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An AY, Baghela A, Zhang P, Falsafi R, Lee AH, Trahtemberg U, Baker AJ, dos Santos CC, Hancock REW. Persistence is key: unresolved immune dysfunction is lethal in both COVID-19 and non-COVID-19 sepsis. Front Immunol 2023; 14:1254873. [PMID: 37822940 PMCID: PMC10562687 DOI: 10.3389/fimmu.2023.1254873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Severe COVID-19 and non-COVID-19 pulmonary sepsis share pathophysiological, immunological, and clinical features, suggesting that severe COVID-19 is a form of viral sepsis. Our objective was to identify shared gene expression trajectories strongly associated with eventual mortality between severe COVID-19 patients and contemporaneous non-COVID-19 sepsis patients in the intensive care unit (ICU) for potential therapeutic implications. Methods Whole blood was drawn from 20 COVID-19 patients and 22 non-COVID-19 adult sepsis patients at two timepoints: ICU admission and approximately a week later. RNA-Seq was performed on whole blood to identify differentially expressed genes and significantly enriched pathways. Using systems biology methods, drug candidates targeting key genes in the pathophysiology of COVID-19 and sepsis were identified. Results When compared to survivors, non-survivors (irrespective of COVID-19 status) had 3.6-fold more "persistent" genes (genes that stayed up/downregulated at both timepoints) (4,289 vs. 1,186 genes); these included persistently downregulated genes in T-cell signaling and persistently upregulated genes in select innate immune and metabolic pathways, indicating unresolved immune dysfunction in non-survivors, while resolution of these processes occurred in survivors. These findings of persistence were further confirmed using two publicly available datasets of COVID-19 and sepsis patients. Systems biology methods identified multiple immunomodulatory drug candidates that could target this persistent immune dysfunction, which could be repurposed for possible therapeutic use in both COVID-19 and sepsis. Discussion Transcriptional evidence of persistent immune dysfunction was associated with 28-day mortality in both COVID-19 and non-COVID-19 septic patients. These findings highlight the opportunity for mitigating common mechanisms of immune dysfunction with immunomodulatory therapies for both diseases.
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Affiliation(s)
- Andy Y. An
- Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Arjun Baghela
- Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Peter Zhang
- Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Reza Falsafi
- Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Amy H. Lee
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Uriel Trahtemberg
- Keenan Research Center for Biomedical Science and the Department of Critical Care, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Department of Critical Care, Galilee Medical Center, Nahariya, Israel
| | - Andrew J. Baker
- Keenan Research Center for Biomedical Science and the Department of Critical Care, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Claudia C. dos Santos
- Keenan Research Center for Biomedical Science and the Department of Critical Care, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert E. W. Hancock
- Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
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Barrueta Tenhunen A, van der Heijden J, Dogné S, Flamion B, Weigl W, Frithiof R, Skorup P, Larsson A, Larsson A, Tenhunen J. HIGH-MOLECULAR-WEIGHT HYALURONAN-A POTENTIAL ADJUVANT TO FLUID RESUSCITATION IN ABDOMINAL SEPSIS? Shock 2023; 59:763-770. [PMID: 36809365 PMCID: PMC10125108 DOI: 10.1097/shk.0000000000002089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
ABSTRACT While fluid resuscitation is fundamental in the treatment of sepsis-induced tissue hypoperfusion, a sustained positive fluid balance is associated with excess mortality. Hyaluronan, an endogenous glycosaminoglycan with high affinity to water, has not been tested previously as adjuvant to fluid resuscitation in sepsis. In a prospective, parallel-grouped, blinded model of porcine peritonitis sepsis, we randomized animals to intervention with adjuvant hyaluronan (add-on to standard therapy, n = 8) or 0.9% saline (n = 8). After the onset of hemodynamic instability, the animals received an initial bolus of 0.1% hyaluronan (1 mg/kg/10 min) or placebo (0.9% saline) followed by a continuous infusion of 0.1% hyaluronan (1 mg/kg/h) or saline during the experiment. We hypothesized that the administration of hyaluronan would reduce the volume of fluid administered (aiming at stroke volume variation <13%) and/or attenuate the inflammatory reaction. Total volumes of intravenous fluids infused were 17.5 ± 11 versus 19.0 ± 7 mL/kg/h in intervention and control groups, respectively ( P = 0.442). Plasma IL-6 increased to 2,450 (1,420-6,890) pg/mL and 3,690 (1,410-11,960) pg/mL (18 hours of resuscitation) in the intervention and control groups (nonsignificant). The intervention counteracted the increase in proportion of fragmented hyaluronan associated with peritonitis sepsis (mean peak elution fraction [18 hours of resuscitation] intervention group: 16.8 ± 0.9 versus control group: 17.9 ± 0.6 [ P = 0.031]). In conclusion, hyaluronan did not reduce the volume needed for fluid resuscitation or decrease the inflammatory reaction, even though it counterbalanced the peritonitis-induced shift toward increased proportion of fragmented hyaluronan.
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Affiliation(s)
- Annelie Barrueta Tenhunen
- Division of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jaap van der Heijden
- Division of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sophie Dogné
- Molecular Physiology Research Unit (URPhyM), Namur Research Institute for Life Sciences (NARILIS), University of Namur (Unamur), Namur, Belgium
| | - Bruno Flamion
- Molecular Physiology Research Unit (URPhyM), Namur Research Institute for Life Sciences (NARILIS), University of Namur (Unamur), Namur, Belgium
| | - Wojciech Weigl
- Division of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Division of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Paul Skorup
- Department of Medical Sciences, Division of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Division of Clinical Chemistry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jyrki Tenhunen
- Division of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Plasma hyaluronan, hyaluronidase activity and endogenous hyaluronidase inhibition in sepsis: an experimental and clinical cohort study. Intensive Care Med Exp 2021; 9:53. [PMID: 34632531 PMCID: PMC8502523 DOI: 10.1186/s40635-021-00418-3] [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: 10/04/2020] [Accepted: 09/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Plasma hyaluronan concentrations are increased during sepsis but underlying mechanisms leading to high plasma hyaluronan concentration are poorly understood. In this study we evaluate the roles of plasma hyaluronan, effective plasma hyaluronidase (HYAL) activity and its endogenous plasma inhibition in clinical and experimental sepsis. We specifically hypothesized that plasma HYAL acts as endothelial glycocalyx shedding enzyme, sheddase. Methods Plasma hyaluronan, effective HYAL activity and HYAL inhibition were measured in healthy volunteers (n = 20), in patients with septic shock (n = 17, day 1 and day 4), in patients with acute pancreatitis (n = 7, day 1 and day 4) and in anesthetized and mechanically ventilated pigs (n = 16). Sixteen pigs were allocated (unblinded, open label) into three groups: Sepsis-1 with infusion of live Escherichia coli (E. coli) 1 × 108 CFU/h of 12 h (n = 5), Sepsis-2 with infusion of E. coli 1 × 108 CFU/h of 6 h followed by 1 × 109 CFU/h of the remaining 6 h (n = 5) or Control with no E. coli infusion (n = 6). Results In experimental E. coli porcine sepsis and in time controls, plasma hyaluronan increases with concomitant decrease in effective plasma HYAL activity and increase of endogenous HYAL inhibition. Plasma hyaluronan increased in patients with septic shock but not in acute pancreatitis. Effective plasma HYAL was lower in septic shock and acute pancreatitis as compared to healthy volunteers, while plasma HYAL inhibition was only increased in septic shock. Conclusion Elevated plasma hyaluronan levels coincided with a concomitant decrease in effective plasma HYAL activity and increase of endogenous plasma HYAL inhibition both in experimental and clinical sepsis. In acute pancreatitis, effective plasma HYAL activity was decreased which was not associated with increased plasma hyaluronan concentrations or endogenous HYAL inhibition. The results suggest that plasma HYAL does not act as sheddase in sepsis or pancreatitis. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-021-00418-3.
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Holdom CJ, Ngo ST, McCombe PA, Henderson RD, Steyn FJ. Low plasma hyaluronan is associated with faster functional decline in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:42-48. [PMID: 34569358 DOI: 10.1080/21678421.2021.1918721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Hyaluronan, a glycosaminoglycan that forms a major constituent of the extracellular matrix, has been shown to be increased in the serum of patients with amyotrophic lateral sclerosis (ALS) with longer disease duration. We sought to determine whether measures of venous hyaluronan may serve as a predictive marker for disease progression in patients with ALS. Methods: Sixty-two patients with ALS, and 59 healthy control participants provided a plasma sample for the assessment of hyaluronan. Hyaluronan was compared against functional measures of disability, disease progression, and survival. Results: Hyaluronan was lower in patients with ALS when compared to healthy controls. Plasma hyaluronan was positively correlated with the change in the revised ALS functional rating scale, ΔFRS. Hyaluronan was also found to improve the prognostic power of the ΔFRS. Conclusion: Hyaluronan may serve as a predictive marker for functional decline in patients with ALS. Longitudinal studies are needed to fully explore the prognostic value of hyaluronan as a biomarker for disease progression, and to improve our understanding of components of the extracellular matrix specific to the pathophysiology of ALS.
