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Langenbeck's Archives of Surgery

Published in:

01-03-2009 | Original Article

Effect of major abdominal surgery on endotoxin release and expression of Toll-like receptors 2/4

Authors: Klaus Buttenschoen, Marion E. Schneider, Katja Utz, Marko Kornmann, Hans G. Beger, Daniela Carli Buttenschoen

Published in: Langenbeck's Archives of Surgery | Issue 2/2009

Abstract

Background

Surgery can cause endotoxemia, and endotoxin aggregates to Toll-like receptors and acts proinflammatory; repetitive endotoxin application can cause tolerance. The objective of the study is to characterize early inflammatory response and expression of TLR2/4 during major abdominal surgery.

Materials and methods

A prospective controlled study of 20 patients with elective major abdominal surgery was performed. Blood samples were collected before and at a defined time after surgery. Endotoxemia, capability of plasma to inactivate endotoxin, cytokine release of LPS-stimulated mononuclear cells, quantitative TLR mRNA expression, and plasma concentrations of TNFα, IL-6, C-reactive protein (CRP), α₁-acid glycoprotein, transferrin, and albumin were measured.

Results

Surgery caused endotoxemia (p = 0.053), and the capability of plasma to inactivate endotoxin was reduced (p = 0.0002). Two hours postoperatively, the plasma concentrations of TNFα and IL-6 peaked significantly, but the liberation capacity of mononuclear cells for cytokines (TNFα, IL-1β, IL-6) was significantly reduced. The concentration of CRP and α₁-acid glycoprotein peaked 48 h postoperatively, but those of transferrin and albumin were significantly decreased (p < 0.001, respectively). Median mRNA expression of TLR2 and TLR4 of mononuclear cells was not altered, and there was no obvious trend over time.

Conclusion

Major abdominal surgery is associated with endotoxemia, reduced capability of plasma to inactivate endotoxin, cytokine kinetics resembling those of healthy man after experimentally given LPS, and substantial acute-phase reaction. The cytokine liberation of mononuclear cells suggests a state of postoperative endotoxin tolerance. Despite these substantial changes, trends in TLR2/4 expression are not obvious.

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Title: Effect of major abdominal surgery on endotoxin release and expression of Toll-like receptors 2/4
Authors: Klaus Buttenschoen
Marion E. Schneider
Katja Utz
Marko Kornmann
Hans G. Beger
Daniela Carli Buttenschoen
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 2/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0357-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of major abdominal surgery on endotoxin release and expression of Toll-like receptors 2/4

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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