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Julian N, Gaugain S, Labeyrie MA, Barthélémy R, Froelich S, Houdart E, Mebazaa A, Chousterman BG. Systemic tolerance of intravenous milrinone administration for cerebral vasospasm secondary to non-traumatic subarachnoid hemorrhage. J Crit Care 2024; 82:154807. [PMID: 38579430 DOI: 10.1016/j.jcrc.2024.154807] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE Delayed cerebral ischemia (DCI) is a severe subarachnoid hemorrhage (SAH) complication, closely related to cerebral vasospasm (CVS). CVS treatment frequently comprises intravenous milrinone, an inotropic and vasodilatory drug. Our objective is to describe milrinone's hemodynamic, respiratory and renal effects when administrated as treatment for CVS. METHODS Retrospective single-center observational study of patients receiving intravenous milrinone for CVS with systemic hemodynamics, oxygenation, renal disorders monitoring. We described these parameters' evolution before and after milrinone initiation (day - 1, baseline, day 1 and day 2), studied treatment cessation causes and assessed neurological outcome at 3-6 months. RESULTS Ninety-one patients were included. Milrinone initiation led to cardiac output increase (4.5 L/min [3.4-5.2] at baseline vs 6.6 L/min [5.2-7.7] at day 2, p < 0.001), Mean Arterial Pressure decrease (101 mmHg [94-110] at baseline vs 95 mmHg [85-102] at day 2, p = 0.001) norepinephrine treatment requirement increase (32% of patients before milrinone start vs 58% at day 1, p = 0.002) and slight PaO2/FiO2 ratio deterioration (401 [333-406] at baseline vs 348 [307-357] at day 2, p = 0.016). Milrinone was interrupted in 8% of patients. 55% had a favorable outcome. CONCLUSION Intravenous milrinone for CVS treatment seems associated with significant impact on systemic hemodynamics leading sometimes to treatment discontinuation.
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Affiliation(s)
- Nathan Julian
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris F-75010, France.
| | - Samuel Gaugain
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris F-75010, France
| | - Marc-Antoine Labeyrie
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Interventional Neuroradiology, Hopital Lariboisière, Paris, France
| | - Romain Barthélémy
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris F-75010, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, University of Paris, France
| | - Emmanuel Houdart
- Department of Interventional Neuroradiology, Hopital Lariboisière, Paris, France
| | - Alexandre Mebazaa
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris F-75010, France
| | - Benjamin G Chousterman
- Université de Paris, INSERM, U942 MASCOT, Paris F-75006, France; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris F-75010, France
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2
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Blot PL, Chousterman BG, Santafè M, Cartailler J, Pacheco A, Magret M, Masclans JR, Artigas A, Roca O, García-de-Acilu M. Subphenotypes in patients with acute respiratory distress syndrome treated with high-flow oxygen. Crit Care 2023; 27:419. [PMID: 37915062 PMCID: PMC10619276 DOI: 10.1186/s13054-023-04687-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) subphenotypes differ in outcomes and treatment responses. Subphenotypes in high-flow nasal oxygen (HFNO)-treated ARDS patients have not been investigated. OBJECTIVES To identify biological subphenotypes in HFNO-treated ARDS patients. METHODS Secondary analysis of a prospective multicenter observational study including ARDS patients supported with HFNO. Plasma inflammation markers (interleukin [IL]-6, IL-8, and IL-33 and soluble suppression of tumorigenicity-2 [sST2]) and lung epithelial (receptor for advanced glycation end products [RAGE] and surfactant protein D [SP-D]) and endothelial (angiopoietin-2 [Ang-2]) injury were measured. These biomarkers and bicarbonate were used in K-means cluster analysis to identify subphenotypes. Logistic regression was performed on biomarker combinations to predict clustering. We chose the model with the best AUROC and the lowest number of variables. This model was used to describe the HAIS (High-flow ARDS Inflammatory Subphenotype) score. RESULTS Among 41 HFNO patients, two subphenotypes were identified. Hyperinflammatory subphenotype (n = 17) showed higher biomarker levels than hypoinflammatory (n = 24). Despite similar baseline characteristics, the hyperinflammatory subphenotype had higher 60-day mortality (47 vs 8.3% p = 0.014) and longer ICU length of stay (22.0 days [18.0-30.0] vs 39.5 [25.5-60.0], p = 0.034). The HAIS score, based on IL-8 and sST2, accurately distinguished subphenotypes (AUROC 0.96 [95%CI: 0.90-1.00]). A HAIS score ≥ 7.45 was predictor of hyperinflammatory subphenotype. CONCLUSION ARDS patients treated with HFNO exhibit two biological subphenotypes that have similar clinical characteristics, but hyperinflammatory patients have worse outcomes. The HAIS score may identify patients with hyperinflammatory subphenotype and might be used for enrichment strategies in future clinical trials.
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Affiliation(s)
- Pierre-Louis Blot
- Département d'anesthésie-Réanimation, Hôpital Lariboisière, Paris, France
- INSERM UMRS-942 MASCOT, Hôpital Lariboisière, Paris, France
| | - Benjamin G Chousterman
- Département d'anesthésie-Réanimation, Hôpital Lariboisière, Paris, France
- INSERM UMRS-942 MASCOT, Hôpital Lariboisière, Paris, France
| | - Manel Santafè
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí (I3PT-CERCA), Parc del Taulí 1, 08028, Sabadell, Spain
| | | | - Andrés Pacheco
- Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mònica Magret
- Servei de Medicina Intensiva, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Joan R Masclans
- Critical Care Department, Hospital del Mar-Parc de Salut MAR. GREPAC-Group Recerca Departamento de Medicina y Ciencias de la Vida Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Director de Docencia PSMAR, Intensive Care Unit Hospital del Mar. Professor of Medicine Universitat Pompeu Fabra (UPF) IMIM (GREPAC - Group Recerca Patologia Critica) Departamento de Medicina Y Ciencias de la Vida (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antoni Artigas
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí (I3PT-CERCA), Parc del Taulí 1, 08028, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Respiratorias, Insituto de Salud Carlos III, Madrid, Spain
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí (I3PT-CERCA), Parc del Taulí 1, 08028, Sabadell, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Marina García-de-Acilu
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí (I3PT-CERCA), Parc del Taulí 1, 08028, Sabadell, Spain
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3
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Boutin L, Morisson L, Riché F, Barthélémy R, Mebazaa A, Soyer P, Gallix B, Dohan A, Chousterman BG. Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit. Acute Crit Care 2023; 38:343-352. [PMID: 37652864 PMCID: PMC10497895 DOI: 10.4266/acc.2023.00136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis. METHODS This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times. RESULTS Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43-0.54) and 0.51 (95% CI, 0.46-0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66-0.77) for elastic net and 0.69 (95% CI, 0.64-0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91-0.96) and 0.75 (95% CI, 0.70-0.80) for elastic net and random forest, respectively. CONCLUSIONS This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.
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Affiliation(s)
- Louis Boutin
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
| | - Louis Morisson
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
| | - Florence Riché
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
| | - Romain Barthélémy
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
| | - Philippe Soyer
- INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
- Department of Radiology, Cochin Hospital, AP-HP, Paris, France
| | - Benoit Gallix
- IHU Strasbourg, Strasbourg, France
- Icube Laboratory and Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Department of Radiology, McGill University, Montreal, QC, Canada
| | - Anthony Dohan
- INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
- Department of Radiology, Cochin Hospital, AP-HP, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, MASCOT, Université Paris Cité, Paris, France
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4
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Basse P, Morisson L, Barthélémy R, Julian N, Kindermans M, Collet M, Huot B, Gayat E, Mebazaa A, Chousterman BG. Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France. Acute Crit Care 2023; 38:172-181. [PMID: 37313663 DOI: 10.4266/acc.2022.01494] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). METHODS This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. RESULTS Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9-12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12-4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11-18]) and the no-WRF group (9 G/L [8-11]) (P=0.002). CONCLUSIONS In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.
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Affiliation(s)
- Pierre Basse
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Louis Morisson
- Department of Anesthesiology and Pain Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Canada
| | - Romain Barthélémy
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Nathan Julian
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Manuel Kindermans
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Magalie Collet
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Benjamin Huot
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- Université Paris-Cité, INSERM, U942 MASCOT, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- Université Paris-Cité, INSERM, U942 MASCOT, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- Université Paris-Cité, INSERM, U942 MASCOT, Paris, France
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5
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Foudhaili A, Barthélémy R, Collet M, de Roquetaillade C, Kerever S, Vitiello D, Mebazaa A, Chousterman BG. Impact of Early Out-of-Bed Mobilization on Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study. World Neurosurg 2023:S1878-8750(23)00395-9. [PMID: 36966907 DOI: 10.1016/j.wneu.2023.03.073] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Effects of early mobilization are not well documented in patients with aneurysmal subarachnoid hemorrhage (aSAH). Only a few studies have investigated it through progressive mobilization protocols and suggested that it is safe and feasible. This study aimed to determine the impact of early out-of-bed mobilization (EOM) on 3-month functional outcome and cerebral vasospasm (CVS) occurrence in patients with aSAH. METHODS A retrospective review of consecutive patients admitted to the intensive care unit with a diagnosis of aSAH was performed. EOM was defined as out-of-bed (OOB) mobilization performed before or on day 4 after aSAH onset. The primary outcome was 3-month functional independence (i.e., a modified Rankin Scale below 3) and the occurrence of CVS. RESULTS A total of 179 patients with aSAH met the inclusion criteria. Thirty-one patients constituted the EOM group, and 148 patients were in the delayed out-of-bed mobilization group. Functional independence was more frequent in the EOM group than in the delayed out-of-bed mobilization group (n = 26 [84%] vs. n = 83 [56%], P = 0.004). In a multivariable analysis, EOM was an independent predictor of functional independence (adjusted odds ratio = 3.11; 95% confidence interval, 1.11-10.36; P < 0.05). The delay between bleeding and first OOB mobilization was also identified as an independent risk factor for the occurrence of CVS (adjusted odds ratio = 1.12; 95% confidence interval = 1.06-1.18, P < 0.001). CONCLUSIONS EOM was independently associated with favorable functional outcome after aSAH. The delay between bleeding and OOB mobilization was an independent risk factor for reduced functional independence and CVS occurrence. Prospective randomized trials are necessary to confirm these results and improve clinical practice.
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Affiliation(s)
- Adéla Foudhaili
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Physical Medicine and Rehabilitation, CHU Lariboisière, AP-HP, Paris, France; Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, Paris, France.
| | - Romain Barthélémy
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France
| | - Magalie Collet
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France
| | - Charles de Roquetaillade
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France
| | - Sébastien Kerever
- Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre de Recherche Epidémiologie et StatistiqueS, Paris, France
| | - Damien Vitiello
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, Paris, France
| | - Alexandre Mebazaa
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France
| | - Benjamin G Chousterman
- Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France
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Blot PL, DE Roquetaillade C, Deniau B, Gaugain S, Kindermans M, Julian N, LE Dorze M, Mebazaa A, Chousterman BG, Barthélémy R. Efficacy of almitrine as a rescue therapy for refractory hypoxemia in COVID and non-COVID acute respiratory distress syndrome. A retrospective monocenter study. Minerva Anestesiol 2023; 89:157-165. [PMID: 36287391 DOI: 10.23736/s0375-9393.22.16736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Almitrine, a drug enhancing hypoxic pulmonary vasoconstriction, has been proposed as a rescue therapy for refractory hypoxemia in COVID related acute respiratory distress syndrome (C-ARDS). We aimed at investigating the response to almitrine depending on the cause of ARDS (COVID vs. non-COVID). METHODS Monocenter retrospective study from 2014 to 2021. All patients diagnosed with moderate to severe ARDS and treated with almitrine as rescue therapy for refractory hypoxemia were studied. Factor independently associated with oxygenation response to almitrine infusion were determined. RESULTS Sixty patients with ARDS and treated with almitrine were analyzed, 36 (60%) due to SARS-CoV-2 infection and 24 (40%) due to other causes. Baseline PaO2/FiO2 was 78 [61-101] mmHg, 76% had at least one prone positioning before the start of almitrine infusion. Median PaO2/FiO2 increased by +38 [7-142] mmHg (+61% [10-151]) after almitrine infusion. PaO2/FiO2 increased by +134 [12-186] mmHg in non-COVID ARDS (NC-ARDS) and by +19 [8-87] mmHg in C-ARDS. The increase in PaO2/FiO2 was lower in C-ARDS than in NC-ARDS (P=0.013). In multivariable analysis, C-ARDS, non-invasive ventilation and concomitant use of norepinephrine were independently associated with a decreased oxygenation response to almitrine infusion. CONCLUSIONS Our study reports a highly variable response to almitrine infusion in ARDS patients with refractory hypoxemia. Independent factors associated with a reduced oxygenation response to almitrine infusion were: COVID ARDS, concomitant use of norepinephrine, and non-invasive ventilatory strategy.
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Affiliation(s)
- Pierre-Louis Blot
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Charles DE Roquetaillade
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Benjamin Deniau
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Samuel Gaugain
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France
| | - Manuel Kindermans
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Nathan Julian
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Matthieu LE Dorze
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France.,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care, Lariboisière Hospital, Paris, France - .,Université Paris-Cité, Inserm UMRS 942 Mascot, Paris, France
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7
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Massart N, Maxime V, Fillatre P, Razazi K, Ferré A, Moine P, Legay F, Voiriot G, Amara M, Santi F, Nseir S, Marque-Juillet S, Bounab R, Barbarot N, Bruneel F, Luyt CE, Pham T, Pavot A, Monnet X, Richard C, Demoule A, Dres M, Mayaux J, Beurton A, Daubin C, Descamps R, Joret A, Du Cheyron D, Pene F, Chiche JD, Jozwiak M, Jaubert P, Voiriot G, Fartoukh M, Teulier M, Blayau C, Bodenes L, Ferriere N, Auchabie J, Le Meur A, Pignal S, Mazzoni T, Quenot JP, Andreu P, Roudau JB, Labruyère M, Nseir S, Preau S, Poissy J, Mathieu D, Benhamida S, Paulet R, Roucaud N, Thyrault M, Daviet F, Hraiech S, Parzy G, Sylvestre A, Jochmans S, Bouilland AL, Monchi M, Déserts MDD, Mathais Q, Rager G, Pasquier P, Reignier J, Seguin A, Garret C, Canet E, Dellamonica J, Saccheri C, Lombardi R, Kouchit Y, Jacquier S, Mathonnet A, Nay MA, Runge I, Martino F, Flurin L, Rolle A, Carles M, Coudroy R, Thille AW, Frat JP, Rodriguez M, Beuret P, Tientcheu A, Vincent A, Michelin F, Tamion F, Carpentier D, Boyer D, Girault C, Gissot V, Ehrmann S, Gandonniere CS, Elaroussi D, Delbove A, Fedun Y, Huntzinger J, Lebas E, Kisoka G, Grégoire C, Marchetta S, Lambermont B, Argaud L, Baudry T, Bertrand PJ, Dargent A, Guitton C, Chudeau N, Landais M, Darreau C, Ferre A, Gros A, Lacave G, Bruneel F, Neuville M, JérômeDevaquet, Tachon G, Gallo R, Chelha R, Galbois A, Jallot A, Lemoine LC, Kuteifan K, Pointurier V, Jandeaux LM, Mootien J, Damoisel C, Sztrymf B, Schmidt M, Combes A, Chommeloux J, Luyt CE, Schortgen F, Rusel L, Jung C, Gobert F, Vimpere D, Lamhaut L, Sauneuf B, Charrrier L, Calus J, Desmeules I, Painvin B, Tadie JM, Castelain V, Michard B, Herbrecht JE, Baldacini M, Weiss N, Demeret S, Marois C, Rohaut B, Moury PH, Savida AC, Couadau E, Série M, Alexandru N, Bruel C, Fontaine C, Garrigou S, Mahler JC, Leclerc M, Ramakers M, Garçon P, Massou N, Van Vong L, Sen J, Lucas N, Chemouni F, Stoclin A, Avenel A, Faure H, Gentilhomme A, Ricome S, Abraham P, Monard C, Textoris J, Rimmele T, Montini F, Lejour G, Lazard T, Etienney I, Kerroumi Y, Dupuis C, Bereiziat M, Coupez E, Thouy F, Hoffmann C, Donat N, Chrisment A, Blot RM, Kimmoun A, Jacquot A, Mattei M, Levy B, Ravan R, Dopeux L, Liteaudon JM, Roux D, Rey B, Anghel R, Schenesse D, Gevrey V, Castanera J, Petua P, Madeux B, Hartman O, Piagnerelli M, Joosten A, Noel C, Biston P, Noel T, Bouar GLE, Boukhanza M, Demarest E, Bajolet MF, Charrier N, Quenet A, Zylberfajn C, Dufour N, Mégarbane B, Voicu S, Deye N, Malissin I, Legay F, Debarre M, Barbarot N, Fillatre P, Delord B, Laterrade T, Saghi T, Pujol W, Cungi PJ, Esnault P, Cardinale M, Ha VHT, Fleury G, Brou MA, Zafimahazo D, Tran-Van D, Avargues P, Carenco L, Robin N, Ouali A, Houdou L, Le Terrier C, Suh N, Primmaz S, Pugin J, Weiss E, Gauss T, Moyer JD, Burtz CP, La Combe B, Smonig R, Violleau J, Cailliez P, Chelly J, Marchalot A, Saladin C, Bigot C, Fayolle PM, Fatséas J, Ibrahim A, Resiere D, Hage R, Cholet C, Cantier M, Trouiler P, Montravers P, Lortat-Jacob B, Tanaka S, Dinh AT, Duranteau J, Harrois A, Dubreuil G, Werner M, Godier A, Hamada S, Zlotnik D, Nougue H, Mekontso-Dessap A, Carteaux G, Razazi K, De Prost N, Mongardon N, Lamraoui M, Alessandri C, de Roux Q, de Roquetaillade C, Chousterman BG, Mebazaa A, Gayat E, Garnier M, Pardo E, LeaSatre-Buisson, Gutton C, Yvin E, Marcault C, Azoulay E, Darmon M, Oufella HA, Hariri G, Urbina T, Mazerand S, Heming N, Santi F, Moine P, Annane D, Bouglé A, Omar E, Lancelot A, Begot E, Plantefeve G, Contou D, Mentec H, Pajot O, Faguer S, Cointault O, Lavayssiere L, Nogier MB, Jamme M, Pichereau C, Hayon J, Outin H, Dépret F, Coutrot M, Chaussard M, Guillemet L, Goffin P, Thouny R, Guntz J, Jadot L, Persichini R, Jean-Michel V, Georges H, Caulier T, Pradel G, Hausermann MH, Nguyen-Valat TMH, Boudinaud M, Vivier E, SylvèneRosseli, Bourdin G, Pommier C, Vinclair M, Poignant S, Mons S, Bougouin W, Bruna F, Maestraggi Q, Roth C, Bitker L, Dhelft F, Bonnet-Chateau J, Filippelli M, Morichau-Beauchant T, Thierry S, Le Roy C, Jouan MS, Goncalves B, Mazeraud A, Daniel M, Sharshar T, Cadoz C, RostaneGaci, Gette S, Louis G, Sacleux SC, Ordan MA, Cravoisy A, Conrad M, Courte G, Gibot S, Benzidi Y, Casella C, Serpin L, Setti JL, Besse MC, Bourreau A, Pillot J, Rivera C, Vinclair C, Robaux MA, Achino C, Delignette MC, Mazard T, Aubrun F, Bouchet B, Frérou A, Muller L, Quentin C, Degoul S, Stihle X, Sumian C, Bergero N, Lanaspre B, Quintard H, Maiziere EM, Egreteau PY, Leloup G, Berteau F, Cottrel M, Bouteloup M, Jeannot M, Blanc Q, Saison J, Geneau I, Grenot R, Ouchike A, Hazera P, Masse AL, Demiri S, Vezinet C, Baron E, Benchetrit D, Monsel A, Trebbia G, Schaack E, Lepecq R, Bobet M, Vinsonneau C, Dekeyser T, Delforge Q, Rahmani I, Vivet B, Paillot J, Hierle L, Chaignat C, Valette S, Her B, Brunet J, Page M, Boiste F, Collin A, Bavozet F, Garin A, Dlala M, KaisMhamdi, Beilouny B, Lavalard A, Perez S, Veber B, Guitard PG, Gouin P, Lamacz A, Plouvier F, Delaborde BP, Kherchache A, Chaalal A, Ricard JD, Amouretti M, Freita-Ramos S, Roux D, Constantin JM, Assefi M, Lecore M, Selves A, Prevost F, Lamer C, Shi R, Knani L, Floury SP, Vettoretti L, Levy M, Marsac L, Dauger S, Guilmin-Crépon S, Winiszewski H, Piton G, Soumagne T, Capellier G, Putegnat JB, Bayle F, Perrou M, Thao G, Géri G, Charron C, Repessé X, Vieillard-Baron A, Guilbart M, Roger PA, Hinard S, Macq PY, Chaulier K, Goutte S, Chillet P, Pitta A, Darjent B, Bruneau A, Lasocki S, Leger M, Gergaud S, Lemarie P, Terzi N, Schwebel C, Dartevel A, Galerneau LM, Diehl JL, Hauw-Berlemont C, Péron N, Guérot E, Amoli AM, Benhamou M, Deyme JP, Andremont O, Lena D, Cady J, Causeret A, De La Chapelle A, Cracco C, Rouleau S, Schnell D, Foucault C, Lory C, Chapelle T, Bruckert V, Garcia J, Sahraoui A, Abbosh N, Bornstain C, Pernet P, Poirson F, Pasem A, Karoubi P, Poupinel V, Gauthier C, Bouniol F, Feuchere P, Heron A, Carreira S, Emery M, Le Floch AS, Giovannangeli L, Herzog N, Giacardi C, Baudic T, Thill C, Lebbah S, Palmyre J, Tubach F, Hajage D, Bonnet N, Ebstein N, Gaudry S, Cohen Y, Noublanche J, Lesieur O, Sément A, Roca-Cerezo I, Pascal M, Sma N, Colin G, Lacherade JC, Bionz G, Maquigneau N, Bouzat P, Durand M, Hérault MC, Payen JF. Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study. Ann Intensive Care 2022; 12:4. [PMID: 35015163 PMCID: PMC8748185 DOI: 10.1186/s13613-022-00979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Barthélémy R, Kindermans M, Delval P, Collet M, Gaugain S, Cecconi M, Mebazaa A, Chousterman BG. Accuracy of cumulative volumes of fluid challenge to assess fluid responsiveness in critically ill patients with acute circulatory failure: a pharmacodynamic approach. Br J Anaesth 2021; 128:236-243. [PMID: 34895718 DOI: 10.1016/j.bja.2021.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/30/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The relationship between the dose (volume of fluid) and the effect (increase of stroke volume [SV]) has been poorly described. We hypothesised that the analysis of the dynamic response of SV during fluid challenge (FC) helps to determine the optimal volume of FC, along with its diagnostic accuracy parameters for fluid responsiveness. METHODS A prospective observational study was conducted in critically ill patients with circulatory failure. Patients monitored with oesophageal Doppler and assigned to an FC of 500 ml of crystalloid were included. The areas under the curve (AUC) and 95% confidence intervals (CI95) of the receiver operating characteristic curves for cumulative volumes from 50 to 450 ml were determined for fluid responsiveness (SV increase ≥15% from baseline) along with other parameters of diagnostic accuracy. In the pharmacodynamic analysis, dose-effect and dose-response models were constructed, with determination of median and 90% effective dose (ED50 and ED90). RESULTS Forty-five patients were included. The AUC increased with cumulative volumes of FC up to 250 ml (AUC250 0.93 [CI95: 0.85-1.00]), followed by a plateau above 0.95 of AUC. The optimal volume was 250 ml, associated with a specificity of 0.89 [CI95: 0.78-1.00], a sensitivity of 0.92 [CI95: 0.69-1.00], and a threshold of 9.6% increase in SV. The ED50 was 156 [CI95: 136-177] ml and the ED90 was 312 [CI95: 269-352] ml. CONCLUSIONS A volume of FC of 250 ml with a threshold of 9.6% increase in SV showed the highest accuracy in detecting fluid responsiveness in critically ill patients with shock. CLINICAL TRIAL REGISTRATION .
