951
|
Shah KG, Wu R, Jacob A, Blau SA, Ji Y, Dong W, Marini CP, Ravikumar TS, Coppa GF, Wang P. Human ghrelin ameliorates organ injury and improves survival after radiation injury combined with severe sepsis. Mol Med 2009; 15:407-14. [PMID: 19779631 DOI: 10.2119/molmed.2009.00100] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/18/2009] [Indexed: 11/06/2022] Open
Abstract
In the terrorist radiation exposure scenario, radiation victims are likely to suffer from additional injuries such as sepsis. Our previous studies have shown that ghrelin is protective in sepsis. However, it remains unknown whether ghrelin ameliorates sepsis-induced organ injury and mortality after radiation exposure. The purpose of this study is to determine whether human ghrelin attenuates organ injury and improves survival in a rat model of radiation combined injury (RCI) and, if so, the potential mechanism responsible for the benefit. To study this, adult male rats were exposed to 5-Gy whole body irradiation followed by cecal ligation and puncture (CLP, a model of sepsis) 48 h thereafter. Human ghrelin (30 nmol/rat) or vehicle (saline) was infused intravenously via an osmotic minipump immediately after radiation exposure. Blood and tissue samples were collected at 20 h after RCI (68 h after irradiation or 20 h after CLP) for various measurements. To determine the longterm effect of human ghrelin after RCI, the gangrenous cecum was removed at 5 h after CLP and 10-d survival was recorded. In addition, vagotomy or sham vagotomy was performed in sham and RCI animals immediately prior to ghrelin administration, and various measurements were performed at 20 h after RCI. Our results showed that serum levels of ghrelin and its gene expression in the stomach were decreased markedly at 20 h after RCI. Administration of human ghrelin attenuated tissue injury markedly, reduced proinflammatory cytokine levels, decreased tissue myeloperoxidase activity, and improved survival after RCI. Furthermore, elevated plasma levels of norepinephrine (NE) after RCI were reduced significantly by ghrelin. However, vagotomy prevented ghrelin's beneficial effects after RCI. In conclusion, human ghrelin is beneficial in a rat model of RCI. The protective effect of human ghrelin appears to be attributed to re-balancing the dysregulated sympathetic/parasympathetic nervous systems.
Collapse
Affiliation(s)
- Kavin G Shah
- The Feinstein Institute for Medical Research and Department of Surgery, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, New York 11030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
952
|
Chatterjee PK, Al-Abed Y, Sherry B, Metz CN. Cholinergic agonists regulate JAK2/STAT3 signaling to suppress endothelial cell activation. Am J Physiol Cell Physiol 2009; 297:C1294-306. [PMID: 19741199 DOI: 10.1152/ajpcell.00160.2009] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The cholinergic anti-inflammatory pathway is a physiological mechanism that inhibits cytokine production and minimizes tissue injury during inflammation. Previous investigations revealed that cholinergic stimulation (via cholinergic agonists and vagus nerve stimulation) suppresses endothelial cell activation and leukocyte recruitment. The purpose of this study was to investigate the mechanisms by which cholinergic agonists (e.g., nicotine and GTS-21) regulate endothelial cell activation. Specifically, we examined the effects of cholinergic agonists on IL-6-mediated endothelial cell activation through the JAK2/STAT3 signaling pathway. Treatment of macrovascular human umbilical vein endothelial cells (HUVECs) and microvascular endothelial cells (MVECs) with the cholinergic agonists nicotine and GTS-21 significantly reduced IL-6-mediated monocyte chemoattractant protein-1 (MCP-1) production and ICAM-1 expression which are regulated through the JAK2/STAT3 pathway. We found that treatment of endothelial cells with cholinergic agonists significantly reduced STAT3 activation by phosphorylation and DNA binding. The inhibition of STAT3 phosphorylation was reversed by sodium orthovanadate, an inhibitor of tyrosine phosphatases, as well as by NSC-87877 suggesting a SHP1/2-dependent mechanism. Further investigations showed that cholinergic agonists reduced the phosphorylation of JAK2, an upstream component of the JAK2/STAT3 pathway. Finally, we observed that nicotine and GTS-21 treatment decreased levels of SOCS3 (suppressor of cytokine signaling; a regulator of the inflammatory activity of IL-6) in activated endothelial cells. These data demonstrate that cholinergic agonists suppress IL-6-mediated endothelial cell activation through the JAK2/STAT3 pathway. Our results have significant implications for better understanding the therapeutic potential of cholinergic agonists for treating IL-6 mediated inflammatory conditions.
Collapse
Affiliation(s)
- Prodyot K Chatterjee
- The Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | | | | |
Collapse
|
953
|
|
954
|
Reyes-García MG, García-Tamayo F. A neurotransmitter system that regulates macrophage pro-inflammatory functions. J Neuroimmunol 2009; 216:20-31. [PMID: 19732963 DOI: 10.1016/j.jneuroim.2009.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 05/16/2009] [Accepted: 06/29/2009] [Indexed: 02/08/2023]
Abstract
Neurotransmitters released through peripheral and autonomic nerves play an important role in the signaling from the cells of the nervous system to lymphocytes, macrophages and other cells of the immune system. Macrophages are related to numerous physiological and pathological inflammatory processes since their cytokines play an important role in the defensive responses against invasive microorganisms, atherosclerosis progress, insulin resistance, behavior deviation, hematopoiesis feedback, degenerative chronic diseases and the stimulation of the hypothalamus-hypophysis-adrenal axis. Production of pro-inflammatory cytokines by macrophages is the main target for the modulatory activity of diverse neurotransmitters. In this brief review, we show how some neurotransmitters released by the central or the autonomic nervous systems down-regulate peripheral macrophages' inflammatory functions to balance immune protective mechanisms, although they can also promote the collateral progress of diverse diseases. The possible therapeutic uses of some neurotransmitters and the agonists or antagonist of their respective receptors are included as well.