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Affiliation(s)
- Cory J Holdom
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Shyuan T Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia, and
| | - Pamela A McCombe
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia, and
| | - Robert D Henderson
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia, and
| | - Frederik J Steyn
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia, and.,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
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Jensen JUS, Peters L, Itenov TS, Bestle M, Thormar KM, Mohr TT, Lundgren B, Grarup J, Lundgren JD. Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients. Clin Chem Lab Med 2020; 57:1422-1431. [PMID: 30951497 DOI: 10.1515/cclm-2018-1350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/04/2019] [Indexed: 01/30/2023]
Abstract
Background The prognostic impact of mild/moderate liver impairment among critically ill patients is not known. We aimed to determine whether acute liver impairment, as measured by several biomarkers, (i) is frequent, (ii) influences prognosis and (iii) to determine whether such an effect is specific for infected critically ill patients. Methods A biomarker and clinical cohort study based on a randomized controlled trial. All-cause mortality was the primary endpoint. Biomarkers hyaluronic acid (HA), bilirubin, albumin, alkaline phosphatase and the international normalized ratio (INR) were determined. Multivariable statistics were applied to estimate risk increase according to liver biomarker increase at baseline and the model was adjusted for age, APACHE II, severe sepsis/septic shock vs. milder infection, chronic alcohol abuse Charlson's co-morbidity index, cancer disease, surgical or medical patient, body mass index, sex, estimated glomerular filtration rate, mechanical ventilation and the other biomarkers. Time-to-event graphs were used. The patients were critically ill patients (n = 1096) from nine mixed medical/surgical intensive care units without known hepatobiliary disease. Results HA levels differed between infected patients (median 210.8 ng/mL [IQR: 93.2-556.6]) vs. the non-infected (median 56.8 ng/mL [IQR: 31.9-116.8], p < 0.001). Serum HA quartiles 2, 3 and 4 were independent predictors of 90-day all-cause mortality for the entire population (infected and non-infected). However, the signal was driven by the infected patients (positive interaction test, no signal in non-infected patients). Among infected patients, HA quartiles corresponded directly to the 90-day risk of dying: 1st quartile: 57/192 = 29.7%, 2nd quartile: 84/194 = 43.3%, 3rd quartile: 90/193 = 46.6%, 4th quartile: 101/192 = 52.3 %, p for trend: <0.0001. This finding was confirmed in adjusted analyses: hazard ratio vs. 1st quartile: 2nd quartile: 1.3 [0.9-1.8], p = 0.14, 3rd quartile: 1.5 [1.1-2.2], p = 0.02, 4th quartile: 1.9 [1.3-2.6], p < 0.0001). High bilirubin was also an independent predictor of mortality. Conclusions Among infected critically ill patients, subtle liver impairment, (elevated HA and bilirubin), was associated with a progressive and highly increased risk of death for the patient; this was robust to adjustment for other predictors of mortality. HA can identify patients at high risk.
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Affiliation(s)
- Jens-Ulrik Stæhr Jensen
- CHIP & PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Copenhagen, Denmark.,Department of Internal Medicine C, Respiratory Medicine Section, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Lars Peters
- CHIP & PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Copenhagen, Denmark
| | - Theis S Itenov
- CHIP & PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Copenhagen, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Hillerød, Denmark
| | - Morten Bestle
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Hillerød, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Glostrup, Denmark
| | - Katrin M Thormar
- Department of Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Gentofte, Denmark
| | - Thomas T Mohr
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Glostrup, Denmark.,Department of Anesthesia and Intensive Care, Copenhagen University Hospital, Gentofte, Denmark
| | - Bettina Lundgren
- Diagnostic Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Jesper Grarup
- CHIP & PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Copenhagen, Denmark
| | - Jens D Lundgren
- CHIP & PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen and University of Copenhagen, Copenhagen, Denmark
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Immunomodulatory activity of hyaluronidase is associated with metabolic adaptations during acute inflammation. Inflamm Res 2019; 69:105-113. [DOI: 10.1007/s00011-019-01297-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/10/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022] Open
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Wang RJ, Moore J, Moisi D, Chang EG, Byanyima P, Kaswabuli S, Musisi E, Sanyu I, Sessolo A, Lalitha R, Worodria W, Davis JL, Crothers K, Lin J, Lederman MM, Hunt PW, Huang L. HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia. PLoS One 2019; 14:e0216680. [PMID: 31091258 PMCID: PMC6519791 DOI: 10.1371/journal.pone.0216680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/08/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Pneumonia is an important cause of morbidity and mortality in persons living with human immunodeficiency virus (HIV) infection. How immune activation differs among HIV-infected and HIV-uninfected adults with pneumonia is unknown. METHODS The Inflammation, Aging, Microbes, and Obstructive Lung Disease (I AM OLD) Cohort is a prospective cohort of adults with pneumonia in Uganda. In this cross-sectional analysis, plasma was collected at pneumonia presentation to measure the following 12 biomarkers: interleukin 6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2), high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, soluble CD27 (sCD27), interferon gamma-inducible protein 10 (IP-10), soluble CD14 (sCD14), soluble CD163 (sCD163), hyaluronan, and intestinal fatty acid binding protein. We asked whether biomarker levels differed between HIV-infected and HIV-uninfected participants, and whether higher levels of these biomarkers were associated with mortality. RESULTS One hundred seventy-three participants were enrolled. Fifty-three percent were HIV-infected. Eight plasma biomarkers-sTNFR-1, sTNFR-2, hsCRP, D-dimer, sCD27, IP-10, sCD14, and hyaluronan-were higher among participants with HIV infection, after adjustment for pneumonia severity. Higher levels of 8 biomarkers-IL-6, sTNFR-1, sTNFR-2, hsCRP, IP-10, sCD14, sCD163, and hyaluronan-were associated with increased 2-month mortality. CONCLUSIONS As in other clinical contexts, HIV infection is associated with a greater degree of immune activation among Ugandan adults with pneumonia. Some of these are also associated with short-term mortality. Further study is needed to explore whether these biomarkers might predict poor long-term outcomes-such as the development of obstructive lung disease-in patients with HIV who have recovered from pneumonia.
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Affiliation(s)
- Richard J. Wang
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (RW); (LH)
| | - Julia Moore
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Daniela Moisi
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Emily G. Chang
- Department of Statistics, University of California Davis, Davis, California, United States of America
| | - Patrick Byanyima
- Makerere University – University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Sylvia Kaswabuli
- Makerere University – University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Emmanuel Musisi
- Makerere University – University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Ingvar Sanyu
- Makerere University – University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Abdulwahab Sessolo
- Makerere University – University of California San Francisco Research Collaboration, Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Rejani Lalitha
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - J. Lucian Davis
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, United States of America
| | - Michael M. Lederman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Peter W. Hunt
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Laurence Huang
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail: (RW); (LH)
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Smart L, Bosio E, Macdonald SP, Dull R, Fatovich DM, Neil C, Arendts G. Glycocalyx biomarker syndecan-1 is a stronger predictor of respiratory failure in patients with sepsis due to pneumonia, compared to endocan. J Crit Care 2018; 47:93-98. [DOI: 10.1016/j.jcrc.2018.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022]
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Nakstad B. The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS). Infect Drug Resist 2018; 11:359-368. [PMID: 29563816 PMCID: PMC5848841 DOI: 10.2147/idr.s155965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction A key challenge in identifying serious bacterial infection in new born infants is the nonspecific clinical presentation of early-onset neonatal sepsis (EONS). Routinely used C-reactive protein, white blood cell count, and platelets are nonspecific. We assessed the diagnostic utility of single biomarkers or combinations of procalcitonin (PCT), interleukin (IL)-6, IL-8, and hyaluronic acid (HA) in newborn infant with EONS, and in human umbilical cord blood (HUCB) from deliveries with chorioamnionitis. Materials and methods Blood was collected from term infants with strictly defined EONS (group 1, n=15), healthy term infants (group 2, n=15), and the umbilical vein from pregnancies with suspected chorioamnionitis (group 3, n=8), and from healthy pregnancies with no signs of infection (group 4, n=15). Results Neonatal plasma PCT and IL-8 showed good predictive value (90% and 83%) for EONS, and the combination of IL-6 or HA with PCT increased the predictability to 87% and 90%, respectively. PCT, IL-6, IL-8, and HA were 8.4-, 4.5-, 3.6-, and 1.9-fold higher when compared with plasma levels in noninfected neonates. PCT, IL-6, and IL-8 in HUCB predicted chorioamnionitis and fever in the delivering mother (89%, 83%, and 72%, respectively). HA was a poor predictor (59%), but its predictability increased in combination with PCT, IL-8, or IL-6. In HUCB from chorioamnionitic deliveries, IL-6, IL-8, and PCT were 23-, 14-, and 2.4-fold higher, respectively, when compared with HUCB from healthy deliveries. There was no correlation between C-reactive protein, white blood cell, and platelet count with PCT, IL-6, IL-8, or HA. Conclusion In neonates that fulfilled the Norwegian consensus definition of neonatal sepsis, PCT, IL-6, and IL-8, but not HA, have the potential to improve our management of neonates at risk. Except for PCT and IL-8, both with a predictability of >80% in neonatal plasma, combinations of biomarkers increased the predictability for EONS and chorioamnionitis.
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Affiliation(s)
- Britt Nakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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10
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Smart L, Macdonald SP, Burrows S, Bosio E, Arendts G, Fatovich DM. Endothelial glycocalyx biomarkers increase in patients with infection during Emergency Department treatment. J Crit Care 2017; 42:304-309. [DOI: 10.1016/j.jcrc.2017.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/17/2017] [Accepted: 07/01/2017] [Indexed: 12/12/2022]
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Lykiardopoulos B, Hagström H, Fredrikson M, Ignatova S, Stål P, Hultcrantz R, Ekstedt M, Kechagias S. Development of Serum Marker Models to Increase Diagnostic Accuracy of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: The New LINKI Algorithm Compared with Established Algorithms. PLoS One 2016; 11:e0167776. [PMID: 27936091 PMCID: PMC5147971 DOI: 10.1371/journal.pone.0167776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/21/2016] [Indexed: 12/28/2022] Open
Abstract
Background and Aim Detection of advanced fibrosis (F3-F4) in nonalcoholic fatty liver disease (NAFLD) is important for ascertaining prognosis. Serum markers have been proposed as alternatives to biopsy. We attempted to develop a novel algorithm for detection of advanced fibrosis based on a more efficient combination of serological markers and to compare this with established algorithms. Methods We included 158 patients with biopsy-proven NAFLD. Of these, 38 had advanced fibrosis. The following fibrosis algorithms were calculated: NAFLD fibrosis score, BARD, NIKEI, NASH-CRN regression score, APRI, FIB-4, King´s score, GUCI, Lok index, Forns score, and ELF. Study population was randomly divided in a training and a validation group. A multiple logistic regression analysis using bootstrapping methods was applied to the training group. Among many variables analyzed age, fasting glucose, hyaluronic acid and AST were included, and a model (LINKI-1) for predicting advanced fibrosis was created. Moreover, these variables were combined with platelet count in a mathematical way exaggerating the opposing effects, and alternative models (LINKI-2) were also created. Models were compared using area under the receiver operator characteristic curves (AUROC). Results Of established algorithms FIB-4 and King´s score had the best diagnostic accuracy with AUROCs 0.84 and 0.83, respectively. Higher accuracy was achieved with the novel LINKI algorithms. AUROCs in the total cohort for LINKI-1 was 0.91 and for LINKI-2 models 0.89. Conclusion The LINKI algorithms for detection of advanced fibrosis in NAFLD showed better accuracy than established algorithms and should be validated in further studies including larger cohorts.
