Compartmentalization of the inflammatory response during acute pancreatitis: correlation with local and systemic complications.
Local and systemic inflammation has been implicated in the pathogenesis of acute pancreatitis and secondary multisystem organ failure. To assess the pro- and antiinflammatory response, the site of mediator production, and their route of diffusion, we sampled simultaneously ascites, thoracic lymph, and blood at the onset of end-organ dysfunction and for the following 6 days in 60 patients with acute pancreatitis. We used immunoassays to measure pro- and antiinflammatory cytokines and cell-based bioassays to assess the net pro- and antiinflammatory activity elicited by the biological fluids. Tumor necrosis factor-alpha and interleukin-1beta were detected in less than 15% of blood and lymph samples. Secondary pro- and antiinflammatory cytokines were found to be elevated early and throughout the sampling period in all compartments. Cytokine levels decreased from ascites to lymph to blood, suggesting a splanchnic origin. Prolonged diversion of ascites and lymph did not alter cytokine gradients, suggesting mediator transfer via the splanchnic blood circulation. Although a net proinflammatory activity ascribed to interleukin-1beta was detected in ascites, a net antiinflammatory activity was measured in virtually all lymph and blood samples, suggesting that the pancreas and the splanchnic area are sites of a proinflammatory response and that an early, dominant, and sustained antiinflammatory activity takes place in circulating compartments.
Dugernier
Thierry L
TL
Department of Intensive Care and Emergency Medicine, St. Luc University Hospital, Hippocrate Avenue, 10 B-1200 Brussels, Belgium. thierry.dugernier@skynet.be
Laterre
Pierre-Francois
PF
Wittebole
Xavier
X
Roeseler
Jean
J
Latinne
Dominique
D
Reynaert
Marc S
MS
Pugin
Jérôme
J
D001202:Ascitic Fluid / Q000378:metabolism; D001681:Biological Assay; D016207:Cytokines / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D018836:Inflammation Mediators / Q000378:metabolism*; D008196:Lymph / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism*; D019283:Pancreatitis, Acute Necrotizing / Q000276:immunology / Q000378:metabolism*; D013152:Splanchnic Circulation; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology / Q000378:metabolism*
D016207:Cytokines; D018836:Inflammation Mediators