Accelerated recovery after endotoxic challenge in heat shock-pretreated mice

Activation of the stress response in macrophages alters the M1/M2 balance by enhancing bacterial killing and IL-10 expression

Macrophages (Mϕs) play an important role in the inflammatory response during injury by participating in the removal of injurious stimuli, such as bacteria, and promoting tissue healing to restore homeostasis. Mϕs can acquire distinct functional phenotypes along a spectrum between two opposite stages (M1/M2) during activation. In the present study, we induced a stress response in Mϕs via heat shock (HS) and found that it incurred an increase in phagocytosis (1.6-fold, P < 0.05) and bacterial killing (2.8-fold, P < 0.01). Upon heat stress activation, Mϕs respond to group B Streptococcus (GBS) infection with lower levels of pro-inflammatory cytokines, TNF-α (2.25-fold, P < 0.01), IL-6 (7-fold, P < 0.001), and inducible nitric oxide synthase (iNOS) (2.22-fold, P < 0.05), but higher levels of the anti-inflammatory cytokine IL-10 (3.9-fold, P < 0.01). Stressed Mϕs exposed to GBS display rapid phagosome maturation, increased extracellular trap (ET) formation and elevated cathelicidin antimicrobial peptide expression (2.5-fold, P < 0.001). These findings are consistent with a heretofore uncharacterized Mϕ activation state formed in response to stress, associated with secretion of large quantities of anti-inflammatory mediators and redirection of antimicrobial mechanisms to NADPH-oxidase-independent pathways. This "friendly activation" of Mϕs is characterized by increased bactericidal activity and more rapid and controlled resolution of the inflammatory response.

KEY MESSAGES

Macrophages form a dual pro-bactericidal and anti-inflammatory state. Stress in the setting of infection triggers friendly activation in macrophages. Heat shock plus infection increases macrophage bactericidal activity. Heat shock plus infection increases macrophage extracellular trap formation. Heat shock plus infection increases macrophage production of cathelicidin and IL-10.

Heat stroke: role of the systemic inflammatory response

Heat stroke is a life-threatening illness that is characterized clinically by central nervous system dysfunction, including delirium, seizures, or coma and severe hyperthermia. Rapid cooling and support of multi-organ function are the most effective clinical treatments, but many patients experience permanent neurological impairments or death despite these efforts. The highest incidence of heat stroke deaths occurs in very young or elderly individuals during summer heat waves, with ∼ 200 deaths per year in the United States. Young, fit individuals may experience exertional heat stroke while performing strenuous physical activity in temperate or hot climates. Factors that predispose to heat stroke collapse include pre-existing illness, cardiovascular disease, drug use, and poor fitness level. For decades the magnitude of the hyperthermic response in heat stroke patients was considered the primary determinant of morbidity and mortality. However, recent clinical and experimental evidence suggests a complex interplay between heat cytotoxicity, coagulation, and the systemic inflammatory response syndrome (SIRS) that ensues following damage to the gut and other organs. Cytokines are immune modulators that have been implicated as adverse mediators of the SIRS, but recent data suggest a protective role for these proteins in the resolution of inflammation. Multi-organ system failure is the ultimate cause of mortality, and recent experimental data indicate that current clinical markers of heat stroke recovery may not adequately reflect heat stroke recovery in all cases. Currently heat stroke is a more preventable than treatable condition, and novel therapeutics are required to improve patient outcome.

Acute pancreatitis: animal models and recent advances in basic research

Acute pancreatitis (AP) is characterized by edema, acinar cell necrosis, hemorrhage, and severe inflammation of the pancreas. Patients with AP present with elevated blood and urine levels of pancreatic digestive enzymes, such as amylase and lipase. Severe AP may lead to systemic inflammatory response syndrome and multiorgan dysfunction syndrome, which account for the high mortality rate of AP. Although most (>80%) cases of AP are associated with gallstones and alcoholism, some are idiopathic. Although the pathogenesis of AP has not yet been elucidated, a common feature is the premature activation of trypsinogen within pancreatic tissues, which triggers autodigestion of the gland. Recent advances in basic research suggest that etiologic factors including cyclooxygenase-2, substance P, and angiotensin II may have novel roles in this disease. Basic research data obtained thus far have been based on animal models of AP ranging from mild edematous pancreatitis to severe necrotizing pancreatitis. In view of this, an adequate selection of experimental animal models is of paramount importance. Notwithstanding these animal models, it should be emphasized that none of these models mimic the clinical situation where varying degrees of severity usually occur. In this review, commonly used animal models of AP will be critically evaluated. A discussion of recent advances in our knowledge about AP risk factors is also included.

