Elevated tumor necrosis factor alpha production concomitant to elevated prostaglandin E2 production by trauma patients' monocytes
T. K. Takayama, C. Miller and G. Szabo
Department of Surgery, University of Massachusetts Medical Center, Worcester 01655.
The level of tumor necrosis factor alpha (TNF alpha), a monokine implicated
in mediating septic shock, is elevated in the blood of some patients with
sepsis. Monocytes from 11 trauma patients and 11 burn patients were
suboptimally stimulated with interferon gamma and muramyl dipeptide, an
analogue of bacterial wall products. The patients with sepsis showed
significantly greater total TNF alpha levels (secreted in combination with
cell-associated) 3 days before septic episodes, as compared with normal
controls (32.38 to 2231.76 ng/10(6) monocytes per milliliter, median =
121.03 ng/10(6) monocytes per milliliter; normal control: 0.00 to 18.20
ng/10(6) monocytes per milliliter, median = 5.93 ng/10(6) monocytes per
milliliter). Increases in patients' total monocyte TNF alpha levels greater
than 30 ng/10(6) monocytes per milliliter correlated with septic episodes.
In patients with sepsis, the total monocyte TNF alpha levels were increased
despite a concomitant increase in their prostaglandin E2 levels in both
stimulated (interferon gamma plus muramyl dipeptide) and unstimulated in
vitro assays (9 patients: stimulated prostaglandin E2 range, 30.1 to 123.6
ng/10(6) monocytes per milliliter). Massively elevated monocyte TNF alpha
and prostaglandin E2 production occurred simultaneously in patients with
sepsis.
