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Role of TNF-alpha in local surgical trauma-induced microvascular dysfunction
J I Yamauchi1, B Vollmar, B Wolf
1Institute for Clinical and Experimental Surgery, University of Saarland, Homburg/Saar, Germany. exjyam@med-rz.uni-sb.de
Background/Aim:
The aim of this study was to gain insight into the mechanisms of microvascular dysfunction after local surgical trauma.
Methods:
The effect of anti-tumor necrosis factor (TNF)-alpha antibody (Ab) on microvascular function, including arteriolar diameter response, nutritive perfusion, leukocyte-endothelial cell interaction and endothelial integrity disruption, was studied in hamster skinfold chamber preparations using intravital fluorescence microscopy.
Results:
Directly after the surgical procedure, arteriolar diameters were found to be markedly (p < 0.05) reduced, but recovered significantly at 8 h and reached plateau levels after 24 h. Surgical trauma further induced a strong inflammatory response characterized by a significant (p < 0.05) increase in leukocyte adherence to the endothelium of postcapillary venules. This inflammatory response was associated with an increase in microvascular permeability, indicating endothelial integrity disruption. Anti-TNF-alpha Ab had no significant effect on the surgical trauma-induced arteriolar vasomotor dysfunction; however, it effectively (p < 0.05) reduced venular leukocyte adherence and attenuated the increase in microvascular permeability.
Conclusion:
Our study indicates that arteriolar constriction, leukocyte-endothelial cell interaction and endothelial macromolecular leakage have to be considered as the characteristic microvascular response after local surgical trauma. It is conceivable that TNF-alpha plays a role in mediating the inflammatory response, but not the dysfunction of vasomotor control.