1
|
Galli E, Maggio E, Pomero F. Venous Thromboembolism in Sepsis: From Bench to Bedside. Biomedicines 2022; 10:biomedicines10071651. [PMID: 35884956 PMCID: PMC9313423 DOI: 10.3390/biomedicines10071651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/22/2022] Open
Abstract
Septic patients were commonly affected by coagulation disorders; thus, they are at high risk of thrombotic complications. In the last decades, novel knowledge has emerged about the interconnected and reciprocal influence of immune and coagulation systems. This phenomenon is called immunothrombosis, and it indicates an effective response whereby immune cells and the coagulation cascade cooperate to limit pathogen invasion and endothelial damage. When this network becomes dysregulated due to a systemic inflammatory activation, as occurs during sepsis, it can result in pathological thrombosis. Endothelium, platelets and neutrophils are the main characters involved in this process, together with the TF and coagulation cascade, playing a critical role in both the host defense and in thrombogenesis. A deeper understanding of this relationship may allow us to answer the growing need for clinical instruments to establish the thrombotic risk and treatments that consider more the connection between coagulation and inflammation. Heparin remains the principal therapeutical response to this phenomenon, although not sufficiently effective. To date, no other significant alternatives have been found yet. In this review, we discuss the role of sepsis-related inflammation in the development and resolution of venous thromboembolism and its clinical implications, from bench to bedside.
Collapse
Affiliation(s)
- Eleonora Galli
- Internal Medicine Residency Program, University of Turin, 10100 Turin, TO, Italy;
- Department of Internal Medicine, M. and P. Ferrero Hospital, 12060 Verduno, CN, Italy;
| | - Elena Maggio
- Department of Internal Medicine, M. and P. Ferrero Hospital, 12060 Verduno, CN, Italy;
| | - Fulvio Pomero
- Department of Internal Medicine, M. and P. Ferrero Hospital, 12060 Verduno, CN, Italy;
- Correspondence: ; Tel.: +39-01721408100
| |
Collapse
|
2
|
Wei Y, Tejera P, Wang Z, Zhang R, Chen F, Su L, Lin X, Bajwa EK, Thompson BT, Christiani DC. A Missense Genetic Variant in LRRC16A/CARMIL1 Improves Acute Respiratory Distress Syndrome Survival by Attenuating Platelet Count Decline. Am J Respir Crit Care Med 2017; 195:1353-1361. [PMID: 27768389 DOI: 10.1164/rccm.201605-0946oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Platelets are believed to contribute to acute respiratory distress syndrome (ARDS) pathogenesis through inflammatory coagulation pathways. We recently reported that leucine-rich repeat-containing 16A (LRRC16A) modulates baseline platelet counts to mediate ARDS risk. OBJECTIVES To examine the role of LRRC16A in ARDS survival and its mediating effect through platelets. METHODS A total of 414 cases with ARDS from intensive care units (ICUs) were recruited who had exome-wide genotyping data, detailed platelet counts, and follow-up data during ICU hospitalization. Association of LRRC16A single-nucleotide polymorphisms (SNPs) and ARDS prognosis, and the mediating effect of SNPs through platelet counts were analyzed. LRRC16A mRNA expression levels for 39 cases with ARDS were also evaluated. MEASUREMENTS AND MAIN RESULTS Missense SNP rs9358856G>A within LRRC16A was associated with favorable survival within 28 days (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.38-0.87; P = 0.0084) and 60 days (P = 0.0021) after ICU admission. Patients with ARDS who carried the variant genotype versus the wild-type genotype showed an attenuated platelet count decline (∆PLT) within 28 days (difference of ∆PLT, -27.8; P = 0.025) after ICU admission. Patients with ∆PLT were associated with favorable ARDS outcomes. Mediation analysis indicated that the SNP prognostic effect was mediated through ∆PLT within 28 days (28-day survival: HRIndirect, 0.937; 95% CI, 0.918-0.957; P = 0.0009, 11.53% effects mediated; 60-day survival: HRIndirect, 0.919; 95% CI, 0.901-0.936; P = 0.0001, 14.35% effects mediated). Functional exploration suggested that this SNP reduced LRRC16A expression at ICU admission, which was associated with a lesser ∆PLT during ICU hospitalization. CONCLUSIONS LRRC16A appears to mediate ∆PLT after ICU admission to affect the prognosis in patients with ARDS.
Collapse
Affiliation(s)
- Yongyue Wei
- 1 Department of Environmental Health and.,2 Department of Biostatistics, School of Public Health and.,3 China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China; and
| | | | | | - Ruyang Zhang
- 1 Department of Environmental Health and.,2 Department of Biostatistics, School of Public Health and
| | - Feng Chen
- 2 Department of Biostatistics, School of Public Health and.,3 China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China; and
| | - Li Su
- 1 Department of Environmental Health and
| | - Xihong Lin
- 4 Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Ednan K Bajwa
- 5 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B Taylor Thompson
- 5 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David C Christiani
- 1 Department of Environmental Health and.,3 China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China; and.,5 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3
|
Zhao C, Yang X, Su EM, Huang Y, Li L, Matthay MA, Su X. Signals of vagal circuits engaging with AKT1 in α7 nAChR +CD11b + cells lessen E. coli and LPS-induced acute inflammatory injury. Cell Discov 2017; 3:17009. [PMID: 28529765 PMCID: PMC5419718 DOI: 10.1038/celldisc.2017.9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/13/2017] [Indexed: 12/14/2022] Open
Abstract
Vagal circuits-α7 nAChR (α7 nicotinic acetylcholine receptor, coded by Chrna7) signaling utilizes spleen as a hub to dampen systemic inflammatory responses. Vagal innervations also extend to the distal airways and alveoli. Vagotomy and deficiency of α7 nAChR deteriorate E. coli and lipopolysaccharide (LPS)-induced acute lung inflammatory responses; however, the underlying mechanisms remain elusive. Here, we hypothesized that vagal circuits would limit splenic release and lung recruitment of α7 nAChR+CD11b+ cells (CD11b is coded by Itgam, a surface marker of monocytes and neutrophils) via phosphorylation of AKT1 and that this process would define the severity of lung injury. Using both E. coli and LPS-induced lung injury mouse models, we found that vagotomy augmented splenic egress and lung recruitment of α7 nAChR+CD11b+ cells, and consequently worsened lung inflammatory responses. Rescue of vagotomy with an α7 nAChR agonist preserved α7 nAChR+CD11b+ cells in the spleen, suppressed recruitment of these cells to the lung and attenuated lung inflammatory responses. Vagal signals via α7 nAChR promoted serine473 phosphorylation of AKT1 in α7 nAChR+CD11b+ cells and stabilized these cells in the spleen. Deletion of Akt1 enhanced splenic egress and lung recruitment of α7 nAChR+CD11b+ cells, which elicited neutrophil-infiltrated lung inflammation and injury. Vagotomy and double deletion of Chrna7 and Itgam reduced serine473 phosphorylation of AKT1 in the spleen and BAL (bronchoalveolar lavage) Ly6CintGr1hi neutrophils and Ly6Chi monocytes, and they facilitated the recruitment of neutrophils and monocytes to the airspaces of E. coli-injured lungs. Double deletion of Chrna7 and Itgam increased lung recruitment of monocytes and/or neutrophils and deteriorated E. coli and LPS-induced lung injury. Thus, signals of vagal circuits engaging with AKT1 in α7 nAChR+CD11b+ cells attenuate E. coli and LPS-induced acute lung inflammatory responses. Targeting this signaling pathway could provide novel therapeutic strategies for treating acute lung injury.
