Increase of interleukin-6 plasma levels after elective craniotomy: Influence of interleukin-10 and catecholamines

Abstract

Accidental and operative trauma are able to induce a systemic reaction of the organism characterized by fever, leukocytosis, catabolism, and an activation of the coagulation system. Interleukin-6 (IL-6) has been found to be an important mediator of this acute-phase response. In this study the influence of elective craniotomy on IL-6 plasma levels was evaluated. Blood samples were obtained from 20 patients undergoing elective craniotomy for vascular or tumorous diseases of the brain. IL-6 increased significantly (p < 0.05) from the pre-operative (0(0-5.4) pg/ml) to the intraoperative (180 min after beginning of surgery) time-point (10.6 (0-18.5) pg/ml). The maximum was reached on the first postoperative morning (13.9(4.3-45.0) pg/ml). Interleukin-10 (IL-10) is an anti-inflammatory cytokine which suppresses IL-6 synthesis in vitro in various cell lines. IL-10 plasma concentrations showed no alterations throughout the study period. Epinephrine plasma concentrations increased significantly from pre-operative values (15 (0-74) pg/ml) to the postoperative time-point (57(9-459) pg/ml). A 4.5-fold increase (p < 0.05) of norepinephrine plasma concentrations was found when comparing the data obtained 60 min after beginning of surgery with the data of the first postoperative morning. In monocytes, which are a major source of plasma IL-6, an elevation of intracellular cAMP stimulates the IL-6 synthesis. The postoperative maximum of IL-6 in plasma could be due to a release of catecholamines. In conclusion this study demonstrated an elevation of IL-6 plasma concentrations during and after elective craniotomy. Increased plasma catecholamine concentrations as well as a damage in the blood-brain barrier due to the surgical trauma with a spill-over of IL-6 from brain tissue into plasma could have contributed to this result.

Serum interleukin-10 in ICU patients with severe acute central nervous system injuries

“…Moreover, some experimental and clinical studies suggest that a phenomenon of 'sympathetic storm' linked with trauma, surgery and psychic stress may play an important role in the increase of IL-10 level [17 -19]. Clinical observations of Heesen et al, in patients after elective craniotomy did not confirm an increase in serum IL-10, despite a significant rise in epinephrine and norepinephrine levels [20]. The lack of significant differences in serum IL-10 between groups of patients with distinct CNL lesion etiology, as well as failure to link IL-10 levels with patients' general or neurological state indicates that systemic release of this cytokine is a common, although strongly individualized, element of acute stress reaction, independent of cause.…”

Correlation between transcranial interleukin-6 gradient and outcome in patients with acute brain injury

“…High IL-6 concentrations can be detected in a series of diseases and clinical syndromes. Among these are the systemic inflammatory response syndrome (16), major surgery (17)(18)(19), sepsis (20), response to multiple trauma (21), and severe burns (22). It is considered that IL-6 is perhaps the most important mediator of acute phase synthesis (23), and once IL-6 is released from the inflammatory focus, it induces a wide range of systemic effects (13)(14)(15).…”

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

“…Despite early enteral feeding, positive or neutral nitrogen balance could not be achieved in these patients (unpublished results, personal communication Professor R. Stocker). TBI induces an increase in serum levels of epinephrine, norepinephrine, and dopamine which are suggested to play a role in causing low T 3 syndrome and which may also influence cytokine levels [17,[47][48][49]. Thus, in this study a disturbed nutritional state and the sympathoadrenal response may both induce or aggravate a low T 3 syndrome in the patients.…”