in infants undergoing cardiac surgery with cardiopulmonary bypass, 60 infants undergoing cardiopulmonary bypass were randomly assigned into a routine therapy group or to an intensive insulin therapy group with 30 infants in each group. Plasma IL-1beta, IL-6, IL-10, and TNF-alpha levels were determined before anesthesia, at the initiation of cardiopulmonary bypass, and at 0, 6, 12, 24, and 48 h after cardiopulmonary bypass. Nuclear factor-kappaBp65 expression and IkappaB expression in peripheral blood mononuclear cells were also measured by Western blot analysis. TNF-alpha, IL-1beta, IL-6, and IL-10 levels were all elevated after the initiation of cardiopulmonary bypass. However, TNF-alpha, IL-1beta, and IL-6 levels were significantly attenuated in the intensive insulin therapy group compared to those in the routine therapy group after initiation of cardiopulmonary bypass (p<0.05 or <0.01). Meanwhile, plasma IL-10 levels were significantly higher in the intensive insulin therapy group than in the routine therapy group after initiation of cardiopulmonary bypass (p<0.05 or <0.01). Accordingly, Nuclear factor-kappaBp65 expression and IkappaB expression were significantly increased after initiation of cardiopulmonary bypass in both groups (p<0.05 or <0.01). The expression of Nuclear factor-kappaBp65, which induces the transcription of pro-inflammatory cytokines was significantly attenuated in the intensive insulin therapy group (p<0.05 or <0.01). Meanwhile, the expression of IkappaB, an inhibitor of NF-kappaB, was significantly higher in the intensive insulin therapy group (p<0.05 or <0.01). These results suggested that intensive insulin therapy may attenuate the systemic inflammatory response in infants undergoing cardiopulmonary bypass.
authors.affiliation: Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 15# Changle West Road, Xi'an 710032, Shaanxi, China.
authors.forename: Chun-Hu
authors.initials: CH
authors.lastname: Gu
authors.forename: Qin
authors.initials: Q
authors.lastname: Cui
authors.forename: Yun-Ya
authors.initials: YY
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Dou
authors.forename: Rong
authors.initials: R
authors.lastname: Zhao
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Pei
authors.forename: Ding-Hua
authors.initials: DH
authors.lastname: Yi
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D020672:I-kappa B Proteins / Q000097:blood; D007223:Infant; D007249:Inflammation / Q000188:drug therapy; D018836:Inflammation Mediators / Q000097:blood*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D016753:Interleukin-10 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007432:Intraoperative Period; D008297:Male; D051996:Transcription Factor RelA / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D001786:Blood Glucose; D020672:I-kappa B Proteins; D018836:Inflammation Mediators; D007328:Insulin; D053583:Interleukin-1beta; D015850:Interleukin-6; D051996:Transcription Factor RelA; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10