51
|
Liu CC, Shih MF, Wen YS, Lai YH, Yang TH. Dexamethasone improves heat stroke-induced multiorgan dysfunction and damage in rats. Int J Mol Sci 2014; 15:21299-313. [PMID: 25411796 PMCID: PMC4264226 DOI: 10.3390/ijms151121299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/06/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022] Open
Abstract
Dexamethasone (DXM) is known as an immunosuppressive drug used for inflammation control. In the present study, we attempted to examine whether DXM administration could attenuate the hypercoagulable state and the overproduction of pro-inflammatory cytokines, improve arterial hypotension, cerebral ischemia and damage, and vital organ failure in a rat model of heat stroke. The results indicated that all the rats suffering from heat stroke showed high serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), accompanied with increased prothrombin time, activated partial thromboplastin time and D-D dimer, and decreased protein C. During the induction period of heat stroke, plasma levels of blood urea nitrogen (BUN), creatinine, glutamic oxaloacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), and alkaline phosphatase (ALP), were consistently increased. High striatal levels of glycerol, glutamate, and lactate/pyruvate were simultaneously detected. On the contrary, the mean arterial pressure, plasma levels of interleukin-10 (IL-10), and local cerebral blood flow at the striatum were all decreased. Importantly, intravenous administration of DXM substantially ameliorated the circulatory dysfunction, systematic inflammation, hypercoagulable state, cerebral ischemia and damage during the induction period of heat stroke. These findings demonstrated that DXM may be an alternative therapy that can ameliorate heat stroke victims by attenuating activated coagulation, systemic inflammation, and vital organ ischemia/injury during heat stroke.
Collapse
Affiliation(s)
- Chia-Chyuan Liu
- Department and Institute of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 717, Taiwan.
| | - Mei-Fen Shih
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan 717, Taiwan.
| | - Yi-Szu Wen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Ying-Hsiu Lai
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Tsai-Hsiu Yang
- Department of Health and Nutrition, Chia-Nan University of Pharmacy and Science, Tainan 717, Taiwan.
| |
Collapse
|
52
|
PAN ZHIGUO, SHAO YU, DONG WENPENG, LIU CHENXI, CHEN YI, JIN HUI, TANG LIQUN, QIU JUNMING, SU LEI. Xuebijing attenuates hypotension through the upregulation of angiotensin II type 1 receptor-associated protein 1 in rats suffering from heat stroke. Int J Mol Med 2014; 34:1699-705. [DOI: 10.3892/ijmm.2014.1950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 09/12/2014] [Indexed: 11/05/2022] Open
|
53
|
Zauner D, Quehenberger F, Hermann J, Dejaco C, Stradner MH, Stojakovic T, Angerer H, Rinner B, Graninger WB. Whole body hyperthermia treatment increases interleukin 10 and toll-like receptor 4 expression in patients with ankylosing spondylitis: A pilot study. Int J Hyperthermia 2014; 30:393-401. [DOI: 10.3109/02656736.2014.956810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
54
|
Moore T, Globa L, Pustovyy O, Vodyanoy V, Sorokulova I. Oral administration of Bacillus subtilis
strain BSB3 can prevent heat stress-related adverse effects in rats. J Appl Microbiol 2014; 117:1463-71. [DOI: 10.1111/jam.12606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/30/2014] [Accepted: 07/19/2014] [Indexed: 12/14/2022]
Affiliation(s)
- T. Moore
- Department of Anatomy, Physiology and Pharmacology; Auburn University; Auburn AL USA
- School of Kinesiology; Auburn University; Auburn AL USA
| | - L. Globa
- Department of Anatomy, Physiology and Pharmacology; Auburn University; Auburn AL USA
| | - O. Pustovyy
- Department of Anatomy, Physiology and Pharmacology; Auburn University; Auburn AL USA
| | - V. Vodyanoy
- Department of Anatomy, Physiology and Pharmacology; Auburn University; Auburn AL USA
| | - I. Sorokulova
- Department of Anatomy, Physiology and Pharmacology; Auburn University; Auburn AL USA
| |
Collapse
|
55
|
Chen Y, Islam A, Abraham P, Deuster P. Single-dose oral quercetin improves redox status but does not affect heat shock response in mice. Nutr Res 2014; 34:623-9. [PMID: 25150121 DOI: 10.1016/j.nutres.2014.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 01/09/2023]
Abstract
Inflammation and oxidative stress are considered as likely contributors to heat injury. However, their roles in regulating the heat shock response in vivo remain unclear. We tested the hypothesis that acute quercetin treatment would improve redox status and reduce heat shock responses in mice. Mice underwent two heat tests before and after single oral administration of either quercetin (15 mg/kg) or vehicle. We measured physiologic and biochemical responses in mice during and 18 to 22 hours after heat tests, respectively. There were no significant differences in core temperature, heart rate, or blood pressure between quercetin and vehicle groups during heat exposure. Mice with relatively severe hyperthermia during the pretreatment heat test showed a significant trend toward a lower peak core temperature during the heat test after quercetin treatment. Compared with mice not exposed to heat, quercetin-treated mice had significantly lower interleukin 6 (P < .01) and higher superoxide dismutase levels (P < .01), whereas vehicle-treated mice had significantly lower total glutathione and higher 8-isoprostane levels in the circulation after heat exposure. Heat exposure significantly elevated heat shock proteins (HSPs) 72 and 90 and heat shock factor 1 levels in mouse liver, heart, and skeletal muscles, but no significant differences in tissue HSPs and heat shock factor 1 were found between quercetin- and vehicle-treated mice. These results suggest that a single moderate dose of quercetin is sufficient to alter redox status but not heat stress response in mice. Acute adaptations of peripheral tissues to heat stress may not be mediated by systemic inflammatory and redox state in vivo.
Collapse
Affiliation(s)
- Yifan Chen
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Aminul Islam
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Preetha Abraham
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Patricia Deuster
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
56
|
Kinoshita K, Sakurai A, Yamaguchi J, Furukawa M, Tanjoh K. Delayed augmentation effect of cytokine production after hyperthermia stimuli. Mol Biol 2014. [DOI: 10.1134/s0026893314030108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
57
|
Leon LR, Dineen S, Blaha MD, Rodriguez-Fernandez M, Clarke DC. Attenuated thermoregulatory, metabolic, and liver acute phase protein response to heat stroke in TNF receptor knockout mice. Am J Physiol Regul Integr Comp Physiol 2013; 305:R1421-32. [DOI: 10.1152/ajpregu.00127.2013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tumor necrosis factor (TNF) is considered an adverse mediator of heat stroke (HS) based on clinical studies showing high serum levels. However, soluble TNF receptors (sTNFR; TNF antagonists) were higher in survivors than nonsurvivors, and TNFR knockout (KO) mice showed a trend toward increased mortality, suggesting TNF has protective actions for recovery. We delineated TNF actions in HS by comparing thermoregulatory, metabolic, and inflammatory responses between B6129F2 (wild type, WT) and TNFR KO mice. Before heat exposure, TNFR KO mice showed ∼0.4°C lower core temperature (Tc; radiotelemetry), ∼10% lower metabolic rate (Mr; indirect calorimetry), and reduced plasma interleukin (IL)-1α and sIL-1RI than WT mice. KO mice selected warmer temperatures than WT mice in a gradient but remained hypothermic. In the calorimeter, both genotypes showed a similar heating rate, but TNFR KO maintained lower Tc and Mr than WT mice for a given heat exposure duration and required ∼30 min longer to reach maximum Tc (42.4°C). Plasma IL-6 increased at ∼3 h of recovery in both genotypes, but KO mice showed a more robust sIL-6R response. Higher sIL-6R in the KO mice was associated with delayed liver p-STAT3 protein expression and attenuated serum amyloid A3 (SAA3) gene expression, suggesting the acute phase response (APR) was attenuated in these mice. Our data suggest that the absence of TNF signaling induced a regulated hypothermic state in the KO mice, TNF-IL-1 interactions may modulate Tc and Mr during homeostatic conditions, and TNF modulates the APR during HS recovery through interactions with the liver IL-6-STAT3 pathway of SAA3 regulation.
Collapse
Affiliation(s)
- Lisa R. Leon
- Thermal Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Shauna Dineen
- Thermal Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Michael D. Blaha
- Thermal Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Maria Rodriguez-Fernandez
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, California; and
| | - David C. Clarke
- Department of Biological Engineering and Center for Cellular Decision Processes, Massachusetts Institute of Technology, Cambridge, Massachusetts
| |
Collapse
|
58
|
Biedenkapp JC, Leon LR. Increased cytokine and chemokine gene expression in the CNS of mice during heat stroke recovery. Am J Physiol Regul Integr Comp Physiol 2013; 305:R978-86. [DOI: 10.1152/ajpregu.00011.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heat stroke (HS) is characterized by a systemic inflammatory response syndrome (SIRS) consisting of profound core temperature (Tc) changes in mice. Encephalopathy is common at HS collapse, but inflammatory changes occurring in the brain during the SIRS remain unidentified. We determined the association between inflammatory gene expression changes in the brain with Tc disturbances during HS recovery in mice. Gene expression changes of heat shock protein (HSP)72, heme oxygenase (hmox1), cytokines (IL-1β, IL-6, TNF-α), cyclooxygenase enzymes (COX-1, COX-2), chemokines (MCP-1, MIP-1α, MIP-1β, CX3CR1), and glia activation markers (CD14, aif1, vimentin) were examined in the hypothalamus (HY) and hippocampus (HC) of control (Tc ∼ 36.0°C) and HS mice at Tc,Max (42.7°C), hypothermia depth (HD; 29.3 ± 0.4°C), and fever (37.8 ± 0.3°C). HSP72 (HY<HC) and IL-1β (HY only) were the only genes that showed increased expression at Tc,Max. HSP72 (HY < HC), hmox1 (HY < HC), cytokine (HY = HC), and chemokine (HY = HC) expression was highest at HD and similar to controls during fever. COX-1 expression was unaffected by HS, whereas HD was associated with approximately threefold increase in COX-2 expression (HY only). COX-2 expression was not increased during fever and indomethacin (COX inhibitor) had no effect on this Tc response indicating fever is regulated by other inflammatory pathways. CD14, aif1, and vimentin activation at HD coincided with maximal cytokine and chemokine expression suggesting glia cells are a possible source of brain cytokines and chemokines during HS recovery. The inflammatory gene expression changes during HS recovery suggest cytokines and/or chemokines may be initiating development or rewarming from hypothermia, whereas fever pathway(s) remain to be elucidated.
Collapse
Affiliation(s)
- Joseph C. Biedenkapp
- United State Army Research Institute of Environmental Medicine, 1Military Nutrition Division,
| | - Lisa R. Leon
- Thermal and Mountain Medicine Division, Natick, Massachusetts
| |
Collapse
|
59
|
Effects of probiotics supplementation on gastrointestinal permeability, inflammation and exercise performance in the heat. Eur J Appl Physiol 2013; 114:93-103. [DOI: 10.1007/s00421-013-2748-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/07/2013] [Indexed: 12/17/2022]
|
60
|
Rodriguez-Fernandez M, Grosman B, Yuraszeck TM, Helwig BG, Leon LR, Doyle III FJ. Modeling the intra- and extracellular cytokine signaling pathway under heat stroke in the liver. PLoS One 2013; 8:e73393. [PMID: 24039931 PMCID: PMC3764238 DOI: 10.1371/journal.pone.0073393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/22/2013] [Indexed: 12/24/2022] Open
Abstract
Heat stroke (HS) is a life-threatening illness induced by prolonged exposure to a hot environment that causes central nervous system abnormalities and severe hyperthermia. Current data suggest that the pathophysiological responses to heat stroke may not only be due to the immediate effects of heat exposure per se but also the result of a systemic inflammatory response syndrome (SIRS). The observation that pro- (e.g., IL-1) and anti-inflammatory (e.g., IL-10) cytokines are elevated concomitantly during recovery suggests a complex network of interactions involved in the manifestation of heat-induced SIRS. In this study, we measured a set of circulating cytokine/soluble cytokine receptor proteins and liver cytokine and receptor mRNA accumulation in wild-type and tumor necrosis factor (TNF) receptor knockout mice to assess the effect of neutralization of TNF signaling on the SIRS following HS. Using a systems approach, we developed a computational model describing dynamic changes (intra- and extracellular events) in the cytokine signaling pathways in response to HS that was fitted to novel genomic (liver mRNA accumulation) and proteomic (circulating cytokines and receptors) data using global optimization. The model allows integration of relevant biological knowledge and formulation of new hypotheses regarding the molecular mechanisms behind the complex etiology of HS that may serve as future therapeutic targets. Moreover, using our unique modeling framework, we explored cytokine signaling pathways with three in silico experiments (e.g. by simulating different heat insult scenarios and responses in cytokine knockout strains in silico).
Collapse
Affiliation(s)
- Maria Rodriguez-Fernandez
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, United States of America
| | - Benyamin Grosman
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, United States of America
| | - Theresa M. Yuraszeck
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, United States of America
| | - Bryan G. Helwig
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
| | - Lisa R. Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States of America
| | - Francis J. Doyle III
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, United States of America
- * E-mail:
| |
Collapse
|
61
|
Chen SH, Lin MT, Chang CP. Ischemic and oxidative damage to the hypothalamus may be responsible for heat stroke. Curr Neuropharmacol 2013; 11:129-40. [PMID: 23997749 PMCID: PMC3637668 DOI: 10.2174/1570159x11311020001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/12/2012] [Accepted: 12/14/2012] [Indexed: 12/11/2022] Open
Abstract
The hypothalamus may be involved in regulating homeostasis, motivation, and emotional behavior by controlling autonomic and endocrine activity. The hypothalamus communicates input from the thalamus to the pituitary gland, reticular activating substance, limbic system, and neocortex. This allows the output of pituitary hormones to respond to changes in autonomic nervous system activity. Environmental heat stress increases cutaneous blood flow and metabolism, and progressively decreases splanchnic blood flow. Severe heat exposure also decreases mean arterial pressure (MAP), increases intracranial pressure (ICP), and decreases cerebral perfusion pressure (CPP = MAP - ICP), all of which lead to cerebral ischemia and hypoxia. Compared with normothermic controls, rodents with heatstroke have higher hypothalamic values of cellular ischemia (e.g., glutamate and lactate-to-pyruvate ratio) and damage (e.g., glycerol) markers, pro-oxidant enzymes (e.g., lipid peroxidation and glutathione oxidation), proinflammatory cytokines (e.g., interleukin-1β and tumor necrosis factor-α), inducible nitric oxide synthase-dependent nitric oxide, and an indicator for the accumulation of polymorphonuclear leukocytes (e.g., myeloperoxidase activity), as well as neuronal damage (e.g., apoptosis, necrosis, and autophagy) after heatstroke. Hypothalamic values of antioxidant defenses (e.g., glutathione peroxidase and glutathione reductase), however, are lower. The ischemic, hypoxic, and oxidative damage to the hypothalamus during heatstroke may cause multiple organ dysfunction or failure through hypothalamic-pituitary-adrenal axis mechanisms. Finding the link between the signaling and heatstroke-induced hypothalamic oxidative and ischemic damage might allow us to clinically attenuate heatstroke. In particular, free radical scavengers, heat shock protein-70 inducers, hypervolemic hemodilution, inducible nitric oxide synthase inhibitors, progenitor stem cells, flutamide, estrogen, interleukin-1 receptor antagonists, glucocorticoid, activated protein C, and baicalin mitigate preclinical heatstroke levels.
Collapse
Affiliation(s)
- Sheng-Hsien Chen
- Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan ; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | | | | |
Collapse
|
62
|
Dahan E, Dichtwald S, Amar E, Sorkine P, Weinbroum AA. Low plasma C-reactive protein level as an early diagnostic tool for heatstroke vs central nervous system-associated infection in the ED. Am J Emerg Med 2013; 31:1176-80. [PMID: 23726745 DOI: 10.1016/j.ajem.2013.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSES Heatstroke (HS) is a life-threatening condition, manifested by systemic inflammation and multiorgan failure. Rapid recognition and treatment are life saving. We report a laboratory-oriented characterization of HS by low plasma C-reactive protein (CRP) level and propose its usefulness in distinguishing this type of hyperpyrexia from central nervous system-associated high core temperature. METHODS After institutional review board approval, records of patients admitted to general intensive care unit between August 2008 and September 2011 with core temperature 39.0°C or higher due to HS or meningoencephalitis (ME) were reviewed. Patients' demographics, CRP on admission and 24 to 48 hours later, serum creatinine, creatine phosphokinase, platelets count, international normalized ratio, alanine transaminase, serum pH, and lactate levels were retrieved. RESULTS Thirty-six patients were admitted to the intensive care unit with high core temperature: 19 patients, aged 21 to 85 years, had HS; 17 individuals, aged 22 to 81 years, had ME. None of the HS individuals had infection. Twelve HS patients were previously healthy; in 13 patients, the event occurred postexercise. Mean admission CRP levels was 2.1 ± 3.3 mg/L in the HS group compared with 129 ± 84 mg/L in the ME patients (P < .0001); mean 24- to 48-hour CRP levels were 14.6 ± 16.8 vs 139 ± 98 mg/L, respectively (P < .0001). There were no clinically significant differences between the groups regarding laboratory parameters indicative of end-organ damage. Six HS patients underwent computed tomography and/or lumbar puncture before starting intensive cooling, due to misdiagnosis; 5 of them died subsequently. CONCLUSIONS Low serum CRP levels characterize non-central nervous system-associated HS. This available laboratory test could identify noninfectious hyperthermic patients upon admission, saving precious time until treatment and avoiding unnecessary diagnostic tests.
