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Lin Y, Postma DF, Steeneken LS, Melo dos Santos LS, Kirkland JL, Espindola‐Netto JM, Tchkonia T, Borghesan M, Bouma HR, Demaria M. Circulating monocytes expressing senescence-associated features are enriched in COVID-19 patients with severe disease. Aging Cell 2023; 22:e14011. [PMID: 37969056 PMCID: PMC10726854 DOI: 10.1111/acel.14011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/17/2023] Open
Abstract
Accurate biomarkers for predicting COVID-19 severity have remained an unmet need due to an incomplete understanding of virus pathogenesis and heterogeneity among patients. Cellular senescence and its pro-inflammatory phenotype are suggested to be a consequence of SARS-CoV-2 infection and potentially drive infection-dependent pathological sequelae. Senescence-associated markers in infected individuals have been identified primarily in the lower respiratory tract, while little is known about their presence in more easily accessible bio-specimens. Here, we measured the abundance of senescence-associated signatures in whole blood, plasma and peripheral blood mononuclear cells (PBMCs) of COVID-19 patients and patients without an infection. Bulk transcriptomic and targeted proteomic assays revealed that the level of senescence-associated markers, including the senescence-associated secretory phenotype (SASP), is predictive of SARS-CoV-2 infection. Single-cell RNA-sequencing data demonstrated that a senescence signature is particularly enriched in monocytes of COVID-19 patients, partially correlating with disease severity. Our findings suggest that monocytes are prematurely induced to senescence by SARS-CoV-2 infection, might contribute to exacerbating a SASP-like inflammatory response and can serve as markers and predictors for COVID-19 and its sequelae.
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Affiliation(s)
- Y. Lin
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG), University of Groningen (RUG)GroningenNetherlands
| | - D. F. Postma
- Department of Internal Medicine and Infectious DiseasesUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | - L. S. Steeneken
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG), University of Groningen (RUG)GroningenNetherlands
| | - L. S. Melo dos Santos
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG), University of Groningen (RUG)GroningenNetherlands
| | - J. L. Kirkland
- Clinical Pharmacy & PharmacologyUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
| | - J. M. Espindola‐Netto
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - T. Tchkonia
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
- Robert and Arlene Kogod Center on AgingMayo ClinicRochesterMinnesotaUSA
| | - M. Borghesan
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG), University of Groningen (RUG)GroningenNetherlands
| | - H. R. Bouma
- Department of Internal Medicine and Infectious DiseasesUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
- Clinical Pharmacy & PharmacologyUniversity Medical Center Groningen (UMCG)GroningenThe Netherlands
| | - M. Demaria
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG), University of Groningen (RUG)GroningenNetherlands
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Lira Chavez FM, Gartzke LP, van Beuningen FE, Wink SE, Henning RH, Krenning G, Bouma HR. Restoring the infected powerhouse: Mitochondrial quality control in sepsis. Redox Biol 2023; 68:102968. [PMID: 38039825 DOI: 10.1016/j.redox.2023.102968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
Sepsis is a dysregulated host response to an infection, characterized by organ failure. The pathophysiology is complex and incompletely understood, but mitochondria appear to play a key role in the cascade of events that culminate in multiple organ failure and potentially death. In shaping immune responses, mitochondria fulfil dual roles: they not only supply energy and metabolic intermediates crucial for immune cell activation and function but also influence inflammatory and cell death pathways. Importantly, mitochondrial dysfunction has a dual impact, compromising both immune system efficiency and the metabolic stability of end organs. Dysfunctional mitochondria contribute to the development of a hyperinflammatory state and loss of cellular homeostasis, resulting in poor clinical outcomes. Already in early sepsis, signs of mitochondrial dysfunction are apparent and consequently, strategies to optimize mitochondrial function in sepsis should not only prevent the occurrence of mitochondrial dysfunction, but also cover the repair of the sustained mitochondrial damage. Here, we discuss mitochondrial quality control (mtQC) in the pathogenesis of sepsis and exemplify how mtQC could serve as therapeutic target to overcome mitochondrial dysfunction. Hence, replacing or repairing dysfunctional mitochondria may contribute to the recovery of organ function in sepsis. Mitochondrial biogenesis is a process that results in the formation of new mitochondria and is critical for maintaining a pool of healthy mitochondria. However, exacerbated biogenesis during early sepsis can result in accumulation of structurally aberrant mitochondria that fail to restore bioenergetics, produce excess reactive oxygen species (ROS) and exacerbate the disease course. Conversely, enhancing mitophagy can protect against organ damage by limiting the release of mitochondrial-derived damage-associated molecules (DAMPs). Furthermore, promoting mitophagy may facilitate the growth of healthy mitochondria by blocking the replication of damaged mitochondria and allow for post sepsis organ recovery through enabling mitophagy-coupled biogenesis. The remaining healthy mitochondria may provide an undamaged scaffold to reproduce functional mitochondria. However, the kinetics of mtQC in sepsis, specifically mitophagy, and the optimal timing for intervention remain poorly understood. This review emphasizes the importance of integrating mitophagy induction with mtQC mechanisms to prevent undesired effects associated with solely the induction of mitochondrial biogenesis.
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Affiliation(s)
- F M Lira Chavez
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands.
| | - L P Gartzke
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands
| | - F E van Beuningen
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands
| | - S E Wink
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands
| | - R H Henning
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands
| | - G Krenning
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands; Sulfateq B.V, Admiraal de Ruyterlaan 5, 9726, GN Groningen, the Netherlands
| | - H R Bouma
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands; Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, 9713, GZ Groningen, the Netherlands
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Olgers TJ, van Os JM, Bouma HR, ter Maaten JC. The validation of a serious game for teaching ultrasound skills. Ultrasound J 2022; 14:29. [PMID: 35870092 PMCID: PMC9308840 DOI: 10.1186/s13089-022-00280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is an important bedside diagnostic tool and is being taught in several specialties. However, mastering the required psychomotor skills takes time and learning curves are different between students. Especially learning to make the right probe movements with the corresponding changes of the ultrasound image on screen, and integrating it into a 3D mental model takes time. This precious bedside-time of trainers and physicians may be reduced using other learning methods for mastering the psychomotor skills, for example the use of serious games. Such a game is under development but it needs to be validated before widespread use can be advised. In this article we describe the development and the first three steps in the validation of a serious game for ultrasound skills. Results We have included 18 ultrasound experts and 24 ultrasound novices who played the serious game ‘Underwater” and provided feedback. They concluded that “underwater” is fun to play and that movement of the 3D-printed probe resembled real ultrasound probe movements. Participants highly valued the potential of the game for training eye–hand coordination and stability of probe handling, two very important skills in performing ultrasound in real practice. Although we compared several in-game parameters such as distance and speed, no difference was observed between novices and experts. This means that content- and face validity of the serious game is demonstrated but optimal parameters to measure differences between novices and experts still have to be determined. Conclusions Our study shows solid content- and face validity of the serious game “UnderWater” for training ultrasound skills, although construct validity could not be demonstrated yet. The game is appreciated as a promising serious game for training eye–hand coordination and learning ultrasound, which may reduce expensive bed-side teaching. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00280-8.
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van den Berg M, van Beuningen FE, Ter Maaten JC, Bouma HR. Hospital-related costs of sepsis around the world: A systematic review exploring the economic burden of sepsis. J Crit Care 2022; 71:154096. [PMID: 35839604 DOI: 10.1016/j.jcrc.2022.154096] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
AIM The aim of this study was to examine the quality of manuscripts reporting sepsis health care costs and to provide an overview of hospital-related expenditures for sepsis in adult patients around the world. METHODS We systematically searched the PubMed, EMBASE, Cochrane and Google Scholar to identify relevant studies between January 2010 and January 2022. We selected articles that provided costs and cost-effectiveness analyses, defined sepsis and described their cost calculation method. All costs were adjusted to 2020 US dollars. Medians and interquartile ranges (IQRs) for various costs of sepsis were calculated. The quality of economic studies was assessed using the Drummond 10-item checklist. RESULTS Overall, 26 studies met our eligibility criteria. The mean total hospital costs per patient varied largely, between €1101 and €91,951. The median (IQR) of the total sepsis costs per country were €36,191 (€17,158 - €53,349), which equals €50 (€34 - €84) per capita annually. The relative amount of healthcare budget spent on sepsis was 2.65%, which equals 0.33% of the gross national product (GNP). CONCLUSION While general sepsis costs are high, there is considerable variability between countries regarding the costs of sepsis. Further studies examining the impact on sepsis costs, especially on the general ward, can help justify, design and monitor initiatives on prevention, diagnosis, and treatment of this time-critical and potentially preventable disease.