Collapse
Affiliation(s)
- Caiqi Zhao
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Xi Yang
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Emily M Su
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Yuanyuan Huang
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Ling Li
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Xiao Su
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| |
Collapse
|
4
|
Blom C, Deller BL, Fraser DD, Patterson EK, Martin CM, Young B, Liaw PC, Yazdan-Ashoori P, Ortiz A, Webb B, Kilmer G, Carter DE, Cepinskas G. Human severe sepsis cytokine mixture increases β2-integrin-dependent polymorphonuclear leukocyte adhesion to cerebral microvascular endothelial cells in vitro. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:149. [PMID: 25882865 PMCID: PMC4409718 DOI: 10.1186/s13054-015-0883-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/13/2015] [Indexed: 12/30/2022]
Abstract
Introduction Sepsis-associated encephalopathy (SAE) is a state of acute brain dysfunction in response to a systemic infection. We propose that systemic inflammation during sepsis causes increased adhesion of leukocytes to the brain microvasculature, resulting in blood-brain barrier dysfunction. Thus, our objectives were to measure inflammatory analytes in plasma of severe sepsis patients to create an experimental cytokine mixture (CM), and to use this CM to investigate the activation and interactions of polymorphonuclear leukocytes (PMN) and human cerebrovascular endothelial cells (hCMEC/D3) in vitro. Methods The concentrations of 41 inflammatory analytes were quantified in plasma obtained from 20 severe sepsis patients and 20 age- and sex-matched healthy controls employing an antibody microarray. Two CMs were prepared to mimic severe sepsis (SSCM) and control (CCM), and these CMs were then used for PMN and hCMEC/D3 stimulation in vitro. PMN adhesion to hCMEC/D3 was assessed under conditions of flow (shear stress 0.7 dyn/cm2). Results Eight inflammatory analytes elevated in plasma obtained from severe sepsis patients were used to prepare SSCM and CCM. Stimulation of PMN with SSCM led to a marked increase in PMN adhesion to hCMEC/D3, as compared to CCM. PMN adhesion was abolished with neutralizing antibodies to either β2 (CD18), αL/β2 (CD11α/CD18; LFA-1) or αM/β2 (CD11β/CD18; Mac-1) integrins. In addition, immune-neutralization of the endothelial (hCMEC/D3) cell adhesion molecule, ICAM-1 (CD54) also suppressed PMN adhesion. Conclusions Human SSCM up-regulates PMN pro-adhesive phenotype and promotes PMN adhesion to cerebrovascular endothelial cells through a β2-integrin-ICAM-1-dependent mechanism. PMN adhesion to the brain microvasculature may contribute to SAE.
Collapse
Affiliation(s)
- Chris Blom
- Department of Physiology and Pharmacology, Western University, 1151 Richmond Str. North, London, ON, N6A 5C1, Canada.
| | - Brittany L Deller
- Department of Physiology and Pharmacology, Western University, 1151 Richmond Str. North, London, ON, N6A 5C1, Canada.
| | - Douglas D Fraser
- Department of Physiology and Pharmacology, Western University, 1151 Richmond Str. North, London, ON, N6A 5C1, Canada. .,Children's Health Research Institute, 800 Commissioners Road East, London, ON, N6C 2V5, Canada. .,Centre for Critical Illness Research, Lawson Health Research Institute, 800 Commissioners Rd East, London, ON, N6C 6B5, Canada. .,Department of Paediatrics, Western University, 100 Collip Circle, London, ON, N6G 4X8, Canada. .,Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| | - Eric K Patterson
- Centre for Critical Illness Research, Lawson Health Research Institute, 800 Commissioners Rd East, London, ON, N6C 6B5, Canada.
| | - Claudio M Martin
- Centre for Critical Illness Research, Lawson Health Research Institute, 800 Commissioners Rd East, London, ON, N6C 6B5, Canada. .,Department of Medicine, Western University, 1151 Richmond Str. North, London, ON, N6A 3K6, Canada.
| | - Bryan Young
- Department of Clinical Neurological Sciences, Western University, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| | - Patricia C Liaw
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,The Thrombosis and Atherosclerosis Research Institute, 237 Barton Str. East, Hamilton, ON, L8L 2X2, Canada.
| | - Payam Yazdan-Ashoori
- Department of Physiology and Pharmacology, Western University, 1151 Richmond Str. North, London, ON, N6A 5C1, Canada.
| | - Angelica Ortiz
- Children's Health Research Institute, 800 Commissioners Road East, London, ON, N6C 2V5, Canada.
| | - Brian Webb
- Thermo Fisher Scientific, 3747 N Meridian Rd, Rockford, IL, 61105, USA.
| | - Greg Kilmer
- Thermo Fisher Scientific, 3747 N Meridian Rd, Rockford, IL, 61105, USA.
| | - David E Carter
- London Regional Genomics Centre, Robarts Research Institute, 1151 Richmond Str. North, London, ON, N6A 5B7, Canada.
| | - Gediminas Cepinskas
- Centre for Critical Illness Research, Lawson Health Research Institute, 800 Commissioners Rd East, London, ON, N6C 6B5, Canada. .,Department of Medical Biophysics, Western University, 1151 Richmond Str. North, London, ON, N6A 5C1, Canada.
| |
Collapse
|
5
|
Vagus nerve through α7 nAChR modulates lung infection and inflammation: models, cells, and signals. BIOMED RESEARCH INTERNATIONAL 2014; 2014:283525. [PMID: 25136575 PMCID: PMC4127262 DOI: 10.1155/2014/283525] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 12/27/2022]
Abstract
Cholinergic anti-inflammatory pathway (CAP) bridges immune and nervous systems and plays pleiotropic roles in modulating inflammation in animal models by targeting different immune, proinflammatory, epithelial, endothelial, stem, and progenitor cells and signaling pathways. Acute lung injury (ALI) is a devastating inflammatory disease. It is pathogenically heterogeneous and involves many cells and signaling pathways. Here, we emphasized the research regarding the modulatory effects of CAP on animal models, cell population, and signaling pathways that involved in the pathogenesis of ALI. By comparing the differential effects of CAP on systemic and pulmonary inflammation, we postulated that a pulmonary parasympathetic inflammatory reflex is formed to sense and respond to pathogens in the lung. Work targeting the formation and function of pulmonary parasympathetic inflammatory reflex would extend our understanding of how vagus nerve senses, recognizes, and fights with pathogens and inflammatory responses.
