Tumor necrosis factor concentrations in hemolytic uremic syndrome patients and children with bloody diarrhea in Argentina.
Hemolytic uremic syndrome (HUS) is thought to be a vascular endothelial injury disease. The mechanism of injury is unknown although verocytotoxins (Shiga-like toxins (SLTs)) are known to be associated with it. Recent evidence suggests that in vitro treatment of some endothelial cells with tumor necrosis factor alpha (TNF-alpha) dramatically increases their susceptibility to SLTs. We studied 25 children with HUS, 63 children with SLT-positive bloody diarrhea, 62 children with bloody diarrhea not associated with SLTs and 39 children admitted for elective surgery, included as an age- and season-matched control group. The TNF-alpha concentrations were found to be significantly elevated in children with HUS (range, 1 to 95 pg/ml; geometric mean, 32.2 pg/ml) compared with the healthy controls (range, 0 to 53 pg/ml; mean, 12.5 pg/ml; P < 0.001). Because it is hypothesized that TNF-alpha elevation might precede development of HUS, we also studied children with blood diarrhea. The TNF-alpha serum concentrations were significantly higher during the first 10 days after onset of bloody diarrhea than after the first 10 days (P < 0.02). Such elevation could be associated with vascular endothelial glycolipid receptor up-regulation and increased susceptibility to the effects of SLTs.
López
E L
EL
Unit 9, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina.
Contrini
M M
MM
Devoto
S
S
de Rosa
M F
MF
Graña
M G
MG
Genero
M H
MH
Canepa
C
C
Gomez
H F
HF
Cleary
T G
TG
D001118:Argentina; D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007118:Immunoassay; D007223:Infant; D008297:Male; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D014409:Tumor Necrosis Factor-alpha