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The role of mitochondria in sepsis-induced cardiomyopathy. Biochim Biophys Acta Mol Basis Dis 2018; 1865:759-773. [PMID: 30342158 DOI: 10.1016/j.bbadis.2018.10.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 02/08/2023]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Myocardial dysfunction, often termed sepsis-induced cardiomyopathy, is a frequent complication and is associated with worse outcomes. Numerous mechanisms contribute to sepsis-induced cardiomyopathy and a growing body of evidence suggests that bioenergetic and metabolic derangements play a central role in its development; however, there are significant discrepancies in the literature, perhaps reflecting variability in the experimental models employed or in the host response to sepsis. The condition is characterised by lack of significant cell death, normal tissue oxygen levels and, in survivors, reversibility of organ dysfunction. The functional changes observed in cardiac tissue may represent an adaptive response to prolonged stress that limits cell death, improving the potential for recovery. In this review, we describe our current understanding of the pathophysiology underlying myocardial dysfunction in sepsis, with a focus on disrupted mitochondrial processes.
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Candel FJ, Borges Sá M, Belda S, Bou G, Del Pozo JL, Estrada O, Ferrer R, González del Castillo J, Julián-Jiménez A, Martín-Loeches I, Maseda E, Matesanz M, Ramírez P, Ramos JT, Rello J, Suberviola B, Suárez de la Rica A, Vidal P. Current aspects in sepsis approach. Turning things around. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:298-315. [PMID: 29938972 PMCID: PMC6172679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs.
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Affiliation(s)
| | - Marcio Borges Sá
- Multidisciplinar Sepsis Unit. Intensive Care Unit. Hospital Son Llatzer. Palma de Mallorca
| | - Sylvia Belda
- Department of Intensive Pediatrics. Maternal and Child Health and Development Network. Hospital 12 de Octubre. Madrid
| | - Germán Bou
- Clinical Microbiology Department. Complejo Hospitalario Universitario. La Coruña
| | - José Luis Del Pozo
- Clinical Microbiology and Infectious Diseases Department. Clinica Universitaria Navarra
| | - Oriol Estrada
- Clinical Innovation Management, Germans Trias i Pujol University Hospital. Barcelona
| | - Ricard Ferrer
- Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group. CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | | | | | - Ignacio Martín-Loeches
- Multidisciplinary Intensive Care Research Organization. CIBERES Instituto de Salud Carlos III. Department of Intensive Care Medicine. St James’s Hospital. Trinity Centre for Health Sciences. Dublin. Ireland
| | - Emilio Maseda
- Department of Anesthesia and Surgical Intensive Care, Hospital Universitario La Paz. Madrid
| | - Mayra Matesanz
- Department of Internal Medicine. Hospital Clínico San Carlos. Madrid
| | - Paula Ramírez
- Critical Care Department. University Hospital la Fe. Valencia
| | - José Tomás Ramos
- José T. Ramos. Department of Public and Mother-Child Health. Hospital Clínico San Carlos, IdISSC Health Research Institute. Universidad Complutense. Madrid
| | - Jordi Rello
- Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS). CIBERES Instituto de Salud Carlos III. Vall d’Hebron University Hospital. Barcelona
| | - Borja Suberviola
- Critical Care Department. Hospital Universitario Marqués de Valdecilla. Santander
| | | | - Pablo Vidal
- Intensive Care Unit. Complexo Hospitalario Universitario de Ourense
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53
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Průcha M, Zazula R, Russwurm S. Sepsis Diagnostics in the Era of "Omics" Technologies. Prague Med Rep 2018; 119:9-29. [PMID: 29665344 DOI: 10.14712/23362936.2018.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Sepsis is a multifactorial clinical syndrome with an extremely dynamic clinical course and with high diverse clinical phenotype. Early diagnosis is crucial for the final clinical outcome. Previous studies have not identified a biomarker for the diagnosis of sepsis which would have sufficient sensitivity and specificity. Identification of the infectious agents or the use of molecular biology, next gene sequencing, has not brought significant benefit for the patient in terms of early diagnosis. Therefore, we are currently searching for biomarkers, through "omics" technologies with sufficient diagnostic specificity and sensitivity, able to predict the clinical course of the disease and the patient response to therapy. Current progress in the use of systems biology technologies brings us hope that by using big data from clinical trials such biomarkers will be found.
