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J Thorac Cardiovasc Surg 1998;116:511-515
© 1998 Mosby, Inc.
Cardiopulmonary Support and Physiology |
From the First Department of Surgery, Osaka University Medical School, Osaka, Japan.
Received for publication Dec 29, 1998. Revisions requested Feb 23, 1998; revisions received April 30, 1998. Accepted for publication May 13, 1998.
Background: Reperfusion injury in the myocardium has recently been considered to be a type of inflammation, and close attention has been paid to the possible involvement of neutrophils, complement, and cytokines in the onset of this injury. Recently, it has been reported that serum levels of interleukin-6 are elevated significantly after myocardial infarction. The major site of interleukin-6 production and its exact roles are still unknown. In this study, we hypothesized that myocytes may produce interleukin-6 during hypoxia and this may play a role in neutrophil-mediated reperfusion injury.
Methods and results: In the clinical study, 20 patients who underwent coronary artery bypass grafting were divided into 2 groups: group F, in which patients were treated with a serine protease inhibitor (FUT-175, 2 mg/kg per hour) during cardiopulmonary bypass, and group C (untreated patients). In group C, myocardial interleukin-6 production, as determined by the difference between the interleukin-6 level in the cardiopulmonary bypass circuit and its level in coronary venous blood, increased significantly after reperfusion (12 ± 4 pg/mL) as compared with that before aortic crossclamping (2 ± 2 pg/mL). In group F, the increase in the interleukin-6 level was suppressed significantly (before aortic crossclamping, 3 ± 2 pg/mL; after reperfusion, 4 ± 3 pg/mL). The interleukin-6 production differed significantly between group C and group F. In the in vitro experimental study, the supernatant from myocytes exposed to 2 hours of hypoxia (group 2H) showed significantly higher levels of interleukin-6 (455 ± 260 pg/mL) than that from normoxic myocytes (group N) (47 ± 15 pg/mL). This interleukin-6 production was suppressed by the addition of FUT-175 (123 ± 24 pg/mL). The interleukin-6 production by endothelial cells of coronary vessels did not differ between group 2H (283 ± 151 pg/mL) and group N (151 ± 86 pg/mL). In a coincubation system with a monolayer of endothelial cells on collagen membrane and myocytes under collagen membrane in a modified Boyden chamber, 2 hours of coincubation showed a significantly higher percent of neutrophil transendothelial migration (group 2H vs N, 78% ± 13% vs 26% ± 11%), value of chemiluminescence (22 ± 8 vs 5 ± 2 x 103 counts/3 minutes), and percent of irreversibly damaged myocytes (48% ± 17% vs 12% ± 8%) than normoxic coincubation. In contrast, anti–interleukin-6 monoclonal antibody significantly attenuated neutrophil transendothelial migration (42% ± 19%) and irreversible damage of myocytes (26% ± 15%) in 2 hours of coincubation.
Conclusions: Interleukin-6 is produced from myocardium during ischemia and reperfusion in patients undergoing coronary bypass grafting. This interleukin-6 may be derived from hypoxic myocytes and play a role in neutrophil-mediated reperfusion injury in myocardium.
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