Collapse
Affiliation(s)
- Esther Dahan
- Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | | | | | |
Collapse
|
63
|
|
64
|
Abstract
The increasing popularity of mass participation endurance events necessitates that on-site medical teams be well versed in the management of both common and life-threatening conditions. Exertional heat stroke is one such condition, which if left untreated can be fatal.
Collapse
|
65
|
Effects of continuous venous-venous hemofiltration on heat stroke patients: a retrospective study. ACTA ACUST UNITED AC 2012; 71:1562-8. [PMID: 22182867 DOI: 10.1097/ta.0b013e31822a71c2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heat stroke (HS) is a fatal illness characterized by an elevated core body temperature above 40°C and complicated with rhabdomyolysis and acute renal failure. We retrospectively analyzed the effect of continuous veno-venous hemofiltration (CVVH) in patients with HS. METHODS A total of 16 patients with HS were retrospectively analyzed. All patients were treated by CVVH for at least 96 hours, and CVVH was initiated with replacement fluid between 25°C and 30°C for 2 hours to 2.5 hours, and 36°C thereafter. The vital signs were monitored and blood samples were collected during CVVH to measure serum urea, creatinine, myoglobin, creatine kinase, and total bilirubin. RESULTS All patients survived. The core temperature of the patients decreased from 41.3 ± 0.2°C to 38.7 ± 0.1°C after 2 hours and to 36.7 ± 0.1°C after 5 hours during CVVH (p < 0.05). Compared with values before starting CVVH, there were remarkable improvements in mean arterial blood pressure, heart rate, and oxygenation index (p < 0.05). The serum creatinine, urea, myoglobin, and creatine kinase decreased significantly (p < 0.05), while the bilirubinemia had no obvious decline (p > 0.05). The scores of APACHE II and arterial lactate had also obvious decline (p < 0.05). The hemodynamic variables were stabilized during CVVH, and no obvious side effects related to CVVH were found. CONCLUSIONS CVVH is safe and feasible in the treatment of patients with HS by lowering core temperature, removal of myoglobin, support of multiorgan function, and modulating systemic inflammatory response syndrome (SIRS). The impact of CVVH on patient outcome, however, still needs proof by larger randomized controlled trials.
Collapse
|
66
|
Smith R, Erlwanger K, Rogers G. The effect of a single dose of tumor necrosis factor alpha inhibitor on gut permeability in rats during exposure to a heat stress. J Therm Biol 2012. [DOI: 10.1016/j.jtherbio.2011.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
67
|
Horseman MA, Rather-Conally J, Saavedra C, Surani S. A case of severe heatstroke and review of pathophysiology, clinical presentation, and treatment. J Intensive Care Med 2012; 28:334-40. [PMID: 22232203 DOI: 10.1177/0885066611434000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Heatstroke is life-threatening condition characterized by hyperthermia and central nervous system disturbances. It can also be classified as a form of systemic inflammatory response syndrome with multiple organ dysfunction and in many ways resembles sepsis. Like sepsis, most patients with heatstroke demonstrate a hyperdynamic hemodynamic response. In contrast to sepsis, rhabdomyolysis may complicate management and initial fluid resuscitation is not well defined. We present an illustrative case report and review of literature.
Collapse
Affiliation(s)
- Michael A Horseman
- Department of Pharmacy Practice, College of Pharmacy, Texas A & M Health Sciences Center, Kingsville, TX, USA
| | | | | | | |
Collapse
|
68
|
Yu X, Larsen B, Urschel S, Cheung PY, Ross DB, Rebeyka I, West L, Li J. The profile of inflammatory and metabolic response in children undergoing heart transplantation. Clin Transplant 2011; 26:E137-42. [PMID: 22168310 DOI: 10.1111/j.1399-0012.2011.01566.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inflammatory and metabolic response is an important factor to determine clinical outcomes. However, it remains unknown in children undergoing heart transplantation (HTx). We examined the perioperative changes in the inflammatory and metabolic response markers C-reactive protein (CRP) and prealbumin (PA) in 38 heart-transplanted children. Data obtained prior to and within one month after HTx included CRP, PA, total and differential white blood cell counts, doses of inotropes and immunosuppressants, cultures of blood and body fluids, duration of cardiopulmonary bypass (CPB), aortic cross clamp and donor heart ischemia, and days in the intensive care unit (ICU) and hospital. CRP was 32±49 mg/L before HTx, increased to 130±55 mg/L on postoperative day 1-2, and decreased to 21±31 mg/L by one month after HTx. PA was 0.15±0.06 g/L before HTx, decreased to 0.12±0.03 g/L on postoperative day 1-2, and then gradually increased to 0.21±0.10 g/L by one month after HTx. Postoperative CRP positively correlated with epinephrine dosage and CPB duration. PA positively correlated with age. In conclusion, inflammatory and metabolic response is present before HTx and acutely intensified after HTx. It may be mainly influenced by CPB duration and cardiovascular function status.
Collapse
Affiliation(s)
- Xiaoyang Yu
- Division of Pediatric Cardiology, Stollery Children's Hospital, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | | | | |
Collapse
|
69
|
Hong JY, Lai YC, Chang CY, Chang SC, Tang GJ. Successful treatment of severe heatstroke with therapeutic hypothermia by a noninvasive external cooling system. Ann Emerg Med 2011; 59:491-3. [PMID: 21982153 DOI: 10.1016/j.annemergmed.2011.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 10/16/2022]
Abstract
Heatstroke is a life-threatening disease; however, no pharmacologic treatment has proven to be effective. In severe cases with multiple organ dysfunction, the mortality remains high and many patients inevitably develop permanent neurologic damage. We report a near-fatal case of exertional heatstroke with multiple organ dysfunction, including generalized convulsions, acute lung injury, and disseminated intravascular coagulation, successfully treated with induced therapeutic hypothermia (33°C [91.4°F]) by a noninvasive external cooling system. After treatment, the patient completely recovered, without any neurologic sequelae during 1 year of follow-up. To our knowledge, this is the first reported case of using therapeutic hypothermia in heatstroke.
Collapse
Affiliation(s)
- Jen-Yee Hong
- Department of Internal Medicine, National Yang-Ming University Hospital, Yilan City, Taiwan
| | | | | | | | | |
Collapse
|
70
|
Sawka MN, Leon LR, Montain SJ, Sonna LA. Integrated Physiological Mechanisms of Exercise Performance, Adaptation, and Maladaptation to Heat Stress. Compr Physiol 2011; 1:1883-928. [DOI: 10.1002/cphy.c100082] [Citation(s) in RCA: 299] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
71
|
Helwig BG, Leon LR. Tissue and circulating expression of IL-1 family members following heat stroke. Physiol Genomics 2011; 43:1096-104. [PMID: 21828249 DOI: 10.1152/physiolgenomics.00076.2011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Interleukin-1 (IL-1) is thought to have a significant role in the pathophysiology of heat stroke (HS), although little is known regarding the actions or expression patterns of the IL-1 family. This study tested the hypotheses that following HS IL-1 family gene expression is dynamic, while loss of IL-1 signaling enhances recovery. IL-1 family expression was determined in plasma, spleen, and liver from C57BL/6J mice (n=24 control, n=20 HS) at maximum core temperature (Tc,Max), hypothermia, and 24 h post-HS (24 h). Soluble IL-1 receptor subtype I (sIL-1RI) protein expression peaked at 24 h (14,659.01±2,016.28 pg/ml, P<0.05), while sIL-1RII peaked at hypothermia (19,099.30±1,177.07 pg/ml). IL-1α gene expression in the spleen (ninefold) and liver (fourfold) along with IL-1RI (threefold spleen and fivefold liver) were maximal at hypothermia. Spleen IL-1β gene expression peaked at Tc,Max (fourfold) but at hypothermia (fourfold) in liver. Gene expression of the IL-1 family member IL-18 peaked (2.5-fold) at Tc,Max but was similar at all other time points. Subsequent studies revealed that despite accruing a greater heating area (298±16 vs. 247±13°C·min, P<0.05), IL-1RI knockout (KO) mice (n=14) showed an attenuated hypothermia depth (28.5±0.2 vs. 27.3±0.5°C, P<0.05) and duration (675±82 vs. 1,283±390 min, P<0.05) with a higher 24 h Tc (36.9 vs. 34.1°C, P<0.05) compared with C57BL/6J mice (n=8). The current results demonstrate that following HS IL-1 family gene expression is altered and IL-1RI KO mice display Tc responses consistent with a more rapid recovery.
Collapse
Affiliation(s)
- Bryan G Helwig
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts 01760, USA.
| | | |
Collapse
|
72
|
O'Connor FG, Casa DJ, Bergeron MF, Carter R, Deuster P, Heled Y, Kark J, Leon L, McDermott B, O'Brien K, Roberts WO, Sawka M. American College of Sports Medicine Roundtable on exertional heat stroke--return to duty/return to play: conference proceedings. Curr Sports Med Rep 2011; 9:314-21. [PMID: 20827100 DOI: 10.1249/jsr.0b013e3181f1d183] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD) to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identified.
