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Skirecki T, Adamik B, Frostell C, Pasławska U, Zieliński S, Glatzel-Plucińska N, Olbromski M, Dzięgiel P, Gozdzik W. Compartment-Specific Differences in the Activation of Monocyte Subpopulations Are Not Affected by Nitric Oxide and Glucocorticoid Treatment in a Model of Resuscitated Porcine Endotoxemic Shock. J Clin Med 2022; 11:2641. [PMID: 35566768 PMCID: PMC9100570 DOI: 10.3390/jcm11092641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Inhaled nitric oxide (iNO) remains one of the treatment modalities in shock, and in addition to its vasoactive properties, iNO exerts immunomodulatory effects. We used a porcine model of endotoxemia with shock resuscitation (control) and additional treatment with iNO and a steroid (treatment group). After 20 h, bone marrow (BM), peripheral blood (PB), and bronchoalveolar lavage fluid (BALF) were collected to analyze the immunophenotype and mitochondrial membrane potential (Δφ) in three subsets of monocytes. In both groups, SLA-DR expression decreased twofold on the circulating CD14+CD163+ and CD14−CD163+ monocytes, while it did not change on the CD14+CD163+. Δφ increased only in the CD14−CD163+ subpopulation (0.8 vs. 2.0, p < 0.001). The analysis of compartment-specific alterations showed that nearly 100% of BALF CD14+CD163+ and CD14−CD163+ monocytes expressed SLA-DR, and it was higher compared to PB (32% and 20%, p < 0.0001) and BM (93% and 67%, p < 0.001, respectively) counterparts. BALF CD14+CD163+ had a threefold higher Δφ than PB and BM monocytes, while the Δφ of the other subsets was highest in PB monocytes. We confirmed the compartmentalization of the monocyte response during endotoxemic shock, which highlights the importance of studying tissue-resident cells in addition to their circulating counterparts. The iNO/steroid treatment did not further impair monocyte fitness.
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Affiliation(s)
- Tomasz Skirecki
- Laboratory of Flow Cytometry, Centre of Postgraduate Medical Education Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Barbara Adamik
- Clinical Department of the Anaesthesiology and Intensive Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.A.); (S.Z.); (W.G.)
| | - Claes Frostell
- Department of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, 182 57 Stockholm, Sweden;
| | - Urszula Pasławska
- Institute of Veterinary Medicine, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
- Department of Internal Medicine and Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland
| | - Stanisław Zieliński
- Clinical Department of the Anaesthesiology and Intensive Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.A.); (S.Z.); (W.G.)
| | - Natalia Glatzel-Plucińska
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (N.G.-P.); (M.O.); (P.D.)
| | - Mateusz Olbromski
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (N.G.-P.); (M.O.); (P.D.)
| | - Piotr Dzięgiel
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (N.G.-P.); (M.O.); (P.D.)
- Department of Physiotherapy, University School of Physical Education, 51-612 Wroclaw, Poland
| | - Waldemar Gozdzik
- Clinical Department of the Anaesthesiology and Intensive Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.A.); (S.Z.); (W.G.)
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Dhondt L, Croubels S, Temmerman R, De Cock P, Meyer E, Van Den Broeck W, De Paepe P, Devreese M. The Development of a Juvenile Porcine Augmented Renal Clearance Model Through Continuous Infusion of Lipopolysaccharides: An Exploratory Study. Front Vet Sci 2021; 8:639771. [PMID: 33996970 PMCID: PMC8116505 DOI: 10.3389/fvets.2021.639771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 12/29/2022] Open
Abstract
Augmented renal clearance (ARC) as observed in the critically ill (pediatric) population can have a major impact on the pharmacokinetics and posology of renally excreted drugs. Although sepsis has been described as a major trigger in the development of ARC in human critically ill patients, mechanistic insights on ARC are currently lacking. An appropriate ARC animal model could contribute to reveal these underlying mechanisms. In this exploratory study, a state of ARC was induced in 8-week-old piglets. Conscious piglets were continuously infused over 36 h with lipopolysaccharides (LPS) from Escherichia coli (O111:B4) to induce sepsis and subsequently trigger ARC. To study the dose-dependent effect of LPS on the renal function, three different doses (0.75, 2.0, 5.0 μg/kg/h) were administered (two ♂ piglets/dose, one sham piglet), in combination with fluid administration (0.9% NaCl) at 6 ml/kg/h. Single boluses of renal markers, i.e., creatinine [40 mg/kg body weight (BW)], iohexol (64.7 mg/kg BW), and para-aminohippuric acid (PAH, 10 mg/kg BW) were administered intravenously to evaluate the effect of LPS on the renal function. Clinical parameters were monitored periodically. Blood sampling was performed to determine the effect on hematology, neutrophil gelatinase-associated lipocalin, and prostaglandin E2 plasma levels. All piglets that were continuously infused with LPS displayed an elevated body temperature, heart rhythm, and respiratory rate ~1-3 h after start of the infusion. After infusion, considerably higher total body clearances of iohexol, creatinine, and PAH were observed, independent of the administration of LPS and/or its dose. Since also the sham piglet, receiving no LPS, demonstrated a comparable increase in renal function, the contribution of fluid administration to the development of ARC should be further evaluated.