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Affiliation(s)
- Romain Barthélémy
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France.
| | - Manuel Kindermans
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France
| | - Paul Delval
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France
| | - Magalie Collet
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France
| | - Samuel Gaugain
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, Paris, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexandre Mebazaa
- Université de Paris, AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, MASCOT UMRS 942, Inserm, Paris, France
| | - Benjamin G Chousterman
- Université de Paris, AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care, DMU Parabol, MASCOT UMRS 942, Inserm, Paris, France
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Abstract
Although more than 90% of children born with congenital heart disease (CHD) survive into adulthood, patients face significantly higher and premature morbidity and mortality. Heart failure as well as non-cardiac comorbidities represent a striking and life-limiting problem with need for new treatment options. Systemic chronic inflammation and immune activation have been identified as crucial drivers of disease causes and progression in various cardiovascular disorders and are promising therapeutic targets. Accumulating evidence indicates an inflammatory state and immune alterations in children and adults with CHD. In this review, we highlight the implications of chronic inflammation, immunity, and immune senescence in CHD. In this context, we summarize the impact of infant open-heart surgery with subsequent thymectomy on the immune system later in life and discuss the potential role of comorbidities and underlying genetic alterations. How an altered immunity and chronic inflammation in CHD influence patient outcomes facing SARS-CoV-2 infection is unclear, but requires special attention, as CHD could represent a population particularly at risk during the COVID-19 pandemic. Concluding remarks address possible clinical implications of immune changes in CHD and consider future immunomodulatory therapies.
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Affiliation(s)
- Laura M Wienecke
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30621, Hannover, Germany.
- Department of Anaesthesiology and Critical Care, Lariboisière University Hospital, DMU Parabol, AP-HP, Paris, France.
- Inserm U942 MASCOT, Université de Paris, Paris, France.
- Department of Cardiology, Angiology and Respiratory Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Sarah Cohen
- Congenital Heart Diseases Department, M3C Hospital Marie Lannelongue, Université Paris-Saclay, Plessis-Robinson, Paris, France
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30621, Hannover, Germany
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care, Lariboisière University Hospital, DMU Parabol, AP-HP, Paris, France
- Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Benjamin G Chousterman
- Department of Anaesthesiology and Critical Care, Lariboisière University Hospital, DMU Parabol, AP-HP, Paris, France
- Inserm U942 MASCOT, Université de Paris, Paris, France
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10
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Meghraoui-Kheddar A, Chousterman BG, Guillou N, Barone SM, Granjeaud S, Vallet H, Corneau A, Guessous K, de Roquetaillade C, Boissonnas A, Irish JM, Combadière C. Two New Neutrophil Subsets Define a Discriminating Sepsis Signature. Am J Respir Crit Care Med 2021; 205:46-59. [PMID: 34731593 DOI: 10.1164/rccm.202104-1027oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sepsis is the leading cause of death in adult intensive care units. At present, sepsis diagnosis relies on non-specific clinical features. It could transform clinical care to have immune cell biomarkers that could predict sepsis diagnosis and guide treatment. For decades, neutrophil phenotypes have been studied in sepsis, but a diagnostic cell subset has yet to be identified. OBJECTIVES To identify an early specific immune signature of sepsis severity that does not overlap with other inflammatory biomarkers, and that distinguishes patients with sepsis from those with non- infectious inflammatory syndrome. METHODS Mass cytometry combined with computational high-dimensional data analysis were used to measure 42 markers on whole blood immune cells from sepsis patients and controls, and automatically and comprehensively characterize circulating immune cells, which enables identification of novel, disease-specific cellular signatures. MEASUREMENTS AND MAIN RESULTS Unsupervised analysis of high-dimensional mass cytometry data characterized previously unappreciated heterogeneity within the CD64+ immature neutrophils and revealed two new subsets distinguished by CD123 and PD-L1 expression. These immature neutrophils exhibited diminished activation and phagocytosis functions. The proportion of CD123-expressing neutrophils correlated with clinical severity. CONCLUSIONS This study showed that these two new neutrophil subsets were specific to sepsis and detectable by routine flow cytometry using seven markers. The demonstration here that a simple blood test distinguishes sepsis from other inflammatory conditions represents a key biological milestone that can be immediately translated into improvements in patient care.
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Affiliation(s)
- Aïda Meghraoui-Kheddar
- Universite de Reims Champagne-Ardenne UFR Pharmacie, 173613, EA4683, Laboratoire d'Immunologie, Reims, France
| | | | | | - Sierra M Barone
- Vanderbilt University, 5718, Nashville, Tennessee, United States
| | | | | | | | | | | | | | - Jonathan M Irish
- Vanderbilt University Medical Center, 12328, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, United States.,Vanderbilt University Medical Center, 12328, Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, United States.,Vanderbilt University, 5718, Department of Cell and Developmental Biology\unskip, Vanderbilt University, Nashville, Tennessee, United States
| | - Christophe Combadière
- Sorbonne Université, 27063, UPMC Univ Paris 06, Inserm, UMRS1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France;
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11
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de Roquetaillade C, Chousterman BG, Mebazaa A. Making things right! Shouldn't we screen patients with thromboembolic events for SARS-CoV-2 infection, during the pandemia? Int J Cardiol 2021; 338:286-287. [PMID: 33794231 PMCID: PMC8006516 DOI: 10.1016/j.ijcard.2021.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- C de Roquetaillade
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France.
| | - B G Chousterman
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France; Université de Paris, Paris, France
| | - A Mebazaa
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France; Université de Paris, Paris, France
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12
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Le Stang MB, Desenclos J, Flamant M, Chousterman BG, Tabibzadeh N. The Good Treatment, the Bad Virus, and the Ugly Inflammation: Pathophysiology of Kidney Involvement During COVID-19. Front Physiol 2021; 12:613019. [PMID: 33776785 PMCID: PMC7993058 DOI: 10.3389/fphys.2021.613019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Kidney involvement is a common complication during SARS-CoV-2 infection. Its association with poor outcomes, especially in critically ill patients, raises issues whether kidney involvement reflects multi-organ damage or if it is a specific feature of the infection. Based on observational studies, autopsy series, and on current understanding of the route of entry of the virus, this review will highlight the different types of kidney involvement during COVID-19 and put them in the perspective of the different pathophysiological hypotheses. Virus entry route through ACE2 ligation and TMPRSS2 coligation allows identifying potential viral targets in the kidney, including tubules, endothelial cells, and glomerulus. While reports have described damages of all these structures and virus kidney tropism has been identified in renal extracts in autopsy series, no direct viral infection has been found in the latter structures thus far on kidney biopsies. Notwithstanding the technical challenge of disclosing viral invasion within tissues and cells, viral direct cytopathogenic effect generally does not appear as the cause of the observed renal damage. Inflammation and altered hemodynamics, described as "viral sepsis," might rather be responsible for organ dysfunction, including kidneys. We shall place these various mechanisms into an integrated vision where the synergy between direct viral pathogenicity and systemic inflammation enhances renal damage. As SARS-CoV-2 inexorably continues its rampant spread, understanding the sequence of events in the kidneys might thus help inform improved therapeutic strategies, including antiviral drugs and immunomodulators.
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Affiliation(s)
| | - Jordan Desenclos
- Nephrology, Dialysis and Transplantation Department, CHU Clermont Ferrand, University Clermont Auvergne, Clermont Ferrand, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
| | - Martin Flamant
- Université de Paris, U1149 INSERM, Paris, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
| | - Benjamin G. Chousterman
- INSERM U942 MASCOT, Université de Paris, Paris, France
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France
| | - Nahid Tabibzadeh
- Université de Paris, U1149 INSERM, Paris, France
- Department of Physiology, Hôpital Bichat, FHU APOLLO, DMU Dream, APHP.Nord, Paris, France
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13
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Blet A, Deniau B, Santos K, van Lier DPT, Azibani F, Wittebole X, Chousterman BG, Gayat E, Hartmann O, Struck J, Bergmann A, Antonelli M, Beishuizen A, Constantin JM, Damoisel C, Deye N, Di Somma S, Dugernier T, François B, Gaudry S, Huberlant V, Lascarrou JB, Marx G, Mercier E, Oueslati H, Pickkers P, Sonneville R, Legrand M, Laterre PF, Mebazaa A. Monitoring circulating dipeptidyl peptidase 3 (DPP3) predicts improvement of organ failure and survival in sepsis: a prospective observational multinational study. Crit Care 2021; 25:61. [PMID: 33588925 PMCID: PMC7885215 DOI: 10.1186/s13054-021-03471-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
Background Dipeptidyl peptidase 3 (DPP3) is a cytosolic enzyme involved in the degradation of various cardiovascular and endorphin mediators. High levels of circulating DPP3 (cDPP3) indicate a high risk of organ dysfunction and mortality in cardiogenic shock patients. Methods The aim was to assess relationships between cDPP3 during the initial intensive care unit (ICU) stay and short-term outcome in the AdrenOSS-1, a prospective observational multinational study in twenty-four ICU centers in five countries. AdrenOSS-1 included 585 patients admitted to the ICU with severe sepsis or septic shock. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by the Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use and need for renal replacement therapy. cDPP3 levels were measured upon admission and 24 h later. Results Median [IQR] cDPP3 concentration upon admission was 26.5 [16.2–40.4] ng/mL. Initial SOFA score was 7 [5–10], and 28-day mortality was 22%. We found marked associations between cDPP3 upon ICU admission and 28-day mortality (unadjusted standardized HR 1.8 [CI 1.6–2.1]; adjusted HR 1.5 [CI 1.3–1.8]) and between cDPP3 levels and change in renal and liver SOFA score (p = 0.0077 and 0.0009, respectively). The higher the initial cDPP3 was, the greater the need for organ support and vasopressors upon admission; the longer the need for vasopressor(s), mechanical ventilation or RRT and the higher the need for fluid load (all p < 0.005). In patients with cDPP3 > 40.4 ng/mL upon admission, a decrease in cDPP3 below 40.4 ng/mL after 24 h was associated with an improvement of organ function at 48 h and better 28-day outcome. By contrast, persistently elevated cDPP3 at 24 h was associated with worsening organ function and high 28-day mortality. Conclusions Admission levels and rapid changes in cDPP3 predict outcome during sepsis. Trial Registration ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015.
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Affiliation(s)
- Alice Blet
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France. .,Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France. .,University of Ottawa Heart Institute and University of Ottawa, Ottawa, ON, Canada.
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France.,Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | | | - Dirk P T van Lier
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Feriel Azibani
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - Xavier Wittebole
- Department of Critical Care Medicine, St Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin G Chousterman
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France.,Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France.,Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | | | | | | | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Albertus Beishuizen
- Department of Intensive Care, Medische Spectrum Twente, Enschede, The Netherlands
| | - Jean-Michel Constantin
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Charles Damoisel
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Nicolas Deye
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Federation of Toxicology APHP, Paris-Diderot University, Paris, France
| | | | | | - Bruno François
- ICU Department, CHU Dupuytren, Limoges, France.,INSERM CIC 1435/UMR 1092, Limoges, France
| | | | | | | | - Gernot Marx
- Klinik Für Operative Intensivmedizin Und Intermediate Care, Universitätsklinikum Der RWTH, Aachen, Germany
| | | | - Haikel Oueslati
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, USA
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Center, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France.,Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 2 rue Ambroise Paré, 75010, Paris, France
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14
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Voicu S, Ketfi C, Stépanian A, Chousterman BG, Mohamedi N, Siguret V, Mebazaa A, Mégarbane B, Bonnin P. Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients. Front Physiol 2021; 11:608788. [PMID: 33488398 PMCID: PMC7820906 DOI: 10.3389/fphys.2020.608788] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) predisposes to deep vein thrombosis (DVT) and pulmonary embolism (PE) particularly in mechanically ventilated adults with severe pneumonia. The extremely high prevalence of DVT in the COVID-19 patients hospitalized in the intensive care unit (ICU) has been established between 25 and 84% based on studies including systematic duplex ultrasound of the lower limbs when prophylactic anticoagulation was systematically administrated. DVT prevalence has been shown to be markedly higher than in mechanically ventilated influenza patients (6–8%). Unusually high inflammatory and prothrombotic phenotype represents a striking feature of COVID-19 patients, as reflected by markedly elevated reactive protein C, fibrinogen, interleukin 6, von Willebrand factor, and factor VIII. Moreover, in critically ill patients, venous stasis has been associated with the prothrombotic phenotype attributed to COVID-19, which increases the risk of thrombosis. Venous stasis results among others from immobilization under muscular paralysis, mechanical ventilation with high positive end-expiratory pressure, and pulmonary microvascular network injuries or occlusions. Venous return to the heart is subsequently decreased with increase in central and peripheral venous pressures, marked proximal and distal veins dilation, and drops in venous blood flow velocities, leading to a spontaneous contrast “sludge pattern” in veins considered as prothrombotic. Together with endothelial lesions and hypercoagulability status, venous stasis completes the Virchow triad and considerably increases the prevalence of DVT and PE in critically ill COVID-19 patients, therefore raising questions regarding the optimal doses for thromboprophylaxis during ICU stay.
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Affiliation(s)
- Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France.,INSERM UMRS 1144, Université de Paris, Paris, France
| | - Chahinez Ketfi
- Department of Clinical Physiology, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France
| | - Alain Stépanian
- Laboratory of Biological Hematology, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France.,EA3518, Université de Paris, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia and Critical Care, Faculté de Santé, Hôpital Lariboisière, APHP, FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,INSERM UMR-S 942 - MASCOT, Université de Paris, Paris, France
| | - Nassim Mohamedi
- Department of Clinical Physiology, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France
| | - Virginie Siguret
- Laboratory of Biological Hematology, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France.,INSERM UMR-S 1140, Université de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Faculté de Santé, Hôpital Lariboisière, APHP, FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,INSERM UMR-S 942 - MASCOT, Université de Paris, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France.,INSERM UMRS 1144, Université de Paris, Paris, France
| | - Philippe Bonnin
- Department of Clinical Physiology, Hôpital Lariboisière, APHP, Faculté de Santé, Université de Paris, Paris, France.,INSERM U1148, LVTS, Université de Paris, Paris, France
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15
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Delrue M, Siguret V, Neuwirth M, Joly B, Beranger N, Sène D, Chousterman BG, Voicu S, Bonnin P, Mégarbane B, Stépanian A. von Willebrand factor/ADAMTS13 axis and venous thromboembolism in moderate-to-severe COVID-19 patients. Br J Haematol 2020; 192:1097-1100. [PMID: 33368196 DOI: 10.1111/bjh.17216] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Maxime Delrue
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Virginie Siguret
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1140, Paris University, Paris, France
| | - Marie Neuwirth
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1140, Paris University, Paris, France
| | - Bérangère Joly
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Nicolas Beranger
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Damien Sène
- Department of Internal Medicine, Lariboisière Hospital, Paris University, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 942, Université de Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1144, Paris University, Paris, France
| | - Philippe Bonnin
- Department of Clinical Physiology, Lariboisière Hospital, Paris University, Paris, France.,INSERM U1265, INSERM, Université de Paris, Paris, France.,INSERM U1148-Laboratory for Vascular and Translational Science, Université de Paris, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1144, Paris University, Paris, France
| | - Alain Stépanian
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
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16
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Delrue M, Siguret V, Neuwirth M, Brumpt C, Voicu S, Burlacu R, Sène D, Chousterman BG, Mohamedi N, Lecompte T, Mégarbane B, Stépanian A. Contrast between Prevalence of HIT Antibodies and Confirmed HIT in Hospitalized COVID-19 Patients: A Prospective Study with Clinical Implications. Thromb Haemost 2020; 121:971-975. [PMID: 33296940 DOI: 10.1055/a-1333-4688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Maxime Delrue
- Hematology Laboratory, AP-HP Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Virginie Siguret
- Hematology Laboratory, AP-HP Lariboisière Hospital, Paris University, Paris, France.,INSERM UMRS 1140, Paris University, Paris, France
| | - Marie Neuwirth
- Hematology Laboratory, AP-HP Lariboisière Hospital, Paris University, Paris, France.,INSERM UMRS 1140, Paris University, Paris, France
| | - Caren Brumpt
- Hematology Laboratory, AP-HP Lariboisière Hospital, Paris University, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, AP-HP Lariboisière Hospital, Paris University, Paris, France.,INSERM UMRS 1144, Paris University, Paris, France
| | - Ruxandra Burlacu
- Department of Internal Medicine, AP-HP Lariboisière Hospital, Paris University, Paris, France
| | - Damien Sène
- Department of Internal Medicine, AP-HP Lariboisière Hospital, Paris University, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Critical Care, AP-HP Lariboisière Hospital, Paris University, Paris, France.,INSERM UMRS 942, Université de Paris, Paris, France
| | - Nassim Mohamedi
- Department of Clinical Physiology, AP-HP Lariboisière Hospital, Paris University, Paris, France
| | - Thomas Lecompte
- Département de Médecine, Service d'Angiologie et d'Hémostase, Hôpitaux Universitaires de Genève, Genève, Switzerland.,Faculté de Médecine Geneva Platelet Group (GpG), Université de Genève, Geneva, Switzerland
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, AP-HP Lariboisière Hospital, Paris University, Paris, France.,INSERM UMRS 1144, Paris University, Paris, France
| | - Alain Stépanian
- Hematology Laboratory, AP-HP Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
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17
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Tabibzadeh N, Zalc M, Michel T, Letavernier E, Mebazaa A, Borouchaki A, Frochot V, Daudon M, Haymann JP, Chousterman BG. Prevalence and identification of crystalluria in critically ill patients: association between uric acid crystals and sepsis. Clin Kidney J 2020; 14:1291-1293. [PMID: 33841875 PMCID: PMC8023188 DOI: 10.1093/ckj/sfaa187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nahid Tabibzadeh
- Renal Physiology Department, Hôpital Bichat, APHP.Nord, Paris, France.,INSERM U1149, Université de Paris, Paris, France
| | - Maxime Zalc
- Department of Anesthesiea and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Thibault Michel
- Department of Anesthesiea and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, APHP.Sorbonne Université, Paris, France.,INSERM UMRS 1155, Sorbonne Université, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiea and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Antoine Borouchaki
- Department of Anesthesiea and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
| | - Vincent Frochot
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, APHP.Sorbonne Université, Paris, France.,INSERM UMRS 1155, Sorbonne Université, Paris, France
| | - Michel Daudon
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, APHP.Sorbonne Université, Paris, France.,INSERM UMRS 1155, Sorbonne Université, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, APHP.Sorbonne Université, Paris, France.,INSERM UMRS 1155, Sorbonne Université, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiea and Critical Care, Hôpital Lariboisière, FHU PROMICE, DMU Parabol, APHP.Nord, Paris, France.,Inserm U942 MASCOT, Université de Paris, Paris, France
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18
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Barthélémy R, Beaucoté V, Bordier R, Collet M, Le Gall A, Hong A, de Roquetaillade C, Gayat E, Mebazaa A, Chousterman BG. Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome: oxygenation versus oxygen delivery. Br J Anaesth 2020; 126:e70-e72. [PMID: 33223045 PMCID: PMC7643656 DOI: 10.1016/j.bja.2020.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Romain Barthélémy
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France.
