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J Thorac Cardiovasc Surg 1998;115:1172-1178
© 1998 Mosby, Inc.
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY |
Supported by the Deutsche Forschungsgemeinschaft (SFB 217) and by theVeru Foundation.
Received for publication April 21, 1997.Revisions requested June 6, 1997.Revisions received Nov. 20, 1997. Accepted for publication Nov. 20, 1997. Address for reprints: Matthias Blumenstein, MD, StiftsklinikAugustinum, Wolkerweg 16, 81375 München, Germany.
Objectives: Major operative trauma likeaorta-coronary bypass operation may lead to postoperative immunodisturbance,putting the patient at an increased risk for infection and sepsis. Themonocyte/macrophage system and the endotoxin receptor CD14 are important in theearly recognition and elimination of invading bacteria. The aim of this studywas to analyze changes in membrane-associated CD14 and soluble CD14 during andafter cardiac involving cardiopulmonary bypass.
Methods:We studied numbers of leukocytes, monocytes, and monocyte subpopulations,expression of monocyte membrane-associated CD14 and plasma levels of solubleCD14 in 10 patients (63 ± 8 years of age), who underwent electivecardiopulmonary bypass.
Results:Cardiopulmonary bypass induced marked postoperative monocytosis, which wasmaximal 20 hours after the operation (485 ± 242 cells/µlbefore, 1080 ± 264 cells/µl 20 hours after surgery).Expression of membrane-associated CD14 on classical CD14++ monocytes decreasedsignificantly by 40%, reaching a nadir 20 hours after surgery (p < 0.05). At the time of maximalmembrane-associated CD14 suppression, the levels of soluble CD14 measured byenzyme-linked immunosorbent assay were clearly increased (3.2 ± 1.0µg/ml before versus 5.6 ± 1.0 µg/ml 20 hours after,p < 0.001). No significant change of thepercentage of small (
) and large (ß) forms of soluble CD14 wasfound.
Conclusions: Cardiopulmonarybypass leads to reduced membrane-associated CD14 expression on peripheral bloodmonocytes and increased levels of soluble CD14 through shedding or secretion ofmembrane-associated CD14 from the cell surface. These findings indicate thatbypass is associated with significant monocyte activation.(J Thorac CardiovascSurg 1998;115:1172-8)
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