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Affiliation(s)
- Byron Lykiardopoulos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Simone Ignatova
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Stål
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ekstedt
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Stergios Kechagias
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
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Pertoft H, Alston-Smith J, Fraser J, Laurent T. Hyaluronan accumulates around portal vessels in liver after endotoxin treatment of rats. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199500200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Livers of normal rats and rats treated with lipopolysaccharide from Escherichia coli were isolated in situ and tested for capability to extract [3H]-hyaluronan. In control livers, excess unlabeled hyaluronan inhibited extraction of [3H]-hyaluronan both at 4°C and 37°C. Furthermore, part of the [3H]-hyaluronan extracted at 4°C could be released by subsequent perfusion with excess of unlabeled hyaluronan. This behaviour is in accordance with the well-characterized receptor-mediated uptake of hyaluronan in sinusoidal endothelial cells. However, in lipopolysaccharide-treated animals, the uptake of [3H]-hyaluronan was not inhibited by unlabelled polysaccharide, nor could [3H]-hyaluronan bound at 4°C be released from its binding sites. Both types of livers were perfused with 10 μg/ml of hyaluronan and recovered for histology. An accumulation of hyaluronan in areas around portal veins was found in endotoxin treated rats, while only traces of hyaluronan could be visualized in the vessels of normal livers. The location of hyaluronan coincided with cell infiltrates. Thus, there is a different mechanism for liver clearance of hyaluronan in the endotoxic animal.
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Affiliation(s)
- H. Pertoft
- Institute of Medical and Physiological Chemistry, University of Uppsala, Biomedical Center, Uppsala, Sweden, Laboratory for Fetal and Neonatal Immunology, Faculty of Veterinary Science, Melbourne University, Victoria, Australia
| | - J. Alston-Smith
- Institute of Medical and Physiological Chemistry, University of Uppsala, Biomedical Center, Uppsala, Sweden, Laboratory for Fetal and Neonatal Immunology, Faculty of Veterinary Science, Melbourne University, Victoria, Australia
| | - J.R.E. Fraser
- Institute of Medical and Physiological Chemistry, University of Uppsala, Biomedical Center, Uppsala, Sweden, Laboratory for Fetal and Neonatal Immunology, Faculty of Veterinary Science, Melbourne University, Victoria, Australia
| | - T.C. Laurent
- Institute of Medical and Physiological Chemistry, University of Uppsala, Biomedical Center, Uppsala, Sweden, Laboratory for Fetal and Neonatal Immunology, Faculty of Veterinary Science, Melbourne University, Victoria, Australia
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Colbert JF, Schmidt EP. Endothelial and Microcirculatory Function and Dysfunction in Sepsis. Clin Chest Med 2016; 37:263-75. [PMID: 27229643 DOI: 10.1016/j.ccm.2016.01.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The microcirculation is a series of arterioles, capillaries, and venules that performs essential functions of oxygen and nutrient delivery, customized to the unique physiologic needs of the supplied organ. The homeostatic microcirculatory response to infection can become harmful if overactive and/or dysregulated. Pathologic microcirculatory dysfunction can be directly visualized by intravital microscopy or indirectly measured via detection of circulating biomarkers. Although several treatments have been shown to protect the microcirculation during sepsis, they have not improved patient outcomes when applied indiscriminately. Future outcomes-oriented studies are needed to test sepsis therapeutics when personalized to a patient's microcirculatory dysfunction.
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Affiliation(s)
- James F Colbert
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Eric P Schmidt
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, University of Colorado School of Medicine, 12700 E. 19th Avenue, Aurora, CO 80045, USA.
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Aya KL, Stern R. Hyaluronan in wound healing: rediscovering a major player. Wound Repair Regen 2015; 22:579-93. [PMID: 25039417 DOI: 10.1111/wrr.12214] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 07/11/2014] [Indexed: 12/12/2022]
Abstract
Wound healing involves a series of carefully modulated steps, from initial injury and blood clot to the final reconstituted tissue or scar. A dynamic reciprocity exists throughout between the wound, blood elements, extracellular matrix, and cells that participate in healing. Multiple cytokines and signal transduction pathways regulate these reactions. A major component throughout most of the process is hyaluronan, a straight-chain carbohydrate extracellular matrix polymer. Hyaluronan occurs in multiple forms, chain length being the only distinguishing characteristic between them. Levels of hyaluronan in its high-molecular-weight form are prominent in the earliest stages of wound repair. Progressively more fragmented forms occur in a manner not previously appreciated. We outline here steps in the wound healing cascade in which hyaluronan participates, as well as providing a review of its metabolism. Although described by necessity in a series of quantum steps, the healing process is constituted by a smooth continuum of overlapping reactions. The prevalence of hyaluronan in the wound (initially termed "hexosamine-containing mucopolysaccharide"), particularly in its early stages, was pointed out over half a century ago by the Harvard surgeon J. Engelbert Dunphy. It appears we are now returning to where we started.
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Affiliation(s)
- Kessiena L Aya
- Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, New York, New York
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Parlato M, Cavaillon JM. Host response biomarkers in the diagnosis of sepsis: a general overview. Methods Mol Biol 2015; 1237:149-211. [PMID: 25319788 DOI: 10.1007/978-1-4939-1776-1_15] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Critically ill patients who display a systemic inflammatory response syndrome (SIRS) are prone to develop nosocomial infections. The challenge remains to distinguish as early as possible among SIRS patients those who are developing sepsis. Following a sterile insult, damage-associated molecular patterns (DAMPs) released by damaged tissues and necrotic cells initiate an inflammatory response close to that observed during sepsis. During sepsis, pathogen-associated molecular patterns (PAMPs) trigger the release of host mediators involved in innate immunity and inflammation through identical receptors as DAMPs. In both clinical settings, a compensatory anti-inflammatory response syndrome (CARS) is concomitantly initiated. The exacerbated production of pro- or anti-inflammatory mediators allows their detection in biological fluids and particularly within the bloodstream. Some of these mediators can be used as biomarkers to decipher among the patients those who developed sepsis, and eventually they can be used as prognosis markers. In addition to plasma biomarkers, the analysis of some surface markers on circulating leukocytes or the study of mRNA and miRNA can be helpful. While there is no magic marker, a combination of few biomarkers might offer a high accuracy for diagnosis.
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Affiliation(s)
- Marianna Parlato
- Unit of Cytokines and Inflammation, Institut Pasteur, 28 rue du Dr Roux, 75724, Paris Cedex 15, France
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Kubilay NZ, Sengel BE, Wood KE, Layon AJ. Biomarkers in Hepatic Disease: A Review Focused on Critically Ill Patients. J Intensive Care Med 2014; 31:104-12. [PMID: 25324195 DOI: 10.1177/0885066614554897] [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: 04/20/2014] [Accepted: 07/17/2014] [Indexed: 11/15/2022]
Abstract
The ability to make a diagnosis early and appropriately is paramount for the survival of the critically ill ICU patient. Along with the myriad physical examination and imaging modalities available, biomarkers provide a window on the disease process. Herein we review hepatic biomarkers in the context of the critical care patient.
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Affiliation(s)
- Nejla Zeynep Kubilay
- The Department of Critical Care Medicine, The Geisinger Health System, Danville, PA, USA Department of Medicine, The Marmara University Teaching and Education Hospital, Istanbul, Turkey
| | - Buket Erturk Sengel
- The Department of Critical Care Medicine, The Geisinger Health System, Danville, PA, USA Department of Medicine, The Marmara University Teaching and Education Hospital, Istanbul, Turkey
| | - Kenneth E Wood
- The Department of Critical Care Medicine, The Geisinger Health System, Danville, PA, USA The Geisinger Medical Center, Danville, PA, USA
| | - A Joseph Layon
- The Department of Critical Care Medicine, The Geisinger Health System, Danville, PA, USA
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Xing G, Ren M, Verma A. Divergent Temporal Expression of Hyaluronan Metabolizing Enzymes and Receptors with Craniotomy vs. Controlled-Cortical Impact Injury in Rat Brain: A Pilot Study. Front Neurol 2014; 5:173. [PMID: 25309501 PMCID: PMC4161003 DOI: 10.3389/fneur.2014.00173] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 08/26/2014] [Indexed: 01/16/2023] Open
Abstract
Traumatic brain injury (TBI) triggers many secondary changes in tissue biology, which ultimately determine the extent of injury and clinical outcome. Hyaluronan [hyaluronic acid (HA)] is a protective cementing gel present in the intercellular spaces whose degradation has been reported as a causative factor in tissue damage. Yet little is known about the expression and activities of genes involved in HA catabolism after TBI. Young adult male Sprague-Dawley rats were assigned to three groups: naïve control, craniotomy, and controlled-cortical impact-induced TBI (CCI-TBI). Four animals per group were sacrificed at 4 h, 1, 3, and 7 days post-CCI. The mRNA expression of hyaluronan synthases (HAS1-3), hyaluronidases (enzymes for HA degradation, HYAL 1–4, and PH20), and CD44 and RHAMM (membrane receptors for HA signaling and removal) were determined using real-time PCR. Compared to the naïve controls, expression of HAS1 and HAS2 mRNA, but not HAS3 mRNA increased significantly following craniotomy alone and following CCI with differential kinetics. Expression of HAS2 mRNA increased significantly in the ipsilateral brain at 1 and 3 days post-CCI. HYAL1 mRNA expression also increased significantly in the craniotomy group and in the contralateral CCI at 1 and 3 days post-CCI. CD44 mRNA expression increased significantly in the ipsilateral CCI at 4 h, 1, 3, and 7 days post-CCI (up to 25-fold increase). These data suggest a dynamic regulation and role for HA metabolism in secondary responses to TBI.
