Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage

Background-Obstructive jaundice is associated with postoperative complicati ons related to increased endotoxaemia and the inflammatory response. In ani mals obstructive jaundice is associated with endotoxaemia and cytokine indu ction, which are reversed by internal biliary drainage. Aims-To study endotoxaemia and the subsequent inflammatory response in obst ructive jaundiced patients and after endoscopic biliary drainage. Methods-In 15 patients with malignant distal obstructive jaundice, inflamma tory and bacteriological parameters were assessed before endoscopic stent p lacement and after three weeks endoscopic drainage. Results-Drainage reduced bilirubin from 252.5 to 45.1 mu mol/l. At baseline low level endotoxaemia was detected (4.3 pg/ml) which was not affected aft er drainage (4.5 pg/ml). Serum interleukin 8 (IL-8) and endotoxin binding p roteins were increased in jaundice and reduced after drainage (IL-8 113.6 t o 20.7 pg/ml; lipopolysaccharide binding protein 24.2 to 16.5 mu g/ml; sCD1 4 17.4 to 7.6 mu g/ml; bactericidal/permeability increasing protein 2.9 to 1.8 ng/ml). Levels of other cytokines, augmented in animals, were only slig htly increased and not changed after drainage (tumour necrosis factor (TNF) : 21.7 and 18.4 pg/ml; sTNFr p55/75: 2.9/7.0 and 2.7/5.6 ng/ml; IL-6: 4.2 a nd 6.1 pg/ml; IL-10: 4.5 and 2.7 pg/ml). Elastase and lactoferrin tended to wards reduction after drainage. All bile cultures were positive after stent ing. Conclusions-The effects of obstructive jaundice in humans on endotoxin and cytokines are different from those in animal models. Obstructive jaundice c auses alterations in circulating endotoxin binding proteins and IL-8. Conce ntrations of other mediators (TNF, previously suggested as being responsibl e for systemic endotoxaemia effects) are low and not affected by drainage.