Collapse
Affiliation(s)
- Francis G O'Connor
- Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University, Bethesda, MD 20814, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
73
|
Kuennen M, Gillum T, Dokladny K, Bedrick E, Schneider S, Moseley P. Thermotolerance and heat acclimation may share a common mechanism in humans. Am J Physiol Regul Integr Comp Physiol 2011; 301:R524-33. [PMID: 21613575 DOI: 10.1152/ajpregu.00039.2011] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thermotolerance and heat acclimation are key adaptation processes that have been hitherto viewed as separate phenomena. Here, we provide evidence that these processes may share a common basis, as both may potentially be governed by the heat shock response. We evaluated the effects of a heat shock response-inhibitor (quercetin; 2,000 mg/day) on established markers of thermotolerance [gastrointestinal barrier permeability, plasma TNF-α, IL-6, and IL-10 concentrations, and leukocyte heat shock protein 70 (HSP70) content]. Heat acclimation reduced body temperatures, heart rate, and physiological strain during exercise/heat stress) in male subjects (n = 8) completing a 7-day heat acclimation protocol. These same subjects completed an identical protocol under placebo supplementation (placebo). Gastrointestinal barrier permeability and TNF-α were increased on the 1st day of exercise/heat stress in quercetin; no differences in these variables were reported in placebo. Exercise HSP70 responses were increased, and plasma cytokines (IL-6, IL-10) were decreased on the 7th day of heat acclimation in placebo; with concomitant reductions in exercise body temperatures, heart rate, and physiological strain. In contrast, gastrointestinal barrier permeability remained elevated, HSP70 was not increased, and IL-6, IL-10, and exercise body temperatures were not reduced on the 7th day of heat acclimation in quercetin. While exercise heart rate and physiological strain were reduced in quercetin, this occurred later in exercise than with placebo. Consistent with the concept that thermotolerance and heat acclimation are related through the heat shock response, repeated exercise/heat stress increases cytoprotective HSP70 and reduces circulating cytokines, contributing to reductions in cellular and systemic markers of heat strain. Exercising under a heat shock response-inhibitor prevents both cellular and systemic heat adaptations.
Collapse
Affiliation(s)
- Matthew Kuennen
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, USA.
| | | | | | | | | | | |
Collapse
|
74
|
Yang TH, Shih MF, Wen YS, Ho WY, Leu KL, Wang MY, Liu CC. Attenuation of circulatory shock and cerebral ischemia injury in heat stroke by combination treatment with dexamethasone and hydroxyethyl starch. EXPERIMENTAL & TRANSLATIONAL STROKE MEDICINE 2010; 2:19. [PMID: 20937119 PMCID: PMC2959042 DOI: 10.1186/2040-7378-2-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 10/11/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increased systemic cytokines and elevated brain levels of monoamines, and hydroxyl radical productions are thought to aggravate the conditions of cerebral ischemia and neuronal damage during heat stroke. Dexamethasone (DXM) is a known immunosuppressive drug used in controlling inflammation, and hydroxyethyl starch (HES) is used as a volume-expanding drug in cerebral ischemia and/or cerebral injury. Acute treatment with a combined therapeutic approach has been repeatedly advocated in cerebral ischemia experiments. The aim of this study is to investigate whether the combined agent (HES and DXM) has beneficial efficacy to improve the survival time (ST) and heat stroke-induced cerebral ischemia and neuronal damage in experimental heat stroke. METHODS Urethane-anesthetized rats underwent instrumentation for the measurement of colonic temperature, mean arterial pressure (MAP), local striatal cerebral blood flow (CBF), heart rate, and neuronal damage score. The rats were exposed to an ambient temperature (43 degrees centigrade) to induce heat stroke. Concentrations of the ischemic and damage markers, dopamine, serotonin, and hydroxyl radical productions in corpus striatum, and the serum levels of interleukin-1 beta, tumor necrosis factor-alpha and malondialdehyde (MDA) were observed during heat stroke. RESULTS After heat stroke, the rats displayed circulatory shock (arterial hypotension), decreased CBF, increased the serum levels of cytokines and MDA, increased cerebral striatal monoamines and hydroxyl radical productions release, and severe cerebral ischemia and neuronal damage compared with those of normothermic control rats. However, immediate treatment with the combined agent at the onset of heat stroke confers significant protection against heat stroke-induced circulatory shock, systemic inflammation; cerebral ischemia, cerebral monoamines and hydroxyl radical production overload, and improves neuronal damage and the ST in rats. CONCLUSIONS Our results suggest that the combination of a colloid substance with a volume-expanding effect and an anti-inflammatory agent may provide a better resuscitation solution for victims with heat stroke.
Collapse
Affiliation(s)
- Tsai-Hsiu Yang
- Department of Health and Nutrition, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Mei-Fen Shih
- Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Yi-Szu Wen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei 11267, Taiwan
| | - Wen-Yueh Ho
- Department and Institute of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Kuen-Lin Leu
- Department and Institute of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Mei-Ying Wang
- Department and Institute of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Chia-Chyuan Liu
- Department and Institute of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| |
Collapse
|
75
|
Abstract
Heatstroke is the most severe form of heat-related disorders that include mild heat intolerance, heat exhaustion and heat stress. The incidence of heat-related disorders is increasing due to several factors that include climate change, co-morbidities and drug usage. Patients with heatstroke present with a core body temperature above 40°C, multiorgan dysfunction and central nervous system disorder. The pathogenesis of heatstroke is not fully understood; however, heat-shock proteins, inflammatory cytokines and their modulators have been implicated. The clinical biochemistry laboratory plays an important role in the management of patients with heatstroke. Biochemical findings in patients with heatstroke include elevated urea, creatinine, cardiac and skeletal muscle enzymes, myoglobin and troponin. There is also biochemical evidence of metabolic acidosis, respiratory alkalosis, hepatic injury with elevated enzyme levels as well as abnormal hematological and coagulation indices. This review article aims at increasing awareness of the biochemical changes seen in patients with heatstroke and their possible role in prognosis and in elucidating the pathogenesis of heatstroke.
Collapse
Affiliation(s)
- Ibrahim A Hashim
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9073, USA
| |
Collapse
|
76
|
Abstract
During exercise, body temperature rises as a result of increased energy metabolism and heat absorbed from the environment. In response to this rise in body temperature, blood flow increases and stress hormones are released. Together, blood flow and stress hormones stimulate increases in the number of circulating leukocytes and alterations in various aspects of immune function, including cytokine production. The extent of changes in leukocyte numbers, cytokine concentrations, and immune cell function depends on how high body temperature rises and the intensity and duration of exercise. In general, increases in body temperature of ≤ 1.8° F (1° C) induce mild changes in immune function, and such changes are unlikely to increase the risk of illness in athletes, firefighters, and military personnel who regularly exercise in hot conditions. More severe immune disturbances during exercise in extreme heat (≥ 106° F or 41° C) may contribute to classical symptoms of heatstroke.
Collapse
Affiliation(s)
- Jonathan Peake
- University of Queensland, School of Human Movement Studies, Brisbane, Australia, Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Brisbane, Australia,
| |
Collapse
|
77
|
Abstract
Heat stroke is a life-threatening illness that is characterized clinically by central nervous system dysfunction, including delirium, seizures, or coma and severe hyperthermia. Rapid cooling and support of multi-organ function are the most effective clinical treatments, but many patients experience permanent neurological impairments or death despite these efforts. The highest incidence of heat stroke deaths occurs in very young or elderly individuals during summer heat waves, with ∼ 200 deaths per year in the United States. Young, fit individuals may experience exertional heat stroke while performing strenuous physical activity in temperate or hot climates. Factors that predispose to heat stroke collapse include pre-existing illness, cardiovascular disease, drug use, and poor fitness level. For decades the magnitude of the hyperthermic response in heat stroke patients was considered the primary determinant of morbidity and mortality. However, recent clinical and experimental evidence suggests a complex interplay between heat cytotoxicity, coagulation, and the systemic inflammatory response syndrome (SIRS) that ensues following damage to the gut and other organs. Cytokines are immune modulators that have been implicated as adverse mediators of the SIRS, but recent data suggest a protective role for these proteins in the resolution of inflammation. Multi-organ system failure is the ultimate cause of mortality, and recent experimental data indicate that current clinical markers of heat stroke recovery may not adequately reflect heat stroke recovery in all cases. Currently heat stroke is a more preventable than treatable condition, and novel therapeutics are required to improve patient outcome.
