Secretion of soluble ST2 - possible explanation for systemic immunosuppression after heart surgery.
BACKGROUND
Cardiopulmonary bypass is known to affect cytokine release leading to a generalized endogenous immune reaction similar to that described in sepsis, without having been explored in great detail. Therefore we evaluated the anti- and pro-inflammatory cytokine responses after heart surgery.


METHODS
16 patients who underwent coronary artery bypass graft (CABG) surgery with extracorporeal circulation were included. ST2, IL-4 and IL-10 served as markers for TH2 cytokine response; IL-6, IL-8 and IFN-gamma as TH1 markers. Furthermore, total immunoglobulin subtype analysis (IgM, IgG, IgE) was performed.


RESULTS
Serum levels of soluble ST2 started to climb at 60 minutes (from 38 +/- 14 preoperatively to 1 480 +/- 890 pg/ml) and peaked 24 hours after surgery (13 360 +/- 2 840 pg/ml, P < 0.001). IL-10 reached a maximum at 60 minutes and returned to baseline levels 24 hours later. IL-6 and IL-8 levels peaked 60 minutes after surgery. IL-4 and IFN-gamma did not change. Only IgM showed a significant peak on day eight ( P < 0.001).


CONCLUSIONS
Our results demonstrate that CABG surgery induces a massive long-lasting secretion of ST2, a protein related to immune suppression.
Szerafin
T
T
Department of Cardiac Surgery, University of Debrecen, Debrecen, Hungary.
Niederpold
T
T
Mangold
A
A
Hoetzenecker
K
K
Hacker
S
S
Roth
G
G
Lichtenauer
M
M
Dworschak
M
M
Wolner
E
E
Ankersmit
H J
HJ
D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007136:Immunoglobulins / Q000097:blood; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D011956:Receptors, Cell Surface / Q000097:blood*; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D013997:Time Factors; D015854:Up-Regulation
D016207:Cytokines; C079241:IL1RL1 protein, human; D007136:Immunoglobulins; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface