Research Reports - Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury
Springerplus. 2014 Feb 18;3:98
Wahlström MR(1), Olivecrona M(2), Ahlm C(3), Bengtsson A(4), Koskinen LO(2), Naredi S(1), Hultin M(1)
OBJECTIVE AND DESIGN: A prospective, randomised, double-blinded, clinical trial
was performed at a level 1 trauma centre to determine if a prostacyclin analogue,
epoprostenol (Flolan®), could attenuate systemic inflammatory response in
patients with severe traumatic brain injury (TBI).
SUBJECTS: 46 patients with severe TBI, randomised to epoprostenol (n = 23) or
placebo (n = 23).
TREATMENT: Epoprostenol, 0.5 ng · kg(-1) · min(-1), or placebo (saline) was given
intravenously for 72 hours and then tapered off over the next 24 hours.
METHODS: Interleukin-6 (IL-6), interleukin-8 (IL-8), soluble intracellular
adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and asymmetric
dimethylarginine (ADMA) levels were measured over five days. Measurements were
made at 24 h intervals ≤24 h after TBI to 97-120 h after TBI.
RESULTS: A significantly lower CRP level was detected in the epoprostenol group
compared to the placebo group within 73-96 h (p = 0.04) and within 97-120 h
(p = 0.008) after trauma. IL-6 within 73-96 h after TBI was significantly lower
in the epoprostenol group compared to the placebo group (p = 0.04). ADMA was
significantly increased within 49-72 h and remained elevated, but there was no
effect of epoprostenol on ADMA levels. No significant differences between the
epoprostenol and placebo groups were detected for IL-8 or sICAM-1.
CONCLUSIONS: Administration of the prostacyclin analogue epoprostenol
significantly decreased CRP and, to some extent, IL-6 levels in patients with
severe TBI compared to placebo. These findings indicate an interesting option for
treatment of TBI and warrants future larger studies.