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1 Centre of Inflammation and Metabolism, Department of Infectious Diseases., Rigshospitalet, Copenhagen 2100, Denmark
2 Copenhagen, Denmark; Centre of Inflammation and Metabolism, Department of Infectious Diseases., Rigshospitalet, Copenhagen 2100, Denmark
3 Centre of Inflammation and Metabolism, Department of Infectious Diseases., Rigshospitalet, Copenhagen 2100, Denmark; Intensive care unit, 4131, Rigshospitalet, Copenhagen, Denmark
4 Medical Department M (Diabetes and Endocrinology), Aarhus Kommunehospitalet, 8000 Aarhus C, Denmark
* To whom correspondence should be addressed. E-mail: krogh-madsen{at}inflammation-metabolism.dk.
Introduction: Novel anti-inflammatory effects of insulin have recently been described and insulin therapy to maintain euglycemia suppresses the plasma levels of free fatty acids (FFA) and increases the survival of critically ill patients. We aimed to explore the effect of short-term high levels of plasma FFA on the inflammatory response to a low dose of endotoxin. Methods: Fourteen healthy male volunteers underwent the following two trials in a randomized crossover design: A) continuous infusion of 20% Intralipid (0.7 ml/kg/h (1.54 g/kg)) for 11 hours and B) infusion of isotonic saline for 11 hours (Control). In each trial, heparin was given to activate LPL, and an intravenous bolus of endotoxin (0.1 ng/kg) was given after 6 hours of Intralipid/saline infusion. Blood samples, and muscle and fat biopsies were obtained before the Intralipid/saline infusion, and before as well as following infusion of an endotoxin bolus. Results: Plasma levels of FFA, triglycerides (TG), and glycerol were markedly increased during the Intralipid infusion. Endotoxin exposure induced an increase in plasma levels of TNF-alpha (TNF), interleukin (IL)-6, and neutrophils and further stimulated gene expression of TNF and IL-6 in both skeletal muscle and adipose tissue. The systemic inflammatory response to endotoxin was significantly pronounced during Intralipid infusion. Conclusion: Short-term hyperlipidemia enhances the inflammatory response to endotoxin, and skeletal muscle and adipose tissue are capable of producing essential inflammatory mediators after endotoxin stimulation.
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