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Affiliation(s)
- Laura Dhondt
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Siska Croubels
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Robin Temmerman
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.,Department of Paediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Evelyne Meyer
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Wim Van Den Broeck
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Peter De Paepe
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Mathias Devreese
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
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Liu Y, Jiang G, Huang X, Li C, Huang X, Zhang X, Lin Q, Liu S, Dai Q. Evaluation of serum antioxidative status, immune status and intestinal condition of Linwu duck challenged by lipopolysaccharide with various dosages and replications. Poult Sci 2021; 100:101199. [PMID: 34116351 PMCID: PMC8193623 DOI: 10.1016/j.psj.2021.101199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
The present study investigated the dosage and replication effects of lipopolysaccharide challenges on the serum oxidative and immune status, and the intestinal morphology and permeability of Linwu ducks at the growing stage. A total of 500 54-day-old Linwu ducks were randomly assigned into 10 treatments, which included a factorial arrangement of 2 levels of LPS challenge replications (1 and 2 times) × 5 levels of lipopolysaccharide challenging dosages (0, 0.1, 0.2, 0.4, and 0.8 mg/kg). Each treatment consisted of 5 cages and 10 ducks per cage. The results showed significant replication effects of LPS on the body weight gain of ducks, that 2 replicates of LPS challenges significantly decreased the body weight gain than one challenge (P = 0.036). Regarding to the serum oxidative and immune status, dosage effects of lipopolysaccharide were found on the serum levels of superoxide dismutase (P = 0.034) and immunoglobulin A (P = 0.007), that 0.4 mg/kg lipopolysaccharides significantly increased the levels of these 2 parameters. Additionally, replication effects were found in the serum levels of interlukin 1β, that 2 replicates of LPS challenges significantly increased the interlukin 1β levels comparing to one challenge (P = 0.010). Regarding to the intestinal conditions, dosage effects of lipopolysaccharides were found on the ratio of villus height and crypt depth (P = 0.005) in duodenum, and the wall thickness of duodenum (P = 0.010) and jejunum (P = 0.001), that lipopolysaccharides at 0.1, 0.2, and 0.8 mg/kg significantly deteriorated the intestinal morphologies, especially in the duodenum and jejunum. Moreover, the dosage effects of lipopolysaccharides and the interactions of dosages and replications significantly influenced the permeabilities of the intestinal segments (P < 0.05). It appeared that 2 replicates of lipopolysaccharides at the dosage at 0.4 mg/kg could trigger oxidative and immunological stress, and damage the intestinal morphology and permeability of Linwu ducks at the growing stage.
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Affiliation(s)
- Yang Liu
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China; College of Animal Science and Technology, Hunan Agriculture University, Changsha 410128, China
| | - Guitao Jiang
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China
| | - Xingguo Huang
- College of Animal Science and Technology, Hunan Agriculture University, Changsha 410128, China
| | - Chuang Li
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China
| | - Xuan Huang
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China
| | - Xu Zhang
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China
| | - Qian Lin
- Institute of Bast Fiber Crops, Chinese Academy of Agricultural Sciences, Changsha 410205, China
| | - Shengli Liu
- Shandong Lonct Enzymes Co., Ltd., Linyi 276000, China
| | - Qiuzhong Dai
- Hunan Institute of Animal and Veterinary Science, Changsha 410131, China.
