BILIARY INTERLEUKIN-6 AND TUMOR-NECROSIS-FACTOR-ALPHA IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Cytokines are low-molecular-weight protein mediators that possess a wi de spectrum of inflammatory, metabolic, and immunomodulatory propertie s. Cytokines have been shown to be produced by monocytes/macrophages, Lymphocytes, fibroblasts, endothelial cells, and more recently, hepato cytes and biliary epithelium The aim of this study was to define bilia ry levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF -alpha) in patients undergoing endoscopic retrograde cholangiopancreat ography (ERCP) in various disease states. Fifty-four patients undergoi ng ERCP comprised the study group, IL-6 and TNF-alpha were measured in aspirated bile using an ELISA technique. Levels of both TNF-alpha and IL-6 were significantly higher in patients with cholangitis (P < 0.00 001). Moreover, IL-6 was 100% specific for cholangitis sind none of th e patients without bacterial cholangitis-including patients with bilia ry obstruction secondary to cholangiocarcinoma or pancreatic carcinoma -had measurable IL-6 in their bile. Low-levels of biliary TNF-alpha we re detectable in five patients without cholangitis: the sensitivity an d specificity of TNF-alpha for cholangitis were 100% and 82%, respecti vely. There was a strong statistical correlation between biliary IL-6 and TNF-alpha levels (r = 0.819, P < 0.0001). In contrast, the correla tions between biliary cytokines and serum biochemical parameters were weak. These results suggest that IL-6 and TNF-alpha are sensitive mark ers for cholangitis and may differentiate it from other types of bilia ry tract disease.