Interleukin-1, interleukin-6 and tumour necrosis factor drive the acute phase response
Expansion
Pro-inflammatory
- Interleukin-1: fever (an endogenous pyrogen), acute phase response
- Interleukin-6: the main driver of hepatic acute phase proteins, including C-reactive protein
- Tumour necrosis factor alpha: fever, cachexia, endothelial activation, and the central mediator of septic shock
- Interleukin-8: neutrophil chemotaxis
- Interferon gamma: macrophage activation
Anti-inflammatory: interleukin-10, transforming growth factor beta.
Acute phase response: rises in CRP, fibrinogen, ferritin, haptoglobin and complement; falls in albumin and transferrin. CRP rises within 6 hours and falls quickly, whereas the ESR is slower in both directions.
Biologic drugs target these directly and are worth pairing with the cytokines: anti-TNF agents (infliximab, adalimumab, etanercept) in rheumatoid arthritis and inflammatory bowel disease, anti-IL-6 (tocilizumab) in rheumatoid arthritis and cytokine release syndrome, and anti-IL-1 (anakinra) in autoinflammatory disease.
Their shared hazard is reactivation of tuberculosis, since these cytokines maintain granulomas.