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Barrueta Tenhunen A, van der Heijden J, Blokhin I, Massaro F, Hansson HA, Feinstein R, Larsson A, Larsson A, Tenhunen J. The antisecretory peptide AF-16 may modulate tissue edema but not inflammation in experimental peritonitis induced sepsis. PLoS One 2020; 15:e0232302. [PMID: 32822373 PMCID: PMC7446908 DOI: 10.1371/journal.pone.0232302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022] Open
Abstract
Sepsis is a life-threatening condition due to a dysregulated immunological response to infection. Apart from source control and broad-spectrum antibiotics, management is based on fluid resuscitation and vasoactive drugs. Fluid resuscitation implicates the risk of volume overload, which in turn is associated with longer stay in intensive care, prolonged use of mechanical ventilation and increased mortality. Antisecretory factor (AF), an endogenous protein, is detectable in most tissues and in plasma. The biologically active site of the protein is located in an 8-peptide sequence, contained in a synthetic 16-peptide fragment, named AF-16. The protein as well as the peptide AF-16 has multiple modulatory effects on abnormal fluid transport and edema formation/resolution as well as in a variety of inflammatory conditions. Apart from its' anti-secretory and anti-inflammatory characteristics, AF is an inhibitor of capillary leakage in intestine. It is not known whether the protein AF or the peptide AF-16 can ameliorate symptoms in sepsis. We hypothesized that AF-16 decreases the degree of hemodynamic instability, the need of fluid resuscitation, vasopressor dose and tissue edema in fecal peritonitis. To test the hypothesis, we induced peritonitis and sepsis by injecting autologous fecal solution into abdominal cavity of anesthetized pigs, and randomized (in a blind manner) the animals to intervention (AF-16, n = 8) or control (saline, n = 8) group. After the onset of hemodynamic instability (defined as mean arterial pressure < 60 mmHg maintained for > 5 minutes), intervention with AF-16 (20 mg/kg (50 mg/ml) in 0.9% saline) intravenously (only the vehicle in the control group) and a protocolized resuscitation was started. We recorded respiratory and hemodynamic parameters hourly for twenty hours or until the animal died and collected post mortem tissue samples at the end of the experiment. No differences between the groups were observed regarding hemodynamics, overall fluid balance, lung mechanics, gas exchange or histology. However, liver wet-to-dry ratio remained lower in AF-16 treated animals as compared to controls, 3.1 ± 0.4, (2.7-3.5, 95% CI, n = 8) vs 4.0 ± 0.6 (3.4-4.5, 95% CI, n = 8), p = 0.006, respectively. Bearing in mind the limited sample size, this experimental pilot study suggests that AF-16 may inhibit sepsis induced liver edema in peritonitis-sepsis.
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Affiliation(s)
- Annelie Barrueta Tenhunen
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Section of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Jaap van der Heijden
- Department of Surgical Sciences, Section of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Ivan Blokhin
- Department of Surgical Sciences, Section of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Fabrizia Massaro
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
- Cardiac Anesthesia and Intensive Care, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Hans Arne Hansson
- Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden
| | - Ricardo Feinstein
- Department of Pathology and Wildlife Diseases, National Veterinary Institute, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Jyrki Tenhunen
- Department of Surgical Sciences, Section of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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5
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Endo Y, Miyasho T, Imahase H, Kawamura Y, Sakamoto Y, Yamashita K. Use of perfusion index to detect hemodynamic changes in endotoxemic pigs. J Vet Emerg Crit Care (San Antonio) 2020; 30:534-542. [PMID: 32652875 DOI: 10.1111/vec.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/23/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The perfusion index (PI) derived from plethysmographic signals provides a noninvasive indication of peripheral perfusion. This study aimed to investigate changes in PI and other hemodynamic variables in pigs subjected to endotoxemia. DESIGN Prospective experimental study. SETTING University teaching hospital. ANIMALS Twelve healthy pigs weighing a mean (± standard deviation [SD]) of 31.7 ± 2.0 kg. INTERVENTIONS Pigs were divided into control and endotoxin groups (n = 6 each). Endotoxemia was induced by IV infusion of lipopolysaccharide. Heart rate, mean arterial pressure, cardiac index (CI), central venous pressure, systemic vascular resistance index (SVRI), extravascular lung water index (ELWI), Global end-diastolic volume (GEDV) index, and pulmonary permeability index were measured using a transpulmonary thermodilution monitor in all pigs. PI was measured using a pulse oximeter probe attached to the tail. Pao2 , Paco2 , and plasma lactate concentration were measured by blood gas analysis. Measurements were taken at baseline (T0 ). Saline or lipopolysaccharide was then administered for 30 min to all pigs (control or endotoxemia group, respectively), and each parameter was measured every 30 min up to 270 min. Data were analyzed by analysis of variance and Student's t-tests. MEASUREMENTS AND MAIN RESULTS There were no significant changes in any variables in the control group, but CI, SVRI, PI, ELWI, blood lactate concentration, and Pao2 changed significantly from baseline in the endotoxin group (P < 0.001, P = 0.0048, P < 0.001, P = 0.0064, P < 0.001, and P = 0.0220, respectively). In the endotoxin group, mean (± SD) %PI increased from T0 to 154 ± 34% at T60 (P = .001) and 135 ± 50% at T90 (P =0 .004), which mirrored significant changes in %CI and %SVRI. CONCLUSION The PI may be useful to detect changes in CI and SVRI.