Collapse
|
6
|
Hou S, Ding H, Lv Q, Yin X, Song J, Landén NX, Fan H. Therapeutic effect of intravenous infusion of perfluorocarbon emulsion on LPS-induced acute lung injury in rats. PLoS One 2014; 9:e87826. [PMID: 24489970 PMCID: PMC3905038 DOI: 10.1371/journal.pone.0087826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/31/2013] [Indexed: 11/21/2022] Open
Abstract
Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS) are the leading causes of death in critical care. Despite extensive efforts in research and clinical medicine, mortality remains high in these diseases. Perfluorocarbon (PFC), a chemical compound known as liquid ventilation medium, is capable of dissolving large amounts of physiologically important gases (mainly oxygen and carbon dioxide). In this study we aimed to investigate the effect of intravenous infusion of PFC emulsion on lipopolysaccharide (LPS) induced ALI in rats and elucidate its mechanism of action. Forty two Wistar rats were randomly divided into three groups: 6 rats were treated with saline solution by intratracheal instillation (control group), 18 rats were treated with LPS by intratracheal instillation (LPS group) and the other 18 rats received PFC through femoral vein prior to LPS instillation (LPS+PFC group). The rats in the control group were sacrificed 6 hours later after saline instillation. At 2, 4 and 6 hours of exposure to LPS, 6 rats in the LPS group and 6 rats in LPS+PFC group were sacrificed at each time point. By analyzing pulmonary pathology, partial pressure of oxygen in the blood (PaO2) and lung wet-dry weight ratio (W/D) of each rat, we found that intravenous infusion of PFC significantly alleviated acute lung injury induced by LPS. Moreover, we showed that the expression of pulmonary myeloperoxidase (MPO), intercellular adhesion molecule-1 (ICAM-1) of endothelial cells and CD11b of polymorphonuclear neutrophils (PMN) induced by LPS were significantly decreased by PFC treatment in vivo. Our results indicate that intravenous infusion of PFC inhibits the infiltration of PMNs into lung tissue, which has been shown as the core pathogenesis of ALI/ARDS. Thus, our study provides a theoretical foundation for using intravenous infusion of PFC to prevent and treat ALI/ARDS in clinical practice.
Collapse
Affiliation(s)
- Shike Hou
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Hui Ding
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Qi Lv
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Xiaofeng Yin
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Jianqi Song
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Ning Xu Landén
- Molecular Dermatology Research Group, Center for Molecular Medicine (CMM), Karolinska University Hospital, Stockholm, Sweden
| | - Haojun Fan
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
- * E-mail:
| |
Collapse
|
7
|
A longer duration of polymyxin B-immobilized fiber column hemoperfusion improves pulmonary oxygenation in patients with septic shock. Shock 2010; 32:478-83. [PMID: 19295483 DOI: 10.1097/shk.0b013e3181a2a978] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Endotoxin plays an important role in the pathogenesis of septic shock. Exposure of endothelial cells to endotoxin activates endothelial cells and increases the surface expression of adhesion molecules, markers of endothelial damage in organ dysfunction. Endotoxin adsorption therapy by polymyxin B-immobilized fiber column (PMX) hemoperfusion has been used for the treatment of septic shock patients. In this study, we measured plasma concentrations of endotoxin and soluble adhesion molecules in septic shock patients before and after the PMX treatment then observed on the relationships between actual duration of use and various outcomes. Sixteen patients with septic shock were studied. The 28-day mortality rate was 50%. The elevated plasma concentrations of endotoxin decreased after the PMX treatment in the survivors but not in the nonsurvivors. The norepinephrine dose and plasma concentrations of soluble endothelial leukocyte adhesion molecule 1 and soluble intercellular adhesion molecule 1 significantly (P < 0.05) decreased in the PMX greater-than-2-h (prolonged) group than in the PMX 2-h (conventional) group (-17.8 +/- 14.6 vs. -1.8 +/- 2.7 microg/min, -143.0 +/- 111.0 vs. 0 +/- 2.8 ng/mL, and -126.2 +/- 144.9 vs. 16.5 +/- 108.1 ng/mL, respectively). Changes in the PaO2-FiO2 ratio and the Sequential Organ Failure Assessment score were significantly (P < 0.05) more improved in the PMX greater-than-2-h group than in the PMX 2-h group (75.4 +/- 80.7 vs. 1.2 +/- 49.2 and -0.8 +/- 1.8 vs. 2.2 +/- 1.9 torr, respectively). We thus suggest that a longer duration of PMX treatment may improve the pulmonary oxygenation associated with decreased adhesion molecules in septic shock.
Collapse
|
8
|
Duval-Araujo I, Guimarães Sarmiento MA, Xavier Grossi GC, Rodrigues Simal CJ, do Nascimento VC, Fernandes Diniz SO. Pulmonary phagocyte depression induced by an acid or alkaline solution in a rat model of peritonitis. Surg Infect (Larchmt) 2008; 8:599-604. [PMID: 18171119 DOI: 10.1089/sur.2004.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Peritonitis is a surgical problem with a high mortality rate attributable to various complications, including respiratory infection. This complication is more common under certain conditions reflective of the origin of peritonitis, suggesting that the composition of the peritoneal fluid exerts an influence on the intensity of the macrophage and peritoneal response. To establish a correlation among macrophage function, absorption of bacteria from the peritoneal cavity, and the pH of the peritoneal fluid, we carried out this study. METHODS Thirty female Wistar rats were divided into three equal groups, all of which received infusions of 0.9% saline by parietal puncture. In group A (control), the saline pH was 7.0; in group B, it was 2.5; and in group C, it was 8.5. After 40 min, 0.25 mL of a suspension containing 10(11) colony-forming units of (99m)Tc-labeled Escherichia coli was infused by the same route. After another 40 min, samples of vena caval blood, spleen, liver, and lung were removed; the radioactivity was counted; bacterial absorption was determined; and the proportional radioactivity/g of tissue was calculated. The values were compared among the groups by the Student t-test, with the level of significance set at p < 0.05. RESULTS There was significantly greater bacterial absorption in group B than in group C (p = 0.004) but no differences in the numbers of bacteria in the liver and spleen. Bacteria were significantly more numerous in the peripheral blood in group B than in groups A and C (p = 0.04 for both). Pulmonary phagocytosis was significantly reduced in group B compared with group A (p = 0.008) and group C (p = 0.005). CONCLUSION Peritonitis associated with acidic conditions in the peritoneal cavity is correlated with a reduction in pulmonary phagocytosis and an increase in the numbers of nonphagocytized bacteria in the peripheral blood, possibly representing a direct or indirect cause of the higher incidence of pneumonia and sepsis in these individuals.
