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Alfred A. Santos, MD; Marcus R. Scheltinga, MD; Elizabeth Lynch, MA; Elaine F. Brown, MA; Pornsi Lawton, MA; Elizabeth Chambers, MA; Jeffrey Browning, PhD; Charles A. Dinarello, MD; Sheldon M. Wolff, MD; Douglas W. Wilmore, MD

Arch Surg. 1993;128(2):138-144.

Abstract
• The body's response to infection/inflammation is initiated by the elaboration of cytokines, such as tumor necrosis factor, interleukin 1-β (IL-1-β), IL-6, and IL-8. Cytokines, in turn, stimulate the pituitary-adrenal axis, and it has been suggested that the corticosteroids elaborated serve as negative feedback signals to diminish inflammatory events. To test this hypothesis, we administered hydrocortisone shortly before endotoxin administration to normal volunteers. Steroids greatly reduced the clinical response to endotoxin and attenuated the appearance of tumor necrosis factor, IL-6, and IL-8 in the circulation. In contrast, IL-1–receptor antagonist, a competitive antagonist of the IL-1 receptor, was unaffected by steroid administration. These data suggest that IL-1–receptor antagonist may act in synergism with corticosteroids to reduce inflammation. Elevation of concentrations of these two factors, corticosteroids and IL-1–receptor antagonist, in plasma appears to be the mechanism used by the body to overcome the effects of inflammatory cytokines.

(Arch Surg. 1993;128:138-144)

Author Affiliations
From the Laboratory for Surgical Metabolism and Nutrition, Department of Surgery, Brigham and Women's Hospital, Boston, Mass, and Harvard Medical School, Boston (Drs Santos, Scheltinga, and Wilmore, and Mss Brown and Chambers); Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts University Medical School, New England Medical Center Hospital, Boston (Ms Lynch and Drs Dinarello and Wolff); and Department of Cell Biology, Biogen Inc, Cambridge, Mass (Ms Lawton and Dr Browning).

Footnotes
Accepted for publication November 7, 1992.

Presented at the 12th Annual Meeting of the Surgical Infection Society, Los Angeles, Calif, April 9, 1992.

Reprint requests to Laboratory for Surgical Metabolism and Nutrition, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Wilmore).

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