Collapse
Affiliation(s)
- María Guadalupe Reyes-García
- Laboratorio de Inmunobiología, Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), México DF, Mexico.
| | | |
Collapse
|
955
|
von Känel R, Thayer JF, Fischer JE. Nighttime vagal cardiac control and plasma fibrinogen levels in a population of working men and women. Ann Noninvasive Electrocardiol 2009; 14:176-84. [PMID: 19419403 DOI: 10.1111/j.1542-474x.2009.00293.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Elevated plasma fibrinogen levels have prospectively been associated with an increased risk of coronary artery disease in different populations. Plasma fibrinogen is a measure of systemic inflammation crucially involved in atherosclerosis. The vagus nerve curtails inflammation via a cholinergic antiinflammatory pathway. We hypothesized that lower vagal control of the heart relates to higher plasma fibrinogen levels. METHODS Study participants were 559 employees (age 17-63 years; 89% men) of an airplane manufacturing plant in southern Germany. All subjects underwent medical examination, blood sampling, and 24-hour ambulatory heart rate recording while kept on their work routine. The root mean square of successive differences in RR intervals during the night period (nighttime RMSSD) was computed as the heart rate variability index of vagal function. RESULTS After controlling for demographic, lifestyle, and medical factors, nighttime RMSSD explained 1.7% (P = 0.001), 0.8% (P = 0.033), and 7.8% (P = 0.007), respectively, of the variance in fibrinogen levels in all subjects, men, and women. Nighttime RMSSD and fibrinogen levels were stronger correlated in women than in men. In all workers, men, and women, respectively, there was a mean +/- SEM increase of 0.41 +/- 0.13 mg/dL, 0.28 +/- 0.13 mg/dL, and 1.16 +/- 0.41 mg/dL fibrinogen for each millisecond decrease in nighttime RMSSD. CONCLUSIONS Reduced vagal outflow to the heart correlated with elevated plasma fibrinogen levels independent of the established cardiovascular risk factors. This relationship seemed comparably stronger in women than men. Such an autonomic mechanism might contribute to the atherosclerotic process and its thrombotic complications.
Collapse
Affiliation(s)
- Roland von Känel
- Department of General Internal Medicine, Bern University Hospital, Inselspital, Bern, Switzerland.
| | | | | |
Collapse
|
956
|
Huston JM, Rosas-Ballina M, Xue X, Dowling O, Ochani K, Ochani M, Yeboah MM, Chatterjee PK, Tracey KJ, Metz CN. Cholinergic neural signals to the spleen down-regulate leukocyte trafficking via CD11b. THE JOURNAL OF IMMUNOLOGY 2009; 183:552-9. [PMID: 19542466 DOI: 10.4049/jimmunol.0802684] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The cholinergic anti-inflammatory pathway is a physiological mechanism that inhibits cytokine production and diminishes tissue injury during inflammation. Recent studies demonstrate that cholinergic signaling reduces adhesion molecule expression and chemokine production by endothelial cells and suppresses leukocyte migration during inflammation. It is unclear how vagus nerve stimulation regulates leukocyte trafficking because the vagus nerve does not innervate endothelial cells. Using mouse models of leukocyte trafficking, we show that the spleen, which is a major point of control for cholinergic modulation of cytokine production, is essential for vagus nerve-mediated regulation of neutrophil activation and migration. Administration of nicotine, a pharmacologic agonist of the cholinergic anti-inflammatory pathway, significantly reduces levels of CD11b, a beta(2)-integrin involved in cell adhesion and leukocyte chemotaxis, on the surface of neutrophils in a dose-dependent manner and this function requires the spleen. Similarly, vagus nerve stimulation significantly attenuates neutrophil surface CD11b levels only in the presence of an intact and innervated spleen. Further mechanistic studies reveal that nicotine suppresses F-actin polymerization, the rate-limiting step for CD11b surface expression. These studies demonstrate that modulation of leukocyte trafficking via cholinergic signaling to the spleen is a specific, centralized neural pathway positioned to suppress the excessive accumulation of neutrophils at inflammatory sites. Activating this mechanism may have important therapeutic potential for preventing tissue injury during inflammation.
Collapse
Affiliation(s)
- Jared M Huston
- The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
957
|
Qiao H, Sanders RD, Ma D, Wu X, Maze M. Sedation improves early outcome in severely septic Sprague Dawley rats. Crit Care 2009; 13:R136. [PMID: 19691839 PMCID: PMC2750194 DOI: 10.1186/cc8012] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/14/2009] [Accepted: 08/19/2009] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Sepsis, a systemic inflammatory response to infective etiologies, has a high mortality rate that is linked both to excess cytokine activity and apoptosis of critical immune cells. Dexmedetomidine has recently been shown to improve outcome in a septic cohort of patients when compared to patients randomized to a benzodiazepine-based sedative regimen. We sought to compare the effects of dexmedetomidine and midazolam, at equi-sedative doses, on inflammation and apoptosis in an animal model of severe sepsis. METHODS After central venous access, Sprague Dawley rats underwent cecal ligation and intestinal puncture (CLIP) with an 18 G needle without antibiotic cover and received either saline, or an infusion of comparable volume of saline containing midazolam (0.6 mg.kg-1.h-1) or dexmedetomidine (5 ug.kg-1.h-1) for 8 hours. Following baseline measurements and CLIP, blood was sampled for cytokine measurement (tumour necrosis factor (TNF)-alpha and interleukin (IL)-6; n = 4-6 per group) at 2, 4 and 5 hours, and animal mortality rate (MR) was monitored (n = 10 per group) every 2 hours until 2 hours had elapsed. In addition, spleens were harvested and apoptosis was assessed by immunoblotting (n = 4 per group). RESULTS The 24 hour MR in CLIP animals (90%) was significantly reduced by sedative doses of either dexmedetomidine (MR = 20%) or midazolam (MR = 30%). While both sedatives reduced systemic levels of the inflammatory cytokine TNF-alpha (P < 0.05); only dexmedetomidine reduced the IL-6 response to CLIP, though this narrowly missed achieving significance (P = 0.05). Dexmedetomidine reduced splenic caspase-3 expression (P < 0.05), a marker of apoptosis, when compared to either midazolam or saline. CONCLUSIONS Sedation with midazolam and dexmedetomidine both improve outcome in polymicrobial severely septic rats. Possible benefits conveyed by one sedative regimen over another may become evident over a more prolonged time-course as both IL-6 and apoptosis were reduced by dexmedetomidine but not midazolam. Further studies are required to evaluate this hypothesis.
