Background: Gram-negative sepsis and its sequelae frequently complicate inv
asive procedures in patients with obstructive jaundice. In response to endo
toxin, Kupffer cells secrete tumour necrosis factor (TNF), a pivotal early
mediator of sepsis. An investigation was carried out into the specific role
of Kupffer cell TNF secretion following endotoxin challenge in obstructive
jaundice.
Methods: Survival following intraperitoneal administration of endotoxin (2.
0, 0.02 and 0.0002 mg per 100 g) was determined in rats following bile duct
ligation (BDL) or sham operation. Plasma TNF concentration was quantified
following endotoxin administration (0.0002 mg per 100 g) at 1, 2 and 6 h. S
ubsequently, the effect of Kupffer cell blockade by gadolinium chloride on
survival and plasma TNF concentration was assessed.
Results: Jaundiced animals showed a significantly increased mortality rate
following intraperitoneal injection of endotoxin 2.0 mg per 100 g (BDL 100
per cent versus sham 0 per cent) and 0.02 mg per 100 g (BDL 70 per cent ver
sus sham 0 per cent; P = 0.002, Fisher's exact test). Median plasma TNF con
centration was significantly greater in jaundiced animals Ih after endotoxi
n administration (BDL 943 (interquartile range (i.q.r.) 211-3900) pg/ml ver
sus sham 64 (i.q.r. 47-127)pg/ml; P = 0.002, Mann-Whitney U test). Kupffer
cell blockade with gadolinium chloride increased the survival rate followin
g endotoxin administration in BDL animals (BDL-GdCl3 100 per cent versus BD
L-saline 40 per cent; P = 0.0003, Fisher's exact test) and decreased median
plasma levels of TNF (BDL-GdCl3 88 (i.q.r. 0-1065) pg/ml versus BDL-saline
16 550 (1255-29 360) pg/ml; P = 0.002, Mann-Whitney U test).
Conclusion: Kupffer cell blockade improved survival and suppressed systemic
TNF activity after endotoxin challenge. In obstructive jaundice, hypersecr
etion of TNF by Kupffer cells may supplement systemic cytokine production a
nd be responsible for significant complications.