Serum Tumor Necrosis Factor-Alpha Profile in Trauma Patients

Rabinovici, Reuven; John, Renz; Esser, Klaus; Vernick, Jerome; Feuerstein, Giora

doi:10.1097/00005373-199311000-00008

Cited by 59 publications

(15 citation statements)

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“…Many studies have found that TNF-␣ was either undetectable as in our study or only detectable in a few patients after trauma [16][17][18] . It has been assumed that the TNF-␣ response is too transient to be detected, or it may be that different mechanisms act independently on different cytokines.…”

Section: Discussionsupporting

confidence: 43%

Immune Modulation after Total Hip Surgery

Daniel

Sun²,

Krohn³

et al. 2007

Eur Surg Res

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Background: Major trauma affects the immune system, and immunosuppression may render the patients susceptible to septic complications. The purpose of this study was to investigate lipopolysaccharide (LPS)-induced releases of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in whole blood in patients undergoing total hip replacement. Methods: Seven patients (6 females) who underwent elective total hip replacement were included. Ex vivo LPS-induced releases of TNF-α and IL-6 were measured in a whole blood assay at days 1, 6, 9 and 12 postoperatively, using low- and high-dose LPS incubation. At the same time, white blood cell counts were analyzed. Results: The amount of TNF-α release was significantly reduced at days 6 and 12. Compared to monocyte counts, TNF-α release was significantly decreased also at day 9 in low- and high-dose LPS stimulation. IL-6 in plasma was significantly increased at day 1 and normalized thereafter. There were no differences in LPS-induced IL-6 levels compared to the levels before surgery. Conclusion: This in vivo/ex vivo study shows a reduced capacity of whole blood to release LPS-induced TNF-α at day 6 through to day 12 after major orthopedic surgery. Attenuated TNF-α release may contribute to an increased postoperative susceptibility to gram-negative sepsis.

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Section: Discussionsupporting

confidence: 43%

Immune Modulation after Total Hip Surgery

Daniel

Sun²,

Krohn³

et al. 2007

Eur Surg Res

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“…Studies with ex vivo endotoxin stimulation of blood samples or isolated mononuclear cells from injured patients have revealed a diminished production capacity for a broad range of secretory products, including infl ammatory cytokines [7][8][9][10][11] . It has been indicated that increased levels of the anti-infl ammatory cytokine interleukin (IL)-10 contributes to this as a compensatory mechanism to prevent an overshooting initial infl ammatory response [12] .…”

mentioning

confidence: 99%

Reduced Capacity of Whole Blood Leucocytes to Express Tumour Necrosis Factor-α and Interleukin-10 following Major Orthopaedic Surgery

Reikeraas¹,

Sun²,

Krohn³

et al. 2005

Eur Surg Res

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Background: Severe trauma is a challenge to the immune response and may cause reduced immune capacity. As a marker of decreased cellular activity, studies with ex vivo lipopolysaccharide (LPS) stimulation of whole blood or isolated mononuclear cells from injured patients have revealed reduced production of inflammatory cytokines. To gain further insight into immune alterations in orthopaedic surgery, we studied LPS-induced tumour necrosis factor (TNF)-α and interleukin (IL)-10 in whole blood of patients during peri- and postoperative phases of total hip replacement. Methods: Four females and 3 males undergoing elective total hip replacement were included in the study. Ex vivo LPS-induced TNF-α and IL-10 were measured in a whole blood assay before, during and at 1 and 6 days after operation. In addition, the counts of white blood cells were determined. Results: During the operation, there were significant reductions in the number of monocytes, but at day 1 and 6 after surgery, there were significant increases as compared to the levels before surgery. The capacity of whole blood to express TNF-α and IL-10 did not change significantly during the operation and the following postoperative day. At day 6, however, there were significant reductions in expression of both TNF-α and IL-10 as compared to the levels before the operation. In relation to the values of monocytes, there was a significant reduction in the expression of TNF-α also at day 1 after operation. Conclusion: Our data indicate that in the course of at least 6 days after a major orthopaedic trauma, there is suppression of the whole blood capacity to express the inflammatory cytokine TNF-α and the anti-inflammatory cytokine IL-10 when exposed to LPS. During this time, then, the patient is particular susceptible to septic complications.

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“…14 In line with this finding, depressed responses to LPS have been observed in other groups of trauma patients (accidental or surgical), 9,[15][16][17][18][19] in patient with sepsis, 20,21 and in hypovolemic shock. 10,22 This depression in the ability to respond to LPS is reminiscent of the phenomenon referred to as ''LPS tolerance,'' which is an adaptive host response to limit overwhelming host responses to bacterial infections.…”

Section: Introductionmentioning

confidence: 66%

Postoperative serum attenuates LPS‐induced release of TNF‐α in orthopaedic surgery

Reikerås

Sun

Wang

et al. 2007

Journal Orthopaedic Research

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Studies with ex vivo stimulation of whole blood samples from injured patients have revealed a diminished production capacity for a broad range of secretory products, including inflammatory cytokines. Recent interest has focused on the release of mediators in serum that depress the cell-mediated immune response following trauma. The involvement of the lipid mediator prostaglandin E2 (PGE2) has been assumed because it is a potent endogenous immunosuppressor. In the present study, we tested the hypothesis that inhibitory substances circulating in the patient's serum after a major musculoskeletal trauma might impair leukocyte function by evaluating the effect of such serum on cytokine release in a whole blood model. Six females and three males undergoing elective total hip replacement were included in the study. Ex vivo LPS-induced TNF-a and IL-10 were measured in whole blood sampled preoperatively and added serum taken before, at the end of operation, and at postoperative days 1 and 6 with saline as negative control. LPS induced significant releases of TNF-a and IL-10 in whole blood. Addition of preoperative, postoperative, and day-1 postoperative serum did not alter the LPS-induced release of TNF-a as compared to saline. In the presence of serum from postoperative day 6, however, the expression of TNF-a was significantly reduced as compared to saline and preoperative serum (p ¼ 0.021 and 0.008, respectively). Neither of the serum samples altered the release of IL-10. PGE2 was significantly (p ¼ 0.008) increased in serum at postoperative day 6 as compared to preoperative levels. In conclusion, these data show that at day 6 after major orthopaedic surgery, the patient serum contained activity that inhibited ex vivo LPS-induced TNF-a release. The potent TNF-a inhibitory activity found at day 6 after injury correlated with increased levels of PGE2 and indicates cellmediated hyporesponsiveness to a second stimulus. ß

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Serum Tumor Necrosis Factor-Alpha Profile in Trauma Patients

Cited by 59 publications

References 0 publications

Immune Modulation after Total Hip Surgery

Immune Modulation after Total Hip Surgery

Reduced Capacity of Whole Blood Leucocytes to Express Tumour Necrosis Factor-α and Interleukin-10 following Major Orthopaedic Surgery

Postoperative serum attenuates LPS‐induced release of TNF‐α in orthopaedic surgery

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