A. Catania et al., Plasma concentrations and anti-L-cytokine effects of alpha-melanocyte stimulating hormone in septic patients, CRIT CARE M, 28(5), 2000, pp. 1403-1407
Objectives: The aim of this research was to investigate endogenous concentr
ations and anti-cytokine effects of the antiinflammatory peptide alpha-mela
nocyte stimulating hormone (alpha-MSH) in patients with systemic inflammati
on. The objectives were to determine the following: changes over time of pl
asma alpha-MSH and relationship with patient outcome, correlation between p
lasma alpha-MSH and tumor necrosis factor (TNF)-alpha plasma concentration
and production in whole blood samples, and influences of alpha-MSH on produ
ction of TNF-alpha and interleukin (II)-1 beta in whole blood samples stimu
lated with lipopolysaccharide (LPs).
Design: Prospective, nonrandomized, clinical study.
Setting: Intensive care unit of a university hospital.
Patients: A total of 21 patients with sepsis syndrome/septic shock and an e
qual number of healthy volunteers.
Interventions: Circulating alpha-MSH and TNF-alpha concentrations and TNF-a
lpha production in supernatants of LPS (1 ng/ml)-stimulated whole blood wer
e measured repeatedly. To determine whether alpha-MSH can modulate producti
on of TNF-alpha and IL-1 beta, these cytokines were measured in whole blood
samples stimulated with LPS (1 ng/ml) in the presence or absence of concen
trations of the peptide.
Measurements and Main Results: Plasma alpha-MSH was low in early samples an
d gradually increased in patients who recovered but not in those who died.
There was a negative correlation between plasma concentrations of alpha-MSH
and TNF-alpha. In blood samples taken at early phases of sepsis syndrome,
production of TNF-alpha was reduced relative to control values; such produc
tion increased in patients who recovered but not in those who died. Additio
n of alpha-MSH to LPS-stimulated whole blood samples inhibited production o
f TNF-alpha and II-1 beta in a concentration-dependent manner.
Conclusions: In patients with systemic inflammation, there are substantial
changes over time in plasma concentrations of alpha-MSH that are reduced in
early phases of the disease. Reduction of this endogenous modulator of inf
lammation could be detrimental to the host. Addition of alpha-MSH to LPS-st
imulated blood samples reduces production of cytokines involved in developm
ent of septic syndrome. This inhibition by alpha-MSH, a peptide that is ben
eficial in treatment of experimental models of sepsis, might therefore be u
seful to treat sepsis syndrome in humans.