Published online Jul 7, 2013. doi: 10.3748/wjg.v19.i25.4001
Revised: March 27, 2013
Accepted: April 10, 2013
Published online: July 7, 2013
Processing time: 140 Days and 12 Hours
AIM: To measure a broad profile of pro- and anti-inflammatory cytokines in patients with clinically proven chronic pancreatitis (CP) taking either antioxidant therapy or placebo as part of the larger ANTICIPATE study.
METHODS: Patients with chronic pancreatitis were recruited to the ANTICIPATE study following informed consent and were randomised to intervention with either antox version 1.2-based antioxidant therapy or placebo. After a separate ethics committee amendment a subgroup of 7 patients from either arm of the study were selected for additional analysis of cytokines. Cytokines were measured at baseline and after 6 mo of either antox therapy or placebo by biochip array and enzyme-linked immunosorbent assay.
RESULTS: Antioxidant therapy and placebo groups were well-matched in terms of age, gender, aetiology of CP, opiate use and disease duration. Baseline antioxidant levels were similar in patients allocated to the antioxidant group as compared to the group allocated to placebo. After 6 mo of antioxidant therapy there was significant elevation in vitamin C levels in the intervention group: 17.6 μg/mL (12.8-29.3 μg/mL) compared to 4.8 μg/mL (1.6-9.1 μg/mL) in placebo (P < 0.001; 95%CI: 9.0-20.2) with similar trends in selenium levels. There was no elevation in a broad array of pro- and anti-inflammatory cytokines in the antioxidant group compared to placebo [interleukin (IL)-1B, IL-4, IL-6, IL-10, tumor necrosis factor-α] either at baseline or after 6 mo of antioxidant therapy.
CONCLUSION: Cytokine levels were low at baseline and at 6 mo despite a significant elevation in plasma antioxidants. In patients with CP, with opiate-dependent abdominal pain, circulating cytokine levels are low suggesting that pain in this disease is not simply a manifestation of inflammation.
Core tip: This study examines cytokine levels in a sub-set of patients recruited from within the ANTICIPATE randomized controlled trial of antox for painful chronic pancreatitis. At baseline, pro- and anti-inflammatory cytokine levels were within the laboratory reference range in patients allocated to the antioxidant arm and those allocated to placebo. After 6 mo of intervention with antox, there was a significant elevation in antioxidant levels in patients in the active treatment arm. This was not associated with any change in either pro- or anti-inflammatory cytokine levels. In patients with chronic pancreatitis, with opiate-dependent abdominal pain, circulating cytokine levels are low suggesting that pain in this disease is not simply a manifestation of inflammation.