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Affiliation(s)
- Miroslav Průcha
- Department of Clinical Biochemistry, Haematology and Immunology, Na Homolce Hospital, Prague, Czech Republic.
| | - Roman Zazula
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Stefan Russwurm
- Department of Anesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
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54
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Sud V, Abboud A, Tohme S, Vodovotz Y, Simmons RL, Tsung A. IL-17A - A regulator in acute inflammation: Insights from in vitro, in vivo and in silico studies. Cytokine 2018; 139:154344. [PMID: 29954675 DOI: 10.1016/j.cyto.2018.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 12/23/2022]
Abstract
Acute inflammation following sterile injury is both inevitable and necessary to restore homeostasis and promote tissue repair. However, when excessive, inflammation can jeopardize the viability of organs and cause detrimental systemic effects. Identifying key-regulators of the immune cascade induced by surgery is vital to attenuating excessive inflammation and its subsequent effects. In this review, we describe the emerging role of IL-17A as a key-regulator in acute inflammation. The role of IL-17A in chronic disease states, such as rheumatoid arthritis, psoriasis and cancer has been well documented, but its significance in acute inflammation following surgery, sepsis, or traumatic injury has not been well studied. We aim to highlight the role of IL-17A in acute inflammation caused by trauma, liver ischemia, and organ transplantation, as well as in post-operative surgical infections. Further investigation of the roles of this cytokine in acute inflammation may stimulate novel therapies or diagnostic modalities.
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Affiliation(s)
- Vikas Sud
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew Abboud
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Samer Tohme
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States
| | - Richard L Simmons
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
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55
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Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis. Crit Care Med 2018; 46:691-698. [DOI: 10.1097/ccm.0000000000002928] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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56
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Davoudi A, Corbett DB, Ozrazgat-Baslanti T, Bihorac A, Brakenridge SC, Manini TM, Rashidi P. Activity and Circadian Rhythm of Sepsis Patients in the Intensive Care Unit. ... IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS. IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS 2018; 2018:17-20. [PMID: 30411088 DOI: 10.1109/bhi.2018.8333359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Early mobilization of critically ill patients in the Intensive Care Unit (ICU) can prevent adverse outcomes such as delirium and post-discharge physical impairment. To date, no studies have characterized activity of sepsis patients in the ICU using granular actigraphy data. This study characterizes the activity of sepsis patients in the ICU to aid in future mobility interventions. We have compared the actigraphy features of 24 patients in four groups: Chronic Critical Illness (CCI) sepsis patients in the ICU, Rapid Recovery (RR) sepsis patients in the ICU, non-sepsis ICU patients (control-ICU), and healthy subjects. We used a total of 15 statistical and circadian rhythm features extracted from the patients' actigraphy data collected over a five-day period. Our results show that the four groups are significantly different in terms of activity features. In addition, we observed that the CCI and control-ICU patients show less regularity in their circadian rhythm compared to the RR patients. These results show the potential of using actigraphy data for guiding mobilization practices, classifying sepsis recovery subtype, as well as for tracking patients' recovery.