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Affiliation(s)
- M van den Berg
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F E van Beuningen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J C Ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - H R Bouma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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de Boer FJ, van Ieperen I, Boersma HE, Bouma HR. Severe hypocalcaemia and hypomagnesemia presenting with severe neurologic and gastro-intestinal symptoms: a case report and review of literature. CAN J EMERG MED 2021; 23:401-403. [PMID: 33544331 PMCID: PMC8102445 DOI: 10.1007/s43678-021-00089-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Affiliation(s)
- F J de Boer
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, EB40, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - I van Ieperen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, EB40, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - H E Boersma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, EB40, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - H R Bouma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, EB40, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Olgers TJ, Azizi N, Bouma HR, Ter Maaten JC. Life after a point-of-care ultrasound course: setting up the right conditions! Ultrasound J 2020; 12:43. [PMID: 32893335 PMCID: PMC7475055 DOI: 10.1186/s13089-020-00190-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Point-of-care Ultrasound (POCUS) is becoming an important diagnostic tool for internal medicine and ultrasound educational programs are being developed. An ultrasound course is often included in such a curriculum. We have performed a prospective observational questionnaire-based cohort study consisting of participants of a POCUS course for internal medicine in the Netherlands in a 2-year period. We investigated the usefulness of an ultrasound course and barriers participants encountered after the course. Results 55 participants (49%) completed the pre-course questionnaire, 29 (26%) completed the post-course questionnaire, 11 participants (10%) finalized the third questionnaire. The number of participants who performs POCUS was almost doubled after the course (from 34.5 to 65.5%). Almost all participants felt insufficiently skilled before the course which declined to 34.4% after the course. The majority (N = 26 [89.7%]) stated that this 2-day ultrasound course was sufficient enough to perform POCUS in daily practice but also changed daily practice. The most important barriers withholding them from performing ultrasound are lack of experts for supervision, insufficient practice time and absence of an ultrasound machine. Conclusions This study shows that a 2-day hands-on ultrasound course seems a sufficient first step in an ultrasound curriculum for internal medicine physicians to obtain enough knowledge and skills to perform POCUS in clinical practice but it also changes clinical practice. However, there are barriers in the transfer to clinical practice that should be addressed which may improve curriculum designing.
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Affiliation(s)
- T J Olgers
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands.
| | - N Azizi
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
| | - H R Bouma
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands.,Dept of Clinical Pharmacy and Pharmacology, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
| | - J C Ter Maaten
- Dept Internal Med, Univ Groningen, Univ Med Ctr Groningen, 9700 RB, Groningen, The Netherlands
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Stolmeijer R, Bouma HR, Zijlstra JG, Drost-de Klerck AM, ter Maaten JC, Ligtenberg JJM. A Systematic Review of the Effects of Hyperoxia in Acutely Ill Patients: Should We Aim for Less? Biomed Res Int 2018; 2018:7841295. [PMID: 29888278 PMCID: PMC5977014 DOI: 10.1155/2018/7841295] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/04/2018] [Accepted: 04/12/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite widespread and liberal use of oxygen supplementation, guidelines about rational use of oxygen are scarce. Recent data demonstrates that current protocols lead to hyperoxemia in the majority of the patients and most health care professionals are not aware of the negative effects of hyperoxemia. METHOD To investigate the effects of hyperoxemia in acutely ill patients on clinically relevant outcomes, such as neurological and functional status as well as mortality, we performed a literature review using Medline (PubMed) and Embase. We used the following terms: hyperoxemia OR hyperoxemia OR ["oxygen inhalation therapy" AND (mortality OR death OR outcome OR survival)] OR [oxygen AND (mortality OR death OR outcome OR survival)]. Original studies about the clinical effects of hyperoxemia in adult patients suffering from acute or emergency illnesses were included. RESULTS 37 articles were included, of which 31 could be divided into four large groups: cardiac arrest, traumatic brain injury (TBI), stroke, and sepsis. Although a single study demonstrated a transient protective effect of hyperoxemia after TBI, other studies revealed higher mortality rates after cardiac arrest, stroke, and TBI treated with oxygen supplementation leading to hyperoxemia. Approximately half of the studies showed no association between hyperoxemia and clinically relevant outcomes. CONCLUSION Liberal oxygen therapy leads to hyperoxemia in a majority of patients and hyperoxemia may negatively affect survival after acute illness. As a clinical consequence, aiming for normoxemia may limit negative effects of hyperoxemia in patients with acute illness.
