Intraoperative Hemoadsorption Reprograms Myeloid Activation and Cytokine Signaling in Patients Undergoing Cardiopulmonary Bypass

All articles of this category (opens in new window) Background: Cardiac surgery with cardiopulmonary bypass (CPB) provokes profound innate immune activation, which contributes to postoperative complications. Blood purification strategies have been proposed to modulate excessive inflammation, but their effects on myeloid subsets and cytokine signaling remain incompletely defined. Methods: In this prospective randomized trial, 50 patients undergoing elective coronary artery bypass grafting with CPB were allocated to either standard management ( n = 25) or intraoperative hemoadsorption ( n = 25). Peripheral blood was sampled at baseline, after CPB, 8 hours, and 24 hours. Flow cytometry quantified CD64 on neutrophils, CD169 and HLA-DR on monocytes, and detailed immune cell subsets. Multiplex cytokine analysis was performed before and after CPB. Group differences, intra-group contrasts, slopes, and correlations were assessed. Results: Hemoadsorption induced a significant downregulation of neutrophil CD64 at 8 and 24 hours ( p < 0.05) with steeper temporal slopes compared with controls. In contrast, CD169 and HLA-DR on monocytes declined more strongly in treated patients. Cytokine profiling demonstrated reduced proinflammatory mediators (IL-8, IL-1α, TNF-β, TRAIL) and relatively increased IL-10, consistent with an anti-inflammatory shift. Correlation analysis linked suppression of monocyte markers to IL-10, GM-CSF, IFN-γ, and IL-1β. Cell subset analysis confirmed these findings: total monocytes decreased more strongly (after CPB: 0.31 ± 0.14 vs. 0.40 ± 0.15 × 10 −9 /L; p = 0.03), particularly intermediate monocytes (0.07 ± 0.04 vs. 0.11 ± 0.05; p = 0.02). Lymphocyte counts declined in both groups, but more prominently in the intervention group (0.8 ± 0.3 vs. 1.0 ± 0.4 ×10 −9 /L; p = 0.05), especially CD4+ T-helper cells (0.41 ± 0.18 vs. 0.53 ± 0.21; p = 0.04). Conclusion: Intraoperative hemoadsorption during CPB promotes neutrophil activation while suppressing monocyte and CD4+ T-cell responses, accompanied by a cytokine shift toward IL-10. This divergent modulation of innate and adaptive immunity may represent a clinically relevant mechanism influencing postoperative immune competence and recovery. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany