Bacterial translocation in a non-lethal rat model of peritonitis

Inflammatory mediators in intra-abdominal sepsis or injury - a scoping review

INTRODUCTION

Inflammatory and protein mediators (cytokine, chemokine, acute phase proteins) play an important, but still not completely understood, role in the morbidity and mortality of intra-abdominal sepsis/injury. We therefore systematically reviewed preclinical and clinical studies of mediators in intra-abdominal sepsis/injury in order to evaluate their ability to: (1) function as diagnostic/prognostic biomarkers; (2) serve as therapeutic targets; and (3) illuminate the pathogenesis mechanisms of sepsis or injury-related organ dysfunction.

METHODS

We searched MEDLINE, PubMed, EMBASE and the Cochrane Library. Two investigators independently reviewed all identified abstracts and selected articles for full-text review. We included original studies assessing mediators in intra-abdominal sepsis/injury.

RESULTS

Among 2437 citations, we selected 182 studies in the scoping review, including 79 preclinical and 103 clinical studies. Serum procalcitonin and C-reactive protein appear to be useful to rule out infection or monitor therapy; however, the diagnostic and prognostic value of mediators for complications/outcomes of sepsis or injury remains to be established. Peritoneal mediator levels are substantially higher than systemic levels after intra-abdominal infection/trauma. Common limitations of current studies included small sample sizes and lack of uniformity in study design and outcome measures. To date, targeted therapies against mediators remain experimental.

CONCLUSIONS

Whereas preclinical data suggests mediators play a critical role in intra-abdominal sepsis or injury, there is no consensus on the clinical use of mediators in diagnosing or managing intra-abdominal sepsis or injury. Measurement of peritoneal mediators should be further investigated as a more sensitive determinant of intra-abdominal inflammatory response. High-quality clinical trials are needed to better understand the role of inflammatory mediators.

Kinetics of proinflammatory cytokines after intraperitoneal injection of tribromoethanol and a tribromoethanol/xylazine combination in ICR mice

Tribromoethanol (2,2,2-tribromoethanol, TBE) is a popular injectable anesthetic agent used in mice in Korea. Our goal was to assess the risks associated with side effects (lesions) in the abdominal cavity, especially at high doses. To understand the underlying pathophysiological changes, we examined levels of cytokines through ELISA of abdominal lavage fluid and spleen collected from mice treated with low and high-dose TBE. ICR mice were anesthetized using one of the following protocols: a combination of TBE 200 mg/kg (1.25%) and xylazine 10 mg/kg; TBE 400 mg/kg (1.25%); and TBE 400 mg/kg (2.5%). Administration of high-dose TBE (400 mg/kg) increased the interleukin-1β and interleukin-6 levels in the peritoneal cavity over the short term (<1 day) compared with sham controls and low-dose TBE (200 mg/kg) groups. Cytokine expression in the low-dose TBE group was similar to the control group, whereas in the high-dose TBE group cytokine levels were higher in abdominal lavage fluid and spleen over the long term (10 days post-injection). We conclude that a combination of TBE 200 mg/kg (1.25%) and xylazine (10 mg/kg) is a safe and effective anesthetic for use in animals.

Peritoneal resorption capacity for lipopolysaccharide and interleukin-6 in acute zymosan-induced chemical peritonitis

AIM

To evaluate peritoneal resorption capacity for lipopolysaccharide (LPS) and interleukin-6 (IL-6) in a model of chemical peritonitis.

METHODS

Zymosan peritonitis was induced in anesthetized rats. LPS was injected intraperitoneally to different groups at 4 h (n = 10), 8 h (n = 9), 12 h (n = 9), and 24 h (n = 9) after peritonitis and to a control group (n = 8). Similarly, IL-6 was injected intraperitoneally to different groups at 4 h (n = 9), 8 h (n = 10), 12 h (n = 10), and 24 h (n = 10) after peritonitis, and to a control group (n = 10). Plasma levels of LPS or IL-6 were measured immediately after intraperitoneal injections of LPS or IL-6, respectively, and at 5, 15, 30, 45, and 60 min later.

RESULTS

There was no change over time in plasma LPS levels in the groups receiving LPS intraperitoneally (p = 0.4). There was highly significant change over time in the IL-6 level in the studied time periods in the groups receiving IL-6 intraperitoneally (p < 0.0001). There was an increase in the plasma IL-6 level when sampled at 4 h after peritonitis.

CONCLUSION

There was a reduction of resorption capacity of inflamed peritoneum for inflammatory mediators in acute chemical peritonitis.

Peritoneal mesothelial cells produce inflammatory related cytokines

BACKGROUND

Peritonitis involves cascading interactions between cytokines that initiate robust signalling processes via the interferon-g and nuclear factor kappa B pathways. The present study evaluates the interplay between various putative inducers of peritonitis and a battery of inflammation-related cytokines.

