Haben die Konzentrationen von Interleukin 6, Procalcitonin und CRP bei Intensivpatienten während des ersten Fieberanstieges eine prognostische Bedeutung?

Serum levels of interleukin 6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) were measured in 38 critically ill patients immediately after an increase in body temperature above 38.3 degrees C. Ten healthy controls were also included for comparison. The onset of fever was accompanied by elevated circulating levels of all the 3 markers in comparison to healthy control subjects. However, only IL-6 levels were significantly higher (p<0.05) in nonsurvivors compared with survivors. Sensitivity, specificity, positive, and negative predictive values for survival were higher for IL-6 in comparison to levels of PCT and CRP. Areas under receiver characteristic operating curves revealed the highest area under the curve for IL-6 compared to PCT and CRP. These data suggest that IL-6 rather than PCT or CRP may be an early predictor of prognosis and mortality in patients with the onset of fever

Validation of an automated enzyme immunoassay for interleukin-6 for routine clinical use

Serum levels of Interleukin-6 (IL-6), a proinflammatory cytokine, are increased in early stages of inflammatory diseases such as infection and sepsis. Assay systems which permit its measurement within a few hours and as a single measurement have not been reported so far. We therefore evaluated a now commercially available automated method for IL-6 measurement on the Cobas Core(R) immunological analyzer (Roche Diagnostic Systems) which enables single IL-6 measurement within about 1 hour. The automated assay correlates well with an established, manual microtiter plate assay (Biosource GmbH) which uses the same antibodies and reagents (r=0.98). Accuracy of the automated method was established by adding known amounts of IL-6 international reference preparation. Recovery of the international standard was in the range of 92-104%. The automated assay had a precision of singletons below 6% and was linear up to 2800 pg/ml. This automated assay provides a suitable, convenient and time saving method for measurement of IL-6 serum levels in the routine clinical laboratory

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen? / Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

In der Diagnostik von Infektionen und inflammatorischen Prozessen ist das C-reaktive Protein (CRP) einer der meistverwendeten Parameter, unter anderem aufgrund der geringen Kosten und der schnellen Verfügbarkeit. Im Zuge der letzten Jahre gewannen jedoch andere Entzündungsparameter, wie zum Beispiel das Interleukin 6 (IL-6) oder Procalcitonin (PCT), zunehmend an Bedeutung. Obwohl diese Parameter im klinischen Alltag noch nicht überall etabliert sind, besitzen sie doch wesentliche Vorteile in der Diagnostik und im Verlaufsmonitoring von entzündlichen Erkrankungen. Beispielsweise ist die Erkennung entzündlicher Komplikationen auf Intensivstationen durch erhöhte IL-6 Spiegel 24 bis 48 Stunden vor einer Erhöhung des CRP möglich. Die deutliche Überlegenheit von PCT gegenüber CRP in der Diagnostik von bakteriellen Infektionen und Sepsis begründet sich in der höheren Spezifität des PCT für bakterielle Infektionen. Der PCT-Verlauf ermöglicht daher eine bessere Beurteilung des Therapieerfolges und Krankheitsverlaufs des Patienten und liefert Hinweise auf eine gegebenenfalls erforderliche Therapieumstellung. Daraus ergibt sich die Frage, ob die Messung des CRP-Spiegels durch IL-6 und/oder PCT ersetzt werden kann. In dieser Übersichtsarbeit wird die derzeitige Bedeutung von CRP im Verhältnis zu den neueren Entzündungsparametern in der Diagnostik von bakteriellen Infektionen, im therapeutischen Monitoring und in seiner Aussagekraft bezüglich der Prognose des Patienten auf Intensivstationen dargestellt.C-reactive protein (CRP) currently constitutes one of the most widely used parameters for the diagnosis of infections and inflammatory processes, due to simple methods and low costs. However, in recent years, other parameters, such as interleukin 6 (IL-6) and procalcitonin (PCT), have gained in importance. Although these parameters are presently not established everywhere in clinical routine, they provide significant advantages in the diagnosis and monitoring of inflammatory diseases. For instance, in intensive care, the increase in IL-6 levels may indicate inflammatory complications 24 to 48 h prior to the increase in circulating CRP levels. In contrast to CRP, PCT shows a higher specificity for bacterial infections, which facilitates the diagnosis of bacterial infections and sepsis. Therefore, PCT values provide a better evaluation of prognosis and therapeutic success and of a necessary change in therapy. These points raise the question whether CRP levels should at least in part be replaced by PCT and/or IL-6. Thus, this review seeks to examine the value of CRP in relation to PCT and IL-6 in the diagnosis of bacterial infections, in therapeutic monitoring, and regarding prognosis in critical care patients