| | - Victor Beaucoté
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France
| | - Raphaëlle Bordier
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France
| | - Magalie Collet
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France
| | - Arthur Le Gall
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France; MΞDISIM, Inria Paris-Saclay - LMS, Ecole Polytechnique, Palaiseau, France
| | - Alex Hong
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France
| | - Charles de Roquetaillade
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France; Inserm UMR-S942, Mascot, Université de Paris, Paris, France
| | - Etienne Gayat
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France; Inserm UMR-S942, Mascot, Université de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France; Inserm UMR-S942, Mascot, Université de Paris, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, FHU Promice, APHP. Nord - Université de Paris, Paris, France; Inserm UMR-S942, Mascot, Université de Paris, Paris, France
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19
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Voicu S, Delrue M, Chousterman BG, Stépanian A, Bonnin P, Malissin I, Deye N, Neuwirth M, Ketfi C, Mebazaa A, Siguret V, Mégarbane B. Imbalance between procoagulant factors and natural coagulation inhibitors contributes to hypercoagulability in the critically ill COVID-19 patient: clinical implications. Eur Rev Med Pharmacol Sci 2020; 24:9161-9168. [PMID: 32965009 DOI: 10.26355/eurrev_202009_22866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Coronavirus Disease-2019 (COVID-19) predisposes patients to thrombosis which underlying mechanisms are still incompletely understood. We sought to investigate the balance between procoagulant factors and natural coagulation inhibitors in the critically ill COVID-19 patient and to evaluate the usefulness of hemostasis parameters to identify patients at risk of venous thromboembolic event (VTE). PATIENTS AND METHODS We conducted an observational study recording VTEs defined as deep vein thrombosis or pulmonary embolism using lower limb ultrasound (92% of the patients), computed tomography pulmonary angiography (6%) and both tests (2%). We developed a comprehensive analysis of hemostasis. RESULTS Ninety-two consecutive mechanically ventilated COVID-19 patients (age, 62 years [53-69] (median [25th-75th percentiles]); M/F sex ratio, 2.5; body-mass index, 28 kg/m2 [25-32]; past hypertension (52%) and diabetes mellitus (30%)) admitted to the Intensive Care Unit (ICU) from 03/11/2020 to 5/05/2020, were included. When tested, patients were receiving prophylactic (74%) or therapeutic (26%) anticoagulation. Forty patients (43%) were diagnosed with VTE. Patients displayed inflammatory and prothrombotic profile including markedly elevated plasma fibrinogen (7.7 g/L [6.1-8.6]), D-dimer (3,360 ng/mL [1668-7575]), factor V (166 IU/dL [136-195]) and factor VIII activities (294 IU/dL [223-362]). We evidenced significant discrepant protein C anticoagulant and chromogenic activities, combined with slightly decreased protein S activity. Plasma D-dimer >3,300 ng/mL predicted VTE presence with 78% (95%-confidence interval (95% CI), 62-89) sensitivity, 69% (95% CI, 55-81) specificity, 66% (95% CI, 51-79) positive predictive value and 80% (95% CI, 65-90) negative predictive value [area under the ROC curve, 0.779 (95%CI, 0.681-0.859), p=0.0001]. CONCLUSIONS Mechanically ventilated COVID-19 patients present with an imbalance between markedly increased factor V/VIII activity and overwhelmed protein C/S pathway. Plasma D-dimer may be a useful biomarker at the bedside for suspicion of VTE.
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Affiliation(s)
- S Voicu
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Université de Paris, Paris, France.
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20
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de Roquetaillade C, Chousterman BG, Tomasoni D, Zeitouni M, Houdart E, Guedon A, Reiner P, Bordier R, Gayat E, Montalescot G, Metra M, Mebazaa A. Unusual arterial thrombotic events in Covid-19 patients. Int J Cardiol 2020; 323:281-284. [PMID: 32918938 PMCID: PMC7481127 DOI: 10.1016/j.ijcard.2020.08.103] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
Introduction COVID-19 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. While several studies reported a high incidence of venous thromboembolic events. The occurrence of arterial thromboses are yet rarely described and could be underestimated. Objectives To describe the clinical and biological characteristics of COVID-19 patients presenting with an associated arterial thromboembolic event. Material and methods We performed a retrospective multicentric study in 3 centers between France and Italy. All patients with a confirmed SARS-CoV-2 infection and arterial thromboembolic events were included in the analysis. Results From March 8th to April 25th 2020, we identified 20 patients (24 events) with arterial thromboembolic events over 209 admitted patients (9.6%) with severe COVID-19 infection. Arterial thrombotic events included acute coronary occlusions (n = 9), stroke (n = 6), limb ischemia (n = 3), splenic infarcts (n = 3), aortic thrombosis (n = 2) and occlusive mesenteric ischemia (n = 1). At the time of the event, 10/20 (50%) of patients received thromboprohylaxis, 2/20 (10%) were receiving treatment dose anticoagulation and 5/20 (25%) were receiving antiplatelet therapy. Conclusion Our observations suggest that serious arterial thrombotic events might occur in Covid-19 patients. However, the exact incidence of such events and the best way to prevent them yet remains to be investigated. SARS-CoV-2 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. High rate of venous thromboembolic events have been described among patients suffering from Covid-19. However, arterial thromboses are yet rarely described in this setting. We report a total of 20 cases of COVID-19 patients suffering from arterial thromboses. Our observations suggest that arterial thrombotic events might occur in Covid-19 patients and could be underestimated.
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Affiliation(s)
- C de Roquetaillade
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France.
| | - B G Chousterman
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France; Université de Paris, Paris, France
| | - D Tomasoni
- Cardiothoracic Department, Civil Hospitals and University of Brescia, Brescia, Italy
| | - M Zeitouni
- Sorbonne Université, Action Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - E Houdart
- Departments of Interventional Neuroradiology, Hôpital Lariboisière (AP-HP), Paris, France
| | - A Guedon
- Departments of Interventional Neuroradiology, Hôpital Lariboisière (AP-HP), Paris, France
| | - P Reiner
- Department of Neurology, Hôpital Lariboisière (AP-HP), Paris, France
| | - R Bordier
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France
| | - E Gayat
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France; Université de Paris, Paris, France
| | - G Montalescot
- Sorbonne Université, Action Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - M Metra
- Cardiothoracic Department, Civil Hospitals and University of Brescia, Brescia, Italy
| | - A Mebazaa
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière (AP-HP), Paris, France; Inserm U942 MASCOT, Paris, France; Université de Paris, Paris, France
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21
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Caillard A, Collet M, Hong A, Chousterman BG. Periintubation Ventilation and Oxygenation of Acutely Ill Patients. Am J Respir Crit Care Med 2020; 201:856-858. [PMID: 32027808 DOI: 10.1164/rccm.201904-0904rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anaïs Caillard
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis - Lariboisière University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France; and.,Inserm U942, Paris, France
| | - Magalie Collet
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis - Lariboisière University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France; and.,Inserm U942, Paris, France
| | - Alex Hong
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis - Lariboisière University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France; and.,Inserm U942, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis - Lariboisière University Hospitals, Assistance Publique - Hôpitaux de Paris, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France; and.,Inserm U942, Paris, France
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22
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Voicu S, Bonnin P, Stépanian A, Chousterman BG, Le Gall A, Malissin I, Deye N, Siguret V, Mebazaa A, Mégarbane B. High Prevalence of Deep Vein Thrombosis in Mechanically Ventilated COVID-19 Patients. J Am Coll Cardiol 2020; 76:480-482. [PMID: 32479784 PMCID: PMC7260513 DOI: 10.1016/j.jacc.2020.05.053] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
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23
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Chousterman BG, Jamme M, Tabibzadeh N, Gaugain S, Damoisel C, Barthélémy R. Delaying Renal Replacement Therapy Could Be Harmful in Patients with Acute Brain Injury. Am J Respir Crit Care Med 2020; 200:645-646. [PMID: 31091956 PMCID: PMC6727164 DOI: 10.1164/rccm.201903-0527le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Benjamin G Chousterman
- Assistance Publique - Hôpitaux de ParisParis, France.,Sorbonne Paris CitéParis, France.,Inserm U942Paris, France
| | - Matthieu Jamme
- Poissy Saint Germain HospitalPoissy, Franceand.,Versailles Saint-Quentin-en-Yvelines UniversityVillejuif, France
| | - Nahid Tabibzadeh
- Assistance Publique - Hôpitaux de ParisParis, France.,Sorbonne Paris CitéParis, France
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Collet M, Huot B, Barthélémy R, Damoisel C, Payen D, Mebazaa A, Chousterman BG. Influence of systemic hemodynamics on microcirculation during sepsis. J Crit Care 2019; 52:213-218. [PMID: 31102939 DOI: 10.1016/j.jcrc.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/20/2019] [Revised: 04/07/2019] [Accepted: 05/01/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE During sepsis, improvement of hemodynamic may not be related to improvement of microcirculation. The aim of this study was to investigate influence of systemic circulation on microcirculation in septic ICU patients. METHODS This is a prospective cohort study of septic ICU patients. Microcirculation was investigated with Near infrared spectrometry (NIRS) measuring tissue oxygen saturation (StO2). StO2 desaturation (desStO2) and resaturation (resStO2) slopes were determined. Analyses were made at baseline and after fluid challenges. RESULTS Seventy-two patients were included. One hundred and sixty measures were performed at baseline. StO2 was 77.8% [72.4-85.0] and resStO2 was 87.3%/min [57.8-141.7]. Univariate analysis showed an association between resStO2 and diastolic arterial pressure (DAP) (p = .001), and norepinephrine dose (p = .033). In multivariate linear regression, there was an association between resStO2 and DAP (β = 1.85 (0.64 to 3.08), p = .004). Fluid challenges (n = 60) increased CO, and resStO2 (all p < .001). In multivariate analysis, variation of stroke volume was associated with variation of resStO2 (p = .004) after fluid challenge. There was no association between CVP and resStO2. CONCLUSIONS DAP was the only independent determinant of resStO2 in septic patients. Fluid challenges may improve microcirculation. CVP did not influence resStO2.
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Affiliation(s)
- Magalie Collet
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Benjamin Huot
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Charles Damoisel
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Didier Payen
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U942, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesia, Burn and Critical Care, Saint-Louis-Lariboisière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; INSERM U1160, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
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Affiliation(s)
- Matthieu Jamme
- Renal Intensive Care Unit and Kidney Transplantation, Tenon University Hospital, Sorbonne Université Pierre et Marie Curie University, Assistance Publique-Hôpital de Paris, Paris, France.
| | - Cédric Rafat
- Renal Intensive Care Unit and Kidney Transplantation, Tenon University Hospital, Sorbonne Université Pierre et Marie Curie University, Assistance Publique-Hôpital de Paris, Paris, France
| | - Samuel Gaugain
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assitance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assitance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U1160, Hôpital Saint-Louis, Paris, France
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26
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Abstract
Sepsis is a complex syndrome characterized by simultaneous activation of pro- and anti-inflammatory processes. After an inflammatory phase, patients present signs of immunosuppression and possibly persistent inflammation. Hematopoietic growth factors (HGFs) are glycoproteins that cause immune cells to mature and/or proliferate. HGFs also have a profound effect on cell functions and behavior. HGFs play crucial role in sepsis pathophysiology and were tested in several clinical trials without success to date. This review summarizes the role played by HGFs during sepsis and their potential therapeutic role in the Management of sepsis-related immune disturbances.
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Affiliation(s)
- Benjamin G Chousterman
- Département d'Anesthésie-Réanimation-SMUR, Hôpitaux Universitaires Lariboisière - Saint-Louis, AP-HP, Paris, France.,INSERM U1160, Hôpital Saint-Louis, Paris, France
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27
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Gayat E, Hollinger A, Cariou A, Deye N, Vieillard-Baron A, Jaber S, Chousterman BG, Lu Q, Laterre PF, Monnet X, Darmon M, Leone M, Guidet B, Sonneville R, Lefrant JY, Fournier MC, Resche-Rigon M, Mebazaa A, Legrand M. Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Med 2018; 44:598-605. [DOI: 10.1007/s00134-018-5160-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/30/2018] [Indexed: 12/25/2022]
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Riché F, Chousterman BG, Valleur P, Mebazaa A, Launay JM, Gayat E. Protracted immune disorders at one year after ICU discharge in patients with septic shock. Crit Care 2018; 22:42. [PMID: 29467023 PMCID: PMC5822646 DOI: 10.1186/s13054-017-1934-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Abstract
Background Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock. Methods We conducted a prospective, single-center, observational study in the surgical ICU of a university hospital. Eighty-six consecutive patients admitted for septic shock of abdominal origin were included in this study. Fifteen different plasma biomarkers were measured at ICU admission, at ICU discharge and at one year after ICU discharge. Three different clusters of biomarkers were distinguished according to their functions, namely: (1) inflammatory response, (2) cell damage and apoptosis, (3) immunosuppression and resolution of inflammation. The primary objective was to characterize variations in the immune status of septic shock patients admitted to ICU up to one year after ICU discharge. The secondary objective was to evaluate the relationship between these biomarker variations and patient outcomes. Results At the onset of septic shock, we observed a cohesive pro-inflammatory profile and low levels of inflammation resolution markers. At ICU discharge, the immune status demonstrated decreased but persistent inflammation and increased immunosuppression, with elevated programmed cell death protein-1 (PD-1) levels, and a counterbalanced resolution process, with elevated levels of interleukin-10 (IL-10), resolvin D5 (RvD5), and IL-7. One year after hospital discharge, homeostasis was not completely restored with several markers of inflammation remaining elevated. Remarkably, IL-7 was persistently elevated, with levels comparable to those observed after ICU discharge, and PD-1, while lower, remained in the elevated abnormal range. Conclusions In this study, protracted immune disturbances were observed one year after ICU discharge. The study results suggested the presence of long-lasting immune illness disorders following a long-term septic insult, indicating the need for long-term patient follow up after ICU discharge and questioning the use of immune intervention to restore immune homeostasis after abdominal septic shock. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1934-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Riché
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.
| | - Benjamin G Chousterman
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Inserm U1160, Hôpital Saint-Louis, 1 rue Claude Vellefaux, 75010, Paris, France
| | - Patrice Valleur
- Department of Visceral Surgery, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Biomarkers in CArdio-Neuro-VAScular diseases (BIOCANVAS), UMR-S 942, Inserm, Paris, France
| | - Jean-Marie Launay
- Biomarkers in CArdio-Neuro-VAScular diseases (BIOCANVAS), UMR-S 942, Inserm, Paris, France.,Department of Biochemistry, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Intensive Care Medicine, Saint Louis Lariboisière University Hospital, University Paris Diderot, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Biomarkers in CArdio-Neuro-VAScular diseases (BIOCANVAS), UMR-S 942, Inserm, Paris, France
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29
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Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol 2017; 39:517-528. [PMID: 28555385 DOI: 10.1007/s00281-017-0639-8] [Citation(s) in RCA: 719] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/05/2017] [Indexed: 12/14/2022]
Abstract
Infectious diseases are a leading cause of death worldwide. Sepsis is a severe clinical syndrome related to the host response to infection. The severity of infections is due to an activation cascade that will lead to an autoamplifying cytokine production: the cytokine storm. Cytokines are a broad category of relatively small proteins (<40 kDa) that are produced and released with the aim of cell signaling. Our understanding of the processes that trigger this tremendous amount of cytokine production has made dramatic progress over the last decades, but unfortunately, these findings could not translate yet into effective treatments; so far, all clinical trials targeting cytokine production or effects failed. This review aims to summarize the pathophysiology of the cytokine storm; to describe the type, effects, and kinetics of cytokine production; and to discuss the therapeutic challenges of targeting cytokines. New promising therapeutic strategies focusing on the endothelium, as a source and a target of cytokines, are described.
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Affiliation(s)
- Benjamin G Chousterman
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Lariboisière-Saint-Louis, AP-HP, Paris, France. .,Inserm U1160, Hôpital Saint-Louis, Paris, France.
| | - Filip K Swirski
- Center for Systems Biology, Department of Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Georg F Weber
- Department of Surgery, University of Erlangen-Nürnberg, Erlangen, Germany
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30
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Chousterman BG, Pirracchio R, Guidet B, Aegerter P, Mentec H. Impact of Resident Rotations on Critically Ill Patient Outcomes: Results of a French Multicenter Observational Study. PLoS One 2016; 11:e0162552. [PMID: 27627449 PMCID: PMC5023104 DOI: 10.1371/journal.pone.0162552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/24/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. METHODS We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotation was explored using multivariate regression, classification tree and random forest models. RESULTS 262,772 patients were included between 1996 and 2010 in the database. The patient characteristics were similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality (OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II<24), the POST period was associated with increased mortality (OR = 1.65, 95%CI = 1.17-2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. CONCLUSION Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.
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Affiliation(s)
| | - Romain Pirracchio
- Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, AP-HP, Paris, France
- Centre de Recherche en Epidémiologie, Equipe ECSTRA, INSERM 1153, PRES Sorbonne Paris Cité, Paris, France
- Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Philippe Aegerter
- Département d'Information Hospitalière et Santé Publique—Unité de Recherche Clinique, Hôpital Ambroise Paré, AP-HP, Boulogne, France
| | - Hervé Mentec
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - CUB-REA network
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
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31
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Abstract
INTRODUCTION Sepsis is a major cause of death worldwide but its orchestrating components remain incompletely understood. On the one hand, development of sepsis results from an infectious focus that cannot be controlled by the immune system, but on the other, responding immune cells that can eliminate the infection inflict damage to the host by contributing to complications such as endothelial leakage, septic shock, and multiorgan failure. AREAS COVERED In this review we give a comprehensive overview of how sepsis occurs, which exogenous and endogenous factors might affect the immune-pathophysiological course of sepsis and finally how this knowledge translates into up-to-date definitions and therapeutic approaches. Expert commentary: Although new immunological mechanisms altering the course of sepsis have been identified recently, future research needs to address the limitations of experimental approaches, redirect the research focus into translational approaches, and finally evaluate personalized treatment strategies.
