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J Thorac Cardiovasc Surg 1996;112:561
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Human cytokine responses to cardiac operations: Prebypass factors

Department of Cardiac Surgery^a

Reply to the Editor:

We appreciate these comments regarding our recent article, ¹ which raise an important question about the triggering mechanism of cytokine responses after clinical cardiopulmonary bypass (CPB). Our previous study ¹ was not designed to evaluate |P`pre-CPB factors," so that cytokine levels were not compared before and after induction of anesthesia. It is true that interleukin-8 values before heparinization were somewhat higher, although nonsignificantly and still at a very low level, in patients having heart transplantation than in those who underwent coronary artery bypass grafting. <sup>1</sup> However, Finn and associates <sup>2</sup> compared interleukin-8 levels in pediatric patients undergoing either CPB or neurosurgical intervention after similar anesthesia induction and found that |P`post-CPB factors" are more important to induce interleukin-8 release.

For further exploration of the mechanism involved, it is necessary to identify the primary source of these cytokines. We recently measured the plasma levels of these cytokines simultaneously in the peripheral arterial blood, the coronary sinus blood, and the mixed venous blood in patients undergoing CPB. Our data indicated that the heart, but not the lung, is a major source of tumor necrosis factor- and interleukin-6. ³ The myocardium may also be an important origin of interleukin-8 during reperfusion after more severe injury. ^{3 , 4} In contrast, neither the heart nor the lung is the main source of interleukin-10. ³

Nevertheless, we agree that some pre-CPB factors may also play a role in influencing cytokine responses associated with CPB. In another recent study, we ⁵ found that steroid administration before operation can significantly inhibit tumor necrosis factor- and interleukin-8 release but greatly enhance interleukin-10 production. Such a |P`priming effect" is certainly interesting and needs to be further investigated.

References

1. Wan S, Marchant A, DeSmet JM, Antoine M, Zhang H, Vachiery J-L, et al. Human cytokine responses to cardiac transplantation and coronary artery bypass grafting. J Thorac Cardiovasc Surg 1996;111:469-77.[Abstract/Free Full Text]
   
2. Finn A, Naik S, Klein N, Levinsky RJ, Strobel S, Elliott M. Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993;105:234-41.[Abstract]
   
3. Wan S, DeSmet JM, Barvais L, Goldstein M, Vincent JL, LeClerc JL. The myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. In press.
   
4. Oz MC, Liao H, Naka Y, et al. Ischemia-induced interleukin-8 release after human heart transplantation: a potential role for endothelial cells. Circulation 1995;92(Suppl):II428-32.
   
5. Wan S, DeSmet JM, Antoine M, Goldman M, Vincent JL, LeClerc JL. Steroid administration in heart and heart-lung transplantation: Is the timing adequate? Ann Thorac Surg 1996;61:674-8.[Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Song Wan Jean-Louis Vincent Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wan, S. Articles by Vincent, J.-L. Search for Related Content PubMed Articles by Wan, S. Articles by Vincent, J.-L.