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Commentary

Serum adipocyte fatty acid-binding protein in the critically ill

Undurti N Das

Author Affiliations

UND Life Sciences, 13800 Fairhill Road, #321, Shaker Heights, OH 44120, USA

Bio-Science Research Centre, Gayatri Vidya Parishad College of Engineering, Visakhapatnam-533 048, India

Jawaharlal Nehru Technological University, Kakinada-533003, India

Critical Care 2013, 17:121  doi:10.1186/cc12517


See related research by Huang et al., http://ccforum.com/content/17/1/R22

Published: 6 March 2013

Abstract

Sepsis due to unabated inflammation is common. Increased production of pro-inflammatory cytokines, free radicals, and eicosanoids has been detected in sepsis and other critical illnesses but could also be due to decreased synthesis and release of anti-inflammatory molecules. Increased serum adipose-fatty acid-binding protein (A-FABP) levels can cause insulin resistance and have been reported in the critically ill, serve as a marker of prognosis, and thus link metabolic homeostasis and inflammation. A-FABP can be linked to the expression of Toll-like receptors, macrophage activation, synthesis and release of pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, activation of cyclooxygenase 2 (COX-2) expression, and eicosanoid synthesis, events that can cause insulin resistance and initiation and progression of inflammation and sepsis. Unsaturated fatty acids and their anti-inflammatory products, such as lipoxins, resolvins, and protectins, may suppress A-FABP expression, inhibit macrophage and COX-2 activation, and decrease production of pro-inflammatory cytokines and ultimately could lead to a decrease in insulin resistance and resolution of inflammation and recovery from sepsis. Serial measurement of these pro- and anti-inflammatory molecules and correlation of their levels to the progression to or recovery from (or both) sepsis and other inflammatory processes may form a new approach to predict prognosis in inflammatory conditions and eventually could lead to the development of new therapeutic strategies.