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Soluble ST2 Protein in Cardiac Surgery: A Possible Negative Feedback Loop To Prevent Uncontrolled Inflammatory Reactions by Tamás Szerafin, Markus Brunner, Ambrus Horváth, Lajos Szentgyörgyi, Bernhard Moser, George Boltz-Nitulescu, Árpád Péterffy, Konrad Hoetzenecker, Barbara Steinlechner, Ernst Wolner, Hendrik Jan Ankersmit

Background: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads to a TH2 cytokine bias in patients undergoing coronary artery bypass grafting (CABG) operation. The relation of soluble ST2 and secretion of IL-10, markers of TH2 T-cell activation, and IL-13 in relation to immunoglobulin isotope production is not known in patients undergoing On- versus Off-pump (CABG) procedure.
Methods: 30 patients were prospectively included in the study (On- vs Off-pump CABG, each n=15). Serum samples were obtained prior to, and 30min, 60 min and 24hrs after operation. ELISA was utilized to detect sST2 and IL-10, IL-13 and immunoglobulin isotype production.
Results: In both cohorts we could demonstrate a significant rise of ST2 24 hours after the CABG procedure. In the On-pump group ST2 levels (pg/ml) before the operation, at 30 and 60 minutes and after 24 hours were 115.3±25, 71.2±15, 114.1±26 and 4231.9±520, respectively. In the Off-pump group they were 200.3±109, 91.2±20, 137±29 and 4144.9±488 (both, p<0.0001, p<0.0001, respectively). IL-10 (pg/ml) levels rose from preoperative values of 6.2±1.6 in the On-pump group and 7.91±1.8 in the Off-pump group to 33.14±8.7 and 13.72±3 after 60 minutes (p 0.0189, p 0.0397, respectively). IL-13 levels and immunoglobulin production did not change significantly within the study period irrespective of the operation procedure used.
Conclusion: In conclusion, our results demonstrate that sST2 and IL-10, markers of TH2 cytokine producing cells, are increased in CABG operation, irrespective of the procedure selected, and settles a longstanding controversy concerning the shift from Th1 to Th2 cells.

DOI: Clin. Lab. 2005;51:657-663