[Frontiers in Bioscience 18, 892-900, June 1, 2013]

Immunosuppression and the infection in patients with early SAP

Jian-Ping Li1, Jun Yang1, Ji-Ren Huang1, Dong-Lin Jiang1, Feng Zhang1, Ming-Feng Liu1, Yi Qiang1, Yuan-Long Gu1

1Department of Hepatobiliary Surgery, Third People' s Hospital of Wuxi Affiliated to Medical School of Nantong University, Wuxi 214041, Jiangsu, P. R. China


1. Abstract
2. Introduction
3. Materials and methods
3.1. Study subjects
3.2. Endotoxin analysis
3.3. Urinary lactulose/mannitol (L/M)
3.4. D(-)-lactate determination
3.5. ELISA
3.6. Flow cytometry
3.7. Statistical analysis
4. Results
4.1. Endotoxin, urinary L/M ratio and D(-)-lactate concentration
4.2. Decreased expression of HLA-DR-positive monocytes
4.3. Th1/Th2 imbalance in SAP
4.4. High levels of Treg cells in SAP
4.5. Plasma TNF-α, IL-6 and IL-10 levels
5. Discussion
6. Acknowledgments
7. References


Few data are available on the relationship between immune response and the infection caused by gut mucosal barrier dysfunction in patients with severe acute pancreatitis (SAP). The aim of this study was to investigate the immune response to gut mucosal barrier dysfunction in patients with early SAP. The results showed that the levels of endotoxin, the lactulose/mannitol (L/M) ratio, the D(-)-lactate concentration, the proportion of HLA-DR-positive monocytes, and the expression levels of TNF-α, IL-6 and IL-10 all decreased from a high level while the frequency of Tregs increased during the first 14 days. The Th1/Th2 ratio was decreased, with a decreased Th1 and an increased Th2 profile, in the beginning, but it was subsequently increased, with an increased Th1 profile. The data from this study showed that immunosuppression, the shift of the Th1/Th2 balance toward a Th2 response, increased Tregs, and related inflammatory cytokines are involved in the complex process of inflammation and infection caused by gut mucosal barrier dysfunction in patients with early SAP.