Does manipulating local surgical wound cytokines improve surgical outcomes?

Exploring the mechanism and crosstalk between IL-6 and IL- 1β on M2 macrophages under metabolic stress conditions

Macrophages are highly variable immune cells that are important in controlling inflammation and maintaining tissue balance. The ability to polarize into two major types-M1, promoting inflammation, and M2, resolving inflammation and contributing to tissue repair-determines their specific roles in health and disease. M2 macrophages are particularly important for reducing inflammation and promoting tissue regeneration, but their function is shaped mainly by surrounding cells. This is evident in obesity, diabetes, and chronic inflammation. Although many cytokines regulate macrophage polarization, interleukin-6 (IL-6) and interleukin-1β (IL-1β) are major players, but their effects on M2 macrophage behavior under metabolic stress remain unclear. This study describes the intricacies within M2 macrophages concerning IL-6 and IL-1β signaling when under metabolic stress. Though, more frequently than not, IL-6 is labelled as pro-inflammatory, it can also behave as an anti-inflammatory mediator. On the other hand, IL-1β is the main pro-inflammatory agent, particularly in metabolic disorders. The relationship between these cytokines and the macrophages is mediated through important pathways such as JAK/STAT and NFκB, which get perturbed by metabolic stress. Therefore, metabolic stress also alters the functional parameters of macrophages, including alterations in mitochondrial metabolism, glycolytic and oxidative metabolism. Phosphorylation alters the kinetics involved in energy consumption and affects their polarization and their function. However, it has been suggested that IL-6 and IL-1β may work in concert or competition when inducing M2 polarization and, importantly, implicate cytokine release, phagocytic activity, and tissue repair processes. In this review, we discuss the recent literature on the participation of IL-6 and IL-1β cytokines in macrophage polarization and how metabolic stress changes cytokine functions and synergistic relations. A better understanding of these cytokines would serve as an important step toward exploring alternative antiviral strategies directed against metabolic disturbance and, hence, approve further endeavors.

Systems biology-based approaches to summarize and identify novel genes and pathways associated with acute and chronic postsurgical pain

STUDY OBJECTIVE

To employ systems biology-based machine learning to identify biologic processes over-represented with genetic variants (gene enrichment) implicated in post-surgical pain.

DESIGN

Informed systems biology based integrative computational analyses.

SETTING

Pediatric research and teaching institution.

INTERVENTIONS

Pubmed search (01/01/2001-10/31/2017) was performed to identify "training" genes associated with postoperative pain in humans. Candidate genes were identified and prioritized using Toppgene suite, based on functional enrichment using several gene ontology annotations, and curated gene sets associated with mouse phenotype-knockout studies.

MEASUREMENTS

Computationally top-ranked candidate genes and literature-curated genes were included in pathway enrichment analyses. Hierarchical clustering was used to visualize select functional enrichment results between the two phenotypes.

MAIN RESULTS

Literature review identified 38 training genes associated with postoperative pain and 31 with CPSP. We identified 2610 prioritized novel candidate genes likely associated with acute and chronic postsurgical pain, the top 10th percentile jointly enriched (p 0.05; Benjamini-Hochberg correction) several pathways, topmost being cAMP response element-binding protein and ion channel pathways. Heat maps demonstrated enrichment of inflammatory/drug metabolism processes in acute postoperative pain and immune mechanisms in CPSP.

CONCLUSION

High interindividual variability in pain responses immediately after surgery and risk for CPSP suggests genetic susceptibility. Lack of large homogenous sample sizes have led to underpowered genetic association studies. Systems biology can be leveraged to integrate genetic-level data with biologic processes to generate prioritized candidate gene lists and understand novel biological pathways involved in acute postoperative pain and CPSP. Such data would be key to informing future polygenic studies with targeted genome wide profiling. This study demonstrates the utility of functional annotation - based prioritization and enrichment approaches and identifies novel genes and unique/shared biological processes involved in acute and chronic postoperative pain. Results provide framework for future targeted genetic profiling of CPSP risk, to enable preventive and therapeutic approaches.

Effect of local anaesthetic infiltration with bupivacaine and ropivacaine on wound healing: a placebo-controlled study

Infiltration of surgical wounds with long-acting local anaesthetics (LA) is used to reduce postoperative incisional pain. We hypothesised that infiltration with LA interferes with wound healing in rats. Seventy-two rats were allocated into nine groups. After intraperitoneal anaesthesia, the interscapular dorsal region was infiltrated with equivolumes of saline, 0·5% bupivacaine or ropivacaine, in a randomised double-blind fashion. A standardised incision was performed in the infiltrated area and sutured closed. The rats were euthanised on the 3rd or 14th day after the operation and tissue from the incision site was subjected to histochemical analyses and mechanical testing (MT). Compared with the control group, bupivacaine displayed a significant increase in the macrophage number on day 3 (+63% versus +27% for ropivacaine). The transforming growth factor β-1 expression had a significant increase in the LA (versus saline) groups, +63% in ropivacaine group and +115% in bupivacaine group on day 3 (P < 0·05). The collagen fibres as measured by dyed area were significantly higher in the bupivacaine group on day 3 (+56%, P < 0·01 versus +15% for ropivacaine). CD34 was reduced in bupivacaine group (-51%, P < 0·05 versus +3% for ropivacaine). On day 14, no statistical differences were observed in either LA group (versus saline) with respect to histopathologic or inflammatory mediators. MT on day 14 showed no differences between the LA and saline groups. The LA-induced increases in histological markers did not extend beyond the third day, suggesting that wound infiltration with long-acting LA does not impair the wound healing process in rats.