Interleukin-6 as possible early marker of stress response after femoral fracture

Abstract

Bone fracture healing is a complex process which at best results in full recovery of function and structure of injured bone tissue, but all the mechanisms involved in this process, and their mutual interaction, are not fully understood. Despite advancement of surgical procedures, this type of fractures is still a major public health concern. In the last few decades, a lot of attention is focused on the oxygen-free radicals and inflammatory response markers as important factors of skeletal injury. Thus, the aim of the present study was to follow the changes in redox balance and inflammatory response in elderly patients with femoral fractures during the earliest stages of fracture healing, by measuring the values of the observed markers immediately after fracture, as well as the first, third, and seventh postoperative day. Present study was performed on a group of 65 elderly patients with femoral neck fractures, recruited from the Orthopedic Clinic, Clinical Centre Kragujevac in the period from February to May 2015. Redox status was measured spectrophotometrically and evaluated by measuring the levels of index of lipid peroxidation (measured as TBARS), nitrite (NO), superoxide anion radical (O), and hydrogen peroxide (HO) in plasma, while activities of corresponding antioxidative enzymes, catalase (CAT), superoxide dismutase (SOD), and reduced glutathione (GSH) were measured in erythrocytes. The cytokine concentrations of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were determined in plasma, using ELISA assays specific for human cytokines. Our study showed that redox status and TNF-α in elderly patients with femoral fractures did not show statistically significant changes during the early phase of fracture healing. On the other hand, IL-6 increased statistically in first day after intervention. This preliminary study has shown our observations, and we hope that these results may help in better understanding mechanisms which are included at fracture healing. More importantly, this study attempted to create a platform for further research.

Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients

“…Our finding of elevated postoperative IL-6 levels following orthopedic surgery is consistent with other studies [4,7,9,19,34,43,46]. IL-6 mediates the transition from innate to adaptive immunity [18,41].…”

Keel Fracture Causes Stress and Inflammatory Responses and Inhibits the Expression of the Orexin System in Laying Hens

“…Keel fracture not only influences the behavior and welfare of laying hens, but also reduces their performance, egg, and bone quality [6,7,8,9]. In rat tibia and human femur models, fracture induces pain, stress, and inflammatory responses [10,11]; however, we do not know whether this response can be seen in laying hens with keel fracture.…”

Inflammatory response in postmenopausal osteoporotic fracture healing

“…All of them included the investigation of IL-6, and they all demonstrated that IL-6 increased considerably at earlier stages of fragility fracture healing and diminished over time. 34 , 63 , 64 It has been postulated that IL-6 is responsible for stimulating the early stage of fracture healing, as reported in a previous study showing that IL-6 level in trauma patients decreased six months after injury. 81 Another study also reported that IL-6 elevated to a great level in patients with head injury within hours of injury, as IL-6 and receptor complex may be capable of stimulating cells of the mesenchymal lineage and therefore may enhance the formation of osteoblastic bone.…”

“… 36 Caetano-Lopes et al 63 found that gene expression of TNF locally at the fracture site of low energy hip arthroplasty patients were similar among all timepoints (the first three days, days 4 to 7, and days 8 or more post-fracture) without any apparent variation in pattern. Pesic et al 64 reported that the level of TNF-α in plasma detected by ELISA was similar among all timepoints (12 hours after fracture, and days 1, 3, and 7) after surgical intervention. Saribal et al 65 demonstrated plasma TNF-α levels by quantitative sandwich enzyme immunoassay were similar between healthy controls and osteoporotic hip fracture patients before and after surgery.…”

“…In Fischer et al, 34 serum level of IL-6 was found to be significantly higher in fracture patients at days 0 and 14 post-fracture compared to healthy controls. 34 Pesic et al 64 demonstrated that IL-6 level in plasma was significantly higher at day 1 after surgical intervention when compared to 12 hours after fracture and days 3 and 7 after intervention. Saribal et al 65 demonstrated that plasma IL-6 levels by quantitative sandwich enzyme immunoassay were similar between healthy controls and osteoporotic hip fracture patients before surgery.…”