Ezetimibe reduces cholesterol content and NF-kappaB activation in liver but not in intestinal tissue in guinea pigs

Background: Statins (HMG CoA reductase inhibitors), in addition to reducing circulating cholesterol and incidence of coronary heart disease, also have pleiotropic, anti-inflammatory effects. Patients with chronic liver diseases, non-alcoholic fatty liver disease (NAFLD) or hepatitis C are often excluded from statin therapy because of adverse effects in a small cohort of patients despite increased cardiovascular risk cholesterol. Ezetimibe, which inhibits cholesterol absorption by inhibition of Niemann-Pick C1 like 1 (NPC1L1) protein in the brush border of intestinal cells, has been suggested as a new therapeutic option in these patients. Methods: Effects of ezetimibe on lipoprotein metabolism, hepatic and intestinal lipid content in guinea pigs, an animal model with a lipoprotein profile and pattern similar to humans were investigated. In order to investigate a possible effect of ezetimibe on cholesterol induced inflammation NF-kappaB activation as an indicator for inflammatory processes in liver and gut tissue was measured. Results: Lipid enriched diet led to accumulation of lipids in hepatic tissue which caused strong hepatic NF-kappaB activation. Ezetimibe reduced lipid diet induced increase of circulating cholesterol by about 77% and prevent hepatic NF-kappaB activation almost completely. In contrast in intestinal cells Ezetimibe, though lowering diet induced cholesterol accumulation, increased triglyceride content and subsequent NF-kappaB activation. Conclusion: In summary these data show, that ezetimibe effectively reduced diet induced circulating cholesterol levels, hepatic lipid accumulation and inflammatory response in our guinea pig model. However this drug elicited a local inflammatory response in intestinal tissue. Whether these diverse effects of ezetimibe on inflammatory parameters such as NF-kappaB have clinical relevance remains to be determined

Toll-Like Receptor Expression in Human Keratinocytes: Nuclear Factor κB Controlled Gene Activation by Staphylococcus aureus is Toll-Like Receptor 2 But Not Toll-Like Receptor 4 or Platelet Activating Factor Receptor Dependent

Cultured primary human keratinocytes were screened for their expression of various members of the toll-like receptor (TLR) family. Keratinocytes were found to constitutively express TLR1, TLR2, TLR3, TLR5, and TLR9 but not TLR4, TLR6, TLR7, TLR8, or TLR10 as shown by polymerase chain reaction analysis. The expression of the crucial receptor for signaling of staphylococcal compounds TLR2 was also confirmed by immunohistochemistry, in contrast to TLR4, which showed a negative staining pattern. Next, we analyzed the activation of the proinflammatory nuclear transcription factor κB by Staphylococcus aureus strain 8325-4. Using nuclear extract gel shifts, RelA staining, and luciferase reporter transfection plasmids we found a clear induction of nuclear factor κB translocation by the bacteria. This translocation induced the transcription of nuclear factor κB controlled genes such as inducible nitric oxide synthetase, COX2, and interleukin-8. Transcription of these genes was followed by production of increased amounts of interleukin-8 protein and NO. Inhibition experiments using monoclonal antibodies and the specific platelet activating factor receptor inhibitor CV3988 showed that nuclear factor κB activation by S. aureus was TLR2 but not TLR4 or platelet activating factor receptor dependent. In line, the purified staphylococcal cell wall components lipoteichoic acid and peptidoglycan, known to signal through TLR2, also showed nuclear factor κB translocation in human keratinocytes, indicating a crucial role of the staphylococcal cell wall in the innate immune stimulation of human keratinocytes. These results help to explain the complex activation of human keratinocytes by S. aureus and its cell wall components in various inflammatory disorders of the skin

