Tumor necrosis factor A and interleucin 6 serum values in patients undergoing extracorporeal shock wave lithotripsy for ureteral stones

OBJECTIVE

Extracorporeal shock wave lithotripsy (ESWL) is highly effective for the treatment of uretral lithiasis and remains the first treatment option for the majority of patients when ureteral lithiasis can not be treated otherwise for more than two decades. In the present study we aim to evaluate the levels of serum tumor necrosis factor a (TNF-a) and interleucin 6 (IL-6) in patients undergoing ESWL and investigate whether preESWL levels of serum TNF-a and IL-6 correllate with any possible infectious complications after ESWL.

SUBJECTS AND METHODS

Thirty patients (17 males and 13 females), with a mean age of 43 who underwent ESWL for ureteral stones and 10 healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-a and IL-6 were obtained before ESWL and after ESWL, 1, 24, and 48 hours and 2, 24, and 48 hours, respectively. The preESWL and postESWL serum TNF-a levels and IL-6 were compared and correlated with possible tissue damage and infectious complications.

RESULTS

We found that serum TNF-a levels were significantly decreased one hour (P<0,001) and increased 24 hours (P=0.007) after ESWL. Furthermore IL-6 was also significantly increased 2 hours (P<0,001), 24 and 48 hours after ESWL (P=0,003 and 0,002 respectively). In 3 patients we observed fever (39 (o)C) postESWL procedure with negative urine culture and high serum values of TNF-a and IL6 preESWL.

IN CONCLUSION

A high specific markers such as serum TNF-a levels (15-25pg/ml) and IL-6 (25-35pg/ml) might be useful to identifying patients with possible infection following ESWL lithotripsy. However, further studies are needed to get more accurate results.

Can tumor necrosis factor a (TNF-a) and interleukin 6 (IL-6) be used as prognostic markers of infection following ureteroscopic lithrotripsy and extracorporeal shock wave lithotripsy for ureteral stones?

OBJECTIVE

Ureteroscopic lithotripsy (URS) and Extracorporeal shock wave lithotripsy (ESWL) are highly effective for the treatment of uretral lithiasis and remain the treatment option for the majority of patients for more than two decades. In the present study we aimed to evaluate the levels of serum tumor necrosis factor A (TNFa) and interleucin 6 (IL6) in patients undergoing ESWL and URS.

SUBJECTS AND METHODS

A total number of seventy patients were involved in our study. Thirty patients (17 males, 13 females), with a mean age of 43 had underwent ESWL and thirty patients (19 males, 11 females), with a mean age of 47 (range: 26-68) underwent URS lithotripsy. Ten healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-a and IL-6 were obtained before URS and ESWL and after the procedure at 1, 24, and 48 hours and at 2, 24, and 48 hours, respectively. The pre ESWL/URS and post ESWL/URS levels were compared and correlated with possible tissue damage. According to ESWL procedure we found that serumTNF-a levels were significantly increased after one hour (P<0,001) and after 24 hours (P=0.007). Furthermore, IL-6was significantly increased at 2 (P< 0,001), 24 and 48 hours post ESWL (P=0,003 and 0,002) respectively. For URS serum TNF-a levels were statistical significantly correlated preoperatively with one hour (P=0,0083) and 48 hours (P<0,001) after URS and IL-6 with 2 and 24 hours (P<0,001). In 3 patients for URS and 1 for ESWL we observed post procedure fever (>38.5C(o)). All those patients had preoperatively high values of TNF-a and Il-6 that increased at 1 and 2-hours respectively. In conclusion, high pre ESWL/URS levels of serum TNF-a and IL-6 may indicate a predisposition for post ESWL/URS inflammation and infection following URS lithotripsy or ESWL procedure.

Serum cytocines values in patients after endoscopic surgery for ureteral lithiasis

Obstructive uropathy due to ureteral stones can cause renal infection and, if left untreated, can cause impairment of renal function. Endoscopic surgery such as ureteroscopy (URS) and laser lithotripsy are the primary therapeutic approach. Cytokines as non invasive markers may have a role to diagnose ureteral damage and infection. We aimed to evaluate serum cytokine levels of tumor necrosis factor-a (TNFa) and interleukin-6 (IL6) in patients undergoing URS and holmium laser lithotripsy. The study included 40 patients (male 25 and 15 female) with a mean age of 47 years and 10 healthy blood donors serving as the control group. None of them had any additional systemic diseases, previous insertion of a ureteral double "j" stent or of a nephrostomy tube, neoplasmatic disease ot renal insufficiency. Routine urine examination and urine culture were obtained to exclude urinary infection. Preoperatively and 1h, 2h, 24h and 48h postoperatively serum samples of TNF-a and IL-6 were collected and measured. Serum TNFa and IL-6 values were correlated with the other variables measured from blood samples after the URS using paired samples Students t-test with confidence interval 95%. A P value of less than 0.01 was considered statistically significant. Correlation between serum TNF-a and IL6 levels with healthy donors were statistically significant in 1h (0.004), 2h (0.001), 24h (0.001) and 48h (0.001 and 0.001) postoperatively, respectively. In conclusion, our study shows that cytokines could be helpful as markers of renal tissue damage. However, further studies are needed to get more accurate results.

Targeted treatment for metastatic renal cell carcinoma and immune regulation

New targeted agents have become the mainstream of treatment in metastatic renal cell carcinoma (mRCC) and substituted the previous cytokine-based therapies. Vascular endothelial growth factor (VEGF) pathway is the principle target for drugs like sunitinib, sorafenib and bevacizumab. As VEGF is regulating dendritic cell (DC) function, inhibition of VEGF results in activation of DCs and a shift towards cellular (type 1) immunity, which is believed to favor cancer rejection. Recent studies have established the immune-stimulating effects of sunitinib that may as well be a marker for effectiveness. On the other hand, sorafenib not only inhibits VEGF receptor (VEGFR) but is also a B-Raf inhibitor (a component of the ras - MAPK pathway) and this leads to downregulation of immune responses. Sorafenib has not yet shown benefit in first-line treatment of mRCC when compared to interferon (IFN)-alpha and sorafenib-mediated immunosuppression may partially account for that. Mammalian target of rapamycin (mTOR), the target of temsirolimus, is an element of the DC activation pathway. There are no data for in vivo effects of temsirolimus in the immune system. The addition of IFN-alpha to temsirolimus resulted in inferior outcomes than temsirolimus alone. IFN-alpha has however still a place in mRCC treatment, as bevacizumab has been approved in combination with IFN-alpha. New clinical trials address the effects of the combination of cytokines with targeted agents. The immune-modulating effects of targeted treatments may be important in pharmacodynamic outcomes, effectiveness or the development of adverse events.