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IL-6 and TNFα release in association with neutrophil activation after cardiopulmonary bypass surgery

Ausschüttung von IL-6 und TNFα bei Neutrophilen-Aktivierung nach kardiopulmonaler Bypass-Operation

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Summary

The serum IL-6 and TNFα response to cardiopulmonary bypass surgery was studied in 12 patients. Human neutrophil elastase was also measured in order to detect the presence of neutrophil activation. Peripheral venous blood samples were obtained before, during, and 1, 2, 3 and 6 days after surgery. Intra-operative samples were also obtained from the coronary sinus and pulmonary artery. Cardiopulmonary bypass stimulated the immediate release of IL-6 into the coronary, pulmonary and systemic circulations. TNFα was transiently detected in the pulmonary circulation in seven patients. Surgery also induced early and sustained activation of neutrophils, which peaked 24 h following maximum IL-6 release. Both IL-6 and TNFα not only enhance neutrophil activation, but also stimulate an adhesive neutrophil-cardiac myocyte interaction which is associated with the release of toxic oxygen radicals. Their detection, in association with concomitant neutrophil activation, suggests a possible pathway for enhanced neutrophil mediated myocardial damage following cardiopulmonary bypass surgery.

Zusammenfassung

Serum Interleukin-6 und TNFα-Spiegel wurden während und nach koronarer Bypass-Operation bei 12 Patienten untersucht. Neutrophilen-Elastase wurde als Marker für die Neutrophilen-Aktivierung bestimmt. Peripher-venöses Blut wurde vor, während und 1, 2, 3 und 6 Tage nach der Operation entnommen. Intraoperativ wurden Proben von dem Koronarsinus und der Pulmonalarterie gewonnen. Kardiopulmonale Bypass-Operation führte zu einer Ausschüttung von IL-6 in die koronare, pulmonale und systemische Zirkulation. TNFα war vorübergehend in der pulmonalen Arterie erhöht. Durch die Operation wurde auch frühzeitig eine Aktivierung von Neutrophilen bewirkt, die 24 Stunden nach der Operation ihr Maximum nach der maximalen IL-6-Ausschüttung erreichte. Der Nachweis von IL-6 und TNFα zusammen mit der Neutrophilen-Elastase weist auf die Möglichkeit einer Myokardschädigung nach kardiopulmonaler Bypass-Operation durch Aktivierung von Cytokinen hin, die zu Komplikationen wie Sepsis und Multiorganversagen führen könnte.

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Authors and Affiliations

  1. Abteilung für Herzchirurgie, Universitätsklinik, Giessen, Germany

    R. G. Holzheimer,  H. Görlach, S. Wilkert &  F. Hehrlein

  2. University Dept. of Surgery, Royal Infirmary, Glasgow, Scotland

    R. G. Molloy M. B. (F. R. C. S. I.)

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  1. R. G. Holzheimer
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Editorial Remarks: This is not an infectious disease study, but comes nevertheless from an author who is intensively concerned with infections and their consequences. We thought that an understanding of Il-6, TNFα and neutrophil activation immediately after cardiopulmonary surgery, after which it is well known that infections can play a fatal role, may be of importance to an infectious disease expert in his assessment of data in this connection.

W. M.

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Holzheimer, R.G., Görlach, H., Wilkert, S. et al. IL-6 and TNFα release in association with neutrophil activation after cardiopulmonary bypass surgery. Infection 22, 37–42 (1994). https://doi.org/10.1007/BF01780764

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