Serum interleukin 6 (IL-6) and C-reactive protein (CRP) levels in colorectal adenoma and cancer patients

BACKGROUND

Colorectal cancer is one of the most common cancers of the gastrointestinal tract and the fourth cause of cancer death in the world. It has been shown that local chronic inflammation may lead to colorectal carcinogenesis via adenomatous polyps. Interleukin-6 and C-reactive protein are biomarkers of inflammation and indicators of the immune response to tumors.

METHODS

Serum levels of interleukin-6, carcinoembryonic antigen and carbohydrate antigen 19-9 were determined using immunoenzymatic assays, and C-reactive protein concentrations by immunoturbidimetric kits in 76 colorectal cancer patients before surgery, in 38 colorectal adenoma patients and in 35 healthy controls.

RESULTS

Serum levels of interleukin-6, C-reactive protein and carcinoembryonic antigen were significantly higher in cancer patients when compared to adenoma patients and healthy subjects, and increased in more advanced stages of disease and in patients with non-resectable tumors. Based on Cox's analysis, the elevated preoperative serum level of C-reactive protein was an independent significant prognostic factor for patients' survival.

CONCLUSIONS

Our findings suggest the usefulness of interleukin-6 in the diagnosis of colorectal cancer patients and C-reactive protein in the survival prognosis.

Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients

BACKGROUND

Pancreatic cancer is an aggressive malignancy of the gastrointestinal tract and one of the most lethal human cancers. It has been shown that endogenous cytokines, produced aberrantly in many malignancies, including pancreatic cancer, may act as autocrine growth factors or as indicators of the immune response to tumors. Granulocyte-colony stimulating factor (G-CSF) and macrophage-colony stimulating factor (M-CSF) are hematopoietic growth factors (HGFs), i.e., cytokines that induce proliferation of hematopoietic and cancer cells.

METHODS

Serum levels of G-CSF, M-CSF, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were determined using immunoenzymatic assays in 62 patients with pancreatic cancer before and 30 days after surgery, and in 65 healthy controls.

RESULTS

Cancer patients had significantly higher levels of all parameters measured compared to healthy subjects, especially in non-resectable tumors. Higher values of diagnostic parameters [specificity, sensitivity and area under receiver operating characteristic (ROC) curve] were observed for M-CSF than G-CSF, and for combined use of M-CSF with CA 19-9. Based on Cox analysis, elevated preoperative serum M-CSF was a significant prognostic factor for patient survival, although not independent of tumor stage.

CONCLUSIONS

Our findings suggest the usefulness of M-CSF as a tumor marker for pancreatic cancer, especially in combination with CA 19-9.

Serum macrophage-colony stimulating factor levels in colorectal cancer patients correlate with lymph node metastasis and poor prognosis

BACKGROUND

Elevated serum concentrations of macrophage-colony stimulating factor (M-CSF) have been found in a variety of malignant diseases. The aim of our study was to assess correlations between serum levels of M-CSF and clinicopathological features and survival rates in patients with colorectal cancer (CRC).

PATIENTS/METHODS

M-CSF and the established tumor markers (carcinoembryonic antigen - CEA and carbohydrate antigen - CA 19-9) were investigated in the sera of 116 colorectal cancer patients and correlated with the clinical parameters of the disease and with the survival of patients. We compared M-CSF serum levels in CRC with colorectal adenoma patients. M-CSF was determined using enzyme-linked immunosorbent assay (ELISA). Tumor markers were measured by microparticle enzyme immunoassays (MEIA).

RESULTS

CRC patients had significantly higher M-CSF and tumor markers levels compared to healthy controls and colorectal adenoma patients, with a significant association between M-CSF levels, disease stage and lymph node metastasis. Serum levels of M-CSF and CEA decreased significantly after radical resection of the tumor. Moreover, the multivariate analysis showed that the serum level of M-CSF in CRC patients was an independent prognostic factor.

CONCLUSION

These findings suggest the potential clinical use of circulating M-CSF measurements, particularly in estimating prognosis for patients with CRC.

