A comparative study of interleukin 6 and 17 serum levels in patients undergoing coronary artery bypass surgery using off-pump and on-pump methods

Document Type : Original Article


1 Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Biology, Faculty of Science, Payam-e Noor University of Mashhad, Mashhad, Iran.

3 Department of anesthesiology, Faculty of medicine, Mashhad University of medical sciences, Mashhad, Iran

4 Department of Biology, Faculty of Science, Payam-e Noor University,Tehran, Iran.

5 Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran


Introduction: This study aims to investigate the role of coronary artery bypass graft (CABG) surgery by off-pump and on-pump methods in the severity of postoperative inflammation based on serum levels of interleukin 6 (IL6) and interleukin 17 (IL17).
This is a cross-sectional study in which 39 patients’ candidate for CABG were evaluated in terms of serum levels of IL17 and IL6 before and after surgery in two groups of off-pump and on-pump CABG.
Thirty-nine patients with an average age of 63±8.9 in the on-pump group and 59±7.74 in the off-pump group were evaluated. There was no significant difference between the two groups in terms of baseline information and underlying diseases. IL6 serum level (p=0.249) was not significantly difference between the two groups. However, IL17 serum level (p=0.012) demonstrated a significant difference between the two groups.
In general, the results of this study showed that increased IL6 serum level following coronary artery bypass was not different between the two methods of CABG surgery. Besides, IL17 exhibited a significant difference between the two groupsi that it was reduced in on-pump group in after surgery. It can be due to special condition’s patients or low sample size of study. Moreover, the postoperative complications were not significantly different between the two groups. This valuable outcome contradicts the popular belief that the use of the CARDIO PULMONARY BYPASS (CPB) system stimulates the immune system and hence its application should be limited.


  1. Meng F, Ma J, Wang W, Lin B. Meta-analysis of interleukin 6, 8, and 10 between offpump and on-pump coronary artery bypass groups. Bosn J Basic Med Sci. 2017 May; 17(2): 85–94. doi: 10.17305/bjbms.2017.1505
  2. Brinkman WT, Squiers JJ, Covington KR, Wheeler DA, Arsalan M, Smith RL, et  al. Mini-extracorporeal circulation and off-pump techniques associated with less inflammatory gene expression as compared to on-pump in the 24-hour postoperative window following coronary artery bypass grafting. J Cardiothorac Surg 2015;10(Suppl 1): A101.  doi: 10.1186/1749-8090-10-S1-A101
  3. Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Offpump vs. On-pump coronary artery bypass surgery: An updated meta-analysis and meta-regression of randomized trials. Eur Heart J 2012;33(10):1257-67.  Doi: 10.1093/eurheartj/ehr307.
  4. Nesher N, Frolkis I, Vardi M, Sheinberg N, Bakir I, Caselman F, et al. Higher levels of serum cytokines and myocardial tissue markers during on-pump versus off-pump coronary artery bypass surgery. J Card Surg 2006;21(4):395-402. doi:10.1111/j.1540-8191.2006.00272.x.
  5.  Wan IY, Arifi AA, Wan S, Yip JH, Sihoe AD, Thung KH, et al. Beating heart revascularization with or without cardiopulmonary bypass: Evaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg 2004;127(6):1624-31.  doi: 10.1016/j.jtcvs.2003.10.043.
  6. Ghorbel MT, Cherif M, Mokhtari A, Bruno VD, Caputo M, Angelini GD. Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery. Physiol Genomics 2010;42(1):67-75. doi: 10.1152/physiolgenomics.00174.2009.
  7.  Rogers CA, Pike K, Angelini GD, Reeves BC, Glauber M, Ferrarini M, et al. An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: The Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovasc Surg 2013;146(2):306-16.e9. DOI: 10.1016/j.jtcvs.2012.04.020.
  8. Brocker C, Thompson D, Matsumoto A, Nebert DW, Vasiliou V. Evolutionary divergence and functions of the human interleukin (IL) gene family. Hum Genomics 2010;5(1):30-55. doi; 10.1186/1479-7364-5-1-30.
  9. Cua DJ, Sherlock J, Chen Y, Murphy CA, Joyce B, Seymour B, et  al. Interleukin-23 rather than interleukin-12 is the critical cytokine for autoimmune inflammation of the brain. Nature 2003;421(6924):744-8. doi; 10.1038/nature01355.
  10.  Kuilman T, Michaloglou C, Vredeveld LC, Douma S, van Doorn R, Desmet CJ, et al. Oncogene-induced senescence relayed by an interleukin-dependent inflammatory network. Cell 2008;133(6):1019-31. Doi:10.1016/j.cell.2008.03.039.
  11. Xing Z, Gauldie J, Cox G, Baumann H, Jordana M, Lei XF, et al. IL-6 is an antiinflammatory cytokine required for controlling local or systemic acute inflammatory responses. J  Clin Invest 1998;101(2):311-20. doi: 10.1172/JCI1368.

12. Andrew H, Lichtman, Shiv Pillai. Cellular and Molecular Immunology. Abul Abbas. Translators: Talibzadeh A, Bajan M, and Khalili A. Tehran: Khalili Publications, 2012. (Persian)

13. Vajgani M. Immunology. Tehran: Tehran University Jihad Organization Publications, 2016.(Persian)Shi C, Zhu L, Chen X, Gu N, Chen L, Zhu L, et al. IL-6 and TNF-a induced obesity-related inflammatory response through transcriptional regulation of miR-146b. J Interferon Cytokine Res 2014;34(5):342-8. doi: 10.1089/jir.2013.0078.

14. Pickup JC, Mattock MB, Chusney GD, Burt D. NIDDM as a disease of the innate immune system: Association of acute-phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia 1997;40(11):1286-92. doi: 10.1007/s001250050822.

15. Phillips CM, Perry IJ. Does inflammation determine metabolic health status in obese and nonobese adults? J Clin Endocrinol Metab 2013;98(10):E1610-9.  doi:10.1210/jc.2013-2038.

16. Vozarova B, Weyer C, Lindsay RS, Pratley RE, Bogardus C, Tataranni PA. High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of Type 2 diabetes. Diabetes 2002;51(2):455-61. doi:10.2337/diabetes.51.2.455.