Preoperative methylprednisolone (15 mg/kg), but not tirilazad mesylate, decreased proinflammatory mediators and increased anti-inflammatory IL-10 during cardiopulmonary bypass.
RCT (n=39)
Double-blind
Randomized
No
Does preoperative methylprednisolone or tirilazad mesylate reduce inflammation and alter immune function in patients undergoing conventional coronary surgery with cardiopulmonary bypass?
Preoperative methylprednisolone, but not tirilazad mesylate, shifts the immune response toward anti-inflammation during cardiopulmonary bypass, though at the cost of increased monocyte functional deficits.
OBJECTIVE: During cardiopulmonary bypass, inflammation and immunosuppression is present. We measured circulating mediators and monocyte-based functions and tested the hypothesis that these variables are influenced by methylprednisolone (MP) or tirilazad mesylate (TM) treatment. DESIGN: Randomized, controlled, double-blind prospective trial. SETTING: A university hospital. PATIENTS: Thirty-nine patients scheduled for conventional coronary surgery with three-vessel disease. INTERVENTIONS: Preoperative application of MP (15 mg/kg) or TM (10 mg/kg) compared with placebo (PL). MEASUREMENTS AND MAIN RESULTS: Circulating proinflammatory markers including interleukin (IL)-6, IL-8, monocyte chemoattractant protein 1, and C-reactive protein were all decreased by MP treatment but not by TM treatment. Whereas rapid increases in circulating anti-inflammatory IL-10 were superinduced by MP but not TM, plasma levels of IL-1RA and transforming growth factor beta were not altered by either treatment. Decreased ex vivo lipopolysaccharide-stimulated secretion of tumor necrosis factor alpha was prolonged after MP treatment but not after TM treatment. Perioperative stimulated secretion of IL-12 and interferon gamma was diminished in all groups, whereas ex vivo IL-1RA secretion tended to increase in all groups. Depression of monocyte surface expression of HLA-DR was significantly greater in patients treated with MP, whereas CD14 expression did not change. CONCLUSIONS: These data confirm that, during cardiopulmonary bypass, pro- and anti-inflammatory systems are activated at the same time, whereas monocyte-based immune functions are depressed. Treatment with MP abrogates proinflammatory mediators and induces a shift toward anti-inflammation at the cost of further functional monocyte deficits, whereas treatment with TM apparently has neither anti-inflammatory nor immunosuppressive actions in this setting.
Volk et al. (2001) conducted an RCT in Coronary artery disease requiring surgery (n=39). Methylprednisolone or tirilazad mesylate vs. Placebo was evaluated on Circulating mediators and monocyte-based functions. Preoperative methylprednisolone (15 mg/kg), but not tirilazad mesylate, decreased proinflammatory mediators and increased anti-inflammatory IL-10 during cardiopulmonary bypass.