Characteristics of Thoracic Duct Lymph in Multiple Organ Dysfunction Syndrome

Sánchez-García, Miguel; Prieto, Alfredo; Tejedor, Alberto; Martín‐Duce, Antonio; Fernandez-Sánchez, F. Javier; Granell, Javier; Álvarez‐Mon, Melchor

doi:10.1001/archsurg.1997.01430250015002

Cited by 29 publications

(4 citation statements)

References 38 publications

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“…(33-34) In case reports of patients with MOF, thoracic duct sampling has confirmed increased lymph: plasma levels of IL-1 (3, IL-6 and IL-10. (35-37)…”

Section: Dysfunctional Immune Response Is Central In the Pathogenesismentioning

confidence: 99%

Claude H. Organ, Jr. Memorial Lecture: Splanchnic hypoperfusion provokes acute lung injury via a 5-lipoxygenase–dependent mechanism

Moore

2010

The American Journal of Surgery

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Postinjury multiple organ failure (MOF) is the net result of the dysfunctional immune response to injury characterized by a hyperactive innate system and a suppressed adaptive system. Acute lung injury (ALI) is the first clinical manifestation of organ failure, followed by renal and hepatic dysfunction. Circulatory shock is integral in the early pathogenesis of MOF, and the gut has been invoked as the “motor of MOF”. Mesenteric lymph is recognized as the mechanistic link between splanchnic ischemia / reperfusion (I/R) and distant organ dysfunction, but the specific mediators remain to be defined. Current evidence suggests the lipid fraction of post-shock mesenteric lymph (PSML) is central in the etiology of ALI. Specifically, our recent work suggests that intestinal phospholipase A2 (PLA2) generated arachidonic acid (AA) and its subsequent 5-lipoxygenase (5-LO) products are essential in the pathogenesis of ALI. Proteins conveyed via PSML may also have an important role. Elucidating these mediators and the timing of their participation in pulmonary inflammation is critical in translating our current knowledge to new therapeutic strategies at the bedside.

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“…(33-34) In case reports of patients with MOF, thoracic duct sampling has confirmed increased lymph: plasma levels of IL-1 (3, IL-6 and IL-10. (35-37)…”

Section: Dysfunctional Immune Response Is Central In the Pathogenesismentioning

confidence: 99%

Claude H. Organ, Jr. Memorial Lecture: Splanchnic hypoperfusion provokes acute lung injury via a 5-lipoxygenase–dependent mechanism

Moore

2010

The American Journal of Surgery

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“…Other studies have demonstrated bacterial translocation to mesenteric lymph nodes [31,32]. Furthermore, mesenteric lymph has subsequently been demonstrated to be a conduit for interleukin-1, interleukin-6, and tumor necrosis factor, but until recently the concept that the mesenteric lymph is the mechanistic link to MOF had not been explored [33][34][35]. In a very provocative report Deitch has recently reported the profound observation that mesenteric lymph diversion eliminates lung injury caused by hemorrhagic shock [7].…”

Section: Figmentioning

confidence: 99%

“…The findings of this present study along with those of Deitch et al make the search for the etiologic agents in the mesenteric lymph very attractive. Postshock mesenteric lymph contains proinflammatory mediators such as interleukin-6, interleukin-1, and TNF [33][34][35]. The fact that mesenteric lymph taken within minutes following shock primes PMNs would indicate that, if cytokines are the etiologic agent, they would need to be preformed and rapidly secreted.…”

Section: Figmentioning

confidence: 99%

Posthemorrhagic Shock Mesenteric Lymph Primes Circulating Neutrophils and Provokes Lung Injury

Zallen

Moore

Johnson

et al. 1999

Journal of Surgical Research

102

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“…3 Subsequent clinical studies have supported this finding. 21,22 After the bacterial translocation mechanism failed to satisfy Koch's postulates, the lymphatic system became the target of investigation as the primary conduit for delivering inflammatory factors from the ischemic gut into the circulation.…”

Section: Discussionmentioning

confidence: 99%

Cross-transfusion of Postshock Mesenteric Lymph Provokes Acute Lung Injury

Wohlauer

Fragoso

Harr

et al. 2011

Journal of Surgical Research

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Objective-Substantial investigation has implicated mesenteric lymph as the mechanistic link between gut ischemia/reperfusion (I/R) and distant organ injury. Specifically, lymph diversion prevents acute lung injury (ALI) in vitro and bioactive lipids and proteins isolated from postshock mesenteric lymph (PSML), maintain bioactivity in vitro. However, Koch's postulates remain to be satisfied via direct cross-transfusion into a naïve animal. We therefore hypothesized that real time cross-transfusion of postshock mesenteric lymph provokes acute lung injury.Methods-One set of Sprague-Dawley rats (lymph donors) was anesthetized, with the mesenteric lymph ducts cannulated and exteriorized to drain freely into a siliconized plastic cup; concurrently, a second group of rats (lymph recipients) was anesthetized, with a cannula inserted into the animal's right internal jugular vein. Blood was removed from the donor rats to induce hemorrhagic shock (MAP of 35 mmHg × 45 minutes). The recipient rats were positioned 10 cm below the plastic cup which emptied into the jugular vein cannula. Thus, mesenteric lymph from the shocked donor rat was delivered to the recipient rat at the rate generated during shock and the subsequent 3 hours of resuscitation. Conclusion-Cross-transfusion of PSML into a naïve animal leads to PMN accumulation and provokes ALI. These data provide evidence that postshock agents released into mesenteric lymph are capable of provoking distant organ injury. Results-Neutrophil

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Characteristics of Thoracic Duct Lymph in Multiple Organ Dysfunction Syndrome

Cited by 29 publications

References 38 publications

Claude H. Organ, Jr. Memorial Lecture: Splanchnic hypoperfusion provokes acute lung injury via a 5-lipoxygenase–dependent mechanism

Claude H. Organ, Jr. Memorial Lecture: Splanchnic hypoperfusion provokes acute lung injury via a 5-lipoxygenase–dependent mechanism

Posthemorrhagic Shock Mesenteric Lymph Primes Circulating Neutrophils and Provokes Lung Injury

Cross-transfusion of Postshock Mesenteric Lymph Provokes Acute Lung Injury

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