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Monoclonal Antibody to Tumor Necrosis Factor Attenuates Cardiopulmonary Dysfunction in Porcine Gram-negative Sepsis

Ciaran J. Walsh, FRCSI; Harvey J. Sugerman, MD; Patrick G. Mullen, FRCSI; P. Declan Carey, FRCSI; Sandra K. Leeper-Woodford, PhD; Gary J. Jesmok, PhD; Earl F. Ellis, PhD; Alpha A. Fowler, MD

Arch Surg. 1992;127(2):138-145.

Abstract
• Tumor necrosis factor (TNF) is implicated in the pathophysiology of gram-negative sepsis. This study examined physiologic and biochemical effects of pretreatment with an anti-TNF monoclonal antibody immediately before the onset of sepsis. Three groups of anesthetized ventilated pigs were studied for 300 minutes. Groups 1 (n=12) and 2 (n=6) received a 1-hour infusion of live Pseudomonas aeruginosa. Group 2 was pretreated with anti-TNF monoclonal antibody (15 mg/kg). Group 3 (n=8) received intravenous sterile saline. Group 1 exhibited a significant rise in plasma TNF activity, which was abolished in group 2. Cardiac index was reduced in both groups 1 and 2 in the first hour but recovered in group 2 (3.3±0.4 L/min per square meter at 300 minutes in group 2 vs 1.3±0.2 L/min per square meter in group 1). Metabolic acidosis was attenuated (arterial pH, 7.39±0.01 in group 2 vs 7.16±0.03 at 300 minutes in group 1). Increased extravascular lung water was also attenuated (5.9±0.7 in group 2 vs 13.2±1.5 mL/kg at 300 minutes in group 1). However, pulmonary hypertension and hypoxemia, which are known cyclooxygenase effects, were not affected. In the early phase of the study, plasma thromboxane B₂ levels were elevated in both groups 1 and 2. We conclude that anti-TNF monoclonal antibody offered significant protection against the effects of sepsis, but that other mediators may be responsible for the early changes seen in this model.

(Arch Surg. 1992;127:138-145)

Author Affiliations
From the Departments of Surgery (Drs Walsh, Sugerman, Mullen, and Carey), Internal Medicine (Drs Leeper-Woodford and Fowler), Pharmacology (Dr Ellis), and Pathology (Drs Leeper-Woodford and Fowler), Medical College of Virginia, Virginia Commonwealth University, Richmond; and Cutter Biological, Miles Inc, Berkeley, Calif (Dr Jesmok).

Footnotes
Accepted for publication October 20, 1991.

Presented at the 11th Annual Meeting of the Surgical Infection Society, Fort Lauderdale, Fla, April 8, 1991.

Reprint requests to PO Box 50, MCV Station, Medical College of Virginia, Richmond, VA 23298-0519 (Dr Fowler).

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