title: The chemokine ligand CXCL16 is an indicator of bacterial infection in necrotizing pancreatitis.
abstract: OBJECTIVE
  Current guidelines tell us that intervention in severe necrotizing pancreatitis ought to be performed as late as possible. However, when pancreatic necrosis becomes infected, the necrotic tissue needs to be removed. Unfortunately, bacterial infection can only be proven by invasive methods.
  
  
  METHODS
  Necrotizing pancreatitis with sterile or infected necrosis was induced in mice. Mice serum samples were examined by antibody-based protein array. After identifying candidate proteins that showed strong regulation, the serum concentration of these proteins was examined by sandwich ELISA. Then, human serum samples were collected from patients with mild pancreatitis, severe pancreatitis with and without pancreatic necrosis and patients with microbiologically proven infection of pancreatic necrosis. These serum samples were then analyzed by sandwich ELISA.
  
  
  RESULTS
  In mice 6 proteins were strongly up-regulated and were further investigated by ELISAs. Of these proteins, CXCL16 and TRANCE (RANKL) concentrations were analyzed in human serum samples. CXCL16 and TRANCE were increased in patients with pancreatic necrosis and abdominal infection. Receiver operated characteristics showed that CXCL16 was superior in predicting infected pancreatic necrosis when compared to C-reactive protein and TRANCE.
  
  
  CONCLUSIONS
  Serum CXCL16 is increased in severe pancreatitis with infected pancreatic necrosis and identifies patients who benefit from surgical necrosectomy.
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany. Electronic address: uwe.wittel@uniklinik-freiburg.de.
authors: Uwe A
authors: UA
authors: Wittel
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
authors: Andrea I
authors: AI
authors: Schmidt
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
authors: Philipp J
authors: PJ
authors: Poxleitner
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
authors: Gabriel J
authors: GJ
authors: Seifert
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
authors: Sophia
authors: S
authors: Chikhladze
authors: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors: Pauli
authors: P
authors: Puolakkainen
authors: Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
authors: Ulrich T
authors: UT
authors: Hopt
authors: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors: Leena
authors: L
authors: Kylänpää
mesh_terms: D000328:Adult; D000818:Animals; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D000075743:Chemokine CXCL16; D054427:Chemokine CXCL6 / Q000097:blood*; D019743:Chemokines, CXC / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D010180:Pancreatectomy; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000601:surgery; D011237:Predictive Value of Tests; D053245:RANK Ligand / Q000097:blood; D051116:Receptors, Scavenger / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C423727:CXCL16 protein, human; D000075743:Chemokine CXCL16; D054427:Chemokine CXCL6; D019743:Chemokines, CXC; C498926:Cxcl16 protein, mouse; D053245:RANK Ligand; D051116:Receptors, Scavenger; D002097:C-Reactive Protein
keywords: Biomarker; CXCL16; Chemokine; Infected necrosis; Infection; Mortality; Necrosis; Necrotizing pancreatitis; SIRS; Systemic inflammatory response syndrome