Endotoxemia during supraceliac aortic crossclamping is associated with suppression of the monocyte CD14 mechanism: Possible role of transforming growth factor-beta(1)

Purpose: Monocyte CD14 and its soluble form (sCD14) mediate the proinflamma tory response to endotoxemia. The aim of this study was to measure the chan ges to these factors after major aortic surgery and the possible inhibitory role of transforming growth factor-beta(1) (TGF-beta(1)) during these proc edures. Methods: Twenty-four patients with supraceliac aortic crossclamping during thoracoabdominal aortic aneurysm (TAAA) repair and 12 patients with infrare nal aortic crossclamping as part of infrarenal aneurysm repair (AAA) were s tudied. Blood was collected at incision, aortic clamping, and reperfusion a nd at 1, 8, and 24 hours after reperfusion. Samples were assayed for endoto xin, peripheral blood monocyte CD14 expression, sCD14, tumor necrosis facto r-alpha, and TGF-beta(1) Results: Although there was significant endotoxemia on reperfusion in both groups of patients, peak plasma endotoxin levels were significantly higher in patients with TAAA (P = .001). Monocyte CD14 and plasma sCD14 were signi ficantly decreased in patients with TAAA at reperfusion and I hour after re perfusion (P < .01, both points). In. patients with AAA, a significant upre gulation of CD14 was observed at 24 hours after reperfusion (P < .01), bur no significant changes in sCD14 were observed. TNF-alpha showed no signific ant changes during the study period in both groups. In patients with TAAA, TGF-beta(1) showed significant elevation at all time points (P < .01); wher eas In patients with AAA, TGF-beta(1) showed no significant changes. Conclusion: Splanchnic ischemia reperfusion in patients who undergo suprace liac aortic damping is associated with peripheral blood monocyte CD14 suppr ession and significant elevation of TGP-beta(1), TGF-beta(1) may play an im portant role in modulating the immune response to endotoxemia during major aortic aneurysm surgery.