Collapse
Affiliation(s)
- Ivana Duval-Araujo
- Postgraduate Surgical Laboratory, Medical School and Radioisotope Laboratory, Pharmaceutical School, Federal University of Minas Gerais, Minas Gerais, Brazil.
| | | | | | | | | | | |
Collapse
|
9
|
van Till JWO, van Veen SQ, van Ruler O, Lamme B, Gouma DJ, Boermeester MA. The innate immune response to secondary peritonitis. Shock 2007; 28:504-17. [PMID: 17589378 DOI: 10.1097/shk.0b013e318063e6ca] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary peritonitis continues to cause high morbidity and mortality despite improvements in medical and surgical therapy. This review combines data from published literature, focusing on molecular patterns of inflammation in pathophysiology and prognosis during peritonitis. Orchestration of the innate immune response is essential. To clear the microbial infection, activation and attraction of leukocytes are essential and beneficial, just like the expression of inflammatory cytokines. Exaggeration of these inflammatory systems leads to tissue damage and organ failure. Nonsurvivors have increased proinflammation, complement activation, coagulation, and chemotaxis. In these patients, anti-inflammatory systems are decreased in blood and lungs, whereas the abdominal compartment shows decreased neutrophil activation and decreased or stationary chemokine and cytokine levels. A later down-regulation of proinflammatory mediators with concomitant overexpression of anti-inflammatory mediators leads to immunoparalysis and failure to clear residual bacterial load, resulting in the occurrence of superimposed infections. Thus, in patients with adverse outcome, the inflammatory reaction is no longer contained within the abdomen, and the inflammatory response has shifted to other compartments. For the understanding of the host response to secondary peritonitis, it is essential to realize that the defense systems presumably are expressed differently and, in part, autonomously in different compartments.
Collapse
Affiliation(s)
- J W Olivier van Till
- Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
10
|
Shi XM, Huang L, Xiong SD, Zhong XY. Protective effect of tanshinone II A on lipopolysaccharide-induced lung injury in rats. Chin J Integr Med 2007; 13:137-40. [PMID: 17609914 DOI: 10.1007/s11655-007-0137-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the protective effect of tanshinone II A on lipopolysaccharide (LPS)-induced lung injury in rats, and possible mechanism. METHODS LPS (O(111): B4) was used to produce a rat model of acute lung injury. Sprague-Dawley rats were randomly divided into 3 groups (8 in each group): the control group, the model group (ALI group), and the tanshinone II A treatment group. Expression of adhesion molecule CD18 on the surface of polymorphonuclear neutrophil (PMNCD18) in venous white blood cells (WBC), and changes in coagulation-anticoagulant indexes were measured 6 h after injection of LPS or normal saline. Changes in malondialdehyde (MDA) content, wet and dry weight (W/D) ratio and morphometry of pulmonary tissue as well as PMN sequestration in the lung were also measured. RESULTS (1) When compared with the control group, expression of PMNCD18 and MDA content were enhanced in the ALI group with a hypercoagulable state (all P<0.01) and an increased W/D ratio (P<0.05). Histopathological morphometry in the lung tissue showed higher PMN sequestration, wider alveolar septa; and lower alveolar volume density (V(V)) and alveolar surface density (S(V)), showing significant difference (P<0.01). (2) When compared with the ALI group, the expression of PMN-CD18, MDA content, and W/D ratio were all lower in Tanshinone II A treatment group (P<0.05) with ameliorated coagulation abnormality (P<0.01). Histopathological morphometry in the lung tissue showed a decrease in the PMN sequestration and the width of alveolar septa (both P<0.01), and an increase in the V(V) and S(V) (P<0.05, P<0.01). CONCLUSION Tan II A plays a protective role in LPS-induced lung injury in rats through improving hypercoagulating state, decreasing PMN-CD18 expression and alleviating migration, reducing lipid peroxidation and alleviating pathological changes.
Collapse
Affiliation(s)
- Xue-Mei Shi
- Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | | | | | | |
Collapse
|
11
|
Di Paola R, Mazzon E, Muià C, Crisafulli C, Genovese T, Di Bella P, Esposito E, Menegazzi M, Meli R, Suzuki H, Cuzzocrea S. Protective effect of Hypericum perforatum in zymosan-induced multiple organ dysfunction syndrome: Relationship to its inhibitory effect on nitric oxide production and its peroxynitrite scavenging activity. Nitric Oxide 2007; 16:118-30. [PMID: 16889996 DOI: 10.1016/j.niox.2006.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 05/23/2006] [Accepted: 05/24/2006] [Indexed: 11/21/2022]
Abstract
Hypericum perforatum is a medicinal plant species containing many polyphenolic compounds, namely flavonoids and phenolic acids. Since polyphenolic compounds have high antioxidant potential, we have investigated the effects of H. perforatum extract on the development of multiple organ dysfunction syndrome caused by zymosan (500 mg/kg, administered i.p. as a suspension in saline) in mice. Organ failure and systemic inflammation in rats was assessed 18 h after administration of zymosan and/or H. perforatum extract and monitored for 12 days (for loss of body weight and mortality). Treatment of mice with H. perforatum extract (30 mg/kg i.p., 1 and 6h after zymosan) attenuated the peritoneal exudation and the migration of polymorphonuclear cells caused by zymosan, pulmonary, intestinal and pancreatic injury, and renal dysfunction as well as the increase in myeloperoxidase in the lung and intestine. Immunohistochemical analysis for inducible nitric oxide synthase (iNOS), nitrotyrosine, and poly(ADP-ribose) (PAR) revealed positive staining in lung and intestine tissues obtained from zymosan-injected mice. The degree of staining for nitrotyrosine, iNOS, and PAR was markedly reduced in tissue sections obtained from zymosan-treated mice, which received H. perforatum extract. In conclusion, this study provides evidence, for the first time, that H. perforatum extract attenuates the degree of zymosan-induced multiple organ dysfunction syndrome in mice.
