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Changes in the interleukin-6/soluble interleukin-6 receptor axis in meningococcal septic shock
Nazima Pathan1, E John Williams, E Emanuelle Oragui
1Department of Paediatrics, Imperial College School of Medicine, St. Mary's Hospital, London, UK.
Objective:
Interleukin-6 is strongly associated with disease severity and outcome in meningococcal septicemia. It is known that interleukin-6 exerts many of its effects via the soluble interleukin-6 receptor. By facilitating the activity of interleukin-6, it is likely that alterations in the levels of soluble interleukin-6 receptor in septic shock could affect the severity of disease. We aimed to investigate changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcal septicemia and the relationship with disease severity.
Design:
Laboratory investigation of interleukin-6 and soluble interleukin-6 receptor levels in children with meningococcal disease.
Setting:
University hospital and laboratories.
Subjects:
Children with severe meningococcal disease requiring intensive care.
Interventions:
Blood samples obtained on admission to the intensive care unit were analyzed for interleukin-6 and soluble interleukin-6 receptor levels. Levels were also serially measured for up to 48 hrs in a subset of patients.
Measurements And Main Results:
Cytokine levels were measured by enzyme-linked immunosorbent assay using mouse monoclonal antihuman antibodies. Acute meningococcemia is associated with a reduction in soluble interleukin-6 receptor levels in proportion to disease severity and is inversely related to interleukin-6 levels. Soluble interleukin-6 receptor returns to levels seen in normal donors following recovery from meningococcal septicemia.
Conclusions:
Changes in the levels of interleukin-6 and soluble interleukin-6 receptor in acute meningococcemia may affect the severity and progression of multiple organ failure. Interventions to modulate this axis may improve outcome from meningococcal septic shock.
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