Hyperstimulation of leukocytes by plasma from cardiopulmonary by-pass patients is diminished by morphine and IL-10 pretreatment

Objective. The trauma of cardiopulmonary by-pass (CPB) in cardiac surgery results in a whole body diffuse inflammatory response characterized in part by hyperstimulation of leukocytes. Partially this is due to an increase in the release of biological response modifiers such as cytokines, as noted by the immunocyte stimulatory actions of cell-free plasma obtained postoperatively from CPB patients. The present study was conducted to determine whether CPB plasma induced immunocyte hyperstimulation can be prevented with naturally occurring immune inhibitory substances, specifically, interleukin (IL)-10 and/or morphine. Experimental design. Controlled in vitro study of the application of drugs to naive immunocytes to block the exitation caused by CPB-plasma. Setting. University-based tertiary care hospital. Patients. Plasma was obtained from ten patients undergoing CPB. Eligibility included admission for elective cardiac surgery, which no chronic illnesses or acute processes. Interventions. Monocytes and granulocytes were pretreated with IL-10 and/or morphine before exposure to plasma obtained from patients undergoing CPB, as CPB-plasma would stimulate naive monocytes and granulocytes in a manner similar to that previously reported in CPB-patients. Measures. Computer-assisted microscopic image analysis, measuring cellular conformational and velocity changes, was used to evaluate the effect of treatment on the immunocytes response to stimulation with CPB plasma. Results. Pretreatment of cells with IL-10 and/or morphine significantly diminished the hyperstimulation induced by CPB-plasma in a concentration-dependent manner. In contrast, when the cells were initially or simultaneously exposed to CPB-plasma, IL-10 and/or morphine had no effect. Conclusions. Taken together, the data strongly suggest that naturally occurring immune inhibitory substances can diminish the immunocyte hyperstimulation associate with CPB-plasma exposure. Thus, since the body's own defense mechanisms appear to exacerbate the trauma of cardiac surgery, prophylactic use of these substances may enable patients to recover at a faster rate