Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass.

Abstract:

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.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Volk T,Schmutzler M,Engelhardt L,Döcke WD,Volk HD,Konertz W,Kox WJ

doi

10.1097/00003246-200111000-00015

subject

Has Abstract

pub_date

2001-11-01 00:00:00

pages

2137-42

issue

11

eissn

0090-3493

issn

1530-0293

journal_volume

29

pub_type

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