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Affiliation(s)
- Anis Davoudi
- Biomedical Engineering Department, University of Florida, Gainesville, FL 32611 USA
| | - Duane B Corbett
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32610, USA
| | | | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL 32610 USA
| | | | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32610, USA
| | - Parisa Rashidi
- Biomedical Engineering Department, University of Florida, Gainesville, FL 32611 USA
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Wang N, Mao L, Yang L, Zou J, Liu K, Liu M, Zhang H, Xiao X, Wang K. Resveratrol protects against early polymicrobial sepsis-induced acute kidney injury through inhibiting endoplasmic reticulum stress-activated NF-κB pathway. Oncotarget 2018; 8:36449-36461. [PMID: 28430592 PMCID: PMC5482667 DOI: 10.18632/oncotarget.16860] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/26/2017] [Indexed: 01/20/2023] Open
Abstract
Resveratrol, a polyphenol compound derived from various edible plants, protects against sepsis-induced acute kidney injury (AKI) via its anti-inflammatory activity, but the underlying mechanisms remain largely unknown. In this study, a rat model of sepsis was established by cecal ligation and puncture (CLP), 30 mg/kg resveratrol was intraperitoneally administrated immediately after the CLP operation. HK-2 cells treated by 1 μg/ml lipopolysaccharide, 0.2 μM tunicamycin, 2.5 mM irestatin 9389 and 20 μM resveratrol were used for in vitro study. The results demonstrated that resveratrol significantly improved the renal function and tubular epithelial cell injury and enhanced the survival rate of CLP-induced rat model of sepsis, which was accompanied by a substantial decrease of the serum content and renal mRNA expressions of TNF-α, IL-1β and IL-6. In addition, resveratrol obviously relieved the endoplasmic reticulum stress, inhibited the phosphorylation of inositol-requiring enzyme 1(IRE1) and nuclear factor-κB (NF-κB) in the kidney. In vitro studies showed that resveratrol enhanced the cell viability, reduced the phosphorylation of NF-κB and production of inflammatory factors in lipopolysaccharide and tunicamycin-induced HK-2 cells through inhibiting IRE1 activation. Taken together, administration of resveratrol as soon as possible after the onset of sepsis could protect against septic AKI mainly through inhibiting IRE1-NF-κB pathway-triggered inflammatory response in the kidney. Resveratrol might be a readily translatable option to improve the prognosis of sepsis.
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Affiliation(s)
- Nian Wang
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Li Mao
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Liu Yang
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Jiang Zou
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Ke Liu
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Meidong Liu
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Huali Zhang
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Xianzhong Xiao
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
| | - Kangkai Wang
- Department of Pathophysiology, Xiangya School of Medicine, Translational Medicine Center of Sepsis, Central South University, Changsha, 410078, Hunan, China
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58
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A systematic review on risk factors associated with sepsis in patients admitted to intensive care units. Aust Crit Care 2018; 32:155-164. [PMID: 29574007 DOI: 10.1016/j.aucc.2018.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We sought to systematically review data on the risk factors influencing the incidence of sepsis in patients admitted to intensive care units (ICUs). REVIEW METHODS An electronic search was undertaken in PubMed, MEDLINE, Scopus, and the Cochrane Library for studies reporting the risk factors of sepsis from the earliest available date up to December 30, 2016. RESULTS Among the 2978 articles, 14 studies met the inclusion criteria with a total of 56 164 participants from nine countries. The extracted risk factors were from the following categories: demographic, critical care interventions, surgery-related factors, pre-existing comorbidities, severity of organ injury, and biomarkers and biochemical and molecular indicators. From demographic factors, older age and male gender were associated with an increased risk of sepsis among ICU-admitted patients. CONCLUSION Our analysis comprehensively summarised the risk factors of sepsis in patients admitted to medical, surgical, neurologic, trauma, and general ICUs. Age, sex, and comorbidities were non-modifiable risk factors; however, critical care interventions and surgery-related factors were modifiable factors and suggest that improving the care of surgical patients and effective management of critical care interventions may play a key role in decreasing the development of sepsis in patients admitted to the ICUs.
