title: Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgery.
abstract: OBJECTIVE
  Compare the effects on inflammatory (TNF-α, IL-6, IL-8 and IL-10) and immunologic (CD3(+), CD4(+), CD8(+), CD11b(+), CD16(+)/56(+) T cells and total lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4% modified fluid gelatin, or crystalloid when used as volume replacement fluids for acute normovolemic hemodilution (a blood conservation technique) in coronary artery bypass graft patients.
  
  
  METHODS
  Thirty patients undergoing coronary artery bypass graft surgery were randomized to receive Isolyte S® (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic hemodilution. Blood samples were taken immediately after induction of anaesthesia (T0), and 2 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after separation from cardiopulmonary bypass. TNF-α, IL-6, IL-8 and IL-10 levels were determined with commercially available ELISA kits. CD3(+) (mature T cells), CD4(+) (T helper cells), CD8(+) (suppressor cytotoxic T cells), CD16(+)/56(+) (natural killer lymphocytes), and CD11b(+) (Mac-1, adhesion receptor) levels were measured using flow-cytometry reagents. The CD4(+):CD8(+) ratio was calculated.
  
  
  RESULTS
  Between-group comparisons showed significantly higher levels of TNF-α at T1 (2 h after weaning from cardiopulmonary bypass) in Group HES compared to Group ISO (p=0.003). IL-8 was significantly lower in Group HES than Group GEL at T1 (p=0.0005). IL-10 was significantly higher in Group HES than in Group GEL at T1 (p=0.0001). The CD4(+):CD8(+) ratio in Group ISO was significantly lower than that in Group HES at T2 (p=0.003). CD11b(+) levels in Group HES were also higher than those in Group GEL and group ISO at T2, but not significantly. CD16/56(+) levels in Group HES were higher than those in Group GEL at T2 (p<0.003). No excessive hemorrhage occurred in any patient. Mediastinal drainage during the first 24 h after surgery in Group HES (347±207 mL) was not significantly different from that of Group GEL (272±177 mL) or Group ISO (247±109) (p>0.05).
  
  
  CONCLUSIONS
  Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and increased anti-inflammatory responses to a greater degree than gelatin solution and isolyte S®. The use of hydroxyethyl starch, compared to gelatin solution and isolyte S®, resulted in less decrease in the CD4(+):CD8(+) ratio, suggesting less immunosuppression.
authors.affiliation: Department of Anaesthesiology and Reanimation, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: ozturktulun@yahoo.com.
authors.forename: Tülün
authors.initials: T
authors.lastname: Öztürk
authors.affiliation: Department of Biochemistry, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: eceonur66@gmail.com.
authors.forename: Ece
authors.initials: E
authors.lastname: Onur
authors.affiliation: Department of Cardiovascular Surgery, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: cerrahoglum@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cerrahoğlu
authors.affiliation: Department of Biochemistry, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: drcalgan@yahoo.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Çalgan
authors.affiliation: Department of Anaesthesiology and Reanimation, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: fundanizamoglu@yahoo.com.
authors.forename: Funda
authors.initials: F
authors.lastname: Nizamoglu
authors.affiliation: Department of Anaesthesiology and Reanimation, Celal Bayar University, Faculty of Medicine, Manisa 45020, Turkey. Electronic address: melek.civi@yahoo.com.
authors.forename: Melek
authors.initials: M
authors.lastname: Çivi
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D005780:Gelatin / Q000008:administration & dosage* / Q000276:immunology* / Q000494:pharmacology; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000276:immunology* / Q000494:pharmacology; D007165:Immunosuppression Therapy; D007249:Inflammation / Q000276:immunology; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; C508609:IL10 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; C025916:modified fluid gelatins; D016753:Interleukin-10; D005780:Gelatin
keywords: Coronary surgery; Cytokine; Gelatin; Hydroxyethyl starch; Inflammation