Cytokine's concentrations and monocyte HLA DR expression as markers defining the therapeutic strategy in contemporary behavior in patients with acute pancreatitis
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1
University Hospital Stara Zagora/Department of surgery, Surgery, Bulgaria
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2
Trakian University, Immunology, Bulgaria
Background
Acute pancreatitis (AP) has an incidence of approximately 40 cases per year per 100,000 adults. Although usually self-limiting, 10% to 20% of afflicted patients will progress to severe pancreatitis. The mortality rate among patients with severe pancreatitis may approach 30% when they progress to multisystem organ failure. The development of acute pancreatitis illustrates the requirement for understanding the basic mechanisms of disease progression to drive the exploration of therapeutic options.
Materials and methods
Cytokines play a major role in the pathogenesis of AP as underlying systemic inflammatory response, tissue damage and organ dysfunction. Therefore, the determination of their concentrations could provide both early evaluation of severity, local and systemic complications, and dynamic assessment of initiated treatment . However, little is known about circulating concentrations of these and other inflammatory cytokines and their real impact in clinical practice.
Results
Over the past 30 years several scoring systems have been developed to predict the severity of acute pancreatitis. However, there are no complete scoring index with high sensitivity and specificity till now. Experimental studies suggest that the prognosis for acute pancreatitis depends upon the degree of pancreatic necrosis and the intensity of multisystem organ failure generated by the systemic inflammatory response. This suggests an intricate balance between localized tissue damage with proinflammatory cytokine production and a systemic, anti-inflammatory response that restricts the inappropriate movement of proinflammatory agents into the circulation. The critical players of this interaction include: the proinflammatory cytokines like , IL-6, IL-1beta, TNF-alpha, IL-8 and platelet activating factor (PAF), the anti-inflammatory cytokines like IL-10. Preclinical work has shown that some of these mediators are markers for disease activity, whereas other inflammatory components may actually drive the disease process as important mediators. Implication of such mediators suggests that interruption or blunting of an inappropriate immune response has the potential to improve outcome. Full understanding of these basic mechanisms involves determining not only which mediators are present, but also closely documenting the kinetics of their appearance.
Conclusions
The detailed understanding of the pathophysiological processes and immunological aspects in patients with acute pancreatitis is at the basis of the development of therapeutic strategies that will provide a significant reduction in morbidity and mortality.
Keywords:
acute pancreatitis,
therapeutic strategy,
specific markers,
monocyte HLA DR expression,
Cytokine's concentrations,
assessment
Conference:
15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013.
Presentation Type:
Abstract
Topic:
Immune-mediated disease pathogenesis
Citation:
Minkov
G,
Yovtchev
Y,
Petrov
A,
Nikolov
S and
Halacheva
K
(2013). Cytokine's concentrations and monocyte HLA DR expression as markers defining the therapeutic strategy in contemporary behavior in patients with acute pancreatitis.
Front. Immunol.
Conference Abstract:
15th International Congress of Immunology (ICI).
doi: 10.3389/conf.fimmu.2013.02.00089
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Received:
08 Mar 2013;
Published Online:
22 Aug 2013.
*
Correspondence:
Dr. Georgi Minkov, University Hospital Stara Zagora/Department of surgery, Surgery, Stara Zagora, Bulgaria, yovtchev@abv.bg