title: What is the significance of perioperative release of macrophage migration inhibitory factor in cardiac surgery?
abstract: Cardiac surgery is associated with release of the pleiotropic cytokine macrophage migration inhibitory factor (MIF). The trigger for MIF release has not yet been elucidated. Owing to its intrinsic antioxidative activity, MIF might reduce oxidative stress and protect from myocardial ischemia and reperfusion (I/R) injury. In the present study, patients scheduled for elective cardiac surgery (n=46) were randomized to undergo coronary artery bypass grafting either conventionally with cardiopulmonary bypass and cardioplegic arrest-induced I/R (cCABG) or in an off-pump procedure (OPCAB) with minimized I/R. We report that only patients who underwent cCABG exhibited a postoperative increase of MIF (p=0.024), while both groups showed an increase in interleukin-6. MIF release appears to be primarily mediated by I/R and to a lesser extent by inflammation. Endogenous peroxidase activity (p=0.021) and serum levels of thioredoxin (p=0.003) were significantly higher in patients who underwent cCABG after surgery. Interestingly, perioperative MIF release was associated with an enhanced antioxidant capacity and a significantly reduced postoperative incidence of atrial fibrillation (p=0.018) and acute kidney injury (p=0.048). The present study highlights the role of MIF increase during cardiac surgery in response to oxidative stress. Based on current observations, we hypothesize that intraoperative MIF secretion is due to I/R and enhances the antioxidant capacity in patients during cardiac surgery.
authors.affiliation: Department of Anesthesiology, University Hospital of the RWTH Aachen, 52074 Aachen, Germany. christian.stoppe@gmail.com
authors.forename: Christian
authors.initials: C
authors.lastname: Stoppe
authors.forename: Thilo
authors.initials: T
authors.lastname: Werker
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Florian
authors.initials: F
authors.lastname: Dollo
authors.forename: Hongqi
authors.initials: H
authors.lastname: Lue
authors.forename: Willibald
authors.initials: W
authors.lastname: Wonisch
authors.forename: Ares
authors.initials: A
authors.lastname: Menon
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
authors.forename: Christian S
authors.initials: CS
authors.lastname: Bruells
authors.forename: Mark
authors.initials: M
authors.lastname: Coburn
authors.forename: Rüdger
authors.initials: R
authors.lastname: Kopp
authors.forename: Richard
authors.initials: R
authors.lastname: Bucala
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bernhagen
authors.forename: Steffen
authors.initials: S
authors.lastname: Rex
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000378:metabolism; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood / Q000378:metabolism*; D008264:Macrophages / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000378:metabolism; D018384:Oxidative Stress; D063868:Patient Outcome Assessment; D059035:Perioperative Period; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D000975:Antioxidants; D002316:Cardiotonic Agents; D008263:Macrophage Migration-Inhibitory Factors