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

In der Diagnostik von Infektionen und inflammatorischen Prozessen ist das C-reaktive Protein (CRP) einer der meistverwendeten Parameter, unter anderem aufgrund der geringen Kosten und der schnellen Verfügbarkeit. Im Zuge der letzten Jahre gewannen jedoch andere Entzündungsparameter, wie zum Beispiel das Interleukin 6 (IL-6) oder Procalcitonin (PCT), zunehmend an Bedeutung. Obwohl diese Parameter im klinischen Alltag noch nicht überall etabliert sind, besitzen sie doch wesentliche Vorteile in der Diagnostik und im Verlaufsmonitoring von entzündlichen Erkrankungen. Beispielsweise ist die Erkennung entzündlicher Komplikationen auf Intensivstationen durch erhöhte IL-6 Spiegel 24 bis 48 Stunden vor einer Erhöhung des CRP möglich. Die deutliche Überlegenheit von PCT gegenüber CRP in der Diagnostik von bakteriellen Infektionen und Sepsis begründet sich in der höheren Spezifität des PCT für bakterielle Infektionen. Der PCT-Verlauf ermöglicht daher eine bessere Beurteilung des Therapieerfolges und Krankheitsverlaufs des Patienten und liefert Hinweise auf eine gegebenenfalls erforderliche Therapieumstellung. Daraus ergibt sich die Frage, ob die Messung des CRP-Spiegels durch IL-6 und/oder PCT ersetzt werden kann. In dieser Übersichtsarbeit wird die derzeitige Bedeutung von CRP im Verhältnis zu den neueren Entzündungsparametern in der Diagnostik von bakteriellen Infektionen, im therapeutischen Monitoring und in seiner Aussagekraft bezüglich der Prognose des Patienten auf Intensivstationen dargestellt.C-reactive protein (CRP) currently constitutes one of the most widely used parameters for the diagnosis of infections and inflammatory processes, due to simple methods and low costs. However, in recent years, other parameters, such as interleukin 6 (IL-6) and procalcitonin (PCT), have gained in importance. Although these parameters are presently not established everywhere in clinical routine, they provide significant advantages in the diagnosis and monitoring of inflammatory diseases. For instance, in intensive care, the increase in IL-6 levels may indicate inflammatory complications 24 to 48 h prior to the increase in circulating CRP levels. In contrast to CRP, PCT shows a higher specificity for bacterial infections, which facilitates the diagnosis of bacterial infections and sepsis. Therefore, PCT values provide a better evaluation of prognosis and therapeutic success and of a necessary change in therapy. These points raise the question whether CRP levels should at least in part be replaced by PCT and/or IL-6. Thus, this review seeks to examine the value of CRP in relation to PCT and IL-6 in the diagnosis of bacterial infections, in therapeutic monitoring, and regarding prognosis in critical care patients

oxLDL uptake by dendritic cells induces upregulation of scavenger-receptors, maturation and differentiation

Several studies have proposed a pathogenic role for oxidized LDL (oxLDL) in atherosclerosis. We tested the hypothesis whether oxLDL modulates dendritic cells (DCs), since these important antigen-presenting cells have been implicated in atherogenesis. We investigated the uptake of oxLDL by DCs, the scavenger-receptors involved and the resulting changes in phenotype and cytokine-spectra. In addition, we analyzed the impact of oxLDL on the nuclear transcription factor-kappa B (NF-kappaB)-pathway.; oxLDL (10microg/ml) increased the expression of the scavenger-receptors CD205 and CD36 and decreased the mannose-receptor expression. The lectin-like oxLDL-receptor (LOX-1)-expression was not affected. The endocytotic capacity of dextran and lucifer-yellow was moderately decreased by oxLDL. Blockage of the scavenger-receptors CD36, LOX-1 and CD205 reduced oxLDL uptake. Furthermore, oxLDL induced DC-maturation and triggered differentiation of DCs in myeloid and plasmacytoid DCs. oxLDL decreased IL-10 secretion and increased IL-6 release. Finally, oxLDL induced an activation of the NF-kappaB-pathway. Inhibition of IkappaBalpha-phosphorylation diminished the oxLDL-induced DC-maturation and -differentiation.; oxLDL uptake by DCs is mediated by the scavenger-receptors LOX-1, CD36, and CD205. oxLDL induces a proinflammatory cytokine profile in human DCs leading to DC-maturation and -differentiation which can, in part, be explained by an activation of the NF-kappaB-pathway. These results support the hypothesis that vascular inflammation may be aggravated by oxLDL induced DC-activation