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However, we would like to add a possible pathomechanism in the development of hyponatremia associated with GBS.</p><p class="elsevierStylePara">According to a previous study by Maimone et al.,<span class="elsevierStyleSup">2</span> interleukin (IL)-6, a multifunctional cytokine, might be implicated in the immunopathogenesis of GBS. In their study, serum IL-6 levels were increased in six (26%) of 23 GBS patients, and detectable levels of IL-6 were also found in the cerebrospinal fluid in 13 (57%).<span class="elsevierStyleSup">2</span> Using enzyme-linked immunospot assays, Press et al.<span class="elsevierStyleSup">3</span> found elevated numbers of IL-6-secreting blood mononuclear cells during the acute phase in patients with GBS.</p><p class="elsevierStylePara">Quite recently and importantly, Swart et al.<span class="elsevierStyleSup">4</span> depicted the cascade-like fashion of events initiated by an inflammatory stimulus (lipopolysaccharides), with tumor necrosis factor-α secreted first, IL-1β second, and IL-6 last, suggesting possible pathways connecting IL-6 to vasopressin release. These pro-inflammatory cytokines are secreted into the systemic circulation to initiate the acute phase response which is involved in the innate immune system.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Furthermore, Mastorakos et al.<span class="elsevierStyleSup">6</span> reported that plasma antidiuretic hormone levels were elevated after IL-6 injection in cancer patients, suggesting that IL-6 activated the magnocellular ADH-secreting neurons and that it might be involved in SIADH. Activation of the subfornical organ and the organum vasculosum of the lamina terminalis by IL-6 could eventually lead to thirst and increased vasopressin secretion by neurons from the supraoptic nucleus and paraventricular nucleus.<span class="elsevierStyleSup">4</span> The combination of antidiuresis and increased water intake may result in hyponatremia.</p><p class="elsevierStylePara">Therefore, there is a possibility that IL-6 may play a central role in the pathogenesis of hyponatremia associated with GBS. However, further studies are necessary to elucidate if IL-6 crosses the blood-brain barrier (BBB), or whether lipopolysaccharides crosse the BBB and then increases IL-6 locally in the brain in the future.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">The authors declare they have no potential conflicts of interest related to the contents of this article.</p>" "pdfFichero" => "P1-E532-S3401-A11115-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Monzón Vázquez T, Florit E, Marqués Vidas M, Rodríguez Cubillo B, Delgado Conde P, Barrientos Guzmán A. Syndrome of inappropriate antidiuretic hormone hypersecretion associated with Guillain-Barré syndrome. Nefrologia 2011;31:498-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21738258" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Maimone D, Annunziata P, Simone IL, Livrea P, Guazzi GC. Interleukin-6 levels in the cerebrospinal fluid and serum of patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. J Neuroimmunol 1993;47:55-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8376548" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Press R, Ozenci V, Kouwenhoven M, Link H. Non-T(H)1 cytokines are augmented systematically early in Guillain-Barré syndrome. Neurology 2002;58:476-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11839856" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Swart RM, Hoorn EJ, Betjes MG, Zietse R. Hyponatremia and inflammation: the emerging role of interleukin-6 in osmoregulation. Nephron Physiol 2011;118:45-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21196778" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9971870" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mastorakos G, Weber JS, Magiakou MA, Gunn H, Chrousos GP. Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrinol Metab 1994;79:934-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7962300" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000001/v0_201502091620/X2013251412000464/v0_201502091620/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000001/v0_201502091620/X2013251412000464/v0_201502091620/en/P1-E532-S3401-A11115-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412000464?idApp=UINPBA000064" ]
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