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59
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Tussilagone Inhibits the Inflammatory Response and Improves Survival in CLP-Induced Septic Mice. Int J Mol Sci 2017; 18:ijms18122744. [PMID: 29258263 PMCID: PMC5751343 DOI: 10.3390/ijms18122744] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
Tussilagone, extracted from Tussilago farfara is an oriental medicine used for asthma and bronchitis. We investigated its mechanism of action, its inhibitory effects on lipopolysaccharide-induced inflammation in macrophages, and its impact on viability in a cecal ligation and puncture (CLP)-induced mouse model of sepsis. Tussilagone suppressed the expression of the inflammatory mediators, nitric oxide and prostaglandin E2, and the inflammatory cytokines, tumor necrosis factor-alpha (TNF-α) and high-mobility group box 1 (HMGB1), in lipopolysaccharide-stimulated RAW 264.7 cells and peritoneal macrophages. Tussilagone also reduced the activation of the mitogen-activated protein kinases and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) involved in the activation of various inflammatory mediators in activated macrophages. Moreover, tussilagone administration (1 mg/kg and 10 mg/kg) produced decreased mortality and lung injury in CLP-activated septic mice. Augmented expression of cyclooxygenase (COX)-2 and TNF-α in pulmonary alveolar macrophages of septic mice were attenuated by tussilagone administration. Tussilagone also suppressed the induction of nitric oxide, prostaglandin E2, TNF-α and HMGB1 in the serum of the septic mice. Overall, tussilagone exhibited protective effects against inflammation and polymicrobial sepsis by suppressing inflammatory mediators possibly via the inhibition of NF-κB activation and the MAP kinase pathway. These results suggest the possible use of tussilagone for developing novel therapeutic modalities for sepsis and other inflammatory diseases.
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60
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Macrophage C-type lectin is essential for phagosome maturation and acidification during Escherichia coli -induced peritonitis. Biochem Biophys Res Commun 2017; 493:1491-1497. [DOI: 10.1016/j.bbrc.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/22/2022]
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61
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Macdonald SP, Williams JM, Shetty A, Bellomo R, Finfer S, Shapiro N, Keijzers G. Review article: Sepsis in the emergency department - Part 1: Definitions and outcomes. Emerg Med Australas 2017; 29:619-625. [PMID: 29094474 DOI: 10.1111/1742-6723.12886] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 01/21/2023]
Abstract
Sepsis has recently been redefined as acute organ dysfunction due to infection. The ED plays a critical role in identifying patients with sepsis. This is challenging due to the heterogeneity of the syndrome, and the lack of an objective standard diagnostic test. While overall mortality rates from sepsis appear to be falling, there is an increasing burden of morbidity among survivors. This largely reflects the growing proportion of older patients with comorbid illnesses among those treated for sepsis.
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Affiliation(s)
- Stephen Pj Macdonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Julian M Williams
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amith Shetty
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Centre for Research in Critical Infection, Westmead Millennium Institute, Sydney, New South Wales, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Finfer
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nathan Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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62
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Involvement of Mitochondrial Disorders in Septic Cardiomyopathy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4076348. [PMID: 29201271 PMCID: PMC5671744 DOI: 10.1155/2017/4076348] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 12/29/2022]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. It remains a leading cause of death worldwide, despite the development of various therapeutic strategies. Cardiac dysfunction, also referred to as septic cardiomyopathy, is a frequent and well-described complication of sepsis and associated with worse clinical outcomes. Recent research has increased our understanding of the role of mitochondrial dysfunction in the pathophysiology of septic cardiomyopathy. The purpose of this review is to present this evidence as a coherent whole and to highlight future research directions.
