Dosage and Timing of Anti-TNF-α Antibody Treatment Determine Its Effect on Resistance to Sepsis after Injury

Antibody against tumor necrosis factor-α (TNF-α) has improved survival in certain models of sepsis, but it remains unproven in clinical studies. In most of the successful animal studies, efficacy has been shown in previously healthy animals subjected to a septic challenge. Patients at risk for sepsi...

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Veröffentlicht in:The Journal of surgical research 1996-07, Vol.64 (1), p.95-101
Hauptverfasser: O'Riordain, Michael G., O'Riordain, Diarmuid S., Molloy, Richard G., Mannick, John A., Rodrick, Mary L.
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container_issue 1
container_start_page 95
container_title The Journal of surgical research
container_volume 64
creator O'Riordain, Michael G.
O'Riordain, Diarmuid S.
Molloy, Richard G.
Mannick, John A.
Rodrick, Mary L.
description Antibody against tumor necrosis factor-α (TNF-α) has improved survival in certain models of sepsis, but it remains unproven in clinical studies. In most of the successful animal studies, efficacy has been shown in previously healthy animals subjected to a septic challenge. Patients at risk for sepsis, however, may be ill for some time before the sepsis supervenes. This situation has been described as a “two-hit” model of critical illness. We have developed an animal burn–sepsis model which conforms to this “two-hit” concept. We have quantified macrophage TNF-α production at different times after the burn (first “hit”) and determined the effect of neutralizing antibody against TNF-α during this period on survival after subsequent sepsis (second “hit”). The objective of this study was to determine the role of TNF-α and the effect of neutralizing antibody against TNF-α in a burn–sepsis model. Animals were subjected to a full thickness burn or sham burn.In vitroTNF-α production from cultured lipopolysaccharide-stimulated splenic adherent cells was determined at various time points thereafter by enzyme-linked immunosorbent assay. Separate animals were treated with neutralizing antibody against TNF-α at different time points after the thermal injury, and survival was determined after septic challenge (cecal ligation and puncture) on Day 10 after the burn. TNF-α production from adherent splenocytes was not elevated in the early days after thermal injury, but was significantly enhanced from Day 6 onward compared with sham-burned animals. Nine percent of the burned mice survived septic challenge compared with 69% of the sham-burned control mice (P< 0.001). Therapy with anti-TNF antibody at 1 × 104neutralizing units (n.u.) kg−1markedly improved outcome if given when TNF-α production was elevated at Day 7 after the burn (survival, 36%;P= 0.01) but did not improve survival when administered at Days 0 or 4 or at the time of the septic challenge (Day 10). High doses of antibody (3.2 × 105n.u.kg−1) were not beneficial and may have been detrimental. These results show that neutralizing antibody against TNF-α may reduce the susceptibility to infection seen after thermal injury, but the timing of administration of the antibody and the dose of antibody used are critical to the outcome. This should be considered when neutralizing antibody against TNF is used in the clinical setting.
doi_str_mv 10.1006/jsre.1996.0312
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In most of the successful animal studies, efficacy has been shown in previously healthy animals subjected to a septic challenge. Patients at risk for sepsis, however, may be ill for some time before the sepsis supervenes. This situation has been described as a “two-hit” model of critical illness. We have developed an animal burn–sepsis model which conforms to this “two-hit” concept. We have quantified macrophage TNF-α production at different times after the burn (first “hit”) and determined the effect of neutralizing antibody against TNF-α during this period on survival after subsequent sepsis (second “hit”). The objective of this study was to determine the role of TNF-α and the effect of neutralizing antibody against TNF-α in a burn–sepsis model. Animals were subjected to a full thickness burn or sham burn.In vitroTNF-α production from cultured lipopolysaccharide-stimulated splenic adherent cells was determined at various time points thereafter by enzyme-linked immunosorbent assay. Separate animals were treated with neutralizing antibody against TNF-α at different time points after the thermal injury, and survival was determined after septic challenge (cecal ligation and puncture) on Day 10 after the burn. TNF-α production from adherent splenocytes was not elevated in the early days after thermal injury, but was significantly enhanced from Day 6 onward compared with sham-burned animals. Nine percent of the burned mice survived septic challenge compared with 69% of the sham-burned control mice (P&lt; 0.001). Therapy with anti-TNF antibody at 1 × 104neutralizing units (n.u.) kg−1markedly improved outcome if given when TNF-α production was elevated at Day 7 after the burn (survival, 36%;P= 0.01) but did not improve survival when administered at Days 0 or 4 or at the time of the septic challenge (Day 10). High doses of antibody (3.2 × 105n.u.kg−1) were not beneficial and may have been detrimental. 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Separate animals were treated with neutralizing antibody against TNF-α at different time points after the thermal injury, and survival was determined after septic challenge (cecal ligation and puncture) on Day 10 after the burn. TNF-α production from adherent splenocytes was not elevated in the early days after thermal injury, but was significantly enhanced from Day 6 onward compared with sham-burned animals. Nine percent of the burned mice survived septic challenge compared with 69% of the sham-burned control mice (P&lt; 0.001). Therapy with anti-TNF antibody at 1 × 104neutralizing units (n.u.) kg−1markedly improved outcome if given when TNF-α production was elevated at Day 7 after the burn (survival, 36%;P= 0.01) but did not improve survival when administered at Days 0 or 4 or at the time of the septic challenge (Day 10). High doses of antibody (3.2 × 105n.u.kg−1) were not beneficial and may have been detrimental. 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In most of the successful animal studies, efficacy has been shown in previously healthy animals subjected to a septic challenge. Patients at risk for sepsis, however, may be ill for some time before the sepsis supervenes. This situation has been described as a “two-hit” model of critical illness. We have developed an animal burn–sepsis model which conforms to this “two-hit” concept. We have quantified macrophage TNF-α production at different times after the burn (first “hit”) and determined the effect of neutralizing antibody against TNF-α during this period on survival after subsequent sepsis (second “hit”). The objective of this study was to determine the role of TNF-α and the effect of neutralizing antibody against TNF-α in a burn–sepsis model. Animals were subjected to a full thickness burn or sham burn.In vitroTNF-α production from cultured lipopolysaccharide-stimulated splenic adherent cells was determined at various time points thereafter by enzyme-linked immunosorbent assay. Separate animals were treated with neutralizing antibody against TNF-α at different time points after the thermal injury, and survival was determined after septic challenge (cecal ligation and puncture) on Day 10 after the burn. TNF-α production from adherent splenocytes was not elevated in the early days after thermal injury, but was significantly enhanced from Day 6 onward compared with sham-burned animals. Nine percent of the burned mice survived septic challenge compared with 69% of the sham-burned control mice (P&lt; 0.001). Therapy with anti-TNF antibody at 1 × 104neutralizing units (n.u.) kg−1markedly improved outcome if given when TNF-α production was elevated at Day 7 after the burn (survival, 36%;P= 0.01) but did not improve survival when administered at Days 0 or 4 or at the time of the septic challenge (Day 10). High doses of antibody (3.2 × 105n.u.kg−1) were not beneficial and may have been detrimental. These results show that neutralizing antibody against TNF-α may reduce the susceptibility to infection seen after thermal injury, but the timing of administration of the antibody and the dose of antibody used are critical to the outcome. This should be considered when neutralizing antibody against TNF is used in the clinical setting.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>8806480</pmid><doi>10.1006/jsre.1996.0312</doi><tpages>7</tpages></addata></record>
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subjects Animals
Antibodies - therapeutic use
Burns - complications
Burns - metabolism
Burns - therapy
Cell Adhesion
Cytokines - metabolism
Cytokines - physiology
Disease Susceptibility
Dose-Response Relationship, Drug
Immunotherapy
Infection - complications
Infection - mortality
Infection - therapy
Inflammation Mediators - metabolism
Macrophages - metabolism
Macrophages - physiology
Male
Mice
Mice, Inbred Strains
Survival Analysis
Time Factors
Tumor Necrosis Factor-alpha - immunology
title Dosage and Timing of Anti-TNF-α Antibody Treatment Determine Its Effect on Resistance to Sepsis after Injury
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