The pathophysiological role of cytokines.

Cytokines are important hormonal mediators, produced in tissues undergoing defence, growth and repair processes. Infection and inflammation in particular result in a cascade of cytokine induction that acts to maintain tissue homeostasis. Most cytokines act within the injured tissues, although some have an endocrine action, recruiting distant tissues in defence of the tissue producing the cytokine and many are important for regulating acquired immunity in secondary lymphoid tissues. Induction of interleukin-1 (IL-1), tumour necrosis factor (TNF) and IL-6 highlight the way in which local tissue cytokine responses are induced and act. Since most cytokines act locally, cytokine measurement presents several difficulties. Only where cytokines (such as IL-6) have a systemic action are plasma cytokine concentrations really meaningful. The presence of cytokine antagonists and soluble cytokine receptors, often released in concert with their respective cytokine agonists, presents additional complexity to interpretation. Measurement and manipulation of cytokines can contribute towards an understanding of their pathophysiological role in both experimental and clinical settings. This includes measurement of plasma IL-6, which has striking relationships to tissue inflammation. Its value is exemplified by some recent studies of stroke patients, where IL-6 reflects not only the initial response but also clinical outcome and survival.