Initiale TNF-alpha und IL-8 mRNA-Expression in Monozyten und neurologischer Verlauf bei Patienten mit schwerem Schädel-Hirn-Trauma

Abstract

Early intracellular mRNA expression of cytokines is preceeding systemic inflammatory response syndrome (SIRS) after severe traumatic brain injury (TBI). The objective of this pilot study was to evaluate ex vivo quantitative TNF-alpha and IL-8 mRNA expression profile of monocytes in patients with isolated severe TBI (GCS score ≤ 8 points, positive cerebral computed tomography [CCT]; short-term neurological recovery < 30 days). Eleven patients (GCS score 5 ± 2) were enrolled immediately after CCT. Blood samples were drawn on admission (A) and 6, 12, 24, 48 and 72 h after trauma. Monocyte separation by anti-CD14 coated magnetic beads was followed by mRNA isolation. Quantitative TNF-alpha and IL-8 mRNA expression were determined using RTPCR and normalized on HPRT mRNA-expression. Patients with bad neurological recovery (n = 7) showed slightly increasing TNF-alpha as well as increasing IL-8 ratios after a transient decrease within 12 hours. In patients with good neurological recovery (n = 4), TNF-alpha and IL-8 ratios decreased significantly during the 72 h observation period. In monocytes of severe TBI patients with good neurological recovery, ex vivo TNF-alpha and IL-8 mRNA expressions were clearly decreased within 72 h after trauma. In contrast, increased TNF-alpha as well as two-step IL-8 mRNA expression might indicate an ongoing intracellular activation after primary severe TBI.