Reduced serum cholinesterase activity indicates splenic modulation of the sterile inflammation
Background - Sterile inflammation is an immediate and well-coordinated immune response to surgical injury. The cholinergic system plays a pivotal role in the inflammatory response. Induced inflammation stimulates the vagus nerve, which in turn activates anti-inflammatory nonneuronal processes. Serum...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
17 August 2017
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| In: |
Journal of surgical research
Year: 2017, Volume: 220, Pages: 275-283 |
| ISSN: | 1095-8673 |
| DOI: | 10.1016/j.jss.2017.07.024 |
| Online Access: | Verlag, Volltext: http://dx.doi.org/10.1016/j.jss.2017.07.024 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0022480417304961 
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| Author Notes: | Aleksandar R. Zivkovic, MD, Kevin M. Tourelle, Thorsten Brenner, MD, Markus A. Weigand, MD, Stefan Hofer, MD, and Karsten Schmidt, MD |
| Summary: | Background - Sterile inflammation is an immediate and well-coordinated immune response to surgical injury. The cholinergic system plays a pivotal role in the inflammatory response. Induced inflammation stimulates the vagus nerve, which in turn activates anti-inflammatory nonneuronal processes. Serum cholinesterase (butyrylcholinesterase [BChE]) is an enzyme that hydrolyzes acetylcholine. Measuring the activity of the BChE in blood might indicate the level of the nonneuronal cholinergic activity. The spleen is a major organ of the immune system playing an important role during inflammation. A functional connection of the neuroimmune reflex has thus far been described only in experimental settings. - Materials and methods - In 48 patients receiving major pancreatic surgery, BChE activity was measured by applying point-of-care-testing, in addition to standard laboratory tests. - Results - The BChE activity decreased in patients receiving surgery. This reduction emerged much earlier than changes in C-reactive protein concentration, an inflammatory biomarker broadly used in the clinical environment. A milder reduction in the BChE activity was observed in patients subjected to surgery with splenectomy than in those with a preserved spleen. - Conclusions - The use of the point-of-care-testing system for quick bedside diagnostics and the rapid effects of inflammation on BChE levels provide a method and a marker to facilitate the early detection of systemic inflammation. Furthermore, this study provides evidence that the experimentally documented neuroimmune interaction is part of the physiological response to surgery-induced sterile inflammation. Splenic function plays an essential role in modulating the cholinergic anti-inflammatory response. |
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| Item Description: | Gesehen am 21.08.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1095-8673 |
| DOI: | 10.1016/j.jss.2017.07.024 |