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Affiliation(s)
- Yusuke Endo
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Taku Miyasho
- Departments of Veterinary Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Hisashi Imahase
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshio Kawamura
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuto Yamashita
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
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6
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Park I, Lee JH, Jang DH, Kim D, Chang H, Kwon H, Kim S, Kim TS, Jo YH. Characterization of Fecal Peritonitis–Induced Sepsis in a Porcine Model. J Surg Res 2019; 244:492-501. [DOI: 10.1016/j.jss.2019.06.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 01/04/2023]
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7
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Liu H, Feye KM, Nguyen YT, Rakhshandeh A, Loving CL, Dekkers JCM, Gabler NK, Tuggle CK. Acute systemic inflammatory response to lipopolysaccharide stimulation in pigs divergently selected for residual feed intake. BMC Genomics 2019; 20:728. [PMID: 31610780 PMCID: PMC6792331 DOI: 10.1186/s12864-019-6127-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background It is unclear whether improving feed efficiency by selection for low residual feed intake (RFI) compromises pigs’ immunocompetence. Here, we aimed at investigating whether pig lines divergently selected for RFI had different inflammatory responses to lipopolysaccharide (LPS) exposure, regarding to clinical presentations and transcriptomic changes in peripheral blood cells. Results LPS injection induced acute systemic inflammation in both the low-RFI and high-RFI line (n = 8 per line). At 4 h post injection (hpi), the low-RFI line had a significantly lower (p = 0.0075) mean rectal temperature compared to the high-RFI line. However, no significant differences in complete blood count or levels of several plasma cytokines were detected between the two lines. Profiling blood transcriptomes at 0, 2, 6, and 24 hpi by RNA-sequencing revealed that LPS induced dramatic transcriptional changes, with 6296 genes differentially expressed at at least one time point post injection relative to baseline in at least one line (n = 4 per line) (|log2(fold change)| ≥ log2(1.2); q < 0.05). Furthermore, applying the same cutoffs, we detected 334 genes differentially expressed between the two lines at at least one time point, including 33 genes differentially expressed between the two lines at baseline. But no significant line-by-time interaction effects were detected. Genes involved in protein translation, defense response, immune response, and signaling were enriched in different co-expression clusters of genes responsive to LPS stimulation. The two lines were largely similar in their peripheral blood transcriptomic responses to LPS stimulation at the pathway level, although the low-RFI line had a slightly lower level of inflammatory response than the high-RFI line from 2 to 6 hpi and a slightly higher level of inflammatory response than the high-RFI line at 24 hpi. Conclusions The pig lines divergently selected for RFI had a largely similar response to LPS stimulation. However, the low-RFI line had a relatively lower-level, but longer-lasting, inflammatory response compared to the high-RFI line. Our results suggest selection for feed efficient pigs does not significantly compromise a pig’s acute systemic inflammatory response to LPS, although slight differences in intensity and duration may occur.
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Affiliation(s)
- Haibo Liu
- Department of Animal Science, Iowa State University, 2258 Kildee Hall, Ames, IA, 50011, USA
| | - Kristina M Feye
- Interdepartmental Immunobiology, Department of Animal Science, Iowa State University, 2258 Kildee Hall, Ames, IA, 50011, USA
| | - Yet T Nguyen
- Department of Mathematics and Statistics, Old Dominion University, Norfolk, VA, 23529, USA
| | - Anoosh Rakhshandeh
- Department of Animal and Food Sciences, Texas Tech University, Lubbock, TX, 79409, USA
| | - Crystal L Loving
- Food Safety and Enteric Pathogens Research Unit, National Animal Disease Center, ARS, USDA, 1920 Dayton Ave, Ames, IA, 50010, USA
| | - Jack C M Dekkers
- Department of Animal Science, Iowa State University, 239 Kildee Hall, Ames, IA, 50011, USA
| | - Nicholas K Gabler
- Department of Animal Science, Iowa State University, 239 Kildee Hall, Ames, IA, 50011, USA
| | - Christopher K Tuggle
- Department of Animal Science, Iowa State University, 2255 Kildee Hall, Ames, IA, 50011, USA.