Collapse
Affiliation(s)
- Hong Qiao
- Department of Anesthesiology, First Hospital, Peking University, No. 8 Xishiku St., Beijing 100034, PR China
| | - Robert D Sanders
- Department of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK
| | - Daqing Ma
- Department of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK
| | - Xinmin Wu
- Department of Anesthesiology, First Hospital, Peking University, No. 8 Xishiku St., Beijing 100034, PR China
| | - Mervyn Maze
- Department of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea & Westminster Hospital, 369 Fulham Rd, London, SW10 9NH, UK
| |
Collapse
|
958
|
Abstract
OBJECTIVE To test the hypothesis that hyporesponsiveness to ghrelin due to reduced growth hormone (GH) contributes to the aging-related hyperinflammatory state in sepsis. SUMMARY BACKGROUND DATA Sepsis and septic shock are a serious problem, particularly in the geriatric population. Ghrelin is an endogenous ligand for the GH secretagogue receptor 1a (GHSR1a, ie, ghrelin receptor). The decline in GH with age is directly associated with many adverse changes that occur with aging. However, the role of GH, ghrelin, and GHSR1a in the age-associated vulnerability to sepsis remains unknown. METHODS Male Fischer 344 rats (young: 3 months; aged: 24 months) were used. Plasma GH levels, ghrelin receptor expression, and neuronal activity in the parasympathostimulatory nuclei of the brain stem in normal young and aged animals were measured. Endotoxemia was induced by intravenous injection of lipopolysaccharide (LPS, 15 mg/kg BW). RESULTS While LPS-induced release of proinflammatory cytokines from macrophages isolated from aged rats decreased, LPS injection resulted in an in vivo hyperinflammatory state. GH levels were lower in aged rats, which was associated with lower expression of GHSR1a in the dorsal vagal complex and a decrease in parasympathostimulatory neuronal activity. GHSR1a antagonist elevated LPS-induced cytokine release in young rats. GH increased GHSR-1a expression in the dorsal vagal complex in aged rats. Coadministration of ghrelin and GH, but not ghrelin alone or GH alone, markedly reduced cytokine levels and organ injury after endotoxemia in aged rats, which was associated with significantly elevated parasympathostimulatory neuronal activity. CONCLUSIONS These findings suggest that the reduced central (brain) responsiveness to ghrelin due to the decreased GH, plays a major role in producing the hyperinflammatory state, resulting in severe organ injuries and high mortality after endotoxemia in aged animals. Ghrelin and GH can be developed as a novel therapy for sepsis in the geriatric population.
Collapse
|
959
|
Miwa K, Shibayama N, Moriguchi T, Goto J, Yanagisawa M, Yamazaki Y, Jung G, Matsuda K. A rapid enzyme-linked immunosorbent assay with two modes of detection for measuring cytokine concentration. J Clin Lab Anal 2009; 23:40-4. [PMID: 19140210 DOI: 10.1002/jcla.20287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Interleukin (IL)-6 and IL-8 were measured in 101 serum samples collected from eight intensive-care unit patients using a polystyrene-based stick enzyme-linked immunosorbent assay (STICKELISA) system. This system consisted of an immobilized-antibody ELISA stick and a noncontact spectrophotometer. Cytokine concentration was detected by two ways: first, rapidly and semi-quantitatively by naked-eye observation of the color change and second, quantitatively using the spectrophotometer for accurate concentration determination. The spectrophotometric assay enabled the quantitation of as little as 100 pg/mL cytokine and took only 45 min to complete. There was a good agreement between the STICKELISA observations and data obtained using a plate ELISA system. The agreement between STICKELISA naked-eye observation and plate ELISA determination was 94 and 85% for IL-6 and IL-8, respectively. The correlation coefficients between the STICKELISA spectrophotometric determination and plate ELISA determination were 0.88 and 0.91 for IL-6 and IL-8, respectively, in a 0.1-5 ng/mL cytokine concentration range. These results demonstrate that the STICKELISA system is a simple, rapid, and quantitative method for bedside cytokine measurement in critical-care settings.
Collapse
Affiliation(s)
- Keishi Miwa
- Toray Industries, Inc., New Frontiers Research Labs, Kamakura, Kanagawa, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
960
|
|
961
|
Sepsis, ghrelin, the cholinergic anti-inflammatory pathway, gut mucosal hyperpermeability, and high-mobility group box 1*. Crit Care Med 2009; 37:2483-5. [DOI: 10.1097/ccm.0b013e3181abf5f4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
962
|
Oke SL, Tracey KJ. The inflammatory reflex and the role of complementary and alternative medical therapies. Ann N Y Acad Sci 2009; 1172:172-80. [PMID: 19743552 PMCID: PMC4533858 DOI: 10.1196/annals.1393.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The body's first defense against invading pathogens or tissue injury is the innate immune system. Since excessive immune responses can be damaging, anti-inflammatory mechanisms function to control the pro-inflammatory response and prevent injury. The cholinergic anti-inflammatory pathway is a neural mechanism that suppresses the innate inflammatory response. Knowledge concerning innervation of the immune system offers a unique opportunity to explore previously unrecognized techniques to treat disease. It also enables consideration of the neurological basis of complementary and alternative medical therapies, such as meditation and acupuncture. This evolving area of research has implications for the pathogenesis of chronic inflammatory conditions including inflammatory bowel disease, rheumatoid arthritis, type 2 diabetes, and other conditions of excessive cytokine release.
Collapse
Affiliation(s)
- Stacey L Oke
- Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, New York, USA
| | | |
Collapse
|
963
|
Fink MP. Editorial: Hemopexin: newest member of the anti-inflammatory mediator club. J Leukoc Biol 2009; 86:203-4. [DOI: 10.1189/jlb.0309137] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
964
|
Vagus nerve stimulation reduces infarct size in rat focal cerebral ischemia. Neurosci Lett 2009; 459:147-51. [DOI: 10.1016/j.neulet.2009.05.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 04/30/2009] [Accepted: 05/06/2009] [Indexed: 11/21/2022]
|
965
|
Moriwaki Y, Watanabe Y, Shinagawa T, Kai M, Miyazawa M, Okuda T, Kawashima K, Yabashi A, Waguri S, Misawa H. Primary sensory neuronal expression of SLURP-1, an endogenous nicotinic acetylcholine receptor ligand. Neurosci Res 2009; 64:403-12. [DOI: 10.1016/j.neures.2009.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 04/20/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
|
966
|
Effect of vagus nerve stimulation on thermal injury in rats. Burns 2009; 36:75-81. [PMID: 19646819 DOI: 10.1016/j.burns.2009.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Revised: 12/03/2008] [Accepted: 02/09/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effects of vagus nerve stimulation on haemodynamics, pulmonary histopathology, arterial blood gas and pro-inflammatory responses to thermal injury. INTERVENTIONS Forty-eight male Sprague-Dawley (SD) rats were randomly divided into six equal groups: normal control (NC) group; thermal injury (TEM) group subjected to 40% total body surface area (%TBSA) third-degree thermal injury; vagotomy (VGX) group subjected to bilateral cervical vagotomy after thermal injury; electrical stimulation (STM) group subjected to bilateral cervical vagotomy plus the left vagus nerve trunk electrical stimulation (5 V, 2 ms and 1 Hz) after thermal injury; the antagonist of muscarinic acetylcholine receptor (MRA) group administrated with atropine (0.1 mg kg(-1)) before electrical stimulation and the antagonist of nicotinic acetylcholine receptor (NRA) group administrated with hexamethonium (10 mg kg(-1)) before electrical stimulation. MEASUREMENTS AND MAIN RESULTS The haemodynamics, histopathology of lung tissue, arterial blood gas, lactic acid, tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels were measured. Vagus nerve electrical stimulation not only significantly increased the mean arterial pressure (MAP) and heart rate (HR), but also decreased the infiltration of inflammatory cells into interstitial and alveolar spaces after thermal challenge and attenuated TNF-alpha and IL-6 production. Hexamethonium pre-treatment significantly reversed the effects of vagal electrical stimulation, but atropine administration before electrical stimulation had no such effects. CONCLUSIONS Direct electrical stimulation of the vagus nerve might produce therapeutic effect on thermal injury. The effect may be realised by limiting the inflammatory response via nicotinic acetylcholine receptors in rats.
Collapse
|
967
|
Werdan K, Schmidt H, Ebelt H, Zorn-Pauly K, Koidl B, Hoke RS, Heinroth K, Müller-Werdan U. Impaired regulation of cardiac function in sepsis, SIRS, and MODS. Can J Physiol Pharmacol 2009; 87:266-74. [PMID: 19370080 DOI: 10.1139/y09-012] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In sepsis, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction syndrome (MODS), a severe prognostically relevant cardiac autonomic dysfunction exists, as manifested by a strong attenuation of sympathetically and vagally mediated heart rate variability (HRV). The mechanisms underlying this attenuation are not limited to the nervous system. They also include alterations of the cardiac pacemaker cells on a cellular level. As shown in human atrial cardiomyocytes, endotoxin interacts with cardiac hyperpolarization-activated cyclic nucleotide-gated (HCN) ion channels, which mediate the pacemaker current If and play an important role in transmitting sympathetic and vagal signals on heart rate and HRV. Moreover, endotoxin sensitizes cardiac HCN channels to sympathetic signals. These findings identify endotoxin as a pertinent modulator of the autonomic nervous regulation of heart function. In MODS, the vagal pathway of the autonomic nervous system is particularly compromised, leading to an attenuation of the cholinergic antiinflammatory reflex. An amelioration of the blunted vagal activity appears to be a promising novel therapeutic target to achieve a suppression of the inflammatory state and thereby an improvement of prognosis in MODS patients. Preliminary data revealed therapeutic benefits (increased survival rates and improvements of the depressed vagal activity) of the administration of statins, beta-blockers, and angiotensin-converting enzyme inhibitors in patients with MODS.
Collapse
Affiliation(s)
- Karl Werdan
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, D-06097 Halle, Saale, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
968
|
Abstract
The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care sedatives: propofol, the benzodiazepines, opioids, and alpha(2)-adrenoceptor agonists. Benzodiazepines, opioids, and possibly even propofol worsen outcome in animal models of infection, whereas preliminary evidence suggests that the alpha(2)-adrenoceptor agonist, dexmedetomidine, may improve outcomes in the setting of infection. Given the burden of sepsis and secondary infections in critical care, choice of sedation may need to be carefully considered to preserve immune responses in critically ill patients.
Collapse
Affiliation(s)
- Robert D Sanders
- Magill Department of Anaesthetics, Intensive Care and Pain Medicine, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
| | | | | |
Collapse
|
969
|
Fagerlund M, Eriksson L. Current concepts in neuromuscular transmission. Br J Anaesth 2009; 103:108-14. [DOI: 10.1093/bja/aep150] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
970
|
Lowry SF. The stressed host response to infection: the disruptive signals and rhythms of systemic inflammation. Surg Clin North Am 2009; 89:311-26, vii. [PMID: 19281886 DOI: 10.1016/j.suc.2008.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The cognate signals from sterile or pathogen-induced sources converge on the same recognition or response pathways. In the surgical patient, a systemic response to infection most often occurs in the context of ongoing inflammatory stress. Such an inflammatory response is modulated initially by the magnitude of injury and by patient-specific (endogenous) factors, such as confounding illness, age, and genetic variation. Over an extended period of stress, treatmentrelated (exogenous) factors add unpredictability to host responses to subsequent challenges, such as acquired infection. The host response is discussed in the context of how existing sterile stressors may modify the response to acquired infection in surgical patients.
Collapse
Affiliation(s)
- Stephen F Lowry
- Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
| |
Collapse
|
971
|
Tsutakawa S, Kobayashi D, Kusama M, Moriya T, Nakahata N. Nicotine enhances skin necrosis and expression of inflammatory mediators in a rat pressure ulcer model. Br J Dermatol 2009; 161:1020-7. [PMID: 19673871 DOI: 10.1111/j.1365-2133.2009.09349.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many bedridden patients develop pressure ulcers, not only in hospital but also at home. Clinical studies have indicated cigarette smoking to be a risk factor for pressure ulcers. However, the contribution of nicotine to pressure ulcer formation has not been identified. OBJECTIVES We aimed to clarify the effect of nicotine on pressure ulcer formation, and its mechanism. METHODS Ischaemia-reperfusion (I/R) was performed in rat dorsal skin to induce pressure ulcers. The extent of the resulting necrotic area was determined. To clarify the mechanism of the effect of nicotine, mRNA levels of cyclooxygenase-2 (COX-2), interleukin (IL)-1beta, IL-6 and inducible nitric oxide synthase (iNOS) and protein expression of COX-2 and iNOS in the necrotic area were investigated by real-time reverse transcription-polymerase chain reaction and Western blotting, respectively. Furthermore, the effects of the COX-2 inhibitor NS-398 and the iNOS inhibitor aminoguanidine on necrosis were examined. RESULTS Skin necrosis in the I/R-treated area was significantly increased by intraperitoneal administration of nicotine (0.175 mg kg(-1) daily). Repeated nicotine administration had little effect on systolic and diastolic blood pressure. I/R treatment increased mRNA levels of COX-2, IL-1beta, IL-6 and iNOS, which were further augmented by nicotine in a dose-dependent manner. Correspondingly, nicotine (0.35 mg kg(-1) daily) markedly enhanced the protein expression of COX-2 and iNOS. Moreover, NS-398 and aminoguanidine showed a tendency to abrogate the increase of I/R-induced skin necrosis caused by nicotine. CONCLUSIONS These results suggest that the increased risk of pressure ulcers due to cigarette smoking is mediated, in part, by nicotine. They also indicated that the effect of nicotine is not mediated by a change in blood pressure, but is elicited via an increase of inflammatory mediators in the I/R-treated skin.
Collapse
Affiliation(s)
- S Tsutakawa
- Department of Cellular Signalling, Graduate School of Pharmaceutical Science, Tohoku University, Aoba 6-3, Aramaki, Aoba-ku, Sendai 980-8578, Japan
| | | | | | | | | |
Collapse
|
972
|
Singh P, Hawkley LC, McDade TW, Cacioppo JT, Masi CM. Autonomic tone and C-reactive protein: a prospective population-based study. Clin Auton Res 2009; 19:367-74. [PMID: 19504232 DOI: 10.1007/s10286-009-0019-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 05/11/2009] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To examine the cross-sectional and longitudinal relationships between cardiac autonomic tone and serum CRP and to investigate potential causal links between these measures. METHODS A population-based sample of 188 home-dwelling, middle-aged and older adults (104 women, mean age 59 years) from Cook County, IL, participated in this prospective cohort study. High-frequency heart rate variability (HF) and pre-ejection period (PEP) served as markers of cardiac parasympathetic and sympathetic tone, respectively. Cardiac autonomic balance (CAB) was defined as the arithmetic difference between normalized values of HF and PEP. Multivariate regression and autoregressive cross-lagged panel analyses were used to investigate cross-sectional and longitudinal relationships, respectively. High-sensitivity enzyme immunoassay measured serum CRP. RESULTS After removing three cases with CRP values suggesting acute inflammation, the mean CRP value was 1.43 mg/L (range 0.02-7.96 mg/L, SD = 1.55). In models that adjusted for gender, age, race/ethnicity, education, body mass index, smoking, exercise, systolic blood pressure and health conditions including diabetes and hypertension, HF (B = -0.15, SE = 0.04, P < 0.01) and CAB (B = -0.14, SE = 0.04, P < 0.01) were significantly associated with natural log (ln) CRP. In longitudinal analysis, higher CRP levels in any one year predicted greater increases in HF in the subsequent year. INTERPRETATION The inverse relationship between HF and CRP in cross-sectional analysis is consistent with previous studies, while the longitudinal results suggest that cardiac parasympathetic tone may increase over time as a result of higher circulating CRP.
