Regulated upon activation, normal T-cell expressed and secreted chemokine and interleukin-6 in rheumatic pulmonary hypertension, targets for therapeutic decisions.
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.
Serag
Amany R
AR
Department of Cardiology, Menoufyia University, Shebin El-Kom, Egypt.
Hazaa
Sahar M
SM
Afifi
Ibtesam K
IK
Ghoname
Naglaa F
NF
Serag
Amro R
AR
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
D015415:Biomarkers; C483024:CCL5 protein, human; D018946:Chemokine CCL5; D015850:Interleukin-6