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63
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TLR4 Signaling Pathway Modulators as Potential Therapeutics in Inflammation and Sepsis. Vaccines (Basel) 2017; 5:vaccines5040034. [PMID: 28976923 PMCID: PMC5748601 DOI: 10.3390/vaccines5040034] [Citation(s) in RCA: 367] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 02/06/2023] Open
Abstract
Toll-Like Receptor 4 (TLR4) signal pathway plays an important role in initiating the innate immune response and its activation by bacterial endotoxin is responsible for chronic and acute inflammatory disorders that are becoming more and more frequent in developed countries. Modulation of the TLR4 pathway is a potential strategy to specifically target these pathologies. Among the diseases caused by TLR4 abnormal activation by bacterial endotoxin, sepsis is the most dangerous one because it is a life-threatening acute system inflammatory condition that still lacks specific pharmacological treatment. Here, we review molecules at a preclinical or clinical phase of development, that are active in inhibiting the TLR4-MyD88 and TLR4-TRIF pathways in animal models. These are low-molecular weight compounds of natural and synthetic origin that can be considered leads for drug development. The results of in vivo studies in the sepsis model and the mechanisms of action of drug leads are presented and critically discussed, evidencing the differences in treatment results from rodents to humans.
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64
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Wang J, Wang P, Gui S, Li Y, Chen R, Zeng R, Zhao P, Wu H, Huang Z, Wu J. Hydroxysafflor Yellow A Attenuates the Apoptosis of Peripheral Blood CD4 + T Lymphocytes in a Murine Model of Sepsis. Front Pharmacol 2017; 8:613. [PMID: 28932195 PMCID: PMC5592278 DOI: 10.3389/fphar.2017.00613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/23/2017] [Indexed: 01/12/2023] Open
Abstract
Sepsis is generally considered as a severe condition of inflammation that leads to lymphocyte apoptosis and multiple organ dysfunction. Hydroxysafflor yellow A (HSYA) exerts anti-inflammatory and anti-apoptotic effects in infectious diseases. However, the therapeutic effect of HSYA on polymicrobial sepsis remains unknown. This study was undertaken to investigate the therapeutic effects and the mechanisms of action of HSYA on immunosuppression in a murine model of sepsis induced by cecal ligation and puncture (CLP). NIH mice were randomly divided into four groups: control group, sham group, CLP group, and CLP+HSYA group. HSYA (120 mg/kg) was intravenously injected into experimental mice at 12 h before CLP, concurrent with CLP and 12 h after CLP. The levels of circulating inflammatory cytokines, the apoptosis of CD4+ and CD8+ T lymphocytes, and protein expression of cytochrome C (Cytc), Bax, Bcl-2, cleaved caspase-9, and cleaved caspase-3 were examined. Plasma levels of IL-6, IL-10 and TNF-alpha as well as the apoptosis of CD4+ T lymphocytes were increased compared with sham group. These changes were accompanied by increases of pro-apoptotic proteins including Cytc, Bax, cleaved caspase-9, and cleaved caspase-3 and decreases of anti-apoptotic protein Bcl-2 in CD4+ T lymphocytes from mice undergoing CLP. In contrast, we fail to observe significant effect of HSYA on the apoptosis of CD8+ T lymphocytes in CLP-treated group. Of note, HSYA treatment reversed all above changes observed in CD4+ T lymphocytes, and significantly increased the ratio of CD4+:CD8+ T lymphocytes in CLP-treated mice. In conclusion, HSYA was an effective therapeutic agent in ameliorating sepsis-induced apoptosis of CD4+ T lymphocytes probably through its anti-inflammatory and anti-apoptotic effects.
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Affiliation(s)
- Jinping Wang
- Department of Pharmacy, Shenzhen Second People's HospitalShenzhen, China
| | - Ping Wang
- Department of Pharmacology and Toxicology, Shenzhen Institute for Drug ControlShenzhen, China
| | - Shuiqing Gui
- Department of Intensive Care Unit, Shenzhen Second People's HospitalShenzhen, China
| | - Yun Li
- The Central Laboratory, Shenzhen Second People's HospitalShenzhen, China
| | - Runhua Chen
- Department of Pharmacology and Toxicology, Shenzhen Institute for Drug ControlShenzhen, China
| | - Renqing Zeng
- Department of Pharmacy, Shenzhen Second People's HospitalShenzhen, China
| | - Peiyan Zhao
- The Central Laboratory, Shenzhen Second People's HospitalShenzhen, China
| | - Hanwei Wu
- The Central Laboratory, Shenzhen Second People's HospitalShenzhen, China
| | - Zheyu Huang
- Department of Pharmacology and Toxicology, Shenzhen Institute for Drug ControlShenzhen, China
| | - Jianlong Wu
- Department of Pharmacy, Shenzhen Second People's HospitalShenzhen, China
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65
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Vandereyken MM, Singh P, Wathieu CP, Jacques S, Zurashvilli T, Dejager L, Amand M, Musumeci L, Singh M, Moutschen MP, Libert CRF, Rahmouni S. Dual-Specificity Phosphatase 3 Deletion Protects Female, but Not Male, Mice from Endotoxemia-Induced and Polymicrobial-Induced Septic Shock. THE JOURNAL OF IMMUNOLOGY 2017; 199:2515-2527. [PMID: 28848068 DOI: 10.4049/jimmunol.1602092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 08/01/2017] [Indexed: 01/27/2023]
Abstract
Dual-specificity phosphatase 3 (DUSP3) is a small phosphatase with poorly known physiological functions and for which only a few substrates are known. Using knockout mice, we recently reported that DUSP3 deficiency confers resistance to endotoxin- and polymicrobial-induced septic shock. We showed that this protection was macrophage dependent. In this study, we further investigated the role of DUSP3 in sepsis tolerance and showed that the resistance is sex dependent. Using adoptive-transfer experiments and ovariectomized mice, we highlighted the role of female sex hormones in the phenotype. Indeed, in ovariectomized females and in male mice, the dominance of M2-like macrophages observed in DUSP3-/- female mice was reduced, suggesting a role for this cell subset in sepsis tolerance. At the molecular level, DUSP3 deletion was associated with estrogen-dependent decreased phosphorylation of ERK1/2 and Akt in peritoneal macrophages stimulated ex vivo by LPS. Our results demonstrate that estrogens may modulate M2-like responses during endotoxemia in a DUSP3-dependent manner.
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Affiliation(s)
- Maud M Vandereyken
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Pratibha Singh
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Caroline P Wathieu
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Sophie Jacques
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Tinatin Zurashvilli
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Lien Dejager
- Inflammation Research Center, VIB, B-9052 Ghent, Belgium; and.,Department of Biomedical Molecular Biology, Ghent University, B-9000 Ghent, Belgium
| | - Mathieu Amand
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Lucia Musumeci
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Maneesh Singh
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Michel P Moutschen
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium
| | - Claude R F Libert
- Inflammation Research Center, VIB, B-9052 Ghent, Belgium; and.,Department of Biomedical Molecular Biology, Ghent University, B-9000 Ghent, Belgium
| | - Souad Rahmouni
- Immunology and Infectious Disease Unit, GIGA-Research, University of Liège, B-4000 Liège, Belgium;
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66
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Esposito S, De Simone G, Boccia G, De Caro F, Pagliano P. Sepsis and septic shock: New definitions, new diagnostic and therapeutic approaches. J Glob Antimicrob Resist 2017; 10:204-212. [PMID: 28743646 DOI: 10.1016/j.jgar.2017.06.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/20/2017] [Accepted: 06/25/2017] [Indexed: 02/06/2023] Open
Abstract
Sepsis and septic shock are common life-threatening pathologies associated with high mortality and substantial costs for healthcare system. Clinical guidelines and bundles for the management of patients with sepsis have recently been updated. Herein, we review the history of sepsis and related conditions definitions from the first consensus conference in 1991 to nowadays, the epidemiologic data resulting from worldwide studies on incidence and mortality, the diagnostic approaches including the microbiological assessment of infection and the use of several prognostic and diagnostic biomarkers and finally we review the main therapeutic measures as the intravenous immunoglobulin therapy and the administration of appropriate antibiotic treatment to provide patients with sepsis a favourable outcome in the antibiotic-resistance era.
