Perioperative Dynamics of TLR2, TLR4, and TREM-1 Expression in Monocyte Subpopulations in the Setting of On-Pump Coronary Artery Bypass Surgery

A S Golovkin,Y V Bayrakova,V G Matveeva,E V Grigoriev,D L Shukevich,I V Kudryavtsev,M N Chernova

doi:10.1155/2013/817901

Abstract

Hypercytokinemia plays a key role in the pathogenesis of systemic inflammatory response syndrome (SIRS). Monocytes are the main source of cytokines in the early inflammatory phase. Simultaneous stimulation of toll-like receptors (TLRs) and triggering receptor expressed on myeloid cells (TREM-1) activating receptor on monocytes results in the amplification of the inflammatory signal and multiple increase in proinflammatory cytokine production. The dynamics of those receptors expression on monocyte surface of patients with uncomplicated SIRS course followed coronary artery bypass surgery (CABG) was studied. The increase in TLR2 and TREM-1 expression on the first day after CABG induces proinflammatory and amplification potentials of monocytes in that period. The decrease in TLR2 surface expression on the seventh day compared to the preoperative values can be regarded as a mechanism limiting inflammatory response. The highest level of TLR2, TLR4, and TREM-1 surface expression was observed in CD14hiCD16+ monocyte subpopulation, confirming its proinflammatory profile.

Highlights

The early postoperative period in coronary artery bypass surgery (CABG) patients is associated with systemic inflammatory response syndrome (SIRS), which is complicated with multiple organ dysfunction and high mortality in 5%–16% of cases (EACTA 2007 data) [1, 2]
We suggest the level of TREM-1, TLR2, and TLR4 surface expression to determine their potential to the inflammatory response amplification
The most numerous CD14hiCD16− subpopulation, which normally makes up 90%–95% of all the blood monocytes, is characterized by active chemokine production (IL-8, CCL2, and CCL3) and marked phagocytic and microbicidal activity but used to have low proinflammatory cytokines production [21]

Summary

Introduction

The early postoperative period in CABG patients is associated with systemic inflammatory response syndrome (SIRS), which is complicated with multiple organ dysfunction and high mortality in 5%–16% of cases (EACTA 2007 data) [1, 2]. SIRS is still being investigated, and its criteria and clinical features of its course for different conditions and diseases are being specified and elaborated [3]. The success of onpump heart surgery often depends on the prompt intensive treatment and prevention of SIRS complications in the postoperative period. SIRS course and criteria as well as the ways of predicting its complications are of a great interest in this group of patients. The leading role of the immune system in the SIRS development has been confirmed. The congenital immune system is inseparably linked to those processes [3]

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