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Affiliation(s)
- R. Stolmeijer
- Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - H. R. Bouma
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. G. Zijlstra
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. M. Drost-de Klerck
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. C. ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. J. M. Ligtenberg
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Bouma HR, Schreuder RM. An unexpected cause of nausea and vomiting in a patient with metastasised lung cancer. Neth J Med 2017; 75:215. [PMID: 28653948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- H R Bouma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
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Bouma HR, Kloppenburg WD. Fever and painful skin lesions after a holiday in Gambia. Neth J Med 2017; 75:41. [PMID: 28124672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- H R Bouma
- Department of Internal Medicine, Martini Hospital Groningen, Groningen, the Netherlands
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Bouma HR, Strijkstra AM, Boerema AS, Deelman LE, Epema AH, Hut RA, Kroese FGM, Henning RH. Blood cell dynamics during hibernation in the European Ground Squirrel. Vet Immunol Immunopathol 2010; 136:319-23. [PMID: 20399508 DOI: 10.1016/j.vetimm.2010.03.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 03/16/2010] [Accepted: 03/22/2010] [Indexed: 11/16/2022]
Abstract
Hibernation is a unique natural model to study large and specific modulation in numbers of leukocytes and thrombocytes, with potential relevance for medical application. Hibernating animals cycle through cold (torpor) and warm (arousal) phases. Previous research demonstrated clearance of leukocytes and thrombocytes from the circulation during torpor, but did not provide information regarding the timing during torpor or the subtype of leukocytes affected. To study the influence of torpor-bout duration on clearance of circulating cells, we measured blood cell dynamics in the European Ground Squirrel. Numbers of leukocytes and thrombocytes decreased within 24h of torpor by 90% and remained unchanged during the remainder of the torpor-bout. Differential counts demonstrated that granulocytes, lymphocytes and monocytes are all affected by torpor. Although a decreased production might explain the reduced number of thrombocytes, granulocytes and monocytes, this cannot explain the observed lymphopenia since lymphocytes have a much lower turnover rate than thrombocytes, granulocytes and monocytes. In conclusion, although underlying biochemical signaling pathways need to be unraveled, our data show that the leukocyte count drops dramatically after entrance into torpor and that euthermic cell counts are restored within 1.5h after onset of arousal, even before body temperature is fully normalized.
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Affiliation(s)
- H R Bouma
- Department of Clinical Pharmacology, Groningen University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, The Netherlands.
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Abstract
Kidneys derived from brain death organ donors show an inferior survival when compared to kidneys derived from living donors. Brain death is known to induce organ injury by evoking an inflammatory response in the donor. Neuronal injury triggers an inflammatory response in the brain, leading to endothelial dysfunction and the release of cytokines in the circulation. Serum levels of interleukin-6, -8, -10, and monocyte chemoattractant protein-1 (MCP-1) are increased after brain death. Binding with cytokine-receptors in kidneys stimulates activation of nuclear factor-kappa B (NF-kappaB), selectins, adhesion molecules and production of chemokines leading to cellular influx. Mitogen-activated protein kinases (MAP-kinases) mediate inflammatory responses and together with NF-kappaB they seem to play an important role in brain death induced renal injury. Altering the activation state of MAP-kinases could be a promising drug target for early intervention to reduce cerebral injury related donor kidney damage and improve outcome after transplantation.
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Affiliation(s)
- H R Bouma
- Department of Clinical Pharmacology, Groningen University Institute of Drug Exploration, University Medical Center Groningen, The Netherlands
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