Investigation of systemic and mesenteric inflammatory signaling and gut-derived endothelial toxicity in patients undergoing high-risk abdominal aortic surgery

Shock
Leigh WilloughbyGeoffrey Warhurst

Abstract

Evidence from animal models of trauma and hemorrhage has suggested that the gut plays an active role in the pathogenesis of systemic inflammatory responses and multiple organ dysfunction syndrome. The aim of the present study was to seek evidence for gut-derived signals in man in a group of eight patients undergoing elective abdominal aortic reconstruction, a procedure that is associated with sterile tissue injury, controlled colonic ischemia as a consequence of aortic cross-clamping, and a significant risk of developing systemic inflammation and multiple organ dysfunction syndrome. Despite the presence of a marked systemic inflammatory response (IL-6, IL-18, monocyte chemoattractant protein 1, and IL-8) and a gut-derived inflammatory signal (IL-6), we could find no evidence that gut-derived pathogen DNA was present in the central or mesenteric circulation, and we could find no evidence that either central or mesenteric plasma samples could induce apoptotic or necrotic cell death in human umbilical vein endothelial cells in vitro. Similarly, we could find no evidence of adhesion molecule upregulation in the endothelial monolayers exposed to central or mesenteric plasma sampled at any time point during surgery. There was, howeve...Continue Reading

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Citations

Aug 15, 2013·Proceedings of the National Academy of Sciences of the United States of America·Lakshmi KannanGeorge C Tsokos
Jul 19, 2011·Shock·Peter A Ward
Dec 14, 2011·American Journal of Respiratory and Critical Care Medicine·Steven M Opal
May 13, 2014·International Journal of Surgery·Mehmet Salih AydinFunda Yalcin
Oct 16, 2012·Journal of the American College of Surgeons·John Alfred Carr
Apr 27, 2016·Current Opinion in Gastroenterology·John Calvin CoffeyPeter Faul
Sep 22, 2016·Best Practice & Research. Clinical Anaesthesiology·Martin Zammert, Simon Gelman

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