Methylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-α, IL-6, IL-8, IL-10

Abstract

Objective: This study examined the correlation between tumour necrosis factor-alfa (TNF-α), interleukin (IL)-6 and IL-8, IL-10 and methylprednisolone pretreatment. Methods: This is a prospective, randomized and double-blinded study. Sixty patients undergoing coronary artery bypass grafting (CABG) were randomized to receive either intravenous methylprednisolone (n=30, Group M) or intravenous placebo (n=30, Group S). The patients received intravenously either 30 mg/kg methylprednisolone (Group M) or placebo (Group S) 10 min before and after cardiopulmonary bypass (CPB). In an intensive care unit (ICU), four additional doses were given at 6-hourly intervals. Blood samples for the measurements of TNF-α, IL-6, IL-8 and IL-10 were obtained before induction of anaesthesia (T0=control value), after induction (T1), before starting CPB (T2), after aortic declamping (T3), at the end of CPB (T4) and 6 hours (T5), 12 hours (T6) and 24 hours (T7) after skin closure. Creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were evaluated at the following intervals: T0, T5, T6 and T7. Results: When compared with the control value, TNF-α, IL-6 and IL-8 significantly increased in Group S and Group M (p B-0.05), but these values were significantly greater in Group S than in Group M (p B-0.05). In comparison with the control value, IL-10 increased in both groups (p B-0.05), but was significantly greater in Group M than in Group S (p B-0.05). CK and CK-MB were increased in both groups in postoperative values compared to control values. In Group S, CK and CK-MB levels were significantly lower than in Group M (p B-0.05). Conclusion: In this study, we have found that pre-operative administration of methylprednisolone has decreased TNF-α, IL-6 and IL-8 release, and increased the perfusing IL-10 levels after CPB. Thus, methylpredniso-lone may decrease the inflammatory response during the CPB procedure.

Gene Expression Changes Associated with Resistance to Intravenous Corticosteroid Therapy in Children with Severe Ulcerative Colitis

“…Corticosteroid resistance could result in reduced inhibition of IL8 by methylprednisolone and thus affect its downstream interactions [34]. IL8 expression was not significantly different between responders and non-responders in this study despite a previous report of elevated IL8 mRNA levels in active UC [41].…”

“…A diagrammatic representation of the immediate interactome of methylprednisolone indicated an inhibitory action on K60 , also known as IL8 (Figure 1) [34]. In turn, IL8 is a known inducer of CEACAM1 and MMP8 [35], [36], [37], and it also interacts with BPI , LCN2 and PPBP [36], [38], [39], [40].…”

Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy

“…Corticosteroids have been used in patients undergoing cardiac surgery with CPB to reduce the systemic infl ammatory response syndrome induced by CPB, despite the fact that few well-controlled studies exist to support their use. 15 Their use is based on limited studies suggesting that corticosteroids may mitigate the infl ammatory response associated with CPB through the reduction of complement activation and the release of infl ammatory cytokines, 5,6,8 and an increase in IL-10 8 and antiinfl ammatory cytokines. signifi cance ( Fig 4 ).…”

“…This therapeutic intervention was based on the observation that perioperative corticosteroids can reduce complement activation and the release of infl ammatory cytokines associated with cardiopulmonary bypass (CPB). [4][5][6][7][8] However, the clinical benefi t of this intervention is uncertain. Studies assessing the use of corticosteroids in patients who undergo CPB are limited by a small number of patients or an absence of physiologic or clinical correlates.…”

Ketamine has no effect on oxygenation indices following elective coronary artery bypass grafting under cardiopulmonary bypass

“…[19] It does appear from this study that ketamine, like glucocorticoids, though successful in reducing serum level of inflammatory markers in the post-CPB period, does not produce improvement in readily measured clinical markers of pulmonary function. Though corticosteroids have been shown to reduce the serum inflammatory markers, [20,21] neither systemic nor inhaled corticosteroids have been shown to offer clinical benefits measured in terms of pulmonary dysfunction, oxygenation, duration of mechanical ventilation, hemodynamic benefit, or improvement in pain control in patients undergoing CPB. [5,22,23] In addition, Cho et al, have studied 50 patients undergoing off-pump CABG and concluded that administration of 0.5 mg/kg of ketamine at induction of general anesthesia did not result in significant changes in serum levels of CRP, IL 6, TNF alpha and cardiac enzymes [24] even though off-pump CABG has been shown to induce marked and similar inflammatory response as that of CPB.…”