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@ARTICLE{Merbecks:156843,
author = {M. B. Merbecks and V. C. Ziesenitz and T. Rubner$^*$ and N.
Meier and B. Klein and H. Rauch and P. Saur and N. Ritz and
T. Loukanov and S. Schmitt$^*$ and M. Gorenflo},
title = {{I}ntermediate monocytes exhibit higher levels of {TLR}2,
{TLR}4 and {CD}64 early after congenital heart surgery.},
journal = {Cytokine},
volume = {133},
issn = {1043-4666},
address = {Oxford [u.a.]},
publisher = {Elsevier},
reportid = {DKFZ-2020-01160},
pages = {155153},
year = {2020},
note = {Volume 133, September 2020, 155153},
abstract = {Congenital heart surgery with cardiopulmonary bypass (CPB)
initiates an immune response which frequently leads to organ
dysfunction and a systemic inflammatory response.
Complications associated with exacerbated immune responses
may severely impact the postoperative recovery. The
objective was to describe the characteristics of monocyte
subpopulations and neutrophils at the level of pattern
recognition receptors (PRR) and the cytokine response after
CPB in infants.An observational cohort study was conducted
between June 2016 and June 2017 of infants < 2 years of
age, electively admitted for surgical correction of
acyanotic congenital heart defects using CPB. Fourteen blood
samples were collected sequentially and processed
immediately during and up to 48 h following cardiac surgery
for each patient. Flow cytometry analysis comprised
monocytic and granulocytic surface expression of CD14, CD16,
CD64, TLR2, TLR4 and Dectin-1 (CLEC7A). Monocyte
subpopulations were further defined as classical
(CD14++/CD16-), intermediate (CD14++/CD16+) and nonclassical
(CD14+/CD16++) monocytes. Plasma concentrations of 14
cytokines, including G-CSF, GM-CSF, IL-1β, IL-1RA, IL-4,
IL-6, IL-8, IL-10, IL-12p40, IL-12p70, TNF-α, IFN-γ,
MIP-1β (CCL4) and TGF-β1, were measured using multiplex
immunoassay for seven points in time.Samples from 21 infants
(median age 7.4 months) were analyzed by flow cytometry and
from 11 infants, cytokine concentrations were measured.
Classical and intermediate monocytes showed first receptor
upregulation with an increase in CD64 expression four hours
post CPB. CD64-expression on intermediate monocytes almost
tripled 48 h post CPB (p < 0.0001). TLR4 was only
increased on intermediate monocytes, occurring 12 h post
CPB (p = 0.0406) along with elevated TLR2 levels
(p = 0.0002). TLR4 expression on intermediate monocytes
correlated with vasoactive-inotropic score (rs = 0.642,
p = 0.0017), duration of ventilation (rs = 0.485,
p = 0.0259), highest serum creatinine (rs = 0.547,
p = 0.0102), postsurgical transfusion (total volume per kg
bodyweight) (rs = 0.469, p = 0.0321) and lowest mean
arterial pressure (rs = -0.530, p = 0.0135).
Concentrations of IL-10, MIP-1β, IL-8, G-CSF and IL-6
increased one hour post CPB. Methylprednisolone
administration in six patients had no significant influence
on the studied surface receptors but led to lower IL-8 and
higher IL-10 plasma concentrations.Congenital heart surgery
with CPB induces a systemic inflammatory process including
cytokine response and changes in PRR expression.
Intermediate monocytes feature specific inflammatory
characteristics in the 48 h after pediatric CPB and TLR4
correlates with poorer clinical course, which might provide
a potential diagnostic or even therapeutic target.},
cin = {W220},
ddc = {570},
cid = {I:(DE-He78)W220-20160331},
pnm = {319H - Addenda (POF3-319H)},
pid = {G:(DE-HGF)POF3-319H},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:32554157},
doi = {10.1016/j.cyto.2020.155153},
url = {https://inrepo02.dkfz.de/record/156843},
}