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Affiliation(s)
- Silvano Esposito
- Department of Infectious disease, University of Salerno, Salerno, Italy.
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67
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Bobelytė O, Gailiūtė I, Zubka V, Žilinskaitė V. Sepsis epidemiology and outcome in the paediatric intensive care unit of Vilnius University Children's Hospital. Acta Med Litu 2017; 24:113-120. [PMID: 28845129 PMCID: PMC5566950 DOI: 10.6001/actamedica.v24i2.3492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Research was carried out at the paediatric intensive care unit (paediatric ICU) of the Children’s Hospital, affiliate of Vilnius University Hospital Santariškių klinikos.
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Affiliation(s)
| | - Ieva Gailiūtė
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Vytautas Zubka
- Children's Hospital, Affiliate of Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
| | - Virginija Žilinskaitė
- Medical Faculty, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariškių klinikos, Vilnius, Lithuania
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68
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Wu HP, Chu CM, Kao KC, Huang SH, Chuang DY. High Interleukin-10 Expression in Type 2 T Helper Cells in Septic Patients. Immunol Invest 2017; 46:385-394. [PMID: 28375710 DOI: 10.1080/08820139.2017.1288237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Interleukin (IL)-10 response is associated with mortality in patients with sepsis. IL-10 is primarily produced by monocytes and type 2 T helper (Th2) cells. The aim of this study was to investigate differences in IL-10 production between monocytes and Th2 cells in patients with sepsis. Forty patients with sepsis and 35 healthy controls were enrolled. Cytokine expressions in peripheral blood mononuclear cells (PBMCs) were measured by flow cytometry. The IL-10 expression in the Th2 cells of the septic patients was higher than in the healthy controls, but the expression of IL-10 in the monocytes of the septic patients was lower than in the healthy controls. After regression analysis, IL-10 expression in Th2 cells was positively associated with sepsis, but IL-10 expression in monocytes was not associated with sepsis or shock. In conclusion, the production of IL-10 in Th2 cells was higher in the patients with sepsis.
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Affiliation(s)
- Huang-Pin Wu
- a Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital , Keelung , Taiwan.,b Chang Gung University College of Medicine , Taoyuan , Taiwan
| | - Chien-Ming Chu
- a Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Kuo-Chin Kao
- b Chang Gung University College of Medicine , Taoyuan , Taiwan.,c Department of Thoracic Medicine , Chang Gung Memorial Hospital , Linkou , Taiwan
| | - Shu-Huan Huang
- d Department of Medical Laboratory , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Duen-Yau Chuang
- e Department of Chemistry , National Chung-Hsing University , Taichung , Taiwan
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69
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Shen XF, Cao K, Jiang JP, Guan WX, Du JF. Neutrophil dysregulation during sepsis: an overview and update. J Cell Mol Med 2017; 21:1687-1697. [PMID: 28244690 PMCID: PMC5571534 DOI: 10.1111/jcmm.13112] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022] Open
Abstract
Sepsis remains a leading cause of death worldwide, despite advances in critical care, and understanding of the pathophysiology and treatment strategies. No specific therapy or drugs are available for sepsis. Neutrophils play a critical role in controlling infection under normal conditions, and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated mediators and signal pathways involved which govern the survival, migration and antimicrobial function of neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically diagnose and/or predict the outcome of sepsis.
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Affiliation(s)
- Xiao-Fei Shen
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ke Cao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin-Peng Jiang
- Department of Rehabilitation Medicine, PLA Army General Hospital, Beijing, China
| | - Wen-Xian Guan
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun-Feng Du
- Department of General Surgery, PLA Army General Hospital, Beijing, China
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