Serum level of sCD163, a soluble receptor for hemoglobin, is influenced by cardiac surgery.

BACKGROUND: The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocytes/ macrophages, is shed to the body fluids in a soluble form (sCD163). OBJECTIVES: To evaluate the dynamics of sCD163 in the blood of patients undergoing cardiac surgery. PATIENTS AND METHODS: Sixty-one adult patients who underwent coronary artery bypass grafting (CABG) were enrolled in the study. They were assigned to undergo CABG using either cardiopulmonary bypass (CPB), "on-pump", (22 patients), modified CPB, mini "on-pump", (17 patients) or without CPB, "off-pump", (22 patients) surgery. Serum levels of sCD163 in venous blood samples taken before and after surgery, and during an early postoperative period, were evaluated by Macro 163(TM) diagnostic kit (IQ Products, Groningen, NL). RESULTS: Compared to the preoperative levels ("on-pump"; 344 ng/mL, "off-pump"; 314.5 ng/mL, mini-invasive "on-pump"; 336.5 ng/mL) serum levels were elevated at the finish of surgery, reaching maximum at the 1(st) postoperative day ("onpump"; 658 ng/mL; p<0.05, "off-pump"; 810.5 ng/mL; p<0.01; mini-invasive "on-pump"; 663 ng/mL; non-significant).No significant differences regarding the serum levels of sCD163 between different surgical approaches were found. CONCLUSION: Serum level of sCD163 scavenger molecule for hemoglobin is elevated at the end of surgery and at the 1(st) postoperative day, being little influenced by cardiopulmonary bypass.

The effect of interferon-gamma and lipopolysaccharide on the growth of Francisella tularensis LVS in murine macrophage-like cell line J774.

BACKGROUND: Francisella tularensis, a causative agent of human tularemia, displaying the ability to proliferate inside the human cells. AIMS: To evaluate the growth potential of F. tularensis LVS strain in macrophage-like cell line J774 modulated by recombinant interferon gamma and E. coli derived lipopolysaccharide. RESULTS: Stimulation of J774 cells either by interferon-gamma or lipopolysaccharide alone, or especially in combination before infection F. tularensis, revealed protective effects. Higher concentrations of stimulating agents were needed to inhibit ongoing F. tularensis infection. CONCLUSIONS: Stimulation of J774 cell line by combination of interferon-gamma with lipopolysaccharide inhibits the intracellular growth of F. tularensis.

RANK/RANKL expression is induced by cardiac surgical operation.

BACKGROUND: Cardiac surgery provokes a systemic inflammatory response in any patient. This complex body reaction involves also RANK/RANKL molecules which have been recently identified as principal regulators of bone metabolism. AIMS: To follow the changes in the expression of RANK/RANKL molecules on innate immune cells of cardiac surgical patients. PATIENTS AND METHODS: Twenty-six patients undergoing cardiac surgical were assigned to undergo coronary artery bypass grafting using either cardiopulmonary bypass ("on-pump") or modified "miniinvasive on-pump". The expression of RANK/RANKL was performed by flow cytometry. RESULTS: Significantly increased expression of RANK on monocytes of "miniinvasive on-pump" patients was found at the 1st, the 3nd, and 7th postoperative days. The similar pattern was found also for monocyte RANKL expression. In addition, RANKL expression was significantly increased at the 3rd postoperative day in "on-pump" patient. No significant differences between "miniinvasive on-pump" and "on-pump" cardiac surgical patients were found. CONCLUSION: The expression of both RANK and RANKL molecules is significantly enhanced on monocytes of "miniinvasive on-pump" cardiac surgical patients.

Expression of Toll-like receptors 2 and 4 on innate immunity cells modulated by cardiac surgical operation.

OBJECTIVE: This study aimed to follow-up on the changes in the expression of Toll-like receptors (TLRs) on monocytes and granulocytes in venous blood of patients undergoing cardiac surgical operation. MATERIAL AND METHODS: TLR2 and TLR4 expression on blood cells was determined by flow cytometry in 40 patients undergoing cardiac surgery performed either with cardiopulmonary bypass (CPB) ("on-pump") or without it ("off-pump"). RESULTS: Intensity of the expression of TLR2 on both monocytes and granulocytes, expressed as median fluorescence intensity, is significantly reduced during CPB, being lower in both groups at the finish of surgery. These changes are not so remarkable in the case of TLR4 expression. Compared to "on-pump" patients, there is a higher relative number of TLR2(+) granulocytes in "off-pump" patients at the finish of surgery and of TLR4(+) granulocytes on the first postoperative day. CONCLUSIONS: We found characteristic patterns in the expression of TLR2 and TLR4 on monocytes and granulocytes in venous blood of patients undergoing cardiac surgery with or without CPB.

The effect of cardiac surgery on peripheral blood lymphocyte populations.