Collapse
Affiliation(s)
- Rosanna Di Paola
- Department of Clinical and Experimental Medicine and Pharmacology, School of Medicine, University of Messina, Torre Biologica, Policlinico Universitario Via C. Valeria, Gazzi, 98100 Messina, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Langouche L, Vanhorebeek I, Vlasselaers D, Vander Perre S, Wouters PJ, Skogstrand K, Hansen TK, Van den Berghe G. Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 2005; 115:2277-86. [PMID: 16075063 PMCID: PMC1180545 DOI: 10.1172/jci25385] [Citation(s) in RCA: 356] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 06/07/2005] [Indexed: 02/06/2023] Open
Abstract
The vascular endothelium controls vasomotor tone and microvascular flow and regulates trafficking of nutrients and biologically active molecules. When endothelial activation is excessive, compromised microcirculation and subsequent cellular hypoxia contribute to the risk of organ failure. We hypothesized that strict blood glucose control with insulin during critical illness protects the endothelium, mediating prevention of organ failure and death. In this preplanned subanalysis of a large, randomized controlled study, intensive insulin therapy lowered circulating levels of ICAM-1 and tended to reduce E-selectin levels in patients with prolonged critical illness, which reflects reduced endothelial activation. This effect was not brought about by altered levels of endothelial stimuli, such as cytokines or VEGF, or by upregulation of eNOS. In contrast, prevention of hyperglycemia by intensive insulin therapy suppressed iNOS gene expression in postmortem liver and skeletal muscle, possibly in part via reduced NF-kappaB activation, and lowered the elevated circulating NO levels in both survivors and nonsurvivors. These effects on the endothelium statistically explained a significant part of the improved patient outcome with intensive insulin therapy. In conclusion, maintaining normoglycemia with intensive insulin therapy during critical illness protects the endothelium, likely in part via inhibition of excessive iNOS-induced NO release, and thereby contributes to prevention of organ failure and death.
Collapse
Affiliation(s)
- Lies Langouche
- Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Thiel M, Chouker A, Ohta A, Jackson E, Caldwell C, Smith P, Lukashev D, Bittmann I, Sitkovsky MV. Oxygenation inhibits the physiological tissue-protecting mechanism and thereby exacerbates acute inflammatory lung injury. PLoS Biol 2005; 3:e174. [PMID: 15857155 PMCID: PMC1088279 DOI: 10.1371/journal.pbio.0030174] [Citation(s) in RCA: 224] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 03/15/2005] [Indexed: 11/19/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) usually requires symptomatic supportive therapy by intubation and mechanical ventilation with the supplemental use of high oxygen concentrations. Although oxygen therapy represents a life-saving measure, the recent discovery of a critical tissue-protecting mechanism predicts that administration of oxygen to ARDS patients with uncontrolled pulmonary inflammation also may have dangerous side effects. Oxygenation may weaken the local tissue hypoxia-driven and adenosine A2A receptor (A2AR)-mediated anti-inflammatory mechanism and thereby further exacerbate lung injury. Here we report experiments with wild-type and adenosine A2AR-deficient mice that confirm the predicted effects of oxygen. These results also suggest the possibility of iatrogenic exacerbation of acute lung injury upon oxygen administration due to the oxygenation-associated elimination of A2AR-mediated lung tissue-protecting pathway. We show that this potential complication of clinically widely used oxygenation procedures could be completely prevented by intratracheal injection of a selective A2AR agonist to compensate for the oxygenation-related loss of the lung tissue-protecting endogenous adenosine. The identification of a major iatrogenic complication of oxygen therapy in conditions of acute lung inflammation attracts attention to the need for clinical and epidemiological studies of ARDS patients who require oxygen therapy. It is proposed that oxygen therapy in patients with ARDS and other causes of lung inflammation should be combined with anti-inflammatory measures, e.g., with inhalative application of A2AR agonists. The reported observations may also answer the long-standing question as to why the lungs are the most susceptible to inflammatory injury and why lung failure usually precedes multiple organ failure.
Collapse
Affiliation(s)
- Manfred Thiel
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
- 2Clinic of AnaesthesiologyUniversity of MunichGermany
| | - Alexander Chouker
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
- 2Clinic of AnaesthesiologyUniversity of MunichGermany
| | - Akio Ohta
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
- 3New England Inflammation and Tissue Protection Institute, Northeastern UniversityBoston, MassachusettsUnited States of America
| | - Edward Jackson
- 4Pharmacology/Medicine Pittsburgh, University of Pittsburgh School of MedicinePennsylvaniaUnited States of America
| | - Charles Caldwell
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
| | - Patrick Smith
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
| | - Dmitry Lukashev
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
- 3New England Inflammation and Tissue Protection Institute, Northeastern UniversityBoston, MassachusettsUnited States of America
| | - Iris Bittmann
- 5Pathology, Klinikum GrosshadernUniversity of MunichGermany
| | - Michail V Sitkovsky
- 1Laboratory of Immunology, National Institute of Allergy and Infectious DiseasesNational Institutes of Health, Bethesda, MarylandUnited States of America
- 3New England Inflammation and Tissue Protection Institute, Northeastern UniversityBoston, MassachusettsUnited States of America
| |
Collapse
|
14
|
Cuzzocrea S, Rossi A, Serraino I, Di Paola R, Dugo L, Genovese T, Britti D, Sciarra G, De Sarro A, Caputi AP, Sautebin L. Role of 5-lipoxygenase in the multiple organ failure induced by zymosan. Intensive Care Med 2004; 30:1935-43. [PMID: 15241586 DOI: 10.1007/s00134-004-2353-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Accepted: 05/21/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated the role of 5-lipoxygenase in the pathogenesis of multiple organ failure (MOF) induced by zymosan. DESIGN Male mice with a targeted disruption of the 5-lipoxygenase gene (5-LOKO) and littermate wild-type (WT) controls (5-LOWT) were used to evaluate the role of 5-lipoxygenase (5-LO) in the pathogenesis of MOF. SETTING University research laboratory. INTERVENTIONS AND MEASUREMENTS MOF was induced by peritoneal injection of zymosan (500 mg/kg i.p. as a suspension in saline) in 5-LOWT and in 5-LOKO mice. MOF was assessed 18 h after administration of zymosan and monitored for 12 days (for loss of body weight and mortality). RESULTS A severe inflammatory process induced by zymosan administration in WT mice coincided with the damage of lung and small intestine, as assessed by histological examination. Myeloperoxidase activity indicative of neutrophil infiltration and lipid peroxidation were significantly increased in zymosan-treated WT mice. Zymosan in the WT mice also induced a significant increase in the plasma level of nitrite/nitrate. Immunohistochemical examination demonstrated a marked increase in the immunoreactivity to ICAM-1 and P-selectin in the lung and intestine of zymosan-treated WT mice. In contrast, the degree of (a) peritoneal inflammation and tissue injury, (b) upregulation/expression of P-selectin and ICAM-1, and (c) neutrophil infiltration were markedly reduced in intestine and lung tissue obtained from zymosan-treated 5-LO deficient mice. Zymosan-treated 5-LOKO showed also a significantly decreased mortality. CONCLUSIONS These findings clearly demonstrate that 5-LO exerts a role in zymosan-induced nonseptic shock.