Pretreatment serum levels of hematopoietic cytokines in patients with colorectal adenomas and cancer

BACKGROUND AND AIM

Hematopoietic cytokines (HCs) regulate the proliferation and differentiation of hematopoietic progenitor cells, and it was proved that HCs can promote cancer growth. The aim of this study is to determine whether HCs might be useful in the diagnosis of colorectal cancer.

MATERIALS AND METHODS

We compared the serum levels of stem cell factor (SCF), interleukin 3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF), and macrophage colony-stimulating factor (M-CSF) in 97 colorectal cancer patients with those in 35 patients with colorectal adenomas and 65 healthy subjects (control group). Additionally, we investigated commonly accepted tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). HCs were determined using enzyme linked immunosorbent assay (ELISA). CEA and CA 19-9 were measured by microparticle enzyme immunoassay.

RESULTS

Serum levels of GM-CSF, M-CSF, and tumor markers were significantly higher in cancer patients as compared to the control group and adenomas patients. Of these, hematopoietic cytokines were found elevated in the higher proportion of patients than CEA and CA 19-9. The sensitivity of SCF was higher than the sensitivity of other cytokines, but diagnostic specificity and predictive value were highest for M-CSF. Moreover, the M-CSF area under the receiver operating characteristic curve was larger than the areas of other cytokines. The highest values of diagnostic parameters were observed for the combined use of M-CSF with CEA.

CONCLUSION

The obtained data support the M-CSF usefulness as a tumor marker for colorectal cancer, especially in combination with CEA.

[Massive bleeding from the upper digestive tract in patients with pseudoaneurysm of splenic artery]

Pancreatic pseudocysts are common complication of both chronic and acute pancreatitis. Sanguination from damaged peripancreatic vessels into the lumen of pseudocyst results in pseudoaneurysm. The rupture of pancreatic pseudoaneurysm into the lumen of digestive tract causes massive bleeding witch source is often difficult to find during endoscopic examination. We present a case of patient with chronic alcohol pancreatitis, with pancreatic pseudocyst and of acute bleeding from upper digestive tract. In the endoscopy we found gastric ulcer with visible vessel. During hospitalization we observed increase the diameter of pseudocyst and circulation of it's liquid contence. Second-look endoscopy showed gastric fundic varices. Surgical operation revealed pseudoaneurysm of splenic artery inserting pressure on gastric wall.

[The laryngological complications of the Gastroesophageal Reflux Diseases]

The aim of the study was the quantitative and qualitative assessment of the pathological reflux episodes present in laryngological diseases in relation to GERD. These findings allowed for outlining the relationship between the reported subjective ailments and the disturbances of function and acidic refluxes diagnosed in pH-metric measurements. The study included 40 patients (23 women, 17 men) with clinical laryngological symptoms of GERD (aged 19-63 years, median 42.2): chronic persistent cough, laryngitis, pharyngitis, ulceration of vocal cords, hacking. The patients underwent laryngological check-up (direct laryngoscopy), gastroscopy, 24-hour pH-metry and manometry of the oesophagus. The analysis of the subjective symptoms reported by the patients was done according to the DeMeester's and Likert's scale. The 24-hour abdominal pH-metry was carried out with the use of microDigitrappr MARK III (Synecpol) pH-meter and antymon probe with the reference epidermal electrode. The manometric analysis of the pressure in lower oesophagal sphincter (LES) and the antral function was done with the use of Köenisberg probe integrated with microDigitrapper.

RESULTS

In 80% of the patients we observed the presence of pathological acid refluxes and so called high pharyngeal refluxes (the total number of reflux episodes--91 +/- 8.2, the number of reflux episodes lasting longer than 5 minutes--19.6 +/- 4.6, "fraction time" the percentage of pH < 4.0-7.1 +/- 2.9). In this group of patients chronic laryngitis was observed in 50% of cases, chronic hacking--in 31%, persistent pain in the pharynx--in 28.1%, strong cough--in 59.4%. In 18.7% of the patients with the pathological recurrent reflux of gastro-intestinal content to the oesophagus we observed inflammatory changes of various extent in gastroscopy. We found a strong causal relationship between cough and hacking and the pathological GERD (time interval 5 min, Wiener's indicator SI > or = 75%).