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Hanslin K, Sjölin J, Skorup P, Wilske F, Frithiof R, Larsson A, Castegren M, Tano E, Lipcsey M. The impact of the systemic inflammatory response on hepatic bacterial elimination in experimental abdominal sepsis. Intensive Care Med Exp 2019; 7:52. [PMID: 31456116 PMCID: PMC6712186 DOI: 10.1186/s40635-019-0266-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/19/2019] [Indexed: 01/29/2023] Open
Abstract
Background Bacterial translocation from the gut has been suggested to induce a systemic inflammatory response syndrome (SIRS) and organ dysfunction. The liver has a pivotal role in eliminating circulating bacteria entering from the gut. We investigated whether pre-existing inflammation affects hepatic bacterial elimination. Methods Fifteen anaesthetised piglets were infused with E. coli in the portal vein for 3 h. The naive group (n = 6) received the bacterial infusion without endotoxin exposure. SIRS (SIRS group, n = 6) was induced by endotoxin infusion 24 h before the bacterial infusion. For effects of anaesthesia, controls (n = 3) received saline instead of endotoxin for 24 h. Bacterial counts and endotoxin levels in the portal and hepatic veins were analysed during bacterial infusion. Results The bacterial killing rate was higher in the naive group compared with the SIRS group (p = 0.001). The ratio of hepatic to portal venous bacterial counts, i.e. the median bacterial influx from the splanchnic circulation, was 0.06 (IQR 0.01–0.11) in the naive group and 0.71 (0.03–1.77) in the SIRS group at 3 h, and a magnitude lower in the naive group during bacteraemia (p = 0.03). Similar results were seen for hepatic endotoxin elimination. Peak log tumour necrosis factor alpha was higher in the naive 4.84 (4.77–4.89) vs. the SIRS group 3.27 (3.26–3.32) mg/L (p < 0.001). Conclusions Our results suggest that hepatic bacterial and endotoxin elimination is impaired in pigs with pre-existing SIRS while the inflammatory response to bacterial infusion is diminished. If similar mechanisms operate in human critical illness, the hepatic elimination of bacteria from the gut could be impaired by SIRS. Electronic supplementary material The online version of this article (10.1186/s40635-019-0266-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katja Hanslin
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Sjölin
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Paul Skorup
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Frida Wilske
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Hedenstierna Laboratory, CIRRUS, Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Section of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Markus Castegren
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Eva Tano
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Hedenstierna Laboratory, CIRRUS, Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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9
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Thorsted A, Bouchene S, Tano E, Castegren M, Lipcsey M, Sjölin J, Karlsson MO, Friberg LE, Nielsen EI. A non-linear mixed effect model for innate immune response: In vivo kinetics of endotoxin and its induction of the cytokines tumor necrosis factor alpha and interleukin-6. PLoS One 2019; 14:e0211981. [PMID: 30789941 PMCID: PMC6383944 DOI: 10.1371/journal.pone.0211981] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/24/2019] [Indexed: 12/29/2022] Open
Abstract
Endotoxin, a component of the outer membrane of Gram-negative bacteria, has been extensively studied as a stimulator of the innate immune response. However, the temporal aspects and exposure-response relationship of endotoxin and resulting cytokine induction and tolerance development is less well defined. The aim of this work was to establish an in silico model that simultaneously captures and connects the in vivo time-courses of endotoxin, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and associated tolerance development. Data from six studies of porcine endotoxemia in anesthetized piglets (n = 116) were combined and used in the analysis, with purified endotoxin (Escherichia coli O111:B4) being infused intravenously for 1–30 h in rates of 0.063–16.0 μg/kg/h across studies. All data were modelled simultaneously by means of importance sampling in the non-linear mixed effects modelling software NONMEM. The infused endotoxin followed one-compartment disposition and non-linear elimination, and stimulated the production of TNF-α to describe the rapid increase in plasma concentration. Tolerance development, observed as declining TNF-α concentration with continued infusion of endotoxin, was also driven by endotoxin as a concentration-dependent increase in the potency parameter related to TNF-α production (EC50). Production of IL-6 was stimulated by both endotoxin and TNF-α, and four consecutive transit compartments described delayed increase in plasma IL-6. A model which simultaneously account for the time-courses of endotoxin and two immune response markers, the cytokines TNF-α and IL-6, as well as the development of endotoxin tolerance, was successfully established. This model-based approach is unique in its description of the time-courses and their interrelation and may be applied within research on immune response to bacterial endotoxin, or in pre-clinical pharmaceutical research when dealing with study design or translational aspects.
