Entleutner Markus, Traeger Tobias, Westerholt Alexandra, Holzmann Bernhard, Stier Albrecht, Pfeffer Klaus, Maier Stefan, Heidecke Claus-Dieter
Chirurgische Klinik und Poliklinik, Technischen Universität München, Munich, Germany.
Int J Colorectal Dis. 2006 Jan;21(1):64-70. doi: 10.1007/s00384-004-0707-0. Epub 2005 Mar 9.
Abdominal sepsis due to secondary fecal peritonitis following anastomosis insufficiency is a rare but life threatening complication of colorectal surgery. The induction of IFN-gamma by IL-12 is believed to play a key role in sepsis as it promotes antibacterial effector mechanisms such as oxidative burst or nitric oxide induction. The impact of gene deficiency for IL-12 (IL-12p40 KO), oxidative burst (p47(phox) KO), or NO induction (iNOS KO) on the outcome of fecal peritonitis was characterized using the murine Colon Ascendens Stent Peritonitis model (CASP). In the IL-12p40 KO model, 3 and 12 h after surgery, serum cytokine levels of IL-1beta, TNF, IL-18, and IL-10 were analyzed. Expression of IL-1beta, IL-10, IP-10, and MIP-1alpha was measured in lung and liver by RNAse Protection Assay. IL-12p40 and iNOS-deficient mice exhibited a significantly higher susceptibility to CASP as compared to the controls, whereas no significant difference was observed in p47(phox) KO mice. Absence of IL-12 resulted in delayed expression of proinflammatory cytokines and chemokines in both the liver and the lung, and was associated with significant reduction of IL-1beta levels in the serum 12 h after CASP. IL-12 and iNOS possess protective functions in fecal murine peritonitis. Surprisingly, no significant contribution of oxidative burst to the immune response was observed. Overall, these findings suggest that IL-12 deficiency causes a profound delay of the immune response after polymicrobial challenge resulting in significantly increased susceptibility in the CASP model.
吻合口漏后继发粪性腹膜炎所致的腹部脓毒症是结直肠手术中一种罕见但危及生命的并发症。IL-12诱导IFN-γ被认为在脓毒症中起关键作用,因为它促进诸如氧化爆发或一氧化氮诱导等抗菌效应机制。使用小鼠结肠升支支架腹膜炎模型(CASP)来表征IL-12基因缺陷(IL-12p40基因敲除)、氧化爆发(p47(phox)基因敲除)或一氧化氮诱导(iNOS基因敲除)对粪性腹膜炎结局的影响。在IL-12p40基因敲除模型中,术后3小时和12小时,分析血清中IL-1β、TNF、IL-18和IL-10的细胞因子水平。通过核糖核酸酶保护试验测量肺和肝中IL-1β、IL-10、IP-10和MIP-1α的表达。与对照组相比,IL-12p40和iNOS缺陷小鼠对CASP的易感性显著更高,而在p47(phox)基因敲除小鼠中未观察到显著差异。IL-12的缺失导致肝和肺中促炎细胞因子和趋化因子的表达延迟,并且与CASP术后12小时血清中IL-1β水平的显著降低相关。IL-12和iNOS在小鼠粪性腹膜炎中具有保护作用。令人惊讶的是,未观察到氧化爆发对免疫反应有显著贡献。总体而言,这些发现表明IL-12缺乏导致多微生物攻击后免疫反应的严重延迟,从而导致在CASP模型中易感性显著增加。