CONCLUSIONS

1. The achieved results confirm the significant role of pathological GERDS in the pathogenesis of many laryngological symptoms. 2. On the basis of the achieved data it seems purposeful that the diagnosis should be much more detailed with the use of 24-hour gastroesophageal pH-metry in the patients with persistent laryngological (mainly cough and hacking) symptoms, especially in case of the patients in whom the reported symptoms are not relieved after routine laryngological treatment. 3. Our findings create the possibility for the modification of the so far diagnostic and therapeutical procedures in this group of patients and the relief of the reported subjective ailments.

Stem cell factor (SCF) and interleukin 3 (IL-3) in the sera of patients with colorectal cancer

For a long time markers that can detect a malignant cell transformation as early as possible have been sought. Substances which have been discovered are known as tumor markers. Stem cell factor (SCF) and interleukin 3 (IL-3) are members of a group of glycoprotein growth factors called hematopoietic cytokines (HCs). These factors take part in the regulation of developmental processes of hematopoietic progenitor cells and it was proved that HCs can be produced by different cancer cells, including colorectal cancer. The aim of this study was to investigate a potential role for SCF and IL-3 as tumor markers for colorectal cancer. We compared the serum levels of SCF and IL-3 in colorectal cancer patients with those in healthy subjects (control group) and commonly accepted tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). We defined the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and receiver-operating characteristics (ROC) curve of tested substances. SCF and IL-3 were determined using enzyme-linked immunosorbent assay (ELISA). CEA and CA 19-9 were measured by microparticle enzyme immunoassay. The serum levels of HCs and tumor markers were investigated in 75 patients with colorectal cancer and in 40 healthy subjects. There were significant differences in the level of circulating SCF and IL-3 in the colorectal cancer patients compared to the control group. Moreover, the diagnostic sensitivity of SCF was higher than the sensitivity of CEA and CA 19-9. The SCF area under the ROC curve was larger than the IL-3 area but smaller than the CEA and CA 19-9 areas. The diagnostic specificities of cytokines were lower than those of tumor markers, but the combined use of cytokines and tumor markers increased the diagnostic values. The highest values of diagnostic parameters were observed for the combined use of SCF and CA 19-9. These results suggest a potential role for SCF and IL-3 as tumor markers for colorectal cancer, especially in combination with CEA or CA 19-9.

Hematopoietic cytokines in the sera of patients with pancreatic cancer

Hematopoietic cytokines (HCs) can affect the growth and spread of cancer. Therefore, in the present study, we investigated in pancreatic cancer patients the serum levels of selected HCs, such as stem cell factor (SCF), interleukin 3 (IL-3), granulocyte-macrophage-colony stimulating factor (GM-CSF), granulocyte-colony stimulating factor (G-CSF) and macrophage-colony stimulating factor (M-CSF) in relation to a control group and to a group of patients with chronic pancreatitis. Classical tumor markers such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) were also tested. We compared the serum level of cytokines with the tumor stage. The diagnostic sensitivity, specificity, positive and negative predictive values and receiver-operating characteristics (ROC) curve for cytokines and classical tumor markers were defined. The cytokines were measured in 48 patients with pancreatic cancer, in 23 patients with chronic pancreatitis and in 40 healthy subjects. HCs were determined using ELISA. CEA and CA 19-9 were measured by microparticle enzyme immunoassay. There were significant differences in the levels of circulating SCF, IL-3, GM-CSF, M-CSF, CEA and CA 19-9 in the pancreatic cancer patients compared to the control group. The serum levels of M-CSF and tumor markers were significantly higher in pancreatic cancer patients compared to the pancreatitis group. The levels of SCF, M-CSF and tumor markers were higher in patients with a more advanced tumor stage. The M-CSF serum levels in the pancreatitis group correlated positively with the tumor markers tested – CEA and CA 19-9. The diagnostic sensitivity of SCF and specificity of M-CSF and tumor markers were the highest. The SCF and M-CSF areas under the ROC curve were greater than the areas for other cytokines. These results suggest the potential usefulness of HCs in pancreatic cancer detection; however, further investigations of early-stage pancreatic cancer patients and confirmation by a prospective study are necessary.

