title: Regulated upon activation, normal T-cell expressed and secreted chemokine and interleukin-6 in rheumatic pulmonary hypertension, targets for therapeutic decisions.
abstract: BACKGROUND
  Recent studies have highlighted the possible influence of chemokines and cytokines on several types of pulmonary arterial hypertension (PAH). Increasing interest has also been focussed on their role as a cause of post-cardiopulmonary bypass (CPB) organ dysfunction.
  
  
  OBJECTIVE
  Chemokines and cytokines are involved in the pathobiology of rheumatic PAH.
  
  
  METHODS
  Serum levels of the chemokine, regulated upon activation, normal T-cell expressed and secreted (RANTES) and the cytokine interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA) in 35 patients with rheumatic mitral valve disease and 10 matched healthy subjects (control group). Eleven patients (31.4%) had severe pulmonary hypertension. Subsequently, 23 patients underwent mitral valve replacement. The relation of RANTES and IL-6 circulating level with postoperative organ dysfunction was analysed through multiple organ dysfunction score (MODS).
  
  
  RESULTS
  Patients with severe PAH have a significantly higher mean serum level of RANTES compared with other patients (6138.6+/-3543.8 pg/ml vs 1818.2+/-475.2 pg/ml, p=0.0003). The serum level of IL-6 in the patients was statistically different from that of the control (378+/-50.8 pg/ml vs 262+/-90.5 pg/ml, respectively, p=0.002). Patients who required postoperative inotropes had higher preoperative and post-CPB levels of both RANTES and IL-6. While patients with postoperative lung dysfunction had higher levels of IL-6 preoperatively and post-CPB and lower levels of RANTES post-CPB.
  
  
  CONCLUSIONS
  RANTES and IL-6 should be investigated as potential therapeutic targets in the control of rheumatic PAH. Improved understanding of the contribution of RANTES and IL-6 to adverse postoperative complications can lead to improved patient outcome.
authors.affiliation: Department of Cardiology, Menoufyia University, Shebin El-Kom, Egypt.
authors.forename: Amany R
authors.initials: AR
authors.lastname: Serag
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Hazaa
authors.forename: Ibtesam K
authors.initials: IK
authors.lastname: Afifi
authors.forename: Naglaa F
authors.initials: NF
authors.lastname: Ghoname
authors.forename: Amro R
authors.initials: AR
authors.lastname: Serag
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D018946:Chemokine CCL5 / Q000097:blood*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000276:immunology*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000276:immunology / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000150:complications / Q000276:immunology / Q000601:surgery; D009102:Multiple Organ Failure / Q000209:etiology / Q000276:immunology; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000276:immunology* / Q000601:surgery; D055815:Young Adult
chemical_list: D015415:Biomarkers; C483024:CCL5 protein, human; D018946:Chemokine CCL5; D015850:Interleukin-6