In vitro production by whole blood of pro- and anti-inflammatory cytokines in neonates with transposition of the great arteries having undergone arterial switch operation

Background

Cardiac operations induce a systemic inflammatory reaction which could influence reactivity of immune competent cells in the days or weeks following the operative procedure and thus postoperative infectious morbidity.

Objectives

To test the hypothesis of whether pro- and anti-inflammatory cytokine synthesis is modified in neonates having undergone cardiac operation.

Methods

15 neonates with transposition of the great arteries were investigated before as well as 5 and 14 days after arterial switch operation. Mean age at operation was 6 days. Whole blood (1 ml) was stimulated in vitro with bacterial endotoxin (LPS) (1 ng/ml) and the concentrations of the pro-inflammatory cytokines TNFα and IL8 and of the natural anti-inflammatory cytokine IL10 were measured in the cell culture supernatant.

Results

As compared with the control culture, there was a significant production of TNFα, IL8 and IL10 before as well as 5 and 14 days after the operation. In comparison with the preoperative results, TNFα and IL8-production decreased significantly 5 days after the operation (P< 0.02 and < 0.05, respectively) whereas IL10-synthesis remained unchanged. There was no significant difference between cytokine production before and 14 days after the operation.

Conclusions

Our results demonstrate that neonates having undergone cardiac operation display transient postoperative inhibition of the reactivity of immune competent cells with decreased production of pro-inflammatory cytokines. In contrast, the production of the natural anti-inflammatory cytokine IL10 remains postoperatively unaltered and could be in turn, at least in part, involved in the postoperative inhibition of TNFα and IL8 synthesis.