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Affiliation(s)
- Anders Thorsted
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Salim Bouchene
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Eva Tano
- Section of Clinical Microbiology and Infectious Medicine, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Markus Castegren
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Division of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Miklós Lipcsey
- Hedenstierna Laboratory, Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jan Sjölin
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mats O. Karlsson
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Lena E. Friberg
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Elisabet I. Nielsen
- Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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10
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Roque K, Shin KM, Jo JH, Lim GD, Song ES, Shin SJ, Gautam R, Lee JH, Kim YG, Cho AR, Kim CY, Kim HJ, Lee MS, Oh HG, Lee BC, Kim JH, Kim KH, Jeong HK, Kim HA, Heo Y. Association between endotoxin levels in dust from indoor swine housing environments and the immune responses of pigs. J Vet Sci 2018; 19:331-338. [PMID: 29366303 PMCID: PMC5974514 DOI: 10.4142/jvs.2018.19.3.331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 11/24/2022] Open
Abstract
Indoor animal husbandry environments are inevitably contaminated with endotoxins. Endotoxin exposure is associated with various inflammatory illnesses in animals. This cross-sectional study evaluated the relationship between the degree of endotoxin exposure and the cellular and humoral immune profiles of fattening pigs. Blood samples were taken from the jugular vein of 47 pigs from ten pig farms in Korea. Whole blood cell counts and plasma immunoglobulin (Ig) classes were determined. Peripheral-blood mononuclear cells were stimulated in vitro with concanavalin A for 48 h, and cytokines released into culture supernatants were measured. The barns in which the pigs lived were assessed for endotoxin levels in the total and respirable dust by using the limulus amebocyte lysate kinetic QCL method. Low and high endotoxin exposures were defined as ≤ 30 and > 30 EU/m3, respectively. Compared to pigs with low endotoxin exposure (n = 19), highly exposed pigs (n = 28) had higher circulating neutrophil and lymphocyte (particularly B cells) counts, IgG and IgE levels, interferon-gamma (IFNγ) and interleukin (IL)-4 productions, and lower IgA levels and tumor necrosis factor-alpha (TNFα) production. The IL-4, IFNγ, and TNFα levels significantly correlated with endotoxin level and/or pig age. Constant exposure of pigs to high levels of airborne endotoxins can lead to aberrant immune profiles.
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Affiliation(s)
- Katharine Roque
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Kyung Min Shin
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Ji Hoon Jo
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Gyeong Dong Lim
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Eun Seob Song
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - So Jung Shin
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Ravi Gautam
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Jae Hee Lee
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Yeon Gyeong Kim
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Ah Rang Cho
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Chang Yul Kim
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Hyun Ji Kim
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
| | - Myung Sook Lee
- Technology Services Division, National Institute of Animal Science, Wanju 55365, Korea
| | - Hyeong-Geu Oh
- Technology Services Division, National Institute of Animal Science, Wanju 55365, Korea
| | - Byung-Chul Lee
- Technology Services Division, National Institute of Animal Science, Wanju 55365, Korea
| | - Jung Hee Kim
- Dodram Pig Farmer's Cooperative, Veterinary Service Center, Daejeon 35352, Korea
| | - Kwang-Ho Kim
- Dodram Pig Farmer's Cooperative, Veterinary Service Center, Daejeon 35352, Korea
| | - Hyun Kyu Jeong
- Dodram Pig Farmer's Cooperative, Veterinary Service Center, Daejeon 35352, Korea
| | - Hyoung Ah Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yong Heo
- Department of Occupational Health, College of Bio-Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Korea
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11
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Xu H, Chen J, Si X, Chen M, Pei F, Qiu C, Wu J, Guan X. PKR inhibition mediates endotoxin tolerance in macrophages through inactivation of PI3K/AKT signaling. Mol Med Rep 2018; 17:8548-8556. [PMID: 29658572 DOI: 10.3892/mmr.2018.8869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/09/2018] [Indexed: 11/05/2022] Open
Abstract
Following long‑term exposure to endotoxins, macrophages enter an immunosuppressive state that renders them unable respond to subsequent exposures to endotoxin, a phenomenon that is termed 'endotoxin tolerance'. Endotoxin tolerance increases the risks of secondary infection and mortality in patients with sepsis. In endotoxin‑tolerant macrophages, the mixed variation of gene transcription is referred to as macrophage reprogramming. The mechanisms underlying macrophage reprogramming remain unclear at present. Interferon‑induced double‑stranded RNA‑dependent protein kinase (PKR) is a widely expressed serine/threonine protein kinase. In addition to antiviral effects, PKR regulates the transcription of inflammatory cytokines by affecting transcription factors. However, the role of PKR in macrophage reprogramming remains to be elucidated. In the present study, the expression of inflammatory cytokines differed in lipopolysaccharide (LPS)‑tolerant RAW264.7 macrophages compared with LPS‑activated macrophages. Specifically, reverse transcription‑quantitative polymerase chain reaction results demonstrated that the mRNA levels of tumor necrosis factor‑α, interleukin‑1β (IL‑1β), C‑X‑C motif chemokine ligand 11, C‑C motif chemokine ligand (CCL17), CCL22 and suppressor of cytokine signaling 3 were decreased, and mRNAs levels of arginase‑1 (Arg1) and nitric oxide synthase 2 (iNOS) were increased, in LPS‑tolerant macrophages compared with LPS‑activated macrophages. Furthermore, western blot analysis demonstrated that the protein levels of phosphorylated (p)‑PKR were significantly decreased in the LPS‑tolerant cells. PKR activation with rotenone (10 µM) abrogated endotoxin tolerance by increasing the levels of the IL‑1β, CCL17 and CCL22 mRNAs and decreasing the levels of the Arg1 and iNOS mRNAs. Furthermore, western blotting demonstrated that AKT was markedly inactivated in endotoxin‑tolerant cells, as indicated by reduced p‑AKT levels. However, levels of p‑AKT were markedly increased following rotenone‑induced PKR activation in endotoxin‑tolerant cells. Ly294002 (10 µM), a phosphatidylinositol‑4,5‑bisphosphate 3‑kinase (PI3K)/AKT signaling inhibitor, partially reversed the rotenone‑induced alleviation of endotoxin tolerance. These results demonstrated that PKR inhibition mediated endotoxin tolerance in macrophages, and these effects were partially mediated by PI3K/AKT signaling. PKR may be a potential target for the treatment of endotoxin tolerance in patients with sepsis.
