Top

Critical Care

Published in:

Open Access 01-10-2002 | Research

Effect of hemofiltration filter adsorption on circulating IL-6 levels in septic rats

Authors: John A Kellum, Michael K Dishart

Published in: Critical Care | Issue 5/2002

Abstract

Introduction

Hemofiltration may modulate the inflammatory response in sepsis through a variety of mechanisms. We sought to distinguish clearance from adsorption as the principal mechanism responsible for reducing circulating IL-6 levels with hemofiltration.

Materials and methods

Nine hours after cecal ligation and puncture in 18 adult male Sprague–Dawley rats, we divided the rats into three groups (6 animals each) and placed groups 2 and 3 on a hemofiltration circuit connected between the right carotid artery and femoral vein using an AN69 membrane. In the hemofiltration group (group 2), ultrafiltrate was replaced with lactated Ringer's solution; in the recirculation group (group 3), the ultrafiltrate was reinfused into the animal. A sham group (group 1) had an arteriovenous circuit inserted but no hemofiltration. Blood was obtained for measurement of IL-6 and tumor necrosis factor (TNF) at the start of hemofiltration and after 5 and 11 hours of treatment.

Results and discussion

IL-6 levels increased only in the sham-treated animals (20.4 ± 11.3 at baseline to 62.3 ± 16.8 pg/ml at 11 hours, P = 0.03) (differences between groups 1 and 2, P = 0.015, and groups 1 and 3, P = 0.028). TNF levels were highly variable but not significantly different among the three groups.

Conclusion

Hemofiltration-associated reductions in circulating IL-6 levels appear to be secondary to adsorption of mediators to the filter membrane. We do not know whether this is due to direct adsorption of IL-6 per se or to the absorption of other mediators with secondary downregulation of IL-6 production or release. In addition, we could not exclude an interaction between adsorption and hemofiltration.

Bellomo R: Continuous hemofiltration as blood purification in sepsis. New Horizons 1995, 3: 732-737.PubMed

Kellum JA: Immunomodulation in sepsis: the role of hemofiltration. Minerva Anestesiol 1999, 65: 410-418.PubMed

Kellum JA, Johnson JP, Kramer D, Palevsky P, Brady JJ, Pinsky MR: Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome. Crit Care Med 1998, 26: 1995-2000. 10.1097/00003246-199812000-00027CrossRefPubMed

Tassani P, Richter JA, Eising GP, Barankay A, Braun SL, Haehnel CH, Spaeth P, Schad H, Meisner H: Influence of combined zero-balanced and modified ultrafiltration on the systemic inflammatory response during coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1999, 13: 285-291.CrossRefPubMed

De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH: Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 1999, 10: 846-853.PubMed

Lee PA, Matson JR, Pryor RW, Hinshaw LB: Continuous arteriovenous hemofiltration therapy for Staphylococcus aureus-induced septicemia in immature swine. Crit Care Med 1993, 21: 914-924.CrossRefPubMed

Bellomo R, Kellum JA, Gandhi CR, Pinsky MR, Ondulik B: The effect of intensive plasma water exchange by hemofiltration on hemodynamics and soluble mediators in canine endotoxemia. Am J Respir Crit Care Med 2000, 161: 1429-1436.CrossRefPubMed

Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR: Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 2000, 28: 3581-3587.CrossRefPubMed

Casey LC, Balk RA, Bone RC: Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 1993, 119: 771-778.CrossRefPubMed

10.

Pinsky MR, Vincent JL, Deviere J, Alegre M, Khan RJ, Dupont E: Serum cytokine levels in human septic shock: relation to multiple-system organ failure and mortality. Chest 1993, 103: 565-575.CrossRefPubMed

11.

Calandra T, Gerain J, Heumann D, Baumgartner JD, Glauser MP: High circulating levels of interleukin-6 in patients with septic shock: evolution during sepsis, prognostic value, and interplay with other cytokines. Am J Med 1991, 91: 23-29.CrossRefPubMed

12.

Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr, for the PROWESS Study Group: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001, 344: 699-709. 10.1056/NEJM200103083441001CrossRefPubMed

13.

Andrejko KM, Chen J, Deutschman CS: Intrahepatic STAT-3 activation and acute phase gene expression predict outcome after CLP sepsis in the rat. Am J Physiol 1998, 275: G1423-G1429.PubMed

14.

Kellum JA, Bellomo R: Hemofiltration in sepsis: where do we go from here? Crit Care 2000, 4: 69-71. 10.1186/cc659PubMedCentralCrossRefPubMed

15.

Lonnemann G, Koch KM, Shaldon S, Dinarello CA: Studies on the ability of hemodialysis membranes to induce, bind and clear human interleukin-1. J Lab Clin Med 1988, 112: 76-86.PubMed

16.

Tetta C, Gianotti L, Cavaillon JM, Wratten ML, Fini M, Braga M, Bisagni P, Giavaresi G, Bolzani R, Giardino R: Coupled plasma filtration-adsorption in a rabbit model of endotoxic shock. Crit Care Med 2000, 28: 1526-1533. 10.1097/00003246-200005000-00045CrossRefPubMed

17.

Kellum JA, Song M, Venkataraman R, Schmigel J, Statile C: Improved survival with hemoadsorption in endotoxin-induced shock in rats [abstract]. Am J Respir Crit Care Med 2002, 165: A176.CrossRef

18.

Patel RT, Deen KL, Youngs D, Warwick J, Keighley MR: Inter-leukin 6 is a prognostic indicator of outcome in severe intra-abdominal sepsis. Brit J Surg 1994, 81: 1306-1308.CrossRefPubMed

19.

Frode TS, Souza GE, Calixto JB: The effects of IL-6 and IL-10 and their specific antibodies in the acute inflammatory responses induced by carrageenan in the mouse model of pleurisy. Cytokine 2002, 17: 149-156. 10.1006/cyto.2001.0980CrossRefPubMed

20.

Hallbeck AL, Walz TM, Wasteson A: Interleukin-6 enhances transforming growth factor-alpha mRNA expression in macrophage-like human monocytoid (U-937-1) cells. Biosci Rep 2001, 21: 325-339. 10.1023/A:1013238300100CrossRefPubMed

21.

Barriere SL, Lowry SF: An overview of mortality risk prediction in sepsis. Crit Care Med 1995, 23: 376-393. 10.1097/00003246-199502000-00026CrossRefPubMed

22.

Ertel W, Morrison MH, Wang P, Ba ZF, Ayala A, Chaudry IH: The complex pattern of cytokines in sepsis. Association between prostaglandins, cachectin, and interleukins. Ann Surg 1991, 214: 141-148.PubMedCentralCrossRefPubMed

Title: Effect of hemofiltration filter adsorption on circulating IL-6 levels in septic rats
Authors: John A Kellum
Michael K Dishart
Publication date: 01-10-2002
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2002
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc1528

At a glance: The STEP trials

Springer Medicine

Effect of hemofiltration filter adsorption on circulating IL-6 levels in septic rats

Abstract

Introduction

Materials and methods

Results and discussion

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results and discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2002

Prone positioning does not affect cannula function during extracorporeal membrane oxygenation or continuous renal replacement therapy

Is insulin an endogenous cardioprotector?

Clinical review: Intensive care follow-up – what has it told us?

Hypothermia and neurologic outcome in patients following cardiac arrest: should we be hot to cool off our patients?

Paediatric intensive care: out of commission

ICUs worldwide: Results of a nationwide survey of Colombian intensive care units