Diagnostic value of pancreatic elastase-1 in human acute pancreatitis

The diagnosis of acute pancreatitis (AP) is usually confirmed by a significant increase of the serum amylase and/or lipase level. However, serum pancreatic elastase-1 (pEla-1) was found to be a more sensitive diagnostic marker in AP, when assayed by the radioimmunoassay procedure. We analyzed the serum concentration of pEla-1, measured by the ELISA technique in 46 patients with AP and in a control group of 12 healthy volunteers. On admission (day 1) we found significantly higher pEla-1 levels in patients with AP than in the controls. During the following days, the concentration of pEla-1 rapidly decreased to nearly undetectable values on the 3rd day. There was no significant difference between patients with mild and severe AP nor those of different etiology. We suggest that pEla-1 has little diagnostic value and does not provide additional information to that of the less expensive and more widely available serum amylase and lipase.

[Interleukin 18 as a new immunomodulator of some digestive tract diseases]

Interleukin 18 has been known since 1989 and since its properties have been recognized, an interest in it is constantly growing. IL-18 induces synthesis and release of proinflammatory cytokines, chemokines and nitric oxide. Thus, it modulates the function of many immunocompetent cells: macrophages, monocytes, lymphocytes and granulocytes. In the paper, properties of IL-18 are reviewed and its implications for pathogenesis of some gastrointestinal diseases, particularly inflammatory bowel diseases, i.e. Crohn Disease and colitis ulcerosa, inflammatory liver diseases such as persistent active hepatitis and primary biliary cirrhosis and acute pancreatitis are discussed.

[Biological properties of interleukin 18]

IL-18 was first described in 1989 and since its properties have been recognized, an interest in it is constantly growing. IL-18 induces synthesis and release of interferon gamma (IFN-gamma), interleukins 8, 4 and 13, tumor necrosis factor alpha (TNF-alpha) and granulocyte/macrophage colony stimulating factor (GM-CSF). Thus, it modulates the function of many immunocompetent cells: macrophages, monocytes, lymphocytes and granulocytes. Another important feature of IL-18 is its ability to induce apoptosis of many cell types by inducing Fas ligand and Fas receptor, and granzymes. IL-18 seems to be particularly attractive as a highly specific marker of Th1-response and a potential element of complex antitumor therapy. In paper, the processes of synthesis, releasing and biological properties of IL-18 are reviewed, particularly in the aspects of immunomodulatory and antitumor activity.

Soluble selectin profiles associated with severe trauma

Severe trauma acts as a trigger for the complex cascade of postinjury events leading to the release of different mediators and the development of generalized inflammation. Selectins are a family of adhesion proteins that are responsible for the adherence of polymorphonuclear neutrophils to the endothelium. This interaction plays an important role in the development of severe complications after multiple trauma. The aim of the present study is to follow the sequential alterations in circulating selectin levels after severe injury and to evaluate the clinical significance of these mediators in monitoring prognosis and outcome. Thirty four severely traumatized patients were entered into the study. Serum sE-selectin, plasma sP-selectin and sL-selectin concentrations were measured and an APACHE II score was calculated on admission to the intensive care unit and during the subsequent 5 days. The patients were divided into survivors and nonsurvivors. Initial soluble P- and E-selectin concentrations were significantly elevated in all trauma patients. The highest values of these adhesion molecules were measured in all the observed days in patients with poor prognosis and outcome. In survivors we found a systematic decrease in the sP-selectin concentrations. On admission, the sL-selectin concentrations in all trauma patients were decreased. There were stable, very low values in nonsurvivors and a slow increase in circulating L-selectin in patients who survived. The pattern of soluble selectins in patients with severe trauma is characterized by increased levels of P- and E-selectin and a decreased concentration of L-selectin. These findings suggest a widespread microvascular endothelial activation on injury in the early posttraumatic period, which may be associated with increased neutrophil-endothelial adhesion, neutrophil extravasation and migration. We suppose that these parameters of endothelial cell activation/injury may be useful as another early prognostic factor in severe trauma.