Collapse
Affiliation(s)
- Salvatore Cuzzocrea
- Department of Clinical and Experimental Medicine and Pharmacology, Torre Biologica, Policlinico Universitario, 98123 Messina, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Khan HA. Zymosan-induced luminol-dependent chemiluminescence response of circulating and extravasated leukocytes in experimental sepsis. Mediators Inflamm 2004; 13:123-5. [PMID: 15203554 PMCID: PMC1781543 DOI: 10.1080/09629350410001688558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This study examines a concurrent profiling of circulating and extravasated polymorphonuclear leukocytes (PMNs) in a rat model of experimental sepsis. Fecal peritonitis was induced in Wistar male rats by intraperitoneal instillation of a fecal suspension in saline (1:1 w/v). Blood and peritoneal fluid were collected 8 h following fecal inoculation for the evaluation of inflammatory response of PMNs using zymosan-induced luminol-dependent chemiluminescence. Fifty microliters of pre-diluted blood or peritoneal fluid samples were mixed with 150 microl of reaction mixture (4 x 10(-4) M luminol+50 microg opsonized zymosan+0.1% gelatin in Hank's balanced salt solution) and the chemiluminescence signal was measured in a luminometer at 37 degrees C. Fecal peritonitis caused a significant leukocytopenia (3540+/-297 mm(-3) versus control value of 7525+/-711 mm(-3), p < 0.001) accompanied by massive infiltration of PMNs in the peritoneal cavity (34700+/-4006 versus 7325+/-425 mm(-3), p < 0.001). The phagocytic activity of circulating blood PMNs was down-regulated whereas a significant up-regulation was observed in the activity of PMNs from peritoneal fluid. In conclusion, this study clearly demonstrates sepsis-induced alterations in both blood and peritoneal fluid PMNs and their quantitative assessment may be helpful in disease evaluation and designing effective therapies.
Collapse
|
16
|
Abstract
During the past decade, a unifying hypothesis has been developed to explain the vascular changes that occur in septic shock on the basis of the effect of inflammatory mediators on the vascular endothelium. The vascular endothelium plays a central role in the control of microvascular flow, and it has been proposed that widespread vascular endothelial activation, dysfunction and eventually injury occur in septic shock, ultimately resulting in multiorgan failure. This has been characterised in various models of experimental septic shock. Now, direct and indirect evidence for endothelial cell alteration in humans during septic shock is emerging. The present review details recently published literature on this rapidly evolving topic.
Collapse
Affiliation(s)
- Caroline Métais
- Département d'Anesthésie et de Réanimation Chirurgicale, Hôpital Huriez, CHRU Lille, Lille, France
| | | | | |
Collapse
|
17
|
Alexis NE, Eldridge MW, Peden DB. Effect of inhaled endotoxin on airway and circulating inflammatory cell phagocytosis and CD11b expression in atopic asthmatic subjects. J Allergy Clin Immunol 2003; 112:353-61. [PMID: 12897742 DOI: 10.1067/mai.2003.1651] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In a cohort of 8 normal and 10 allergic asthmatic volunteers, we previously reported that inhalation of 5 microg of endotoxin (LPS) induced airway inflammation that correlated with CD14 expression that was, in turn, correlated with eosinophil numbers in the airway. Macrophage and neutrophil functions have been reported to be modified by endotoxin in vitro and in vivo, and response to endotoxin is mediated largely by airway phagocytes and related to allergic inflammation. OBJECTIVE We sought to examine functional and cell-surface phenotype changes in phagocytes recovered from atopic asthmatic subjects after endotoxin challenge. METHODS Sputum and peripheral blood from 10 allergic asthmatic subjects was recovered after saline and LPS challenge. Assessment of phagocytosis and cell-surface phenotype (CD11b, CD14, and CD64) was performed on phagocytes obtained from sputum (n = 7) and blood samples (n = 10). RESULTS Phagocytosis of blood and sputum phagocytes was blunted after LPS challenge in a fashion that correlated with the increase in airway neutrophils after LPS challenge. Cell-surface expression of CD14 (membrane-bound CD14) was increased in sputum cells, whereas CD11b was decreased in sputum and circulating phagocytes. Baseline expression of CD11b in blood correlated with the magnitude of the neutrophil response after LPS inhalation, as well as (inversely) with baseline airway eosinophil levels. CONCLUSIONS Inhalation of endotoxin at levels adequate to induce a neutrophil influx to the airways (but not systemic symptoms) results in decreased phagocytosis in both airway and circulating cells and modifies CD11b expression in a way that implicates its involvement in phagocyte responsiveness to inhaled LPS.