BACKGROUND: Cardiac surgery using cardiopulmonary bypass (CPB) is associated with some adverse postoperative complications caused by an altered immune response. An alternative approach to cardiac surgery, operating without the use of CPB (i.e. off-pump surgery), seems to display less adverse impacts on the immune response. PATIENTS AND METHODS: Peripheral blood lymphocytes in 40 patients undergoing cardiac surgery either with CPB ("on-pump") or without CPB ("off-pump") were followed using flow cytometry. The samples of peripheral blood were taken at five intervals: preoperatively, after termination of the surgery, on the first, on the third and on the seventh postoperative day, respectively. RESULTS: The most substantial changes appeared on the first postoperative day in both subgroups of patients. While the percentage of both total T cells and CD4+ T cells were decreased, the percentage of HLA-DR+ activated lymphocytes was increased. These changes were more profound in the "on-pump" subgroup compared to the "off-pump" subgroup. CONCLUSION: Our results may suggest that the "off-pump" surgical approach reveals less adverse impact on adaptive immune responses.

The expression of CD38 ADP-ribosyl cyclase ectoenzyme in immune cells of cardiac surgical patients.

BACKGROUND: This study was aimed at following the changes in the expression of CD38 ADP-ribosyl cyclase ectoenzyme on peripheral blood immune cells of patients undergoing cardiac surgical operations. PATIENTS AND METHODS: The expression of CD38 on lymphoid and myeloid cells was determined by immunofluorescence and flow cytometry in forty cardiac surgical patients assigned to surgery either using ("on-pump", n=20) or without the use ("off-pump", n=20) of cardiopulmonary bypass. RESULTS: There was a very rapid upregulation of CD38 expression in "on-pump" patients, becoming significant at declamping of aorta (p<0.01) for myeloid cells and at the weaning from CPB (p<0.001) for lymphocytes. The increased expression of CD38 on lymphocytes in "off-pump" patients was prolonged for the entire observation period. However, significant differences in the expression of CD38 between "on-pump" and "off-pump" patients were not found either in lymphoid or myeloid cells. CONCLUSION: CD38 expression in immune cells of cardiac surgical patients is upregulated early during surgery, providing additional activation stimuli to the cell substrate of the inflammatory response induced by cardiac surgery.

Early expression of FcgammaRI (CD64) on monocytes of cardiac surgical patients and higher density of monocyte anti-inflammatory scavenger CD163 receptor in "on-pump" patients.

OBJECTIVE: Activation of innate immunity cells is inseparably linked to cardiac surgical operation. The aim of this study was to assess the kinetics in the expression of receptor for Fc part of IgG, FcgammaRI (CD64), and scavenger receptor CD163 on peripheral blood cells of cardiac surgical patients and to examine the effect of cardiac bypass as a separable influence on the systemic acute inflammatory response. METHODS: Forty patients, twenty in each group, were randomly assigned to CABG surgery performed either with "on-pump" or without "off-pump" cardiopulmonary bypass. Standardized quantitative flow cytometry method was used to determine the expression of surface markers. RESULTS: The density of CD64 molecule on monocytes reached maximum on the 1st postoperative day (P<.001) whereas the peak for CD64 molecule expression on granulocytes was postponed to the 3rd postoperative day (P<.001). The expression of CD163 scavenger molecule on monocytes reached maximum on the 1st postoperative day (P<.001). The density of CD163 molecule on monocytes on the 1st postoperative day is significantly higher in "on-pump" patients in comparison with "off-pump" patients (P<.001). CONCLUSION: In cardiac surgical patients the expression of activation marker FcgammaR1 (CD64) on monocytes is increased earlier in comparison with granulocytes in both "on-pump" and "off-pump" patients. The expression of scavenger molecule CD163 on monocytes is significantly higher in "on-pump" patients.

The inflammatory response in cardiac surgery. An up-to-date overview with the emphasis on the role of heat shock proteins (HSPs) 60 and 70.

Cardiac surgical operations are associated with the development of a systemic inflammatory response syndrome (SIRS). In most cases, the inflammatory response is apparent only in its subclinical form. In some cases, however, it can become clinically manifest or even life-threatening. This review article presents some new data regarding its biological importance, along with an insight into the recently discovered role played by heat shock proteins 60 and 70.

Essential PTX3 biology (not only) for cardiologists and cardiac surgeons.

Inflammation has been recognized to form an integral part of the atherosclerotic process. Much consideration has been given lately to the role played in atherogenesis by C-reactive protein (CRP). Although not accepted unequivocally, CRP appears to be not only a marker, but also an active mediator of the atherosclerotic process. Pentraxin 3 (PTX3) is a newly identified acute phase reactant which shares some structural and some functional properties with CRP. On the other hand, pentraxin 3 displays unique biological properties of its own, including a possible role in the pathogenesis of cardiovascular diseases and in processes accompanying the natural evolution of surgical wounds. This review article discusses recent information concerning basic pentraxin 3 biology in inflammation and in innate immunity reactions as viewed by a cardiologist in the context of acute coronary events and by a surgeon in patients struck with multiple wounds who are at the same time menaced by bacterial infections.

