Immunosuppressive Effects of Prostaglandin E1 during and after Cardiopulmonary Bypass Operation in Patients with Ischemic Heart Diseases

Ryuichi Shibano Ataru Kuroiwa* Tadashi Tashiro
Michio Kimura

(Department of Cardiovascular Surgery and Department of Microbiology and Immunology*, Fukuoka University School of Medicine, Fukuoka, Japan)

The Immunosuppressive effects of prostaglandin E1 (PGE1) used in cardiopulmonary bypass (CPB) operation were studied. We examined 30 patients, with ischemic heart diseases. The patients were divided into 3 groups: 11 patients given PGE1 in group PG (G-PG), 10 patients given amurinon, a phosphodiesterase inhibiter, in group A (G-A), and 9 patients not given either of those drugs in the control group (G-C). Immunologically, lymphocyte subpopulations, and adhesion molecule expression on cell membrane and phagocytosis of neutrophils were analyzed before, at the time of, and after the operation until POD 7. The prominent effects of PGE1 were observed on neutrophils. The expression of CD62L, an adhesion molecule designated as L-selectin, on the cell surface membrane of neutrophils significantly increased during and after CPB in G-A and G-C, but it remained unchanged in G-PG during the observation period. Moreover, CPB caused an enhancement of the phagocytic activity of neutrophils in all groups, but its degree was much less in G-PG than in the other two groups. Among lymphocyte subpopulations, the number of CD3+T-cells in G-PG rather than that of CD20+B-cells reduced more greatly than those values observed in G-A and G-C. The decrease of T-cell number, throughout the observation period, in G-PG seemed to be mainly due to the decrease of the number of CD4+T-cells designated as helper T-cells, although the number of CD8+T-cells designated as killer/suppressor T-cells slightly decreased on PODs 3 and 7. Amurinon, as a whole, did not exert any significant effect either on lymphocytes or on neutrophils in our experiments. Taken together, these results show that the treatment of patients with PGE1 during CPB causes suppressive effects on immunorelevant cells. It may mitigate the activity of neutrophils, which are suspected as a possible culprit causing reperfusion injury. However, these suppressive effects, including the lowered numbers of CD4+T-cells, may render the patients more vulnerable to infection. Much more intensive cares is required in these patients after operations.
@Jpn. J. Cardiovasc. Surg. 31F167-172 (2002)