INTERLEUKIN-6 AND INTERLEUKIN-10 IN CEREBROSPINAL-FLUID AFTER SEVERE TRAUMATIC BRAIN INJURY IN CHILDREN

Cytokines may play an important role in the pathophysiology of traumat ic brain injury (TBI) in children. Interleukin-6 (IL-6) is a proinflam matory cyotkine that plays a role in regenerative processes within the central nervous system (CNS), whereas interleukin-10 (IL-PO) is an an tiinflammatory cytokine. Both have been measured in serum and cerebros pinal fluid (CSF) as an index of the degree of inflammation in disease s, including sepsis and meningitis. We hypothesized that both IL-6 and IL-10 would be increased in the CSF of children after severe TBI. Fif teen children who sustained severe TBI (Glascow Coma Score [GCS] less than or equal to 7) were studied. Standard neurointensive care was pro vided. Ventricular CSF collected the first 3 days after TBI was analyz ed for IL-6 and IL-10 concentrations by ELISA. Controls were 20 childr en who were evaluated for meningitis with diagnostic lumbar puncture s ubsequently found to have no CSF pleocytosis and negative cultures. IL -6 was increased in children after TBI versus controls on all days stu died (day 1, 3158.2 +/- 621.8 pg/ml; day 2, 1111.6 +/- 337.0 pg/ml; da y 3, 826.7 +/- 193.5 pg/ml vs. 20.6 +/- 5.8 pg/ml, p < 0.0001, Mann-Wh itney Rank Sum). IL-10 was increased in children after TBI vs controls on all days studied (day 1, 47.2 +/- 12.9 pg/ml; day 2, 21.0 +/- 6.7 pg/ml; day 3, 15.5 +/- 5.9 pg/ml vs. 8.9 +/- 7.5 pg/ml, p < 0.01). Inc reased IL-10 concentrations were independently associated with age < 4 years and mortality (p = 0.004 and 0.04, respectively, multivariate l inear model). This study demonstrates that IL-6 is increased after TBI in children to levels similar to those reported in adults and is the first to show that IL-10 is increased in CSF of humans after TBI. Thes e data suggest that there may be an age-dependent production of IL-10 after TBI in children.