Aprotinin and methylprednisolone equally blunt cardiopulmonary bypass-induced inflammation in humans

J Thorac Cardiovasc Surg. 1995 Dec;110(6):1658-62. doi: 10.1016/S0022-5223(95)70027-7.

Abstract

Cardiopulmonary bypass induces an inflammatory state characterized by tumor necrosis factor-alpha release. Integrin CD11b is a neutrophil surface adhesive glycoprotein integrin that is rapidly and permanently unregulated by tumor necrosis factor-alpha exposure. The CD11b integrin is known to be the primary neutrophil integrin responsible for neutrophil lung and myocardial entrapment after cardiopulmonary bypass and subsequent reperfusion injury. Twenty-four adults admitted to the hospital for myocardial revascularization were equally randomized to one of three groups: group A (control), group B (methylprednisolone before cardiopulmonary bypass), and group C (low-dose aprotinin protocol). Blood was collected at three times: (1) baseline, (2) 50 minutes of cardiopulmonary bypass duration, and (3) 30 minutes after cardiopulmonary bypass termination. Neutrophil CD11b integrin expression was measured by fluorescence-activated cell sorter analysis and plasma tumor necrosis factor-alpha levels measured by enzyme-linked immunosorbent assay. Group A demonstrated significant (p < 0.05) increases in CD11b expression at times 2 and 3 when results were compared with those of the same group baseline and with those of groups B and C at similar times. No significant changes were noted between groups B and C at any time. Group A demonstrated a significant (p < 0.05) increase in levels of tumor necrosis factor-alpha at time 3 when results were compared with those of the same group baseline and of groups B and C at the same time. No significant changes were noted between B and C at any time. These results demonstrate low-dose aprotinin has a similar antiinflammatory effect to that of methylprednisolone in blunting cardiopulmonary bypass-induced systemic tumor necrosis factor-alpha release and neutrophil integrin CD11b upregulation.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Aprotinin / therapeutic use*
  • Cardiopulmonary Bypass / adverse effects*
  • Coronary Artery Bypass*
  • Elective Surgical Procedures
  • Enzyme-Linked Immunosorbent Assay
  • Humans
  • Inflammation / etiology
  • Inflammation / prevention & control*
  • Macrophage-1 Antigen / blood
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Neutrophils / metabolism
  • Time Factors
  • Tumor Necrosis Factor-alpha / analysis

Substances

  • Anti-Inflammatory Agents
  • Macrophage-1 Antigen
  • Tumor Necrosis Factor-alpha
  • Aprotinin
  • Methylprednisolone