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Affiliation(s)
- Hailin Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Juan Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xiang Si
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Minying Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Fei Pei
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Chunfang Qiu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
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12
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Endothelial cell tolerance to lipopolysaccharide challenge is induced by monophosphoryl lipid A. Clin Sci (Lond) 2015; 130:451-61. [PMID: 26669797 DOI: 10.1042/cs20150592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/15/2015] [Indexed: 01/18/2023]
Abstract
Prior exposure to lipopolysaccharide (LPS) produces a reduced or "tolerant" inflammatory response to subsequent challenges with LPS, however the potent pro-inflammatory effects of LPS limit its clinical benefit. The adjuvant monophosphoryl lipid A (MPLA) is a weak toll-like receptor 4 (TLR4) agonist that induces negligible inflammation but retains potent immunomodulatory properties. We postulated that pre-treatment with MPLA would inhibit the inflammatory response of endothelial cells to secondary LPS challenge. Human umbilical vein endothelial cells (HUVECs), were exposed to MPLA (10 μg/ml), LPS (100 ng/ml) or vehicle control. HUVECs were then washed and maintained in culture for 24 h before being challenged with LPS (100 ng/ml). Supernatants were collected and examined for cytokine production in the presence or absence of siRNA inhibitors of critical TLR4 signalling proteins. Pre-treatment with MPLA attenuated interleukin (IL)-6 production to secondary LPS challenge to a similar degree as LPS. The application of myeloid differentiation primary response gene 88 (MyD88) siRNA dramatically reduced MPLA-induced tolerance while TIR-domain-containing adapter-inducing interferon-β (TRIF) siRNA had no effect. The tolerant phenotype in endothelial cells was associated with reduced IκB kinase (IKK), p38 and c-Jun N-terminal kinase (JNK) phosphorylation and enhanced IL-1 receptor associated kinase-M (IRAK-M) expression for LPS-primed HUVECs, but less so in MPLA primed cells. Instead, MPLA-primed HUVECs demonstrated enhanced p-extracellular-signal-regulated kinase (ERK) phosphorylation. In contrast with leucocytes in which tolerance is largely TRIF-dependent, MyD88 signalling mediated endotoxin tolerance in endothelial cells. Most importantly, MPLA, a vaccine adjuvant with a wide therapeutic window, induced tolerance to LPS in endothelial cells.
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13
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Julian MW, Strange HR, Ballinger MN, Hotchkiss RS, Papenfuss TL, Crouser ED. Tolerance and Cross-Tolerance following Toll-Like Receptor (TLR)-4 and -9 Activation Are Mediated by IRAK-M and Modulated by IL-7 in Murine Splenocytes. PLoS One 2015. [PMID: 26218271 PMCID: PMC4517781 DOI: 10.1371/journal.pone.0132921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Immune suppression during critical illness predisposes to serious infections. We sought to determine the mechanisms regulating tolerance and cross-tolerance to common pro-inflammatory danger signals in a model that recapitulates the intact in vivo immune response. Materials and Methods Flt3-expanded splenocytes obtained from wild-type or matching IRAK-M knockout (IRAK-M-/-), C57BL/6, male mice (8–10 weeks old) were treated repeatedly or alternately with either LPS or CpGA DNA, agonists of Toll-like receptor (TLR)-4 and -9, respectively, over successive 24-hour periods. Supernatants were collected following each 24-hour period with cytokine release (ELISA) and splenocyte IRAK-M expression (Western blot) determined. Tolerance and cross-tolerance were assessed in the absence or presence of programmed death receptor (PD)-1 blocking antibody or IL-7 pre-treatment. Main Results Splenocytes notably exhibited both tolerance and cross-tolerance to subsequent treatments with either LPS or CpGA DNA. The character of tolerance and cross-tolerance in this model was distinct following initial LPS or CpGA treatment in that TNFα and IFNγ release (not IL-10) were suppressed following LPS; whereas, initial CpGA treatment suppressed TNFα, IFNγ and IL-10 release in response to subsequent stimulation (LPS or CpGA). Tolerance and cross-tolerance were unrelated to IL-10 release or PD-1 but were attenuated in IRAK-M-/- splenocytes. IL-7 significantly suppressed IRAK-M expression and restored TNFα and IFNγ production without influencing IL-10 release. Conclusions In summary, acute immune tolerance and cross-tolerance in response to LPS or CpGA were distinct in that LPS selectively suppressed pro-inflammatory cytokine responses; whereas, CpGA suppressed both pro- and anti-inflammatory responses. The induction of tolerance and cross-tolerance in response to common danger signals was mechanistically unrelated to IL-10 or PD-1 but was directly influenced by IRAK-M expression. IL-7 reduced IRAK-M expression and attenuated immune tolerance induced by either LPS or CpGA, and thus may be useful for reversal of immune tolerance in the setting of critical illness.
