Systemic Inflammation and the Breakdown of Intestinal Homeostasis Are Key Events in Chronic Spinal Cord Injury Patients

Int J Mol Sci. 2021 Jan 13;22(2):744. doi: 10.3390/ijms22020744.


Our aim was to investigate the subset distribution and function of circulating monocytes, proinflammatory cytokine levels, gut barrier damage, and bacterial translocation in chronic spinal cord injury (SCI) patients. Thus, 56 SCI patients and 28 healthy donors were studied. The levels of circulating CD14+highCD16-, CD14+highCD16+, and CD14+lowCD16+ monocytes, membrane TLR2, TLR4, and TLR9, phagocytic activity, ROS generation, and intracytoplasmic TNF-α, IL-1, IL-6, and IL-10 after lipopolysaccharide (LPS) stimulation were analyzed by polychromatic flow cytometry. Serum TNF-α, IL-1, IL-6 and IL-10 levels were measured by Luminex and LPS-binding protein (LBP), intestinal fatty acid-binding protein (I-FABP) and zonulin by ELISA. SCI patients had normal monocyte counts and subset distribution. CD14+highCD16- and CD14+highCD16+ monocytes exhibited decreased TLR4, normal TLR2 and increased TLR9 expression. CD14+highCD16- monocytes had increased LPS-induced TNF-α but normal IL-1, IL-6, and IL-10 production. Monocytes exhibited defective phagocytosis but normal ROS production. Patients had enhanced serum TNF-α and IL-6 levels, normal IL-1 and IL-10 levels, and increased circulating LBP, I-FABP, and zonulin levels. Chronic SCI patients displayed impaired circulating monocyte function. These patients exhibited a systemic proinflammatory state characterized by enhanced serum TNF-α and IL-6 levels. These patients also had increased bacterial translocation and gut barrier damage.

Keywords: bacterial translocation; chronic spinal cord injury; cytokines; gut barrier damage; monocyte; systemic inflammation.

MeSH terms

  • Adult
  • Biomarkers
  • Case-Control Studies
  • Chronic Disease
  • Cytokines / metabolism
  • Disease Susceptibility*
  • Female
  • Homeostasis
  • Humans
  • Inflammation / complications*
  • Inflammation Mediators / metabolism
  • Intestinal Diseases / complications*
  • Male
  • Monocytes / immunology
  • Monocytes / metabolism
  • Phagocytes / immunology
  • Phagocytes / metabolism
  • Phagocytosis
  • Severity of Illness Index
  • Spinal Cord Injuries / etiology*
  • Spinal Cord Injuries / metabolism*
  • Spinal Cord Injuries / pathology
  • Tumor Necrosis Factor-alpha / metabolism
  • Young Adult


  • Biomarkers
  • Cytokines
  • Inflammation Mediators
  • Tumor Necrosis Factor-alpha