The proliferative cytokines TGF-β and VEGF in pleural effusions post-coronary artery bypass graft

Chibante, António MS; Vaz, Marcelo Alexandre C; Suso, Francisco Vargas

doi:10.1016/S2173-5115(06)70407-9

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Abstract

Coronary artery bypass graft (CABG) surgeries can impact on the pericardium and pleural space, leading to inflammation which can cause effusion.

Aim

To study the role of the proliferative cytokines TGF-β and VEGF in the fluids of 16 transudates and 43 pleural effusions of patients who underwent CABG at the Heart Unit and Pulmonology Unit of the University Hospital of São Paulo. Levels of cytokines were assessed 2, 24 and 48 hours post-surgery.

Results

The pleural effusion after CABG is an exsudative mobilizer of TGF-β and VEGF cytokines immediately after surgery. The TGF-β concentrations were elevated 2 hours after surgery but started to fall soon after, reaching transudate levels after 48 hours. VEGF levels were high in the first 2 hours post surgery and tended to maintain the same concentrations for at least 48 hours after surgery.

Conclusions

Based on the results obtained, TGF-β is a cytokine that seems to work as a trigger, leading the pleural mesothelial cell to express VEGF a cause of pleural effusion in CABG surgeries.

Key-words:

Inflammation

cytokines

pleural effusions

coronary artery bypass grafting

Resumo

A cirurgia de revascularização do miocárdio envolve o acometimento, tanto do pericárdio como da pleura, conduzindo ao favorecimento de processos inflamatórios responsáveis pelo desenvolvimento de derrames nestes compartimentos.

Objectivo

Estudar o comportamento das citocinas proliferativas TGF-β (factor beta de transformação do crescimento) e VEGF (factor de crescimento do endotélio vascular) nos líquidos de 16 transudatos e de 43 derrames pleurais de doentes submetidos a cirurgias de revascularização do miocárdio provenientes do Instituto de Coração e do Serviço de Pneumologia da Universidade do São Paulo nos intervalos de 2, 24 e 48 horas de pós-operatório.

Resultados

O derrame pleural pós-revascularização do miocárdio é um exsudato mobilizador de TGF-β e VEGF no pós-operatório imediato. Os níveis de TGF-β apresentam-se elevados nas primeiras 2 horas para caírem progressivamente até se aproximarem dos valores dos transudatos ao fim de 48 horas, enquanto o VEGF se inicia com níveis elevados já nas primeiras 2 horas com tendência a aumento pelo menos até 48 horas de pós-operatório.

Conclusões

O TGF-β parece comportar-se como elemento gatilho sobre a célula mesotelial pleural para a liberação de VEGF no desenvolvimento de derrame pleural nas cirurgias de revascularização do miocárdio.

Palavras-chave:

Inflamação

citocinas

derrame pleural

revascularização do miocárdio

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