METHODS

Cultures of peritoneal mesothelial cells were isolated from omenta harvested from male Wistar rats. These cultures were exposed to tumour necrosis factor (TNF)-alpha, lipopolysaccharide, zymosan, myeloperoxidase, peritoneal fluid from rats with zymosan-induced peritonitis, and peritoneal fluid from control animals. The production of TNF-alpha, interleukin (IL)-1beta, IL-6, and IL-10 was assessed after 4, 12 and 24 h.

RESULTS

Lipopolysaccharide and zymosan stimulated TNF-alpha, IL-1beta, and IL-10 production; and peritoneal fluids from both control animals and animals with zymosan-induced peritonitis stimulated the production of TNF-alpha, IL-1RII, and IL-6. Expression and secretion of TNF-alpha occurred in a constitutive manner and was regulation at the protein level. The decoy molecule IL-1 receptor type II (IL-1RII) was produced at the same time as IL-1beta and production of the anti-inflammatory cytokine IL-10 was evident within 4 h. IL-6 was constitutively expressed and regulated at the transcriptional level as indicated by a marked discontinuity between the amount of IL-6 produced and the extent IL-6 messenger ribonucleic acid (mRNA) expression.

CONCLUSIONS

Tumour necrosis factor-alpha might not be the sole primary mediator of peritonitis. The anti-inflammatory molecules IL-1RII and IL-10 are induced at the same time as the pro-inflammatory cytokines TNF-alpha, IL-1beta, and IL-6. This suggests that complex control systems are set in place by the factors that stimulate peritoneal mesothelial cells and might have the potential to cause peritonitis.

Lavage enhances the production of proinflammatory mediators by peritoneal mesothelial cells in an experimental model

PURPOSE

There is a lack of clinical evidence supporting the use of lavage in patients with peritonitis. It is known that fluids such as normal saline cause temporary damage to the peritoneum and that increased production of proinflammatory mediators is associated with a poor outcome. This study used an experimental model to evaluate the effect of lavage on the peritoneal mesothelium and the ability of peritoneal mesothelial cells to produce a battery of proinflammatory mediators (TNFalpha, IL-1beta, GROalpha, and ICAM-I.).

METHODS

Wistar rats were allocated into four groups (control, peritonitis, lavage, peritonitis plus lavage). Peritonitis was induced by exposure to zymosan and saline was used for lavage. After 18, 24, and 43 hours, mesothelial imprints were taken from the peritoneum for histology, semiquantitative reverse transcription-polymerase chain reaction, Western blot analyses, and immunocytochemistry.

RESULTS

Both peritonitis and lavage caused peritoneal damage at 18 and 24 hours, and this effect was additive. At varying times, peritoneal mesothelial cells from animals undergoing lavage had greater up-regulation (P < 0.05) of mRNA expression for TNFalpha, IL-1beta, GROalpha, and ICAM-I and greater production (P < 0.05) of TNFalpha, IL-1RII, GROalpha, and ICAM-I. The latter was heavily concentrated at the cell membrane.

CONCLUSIONS

Lavage causes self-limiting peritoneal damage and this is associated with an up-regulation of proinflammatory mediators in animals with peritonitis.

Zymosan induces nitric oxide production by peritoneal mesothelial cells

INTRODUCTION

The production of nitric oxide is an important peritoneal defense mechanism. We have evaluated the effect of various putative stimulants on nitric oxide production by peritoneal mesothelial cells.

METHODS

Wistar rats were randomized to either a control group or a peritonitis group (5 mg zymosan intraperitoneally). Groups of five animals were sacrificed at 4, 18, 24, 48 and 96 h after the induction of peritonitis and their peritoneal fluid was harvested for assay. Cultures of peritoneal mesothelial cells were stimulated with lipopolysaccharide, myeloperoxidase, TNFalpha, zymosan, peritoneal fluid from a control animal and peritoneal fluid from a peritonitis animal. Supernatants were collected after incubation for 4, 24 and 48 h for assay. The assay for nitric oxide was based upon the nitrite content of the samples.

RESULTS

The intraperitoneal administration of zymosan was associated with an increased production of nitric oxide (NO) when compared with control animals (P < 0.01). In cultures of peritoneal mesothelial cells, zymosan, but not the other putative stimulants, was associated with a marked output of nitric oxide (P < 0.001).

CONCLUSION

Zymosan has a direct effect on peritoneal mesothelial cells, which are able to generate nitric oxide in the absence of co-stimulatory molecules. This suggests that it may be possible to use some form of external stimulation to up-regulate the NO response by peritoneal mesothelial cells.