Influence of steroids on complement and cytokine generation after cardiopulmonary bypass

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Background.

It is recognized that the inflammatory mediators complement and cytokines are generated during cardiopulmonary bypass as an endogenous response to extracorporeal circulation.

Methods.

Nineteen randomized patients (10 steroid/9 nonsteroid) entered an institutional review board-approved protocol to measure complement and interleukin level generation before and after elective coronary revascularization. The steroid regimen involved 1 g of methylprednisolone sodium succinate intravenously before bypass and 4 mg of dexamethasone every 6 hours for four doses during the first 24 hours of recovery. Complement and interleukin levels were measured before bypass, immediately after bypass, and at 24, 48 and 72 hours of recovery.

Results.

In the nonsteroid group, there was a significant elevation in all inflammatory mediators relative to the steroid group. The predominant changes occurred at 24 hours after operation.

Conclusions.

Steroids produced a dramatic reduction in complement and interleukin levels. The number of patients was clearly too small to document a clinical consequence of steroid administration.

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    Dexamethasone (DEX) is a glucocorticoid with anti-inflammatory and immunosuppressive properties (Auphan et al., 1995). In addition, it inhibits the activation of complement (Engelman et al., 1995; Packard and Weiler, 1983). Given the important role of complement in promoting adaptive immunity and supporting the efficacy of radiotherapy, we treated mice with DEX starting 1 day before radiotherapy.

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Presented at the International Symposium on Myocardial Protection From Surgical Ischemia-Reperfusion Injury, Asheville, NC, Sep 25–28, 1994.

Supported by National Institutes of Health grants HL 22559-14 and HL 34360-07.

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