Pro- and anti-inflammatory cytokine imbalance in cholecystitis: implications for immune dysregulation

Background and objectives. Interleukins play an important role in the inflammatory process of cholecystitis and orchestrate both acute and chronic phases of the disease. They control the immune response that are involved in the resolution and progression of the disease. Some of them had proinflammatory activity that initiates the process of inflammation and activates inflammatory cells for restricting the infection. However, this may result in tissue damage if cytokine is produced in excess. Persistent interleukin production results in chronic inflammation (Chronic Cholecystitis) and produces some of the complications like fibrosis of the gallbladder and gallbladder dysfunction. This study aimed to evaluate the serum levels of cytokine (IL-10, IL-37, TGF-β1) as anti-inflammatory cytokines and (Il-17, IL-23) as pro-inflammatory cytokines in patients with acute and chronic cholecystitis compared with control healthy individuals. Materials and methods. A case-control study was conducted. A total of 179 patients and apparently healthy indivi­duals were enrolled. Blood samples were collected for determination of cytokines levels using the ELIZA technique. Results. There were statistically significant differences in the mean levels of the studied cytokines. The results revealed that the level of all tested serum interleukins in healthy control individuals was higher than in acute and chronic cholecystitis patients (except for IL-17). There was a significant positive correlation among the studied interleukins. ROC analysis revealed that TGF-β1 had the best discrimination between patient and control groups. Conclusions. The presence of a significant increase in cytokine levels in healthy subjects compared to acute and chronic cholecystitis patients may reflect an inappropriate immune response in diseased patients. The non-significant difference in cytokine levels according to stone number suggests that gallstones do not cause variation in the circulating inflammatory profile. The calculated anti/pro-inflammatory cytokine ratio in this study reflects that the amount of anti-inflammatory cytokines was higher than that of pro-inflammatory cytokines, which may indicate a stronger systemic anti-inflammatory response.