Collapse
Affiliation(s)
- Lisa R Leon
- U.S. Army Research Institute of Environmental Medicine, Thermal Mountain Medicine Division, Kansas St., Bldg 42, Natick, MA 01760-5007, USA.
| | | |
Collapse
|
78
|
Liu WS, Chen CT, Foo NH, Huang HR, Wang JJ, Chen SH, Chen TJ. Human umbilical cord blood cells protect against hypothalamic apoptosis and systemic inflammation response during heatstroke in rats. Pediatr Neonatol 2009; 50:208-16. [PMID: 19856864 DOI: 10.1016/s1875-9572(09)60065-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intravenous administration of human umbilical cord blood cells (HUCBC) has been shown to improve heatstroke by reducing arterial hypotension as well as cerebral ischemia and damage in a rat model. To extend these findings, we assessed both hypothalamic neuronal apoptosis and systemic inflammatory responses in the presence of HUCBCs or vehicle medium immediately after initiation of heatstroke. METHODS Anesthetized rats, immediately after the initiation of heat stress, were divided into two groups and given either serum-free lymphocyte medium (0.3mL per rat, intravenously) or HUCBCs (5 x 10(6) in 0.3 mL serum-free lymphocyte medium, intravenously). Another group of rats were exposed to room temperature (26 degrees C) and used as normothermic controls. Heatstroke was induced by exposing the anesthetized rats to a high ambient temperature of 43 degrees C for 68 minutes. RESULTS After the onset of heatstroke, animals treated with serum-free lymphocyte medium displayed hyperthermia, hypotension, bradycardia, hypothalamic neuronal apoptosis and degeneration, and up-regulation of systemic inflammatory response molecules including serum tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1 and E-selectin. Heatstroke-induced hypotension, bradycardia, hypothalamic neuronal apoptosis and degeneration, and increased systemic inflammatory response molecules were significantly inhibited by HUCBC treatment. Although heatstroke-induced hyperthermia was not affected by HUCBC treatment, the serum levels of the anti-inflammatory cytokine interleukin-10 were significantly increased by HUCBC therapy during hyperthermia. CONCLUSIONS These findings suggest that HUCBC transplantation may prevent the occurrence of heatstroke by reducing hypothalamic neuronal damage and the systemic inflammatory responses.
Collapse
Affiliation(s)
- Won-Shiung Liu
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
79
|
Lim CL, Pyne D, Horn P, Kalz A, Saunders P, Peake J, Suzuki K, Wilson G, Mackinnon LT. The effects of increased endurance training load on biomarkers of heat intolerance during intense exercise in the heat. Appl Physiol Nutr Metab 2009; 34:616-24. [DOI: 10.1139/h09-021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effects of increased training (IT) load on plasma concentrations of lipopolysaccharides (LPS), proinflammatory cytokines, and anti-LPS antibodies during exercise in the heat were investigated in 18 male runners, who performed 14 days of normal training (NT) or 14 days of 20% IT load in 2 equal groups. Before (trial 1) and after (trial 2) the training intervention, all subjects ran at 70% maximum oxygen uptake on a treadmill under hot (35 °C) and humid (∼40%) conditions, until core temperature reached 39.5 °C or volitional exhaustion. Venous blood samples were drawn before, after, and 1.5 h after exercise. Plasma LPS concentration after exercise increased by 71% (trial 1, p < 0.05) and 21% (trial 2) in the NT group and by 92% (trial 1, p < 0.01) and 199% (trial 2, p < 0.01) in the IT group. Postintervention plasma LPS concentration was 35% lower before exercise (p < 0.05) and 47% lower during recovery (p < 0.01) in the IT than in the NT group. Anti-LPS IgM concentration during recovery was 35% lower in the IT than in the NT group (p < 0.05). Plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations after exercise (IL-6, 3−7 times, p < 0.01, and TNF-α, 33%, p < 0.01) and during recovery (IL-6, 2−4 times, p < 0.05, and TNF-α, 30%, p < 0.01) were higher than at rest within each group. These data suggest that a short-term tolerable increase in training load may protect against developing endotoxemia during exercise in the heat.
Collapse
Affiliation(s)
- Chin Leong Lim
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - David Pyne
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Peggy Horn
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Amelia Kalz
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Philo Saunders
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Jonathan Peake
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Katsuhiko Suzuki
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Gary Wilson
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| | - Laurel T. Mackinnon
- School of Human Movement Studies, University of Queensland, St Lucia, 4072, Brisbane, Australia
- Division of Health, Design, and Science, University of Canberra, ACT 2601 Canberra, Australia
- Australian Institute of Sport, Leverrier St., Bruce ACT 2601, Canberra, Australia
- Faculty of Sport Sciences, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
- Defence Medical and Environmental Research Institute, DSO National Labs, 27 Medical Drive, #09-01, Singapore 117510, Singapore
| |
Collapse
|
80
|
Miyauchi T, Tsuruta R, Kutsuna S, Nakahara T, Fujita M, Kasaoka S, Maekawa T. Successful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations. J Anesth 2009; 23:266-9. [PMID: 19444568 DOI: 10.1007/s00540-008-0725-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/22/2008] [Indexed: 12/14/2022]
Abstract
A 37-year-old man was transferred to our emergency center because of heat stroke with circulatory shock. Despite aggressive body cooling, massive intravenous transfusion, and supply of inotropic agents, shock was persistent. To evaluate adrenal function, an adrenocorticotropic hormone stimulation test was conducted and the results indicated that he had critical illness-related corticosteroid insufficiency (CIRCI) as a result of adrenal insufficiency. Continuous hydorocortisone administration was started and he recovered from shock within a few hours. He was discharged on the thirty-seventh hospital day. Serum cortisol and cytokine concentrations were initially high and the cytokines decreased subsequent to hydrocortisone administration. It is speculated that CIRCI is an exacerbating factor in heat stroke, and hydrocortisone may be a potential therapeutic approach in such patients.
Collapse
Affiliation(s)
- Takashi Miyauchi
- Advanced Medical Emergency And Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan
| | | | | | | | | | | | | |
Collapse
|
81
|
|
82
|
Thermoregulatory responses to environmental toxicants: The interaction of thermal stress and toxicant exposure. Toxicol Appl Pharmacol 2008; 233:146-61. [DOI: 10.1016/j.taap.2008.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Indexed: 11/23/2022]
|
83
|
Shen KH, Chang CK, Lin MT, Chang CP. Interleukin-1 receptor antagonist restores homeostatic function and limits multiorgan damage in heatstroke. Eur J Appl Physiol 2008; 103:561-8. [DOI: 10.1007/s00421-008-0755-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
|
84
|
Abstract
Heat stroke is a life-threatening illness that affects all segments of society, including the young, aged, sick, and healthy. The recent high death toll in France (Dorozynski, 2003) and the death of high-profile athletes has increased public awareness of the adverse effects of heat injury. However, the etiology of the long-term consequences of this syndrome remains poorly understood such that preventive/treatment strategies are needed to mitigate its debilitating effects. Cytokines are important modulators of the acute phase response (APR) to stress, infection, and inflammation. Current data implicating cytokines in heat stroke responses are mainly from correlation studies showing elevated plasma levels in heat stroke patients and experimental animal models. Correlation data fall far short of revealing the mechanisms of cytokine actions such that additional research to determine the role of these endogenous substances in the heat stroke syndrome is required. Furthermore, cytokine determinations have occurred mainly at end-stage heat stroke, such that the role of these substances in progression and long-term recovery is poorly understood. Despite several studies implicating cytokines in heat stroke pathophysiology, few studies have examined the protective effect(s) of cytokine antagonism on the morbidity and mortality of heat stroke. This is particularly surprising since heat stroke responses resemble those observed in the endotoxemic syndrome, for which a role for endogenous cytokines has been strongly implicated. The implication of cytokines as mediators of endotoxemia and the presence of circulating endotoxin in heat stroke patients suggests that much knowledge can be gained from applying our current understanding of endotoxemic pathophysiology to the study of heat stroke. Heat shock proteins (HSPs) are highly conserved proteins that function as molecular chaperones for denatured proteins and reciprocally modulate cytokine production in response to stressful stimuli. HSPs have been shown repeatedly to confer protection in heat stroke and injury models. Interactions between HSPs and cytokines have received considerable attention in the literature within the last decade such that a complex pathway of interactions between cytokines, HSPs, and endotoxin is thought to be occurring in vivo in the orchestration of the APR to heat injury. These data suggest that much of the pathophysiologic changes observed with heat stroke are not a consequence of heat exposure, per se, but are representative of interactions among these three (and presumably additional) components of the innate immune response. This chapter will provide an overview of current knowledge regarding cytokine, HSP, and endotoxin interactions in heat stroke pathophysiology. Insight is provided into the potential therapeutic benefit of cytokine neutralization for mitigation of heat stroke morbidity and mortality based on our current understanding of their role in this syndrome.