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Affiliation(s)
- Guoqiang Xing
- Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Ming Ren
- Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Ajay Verma
- Department of Neurology, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
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Tang SC, Yeh SJ, Tsai LK, Hu CJ, Lien LM, Peng GS, Yang WS, Chiou HY, Jeng JS. Association between plasma levels of hyaluronic acid and functional outcome in acute stroke patients. J Neuroinflammation 2014; 11:101. [PMID: 24912490 PMCID: PMC4066288 DOI: 10.1186/1742-2094-11-101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/28/2014] [Indexed: 12/12/2022] Open
Abstract
Background Activation of hyaluronic acid (HA) and associated enzyme synthesis has been demonstrated in experimental stroke animal models. Our study aimed to investigate the plasma levels of HA in acute stroke patients and the associations between HA levels and functional outcome. Methods This was a multicenter case–control study. Acute stroke patients and age- and sex-matched non-stroke controls were recruited. Plasma levels of HA in acute stroke patients were determined at <48 hours and at 48 to 72 hours after stroke onset by standard ELISA. Favorable functional outcome was defined as modified Rankin scale ≤2 at 3 months after stroke. Results The study included 206 acute stroke patients, including 43 who had intracerebral hemorrhage and 163 who had ischemic stroke, and 159 controls. The plasma levels of HA in the acute stroke patients were significantly higher than those in the controls (219.7 ± 203.4 ng/ml for <48 hours and 343.1 ± 710.3 ng/ml for 48 to 72 hours versus 170.4 ± 127.9 ng/ml in the controls; both P < 0.05). For intracerebral hemorrhage patients, HA ≤500 ng/ml (<48 hours) was an independent favorable outcome predictor (P = 0.016). For ischemic stroke patients, an inverted U-shaped association between plasma HA (48 to 72 hours) and outcome was noted, indicating that ischemic stroke patients with too high or too low plasma HA levels tended to have an unfavorable outcome. Conclusion HA plasma level was elevated in patients with acute stroke, and can predict 3-month functional outcome, particularly for patients with intracerebral hemorrhage.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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NELSON A, BERKESTEDT I, BODELSSON M. Circulating glycosaminoglycan species in septic shock. Acta Anaesthesiol Scand 2014; 58:36-43. [PMID: 24341693 DOI: 10.1111/aas.12223] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Glycosaminoglycans (GAGs) are negatively charged polysaccharides present, e.g., on the luminal face of the blood vessels as heparan sulphate (HS) and hyaluronic acid (HA), in the interstitium as HA, and in neutrofils and plasma as chondroitin sulphate (CS) and HA. Total plasma levels of GAG are increased in human septic shock, but the origin and pathophysiological implications are unclear. In order to determine the source of circulating GAG in sepsis, we compared plasma levels of HS, HA, CS and keratan sulphate (KS) in patients with septic shock and controls. METHODS HS and KS were measured with enzyme-linked immunosorbent assay, and HA and CS disaccharides with liquid chromatography tandem mass spectrometry in plasma obtained from patients admitted to intensive care fulfilling criteria for septic shock as well as from matched control patients scheduled for neurosurgery. RESULTS Median levels of HS and HA were fourfold increased in septic shock and were higher in patients that did not survive 90 days (threefold and fivefold for HS and HA, respectively). Median CS levels were unaltered, while KS levels were slightly decreased in sepsis patients. HS and HA levels correlated with levels of interleukin-6 and interleukin-10. Except for HA, GAG levels did not correlate to liver or kidney sequential organ function score. CONCLUSION Median plasma level of HS and HA is increased in septic shock patients, are higher in patients that do not survive, and correlates with inflammatory activation and failing circulation. The increased levels could be due to vascular damage.
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Affiliation(s)
- A. NELSON
- Section of Anesthesiology and Intensive Care; Department of Clinical Sciences; Lund University and Skane University Hospital; Lund Sweden
| | - I. BERKESTEDT
- Section of Anesthesiology and Intensive Care; Department of Clinical Sciences; Lund University and Skane University Hospital; Lund Sweden
| | - M. BODELSSON
- Section of Anesthesiology and Intensive Care; Department of Clinical Sciences; Lund University and Skane University Hospital; Lund Sweden
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Osterholt HCD, Lundeland B, Sonerud T, Saugstad OD, Nakstad B. The impact of hyaluronan on monocyte Toll-like receptor expression in term infant cord blood. Acta Paediatr 2012; 101:706-13. [PMID: 22372604 DOI: 10.1111/j.1651-2227.2012.02650.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To explore the possible effects of hyaluronan, an endogenous mediator of inflammation, on monocyte surface expression of Toll-like receptors 2 and 4 in human umbilical cord blood ex vivo, and in a model mimicking Gram-negative neonatal sepsis. METHODS Term infant cord blood was obtained after elective caesarean sections, n = 15. Both unstimulated and lipopolysaccharide-stimulated (10 ng/mL) blood was incubated with 500 μg/mL high- or low-molecular-weight hyaluronan for 6 h. Expression of Toll-like receptors 2 and 4 on monocytes was measured using flow cytometry, and plasma concentrations of proinflammatory cytokines and matrix metalloproteinase 9 were analysed. RESULTS (MEAN ± SEM): We found a significant decrease in Toll-like receptor 4 expression in the presence of high-molecular-weight hyaluronan (HMW HA) in unstimulated blood (median fluorescence intensity 141 ± 7.3 vs. 163 ± 9.8, p = 0.019). There were no significant changes in Toll-like receptor 2 expression. Levels of cytokines and matrix metalloproteinase 9 increased in the presence of both forms of hyaluronan. CONCLUSIONS Our results confirm that hyaluronan affects the neonatal immune response. The biological significance of these findings requires further clarification. More studies are needed to validate the possible down-modulation of Toll-like receptor 4 exerted by HMW HA.
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Yagmur E, Koch A, Haumann M, Kramann R, Trautwein C, Tacke F. Hyaluronan serum concentrations are elevated in critically ill patients and associated with disease severity. Clin Biochem 2012; 45:82-7. [DOI: 10.1016/j.clinbiochem.2011.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 12/18/2022]
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Luquita A, Urli L, Svetaz MJ, Gennaro AM, Giorgetti ME, Pistone G, Volpintesta R, Palatnik S, Rasia M. In vitro and ex vivo effect of hyaluronic acid on erythrocyte flow properties. J Biomed Sci 2010; 17:8. [PMID: 20152040 PMCID: PMC2830998 DOI: 10.1186/1423-0127-17-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 02/12/2010] [Indexed: 11/22/2022] Open
Abstract
Background Hyaluronic acid (HA) is present in many tissues; its presence in serum may be related to certain inflammatory conditions, tissue damage, sepsis, liver malfunction and some malignancies. In the present work, our goal was to investigate the significance of hyaluronic acid effect on erythrocyte flow properties. Therefore we performed in vitro experiments incubating red blood cells (RBCs) with several HA concentrations. Afterwards, in order to corroborate the pathophysiological significance of the results obtained, we replicated the in vitro experiment with ex vivo RBCs from diagnosed rheumatoid arthritis (RA) patients, a serum HA-increasing pathology. Methods Erythrocyte deformability (by filtration through nucleopore membranes) and erythrocyte aggregability (EA) were tested on blood from healthy donors additioned with purified HA. EA was measured by transmitted light and analyzed with a mathematical model yielding two parameters, the aggregation rate and the size of the aggregates. Conformational changes of cytoskeleton proteins were estimated by electron paramagnetic resonance spectroscopy (EPR). Results In vitro, erythrocytes treated with HA showed increased rigidity index (RI) and reduced aggregability, situation strongly related to the rigidization of the membrane cytoskeleton triggered by HA, as shown by EPR results. Also, a significant correlation (r: 0.77, p < 0.00001) was found between RI and serum HA in RA patients. Conclusions Our results lead us to postulate the hypothesis that HA interacts with the erythrocyte surface leading to modifications in erythrocyte rheological and flow properties, both ex vivo and in vitro.
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Affiliation(s)
- A Luquita
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Cátedra de Física Biológica, Santa Fe 3100, 2000 Rosario, Argentina.
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Pierrakos C, Vincent JL. Sepsis biomarkers: a review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R15. [PMID: 20144219 PMCID: PMC2875530 DOI: 10.1186/cc8872] [Citation(s) in RCA: 845] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 12/28/2009] [Accepted: 02/09/2010] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy. METHODS We used an electronic search of the PubMed database using the key words "sepsis" and "biomarker" to identify clinical and experimental studies which evaluated a biomarker in sepsis. RESULTS The search retrieved 3370 references covering 178 different biomarkers. CONCLUSIONS Many biomarkers have been evaluated for use in sepsis. Most of the biomarkers had been tested clinically, primarily as prognostic markers in sepsis; relatively few have been used for diagnosis. None has sufficient specificity or sensitivity to be routinely employed in clinical practice. PCT and CRP have been most widely used, but even these have limited ability to distinguish sepsis from other inflammatory conditions or to predict outcome.
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Affiliation(s)
- Charalampos Pierrakos
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, 1070 Brussels, Belgium.
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Ozturk B, Kuscu F, Tutuncu E, Sencan I, Gurbuz Y, Tuzun H. Evaluation of the association of serum levels of hyaluronic acid, sICAM-1, sVCAM-1, and VEGF-A with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever. J Clin Virol 2009; 47:115-9. [PMID: 20005156 DOI: 10.1016/j.jcv.2009.10.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 10/10/2009] [Accepted: 10/27/2009] [Indexed: 01/23/2023]
Abstract
BACKGROUND Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic disease. Pathogenesis of the disease has not been well described yet. A well-known pathogenic feature of CCHF virus is its capability to damage endothelium. Increased hyaluronic acid (HA) levels indicate liver sinusoidal endothelial damage. Soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and vascular endothelial growth factor-A (VEGF-A) play a role in the inflammatory process, vascular damage and plasma leakage. OBJECTIVES To investigate whether or not there is a relationship between HA, sICAM-1, sVCAM-1 and VEGF-A serum levels and fatality in CCHF. STUDY DESIGN Sixty-one patients who were confirmed by RT-PCR and serological tests for CCHF, included in the current study. HA, sICAM-1, sVCAM-1, VEGF-A levels in serum samples were analyzed by ELISA. RESULTS There were statistically significant differences between fatal and non-fatal CCHF patients in terms of HA, sICAM-1, sVCAM-1, and VEGF-A levels. In addition, AST and ALT levels were positively correlated with HA, sICAM-1, sVCAM-1, and VEGF-A levels. CONCLUSION HA, sICAM-1, sVCAM-1, and VEGF-A levels of the patients that died during hospitalization were statistically significantly higher than the patients that survived, and this finding suggests that the level of these molecules could be used as a prognostic marker in CCHF.
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Affiliation(s)
- Baris Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
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Becker LC, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG, Shank RC, Slaga TJ, Snyder PW, Andersen FA. Final report of the safety assessment of hyaluronic acid, potassium hyaluronate, and sodium hyaluronate. Int J Toxicol 2009; 28:5-67. [PMID: 19636067 DOI: 10.1177/1091581809337738] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hyaluronic acid, sodium hyaluronate, and potassium hyaluronate function in cosmetics as skin conditioning agents at concentrations up to 2%. Hyaluronic acid, primarily obtained from bacterial fermentation and rooster combs, does penetrate to the dermis. Hyaluronic acid was not toxic in a wide range of acute animal toxicity studies, over several species and with different exposure routes. Hyaluronic acid was not immunogenic, nor was it a sensitizer in animal studies. Hyaluronic acid was not a reproductive or developmental toxicant. Hyaluronic acid was not genotoxic. Hyaluronic acid likely does not play a causal role in cancer metastasis; rather, increased expression of hyaluronic acid genes may be a consequence of metastatic growth. Widespread clinical use of hyaluronic acid, primarily by injection, has been free of significant adverse reactions. Hyaluronic acid and its sodium and potassium salts are considered safe for use in cosmetics as described in the safety assessment.
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Affiliation(s)
- Lillian C Becker
- MS, Cosmetic Ingredient Review, 1101 17th Street, NW, Suite 412, Washington, DC 20036, USA.
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Abstract
The lymphatic system is best known for draining interstitial fluid from the tissues and returning it to the blood circulation. However, the lymphatic system also provides the means for immune surveillance in the immune system, acting as conduits that convey soluble antigens and antigen-presenting cells from the tissues to the lymph nodes, where primary lymphocyte responses are generated. One macromolecule that potentially unites these two functions is the large extracellular matrix glycosaminoglycan hyaluronan (HA), a chemically simple copolymer of GlcNAc and GlcUA that fulfills a diversity of functions from danger signal to adhesive substratum, depending upon chain length and particular interaction with its many different binding proteins and a small but important group of receptors. The two most abundant of these receptors are CD44, which is expressed on leukocytes that traffic through the lymphatics, and LYVE-1, which is expressed almost exclusively on lymphatic endothelium. Curiously, much of the HA within the tissues is turned over and degraded in lymph nodes, by a poorly understood process that occurs in the medullary sinuses. Indeed there are several mysterious aspects to HA in the lymphatics. Here we cover some of these by reviewing recent findings in the biology of lymphatic endothelial cells and their possible roles in HA homeostasis together with fresh insights into the complex and enigmatic nature of LYVE-1, its regulation of HA binding by sialylation and self-association, and its potential function in leukocyte trafficking.
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Affiliation(s)
- David G Jackson
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK. David.
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Yamasaki K, Muto J, Taylor KR, Cogen AL, Audish D, Bertin J, Grant EP, Coyle AJ, Misaghi A, Hoffman HM, Gallo RL. NLRP3/cryopyrin is necessary for interleukin-1beta (IL-1beta) release in response to hyaluronan, an endogenous trigger of inflammation in response to injury. J Biol Chem 2009; 284:12762-71. [PMID: 19258328 DOI: 10.1074/jbc.m806084200] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Inflammation under sterile conditions is a key event in autoimmunity and following trauma. Hyaluronan, a glycosaminoglycan released from the extracellular matrix after injury, acts as an endogenous signal of trauma and can trigger chemokine release in injured tissue. Here, we investigated whether NLRP3/cryopyrin, a component of the inflammasome, participates in the inflammatory response to injury or the cytokine response to hyaluronan. Mice with a targeted deletion in cryopyrin showed a normal increase in Cxcl2 in response to sterile injuries but had decreased inflammation and release of interleukin-1beta (IL-1beta). Similarly, the addition of hyaluronan to macrophages derived from cryopyrin-deficient mice increased release of Cxcl2 but did not increase IL-1beta release. To define the mechanism of hyaluronan-mediated activation of cryopyrin, elements of the hyaluronan recognition process were studied in detail. IL-1beta release was inhibited in peritoneal macrophages derived from CD44-deficient mice, in an MH-S macrophage cell line treated with antibodies to CD44, or by inhibitors of lysosome function. The requirement for CD44 binding and hyaluronan internalization could be bypassed by intracellular administration of hyaluronan oligosaccharides (10-18-mer) in lipopolysaccharide-primed macrophages. Therefore, the action of CD44 and subsequent hyaluronan catabolism trigger the intracellular cryopyrin --> IL-1beta pathway. These findings support the hypothesis that hyaluronan works through IL-1beta and the cryopyrin system to signal sterile inflammation.
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Affiliation(s)
- Kenshi Yamasaki
- Division of Dermatology, University of California, and Veterans Affairs San Diego Health Care System, San Diego, CA 92161, USA
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Berg S. Hyaluronan in sepsis. Acta Anaesthesiol Scand 2008. [DOI: 10.1111/j.1399-6576.1995.tb04060.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mehta P, Ploutz-Snyder R, Nandi J, Rawlins SR, Sanderson SO, Levine RA. Diagnostic accuracy of serum hyaluronic acid, FIBROSpect II, and YKL-40 for discriminating fibrosis stages in chronic hepatitis C. Am J Gastroenterol 2008; 103:928-36. [PMID: 18371145 DOI: 10.1111/j.1572-0241.2007.01761.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Noninvasive serum markers of liver fibrosis are being used as an alternative to liver biopsy. Currently available tests distinguish, with accuracy, only absent/minimal fibrosis (Ishak stages 0-1) and advanced fibrosis/cirrhosis (Ishak stages 4-6), but not intermediate fibrosis (Ishak stages 2-3). Our aim was to evaluate the diagnostic accuracy of hyaluronic acid (HA), FIBROSpect II (FS-II), and YKL-40 (chondrex, human cartilage glycoprotein-39) in various clinically important categories of fibrosis, and further correlate these serum markers with digital quantification of fibrosis (DQF) and Ishak stages. METHODS Serum HA, YKL-40, and FS-II were retrospectively assessed and correlated with Ishak stages and DQF scores in 75 patients with chronic hepatitis C (HCV). Spearman's rho statistics assessed relationships among all parameters, and receiver operator characteristic curves evaluated accuracy of each parameter when compared to the Ishak stages. RESULTS All three serum markers and DQF correlated highly with one another (P < or = 0.01) and with Ishak stages of fibrosis. Among the serum markers, HA was effective in discriminating between Ishak stages 0-1 and Ishak stages 2-3 compared with FS-II, with an area under the curve of 0.76 versus 0.66 and a false-positive rate of 0.33 versus 0.67, respectively. All three serum markers predicted advanced fibrosis and cirrhosis. YKL-40 had the highest false-positive rates in all categories of fibrosis. CONCLUSIONS HA can be utilized as a reliable surrogate marker in distinguishing three clinically relevant stages of fibrosis: absent/minimal, intermediate, and advanced/cirrhosis. HA should be considered as a cost-effective alternative to other serum markers for staging fibrosis and for determining the timing and selection of HCV treatment.
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Affiliation(s)
- Preeti Mehta
- Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13210, USA
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Stern R, Maibach HI. Hyaluronan in skin: aspects of aging and its pharmacologic modulation. Clin Dermatol 2008; 26:106-22. [DOI: 10.1016/j.clindermatol.2007.09.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hyaluronic Acid: Its Function and Degradation in in vivo Systems. BIOACTIVE NATURAL PRODUCTS (PART N) 2008. [DOI: 10.1016/s1572-5995(08)80035-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Engström-Laurent A. Changes in hyaluronan concentration in tissues and body fluids in disease states. CIBA FOUNDATION SYMPOSIUM 2007; 143:233-40; discussion 240-7, 281-5. [PMID: 2680345 DOI: 10.1002/9780470513774.ch14] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Proteins which specifically bind hyaluronan have been used to develop sensitive immunoassay-like analytical techniques. These assays have made it possible to analyse hyaluronan concentrations in nanogram amounts in tissues and body fluids. The normal adult human circulating level of hyaluronan varies between 10 and 100 micrograms/l. Increased levels of serum hyaluronan (greater than 1 mg/l) have been found in inflammatory rheumatic diseases such as rheumatoid arthritis, scleroderma and psoriatic arthritis. Even higher levels occur in serum from patients with cirrhotic liver diseases and in patients with malignant mesothelioma. Elevated serum hyaluronan levels are a sign either of increased production and/or outflow from the tissues or of decreased elimination of the polysaccharide in the liver endothelial cells or in other parts of the reticuloendothelial system or through the kidneys. The serum concentration is also influenced by increased age and by the degree of physical activity. Important information on pathological processes has been gained by analysing the hyaluronan concentration in other body fluids such as urine, perfusion fluid from the intestine and bronchoalveolar lavage fluid. In the future these analyses should also be useful in clinical work.
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Neudecker J, Neudecker BA, Raue W, Stern R, Schwenk W. Hyaluronan levels during laparoscopic versus open colonic resections. Surg Endosc 2007; 22:660-3. [PMID: 17623246 DOI: 10.1007/s00464-007-9455-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Plasma hyaluronan binds to fibrinogen, affecting intravascular fibrin polymerization and fibrin clot formation. It has been hypothesized that alterations in fibrin clot formation influence the risk of thromboembolism in those undergoing surgery. The aim of this study is to quantify the intravascular components, especially plasma hyaluronan levels, in laparoscopic and conventional colorectal resections that contribute to thromboembolism formation. METHODS Prospective cohort analysis of consecutive patients which were participating in the prospective randomized multi-center trial Lapkon II comparing the long-term effects of laparoscopic and conventional resection for colon cancer. Plasma samples were obtained from 15 patients at the beginning and the end of laparoscopic or conventional colorectal resections. Concentrations and activities of tissue plasminogen activator(t-PA), plasminogen activator inhibitor type 1(PAI-1), t-PA/PAI complex, fibrinogen, d-dimers and hyaluronan were determined by using commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS No differences in age, sex and type of resection between the laparoscopic and conventional-surgery groups were observed. Laparoscopic procedures lasted longer (p < 0.05). Concentration and activities of t-PA, PAI-1, t-PA/PAI complex, fibrinogen and d-dimers did not vary between the two groups. Plasma hyaluronan decreased from 28.6 to 17.9 IU/ml (p < 0.05) during laparoscopic compared to conventional procedures. Plasma hyaluronan levels were significantly different at the end of operation between the two groups (p < 0.05) . CONCLUSIONS Plasma hyaluronan levels were decreased in patients undergoing laparoscopic colorectal resections, compared to those undergoing conventional procedures. Therefore, interactions between plasma hyaluronan and fibrinogen may be lower, with a sequential decrease in fibrin polymerization, and a possibly reduced risk of deep venous thrombosis.
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Affiliation(s)
- J Neudecker
- Department of General, Visceral, Vascular and Thoracic Surgery, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany.
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Honsawek S, Kongtawelert P, Pothacharoen P, Khongphatthanayothin A, Chongsrisawat V, Poovorawan Y. Increased levels of serum hyaluronan in patients with dengue infection. J Infect 2006; 54:225-9. [PMID: 16876870 DOI: 10.1016/j.jinf.2006.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 06/07/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Serum hyaluronan (HA) is ubiquitously distributed in connective tissues. Circulating HA is degraded by hepatic sinusoidal endothelial cell. The aim of the present study was to evaluate serum HA levels and to determine their importance in dengue fever (DF)/dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) patients. METHODS Serum HA levels were measured by an ELISA-based method in 16 patients with DF, 14 patients with DHF and 10 patients with DSS. The HA levels were compared with those in 48 acute hepatitis A patients; 8 healthy blood donors serve as controls. RESULTS In acute phase, mean serum HA levels significantly increased in patients with DSS (7316.3+/-10,359.0 ng/ml) in comparison to patients with hepatitis A (93.8+/-50.4 ng/ml; P<0.0001), and healthy controls (48.3+/-16.3 ng/ml; P<0.0001). Serum levels of HA in patients with DSS rapidly decreased during the convalescent phase, but were still significantly higher than those in healthy controls (915.2+/-1294.8, and 48.3+/-16.3 ng/ml; P<0.0005). CONCLUSIONS The increased HA in dengue patients could be attributed to sinusoidal endothelial damage rendering the endothelium incapable of HA clearance. The elevation of HA production may involve the pathogenesis of dengue infection. Further studies are needed to determine whether the increase in the HA production or decrease in its clearance is responsible for the elevated serum HA.
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Affiliation(s)
- Sittisak Honsawek
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Stern R, Asari AA, Sugahara KN. Hyaluronan fragments: an information-rich system. Eur J Cell Biol 2006; 85:699-715. [PMID: 16822580 DOI: 10.1016/j.ejcb.2006.05.009] [Citation(s) in RCA: 800] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 05/05/2006] [Accepted: 05/05/2006] [Indexed: 02/08/2023] Open
Abstract
Hyaluronan is a straight chain, glycosaminoglycan polymer of the extracellular matrix composed of repeating units of the disaccharide [-D-glucuronic acid-beta1,3-N-acetyl-D-glucosamine-beta1,4-]n. Hyaluronan is synthesized in mammals by at least three synthases with products of varying chain lengths. It has an extraordinary high rate of turnover with polymers being funneled through three catabolic pathways. At the cellular level, it is degraded progressively by a series of enzymatic reactions that generate polymers of decreasing sizes. Despite their exceedingly simple primary structure, hyaluronan fragments have extraordinarily wide-ranging and often opposing biological functions. There are large hyaluronan polymers that are space-filling, anti-angiogenic, immunosuppressive, and that impede differentiation, possibly by suppressing cell-cell interactions, or ligand access to cell surface receptors. Hyaluronan chains, which can reach 2 x 10(4) kDa in size, are involved in ovulation, embryogenesis, protection of epithelial layer integrity, wound repair, and regeneration. Smaller polysaccharide fragments are inflammatory, immuno-stimulatory and angiogenic. They can also compete with larger hyaluronan polymers for receptors. Low-molecular-size polymers appear to function as endogenous "danger signals", while even smaller fragments can ameliorate these effects. Tetrasaccharides, for example, are anti-apoptotic and inducers of heat shock proteins. Various fragments trigger different signal transduction pathways. Particular hyaluronan polysaccharides are also generated by malignant cells in order to co-opt normal cellular functions. How the small hyaluronan fragments are generated is unknown, nor is it established whether the enzymes of hyaluronan synthesis and degradation are involved in maintaining proper polymer sizes and concentration. The vast range of activities of hyaluronan polymers is reviewed here, in order to determine if patterns can be detected that would provide insight into their production and regulation.
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Affiliation(s)
- Robert Stern
- Department of Pathology and UCSF Comprehensive Cancer Center, School of Medicine, University of California San Francisco, 513 Parnassus Avenue, S-564, San Francisco, CA 94143-0511, USA.
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Sakayama K, Kidani T, Sugawara Y, Masuno H, Matsuda Y, Yamamoto H. Elevated Concentration of Hyaluronan in the Cerebrospinal Fluid is a Secondary Marker of Spinal Disorders. ACTA ACUST UNITED AC 2006; 19:262-5. [PMID: 16778660 DOI: 10.1097/01.bsd.0000203944.65803.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyaluronan (HA) was measured in cerebrospinal fluid (CSF) to ascertain the clinical significance of this substance in patients with spinal disorders, a topic that, to the best of our knowledge, has not previously been studied. METHODS We examined correlations of CSF HA concentration with age, sex, height, body weight, and spinal disorders. By using a sandwich-binding protein assay, HA was measured in CSF samples obtained from 500 patients aged 12 to 104 years who underwent lumbar spinal anesthesia for surgery, myelography, or CSF examination. These patients were classified into 3 groups: (1) a control group (306 patients with injury or benign tumor of the lower limbs); (2) a cervical disorders group (84 patients with cervical disc herniation, cervical spondylotic myelopathy, or ossification of the posterior longitudinal ligament); and (3) a lumbar disorders group (110 patients with lumbar disc herniation, lumbar spinal canal stenosis tethered cord syndrome, lumbar fracture, or spondylolytic spondylolisthesis). RESULTS CSF HA concentration was found to be positively correlated with age, and was significantly higher in patients with cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, or lumbar spinal canal stenosis tumor than in the control group. CONCLUSIONS CSF HA concentration might be a secondary marker for inflammation in patients with spinal disease.
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Affiliation(s)
- Kenshi Sakayama
- Department of Orthopaedic Surgery, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, Japan.
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Abstract
A new pathway of intermediary metabolism is described involving the catabolism of hyaluronan. The cell surface hyaluronan receptor, CD44, two hyaluronidases, Hyal-1 and Hyal-2, and two lysosomal enzymes, beta-glucuronidase and beta-N-acetylglucosaminidase, are involved. This metabolic cascade begins in lipid raft invaginations at the cell membrane surface. Degradation of the high-molecular-weight extracellular hyaluronan occurs in a series of discreet steps generating hyaluronan chains of decreasing sizes. The biological functions of the oligomers at each quantum step differ widely, from the space-filling, hydrating, anti-angiogenic, immunosuppressive 10(4)-kDa extracellular polymer, to 20-kDa intermediate polymers that are highly angiogenic, immuno-stimulatory, and inflammatory. This is followed by degradation to small oligomers that can induce heat shock proteins and that are anti-apoptotic. The single sugar products, glucuronic acid and a glucosamine derivative are released from lysosomes to the cytoplasm, where they become available for other metabolic cycles. There are 15 g of hyaluronan in the 70-kg individual, of which 5 g are cycled daily through this pathway. Some of the steps in this catabolic cascade can be commandeered by cancer cells in the process of growth, invasion, and metastatic spread.
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Affiliation(s)
- Robert Stern
- Department of Pathology, School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, S-564, San Francisco, CA 94143-0511, USA.
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George J, Stern R. Serum hyaluronan and hyaluronidase: very early markers of toxic liver injury. Clin Chim Acta 2004; 348:189-97. [PMID: 15369754 DOI: 10.1016/j.cccn.2004.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Revised: 05/24/2004] [Accepted: 05/24/2004] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dimethylnitrosamine (DMN), a potent hepatotoxin, administered to rats, provides a convenient model for toxic liver injury. Indicators of early liver injury are important clinically, for surveillance, for screening new drugs that are potentially hepatotoxic and for identifying drugs that protect against liver injury. Both cirrhosis and wound healing culminate in deposition of fibrous connective tissue and scarring. Increased hyaluronan (HA) occurs in the earliest stage of wound healing. Hyaluronidase, the enzyme that degrades hyaluronan, is also elevated whenever rapid turnover of hyaluronan occurs. We test the hypothesis that elevated levels of circulating hyaluronan and hyaluronidase could provide indicators of very early liver damage. METHODS Dimethylnitrosamine was administered to adult male albino rats by intraperitoneal injections for 7 consecutive days. RESULTS Increased serum hyaluronan levels observed on day 2 reached a maximum on day 4. Hyaluronidase was elevated on the first day and reached a maximum on day 2 that was 30-times control levels. Hyaluronan-specific staining in liver sections was maximal on day 7, occurring predominantly in portal triads and in sinusoidal spaces. Individual hepatocytes were slightly enlarged and contained intracellular hyaluronan, which was not evident in control sections. Though circulating hyaluronan levels had decreased after day 4, continued hyaluronan staining persisted in liver sections through day 21. Conventional indicators of liver injury, such as serum aminotransferase enzymes, did not reach a peak until day 7. Conventional gross and histopathological changes, including severe centrilobular congestion and hemorrhagic necrosis, were observed only after day 7. Both hyaluronan and hyaluronidase are indicators of very early liver damage in the dimethylnitrosamine-treated rat, occurring well before conventional indicators appear, or before overt histopathologic changes of liver damage can be seen. However, levels are increased only transiently, indicating that serial assays are necessary. CONCLUSIONS Measures of circulating hyaluronidase activity may be used to assess liver damage.
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Affiliation(s)
- Joseph George
- Division of Molecular Medicine, Department of Medicine, Columbia University, New York, NY 10032, USA
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Bozkurt T, Tanyildizi S, Türk G. Effects of levamisole on hyaluronidase activity and sperm characteristics in rams. Theriogenology 2004; 62:323-9. [PMID: 15159124 DOI: 10.1016/j.theriogenology.2003.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2003] [Revised: 08/28/2003] [Accepted: 10/15/2003] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine the effects of levamisole on sperm characteristics and hyaluronidase activity of blood serum and semen. For this purpose, 12 Akkaraman rams (2-3 years old) were used. Levamisole hydrochloride was administered orally at a dose of 7.5mg/kg body weights once daily for 2 days. Serum and semen samples were collected from the rams at post-treatment 1, 2, 4, 24, 48, 72, 96, 120, 144, 216, 288 and 384 h and examined for sperm characteristics and hyaluronidase activity. The results showed that the use of levamisole caused significant (P < 0.01) increase in serum hyaluronidase activity at all times except the 72 h, and in semen hyaluronidase activity at 1, 2, 4, 24, 72, 96 and 120 h compared to the control group. In addition, the levamisole caused significant (P < 0.05) decreases in semen volume, sperm motility, concentration and total sperm number at all times. There was no correlation between semen hyaluronidase activity and the sperm characteristics. In conclusion, levamisole did not have any deleterious effect on hyaluronidase enzyme. However, the use of this drug in rams during the breeding season is harmful due to the decrease of sperm characteristics.
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Affiliation(s)
- Tanzer Bozkurt
- Department of Reproduction and Artificial Insemination, Faculty of Veterinary Medicine, Firat University, 23119 Elaziğ, Turkey.
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Tanyildizi S, Bozkurt T. The effects of lincomycin-spectinomycin and sulfamethoxazole-trimethoprim on hyaluronidase activities and sperm characteristics of rams. J Vet Med Sci 2003; 65:775-80. [PMID: 12939503 DOI: 10.1292/jvms.65.775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effects of lincomycin-spectinomycin and sulfamethoxazole-trimethoprim combinations on the hyaluronidase enzyme of serum and semen and on sperm characteristics in rams were determined. Thirthy-two Akkaraman rams were used. The rams were randomly divided into four groups. Group A and group B were determined as control groups of group C (lincomycin-spectinomycin) and D (sulfamethoxazole-trimethoprim), respectively. Combinations of lincomycin-spectinomycin and sulfamethoxazole-trimethoprim were administered at doses of 15 mg.kg(-1) intramuscularly and 12 mg.kg(-1) body weights orally, respectively. Blood and semen samples were collected at 4, 12, 24, 48, 72, 192 and 384 hr. Semen hyaluronidase activities of rams in group C increased significantly (p<0.001, <0.05) compared with the control group at 24 and 48 hr, respectively. Semen hyaluronidase activities in group D rams also increased significantly (p<0.001) in comparison with the control group at all times except 72 and 384 hr. Serum hyaluronidase activities increased significantly (p<0.01, <0.001) at 24 and 48 hr after treatment of lincomycin-spectinomycin. Additionally, significant (p<0.05, <0.001) increases were detected in the serum hyaluronidase activities of group D at 48 and 72 hr, respectively. No significant correlation was found between serum and semen hyaluronidase activities. Furthermore, significant increases (p<0.05) were observed in the percentages of motile sperm in the rams of group C and D compared with the control groups. The values of sperm concentration and total number of sperm in group C and D rams decreased significantly (p<0.001) in comparison with control groups. No significant correlations were found between the semen hyaluronidase activities and sperm characteristics. In conclusion, these findings show that the combinations of lincomycin-spectinomycin and sulfamethoxazole-trimethoprim do not have any harmful effects on hyaluronidase activities and sperm motility. However, the use of both antibiotic combinations in breeding rams during the ramming season is not advisable due to the decrease of sperm concentration.
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Affiliation(s)
- Sadettin Tanyildizi
- Department of Pharmacology, Faculty of Veterinary Medicine, Firat University, Elazig-Turkey
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Babic Z, Jagić V, Petrović Z, Bilić A, Dinko K, Kubat G, Troskot R, Vukelić M. Elevated serum values of procollagen III peptide (PIIIP)in patients with ulcerative colitis who will develop pseudopolyps. World J Gastroenterol 2003; 9:619-21. [PMID: 12632532 PMCID: PMC4621596 DOI: 10.3748/wjg.v9.i3.619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the impact of procollagen III peptide as a marker of collagenesis in the development of pseudopolyps in patients with ulcerative colitis.
METHODS: Development of pseudopolyps was monitored in 25 patients with ulcerative colitis classified according to Powell-Tuck index as mild (n = 12) or moderate (n = 13) form of disease. Patients with a mild form of disease were treated with oral mesalazine medication (2-4 g/day) and local mesalazine preparation (suppository). Patients with a moderate form of disease received oral mesalazine medication (2-4 g/day), local mesalazine preparation (suppository) and local methylprednisolone at an initial dose of 60 mg/day, followed by dose tapering. How many significant variables (previously determined by analysis of variance) were elevated in the groups with and without pseudopolyp developement was observed. ROC analysis for calculation of new index was made.
RESULTS: Serum values of procollagen III peptide (PIIIP), C-reactive protein (CRP) and C4 complement component (C4) were statistically significantly lower in the group of patients free from pseudopolyp development than those who developed one or more pseudopolyps (0.45 ± 0.12 vs 1.42 ± 0.70, P < 0.0027; 7.6 ± 4.7 vs 17.8 ± 9.17, P < 0.035; and 0.46 ± 0.11 vs 0.34 ± 0.16, P < 0.068, respectively) at endoscopic conrtrols with patohistologically samples during 13 months. There were no statistically significant differences in the values of C3, ceruloplasmin and IgM between the two groups (P > 0.05). Discrimination function analysis yielded highest standardized cannon coefficients for PIIIP (0.876), CRP (0.104), C3 (-0.534) and C4 (0.184) (P < 0.036). The elevation in two of three laboratory variables (PIIIP, CRP and C4) reached sensitivity of 93% and specificity of 90% in the development of pseudopolyps.
CONCLUSION: It is proposed that an increase in two of the three laboratory parameters (PIIIP, CRP and C4) could improve the accuracy of prediction of the development of pseudopolyps. When using PIIIP, CRP and C4 on decision making, the positive predictive value and accuracy were 90% and 92%, respectively.
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Affiliation(s)
- Zarko Babic
- Division of Hepatogastroenterology, Department of Medicine, Sveti Duh General Hospital, Zagreb, Croatia.
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Hasegawa T, Kimura T, Hoki M, Okada A, Mushiake S, Yagi M, Imura K. Measurement of serum hyaluronic acid as a sensitive marker of liver fibrosis in biliary atresia. J Pediatr Surg 2000; 35:1643-6. [PMID: 11083443 DOI: 10.1053/jpsu.2000.18342] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to clarify whether serum hyaluronic acid level (SHA) can reflect the degree of liver fibrosis in biliary atresia (BA). METHODS SHA was measured in 44 postoperative BA patients at 7 months to 22 years of age, with sandwich enzyme method (Hy-A 100 kit). SHA was compared with T.Bil (group 1, T Bil < 2; group 2, 2 < or = T Bil < 5; group 3, T Bil > or = 5 mg/dL), fibrosis score (0-6, the number of abnormal values among Alb, PT, ChE, T Chol, Fischer's ratio, prealbumin), and histologic grading (0-IV). RESULTS SHA was 499.8 +/- 332.5 in group 3, significantly higher than in the control, group 1, or group 2. As fibrosis score rose, SHA became higher, and SHA in Score 6 (430.1 +/- 366.1 ng/mL) and score-5 (172.9 +/- 141.8 ng/mL) was significantly higher than in the control and other scores, respectively. As the histologic grade rose, SHA became higher, and SHA in grade IV (444.8 +/- 323.5 ng/mL) and grade III (166.0 +/- 70.3 ng/mL) was significantly higher than in the control or other Grades. Serial change of SHA since before HPE was parallel to the clinical course in 8 patients. CONCLUSION SHA may be a useful serum marker reflecting the degree of liver fibrosis in BA.
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Affiliation(s)
- T Hasegawa
- Department of Pediatric Surgery, Osaka University Medical School, Suita City, Japan
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Mio K, Carrette O, Maibach HI, Stern R. Evidence that the serum inhibitor of hyaluronidase may be a member of the inter-alpha-inhibitor family. J Biol Chem 2000; 275:32413-21. [PMID: 10908571 DOI: 10.1074/jbc.m005428200] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A study of the uncharacterized serum inhibitors of hyaluronidase, first described half a century ago, was undertaken. Activity was measured against bovine testicular hyaluronidase using a microtiter-based assay and reverse hyaluronan substrate gel zymography. The predominant inhibitory activity was magnesium-dependent and could be eliminated by protease or chondroitinase digestion and by heat treatment. Kinetics of inhibition were similar against hyaluronidases from testis and snake and bee venoms. The inhibitor had no effect on Streptomyces hyaluronidase, indicating that inhibition was not through protection of the hyaluronan substrate. Inhibition levels in serum were increased in mice following carbon tetrachloride or interleukin-1 injection, inducers of the acute-phase response. Reverse zymography identified a predominant band of 120-kDa relative molecular size, with two bands of greater and one of smaller size. The predominant protein was tentatively identified as a member of the inter-alpha-inhibitor family. Inhibition was also observed using either purified inter-alpha-inhibitor or an inter-alpha-inhibitor-related 120-kDa complex. Inter-alpha-inhibitor, found in the hyaluronan-rich cumulus mass surrounding mammalian ova and the coat of fibroblasts and mesothelial cells, may function to stabilize such matrices by protecting against hyaluronidase degradation. Turnover of circulating hyaluronan is extraordinarily rapid, with a half-life of 2-5 min. Prompt increases in levels of serum hyaluronan occur in patients with shock, septicemia, or massive burns, increases that can be attributed, in part, to suppression of degradation by these acute-phase reactants, the inhibitors of hyaluronidase.