[Effect of severe multiple trauma complicated by acute lung injury on endothelial cell activity]

The pulmonary endothelium synthesizes many bioactive compounds and their activation or injury may cause release these substances into the blood. We determined the influence of trauma severity for endothelium activation/injury by measurement of specific endothelial cell markers--soluble E-selectin (sES) and von Willebrand factor antigen (vWF:Ag). Thirty six severely traumatized patients were stratified according to an Injury Severity Score (ISS). Group I--patients with ISS > or = 35, Group II--patients with ISS < 35. Eleven healthy volunteers served as controls. Serum sES and plasma vWF:Ag concentrations were measured and PaO2/FiO2 ratio, Lung Injury Score (LIS) and APACHE II ratio were calculated at the admission to IC, after 24 h and on 2, 3, 5, 7, 10th day. In all investigated time periods, we observed significant increase in serum sES concentration among patients from group I, in comparison to initial value and control. On day 3, serum sES concentration was significantly increased in group I, in comparison to group II. In the first seven days, plasma vWF:Ag concentration in patients with severe multiple trauma (ISS > or = 35) was significantly elevated, in comparison to group II and control. At the admission, significant correlation between plasma vWF:Ag and ISS was found (Rs = 0.568, p < 0.001). Significant correlation between plasma vWF:Ag and serum sES concentration was also observed (Rs = 0.501, p < 0.001). In conclusion, severe trauma patients manifest endothelial cell activation/injury. Plasma vWF:Ag concentration seems to be an important, early marker of trauma severity, while serum sE-selectin level may serve as prognostic factor in immediate postinjury period course.

[Acute pancreatitis complicated by pancreatic ascites. Diagnostic and therapeutic difficulties]

The authors report a case of acute pancreatitis, complicated by pancreatic-peritoneal fistula and ascites in 26 year old man, with a history of excessive alcoholic intake. Biochemical investigation of ascitic and pleural fluids, which revealed markedly elevated activity of pancreatic enzymes and protein indicated their pancreatic origin. After 25 days of treatment with somatostatin and parenteral nutrition, the condition of the patient improved and he was dismissed home.

Oxygen-derived free radicals in cerulein-induced acute pancreatitis

Conscious rats were treated with a supramaximal dose of 5.10(-6)g.kg-1.h-1 of cerulein for periods of 3 and 12 h. In both groups of animals typical features of acute oedematous pancreatitis were proved by biochemical and histologic examinations. The most important finding of our study was the decrease of superoxide dismutase (SOD) activity in pancreatic tissue, accompanied by a slight increase of this scavenger enzyme in serum of rats stimulated with cerulein during 3 h. Parallelly, evident elevation of malondialdehyde (MDA) concentration in pancreatic tissue was noted. After the 12-h infusion of cerulein we were not able to detect any SOD activity in pancreatic tissue, whereas this activity appeared in ascitic fluid of tested animals. Further increase of MDA concentration in pancreatic tissue, in comparison with 3-h pancreatitis, was found. These data suggest that in 3-h and 12-h cerulein-induced pancreatitis the oxygen-derived free radicals mediate the increased lipid peroxidation in pancreatic tissue. We think that the depletion of the scavenger enzyme SOD may be responsible for such a disturbance of lipid metabolism.

Influence of buprenorphine on acute experimental pancreatitis

Buprenorphine (15 micrograms/kg b.wt. per hour) distinctly reduced pain sensitivity in acute 3% sodium-taurocholate pancreatitis in male Wistar rats without interfering with the course of the disease. This was seen by assessment of enzyme elevation in serum and ascites and by histological evaluation of the pancreas. Buprenorphine is therefore recommended for animal experiments to study the effect of therapeutic principles in acute pancreatitis.

Subcutaneous administration of the synthetic trypsin inhibitor Foy-305 induces hypertrophy of the exocrine pancreas

The serine protease inhibitor camostate (Foy-305; 200 mg/kg body weight) had been administered twice daily either subcutaneously or orally to mice for 5, 10 and 15 days. Within 5 days, pancreatic weight, concentration of trypsin, amylase and protein were significantly increased and even more increased after 10 and 15 days. This effect is less pronounced after subcutaneous administration in comparison to oral treatment.