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Affiliation(s)
- Mark W. Julian
- Dorothy M. Davis Heart and Lung Research Institute, Division of Pulmonary Allergy, Critical Care, and Sleep Medicine, Wexner Medical Center, Columbus, OH, United States of America
| | - Heather R. Strange
- College of Veterinary Medicine, Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, United States of America
| | - Megan N. Ballinger
- Dorothy M. Davis Heart and Lung Research Institute, Division of Pulmonary Allergy, Critical Care, and Sleep Medicine, Wexner Medical Center, Columbus, OH, United States of America
| | - Richard S. Hotchkiss
- Departments of Anesthesiology, Medicine and Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Tracey L. Papenfuss
- College of Veterinary Medicine, Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, United States of America
| | - Elliott D. Crouser
- Dorothy M. Davis Heart and Lung Research Institute, Division of Pulmonary Allergy, Critical Care, and Sleep Medicine, Wexner Medical Center, Columbus, OH, United States of America
- * E-mail:
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14
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Skorup P, Maudsdotter L, Lipcsey M, Castegren M, Larsson A, Jonsson AB, Sjölin J. Beneficial antimicrobial effect of the addition of an aminoglycoside to a β-lactam antibiotic in an E. coli porcine intensive care severe sepsis model. PLoS One 2014; 9:e90441. [PMID: 24587365 PMCID: PMC3938751 DOI: 10.1371/journal.pone.0090441] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/30/2014] [Indexed: 12/13/2022] Open
Abstract
This study aimed to determine whether the addition of an aminoglycoside to a ß-lactam antibiotic increases the antimicrobial effect during the early phase of Gram-negative severe sepsis/septic shock. A porcine model was selected that considered each animal's individual blood bactericidal capacity. Escherichia coli, susceptible to both antibiotics, was given to healthy pigs intravenously during 3 h. At 2 h, the animals were randomized to a 20-min infusion with either cefuroxime alone (n = 9), a combination of cefuroxime+tobramycin (n = 9), or saline (control, n = 9). Blood samples were collected hourly for cultures and quantitative polymerase chain reaction (PCR). Bacterial growth in the organs after 6 h was chosen as the primary endpoint. A blood sample was obtained at baseline before start of bacterial infusion for ex vivo investigation of the blood bactericidal capacity. At 1 h after the administration of the antibiotics, a second blood sample was taken for ex vivo investigation of the antibiotic-induced blood killing activity. All animals developed severe sepsis/septic shock. Blood cultures and PCR rapidly became negative after completed bacterial infusion. Antibiotic-induced blood killing activity was significantly greater in the combination group than in the cefuroxime group (p<0.001). Growth of bacteria in the spleen was reduced in the two antibiotic groups compared with the controls (p<0.01); no difference was noted between the two antibiotic groups. Bacterial growth in the liver was significantly less in the combination group than in the cefuroxime group (p<0.05). High blood bactericidal capacity at baseline was associated with decreased growth in the blood and spleen (p<0.05). The addition of tobramycin to cefuroxime results in increased antibiotic-induced blood killing activity and less bacteria in the liver than cefuroxime alone. Individual blood bactericidal capacity may have a significant effect on antimicrobial outcome.
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Affiliation(s)
- Paul Skorup
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Lisa Maudsdotter
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Miklós Lipcsey
- Section of Anesthesiology & Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Section of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ann-Beth Jonsson
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Jan Sjölin
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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15
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Sperber J, Lipcsey M, Larsson A, Larsson A, Sjölin J, Castegren M. Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis. PLoS One 2013; 8:e83182. [PMID: 24349457 PMCID: PMC3861481 DOI: 10.1371/journal.pone.0083182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/22/2013] [Indexed: 01/16/2023] Open
Abstract
Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.
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Affiliation(s)
- Jesper Sperber
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Biochemical Structure and Function, Uppsala University, Uppsala, Sweden
| | - Jan Sjölin
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden
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