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Affiliation(s)
- Florian Uhle
- a Department of Anesthesiology , Heidelberg University Hospital , Heidelberg , Germany
| | - Benjamin G Chousterman
- b Department of Anesthesia, Intensive Care and SAMU , Hôpital Lariboisière, AP-HP, and Université Paris Diderot , Paris , France
| | - Robert Grützmann
- c Department of Surgery , University Hospital Erlangen-Nürnberg , Erlangen , Germany
| | - Thorsten Brenner
- a Department of Anesthesiology , Heidelberg University Hospital , Heidelberg , Germany
| | - Georg F Weber
- c Department of Surgery , University Hospital Erlangen-Nürnberg , Erlangen , Germany
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32
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Theurl I, Hilgendorf I, Nairz M, Tymoszuk P, Haschka D, Asshoff M, He S, Gerhardt LMS, Holderried TAW, Seifert M, Sopper S, Fenn AM, Anzai A, Rattik S, McAlpine C, Theurl M, Wieghofer P, Iwamoto Y, Weber GF, Harder NK, Chousterman BG, Arvedson TL, McKee M, Wang F, Lutz OMD, Rezoagli E, Babitt JL, Berra L, Prinz M, Nahrendorf M, Weiss G, Weissleder R, Lin HY, Swirski FK. On-demand erythrocyte disposal and iron recycling requires transient macrophages in the liver. Nat Med 2016; 22:945-51. [PMID: 27428900 PMCID: PMC4957133 DOI: 10.1038/nm.4146] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
Iron is an essential component of the erythrocyte protein hemoglobin and is crucial to oxygen transport in vertebrates. In the steady state, erythrocyte production is in equilibrium with erythrocyte removal. In various pathophysiological conditions, however, erythrocyte life span is compromised severely, which threatens the organism with anemia and iron toxicity. Here we identify an on-demand mechanism that clears erythrocytes and recycles iron. We show that monocytes that express high levels of lymphocyte antigen 6 complex, locus C1 (LY6C1, also known as Ly-6C) ingest stressed and senescent erythrocytes, accumulate in the liver via coordinated chemotactic cues, and differentiate into ferroportin 1 (FPN1, encoded by SLC40A1)-expressing macrophages that can deliver iron to hepatocytes. Monocyte-derived FPN1(+)Tim-4(neg) macrophages are transient, reside alongside embryonically derived T cell immunoglobulin and mucin domain containing 4 (Timd4, also known as Tim-4)(high) Kupffer cells (KCs), and depend on the growth factor Csf1 and the transcription factor Nrf2 (encoded by Nfe2l2). The spleen, likewise, recruits iron-loaded Ly-6C(high) monocytes, but these do not differentiate into iron-recycling macrophages, owing to the suppressive action of Csf2. The accumulation of a transient macrophage population in the liver also occurs in mouse models of hemolytic anemia, anemia of inflammation, and sickle cell disease. Inhibition of monocyte recruitment to the liver during stressed erythrocyte delivery leads to kidney and liver damage. These observations identify the liver as the primary organ that supports rapid erythrocyte removal and iron recycling, and uncover a mechanism by which the body adapts to fluctuations in erythrocyte integrity.
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Affiliation(s)
- Igor Theurl
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ingo Hilgendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Heart Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Manfred Nairz
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Piotr Tymoszuk
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Haschka
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Malte Asshoff
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Shun He
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Louisa M. S. Gerhardt
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias A. W. Holderried
- Department of Internal Medicine III, Oncology, Hematology and Rheumatology, University Hospital, Bonn, Germany
| | - Markus Seifert
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sieghart Sopper
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Ashley M. Fenn
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Atsushi Anzai
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara Rattik
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Cameron McAlpine
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Milan Theurl
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Wieghofer
- Institute of Neuropathology, Freiburg University Medical Centre, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Georg F. Weber
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nina K. Harder
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin G. Chousterman
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mary McKee
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Fudi Wang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Emanuele Rezoagli
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jodie L. Babitt
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Lorenzo Berra
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marco Prinz
- Institute of Neuropathology, Freiburg University Medical Centre, Freiburg, Germany
- BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Guenter Weiss
- Department of Internal Medicine VI, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Herbert Y. Lin
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Program in Membrane Biology, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Filip K. Swirski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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33
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Aryal B, Rotllan N, Araldi E, Ramírez CM, He S, Chousterman BG, Fenn AM, Wanschel A, Madrigal-Matute J, Warrier N, Martín-Ventura JL, Swirski FK, Suárez Y, Fernández-Hernando C. ANGPTL4 deficiency in haematopoietic cells promotes monocyte expansion and atherosclerosis progression. Nat Commun 2016; 7:12313. [PMID: 27460411 PMCID: PMC4974469 DOI: 10.1038/ncomms12313] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/21/2016] [Indexed: 12/27/2022] Open
Abstract
Lipid accumulation in macrophages has profound effects on macrophage gene expression and contributes to the development of atherosclerosis. Here, we report that angiopoietin-like protein 4 (ANGPTL4) is the most highly upregulated gene in foamy macrophages and it's absence in haematopoietic cells results in larger atherosclerotic plaques, characterized by bigger necrotic core areas and increased macrophage apoptosis. Furthermore, hyperlipidemic mice deficient in haematopoietic ANGPTL4 have higher blood leukocyte counts, which is associated with an increase in the common myeloid progenitor (CMP) population. ANGPTL4-deficient CMPs have higher lipid raft content, are more proliferative and less apoptotic compared with the wild-type (WT) CMPs. Finally, we observe that ANGPTL4 deficiency in macrophages promotes foam cell formation by enhancing CD36 expression and reducing ABCA1 localization in the cell surface. Altogether, these findings demonstrate that haematopoietic ANGPTL4 deficiency increases atherogenesis through regulating myeloid progenitor cell expansion and differentiation, foam cell formation and vascular inflammation. Angiopoietin-like 4 protein (ANGPTL4) is a regulator of lipoprotein metabolism whose role in atherosclerosis has been controversial. Here the authors show that ANGPTL4 deficiency in haematopoietic cells increases atherogenesis by promoting myeloid progenitor cell expansion and differentiation, foam cell formation and vascular inflammation.
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Affiliation(s)
- Binod Aryal
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Departments of Medicine and Cell Biology, Leon H. Charney Division of Cardiology and Cell Biology, New York University School of Medicine, New York, New York 10016, USA
| | - Noemi Rotllan
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Elisa Araldi
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Cristina M Ramírez
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Shun He
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Benjamin G Chousterman
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Ashley M Fenn
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Amarylis Wanschel
- Departments of Medicine and Cell Biology, Leon H. Charney Division of Cardiology and Cell Biology, New York University School of Medicine, New York, New York 10016, USA
| | - Julio Madrigal-Matute
- Departments of Medicine and Cell Biology, Leon H. Charney Division of Cardiology and Cell Biology, New York University School of Medicine, New York, New York 10016, USA
| | - Nikhil Warrier
- Departments of Medicine and Cell Biology, Leon H. Charney Division of Cardiology and Cell Biology, New York University School of Medicine, New York, New York 10016, USA
| | - Jose L Martín-Ventura
- Vascular Research Lab, IIS-Fundación Jimenez-Díaz, Universidad Autónoma de Madrid, Madrid 28040, Spain
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Yajaira Suárez
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Carlos Fernández-Hernando
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, Connecticut 06520, USA.,Integrative Cell Signaling and Neurobiology of Metabolism Program, Section of Comparative Medicine and Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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34
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Abstract
Innate response activator (IRA) B cells are a subset of B-1a derived B cells that produce the growth factors granulocyte macrophage colony stimulating factor and IL-3. In mouse models of sepsis and pneumonia, B-1a B cells residing in serosal sites recognize bacteria, migrate to the spleen or lung, and differentiate to IRA B cells that then contribute to the host response by amplifying inflammation and producing polyreactive IgM. In atherosclerosis, IRA B cells accumulate in the spleen, where they promote extramedullary hematopoiesis and activate classical dendritic cells. In this review, we focus on the ontogeny and function of IRA B cells in acute and chronic inflammation.
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Affiliation(s)
- Benjamin G Chousterman
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Simches Research Building, 185 Cambridge St., Boston, MA 02114, USA
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Simches Research Building, 185 Cambridge St., Boston, MA 02114, USA
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35
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He S, Chousterman BG, Fenn A, Anzai A, Nairz M, Brandt M, Hilgendorf I, Sun Y, Ye YX, Iwamoto Y, Tricot B, Weissleder R, Macphee C, Libby P, Nahrendorf M, Swirski FK. Lp-PLA2 Antagonizes Left Ventricular Healing After Myocardial Infarction by Impairing the Appearance of Reparative Macrophages. Circ Heart Fail 2015; 8:980-7. [PMID: 26232205 PMCID: PMC4568849 DOI: 10.1161/circheartfailure.115.002334] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022]
Abstract
Supplemental Digital Content is available in the text. Healing after myocardial infarction (MI) involves the biphasic accumulation of inflammatory Ly-6Chigh and reparative Ly-6Clow monocytes/macrophages. Excessive inflammation disrupts the balance between the 2 phases, impairs infarct healing, and contributes to left ventricle remodeling and heart failure. Lipoprotein-associated phospholipase A2 (Lp-PLA2), a member of the phospholipase A2 family of enzymes, produced predominantly by leukocytes, participates in host defenses and disease. Elevated Lp-PLA2 levels associate with increased risk of cardiovascular events across diverse patient populations, but the mechanisms by which the enzyme elicits its effects remain unclear. This study tested the role of Lp-PLA2 in healing after MI.
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Affiliation(s)
- Shun He
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Benjamin G Chousterman
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Ashley Fenn
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Atsushi Anzai
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Manfred Nairz
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Martin Brandt
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Ingo Hilgendorf
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Yuan Sun
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Yu-Xiang Ye
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Yoshiko Iwamoto
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Benoit Tricot
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Ralph Weissleder
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Colin Macphee
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Peter Libby
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Matthias Nahrendorf
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.)
| | - Filip K Swirski
- From the Center for Systems Biology, Massachusetts General Hospital, Boston (S.H., B.G.C., A.F., A.A., M.N., I.H., Y.S., Y.-X.Y., Y.I., B.T., R.W., M.N., F.K.S.); Biological Sciences, GlaxoSmithKline, Collegeville, PA (M.B.); Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.); GlaxoSmithKline, King of Prussia, PA (C.M.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (P.L.).
