Extensive animal work has established mesenteric lymph as the mechanistic link between gut
ischemia/reperfusion and distant organ injury. Our
trauma and transplant services provide a unique opportunity to assess the relevance of our animal data to human mesenteric lymph under conditions that simulate those used in the laboratory. Mesenteric lymph was collected from 11 patients with lymphatic
injuries, during semielective spine reconstruction or immediately before organ donation. The lymph was tested for its ability to activate human neutrophils in vitro and was analyzed by label-free proteomic analysis. Human mesenteric lymph primed human polymorphonuclear neutrophils in a pattern similar to that observed in previous rodent, swine, and primate studies. A total of 477
proteins were identified from the 11 subjects' lymph samples with greater than 99% confidence. In addition to classic
serum proteins, markers of
hemolysis, extracellular matrix components, and general tissue damage were identified. Both tissue injury and
shock correlate strongly with production of bioactive lymph. Products of red blood cell
hemolysis correlate strongly with human lymph bioactivity, and
immunoglobulins have a negative correlation with the proinflammatory lymph. These human data corroborate the current body of research implicating postshock mesenteric lymph in the development of systemic
inflammation and
multiple organ failure. Further studies will be required to determine if the
proteins identified participate in the pathogenesis of
multiple organ failure and if they can be used as diagnostic markers.