Acute Inflammation and Metabolism
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REVIEW
Acute Inflammation and Metabolism Miguel Lourenço Varela,1,2,3 Mihail Mogildea,1 Ignacio Moreno,1 and Ana Lopes1
Inflammation is an adaptive process to the noxious stimuli that the human body is constantly exposed to. From the local inflammatory response to a full-blown systemic inflammation, a wide complex sequence of events occurs. Persistent immunosuppression and catabolism may ensue, until multiple organ failure finally sets in. And since clinically useful and specific biomarkers are lacking, diagnosis may come late. A thorough understanding of these events (how they begin, how they evolve, and how to modulate them) is imperative, but as yet poorly studied. This review aims to consolidate current knowledge of these events so that the management of these patients is not only evidence-based, but also built on an understanding of the inner workings of the human body in health and in disease.
Abstract—
KEY WORDS: inflammation; metabolic stress; systemic inflammatory response syndrome; multiple organ dysfunction syndrome; CARS; PICS.
The human body is exposed constantly to external noxious stimuli. Throughout its evolutionary process, it has developed multiple mechanisms to detect, respond to, and repair with the aim of maintaining homeostasis. Inflammation is the adaptive response to those stimuli, whether it is imparted by infection, trauma, surgery, burns, ischemia, or necrotic tissue. It is not an all-or-nothing process; hence, the term Bpara-inflammation^ is used to describe the cellular state between tissue homeostasis and a full-blown inflammatory response [1, 2]. Inflammation exerts important effects on metabolic and neuroendocrine functions, much of which are yet to the fully elucidated. Consequently, there are many potential implications waiting to be clinically validated [1]. This review is divided into three sections: BTHE FUNDAMENTAL PRINCIPLES^ describes the
fundamental principles of inflammation and metabolism; BENHANCED FUNDAMENTAL PRINCIPLE^ looks into more advanced clinical concepts; BPRACTICAL IMPLICATIONS FOR CLINICIANS^ outlines how this knowledge can be applied to clinical practice.
THE FUNDAMENTAL PRINCIPLES There is more to inflammation than the four classic signs of redness, swelling, heat, and pain. Rudolph Virchow added in 1858 a fifth sign—disturbance of function—and it would prove to be a key player in the events that accompany inflammation, both locally and systemically [2].
1
Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal 2 Intensive Care Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal 3 To whom correspondence should be addressed at Internal Medicine 1, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Rua Leão Penedo, Faro, 8000-386, Portugal. E-mail: [email protected]
The Inflammatory Pathway The inflammatory process has been best studied in response to infectious stimuli, particularly bacterial infections
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