Exogenous heat shock protein 70 mediates sepsis manifestations and decreases the mortality rate in rats

Mammalian responses to bacterial lipopolysaccharide (LPS) from the outer membrane of Gram-negative bacteria can lead to an uncontrolled inflammatory reaction that can be deadly for the host. We checked whether heat shock protein 70 (Hsp70) protein is able to protect animals from the deleterious effects of bacterial LPS by monitoring the effect of exogenous Hsp70 injections before and after LPS administration. Our research with rats demonstrates for the first time that administration of exogeneous Hsp70 before and after LPS challenges can reduce mortality rates and modify several parameters of hemostasis and hemodynamics. Hsp70 isolated from bovine muscles showed significant protective effects against the impaired coagulation and fibrinolytic systems caused by LPS, and reduced the mortality caused by Escherichia coli and Salmonella typhimurium LPS injections significantly. Characteristically, Hsp70 preparations used in the experiments result in different effects when administered before and after an LPS challenge, and the effects of Hsp70 injections also differ significantly depending on the origin of the LPS (E coli vs S typhimurium). Based on our data, mammalian Hsp70 appears to be an attractive target in therapeutic strategies designed to stimulate endogenous protective mechanisms against many deleterious consequences of septic shock by accelerating the functional recovery of susceptible organs in humans.

Sequence makes a difference: paradoxical effects of stress in vivo

In vitro studies have shown that induction of heat shock before an inflammatory stimulus is cytoprotective, whereas induction of heat shock after an inflammatory stimulus can lead to apoptosis (the "heat shock paradox"). We sought to determine whether induction of the heat shock response in vivo caused similar, order-dependent effects on survival, and if so, by what mechanism. ND4 and C57BL/6 mice were used to calibrate the response to hyperthermia at 41.5 degrees C via induction of inducible heat shock protein 70. Sequences of heat shock and septic stresses were studied in murine models of hyperthermia (41.5 degrees C for 20 min) and cecal ligation and puncture (CLP), respectively. Previous heat shock to 41.5 degrees C did not protect CLP mice when compared with control CLP animals heated to 37 degrees C, but heat shock increased mortality when activated after CLP compared with controls. This effect of heat shock on CLP mortality was strain independent, and did not involve alterations in CLP-induced thymus, spleen, or intestinal apoptosis. We conclude that the heat shock paradox can occur in vitro and in vivo, and that the negative effects of heat shock on survival after CLP appeared to be strain independent. Furthermore, the stress of general anesthesia and warming also altered CLP mortality unexpectedly. The cellular mechanisms responsible for these "stressor" paradoxes in vivo are not known, but do not involve altered sepsis-induced apoptosis.

Enhanced LPS-induced TNFα production in heat-shocked human promonocytic cells: regulation at the translational/post-translational level

Heat shock proteins (hsps) play an important role in maintaining cellular homeostasis and protecting cells from various insults. Recent evidence also implicates hsps in the regulation of the immune response, particularly the inflammatory process. In the present study, we showed that human promonocytic cells (THP-1) produced elevated levels of tumor necrosis factor alpha (TNF alpha) after incubation with bacterial lipopolysaccharide (LPS) when cells were pre-stressed by a mild heat shock (HS) of 42 degrees C (1.5 h) followed by recovery at 37 degrees C (3 h) in comparison with non-stressed cells also stimulated with LPS. This enhanced TNF alpha production was not due to changes in nuclear factor-kappaB (NF-kappa B) activation, TNF alpha transcription rates, or mRNA stability. Thus, an effect at the translational or posttranslational level is likely responsible. Elevated production of TNF alpha was not observed when cells were stimulated with LPS immediately after stress or when HS temperature was increased to 43 degrees C. This negative effect of HS is likely due to a harmful effect of temperature. Moreover, enhanced LPS-induced TNF alpha production was not observed after differentiation of promonocytes into macrophage-like cells. Thus, our results show that the stress temperature, recovery period, and differentiation stage of the cell modulate the effect of HS on the inflammatory process.

Basal and inducible levels of Hsp70 in patients with acute heat illness induced during training

Heat shock proteins (Hsps) or stress proteins, and, in particular, the inducible, cytosolic Hsp70, represent a highly conserved response to heat exposure and to a variety of noxious stimuli. Many investigations have shown correlations between the aberrant expression of Hsps and disease states. Whether the basal and inducible levels of Hsp70 are of any biological significance in patients with heat-induced diseases remains unknown. In the present study, we compared the basal and inducible levels of Hsp70 by flow cytometry in lymphocytes of patients with heat-induced diseases and after recovery from this disease, and in matched controls. Both groups comprised individuals who exercised by running in the same hot environment. The level of inducible Hsp70 was also measured after a heat treatment of lymphocytes in vitro. The results show that there is variation of basal and inducible Hsp70 levels among individuals. However, the group of patients suffering from heat-induced illnesses in May shows a significantly higher basal (P = 0.02) level of Hsp70 than does the control group. Individuals who have an increased level of Hsp70 may be more sensitive to heat or may respond differently. The level of Hsp70 may represent a biomarker to evaluate whether they are more susceptible to stresses than other individuals. Interestingly, the basal level of Hsp70 is higher in both the patient group and the control group in November than in May. In fact, the basal levels of Hsp70 in the patient and control groups are essentially the same in November, perhaps reflecting the successful stress conditioning of both groups.