Early Cytokine Profile Changes In Interstitial And Necrotic Forms Of Acute Pancreatitis

Abstract

Acute pancreatitis (AP) is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP) and necrotic acute pancreatitis (NAP), especially in those patients who had lethal outcomes.The prospective study enrolled 52 patients who were divided into IAP (65.38% of patients) and NAP (34.62% of patients) groups. The serum levels of interleukins (IL) 6, 8 and 10, together with tumour necrosis factor (TNF)-alpha were measured on the 1st and 3rd day of hospitalisation. Significantly higher values of IL-6, IL-8 and IL-10 were found on day 1 and 3 in NAP than in IAP. IL-6 was significantly higher on both days of measurement, whereas IL-10 on the first day and IL-8 on the third day were significantly higher in the group of patients who did not survive in comparison with patients who had the interstitial form of AP.In conclusion, the data from this study showed that immune suppression and excessive immune stimulation in the first three days after admission could indicate the development of NAP and a potentially lethal outcome.

Does the Automatic Measurement of Interleukin 6 Allow for Prediction of Complications during the First 48 h of Acute Pancreatitis?

“…The study by Kay et al [ 20 ] suggests that the initial inflammatory response in AP develops as naive Th17 cells are generated in response to macrophage-derived IL-6 [ 20 ], whereas the development of SAP occurs as a result of Th17 response with a greater pathogenic potential (IL-23 induced), probably due to dysfunctional autophagy or the inability of monocytes to mount an adequate IL-10 anti-inflammatory response due to anergy [ 20 ]. Moreover, Kostic et al [ 21 ] have demonstrated that IL-6, IL-8, and IL-10 levels in the first three days of AP are accurate markers of necrosis and of a potentially lethal outcome. Observations made by Kostic et al [ 21 ] of significantly higher IL-6 levels in patients with necrotizing AP, remain consistent with the results presented in this article.…”

“…Moreover, Kostic et al [ 21 ] have demonstrated that IL-6, IL-8, and IL-10 levels in the first three days of AP are accurate markers of necrosis and of a potentially lethal outcome. Observations made by Kostic et al [ 21 ] of significantly higher IL-6 levels in patients with necrotizing AP, remain consistent with the results presented in this article.…”

“…In literature, a number of valuable studies justify the need for IL-6 assessment in the early prediction of AP severity [ 1 , 2 , 9 , 11 , 21 , 30 ], however, in light of contradictory information regarding the analytical aspect of IL-6 measurements and prognostic utility of different assays in the first 48 h of AP, implementation of this diagnostic procedure requires re-evaluation.…”

“…Since 1988, when Rinderknecht proposed a new pathophysiological concept to describe a complex network of inflammatory mediators released by activated leukocytes, clinical studies explored a wide range of inflammatory cytokines, chemokines, reactive oxygen species, adhesion molecules, and acute phase proteins as potential predictors of SAP [ 13 , 14 , 15 , 16 , 17 ]. In addition, the role of inflammatory cells and the mechanisms associated with the development of SIRS and compensatory anti-inflammatory response syndrome (CARS) in the course of SAP were extensively studied [ 18 , 19 , 20 , 21 ]. It is currently possible to measure the concentrations of both pro-inflammatory (tumor necrosis factor-α—TNFα, interleukins: IL-1β, IL-6, IL-8, IL-18, IL-33) and anti-inflammatory cytokines (IL-1 receptor antagonist—IL-1Ra, IL-10) [ 2 , 21 , 22 , 23 , 24 ].…”

“…In addition, the role of inflammatory cells and the mechanisms associated with the development of SIRS and compensatory anti-inflammatory response syndrome (CARS) in the course of SAP were extensively studied [ 18 , 19 , 20 , 21 ]. It is currently possible to measure the concentrations of both pro-inflammatory (tumor necrosis factor-α—TNFα, interleukins: IL-1β, IL-6, IL-8, IL-18, IL-33) and anti-inflammatory cytokines (IL-1 receptor antagonist—IL-1Ra, IL-10) [ 2 , 21 , 22 , 23 , 24 ]. Moreover, the studies by Huan et al [ 25 ] and Manohar et al [ 26 ] indicate that some cytokines, i.e., IL-6 and IL-22, can act as both pro- and anti-inflammatory agents [ 20 ].…”