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Affiliation(s)
- K Mio
- Lion Corporation, Life Science Research Center, Kanagawa, 256-0811 Japan
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Wang P, Ba ZF, Chaudry IH. Liver endothelial cell function is depressed only during hypodynamic sepsis. J Surg Res 1997; 68:38-43. [PMID: 9126193 DOI: 10.1006/jsre.1996.4987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although studies have indicated that hepatocellular function is depressed early after the onset of sepsis, it remains unknown whether liver endothelial cell function is also compromised under such conditions. To study this, male rats were subjected to polymicrobial sepsis by cecal ligation and puncture (CLP), followed by administration of 3 ml/100 g body wt normal saline subcutaneously to these and to sham-operated animals. Blood samples (0.2-ml aliquots) were taken from the carotid artery, portal vein, and hepatic vein at 2, 5, 10 (i.e., hyperdynamic sepsis), or 20 hr (hypodynamic sepsis) after CLP, and plasma hyaluronic acid (HA) was determined using a Pharmacia assay kit. In addition, HA clearance was assessed at 5, 10, or 20 hr after CLP by injecting 30 micrograms/100 g body wt HA intravenously. Plasma HA was determined at 2-40 min after the administration of HA. The results indicate that plasma levels of HA in blood from three different sites did not increase significantly until 10 hr after CLP. Clearance of HA decreased only at 20 hr after CLP, compared to sham-operated animals. These results suggest that the increased plasma levels of HA at 10 hr after the onset of sepsis are solely due to the increased release/production of the polysaccharide. Since circulating HA is cleared exclusively by the liver endothelial cell, the results demonstrate that liver endothelial cell dysfunction (i.e., the increased circulating HA levels and decreased HA clearance) occurs only during the late, hypodynamic stage of polymicrobial sepsis.
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Affiliation(s)
- P Wang
- Center for Surgical Research, Brown University School of Medicine, Providence, Rhode Island, USA
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Laurent UB, Laurent TC, Hellsing LK, Persson L, Hartman M, Lilja K. Hyaluronan in human cerebrospinal fluid. Acta Neurol Scand 1996; 94:194-206. [PMID: 8899053 DOI: 10.1111/j.1600-0404.1996.tb07052.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We studied the concentration of hyaluronan in cerebrospinal fluid (CSF) in various diseases and attempted to define its reference interval. A radioassay utilizing cartilage proteins with affinity for hyaluronan was used in determining the concentration of 200 lumbar and 27 ventricular CSF specimens and 11 brain cyst fluids. Molecular weight distributions were determined by gel chromatography and localization in brain tissue by histochemistry. The hyaluronan level of lumbar CSF showed an increase with age; comparatively healthy children had (mean +/- SD) 50 +/- 41 micrograms/L (n = 40) and adults 166 +/- 77 micrograms/L (n = 9); i.e. significantly different values. The highest level was recorded in a patient with meningitis (> 8000 micrograms/L). More than 4000 micrograms/ L was noted in a patient with tumour metastasis in the cerebellum. Significantly elevated levels were especially found with spinal stenosis, head injury and cerebral infarction, but also in inflammatory medical disorders, hydrocephalus and encephalitis. We found no significant increase in multiple sclerosis and some other neurological diseases. Ventricular CSF of adults contained significantly less hyaluronan (53 +/- 73 micrograms/L; n = 16) than lumbar CSF. Hyaluronan in cyst fluids varied from 31 to 25,000 micrograms/L. Weight average molecular weight of hyaluronan in CSF was 2.9-3.0 x 10(5) and in brain tumour cyst fluid 2.4 x 10(6). In search for the origin of hyaluronan in CSF it was found that its concentration in the choroid plexus and leptomeninges was low, but that hyaluronan was accumulated in the superficial layer of the cerebral cortex. Continued screening for hyaluronan in CSF may be valuable in cases of inflammatory diseases, tumours and obstruction to CSF flow.
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Affiliation(s)
- U B Laurent
- Department of Ophthalmology, University of Uppsala, Sweden
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Yamada M, Fukuda Y, Koyama Y, Nakano I, Urano F, Katano Y, Hayakawa T. Serum hyaluronic acid reflects the effect of interferon treatment on hepatic fibrosis in patients with chronic hepatitis C. J Gastroenterol Hepatol 1996; 11:646-51. [PMID: 8840240 DOI: 10.1111/j.1440-1746.1996.tb00308.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Changes in serum hyaluronic acid (HA) in 35 patients treated with interferon (IFN) were studied and the histological change in fibrosis was analysed. Serum HA levels and hepatitis C virus (HCV) RNA were followed from the start of therapy to 12 months after completion of treatment. Histological changes in pre- and post-treatment liver biopsies were assessed using a modified Knodell's scoring system. The serum levels of HA (r = 0.79; P < 0.0001) correlated with the degree of fibrosis more closely than with that of amino terminal peptides of type III procollagen (PIIIP; r = 0.45; P < 0.05) or type IV collagen (IV-C; r = 0.42; P < 0.05). Only complete responders (CR) had a significant decrease in serum levels of HA and IV-C (P < 0.05), in parallel with histological improvement (P < 0.01). Neither partial responders (PR) nor non-responders (NR) had significant changes in histological scores and in serum levels of fibrotic markers. Significant differences were observed between CR and NR, both in HA levels (P < 0.01) and PIIIP levels (P < 0.05) 12 months after the cessation of treatment. These results suggest that serum HA is an indicator of the extent of fibrosis in chronic hepatitis C. Serial determinations of serum HA levels may be of use for monitoring the histological response of hepatic fibrosis to IFN treatment in chronic hepatitis C.
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Affiliation(s)
- M Yamada
- Second Department of Internal Medicine, Nagoya University School of Medicine, Aichi, Japan
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48
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Abstract
Hyaluronan is a connective tissue polysaccharide which has also been found in blood serum in concentrations < 100 micrograms/L (average 30-40 micrograms/L in middle-aged persons). The serum level is regulated by the influx of the polysaccharide from the tissues via lymph and its receptor-mediated clearance by liver endothelial cells. Markedly high serum levels are noted in certain liver diseases, especially in patients with cirrhosis, when the clearance is impaired. In these cases serum hyaluronan can be used to follow the development of the disease. Serum hyaluronan is also a sensitive marker for impending rejection of liver transplants. Patients with rheumatoid arthritis constitute another major group with increased serum hyaluronan, but in this case the level varies markedly during the day corresponding to physical activity. There are good indications that in these subjects the excess hyaluronan comes from the joints. Under stringent sampling conditions of serum it should be possible to extract interesting information on the inflammatory joint process. Increased hyaluronan levels are also seen in other inflammatory diseases and it is of special interest that high hyaluronan levels in patients with septic conditions is a sign of poor prognosis. Certain tumours, notably Wilms' tumour and mesothelioma, produce factors which activate synthesis of hyaluronan and increase its serum level. Rare hereditary diseases with disturbances of hyaluronan metabolism and elevated blood levels have also been discovered, e.g. Werner's syndrome and cutaneous hyaluronanosis. Information accumulated during the last decade regarding the metabolism of hyaluronan has made this polysaccharide an interesting clinical marker for a number of pathological conditions.
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Affiliation(s)
- T C Laurent
- Department of Medical, University of Uppsala, Sweden
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Kjeldsen J, Schaffalitzky de Muckadell OB, Junker P. Seromarkers of collagen I and III metabolism in active Crohn's disease. Relation to disease activity and response to therapy. Gut 1995; 37:805-10. [PMID: 8537052 PMCID: PMC1382943 DOI: 10.1136/gut.37.6.805] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Crohn's disease is characterised by gradual development of intestinal fibrotic lesions containing large amounts of collagen type I, III, and V. Measurement of circulating connective tissue metabolites has emerged as a useful tool for assessment of fibroproliferative activity in various diseases. Serum concentrations of procollagen peptides, N-terminal propeptide of type III procollagen (PII-INP), and C-terminal propeptide of type I procollagen (PICP), reflect the synthesis rate of the parent collagens, while the C-terminal telopeptide of type I collagen (ICTP) reflects its degradation. S-PIIINP, S-PICP, and S-ICTP were measured by radioimmunoassays in 29 patients with active Crohn's disease. S-ICTP was significantly increased, median 6.2 micrograms/l (95% CI 5.2 to 8.7 micrograms/l) versus controls 2.6 micrograms/l (2.5 to 2.7 micrograms/l) (p < 0.0001), S-PICP reduced, 100 micrograms/l (80 to 110 micrograms/l) versus 132 micrograms/l (124 to 141 micrograms/l) (p = 0.001), and S-PIIINP did not differ from controls. Patients with sustained clinical remission during prednisolone therapy exhibited an increase in S-PICP (p = 0.0052). S-PIIINP changed significantly (p = 0.0002), however, exhibiting a biphasic pattern. S-ICTP decreased (p = 0.015) in treatment responders but remained above the upper normal limit even when clinical remission had been achieved. Non-responders showed no significant changes in any of the marker molecules of collagen synthesis or degradation. Correlations were found between S-PIIINP and S-PICP (p < 0.005) and S-ICTP (p < 0.02), and between S-ICTP and S-orosomucoid (p < 0.005) and S-C reactive protein (p < 0.02). By contrast, there was no relation between the connective tissue metabolites and Harvey Bradshaw Index. These data provide evidence that collagen I degradation is increased not only in active Crohn's disease, but also in patients entering clinical remission. The concurrent normal/low-normal values of markers of collagen formation may reflect a changed local or systemic elimination of the propeptides.
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Affiliation(s)
- J Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Denmark
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Hasselbalch H, Hovgaard D, Nissen N, Junker P. Serum hyaluronan is increased in malignant lymphoma. Am J Hematol 1995; 50:231-3. [PMID: 7485095 DOI: 10.1002/ajh.2830500402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The serum concentration of hyaluronan (HYA) was measured in 41 patients with malignant lymphoma, including 21 patients with non-Hodgkin's malignant lymphoma and 20 patients with Hodgkin's disease. Thirty-four patients were studied at diagnosis. The remaining 7 patients had relapsing or resistant disease. The patients were categorized into four stages according to conventional staging procedures. The median serum HYA concentration in patients with malignant lymphoma was significantly higher (median 40.7 ng/ml; 95% confidence limits 26.1-57.6 ng/ml) than in an age-matched healthy reference group (median 14.5 ng/ml, 95% confidence limits 11-19.4 ng/ml) (P = 0.00032). The highest serum HYA levels were found in patients with relapsing/resistant disease, all being in stages III and IV (median 181.5; range 11.9-500 ng/ml), as compared to previously untreated patients (median 29.8; range 9.1-108) (P = 0.0002) and controls (median 14.2; range 6.7-51.2). Decreased uptake and degradation of HYA owing to malignant transformation of lymphatic tissue is the most plausible explanation to these findings.
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Affiliation(s)
- H Hasselbalch
- Department of Medicine and Haematology L, Rigshospitalet, Copenhagen, Denmark
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