Collapse
Affiliation(s)
- Puneet Singh
- University of Chicago Pritzker School of Medicine, IL, USA
| | | | | | | | | |
Collapse
|
973
|
|
974
|
Jae SY, Heffernan KS, Yoon ES, Lee MK, Fernhall B, Park WH. The inverse association between cardiorespiratory fitness and C-reactive protein is mediated by autonomic function: a possible role of the cholinergic antiinflammatory pathway. Mol Med 2009; 15:291-6. [PMID: 19603105 DOI: 10.2119/molmed.2009.00057] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/01/2009] [Indexed: 11/06/2022] Open
Abstract
Although studies have shown an inverse association between cardiorespiratory fitness (CRF) and C-reactive protein (CRP) levels, the underlying mechanisms are not fully understood. There is emerging evidence that autonomic nervous system function is related to CRP levels. Because high CRF is related to improved autonomic function, we hypothesized that the association between high CRF and low CRP levels would be affected by autonomic nervous system function. Cross-sectional analyses were conducted on 2,456 asymptomatic men who participated in a medical screening program. Fasting blood samples for cardiovascular disease risk factors were analyzed, and CRF was measured by maximal exercise treadmill test with expired gas analysis. We used an index of cardiac autonomic imbalance defined as the ratio of resting heart rate to 1 min of heart rate recovery after exercise (RHR/HRR). CRF was significantly correlated with CRP (r = -0.16, P < 0.05), and RHR/HRR (r = -0.48, P < 0.05), while RHR/HRR was significantly correlated with CRP (r = 0.25, P < 0.05). In multivariable linear regression models that adjusted for age, body mass index, smoking, disease status, medications, lipid profiles, glucose, and systolic blood pressure, CRF was inversely associated with CRP (beta = -0.09, P < 0.05). However, this relationship was no longer significant after adjusting for RHR/HRR in a multivariable linear regression model (beta = -0.03, P = 0.29). These results suggest that autonomic nervous system function significantly affects the relationship between CRF and inflammation in middle-aged men. Thus, physical activity or exercise training may favorably affect the cholinergic antiinflammatory pathway, but additional research is needed to confirm this finding.
Collapse
Affiliation(s)
- Sae Young Jae
- The Health and Integrative Physiology Laboratory, Department of Sports Informatics, University of Seoul, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
975
|
Breivik T, Gundersen Y, Gjermo P, von Hörsten S, Opstad PK. Nicotinic acetylcholine receptor activation mediates nicotine-induced enhancement of experimental periodontitis. J Periodontal Res 2009; 44:297-304. [DOI: 10.1111/j.1600-0765.2009.01223.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
976
|
TACHÉ YVETTE, BERNSTEIN CHARLESN. Evidence for the role of the brain-gut axis in inflammatory bowel disease: depression as cause and effect? Gastroenterology 2009; 136:2058-61. [PMID: 19406133 PMCID: PMC3675266 DOI: 10.1053/j.gastro.2009.04.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- YVETTE TACHÉ
- CURE: Digestive Diseases Research Center and Center for Neurobiology of Stress, Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - CHARLES N. BERNSTEIN
- University of Manitoba IBD Clinical and Research Centre and Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
977
|
Abstract
Inflammation can cause damage and even death. What controls this primitive and potentially lethal innate immune response to injury and infection? Molecular and neurophysiological studies during the past decade have revealed a pivotal answer: immunity is coordinated by neural circuits that operate reflexively. The afferent arc of the reflex consists of nerves that sense injury and infection. This activates efferent neural circuits, including the cholinergic anti-inflammatory pathway, that modulate immune responses and the progression of inflammatory diseases. It might be possible to develop therapeutics that target neural networks for the treatment of inflammatory disorders.
Collapse
|
978
|
Thayer JF, Sternberg EM. Neural concomitants of immunity--focus on the vagus nerve. Neuroimage 2009; 47:908-10. [PMID: 19481613 DOI: 10.1016/j.neuroimage.2009.05.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/15/2009] [Accepted: 05/22/2009] [Indexed: 12/30/2022] Open
|
979
|
Hauber H, Zabel P. ZURÜCKGEZOGEN: Pathophysiologie und Keimspektrum der Sepsis. Internist (Berl) 2009; 50:779-80, 782-4, 786-7. [DOI: 10.1007/s00108-008-2284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
980
|
Multiple roles for nicotine in Parkinson's disease. Biochem Pharmacol 2009; 78:677-85. [PMID: 19433069 DOI: 10.1016/j.bcp.2009.05.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/30/2009] [Accepted: 05/01/2009] [Indexed: 01/11/2023]
Abstract
There exists a remarkable diversity of neurotransmitter compounds in the striatum, a pivotal brain region in the pathology of Parkinson's disease, a movement disorder characterized by rigidity, tremor and bradykinesia. The striatal dopaminergic system, which is particularly vulnerable to neurodegeneration in this disorder, appears to be the major contributor to these motor problems. However, numerous other neurotransmitter systems in the striatum most likely also play a significant role, including the nicotinic cholinergic system. Indeed, there is an extensive anatomical overlap between dopaminergic and cholinergic neurons, and acetylcholine is well known to modulate striatal dopamine release both in vitro and in vivo. Nicotine, a drug that stimulates nicotinic acetylcholine receptors (nAChRs), influences several functions relevant to Parkinson's disease. Extensive studies in parkinsonian animals show that nicotine protects against nigrostriatal damage, findings that may explain the well-established decline in Parkinson's disease incidence with tobacco use. In addition, recent work shows that nicotine reduces l-dopa-induced abnormal involuntary movements, a debilitating complication of l-dopa therapy for Parkinson's disease. These combined observations suggest that nAChR stimulation may represent a useful treatment strategy for Parkinson's disease for neuroprotection and symptomatic treatment. Importantly, only selective nAChR subtypes are present in the striatum including the alpha4beta2*, alpha6beta2* and alpha7 nAChR populations. Treatment with nAChR ligands directed to these subtypes may thus yield optimal therapeutic benefit for Parkinson's disease, with a minimum of adverse side effects.
