Immune Activation in Patients With Irritable Bowel Syndrome Tobias Liebregts, Birgit Adam, Christoph Bredack, Alexander Röth, Susanne Heinzel, Sue Lester, Sarah Downie–Doyle, Eric Smith, Paul Drew, Nicholas J. Talley, Gerald Holtmann  Gastroenterology  Volume 132, Issue 3, Pages 913-920 (March 2007) DOI: 10.1053/j.gastro.2007.01.046 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 (A) TNF-α production (pg/mL) by PBMCs from HCs and IBS patients before (baseline) and (B) after stimulation with 1 ng/mL of E coli LPS. The boxed area represents the interquartile range of HCs. Under baseline conditions, subjects with D-IBS showed significantly (P < .05) higher TNF-α levels compared with HCs. LPS co-incubation caused a significant increase of TNF-α in all subjects compared with nonstimulated PBMCs. The LPS-induced TNF-α production was significantly (P = .005) higher in D-IBS patients compared with HCs. No significant differences were observed in M-IBS and C-IBS, whereas PI-IBS showed significantly higher baseline and LPS-stimulated TNF-α levels compared with HCs. Patients with PI-IBS did not differ significantly from patients with D-IBS. Gastroenterology 2007 132, 913-920DOI: (10.1053/j.gastro.2007.01.046) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 (A) IL-1β production (pg/mL) by PBMCs from HCs and IBS patients before (baseline) and (B) after stimulation with 1 ng/ml of E coli LPS. The boxed area represents the interquartile range of HCs. Under baseline conditions, subjects with D-IBS showed significantly (P = .004) higher IL-1β levels compared with HCs. Co-incubation with LPS significantly enhanced IL-1β production in all subjects compared with baseline. The LPS-induced increase of IL-1β was significantly higher in D-IBS (P = .01) and C-IBS (P = .012) patients compared with HCs, whereas there were no significant alterations in M-IBS. PI-IBS patients showed significantly (P < .05) higher baseline and LPS-induced IL-1β levels compared with HCs without a significant difference vs D-IBS. Gastroenterology 2007 132, 913-920DOI: (10.1053/j.gastro.2007.01.046) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 (A) IL-6 production (pg/mL) by PBMCs from HCs and IBS patients before (baseline) and (B) after stimulation with 1 ng/mL of E coli LPS. The boxed area represents the interquartile range of HCs. Compared with controls, baseline (P = .005) and LPS-stimulated (P = .011) IL-6 production was significantly higher in D-IBS and (P < .05) PI-IBS patients. There were no significant differences in M-IBS and C-IBS. Gastroenterology 2007 132, 913-920DOI: (10.1053/j.gastro.2007.01.046) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Correlation of E coli LPS-induced TNF-α production (pg/mL) and anxiety scores assessed by the Hospital Anxiety and Depression Scale. A score of 11 or greater is considered indicative of an anxiety disorder. Overall, LPS-induced TNF-α release is associated significantly with anxiety scores (r = 0.59, P < .001) in patients with IBS, although it did not reach statistical significance for the IBS subgroups (M-IBS: r = 0.26, P = .30; C-IBS: r = 0.31, P = .17; D/PI-IBS: r = 0.45, P = .14). ●, M-IBS; ○, C-IBS; ▼, D-IBS; Δ, PI-IBS. Gastroenterology 2007 132, 913-920DOI: (10.1053/j.gastro.2007.01.046) Copyright © 2007 AGA Institute Terms and Conditions