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Ertel, Wolfgang and Jarrar, Doreid and Jochum, Marianne and Thiele, Volker and Kenney, John and Faist, Eugen and Schildberg, Friedrich-Wilhelm (1994): Enhanced release of elastase is not concomitant with increased secretion of granulocyte-activating cytokines in whole blood from patients with sepsis. In: Archives of surgery, Vol. 129, No. 1: pp. 90-97
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Abstract

Die Diskussion am Ende des Artikels wurde gelöscht (§137l UrhG).

Abstract

Background The proteolytic enzyme elastase released by granulocytes (polymorphonuclear leukocytes [PMN]) in high concentrations during sepsis causes degradation of essential plasma proteins, endothelial damage, and tissue edema. This may result in organ dysfunction and organ failure during sepsis, since increased elastase plasma levels correlate with the mortality rate of patients with sepsis. In vitro studies demonstrated a regulatory role of inflammatory cytokines (tumor necrosis factor-{alpha} [TNF-{alpha}], interleukin 1β [IL-1β], IL-8]) upregulatingprotease release by PMN. In this light, the interactions between cytokine release by macrophages and altered elastase secretion during sepsis remain to be determined. Methods An ex vivo model consisting of lipopolysaccharide stimulation of human whole blood as a relevant physiological milieu was used. Heparinized blood was obtained from 20 patients with sepsis syndrome (APACHE II [Acute Physiology and Chronic Health Evaluation II] score 28.5±1.2 points [mean±SD]) on days 0 through 3, 5, 7, and 10 after sepsis diagnosis and from 20 control patients without infection. Blood was incubated with lipopolysaccharide (1 mg/L) for 8 hours. Plasma levels of elastase, TNF-{alpha}, IL-1β, and IL-8 were determined using enzyme-linked immunosorbent assay or bioassay (TNF-{alpha}), respectively. Results Elastase plasma levels in whole blood from patients with sepsis were increased up to 188% (P<.01) above normal, while the release of TNF-{alpha} (-87%), IL-1 β (-91%), and IL-8 (-51%) was markedly (P<.01) decreased compared with control patients. Neutralization of TNF-{alpha} or IL-1β did not attenuate the increased release of elastase. Conclusions These data indicate an increased release of elastase by PMN despite a reduced secretion of PMNactivating cytokines. Although priming effects of TNF-{alpha}, IL-1β, and IL-8 on protease secretion in vivo cannot be excluded completely, other mediators or mechanisms may be involved in the upregulation of detrimental protease release during sepsis.