Collapse
|
981
|
Bbeta15-42 (FX06) reduces pulmonary, myocardial, liver, and small intestine damage in a pig model of hemorrhagic shock and reperfusion. Crit Care Med 2009; 37:598-605. [PMID: 19114899 DOI: 10.1097/ccm.0b013e3181959a12] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The fibrin-derived peptide Bbeta15-42 (also called FX06) has been shown to reduce myocardial infarct size following ischemia/reperfusion. Hemorrhagic shock (HS) followed by volume resuscitation represents a similar scenario, whereby a whole organism is vulnerable to reperfusion injury. DESIGN We subjected male farm-bred landrace pigs ( approximately 30 kg) to HS by withdrawing blood to a mean arterial pressure of 40 mm Hg for 60 minutes. Pigs were then resuscitated with shed blood and crystalloids for 60 minutes, and at this time, FX06 (2.4 mg/kg, n = 8) or vehicle control (phosphate buffered saline; 2.4 mg/kg, n = 7) was injected as an intravenous bolus. SETTING University hospital laboratory. SUBJECTS Anesthetized male farm-bred landrace pigs. MEASUREMENTS AND MAIN RESULTS Data are presented as mean +/- sd. Five hours after resuscitation, controls presented acute lung injury (Pao2/Fio2-ratio <300 mm Hg; extra-vascular lung water index (marker for lung injury): 9.0 +/- 1.8 mL/kg) and myocardial dysfunction/damage (cardiac index: 4.3 +/- 0.25 L/min/m; stroke volume index: 30 +/- 6 mL/m; cardiac TnT levels: 0.58 +/- 0.25 ng/mL). In contrast, FX06-treated animals showed significantly improved pulmonary and circulatory function (Pao2/Fio2-ratio >*400 mm Hg; extra-vascular lung water index: *5.2 +/- 2.1 mL/kg, cardiac index: *6.3 +/- 1.4 L/min/m; stroke volume index: *51 +/- 11 mL/m; cardiac TnT levels: *0.11 +/- 0.09 ng/mL; *p < 0.05). Also, tissue oxygenation (tpO2; mm Hg) was significantly improved during reperfusion in FX06-treated pigs when compared with controls (liver 51 +/- 4 vs. *65 +/- 4; serosa 44 +/- 5 vs. *55 +/- 7; mucosa 14 +/- 4 vs. *26 +/- 4). Finally, FX06 reduced accumulation of myeloperoxidase-positive cells (mainly neutrophils) in myocardium, liver, and small intestine and reduced interleukin-6 plasma levels (*p < 0.05; compared with controls). CONCLUSION We conclude that in a pig model of HS and reperfusion, administration of FX06 during reperfusion protects shock- susceptible organs such as heart, lung, liver, and small intestine.
Collapse
|
982
|
Forsgren S, Grimsholm O, Jönsson M, Alfredson H, Danielson P. New insight into the non-neuronal cholinergic system via studies on chronically painful tendons and inflammatory situations. Life Sci 2009; 84:865-70. [PMID: 19409915 DOI: 10.1016/j.lfs.2009.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/14/2009] [Accepted: 04/17/2009] [Indexed: 11/29/2022]
Abstract
For certain parts of the body, it is nowadays accepted that there is a cholinergic system that is not related to cholinergic innervation, i.e. a non-neuronal cholinergic system. It might be argued that this system is of minor importance. New information obtained shows, however, that the non-neuronal cholinergic system is more widely distributed in the body than what is previously recognised. In recent studies, the existence of such a system has thus been shown for human tendons, especially in chronically painful situations (tendinopathy/tendinosis), in the synovial tissue of patients with rheumatoid arthritis and osteoarthritis, and in the mucosa of ulcerative colitis patients. There is evidence of both acetylcholine (ACh) production and a marked existence of muscarinic (M2) ACh receptors in these situations. The non-neuronal cholinergic system may be involved in the establishment of a 'cholinergic anti-inflammatory pathway' and in proliferative and tissue reorganisation processes via autocrine/paracrine effects. The new information obtained suggests that this system plays an important functional role in chronically painful tendons and in inflammatory conditions. The findings of such a system in various parts of the body, when taken together, show that not only should the classical neuronal cholinergic system be considered in discussion of the cholinergic influences in the body. Additionally, the production of ACh in local cells in the tissues represents an important extra supply of the transmitter. ACh effects can be obtained whether or not there is a cholinergic innervation in the tissue.
Collapse
Affiliation(s)
- Sture Forsgren
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, SE-901 87 Umeå, Sweden.
| | | | | | | | | |
Collapse
|
983
|
Hu T, Fu Q, Liu X, Zhang H, Dong M. Increased acetylcholinesterase and capase-3 expression in the brain and peripheral immune system of focal cerebral ischemic rats. J Neuroimmunol 2009; 211:84-91. [PMID: 19411116 DOI: 10.1016/j.jneuroim.2009.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 03/31/2009] [Accepted: 04/02/2009] [Indexed: 10/20/2022]
Abstract
Cerebral ischemia induces rapid neuro-immunological injury as demonstrated by changes in inflammatory factors, cytokines and chemokines in the circulation and peripheral immune system. In addition, elevated acetylcholinesterase (AChE) activity was reported in ischemic brain tissue. Here, we evaluated the time dependent changes in AChE levels and cytokines and NK activity, as well as the relationship of AChE to apoptosis in the brain, spleen and thymus at different time points after focal cerebral ischemia. The data show an elevated level of immunoreactive AChE in the cortex of ischemic brains. This sustained elevated level of AChE in the brain, thymus and spleen activates capase-3 in response to cerebral ischemia. We propose that this pro-apoptotic activity may result in a T helper cell (Th1/Th2) imbalance and impaired immune function in ischemia.