Collapse
Affiliation(s)
- Lisa R Leon
- US Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA 01760-5007, USA.
| |
Collapse
|
85
|
Hausfater P, Hurtado M, Pease S, Juillien G, Lvovschi VE, Salehabadi S, Lidove O, Wolff M, Bernard M, Chollet-Martin S, Riou B. Is procalcitonin a marker of critical illness in heatstroke? Intensive Care Med 2008; 34:1377-83. [PMID: 18369592 DOI: 10.1007/s00134-008-1083-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 02/28/2008] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To study the effect of non-exertional heatstroke on serum procalcitonin (PCT) levels. DESIGN Cohort study. SETTING The emergency and intensive care departments of two academic tertiary-care hospitals, Paris, France PATIENTS A total of 53 patients with defined heatstroke attending the emergency department and/or the intensive care unit during the August 2003 heat wave in France. INTERVENTIONS None. MEASUREMENTS Serum PCT measurement using a sensitive assay and vital and routine biological variables on arrival of patients presenting with classic heatstroke. Thirty-day mortality was recorded. RESULTS Among the 53 patients included, 14 (26%) were admitted to an intensive care unit (ICU). At 30 days, 24 patients (45%) had died. Median PCT value was 0.58 microg/l (95% confidence interval 0.16-1.61) and 31 (58%) patients had PCT above 0.2 microg/l (PCT+). Temperature above or equal to 40 degrees C was the only variable significantly associated with fatal outcome. Median PCT values were 1.4 microg/l (0.16-4.71) and 0.18 microg/l (0.12-1.61) in the group of deceased and surviving patients respectively (p = 0.22). All patients admitted in ICU had elevated PCT values. Patients PCT+ initially presented with a more pronounced systemic inflammatory response. Microbiologically or clinically documented infection was not more frequent in PCT+ group. CONCLUSION High serum PCT levels can be observed in heatstroke without any concomitant documented bacterial infection. The PCT is not a valid mortality predictor in heatstroke but could be an indicator of the severity of illness. Heatstroke could represent a model of a "non-septic" pathway of PCT synthesis.
Collapse
Affiliation(s)
- Pierre Hausfater
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, Cedex 13, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
86
|
Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and hemodynamic management in heatstroke: practical recommendations. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R54. [PMID: 17498312 PMCID: PMC2206402 DOI: 10.1186/cc5910] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 04/12/2007] [Accepted: 05/12/2007] [Indexed: 11/30/2022]
Abstract
Introduction Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established. Methods A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders. Results Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare. Conclusion A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated.
Collapse
Affiliation(s)
- Abderrezak Bouchama
- Department of Comparative Medicine MBC-03, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Mohammed Dehbi
- Department of Comparative Medicine MBC-03, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Enrique Chaves-Carballo
- Department of Neurosciences MBC-76, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
- Departments of Pediatrics and History and Philosophy of Medicine, Kansas University Medical Center, Kansas, USA
| |
Collapse
|
87
|
Poly(ADP-ribose) polymerase-1 inhibition increases expression of heat shock proteins and attenuates heat stroke-induced liver injury. Crit Care Med 2008; 36:526-34. [PMID: 18091544 DOI: 10.1097/01.ccm.0000299735.43699.e9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heat stroke is a life-threatening illness characterized by an increased core body temperature as a result of exposure to high ambient temperature. Despite advances in supportive care, heat stroke is often fatal, and no specific and effective therapies exist. The pathophysiological responses to heat stroke involve a systemic inflammatory response and a disseminated intravascular coagulation in the host, which lead to a multiorgan dysfunction syndrome. Poly(ADP-ribose) polymerase-1 (PARP-1) is a nuclear DNA-binding protein that has been shown to play a relevant role in cell necrosis and organ failure in various diseases associated with inflammation. Therefore, we set out to investigate whether inhibition of PARP activity might affect the heat stroke-induced injury. DESIGN Controlled animal study. SETTING Research laboratory of an academic institution. SUBJECTS PARP-1-deficient mice (Parp-1(-/-)) and wild-type mice (C57BL/6J). INTERVENTIONS Wild-type mice untreated or treated with either PJ34 or 3-AB, two generic PARP inhibitors, and Parp-1(-/-) mice were subjected to heat exposure as a model to study heat stroke. MEASUREMENTS AND MAIN RESULTS We measured rectal temperature, serum interleukin-1beta and interleukin-6, liver histology, and heat shock proteins expression. We found that the heat stroke-induced injury was attenuated in mice lacking PARP-1 and was markedly reduced in wild-type mice treated with PARP inhibitors. Interestingly, heat-induced expression of heat shock proteins 27 and 70 was boosted after PARP inhibition. Indeed, PARP inhibition increased expression of heat shock proteins 27 and 70 even in the absence of heat exposure. Accordingly, PARP inhibition increased thermal tolerance that may contribute to attenuate the clinical effects of heat stroke, resulting in increased survival. CONCLUSIONS Our results find a new protective function of PARP inhibitors and support their potential therapeutic application in the treatment of heat stroke.
Collapse
|
88
|
Chen SH, Huang KF, Lin MT, Chang FM. Human umbilical cord blood cells or estrogen may be beneficial in treating heatstroke. Taiwan J Obstet Gynecol 2007; 46:15-25. [PMID: 17389184 DOI: 10.1016/s1028-4559(08)60101-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This current review summarized animal models of heatstroke experimentation that promote our current knowledge of therapeutic effects on cerebrovascular dysfunction, coagulopathy, and/or systemic inflammation with human umbilical cord blood cells (HUCBCs) or estrogen in the setting of heatstroke. Accumulating evidences have demonstrated that HUCBCs provide a promising new therapeutic method against neurodegenerative diseases, such as stroke, traumatic brain injury, and spinal cord injury as well as blood disease. More recently, we have also demonstrated that post- or pretreatment by HUCBCs may resuscitate heatstroke rats with by reducing circulatory shock, and cerebral nitric oxide overload and ischemic injury. Moreover, CD34+ cells sorted from HUCBCs may improve survival by attenuating inflammatory, coagulopathy, and multiorgan dysfunction during experimental heatstroke. Many researchers indicated pro- (e.g. tumor necrosis factor-alpha [TNF-alpha]) and anti-inflammatory (e.g. interleukin-10 [IL-10]) cytokines in the peripheral blood stream correlate with severity of circulatory shock, cerebral ischemia and hypoxia, and neuronal damage occurring in heatstroke. It has been shown that intravenous administration of CD34+ cells can secrete therapeutic molecules, such as neurotrophic factors, and attenuate systemic inflammatory reactions by decreasing serum TNF-alpha but increasing IL-10 during heatstroke. Another line of evidence has suggested that estrogen influences the severity of injury associated with cerebrovascular shock. Recently, we also successfully demonstrated estrogen resuscitated heatstroke rats by ameliorating systemic inflammation. Conclusively, HUCBCs or estrogen may be employed as a beneficial therapeutic strategy in prevention and repair of cerebrovascular dysfunction, coagulopathy, and/or systemic inflammation during heatstroke.
Collapse
Affiliation(s)
- Sheng-Hsien Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | | | | | | |
Collapse
|
89
|
Yao X, Feng ZT, Bai QX, Ji L, Jia Z, Wu Y, Liu WG, Sun R. Effects of colon hydrotherapy on liver injury induced by hyperthermia in dogs. Shijie Huaren Xiaohua Zazhi 2007; 15:64-68. [DOI: 10.11569/wcjd.v15.i1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of colon hydrothe-rapy on the liver injury induced by hyperthermia in dogs.
METHODS: After the dog models of heat stroke were set up, the dogs were randomly divided into two groups, receiving colon hydrotherapy and conventional therapy, respectively. Cooling time as well as serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), malondialdehyde (MDA) and superoxide dismutase (SOD) levels before heat stroke, 6, 24 and 48 h after heat stroke were determined. The dogs were sacrificed 48 h after heat stroke. The contents of liver MDA and SOD were also measured and pathological changes were observed by light and electron microscopy.
RESULTS: In compared with those in conventional therapy group, the cooling time of dogs in colon hydrotherapy group was decreased (t = 5.39, P < 0.01), accompanied with reduced ALT, AST, MDA and elevated SOD at the 24th (t = 3.46, P < 0.01; t = 3.74, P < 0.01; t = 2.43, P < 0.05; t = 2.44, P < 0.05) and 48th (t = 3.33, P < 0.01; t = 2.97, P < 0.05; t = 3.32, P < 0.01; t = 4.34, P < 0.01) after heat stroke. The content of liver MDA was decreased (t = 4.08, P < 0.01) while that of SOD was increased (t = 6.52, P < 0.01) in colon hydrotherapy group. The values of LDH were similar between the two groups (P > 0.05). Light microscopy showed that hepatocellular cholestasis, fatty changes and focal necrosis were lessened, accompanied by lessened congestion of sinus hepaticus and decreased inflammatory cells in colon hydrotherapy group. In addition, ultrastructural observation showed that fusion of mitochondrial cristaes and degranulation of rough endoplasmic reticulum were decreased in colon hydrotherapy group.
CONCLUSION: Colon hydrotherapy is a more rapid cooling technique than conventional therapy, and it can promote the decrease of serum enzymes and relieve the hepatic injury induced by lipid peroxidation and pathological lesion.
Collapse
|
90
|
Lim CL, Wilson G, Brown L, Coombes JS, Mackinnon LT. Pre-existing inflammatory state compromises heat tolerance in rats exposed to heat stress. Am J Physiol Regul Integr Comp Physiol 2007; 292:R186-94. [PMID: 16990481 DOI: 10.1152/ajpregu.00921.2005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated the roles of endotoxemia and heat-induced tissue damage in the pathology of heat stroke. In groups of eight, male Wistar rats were treated with heat exposure only (HE), or heat exposure with turpentine (T+HE), dexamethasone (D+HE), and turpentine and dexamethasone combined (TD+HE). The rats remained sedated for 2 h after receiving the respective treatments, followed by heat exposure until the core temperature (Tc) was 42°C for 15 min; control rats received turpentine (T), dexamethasone (D), and turpentine and dexamethasone (TD) without heat stress. Blood samples were collected before treatment ( baseline I), after 2 h of passive rest ( baseline II), at Tc 40°C (T40), and 15 min after achieving Tc 42°C (T42). No rats died in the nonheat-stressed groups. Survival rate was lowest in the TD+HE rats (37.5%), followed by the HE (62.5%), T+HE (75%), and D+HE (100%) rats ( P < 0.05). The duration of survival at T42°C was shortest in the TD+HE rats (9.9 ± 6.2 min) ( P < 0.01), followed by the T+HE (11.3 ± 6.1 min) and the HE (12.2 ± 4 min) ( P < 0.05) rats. The increase in plasma IL-6 concentrations was highest in the T+HE (352%) and HE (178%) rats ( P < 0.05). D+HE treatment suppressed the increases in plasma aspartate transaminase, alanine aminotransferase, and IL-6 and LPS concentrations during severe heat stress. Heat stroke can be triggered by endotoxemia or heat-induced tissue damage, and preexisting inflammation compromises heat tolerance, whereas blocking endotoxemia increases heat tolerance.
Collapse
Affiliation(s)
- Chin Leong Lim
- School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia.
| | | | | | | | | |
Collapse
|
91
|
Sonna LA, Sawka MN, Lilly CM. Exertional heat illness and human gene expression. PROGRESS IN BRAIN RESEARCH 2007; 162:321-46. [PMID: 17645926 DOI: 10.1016/s0079-6123(06)62016-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microarray analysis of gene expression at the level of RNA has generated new insights into the relationship between cellular responses to acute heat shock in vitro, exercise, and exertional heat illness. Here we discuss the systemic physiology of exertional hyperthermia and exertional heat illness, and compare the results of several recent microarray studies performed in vitro on human cells subjected to heat shock and in vivo on samples obtained from subjects performing exercise or suffering from exertional heat injury. From these comparisons, a concept of overlapping component responses emerges. Namely, some of the gene expression changes observed in peripheral blood mononuclear cells during exertional heat injury can be accounted for by normal cellular responses to heat, exercise, or both; others appear to be specific to the disease state itself. If confirmed in future studies, these component responses might provide a better understanding of adaptive and pathological responses to exercise and exercise-induced hyperthermia, help find new ways of identifying individuals at risk for exertional heat illness, and perhaps even help find rational molecular targets for therapeutic intervention.
Collapse
Affiliation(s)
- Larry A Sonna
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | | | | |
Collapse
|
92
|
Chen CM, Hou CC, Cheng KC, Tian RL, Chang CP, Lin MT. Activated protein C therapy in a rat heat stroke model. Crit Care Med 2006; 34:1960-6. [PMID: 16715032 DOI: 10.1097/01.ccm.0000224231.01533.b1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effects of activated protein C in an animal model of heat stroke. DESIGN Laboratory investigation. SETTING Chi-Mei Medical Center research laboratory. SUBJECTS Male Sprague-Dawley rats weighing 252-304 g. INTERVENTIONS Anesthetized animals were subjected to heat stress (40 degrees C) to induce heat stroke. A bolus injection of normal saline or recombinant human activated protein C (drotrecogin alfa, activated) was conducted via femoral catheters immediately after the onset of heat stroke. Blood sampling was done before initiation of heat stress and 0 and 40 mins after the onset of heat stroke. MEASUREMENTS AND MAIN RESULTS When the vehicle-treated rats underwent heat exposure, their survival time values were found to be 56-64 mins (n = 16). Resuscitation with activated protein C significantly and dose-dependently improved survival during heat stroke (108-246 mins for doses of 0.5-20 mg of activated protein C per kilogram of body weight) (n = 32). All heat-stressed animals displayed systemic inflammation and activated coagulation, evidenced by increased tumor necrosis factor-alpha, prothrombin time, activated partial thromboplastin time, and D-dimer and decreased platelet count and protein C. Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase; increased striatal levels of glutamate, glycerol, and lactate/pyruvate ratio; and decreased striatal levels of partial pressure of oxygen and local cerebral blood flow, which were all observed during heat stroke. These heat stroke reactions were all significantly suppressed by resuscitation with activated protein C but not vehicle solution. CONCLUSIONS The results indicate that systemic delivery of human recombinant activated protein C at the time point of onset of heat stroke may improve survival by ameliorating systemic inflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.
Collapse
Affiliation(s)
- Chin-Ming Chen
- Department of Critical Care Medicine, Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
93
|
Lim CL, Mackinnon LT. The roles of exercise-induced immune system disturbances in the pathology of heat stroke : the dual pathway model of heat stroke. Sports Med 2006; 36:39-64. [PMID: 16445310 DOI: 10.2165/00007256-200636010-00004] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heat stroke is a life-threatening condition that can be fatal if not appropriately managed. Although heat stroke has been recognised as a medical condition for centuries, a universally accepted definition of heat stroke is lacking and the pathology of heat stroke is not fully understood. Information derived from autopsy reports and the clinical presentation of patients with heat stroke indicates that hyperthermia, septicaemia, central nervous system impairment and cardiovascular failure play important roles in the pathology of heat stroke. The current models of heat stroke advocate that heat stroke is triggered by hyperthermia but is driven by endotoxaemia. Endotoxaemia triggers the systemic inflammatory response, which can lead to systemic coagulation and haemorrhage, necrosis, cell death and multi-organ failure. However, the current heat stroke models cannot fully explain the discrepancies in high core temperature (Tc) as a trigger of heat stroke within and between individuals. Research on the concept of critical Tc as a limitation to endurance exercise implies that a high Tc may function as a signal to trigger the protective mechanisms against heat stroke. Athletes undergoing a period of intense training are subjected to a variety of immune and gastrointestinal (GI) disturbances. The immune disturbances include the suppression of immune cells and their functions, suppression of cell-mediated immunity, translocation of lipopolysaccharide (LPS), suppression of anti-LPS antibodies, increased macrophage activity due to muscle tissue damage, and increased concentration of circulating inflammatory and pyrogenic cytokines. Common symptoms of exercise-induced GI disturbances include diarrhoea, vomiting, gastrointestinal bleeding, and cramps, which may increase gut-related LPS translocation. This article discusses the current evidence that supports the argument that these exercise-induced immune and GI disturbances may contribute to the development of endotoxaemia and heat stroke. When endotoxaemia can be tolerated or prevented, continuing exercise and heat exposure will elevate Tc to a higher level (>42 degrees C), where heat stroke may occur through the direct thermal effects of heat on organ tissues and cells. We also discuss the evidence suggesting that heat stroke may occur through endotoxaemia (heat sepsis), the primary pathway of heat stroke, or hyperthermia, the secondary pathway of heat stroke. The existence of these two pathways of heat stroke and the contribution of exercise-induced immune and GI disturbances in the primary pathway of heat stroke are illustrated in the dual pathway model of heat stroke. This model of heat stroke suggests that prolonged intense exercise suppresses anti-LPS mechanisms, and promotes inflammatory and pyrogenic activities in the pathway of heat stroke.
Collapse
Affiliation(s)
- Chin Leong Lim
- School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia.
| | | |
Collapse
|
94
|
Johnson SI, McMichael M, White G. Heatstroke in small animal medicine: a clinical practice review. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00191.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
95
|
Leon LR, Blaha MD, DuBose DA. Time course of cytokine, corticosterone, and tissue injury responses in mice during heat strain recovery. J Appl Physiol (1985) 2006; 100:1400-9. [PMID: 16239608 DOI: 10.1152/japplphysiol.01040.2005] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Elevated circulating cytokines are observed in heatstroke patients, suggesting a role for these substances in the pathophysiological responses of this syndrome. Typically, cytokines are determined at end-stage heatstroke such that changes throughout progression of the syndrome are poorly understood. We hypothesized that the cytokine milieu changes during heatstroke progression, correlating with thermoregulatory, hemodynamic, and tissue injury responses to heat exposure in the mouse. We determined plasma IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12p40, IL-12p70, IFN-γ, macrophage inflammatory protein-1α, TNF-α, corticosterone, glucose, hematocrit, and tissue injury during 24 h of recovery. Mice were exposed to ambient temperature of 39.5 ± 0.2°C, without food and water, until maximum core temperature (Tc,Max) of 42.7°C was attained. During recovery, mice displayed hypothermia (29.3 ± 0.4°C) and a feverlike elevation at 24 h (control = 36.2 ± 0.3°C vs. heat stressed = 37.8 ± 0.3°C). Dehydration (∼10%) and hypoglycemia (∼65–75% reduction) occurred from Tc,Max to hypothermia. IL-1α, IL-2, IL-4, IL-12p70, IFN-γ, TNF-α, and macrophage inflammatory protein-1α were undetectable. IL-12p40 was elevated at Tc,Max, whereas IL-1β, IL-6, and IL-10 inversely correlated with core temperature, showing maximum production at hypothermia. IL-6 was elevated, whereas IL-12p40 levels were decreased below baseline at 24 h. Corticosterone positively correlated with IL-6, increasing from Tc,Max to hypothermia, with recovery to baseline by 24 h. Tissue lesions were observed in duodenum, spleen, and kidney at Tc,Max, hypothermia, and 24 h, respectively. These data suggest that the cytokine milieu changes during heat strain recovery with similarities between findings in mice and those described for human heatstroke, supporting the application of our model to the study of cytokine responses in vivo.
Collapse
Affiliation(s)
- Lisa R Leon
- Thermal and Mountain Medicine Division, US Army Research Institute of Environmental Medicine, Kansas St., Bldg. 42, Natick, MA 01760-5007, USA.
| | | | | |
Collapse
|
96
|
|
97
|
Lee JJ, Lin MT, Wang NL, Lin CL, Chang CK. PLATONIN, A CYANINE PHOTOSENSITIZING DYE, CAUSES ATTENUATION OF CIRCULATORY SHOCK, HYPERCOAGULABLE STATE, AND TISSUE ISCHEMIA DURING HEAT STROKE. Shock 2005; 24:577-82. [PMID: 16317390 DOI: 10.1097/01.shk.0000184284.49752.38] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the therapeutic effect of platonin, a cyanine photosensitizing dye as well as an inhibitor of proinflammatory cytokines, in an animal model of heat stroke. Anesthetized rats, immediately after the onset of heat stroke, were divided into two major groups and given the following: normal saline (1 mL per kg body weight) intravenously, or platonin (12.5-50 microg/mL per kg body weight) intravenously. They were exposed to ambient temperature of 43 degrees C to induce heat stroke. Another group of rats was exposed to room temperature (26 degrees C) and used as normothermic controls. Their physiologic and biochemical parameters were continuously monitored. When the vehicle-treated rats underwent heat exposure, their survival time values were found to be 18 to 22 min. Resuscitation with intravenous doses of platonin, but not normal saline, immediately at the onset of heat stroke, significantly improved survival during heat stroke (41-147 min). All heat-stressed animals displayed systemic inflammation and activated coagulation, evidenced by increased tumor necrosis factor-alpha, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, and D-dimer, and decreased platelet count and protein C. Biochemical markers evidenced cellular ischemia and injury/dysfunction: plasma levels of blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase, and striatal levels of partial pressure of oxygen, local cerebral blood flow, glycerol, glutamate, and lactate/pyruvate were all elevated during heat stroke. The systemic inflammation, hypercoagulable state, and cerebral ischemia and injury during heat stroke were all significantly suppressed by platonin. The data demonstrate that platonin therapy may resuscitate heat stroke victims by reducing circulatory shock, systemic inflammation, hypercoagulable state, and tissue ischemia and injury.
Collapse
Affiliation(s)
- Jie-Jen Lee
- Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, 110
| | | | | | | | | |
Collapse
|
98
|
Gordon CJ, Leon LR. Thermal stress and the physiological response to environmental toxicants. REVIEWS ON ENVIRONMENTAL HEALTH 2005; 20:235-63. [PMID: 16422347 DOI: 10.1515/reveh.2005.20.4.235] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Most toxicological and pharmacological studies are performed in laboratory animals maintained under comfortable environmental conditions. Yet, the exposure to environmental toxicants as well as many drugs can occur under stressful environmental conditions during rest or while exercising. The intake and biological efficacy of many toxicants is exacerbated by exposure to heat stress, which can occur in several ways. The increase in pulmonary ventilation during exposure to hot environments results in an increase in the uptake of airborne toxicants. Furthermore, the transcutaneous absorption of pesticides on the skin as well as drugs delivered by skin patches is increased during heat stress because of the combined elevation in skin blood flow coupled with moist skin from sweat. The thermoregulatory response to toxicant exposure, such as hypothermia in relatively small rodents and fever in humans, also modulates the physiological response to most chemical agents. This paper endeavors to review the issue of environmental heat stress and exercise and how they influence thermoregulatory and related pathophysiological responses to environmental toxicants, as well as exposure to drugs.
Collapse
Affiliation(s)
- Christopher J Gordon
- Neurotoxicology Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.
| | | |
Collapse
|
99
|
Bouchama A, Ollivier V, Roberts G, Al Mohanna F, de Prost D, Eldali A, Saussereau E, El-Sayed R, Chollet-Martin S. EXPERIMENTAL HEATSTROKE IN BABOON: ANALYSIS OF THE SYSTEMIC INFLAMMATORY RESPONSE. Shock 2005; 24:332-5. [PMID: 16205317 DOI: 10.1097/01.shk.0000180620.44435.9c] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to analyze the pattern of the inflammatory response to heatstroke in an experimental baboon model with a view to identifying potential target for therapeutic interventions. Blinded analysis of plasma collected from 12 juvenile baboons (Papio hamadryas) in heatstroke was used. Eight anesthetized animals were heat-stressed in an incubator at 44 degrees C to 47 degrees C until rectal temperature was 42.5 degrees C (moderate heatstroke; n = 4) or systolic arterial pressure fell to <90 mmHg (severe heatstroke; n = 4) and were allowed to recover at room temperature. Four sham-heated animals served as a control group. We performed sequential measurement of cytokines. The rectal temperature on completion of heat stress was 42.5 degrees C +/- 0.0 degrees C and 43.3 degrees C +/- 0.1 degrees C in moderate and severe heatstroke, respectively. Heat stress elicited early, simultaneous release of anti-inflammatory cytokines and chemokines (IL-10, IL-1ra, sTNFr I and II, and IL-8). Circulating levels of IL-12p40 were significantly decreased, whereas TNFalpha, IL-1beta, and IL-4 were below the detection limit in all animals. No baboon survived severe heatstroke; there was neurological morbidity without mortality in moderate heatstroke. Nonsurvivors displayed significantly greater activity/alterations in inflammation markers than survivors. Sham-heated animals had no evidence of inflammation activation. These results show that heatstroke activates complex systemic inflammatory and regulatory responses associated with outcome. Further definition of this ambivalent response is needed before identification of target of successful modulation may become possible.
Collapse
Affiliation(s)
- Abderrezak Bouchama
- Department of Comparative Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia.
| | | | | | | | | | | | | | | | | |
Collapse
|
100
|
Aibiki M, Ohtsubo S, Nishiyama T, Maekawa S, Oka H, Dote K, Shirakawa Y. Elevated serum beta-D-glucan level and depressed neutrophil phagocytosis in a heatstroke patient. Resuscitation 2005; 65:115-7. [PMID: 15797285 DOI: 10.1016/j.resuscitation.2004.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Revised: 09/13/2004] [Accepted: 09/13/2004] [Indexed: 11/25/2022]
Abstract
Endotoxemia has been reported as a mechanism for the fatal sequela after heatstroke. Subsequent disseminated fungal infection in a heatstroke patient has been also described. Beta-D-glucan, a constituent of the fungal cell wall, is an early diagnostic measure for fungal infection. In a heatstroke case, we examined for the first time levels of serum beta-d-glucan and endotoxin. A 34-year-old man with a body temperature of 43.5 degrees C was admitted in a state of shock. Prior to the development of disseminated intravascular coagulopathy (DIC), a remarkable elevation of serum beta-D-glucan level to 116 pg/mL (normal level<6.0 pg/mL) was revealed on the first day of admission. However, serum endotoxin was not detected when using a method that excluded beta-D-glucan contamination from endotoxin measurement (normal level<1.0 pg/mL). This change of beta-D-glucan level was accompanied by a depressed neutrophil function, especially in phagocytosis of 34% (normal range 70-90%) but not in bacterocidal function (81% versus a normal range of 70-100%). After intensive care including continuous hemodiafiltration, the patient regained consciousness but remained ataxic due to cerebellar infarction, which might have resulted from DIC, and subsequent bilateral fungal oculitis were revealed 45 days after admission. This case report demonstrates the elevation of serum beta-D-glucan but normal endotoxin levels after heatstroke, which may prompt further study to re-examine the serum levels of endotoxin in such catastrophic insults.
Collapse
Affiliation(s)
- Mayuki Aibiki
- Ehime University, School of Medicine, Department of Emergency Medicine, Shitsukawa 454, Shigenobu, Onsen, Ehime 791-0259, Japan.
| | | | | | | | | | | | | |
Collapse
|