title: Regional and systemic cytokine responses to acute inflammation of the vermiform appendix.
abstract: OBJECTIVE
  To measure local (peritoneal fluid) and systemic (plasma) cytokine profiles in patients with infection-inflammation of the vermiform appendix, a relatively mild, localized inflammatory process.
  
  
  BACKGROUND
  The systemic host response to invading microorganisms, often termed the systemic inflammatory response syndrome (SIRS), includes changes in heart rate, respiratory rate, body temperature, and circulating white blood cell numbers. Although these changes can be induced experimentally by administering proinflammatory cytokines, the mediators that appear in the bloodstream during early, localized infection in humans have not been defined.
  
  
  METHODS
  The authors studied 56 patients with pathologically proven appendicitis. Blood was obtained before the induction of anesthesia, when 82% of the patients met the criteria for SIRS. Peritoneal fluid (PF) was obtained by intraoperative lavage. Cytokines were measured by immunoassay. To assess the net impact of the mediators within plasma, the authors studied the ability of patient plasma to augment or suppress bacterial lipopolysaccharide (LPS) stimulation of monocytes in vitro.
  
  
  RESULTS
  Of the proinflammatory cytokines, tumor necrosis factor-alpha was present in PF but not in plasma, interleukin (IL)-1beta and interferon-gamma were found in low concentrations in both PF and plasma, and IL-12 (p70) was detectable in plasma but not PF. In contrast, IL-6 and IL-1 receptor antagonist (IL-1ra) were the most abundant cytokines in the PF and plasma, and the concentrations of IL-4 and IL-10 were also elevated in both compartments. Patients with more severe appendicitis had higher plasma levels of IL-6 and IL-10 and lower plasma levels of IL-12 and interferon-gamma than did those with uncomplicated disease. Patient plasma inhibited LPS-induced stimulation of a monocyte cell line, and this inhibition was accentuated by complicated disease.
  
  
  CONCLUSIONS
  As judged from the pattern of soluble cytokines in plasma and the effect of the plasma on monocyte activation by LPS, mild, localized infection can induce a systemic response that is predominantly anti-inflammatory.
authors.affiliation: Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Rivera-Chavez
authors.forename: Herbert
authors.initials: H
authors.lastname: Wheeler
authors.forename: Guy
authors.initials: G
authors.lastname: Lindberg
authors.forename: Robert S
authors.initials: RS
authors.lastname: Munford
authors.forename: Grant E
authors.initials: GE
authors.lastname: O'Keefe
mesh_terms: D000208:Acute Disease; D000328:Adult; D001064:Appendicitis / Q000276:immunology / Q000378:metabolism*; D001202:Ascitic Fluid / Q000737:chemistry; D016207:Cytokines / Q000378:metabolism*; D004926:Escherichia coli; D005260:Female; D006801:Humans; D007118:Immunoassay; D018836:Inflammation Mediators / Q000378:metabolism*; D007371:Interferon-gamma / Q000378:metabolism; D007378:Interleukins / Q000378:metabolism; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D009000:Monocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators; D007378:Interleukins; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma