Alsfasser G, Antoniu B, Thayer S P, Warshaw A L, Fernández-del Castillo C
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Pancreatology. 2005;5(1):37-43; discussion 43. doi: 10.1159/000084489. Epub 2005 Mar 15.
Release of TNFalpha is thought to play an important role in mediating systemic effects in acute pancreatitis (AP). We have been unable to find an elevation of plasma TNFalpha in AP and hypothesize that it is susceptible to catabolism by circulating pancreatic proteases.
(1) AP was induced in Sprague-Dawley rats by cerulein hyperstimulation preceded by intraductal infusion of saline (mild) or glycodeoxycholic acid (severe). Healthy and sham-operated animals served as controls. Severity of pancreatitis was confirmed by histology. Plasma TNFalpha levels were measured at various time points after induction of AP with competitive ELISA. (2) Recombinant rat TNFalpha (rrTNFalpha) was incubated with trypsin, elastase, chymotrypsin and pepsin. Western Blot was performed to visualize TNF degradation. (3) RrTNFalpha was incubated in a concentration and time-dependant manner with proteases and TNF bioactivity was evaluated with a cytotoxicity assay.
(1) Plasma TNFalpha levels in severe pancreatitis were significantly lower than in sham-operated controls after 0.5 and 6 h. (2) Incubation with proteases showed degradation in the presence of trypsin, elastase and chymotrypsin and no effect of pepsin. (3) There was a concentration dependent inactivation of rrTNFalpha in the presence of pancreatic proteases and a complete time-dependent inactivation in the presence of trypsin.
Plasma TNFalpha does not rise in experimental AP, and levels are significantly lower in severe pancreatitis compared to sham-operated controls. Our study demonstrates degradation and inactivation of TNFalpha by pancreatic proteases, suggesting that it is unlikely it plays an important role in the development of distant organ failure.
肿瘤坏死因子α(TNFα)的释放被认为在急性胰腺炎(AP)的全身效应介导中起重要作用。我们在AP患者中未能发现血浆TNFα升高,并推测它易被循环中的胰腺蛋白酶分解代谢。
(1)通过在导管内注入生理盐水(轻度)或甘氨脱氧胆酸(重度)后用雨蛙素过度刺激,在Sprague-Dawley大鼠中诱导AP。健康和假手术动物作为对照。通过组织学确认胰腺炎的严重程度。用竞争性酶联免疫吸附测定法在诱导AP后的不同时间点测量血浆TNFα水平。(2)将重组大鼠TNFα(rrTNFα)与胰蛋白酶、弹性蛋白酶、糜蛋白酶和胃蛋白酶一起孵育。进行蛋白质印迹以观察TNF的降解。(3)将rrTNFα以浓度和时间依赖性方式与蛋白酶孵育,并用细胞毒性测定法评估TNF的生物活性。
(1)重度胰腺炎患者在0.5小时和6小时后的血浆TNFα水平显著低于假手术对照组。(2)与蛋白酶孵育显示在胰蛋白酶、弹性蛋白酶和糜蛋白酶存在下发生降解,而胃蛋白酶无作用。(3)在胰腺蛋白酶存在下rrTNFα呈浓度依赖性失活,在胰蛋白酶存在下呈完全时间依赖性失活。
实验性AP中血浆TNFα不升高,与假手术对照组相比,重度胰腺炎患者的水平显著降低。我们的研究证明了胰腺蛋白酶对TNFα的降解和失活,提示其在远处器官衰竭的发生中不太可能起重要作用。