An adequately robust early TNF-alpha response is a hallmark of survival following trauma/hemorrhage

Autor: Juan Carlos Puyana, Derek Barclay, Andres Torres, Michael R. Pinsky, Gilles Clermont, Rajaie Namas, Patricio M. Polanco, Juan B. Ochoa, Lisa Gordon, Hernando Gomez, Hyung Kook Kim, Linda Hermus, Yoram Vodovotz, Sven Zenker, Andrew B. Peitzman, Matthew R. Rosengart, Ali Ghuma, Timothy R. Billiar, Ruben Zamora
Jazyk: angličtina
Rok vydání: 2009
Předmět:
Oncology
Male
medicine.medical_specialty
Resuscitation
Pathology
Critical Care and Emergency Medicine
Time Factors
Immunology/Innate Immunity
Sus scrofa
lcsh:Medicine
Inflammation
Shock
Hemorrhagic
Trauma hemorrhage
03 medical and health sciences
0302 clinical medicine
Critical Care and Emergency Medicine/Sepsis and Multiple Organ Failure
Internal medicine
Medicine
Animals
Humans
lcsh:Science
Survival analysis
Critical Care and Emergency Medicine/Trauma
Nitrites
030304 developmental biology
0303 health sciences
Multidisciplinary
Nitrates
business.industry
Tumor Necrosis Factor-alpha
lcsh:R
030208 emergency & critical care medicine
Middle Aged
Survival Analysis
3. Good health
Disease Models
Animal
Thoracotomy
Shock (circulatory)
Tumor necrosis factor alpha
Female
lcsh:Q
medicine.symptom
business
Research Article
Zdroj: PLoS ONE, Vol 4, Iss 12, p e8406 (2009)
PLoS ONE
ISSN: 1932-6203
Popis: BACKGROUND:Trauma/hemorrhagic shock (T/HS) results in cytokine-mediated acute inflammation that is generally considered detrimental. METHODOLOGY/PRINCIPAL FINDINGS:Paradoxically, plasma levels of the early inflammatory cytokine TNF-alpha (but not IL-6, IL-10, or NO(2) (-)/NO(3) (-)) were significantly elevated within 6 h post-admission in 19 human trauma survivors vs. 4 non-survivors. Moreover, plasma TNF-alpha was inversely correlated with Marshall Score, an index of organ dysfunction, both in the 23 patients taken together and in the survivor cohort. Accordingly, we hypothesized that if an early, robust pro-inflammatory response were to be a marker of an appropriate response to injury, then individuals exhibiting such a response would be predisposed to survive. We tested this hypothesis in swine subjected to various experimental paradigms of T/HS. Twenty-three anesthetized pigs were subjected to T/HS (12 HS-only and 11 HS + Thoracotomy; mean arterial pressure of 30 mmHg for 45-90 min) along with surgery-only controls. Plasma obtained at pre-surgery, baseline post-surgery, beginning of HS, and every 15 min thereafter until 75 min (in the HS only group) or 90 min (in the HS + Thoracotomy group) was assayed for TNF-alpha, IL-6, IL-10, and NO(2) (-)/NO(3) (-). Mean post-surgery+/-HS TNF-alpha levels were significantly higher in the survivors vs. non-survivors, while non-survivors exhibited no measurable change in TNF-alpha levels over the same interval. CONCLUSIONS/SIGNIFICANCE:Contrary to the current dogma, survival in the setting of severe, acute T/HS appears to be associated with an immediate increase in serum TNF-alpha. It is currently unclear if this response was the cause of this protection, a marker of survival, or both. This abstract won a Young Investigator Travel Award at the SHOCK 2008 meeting in Cologne, Germany.
Databáze: OpenAIRE
Externí odkaz: