Circulating Cytokines and Granulocyte-Derived Enzymes During Complex Heart Surgery:<i>A Clinical Study with Special Reference to Heparin-Coating of Cardiopulmonary Bypass Circuits</i>

Borowiec, Jan; Hagman, Leif; Tötterman, Thomas H.; Pekna, Marcela; Thelin, Stefan

doi:10.3109/14017439509107225

Cited by 18 publications

(2 citation statements)

References 19 publications

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“…These results correspond to the data published about adult oxygenation systems. [34][35][36] If surface-modified materials are able to minimize the contact phase activation, the cascade reactions they would otherwise trigger are reduced. Relationships between the initial phases of classic complement activation (CI) and the contact phase system as well as the key enzyme for fibrinolysis (plasmin) have already been described in vitro and in vivo.…”

Section: Contact Activation and Neutrophilsmentioning

confidence: 99%

Haemocompatibility of paediatric membrane oxygenators with heparin-coated surfaces

et al. 1999

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Extracorporeal circulation (ECC) in paediatric patients with heparin-coated oxygenation systems is rarely investigated. The objective of this study was to evaluate, preclinically, the haemocompatibility of paediatric membrane oxygenators with heparin-coated surfaces. We compared 16 paediatric membrane oxygenators (Minimax, Medtronic) in an in vitro heart-lung machine model with fresh human blood. Eight of these oxygenation systems had a covalent heparin coating (Carmeda bioactive surface). After 90 min simulated ECC, the heparin-coated systems showed significantly higher platelet count, lower platelet-factor 4 release, reduced contact activation (factor XIIa and kallikrein), and lower neutrophil elastase levels (p < 0.05), compared to the noncoated oxygenator group. More biocompatible materials for paediatric operations may ameliorate the various postperfusion syndromes arising from ECC procedures, particularly unspecific inflammation, hyperfibrinolysis and blood loss.

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Section: Contact Activation and Neutrophilsmentioning

confidence: 99%

Haemocompatibility of paediatric membrane oxygenators with heparin-coated surfaces

et al. 1999

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“…175 The activation of neutrophils during cardiac surgical procedures has been demonstrated in multiple experimental and clinical studies by showing up-regulation of integrin expression and increases in levels of enzymes such as myeloperoxidase and elastase. [176][177][178] Leukocyte filters were first introduced to reduce the large number of leukocytes that contaminated standard red cell transfusions. '79 Technical improvements of these filters led to their introduction into the field of cardiac surgery in the early 1990s.180 The concept of leukocyte filtration to minimize and reduce the effects of toxic enzymes and inflammatory mediators released by neutrophils have led to numerous studies with conflicting results.…”

Section: Leukocyte Depletionmentioning

confidence: 99%

Microvascular Inflammatory Response in Cardiac Surgery

Chong¹,

Hampton²,

Verrier

2003

Semin Cardiothorac Vasc Anesth

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Cardiac surgical procedures, with or without cardiopulmonary bypass, elicit a systemic inflammatory response in patients that induces the elaboration of multiple cytokines, chemokines, adhesion molecules, and destructive enzymes. This inflammatory reaction involves multiple interdependent and redundant cell types and humoral cascades, which allows for amplification and positive feedback at numerous steps. This systemic inflammatory response ultimately results in a broad spectrum of clinical manifestations, with multiple organ failure being the most severe form. Investigative efforts have focused on understanding the mechanism of this systemic inflammatory response syndrome in order to develop potential therapeutic targets to inhibit it, thereby possibly decreasing postoperative morbidity and mortality. Multiple therapeutic methods have been investigated, including pharmacologic inhibitors and modifications of surgical technique and the cardiopulmonary bypass circuit. Although studies have demonstrated that the use of these therapies in experimental and clinical settings has attenuated the systemic inflammatory response, they have failed to conclusively show clinical benefit from these therapies. These therapies may be too specific to minimize the deleterious effects of a systemic inflammatory response that results from the activation of multiple, interdependent, and redundant inflammatory cascades and cell types. Hence, further studies that investigate the molecular and cellular events underlying the systemic inflammatory response syndrome and the resultant effects of anti-inflammatory therapies are warranted to ultimately achieve improvements in clinical outcome after cardiac surgical procedures.

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Interindividual variations in cytokine levels following cardiopulmonary bypass

Misoph¹,

Babin‐Ebell²

1997

Heart Vessels

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Cardiopulmonary bypass (CPB) is associated with an inflammatory response, mainly caused by the trauma of surgery, contact of blood with the artificial surface of the circuit, and reperfusion injury, resulting in increased capillary permeability, respiratory distress, low cardiac output, and multiorgan failure. The inflammatory reaction includes an activation of the humoral and cellular immune system with enhanced release of cytokines. The present study focused on the effect of CPB on the time course of pro- and anti-inflammatory cytokines. In 20 patients undergoing coronary artery bypass grafting, the plasma concentration of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-2, IL-4, IL-6, IL-8, and IL-10 was investigated pre-, intra-, and postoperatively by enzyme-linked immunosorbent assay technique. With the exception of IFN-gamma, all the other cytokines could be detected in the patients plasma. However, neither TNF-alpha nor IL-1 beta and IL-2 revealed significant changes in concentration during the investigated time period. In contrast, IL-6 and IL-8 levels peaked early postoperatively, reaching median concentrations of 430 pg/ml (221 pg per ml/558 pg per ml; lower/upper quartiles, respectively) and approximately 12 pg/ml (0/17 pg/ml; lower/upper quartiles, respectively). IL-4 and IL-10, respectively, revealed maximal concentrations of approximately 2 pg/ml (0/39 pg/ml; lower/upper quartiles, respectively) and 208 pg/ml (76 pg per ml/380 pg per ml; lower/upper quartiles, respectively) immediately after protamine administration, preceding the maximal concentration of IL-6. The degree of the observed modulation of cytokine patterns during and after CPB seemed to be patient-dependent, since large interindividual variations in cytokine levels were observed, not only preoperatively, but especially during and following CPB. However, IL-6 and IL-10 showed the least interindividual variations, suggesting that these cytokines may give reliable information regarding modulation of the immune response following CPB and its consequences for the patient's outcome.

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Circulating Cytokines and Granulocyte-Derived Enzymes During Complex Heart Surgery:A Clinical Study with Special Reference to Heparin-Coating of Cardiopulmonary Bypass Circuits

Cited by 18 publications

References 19 publications

Haemocompatibility of paediatric membrane oxygenators with heparin-coated surfaces

Haemocompatibility of paediatric membrane oxygenators with heparin-coated surfaces

Microvascular Inflammatory Response in Cardiac Surgery

Interindividual variations in cytokine levels following cardiopulmonary bypass

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