Intestinal Permeability and Systemic Endotoxemia After Laparotomic or Laparoscopic Cholecystectomy

Schietroma, Mario; Carlei, Francesco; Cappelli, Sonia; Amicucci, Gianfranco

doi:10.1097/01.sla.0000201455.89037.f6

Cited by 67 publications

(49 citation statements)

References 27 publications

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“…This could be the result of the internalization of LBP by cells of the innate immune system. The level of LPS is commonly measured to assess the degree of microbial translocation quantitatively, and plasma levels are directly associated with the degree of intestinal permeability (23). sCD14 is produced primarily following the activation of monocytes and macrophages (24,25).…”

Section: Discussionmentioning

confidence: 99%

Microbial Translocation Associated with an Acute-Phase Response and Elevations in MMP-1, HO-1, and Proinflammatory Cytokines in Strongyloides stercoralis Infection

et al. 2017

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Microbial translocation, characterized by elevated levels of lipopolysaccharide (LPS) and related markers, is a common occurrence in HIV and some parasitic infections. This is usually associated with extensive inflammation and immune activation. To examine the occurrence of microbial translocation and the associated inflammatory response in asymptomatic Strongyloides stercoralis infection, we measured the plasma levels of LPS and other microbial translocation markers, acutephase proteins, inflammatory markers, and proinflammatory cytokines in individuals with (infected [INF] . Following treatment of S. stercoralis infection, the elevated levels of microbial translocation markers, acute-phase proteins, and inflammatory markers were all diminished. Our data thus show that S. stercoralis infection is characterized by microbial translocation and accompanying increases in levels of acute-phase proteins and markers of inflammation and provide data to suggest that microbial translocation is a feature of asymptomatic S. stercoralis infection and is associated with an inflammatory response.KEYWORDS microbial translocation markers, Strongyloides stercoralis, acute-phase proteins, inflammatory markers, proinflammatory cytokines M icrobial translocation refers to the process by which the translocation of bacterial products results in elevated levels of lipopolysaccharide (LPS) in the circulation without overt bacteremia (1). LPS and 16S rRNA (common to most bacteria) are often used as indicators of bacterial translocation, and endotoxin core IgG antibody (EndoCAb) is also used as a surrogate marker for the measurement of circulating LPS levels (1, 2). iFABP may also reflect a breach in epithelial integrity associated with chronic intestinal infections (3). The prevalence of increased acute-phase protein concentrations during episodes of inflammation is used as a supporting prognostic and diag-

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Section: Discussionmentioning

confidence: 99%

Microbial Translocation Associated with an Acute-Phase Response and Elevations in MMP-1, HO-1, and Proinflammatory Cytokines in Strongyloides stercoralis Infection

et al. 2017

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“…Similarly, in the mouse model of graft-versus-host disease following stem cell transplantation, microbial translocation negatively affects the expression of intestinal ␣-defensins, leading to the outgrowth of E. coli, which causes septicemia (31). High levels of endotoxemia have also been described for subjects who have undergone laparotomic cholecystectomy, suggesting that intestinal manipulation may impair gut mucosal barrier function (27). The idea that microbial translocation is a key mechanism of mucosal immune dysfunction, chronic systemic immune activation, and, ultimately, disease progression during HIV infection was originally proposed by Brenchley et al in a landmark hypothesis article (32).…”

Section: Definition Of Microbial Translocationmentioning

confidence: 99%

“…Lipopolysaccharide (LPS), a component of Gram-negative bacterial cell walls and a known agonist of Toll-like receptor 4 (TLR-4) (24), is considered a major marker of microbial translocation (25)(26)(27). In addition to local defense against microbial translocation at the level of the GI mucosa and within the liver, several lines of protection are active in the systemic circulation to neutralize translocating LPS and its downstream effects as a potent immune-activating molecule, thus limiting the detrimental effects of microbial translocation.…”

Section: Definition Of Microbial Translocationmentioning

confidence: 99%

Microbial Translocation in the Pathogenesis of HIV Infection and AIDS

2013

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SUMMARYIn pathogenic simian immunodeficiency virus (SIV) and human immunodeficiency virus (HIV) infections, the translocation of microbial products from the gastrointestinal (GI) tract to portal and systemic circulation has been proposed as a major driver of the chronic immune activation that is associated with disease progression. Consistently, microbial translocation is not present in nonpathogenic SIV infections of natural host species.In vivostudies demonstrated that HIV/SIV-associated microbial translocation results from a series of immunopathological events occurring at the GI mucosa: (i) early and severe mucosal CD4+depletion, (ii) mucosal immune hyperactivation/persistent inflammation; (iii) damage to the integrity of the intestinal epithelium with enterocyte apoptosis and tight junction disruption; and (iv) subverted the gut microbiome, with a predominance of opportunistic bacteria. Directin situevidence of microbial translocation has been provided for SIV-infected rhesus macaques showing translocated microbial products in the intestinal lamina propria and distant sites. While the mechanisms by which microbial translocation causes immune activation remain controversial, a key pathogenic event appears to be innate immunity activation via Toll-like receptors and other pathogen recognition receptors. Accumulating clinical observations suggest that microbial translocation might affect HIV disease progression, response to therapy, and non-AIDS comorbidities. Given its detrimental effect on overall immunity, several interventions to prevent/block microbial translocation are currently under investigation as novel therapeutic agents for HIV/AIDS.

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“…Endotoxin is a potent stimulator of the release of cytokines such as IL-6 and tumor necrosis factor (TNF) [33,35,36] . These inflammatory mediators play an important role in the pathogenesis of systemic inflammatory response syndrome and multiple organ dysfunction syndrome [37] .…”

Section: Introductionmentioning

confidence: 99%

Systemic inflammation and immune response after laparotomyvslaparoscopy in patients with acute cholecystitis, complicated by peritonitis

Sista

Schietroma²,

Santis³

et al. 2013

WJGS

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AIM:To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach. METHODS:From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 ℃, leukocytosis greater than 10 × 10 9 /L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis, complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-operative day 6. RESULTS:The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC grou...

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Intestinal Permeability and Systemic Endotoxemia After Laparotomic or Laparoscopic Cholecystectomy

Cited by 67 publications

References 27 publications

Microbial Translocation Associated with an Acute-Phase Response and Elevations in MMP-1, HO-1, and Proinflammatory Cytokines in Strongyloides stercoralis Infection

Microbial Translocation Associated with an Acute-Phase Response and Elevations in MMP-1, HO-1, and Proinflammatory Cytokines in Strongyloides stercoralis Infection

Microbial Translocation in the Pathogenesis of HIV Infection and AIDS

Systemic inflammation and immune response after laparotomyvslaparoscopy in patients with acute cholecystitis, complicated by peritonitis

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