The long pentraxin 3 in cardiac surgery: distinct responses in "on-pump" and "off-pump" patients.

OBJECTIVE: Pentraxin 3 (PTX3) is a newly identified acute phase reactant with non-redundant functions in innate immunity. The purpose of this study was to assess the kinetics of release of PTX3 in cardiac surgical patients, operated on either with or without the use of cardiopulmonary bypass (CPB). DESIGN: Thirty-four patients, seventeen in each group, were randomly assigned to CABG surgery performed either with ("on-pump") or without ("off-pump") CPB. Blood samples were collected both during and after the operation up to the 7(th) day. RESULTS: In patients operated on with the use of CPB, PTX3 levels increased throughout the operation. Compared to baseline levels the highest PTX3 value (p<0.000) was attained on the 1(st) postoperative day in both "on-pump" and "off-pump" patients. In contrast to CPB patients, however, PTX3 levels in the latter group declined slowly, remaining elevated as long as the 3(rd) postoperative day (p<0.042). CONCLUSIONS: Operations performed with the use of CPB are associated with a more pronounced release of PTX3 immediately after operation.

Lipopolysaccharide binding protein and sCD14 are not produced as acute phase proteins in cardiac surgery.

OBJECTIVES: The changes in the serum levels of lipopolysaccharide binding protein (LBP) and sCD14 during cardiac surgery were followed in this study. DESIGN: Thirty-four patients, 17 in each group, were randomly assigned to coronary artery bypass grafting surgery performed either with ("on-pump") or without ("off-pump") cardiopulmonary bypass. LBP and sCD14 were evaluated by ELISA. RESULTS: The serum levels of LBP were gradually increased from the 1st postoperative day and reached their maximum on the 3rd postoperative day in both "on-pump" and "off-pump" patients (30.33+/-9.96 microg/mL; 37.99+/-16.58 microg/mL), respectively. There were no significant differences between "on-pump" and "off-pump" patients regarding LBP. The significantly increased levels of sCD14 from the 1st up to the 7th postoperative day in both "on-pump" and "off-pump" patients were found with no significant differences between these groups. No correlations between LBP and sCD14 and IL-6, CRP and long pentraxin PTX3 levels were found. CONCLUSIONS: The levels of LBP and sCD14 are elevated in cardiac surgical patients being similar in both groups. These molecules are not produced as acute phase proteins in these patients.

Expression of an activated form of integrin beta2 chain CD18 in cardiac surgical operations.

BACKGROUND: Myeloid cells are extensively activated in patients undergoing cardiosurgical operations. It is supposed that this activation is more profound in patients operated with cardiopulmonary bypass (CPB) ("on-pump") in comparison with patients operated without CPB ("off-pump"). AIMS: To evaluate changes in the expression of a novel activation marker expressed on myeloid cells recognized by MEM-148 antibody. PATIENTS AND METHODS: The expression of MEM-148 positive myeloid cells was evaluated by flow cytometry in 40 patients who underwent coronary artery bypass surgery (CABG) randomly assigned to "on-pump" or "off-pump" technique. RESULTS: The relative and absolute number of MEM-148 positive myeloid cells is significantly diminished during "on-pump" surgery. A significant increase in their number in postoperative period in both "on-pump" and "off-pump" patients was found. There were no significant differencies between "on-pump" and "off-pump" patients. CONCLUSIONS: The very trauma of surgery seems to be more relevant in starting on activation of myeloid cells them CPB itself.

Expression of an Activated Form of Integrin ß2 Chain CD18 in Cardiac Surgical Operations.

BACKGROUND: Myeloid cells are extensively activated in patients undergoing cardiosurgical operations. It is supposed that this activation is more profound in patients operated with cardiopulmonary bypass (CPB) ("on-pump") in comparison with patients operated without CPB ("off-pump"). AIMS: To evaluate changes in the expression of a novel activation marker expressed on myeloid cells recognized by MEM-148 antibody. PATIENTS AND METHODS: The expression of MEM-148 positive myeloid cells was evaluated by flow cytometry in 40 patients who underwent coronary artery bypass surgery (CABG) randomly assigned to "on-pump" or "off-pump" technique. RESULTS: The relative and absolute number of MEM-148 positive myeloid cells is significantly diminished during "on-pump" surgery. A significant increase in their number in postoperative period in both "on-pump" and "off-pump" patients was found. There were no significant differencies between "on-pump" and "off-pump" patients. CONCLUSIONS: The very trauma of surgery seems to be more relevant in starting on activation of myeloid cells them CPB itself.