Effects of pulsed or continuous infusion of cortisol on immune function in sheep

Triiodothyronine Administration in a Model of Septic Shock: A Randomized Blinded Placebo-Controlled Trial

OBJECTIVES

Triiodothyronine concentration in plasma decreases during septic shock and may contribute to multiple organ dysfunction. We sought to determine the safety and efficacy of administering triiodothyronine, with and without hydrocortisone, in a model of septic shock.

DESIGN

Randomized blinded placebo-controlled trial.

SETTING

Preclinical research laboratory.

SUBJECTS

Thirty-two sheep rendered septic with IV Escherichia coli and receiving protocol-guided sedation, ventilation, IV fluids, and norepinephrine infusion.

INTERVENTIONS

Two hours following induction of sepsis, 32 sheep received a 24-hour IV infusion of 1) placebo + placebo, 2) triiodothyronine + placebo, 3) hydrocortisone + placebo, or 4) triiodothyronine + hydrocortisone.

MEASUREMENTS AND MAIN RESULTS

Primary outcome was the total amount of norepinephrine required to maintain a target mean arterial pressure; secondary outcomes included hemodynamic and metabolic indices. Plasma triiodothyronine levels increased to supraphysiological concentrations with hormonal therapy. Following 24 hours of study drug infusion, the amount of norepinephrine required was no different between the study groups (mean ± SD μg/kg; placebo + placebo group 208 ± 392; triiodothyronine + placebo group 501 ± 370; hydrocortisone + placebo group 167 ± 286; triiodothyronine + hydrocortisone group 466 ± 495; p = 0.20). There was no significant treatment effect on any hemodynamic variable, metabolic parameter, or measure of organ function.

CONCLUSIONS

A 24-hour infusion of triiodothyronine, with or without hydrocortisone, in an ovine model of septic shock did not markedly alter norepinephrine requirement or any other physiological parameter.

Effect of artificial rearing on lamb welfare and meat quality

Twenty male Comisana lambs were equally divided into two groups. Ten subjects were artificially reared, 10 others were ewe reared and used as control. Unseparated control animals displayed increased cellular immune response to a percutaneous injection of phytohemagglutinin (P<0.001). During the open field test, ewe-reared lambs showed a higher number of flight attempts (P<0.01). Carcass yield were higher for artificially reared animals (P<0.05). Conversely, legs of ewe-reared animals had significantly more fat (P<0.05) and a higher content of saturated fatty acids (P<0.001). Polyunsaturated fatty acid content was higher in artificially reared lamb meat (P<0.01), although the ratio n-6/n-3 was well above the recommended values. The triangle test showed a significant difference in sensory analysis between the two products (P<0.05). Finally, for both rearing systems legs without subcutaneous fat showed a higher percentage of polyunsaturated fatty acids and a corresponding lower content of saturated fatty acids (P<0.001).

The periparturient relaxation of immunity in Merino ewes infected with Trichostrongylus colubriformis: endocrine and body compositional responses

The temporal association between the periparturient rise in worm egg count of grazing Merino ewes to infection with Trichostrongylus colubriformis and the underlying causal mechanisms was investigated in an experiment that incorporated two levels of pregnancy (pregnant or unmated), two levels of infection (infected with 6000 T. colubriformis L(3)/week or uninfected) and, following lambing, three levels of lactation (non-lactating/"dry", early-weaned 2 days after parturition, or suckled). In addition to parasitological and host immune responses reported in a previous paper (Beasley et al., 2010), a range of endocrine and body compositional changes were monitored from day -50 to day 42, relative to the midpoint of lambing (day 0). By day -19, pregnant ewes had begun to mobilise fat and eye muscle, and after 42 days of suckling had lost 31% and 8%, respectively, of their existing depots. In comparison to non-pregnant (dry) ewes, the endocrine profiles of late-pregnant ewes were characterised by low levels of cortisol and prolactin and high levels of progesterone and oestradiol. Lactating ewes had lower levels of cortisol and leptin and higher levels of prolactin compared to both dry and early-weaned ewes. The mobilisation of fat and protein reserves throughout lactation in suckled ewes was closely associated with leptin and cortisol profiles, and provided strong evidence of an underlying nutritional basis for the periparturient relaxation of immunity. Both leptin and cortisol concentrations were also associated with both parasite burden and the immune status of the ewe. It is suggested that lower blood cortisol levels in suckled ewes contribute to a Th1 biased immune response that leads to an increased susceptibility to gastrointestinal nematodes. The results provide a detailed characterisation of the physiology underlying the periparturient relaxation of immunity to T. colubriformis, from which further investigations will aim to expose potential causal factors.