Collapse
Affiliation(s)
- Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, 27599, USA
| | | | | |
Collapse
|
18
|
Gries A, Herr A, Kirsch S, Günther C, Weber S, Szabo G, Holzmann A, Böttiger BW, Martin E. Inhaled nitric oxide inhibits platelet-leukocyte interactions in patients with acute respiratory distress syndrome. Crit Care Med 2003; 31:1697-704. [PMID: 12794407 DOI: 10.1097/01.ccm.0000063446.19696.d3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In addition to its effects on platelet function, recent studies suggest that inhaled nitric oxide (NO) also influences the function of circulating leukocytes. Therefore, the aim of this work was to investigate the formation of platelet-leukocyte aggregates (PLAs) and platelet and leukocyte cell surface receptor expression during NO therapy in patients with acute respiratory distress syndrome. METHODS In 16 patients responding to NO therapy with an improvement in oxygenation (NO group) and in four nonresponders (control), platelet P-selectin expression, platelet fibrinogen binding, the expression CD11a on leukocytes, and the formation of PLAs were investigated at 0, 60, 120, and 180 mins of therapy or at corresponding time points by means of flow cytometry. In addition, PLA was investigated in 30 healthy volunteers during NO inhalation, in five mechanically ventilated patients without acute respiratory distress syndrome and without NO inhalation, and during NO incubation in platelet-rich plasma of ten healthy volunteers in vitro. RESULTS NO therapy inhibited PLA formation at 60 (13% +/- 4% in the NO group vs. 19% +/- 7% in the control group, p <.01) and 120 mins (14% +/- 4% vs. 18% +/- 7%, p <.05) and slightly decreased CD11a expression at 60 mins (152 +/- 22 arbitrary units vs. 187 +/- 36 arbitrary units, p <.05). Furthermore, besides inhibiting platelet fibrinogen binding, NO also led to a significant inhibition of P-selectin expression at 120 (38% +/- 4% vs. 43% +/- 5%, p <.05) and 180 mins (34% +/- 5% vs. 43% +/- 6%, p <.01), demonstrating a significant correlation between changes in P-selectin expression and PLA formation. In contrast, PLA formation was not influenced by mechanical ventilation in patients without acute respiratory distress syndrome. These results were further supported by additional studies showing inhibition of PLA formation in healthy volunteers as well. CONCLUSIONS NO-dependent inhibition of PLA formation in patients with acute respiratory distress syndrome can be explained by the inhibition in platelet P-selectin expression. Thus, this study provides rational evidence of systemic antileukocytic and antiplatelet properties of NO therapy in the clinical setting.
Collapse
Affiliation(s)
- André Gries
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Uchiba M, Okajima K, Kaun C, Binder BR, Wojta J. Gabexate mesilate, a synthetic anticoagulant, inhibits the expression of endothelial leukocyte adhesion molecules in vitro. Crit Care Med 2003; 31:1147-53. [PMID: 12682486 DOI: 10.1097/01.ccm.0000060005.48885.2b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Gabexate mesilate, a synthetic protease inhibitor, has been shown to reduce endotoxin-induced pulmonary vascular injury in an animal model of sepsis by inhibiting leukocyte activation. We examined whether gabexate mesilate inhibits tumor necrosis factor-alpha-induced expression of leukocyte adhesion molecules in cultured endothelial cells. DESIGN Prospective, randomized, controlled study. SETTING Research laboratory at a university medical center. SUBJECTS Cultured human umbilical vein endothelial cell (HUVECs). INTERVENTIONS HUVECs were stimulated with tumor necrosis factor-alpha or lipopolysaccharide in the presence or absence of gabexate mesilate. Expression of E-selectin and intercellular adhesion molecule-1 was measured by cellular enzyme-linked immunosorbent assay. Messenger RNA levels of E-selectin and intercellular adhesion molecule-1 were determined by reverse transcription-polymerase chain reaction. DNA-binding activity of p65 in the nuclear extracts was evaluated by enzyme-linked immunosorbent assay. Nuclear translocation of nuclear factor-kappaB induced by tumor necrosis factor-alpha was evaluated by immunocytostaining and Western blot analysis. Degradation and phosphorylation of inhibitor of nuclear factor-kappaB (IkappaB) induced by tumor necrosis factor-alpha were evaluated by Western blot analysis. MEASUREMENTS AND MAIN RESULTS Gabexate mesilate inhibited the tumor necrosis factor-alpha-induced increases in the endothelial expression of E-selectin and intercellular adhesion molecule-1 by inhibiting the transcription. Tumor necrosis factor-alpha-induced increase in DNA binding of p65 was inhibited by gabexate mesilate through inhibition of the nuclear translocation of p65. Gabexate mesilate inhibited the tumor necrosis factor-alpha-induced degradation of IkappaBalpha, an inhibitor of nuclear factor-kappaB, by inhibiting phosphorylation of IkappaBalpha in HUVECs. CONCLUSIONS Gabexate mesilate inhibited the expression of leukocyte adhesion molecules by inhibiting the nuclear factor-kappaB-mediated transcription in HUVECs. Inhibition of nuclear factor-kappaB activation by gabexate mesilate could be explained by inhibition of degradation of IkappaB. Gabexate mesilate might reduce lipopolysaccharide-induced pulmonary vascular injury not only by inhibiting monocytic tumor necrosis factor-alpha production but by inhibiting the expression of endothelial leukocyte adhesion molecules.
Collapse
Affiliation(s)
- Mitsuhiro Uchiba
- Department of Laboratory Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | | | | | | | | |
Collapse
|
20
|
Vallet B. Bench-to-bedside review: endothelial cell dysfunction in severe sepsis: a role in organ dysfunction? Crit Care 2003; 7:130-8. [PMID: 12720559 PMCID: PMC270612 DOI: 10.1186/cc1864] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
During the past decade a unifying hypothesis has been developed to explain the vascular changes that occur in septic shock on the basis of the effect of inflammatory mediators on the vascular endothelium. The vascular endothelium plays a central role in the control of microvascular flow, and it has been proposed that widespread vascular endothelial activation, dysfunction and eventually injury occurs in septic shock, ultimately resulting in multiorgan failure. This has been characterized in various models of experimental septic shock. Now, direct and indirect evidence for endothelial cell alteration in humans during septic shock is emerging. The present review details recently published literature on this rapidly evolving topic.
Collapse
Affiliation(s)
- Benoît Vallet
- Department of Anesthesiology and Intensive Care, University Hospital, Lille, France.
| |
Collapse
|
21
|
Groeneveld ABJ. Vascular pharmacology of acute lung injury and acute respiratory distress syndrome. Vascul Pharmacol 2002; 39:247-56. [PMID: 12747964 DOI: 10.1016/s1537-1891(03)00013-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) following sepsis, major trauma and surgery are leading causes of respiratory insufficiency, warranting artificial ventilation in the intensive care unit. It is caused by an inflammatory reaction in the lung upon exogenous or endogenous etiologies eliciting proinflammatory factors, and results in increased alveolocapillary permeability and protein-rich alveolar edema. The interstitial and alveolar inflammation and edema alter ventilation perfusion matching, gas exchange and mechanical properties of the lung. The current therapy of the condition is supportive, paying careful attention to fluid balance, relieving the increased work of breathing and improving gas exchange by mechanical ventilation, but in vitro, animal and some clinical research is done to evaluate the value of anti-inflammatory therapies on morbidity and outcome, including inflammatory cell-stabilizing corticosteroids, xanthine derivates, prostanoids and inhibitors, O(2) radical scavenging factors such as N-acetylcysteine, surfactant replacement, vasodilators including inhaled nitric oxide, vasoconstrictors such as almitrine, and others. None of these compounds has been proven to benefit survival in patients, however, even though carrying a physiologic benefit, except perhaps for steroids that may improve outcome in the later stage of ARDS. This partly relates to the difficulty to assess the lung injury at the bedside, to the multifactorial pathogenesis and the severity of comorbidity, adversely affecting survival.
Collapse
Affiliation(s)
- A B Johan Groeneveld
- Department of Intensive Care, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| |
Collapse
|
22
|
Calkins CM, Bensard DD, Partrick DA, Karrer FM, McIntyre RC. Altered neutrophil function in the neonate protects against sepsis-induced lung injury. J Pediatr Surg 2002; 37:1042-7; discussion 1042-7. [PMID: 12077768 DOI: 10.1053/jpsu.2002.33841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Neutrophils (PMNs) are well known effectors of lung injury after sepsis. The accumulation of PMNs into the lung is dependent on a complex cascade of events that includes the local production of chemokines. Interestingly, neonates are protected from lung injury after zymosan-induced sepsis. The authors hypothesized that this protection was caused by either altered PMN function or diminished lung chemokine production compared with the adult. METHODS Sepsis was induced in neonatal and adult rats by an intraperitoneal injection of zymosan. Animals were killed 24 hours later and lungs examined for PMN accumulation and function, chemokine production, and lung injury. RESULTS Septic neonates (SN) were protected from pulmonary edema when compared with septic adults (SA). Lung PMN number and chemokine (MIP-2) production increased in both septic neonates and adults when compared with vehicle (V) treated animals. Conversely, PMN function was decreased significantly in neonates when compared with adults. CONCLUSIONS Despite equivalent lung PMN accumulation and chemotactic protein production, PMN function and lung injury in septic neonates was diminished when compared with that of adults. These findings suggest that neonates may be relatively protected from sepsis-induced lung injury caused by immature PMN function.
Collapse
Affiliation(s)
- Casey M Calkins
- Division of General Surgery, Department of Surgery, University of Colorado Health Sciences Center and The Children's Hospital of Denver, Denver, CO 80262, USA
| | | | | | | | | |
Collapse
|
23
|
|
24
|
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
| |
Collapse
|
25
|
Gao X, Xu N, Sekosan M, Mehta D, Ma SY, Rahman A, Malik AB. Differential role of CD18 integrins in mediating lung neutrophil sequestration and increased microvascular permeability induced by Escherichia coli in mice. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2001; 167:2895-901. [PMID: 11509637 DOI: 10.4049/jimmunol.167.5.2895] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The in vivo contributions of CD18 integrin-dependent and -independent mechanisms in mediating the increases in lung neutrophil (polymorphonuclear leukocyte; PMN) sequestration and microvascular permeability are not well understood. We determined the time course of these responses to Gram-negative sepsis in the mouse lung and addressed the specific contributions of CD18 integrins and ICAM-1. PMN sequestration in the lung was assessed by morphometric analysis, and transalveolar PMN migration was assessed by bronchoalveolar lavage. Lung tissue PMN number increased by 6-fold within 1 h after i.p. Escherichia coli challenge; this value peaked at 3 h (7-fold above control) and decreased at 12 h (3.5-fold above control). PMN migration into the airspace was delayed; the value peaked at 6 h and remained elevated up to 12 h. Saturating concentrations of anti-CD18 and anti-ICAM-1 mAbs reduced lung tissue PMN sequestration and migration; however, peak responses at 3 and 6 h were inhibited by 40%, indicating that only a small component of PMN sequestration and migration was CD18 dependent at these times. In contrast to the time-dependent decreased role of CD18 integrins in mediating PMN sequestration and migration, CD18 and ICAM-1 blockade prevented the increase in lung microvascular permeability and edema formation at all times after E. coli challenge. Thus, Gram-negative sepsis engages CD18/ICAM-1-independent mechanisms capable of the time-dependent amplification of lung PMN sequestration and migration. The increased pulmonary microvascular permeability induced by E. coli is solely the result of engagement of CD18 integrins even when PMN accumulation and migration responses are significantly CD18 independent.
Collapse
Affiliation(s)
- X Gao
- Department of Pharmacology, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVES a) To review endothelial properties and to establish how these unperturbed properties contribute to the maintenance of endothelium anticoagulant activity; b) to better understand the relative contributions of endothelial cells and monocytes in sepsis-induced altered coagulation. DATA SOURCES A summary of published literature from MEDLINE search files and other original articles and reviews published on endothelial cell and monocyte functions and modifications owing to sepsis. DATA EXTRACTION AND SYNTHESIS Unperturbed endothelial cells provide anticoagulant properties; exposure to inflammatory and/or septic stimuli can rapidly lead to procoagulant behavior. Sepsis alters endothelial cell surface and induces tissue factor synthesis at the endothelial and subendothelial levels. During endotoxemia, endothelial cells generate adhesion molecules that bind leukocytes and monocytes, increasing local procoagulant reactions. Tissue factor expression is also increased at the level of the monocyte; the relative importance of endothelial injury and monocyte activation in coagulation disorders was recently assessed. Endothelium protection before induction of septic shock was not associated with any reduction in monocyte tissue factor expression, suggesting that altered coagulation was present despite normal endothelial cell function. On the other hand, decreased monocyte tissue factor expression was associated with a marked reduction in endothelial injury, increased endothelium-derived relaxation, and improved survival rate in treated animals. CONCLUSIONS This review suggests that monocyte activation and tissue factor expression may be of paramount importance in sepsis-associated injuries and that coagulation activation may contribute to the endothelial cell injury observed during sepsis. Endothelial injury, in turn, exacerbates sepsis-induced coagulation abnormalities.
Collapse
Affiliation(s)
- B Vallet
- Department of Anesthesiology and Intensive Care, Lille University Hospital, Fance
| | | |
Collapse
|
27
|
Abstract
The basic physiology of leucocyte emigration from the intravascular space into the tissues is now known to be dependent on a class of cell surface molecules that have come to be known as adhesion molecules. Many cell-cell interactions are dependent on adhesion and signal transduction via the various adhesion molecules, particularly the integrins. The study of the functions of these molecules has been enhanced by the development of blocking and activating monoclonal antibodies, knockout mice, and by the rare "experiments of nature" in the human population, in whom there is absence or dysfunction of one of the adhesion molecules. This review describes these leucocyte adhesion defects and discusses how they have provided important insights into the function of these molecules.
Collapse
Affiliation(s)
- D Inwald
- Portex Department of Anaesthesia, Intensive Care and Respiratory Medicine, Institute of Child Health, London, UK.
| | | | | |
Collapse
|