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36
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Chousterman BG, Boissonnas A, Poupel L, Baudesson de Chanville C, Adam J, Tabibzadeh N, Licata F, Lukaszewicz AC, Lombès A, Deterre P, Payen D, Combadière C. Ly6Chigh Monocytes Protect against Kidney Damage during Sepsis via a CX3CR1-Dependent Adhesion Mechanism. J Am Soc Nephrol 2015; 27:792-803. [PMID: 26160897 DOI: 10.1681/asn.2015010009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 01/05/2015] [Accepted: 05/20/2015] [Indexed: 12/24/2022] Open
Abstract
Monocytes have a crucial role in both proinflammatory and anti-inflammatory phenomena occurring during sepsis. Monocyte recruitment and activation are orchestrated by the chemokine receptors CX3CR1 and CCR2 and their cognate ligands. However, little is known about the roles of these cells and chemokines during the acute phase of inflammation in sepsis. Using intravital microscopy in a murine model of polymicrobial sepsis, we showed that inflammatory Ly6C(high) monocytes infiltrated kidneys, exhibited altered motility, and adhered strongly to the renal vascular wall in a chemokine receptor CX3CR1-dependent manner. Adoptive transfer of Cx3cr1-proficient monocyte-enriched bone marrow cells into septic Cx3cr1-depleted mice prevented kidney damage and promoted mouse survival. Modulation of CX3CR1 activation in septic mice controlled monocyte adhesion, regulated proinflammatory and anti-inflammatory cytokine expression, and was associated with the extent of kidney lesions such that the number of lesions decreased when CX3CR1 activity increased. Consistent with these results, the pro-adhesive I249 CX3CR1 allele in humans was associated with a lower incidence of AKI in patients with sepsis. These data show that inflammatory monocytes have a protective effect during sepsis via a CX3CR1-dependent adhesion mechanism. This receptor might be a new therapeutic target for kidney injury during sepsis.
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Affiliation(s)
- Benjamin G Chousterman
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France; Département d'Anesthésie-Réanimation-Service d'Aide Médicale Urgente (SMUR), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Boissonnas
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France;
| | - Lucie Poupel
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Camille Baudesson de Chanville
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Julien Adam
- Institut Gustave-Roussy, Université Paris-Sud Villejuif, France
| | - Nahid Tabibzadeh
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Service des Explorations Fonctionnelles and Institut National de la Santé et de la Recherche Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France; and
| | - Fabrice Licata
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Anne-Claire Lukaszewicz
- Département d'Anesthésie-Réanimation-Service d'Aide Médicale Urgente (SMUR), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, U1160, Paris, France
| | - Amélie Lombès
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Philippe Deterre
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Didier Payen
- Département d'Anesthésie-Réanimation-Service d'Aide Médicale Urgente (SMUR), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, U1160, Paris, France
| | - Christophe Combadière
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), University of Paris 06, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1135, Paris, France; Centre National de la Recherche Scientifique (CNRS), Paris, France;
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37
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Weber GF, Chousterman BG, He S, Fenn AM, Nairz M, Anzai A, Brenner T, Uhle F, Iwamoto Y, Robbins CS, Noiret L, Maier SL, Zönnchen T, Rahbari NN, Schölch S, Klotzsche-von Ameln A, Chavakis T, Weitz J, Hofer S, Weigand MA, Nahrendorf M, Weissleder R, Swirski FK. Interleukin-3 amplifies acute inflammation and is a potential therapeutic target in sepsis. Science 2015; 347:1260-5. [PMID: 25766237 PMCID: PMC4376966 DOI: 10.1126/science.aaa4268] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sepsis is a frequently fatal condition characterized by an uncontrolled and harmful host reaction to microbial infection. Despite the prevalence and severity of sepsis, we lack a fundamental grasp of its pathophysiology. Here we report that the cytokine interleukin-3 (IL-3) potentiates inflammation in sepsis. Using a mouse model of abdominal sepsis, we showed that innate response activator B cells produce IL-3, which induces myelopoiesis of Ly-6C(high) monocytes and neutrophils and fuels a cytokine storm. IL-3 deficiency protects mice against sepsis. In humans with sepsis, high plasma IL-3 levels are associated with high mortality even after adjusting for prognostic indicators. This study deepens our understanding of immune activation, identifies IL-3 as an orchestrator of emergency myelopoiesis, and reveals a new therapeutic target for treating sepsis.
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Affiliation(s)
- Georg F Weber
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany.
| | - Benjamin G Chousterman
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shun He
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley M Fenn
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Manfred Nairz
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Atsushi Anzai
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thorsten Brenner
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Clinton S Robbins
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorette Noiret
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah L Maier
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Tina Zönnchen
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Nuh N Rahbari
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Schölch
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Anne Klotzsche-von Ameln
- Department of Clinical Pathobiochemistry and Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Triantafyllos Chavakis
- Department of Clinical Pathobiochemistry and Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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38
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Weber GF, Chousterman BG, Hilgendorf I, Robbins CS, Theurl I, Gerhardt LMS, Iwamoto Y, Quach TD, Ali M, Chen JW, Rothstein TL, Nahrendorf M, Weissleder R, Swirski FK. Pleural innate response activator B cells protect against pneumonia via a GM-CSF-IgM axis. ACTA ACUST UNITED AC 2014; 211:1243-56. [PMID: 24821911 PMCID: PMC4042649 DOI: 10.1084/jem.20131471] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In response to lung infection, pleural innate response activator B cells produce GM-CSF–dependent IgM and ensure a frontline defense against bacterial invasion. Pneumonia is a major cause of mortality worldwide and a serious problem in critical care medicine, but the immunophysiological processes that confer either protection or morbidity are not completely understood. We show that in response to lung infection, B1a B cells migrate from the pleural space to the lung parenchyma to secrete polyreactive emergency immunoglobulin M (IgM). The process requires innate response activator (IRA) B cells, a transitional B1a-derived inflammatory subset which controls IgM production via autocrine granulocyte/macrophage colony-stimulating factor (GM-CSF) signaling. The strategic location of these cells, coupled with the capacity to produce GM-CSF–dependent IgM, ensures effective early frontline defense against bacteria invading the lungs. The study describes a previously unrecognized GM-CSF-IgM axis and positions IRA B cells as orchestrators of protective IgM immunity.
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Affiliation(s)
- Georg F Weber
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 Department of Visceral, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Benjamin G Chousterman
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Ingo Hilgendorf
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Clinton S Robbins
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Igor Theurl
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Louisa M S Gerhardt
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Tam D Quach
- Center for Oncology and Cell Biology, The Feinstein Institute for Medical Research, Manhasset, NY 11030
| | - Muhammad Ali
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - John W Chen
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Thomas L Rothstein
- Center for Oncology and Cell Biology, The Feinstein Institute for Medical Research, Manhasset, NY 11030
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 Department of Systems Biology, Harvard Medical School, Boston, MA 02115
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
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Hilgendorf I, Gerhardt LMS, Tan TC, Winter C, Holderried TAW, Chousterman BG, Iwamoto Y, Liao R, Zirlik A, Scherer-Crosbie M, Hedrick CC, Libby P, Nahrendorf M, Weissleder R, Swirski FK. Ly-6Chigh monocytes depend on Nr4a1 to balance both inflammatory and reparative phases in the infarcted myocardium. Circ Res 2014; 114:1611-22. [PMID: 24625784 DOI: 10.1161/circresaha.114.303204] [Citation(s) in RCA: 388] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
RATIONALE Healing after myocardial infarction involves the biphasic accumulation of inflammatory lymphocyte antigen 6C (Ly-6C)(high) and reparative Ly-6C(low) monocytes/macrophages (Mo/MΦ). According to 1 model, Mo/MΦ heterogeneity in the heart originates in the blood and involves the sequential recruitment of distinct monocyte subsets that differentiate to distinct macrophages. Alternatively, heterogeneity may arise in tissue from 1 circulating subset via local macrophage differentiation and polarization. The orphan nuclear hormone receptor, nuclear receptor subfamily 4, group a, member 1 (Nr4a1), is essential to Ly-6C(low) monocyte production but dispensable to Ly-6C(low) macrophage differentiation; dependence on Nr4a1 can thus discriminate between systemic and local origins of macrophage heterogeneity. OBJECTIVE This study tested the role of Nr4a1 in myocardial infarction in the context of the 2 Mo/MΦ accumulation scenarios. METHODS AND RESULTS We show that Ly-6C(high) monocytes infiltrate the infarcted myocardium and, unlike Ly-6C(low) monocytes, differentiate to cardiac macrophages. In the early, inflammatory phase of acute myocardial ischemic injury, Ly-6C(high) monocytes accrue in response to a brief C-C chemokine ligand 2 burst. In the second, reparative phase, accumulated Ly-6C(high) monocytes give rise to reparative Ly-6C(low) F4/80(high) macrophages that proliferate locally. In the absence of Nr4a1, Ly-6C(high) monocytes express heightened levels of C-C chemokine receptor 2 on their surface, avidly infiltrate the myocardium, and differentiate to abnormally inflammatory macrophages, which results in defective healing and compromised heart function. CONCLUSIONS Ly-6C(high) monocytes orchestrate both inflammatory and reparative phases during myocardial infarction and depend on Nr4a1 to limit their influx and inflammatory cytokine expression.
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Affiliation(s)
- Ingo Hilgendorf
- From the Center for Systems Biology (I.H., L.M.S.G., C.W., B.G.C., Y.I., M.N., R.W., F.K.S.) and Department of Cardiology (T.C.T., M.S.-C.), Massachusetts General Hospital, Boston; Department of Gastroenterology, Hepatology, and Infectious Diseases, University of Duesseldorf, Duesseldorf, Germany (T.A.W.H.); Department of Medicine (R.L.) and Cardiovascular Division, Department of Medicine (P.L.), Brigham and Women's Hospital, Boston, MA; Department of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany (A.Z.); Division of Inflammation Biology, La Jolla Institute for Allergy and Immunology, CA (C.C.H.); and Department of Systems Biology, Harvard Medical School, Boston, MA (R.W.)
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Chousterman BG, Bouadma L, Moutereau S, Loric S, Alvarez-Gonzalez A, Mekontso-Dessap A, Laissy JP, Rahmouni A, Katsahian S, Brochard L, Schortgen F. Prevention of contrast-induced nephropathy by N-acetylcysteine in critically ill patients: Different definitions, different results. J Crit Care 2013; 28:701-9. [DOI: 10.1016/j.jcrc.2013.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 11/24/2022]
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