Tumor necrosis factor-α and interleukin-10 gene expression in peripheral blood mononuclear cells after cardiac surgery

OBJECTIVE: Cytokine response after cardiac surgery may be genetically influenced. A study was carried out to investigate the relation between cytokine gene expression in peripheral blood mononuclear cells, genotype, and clinical events after cardiac surgery. DESIGN: A case-control study was performed. SETTING: Cardiac intensive care unit in a university hospital. SUBJECTS: A total of 82 patients having elective cardiac surgery were divided into those having uncomplicated recovery (n = 48) or recovery complicated by hyperlactatemia or requirement for inotropic support (n = 34). INTERVENTIONS: The relative change in peripheral blood mononuclear cell tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) messenger RNA 1 and 6 hrs after cardiopulmonary bypass was compared with a baseline preoperative level using quantitative reverse transcriptase polymerase chain reaction. DNA was analyzed for carriage of TNF-α and IL-10 polymorphic alleles. MEASUREMENTS AND MAIN RESULTS: Cardiopulmonary bypass was longer in duration in the complicated group. TNF-α gene expression decreased and IL-10 gene expression increased in peripheral blood mononuclear cells after surgery when compared with preoperative levels. One hour after cardiopulmonary bypass, the complicated group had more TNF-α and less IL-10 messenger RNA production than the uncomplicated group. The IL-10/TNF-α ratio was greater in uncomplicated than in complicated recovery patients. An IL-10 haplotype was identified that was less frequent in the complicated group. There was no difference between groups in TNF-α genotype. On multivariate analysis, cardiopulmonary bypass time and the IL-10/TNF-α messenger RNA ratio were independent predictors of outcome. CONCLUSIONS: There is a predominant anti-inflammatory cytokine response after uneventful cardiac surgery. IL-10 may have a protective role after cardiac surgery.