Comparison of immunosuppression in dry and lactating Awassi ewes due to water deprivation stress

In seminomadic farming practice, dry and lactating ewes are exposed to different degrees of water deprivation, leading to stress followed by various disease outbreaks. This study compares quantitatively the immunosuppression to Salmonella Enteritidis (SE) fimbriae (14 and 21 kDa) and other major polypeptides (28.9, 37.7, 42.9, 68.0, 92.6 and 96.8 kDa) in water-deprived dry and lactating ewes. Sixteen dry and lactating multiparous Awassi ewes were divided into four treatment groups (A, A', B and B'). Ewes in groups A and B were lactating, whereas ewes in groups A' and B' were dry. All ewes were administered a killed SE vaccine, subcutaneously in the neck, at the initiation of the experiment. The water availability for ewes in groups B (lactating) and B' (dry) was ad libitum, while that for ewes in groups A (lactating) and A' (dry) was once every 4 days. A serum sample was collected from the jugular vein of each ewe at zero time (initiation of the experiment, when SE bacterin was delivered) and at 2, 9, 12, 15 and 18 days post SE vaccination. The percentage reduction in the level of humoral antibody response to polypeptides of > or = 21 kDa was more apparent in water-deprived lactating ewes of group A between 9 and 18 days post initiation of thirst. In this period, immunosuppression to polypeptides > or = 21 kDa was present in 14 out of 16 observations in group A (water-deprived lactating), with significant immunosuppression in 9 observations in relation to the respective control (p<0.05), while it was present in only 4 out of 16 observations in group A' (water-deprived dry), with significant immunosuppression in 2 observations (p <0.05). In conclusion, immunosuppression to polypeptides of > or =21 kDa is more significant in lactating water-deprived ewes in the period 9-18 days post initiation of thirst, a result that will influence our future sheep welfare awareness programmes targeting an elimination of the practice of water deprivation in seminomadic sheep farming.

Use of corticosteroid therapy in patients with sepsis and septic shock: an evidence-based review

OBJECTIVE

In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of corticosteroid therapy in patients with sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.

DESIGN

The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee.

METHODS

The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591.

CONCLUSIONS

Low doses of corticosteroids are recommended in patients with septic shock. In the absence of vasopressor requirement, corticosteroids should not be used to treat sepsis. High-dose corticosteroids are not recommended in severe sepsis. The use of adrenal function tests to guide decisions on corticosteroid therapy, the weaning of steroids at the end of the treatment period, the decision to discontinue steroids earlier with resolution of shock, and the addition of oral fludrocortisone are considered optional approaches.

Effect of cortisol infusion patterns and castration on metabolic and immunological indices of stress response in cattle

This study tested the hypotheses that: (1) either acute stress induced by Burdizzo castration, or cortisol infusion would modulate plasma glucose, insulin and growth hormone (GH) concentrations; and (2) immune modulation induced by cortisol would be dependent on the pattern, intensity and duration of circulating cortisol concentrations. Fifty 9.2-month-old Holstein x Friesian bulls (232 +/- 2.0 kg) were blocked by weight and randomly assigned to one of five treatments (n = 10 per treatment): (1) sham handled control; (2) Burdizzo castration; (3) hydrocortisone infusion to mimic the castration-induced secretion pattern of cortisol; (4) hourly pulse infusion of hydrocortisone; and (5) sustained infusion of hydrocortisone for 8h. Blood samples were collected intensively on day 0, and weekly from days 1 to 35. Castration acutely increased plasma cortisol, GH and haptoglobin concentrations, suppressed lymphocyte in vitro interferon-gamma (IFN-gamma) production, but had no effect on plasma glucose and insulin concentrations. Cortisol infusion to simulate the castration-induced secretion pattern of cortisol, and pulse infusion of cortisol did not suppress the IFN-gamma production. A sustained infusion of cortisol resulted in the transient suppression of IFN-gamma production. Moreover, the sustained cortisol infusion resulted in increased plasma glucose, insulin and GH concentrations. The overall 14-day feed intakes and 35-day growth rates were not affected by treatments. In conclusion, cortisol infusion to induce immune suppression in vivo occurred only at pharmacological doses. Within physiological ranges, cortisol was not associated with the suppression of immune function, indicating that during castration cortisol per se is not responsible for the suppression of in vitro IFN-gamma production.

BOVIGAM: an in vitro cellular diagnostic test for bovine tuberculosis

BOVIGAM which is based on the detection of gamma interferon (IFN- gamma) is a rapid, laboratory assay of a cell mediated immune response that may be used for the detection of tuberculosis (TB) infection in animals. Whole blood is first incubated overnight with bovine PPD, avian PPD or negative control antigens, and IFN- gamma in the supernatant plasma is then measured by EIA. TB infection is indicated by a predominant IFN- gamma response to bovine PPD. Since 1988, BOVIGAM has been extensively trialed on more than 200 000 cattle in Australia, Brazil, Ireland, Northern Ireland, Italy, New Zealand, Romania, Spain and the USA. Sensitivity has varied between 81.8% and 100% for culture-confirmed bovine TB and specificity between 94% and 100%. The IFN- gamma assay detects M. bovis infection earlier than the skin test and in New Zealand is applied to detect skin-test negative cattle with TB, where after slaughter a significant number of IFN- gamma reactors have TB. BOVIGAM is also approved in New Zealand for serial testing skin test positive cattle when non-specificity is suspected. Cattle are tested 7-30 days after a positive caudal fold test. The boosting effect of the skin test on T-cell activity allows blood to be cultured with PPD up to 30 h after collection without effecting accuracy. The BOVIGAM results are not affected by poor nutritional condition and are only mildly and briefly affected by dexamethasone treatment and parturition. IFN- gamma responses of cattle vaccinated with BCG are dose-dependent and short-lived. The BOVIGAM kit is now used routinely in many countries for the detection of M. bovis infected cattle, buffalo and goats.