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Plasma levels of immunosuppressive mediators during cardiopulmonary bypass
E Borrelli1, P Giomarelli, A Naldini
1Institute of Thoracic and Cardiovascular Surgery Via Laterina University of Siena Siena 8 - 53100 Siena Italy.
Insights
Cardiopulmonary bypass (CPB) significantly increases immunosuppressive mediators like complement fraction C3a and transforming growth factor-beta(1). These changes correlate with a suppressed immune cell proliferation during CPB procedures.
Area of Science:
- Immunology
- Cardiovascular Surgery
Background:
- Extracorporeal circulation, particularly cardiopulmonary bypass (CPB), is associated with significant immunological alterations.
- Understanding the mediators involved in CPB-induced immunosuppression is crucial for patient outcomes.
Purpose of the Study:
- To evaluate plasma levels of complement fraction C3a (C3a) and transforming growth factor-beta(1) (TGF-beta(1)) during extracorporeal circulation.
- To assess the impact of CPB on the proliferation of peripheral blood mononuclear cells (PBMCs).
Main Methods:
- Study included 16 patients undergoing hypothermic or normothermic CPB and 4 controls without CPB.
- Blood samples were collected at multiple time points: pre-CPB, during CPB (every 30 min), post-CPB, and post-protamine administration.
- Plasma levels of C3a and TGF-beta(1) were measured, and PBMC proliferation after phytohaemagglutinin (PHA) stimulation was assessed.
Main Results:
- Both C3a and TGF-beta(1) levels significantly increased during and after CPB in both hypothermic and normothermic groups.
- The increase in C3a and TGF-beta(1) was more prominent in the normothermic group, but not statistically significant compared to the hypothermic group.
- PBMC proliferation index decreased significantly within 30 minutes of CPB initiation and remained suppressed throughout the procedure.
Conclusions:
- Elevated plasma levels of C3a and TGF-beta(1) suggest their involvement in the immunosuppressive effects observed during extracorporeal circulation.
- These findings highlight a potential role for C3a and TGF-beta(1) in mediating immunological changes associated with CPB.
Abstract:
The aim of this study was to evaluate plasma levels of two mediators with immunosuppressive properties, complement fraction C3a (C3a) and transforming growth factor-beta(1) (TGF-beta(1)), during extracorporeal circulation. The proliferation index after phytohaemagglutinin (PHA) stimulation of isolated peripheral blood mononuclear cells was also investigated. Sixteen patients undergoing hypothermic (n = 8, group 1) and normothermic (n = 8, group 2) cardiopulmormry bypass (CPB) were enrolled in this study. As a control, we evaluated four patients undergoing thoracovascular operations without CPB. Blood samples were collected before CPB but after anaesthesia, every 30 min during CPB, at the end of CPB and 10 min after protamine administration. Both C3a and TGF-beta(1) increased significantly during CPB and after protamine administration in the hypothermic as well as the normothermic group. In the latter case the increase of C3a and TGF-beta(1), although more prominent, was not significantl higher than in the former group. Conversely, the proliferation, index of peripheral mononuclear cells had already decreased 30 min after CPB was started and remained depressed throughout the CPB time. These results suggest a possible role of C3a and TGF-beta(1) in the immunological changes occurring during extracorporeal circulation.
