Key result
Cardiopulmonary bypass induces early and transient lipopolysaccharide hyporesponsiveness, decreasing ex vivo cytokine production by 78% to 86% from pre-bypass levels at 120 minutes.
Why the study?
Does cardiopulmonary bypass alter ex vivo cytokine production in LPS-stimulated whole blood cells?
Observational (n=25)
No
Does cardiopulmonary bypass alter ex vivo cytokine production in LPS-stimulated whole blood cells?
Cardiopulmonary bypass induces early and transient LPS hyporesponsiveness in whole blood, which is partly mediated by IL-10 in vivo, but contact with an extracorporeal circuit alone is sufficient to induce this effect.
May heighten early infection risk after CPB; hypothesis-generating for immunomodulatory interventions in cardiac surgery.
OBJECTIVE: To determine whether cardiopulmonary bypass (CPB) alters the ex vivo cytokine production of whole blood cells stimulated by lipopolysaccharide (LPS) and to assess the roles of interleukin (IL)-10 and an extracorporeal circuit (ECC) in the alteration. DESIGN: Prospective, controlled study. SETTING: Biochemistry laboratory and surgical intensive care unit in a university hospital. PATIENTS: Seventeen consecutive adult patients undergoing coronary artery bypass grafting or valve surgery with normothermic CPB and eight healthy volunteers. INTERVENTIONS: Blood samples for cytokine measurement were drawn from patients before and during (at 60, 90, 120, 180 and 360 mins) CPB and were cultured with and without LPS and with and without anti-IL-10 antibodies. Blood was also drawn from healthy subjects and sampled for cytokine analysis before and during circulation in an isolated ECC. MEASUREMENTS AND MAIN RESULTS: The concentrations of ex vivo tumor necrosis factor (TNF)-alpha, IL-6, IL-8, and IL-10, measured by enzyme-linked immunosorbent assay, were reduced in both experimental settings. In patients on CPB, LPS hyporesponsiveness was detected at 60 mins after the onset of CPB and was maximal at 120 mins (78% to 86% decreases from pre-CPB levels) but was transient, except for TNF-alpha. The plasma concentration of IL-10 peaked at 90 mins after the start of CPB, but the role of IL-10 in LPS hyporesponsiveness appears limited because anti-IL-10 antibodies significantly increased ex vivo production of IL-6 but not TNF-alpha or IL-8. In the isolated ECC study, no IL-10 was detected in plasma, yet the ex vivo production of the cytokines (except IL-8) was decreased (by 66% to 95%). CONCLUSION: Our results demonstrate the following: a) CPB induces an early and transient LPS hyporesponsiveness of whole blood as measured by cytokine production; b) IL-10 seems only partly involved in this process, and its role is restricted to an in vivo situation; and c) contact of blood with an ECC is sufficient to induce LPS hyporesponsiveness.
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Dehoux et al. (2000) conducted an observational in Coronary artery bypass grafting or valve surgery (n=25). Cardiopulmonary bypass vs. Pre-bypass levels was evaluated on Ex vivo cytokine production of whole blood cells stimulated by lipopolysaccharide. Cardiopulmonary bypass induces early and transient lipopolysaccharide hyporesponsiveness, decreasing ex vivo cytokine production by 78% to 86% from pre-bypass levels at 120 minutes.
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