Collapse
Affiliation(s)
- Tao Hu
- Department of Immunology, Binzhou Medical College, Yantai, PR China.
| | | | | | | | | |
Collapse
|
984
|
Engler H, Doenlen R, Riether C, Engler A, Niemi MB, Besedovsky HO, del Rey A, Pacheco-López G, Feldon J, Schedlowski M. Time-dependent alterations of peripheral immune parameters after nigrostriatal dopamine depletion in a rat model of Parkinson's disease. Brain Behav Immun 2009; 23:518-26. [PMID: 19486644 DOI: 10.1016/j.bbi.2009.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 11/26/2022] Open
Abstract
Dysfunction of the central dopaminergic system is associated with neurodegenerative disorders and mental illnesses such as Parkinson's disease and schizophrenia. Patients suffering from these diseases were reported to exhibit altered immune functions compared to healthy subjects and imbalance of the central dopaminergic system has been suggested as one causative factor for the immune disturbances. However, it is unclear whether the observed immune changes are primary or secondary to the disease. Here we demonstrate that central dopamine (DA) depletion in a rat model of Parkinson's disease induced transient changes in blood leukocyte distribution and cytokine production that were apparent until four weeks after bilateral intrastriatal administration of the neurotoxin 6-hydroxydopamine (6-OHDA). Eight weeks after treatment, no differences in blood immune parameters were anymore evident between neurotoxin-treated and control animals. Nevertheless, animals with a widespread damage of dopaminergic neurons in the nigrostriatal system showed an exacerbated pro-inflammatory response following in vivo challenge with bacterial lipopolysaccharide. Our data indicate that peripheral immune perturbations in the early phase after intrastriatal 6-OHDA administration might have been related to the neurodegenerative process itself whereas the increased sensitivity to the inflammatory stimulus seems to have resulted from an impaired dopaminergic control of prolactin (PRL) and corticosterone (CORT) secretion. The findings demonstrate that the brain dopaminergic system is involved in peripheral immune regulation and suggest that central dopaminergic hypoactivity bears the risk of excessive inflammation, e.g., during infection or tissue injury.
Collapse
Affiliation(s)
- Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
985
|
Ganzinelli S, Borda E, Joensen L, Sterin-Borda L. Chagasic antibodies induce cardiac COX-2/iNOS mRNA expression with PGE2/NO production. Int J Cardiol 2009; 134:212-23. [DOI: 10.1016/j.ijcard.2008.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 01/22/2008] [Accepted: 02/11/2008] [Indexed: 01/22/2023]
|
986
|
Hecker A, Mikulski Z, Lips KS, Pfeil U, Zakrzewicz A, Wilker S, Hartmann P, Padberg W, Wessler I, Kummer W, Grau V. Pivotal Advance: Up-regulation of acetylcholine synthesis and paracrine cholinergic signaling in intravascular transplant leukocytes during rejection of rat renal allografts. J Leukoc Biol 2009; 86:13-22. [PMID: 19201987 DOI: 10.1189/jlb.1107722] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
During acute rejection, large numbers of leukocytes accumulate in the blood vessels of experimental renal allografts. About 70% of them are activated, cytotoxic monocytes that appear to be involved in allograft destruction. ACh exerts anti-inflammatory effects upon monocytes/macrophages and has been proposed to be a key player in neuroimmunological interactions. Its short half-life, however, makes it unlikely that neuronal ACh affects blood leukocytes. Renal transplantation was performed in the allogeneic DA to LEW and in the isogeneic LEW to LEW rat strain combination. Intravascular leukocytes were harvested after 4 days, and the expression of CHT1, cChAT, pChAT, and nAChR subunits was investigated by RT-PCR, immunoblotting, and immunohistochemistry. Monocytes were identified by double-labeling with ED1-antibody, directed to a CD68-like antigen. ACh content was measured by HPLC. [Ca(2+)](i) was monitored by Fura-2. Intravascular graft leukocytes express CHT1 and cChAT mRNA and protein and pChAT protein. Their expression is strongly up-regulated in vivo during acute allograft rejection. Immunohistochemistry revealed CHT1, cChAT, and pChAT protein in ED1-positive monocytes. The ACh content of allograft intravascular leukocytes was sixfold higher than that of isografts. Intravascular leukocytes express nAChR subunits, and an ATP-induced increase in [Ca(2+)](i) was augmented in vitro by a nAChR inhibitor in allograft but not isograft leukocytes. Intravascular graft leukocytes, among them monocytes, up-regulate non-neuronal ACh synthesis and develop auto-/paracrine cholinergic attenuation of ATP signaling during acute allograft rejection.
Collapse
Affiliation(s)
- Andreas Hecker
- Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
987
|
Oral phosphatidylcholine pretreatment decreases ischemia-reperfusion-induced methane generation and the inflammatory response in the small intestine. Shock 2009; 30:596-602. [PMID: 18461026 DOI: 10.1097/shk.0b013e31816f204a] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have shown that phosphatidylcholine (PC) metabolites may have a function in counteracting the production of reactive oxygen species (ROS), and that this mechanism can lead to the generation of methane from choline. The aims were to establish whether the dietary administration of PC can protect the reperfused small bowel mucosa by its acting as an anti-inflammatory agent and to investigate this possibility in association with in vivo methane generation. Group 1 (n = 5) of anesthetized dogs served as sham-operated controls, whereas in groups 2 (n = 6) and 3 (n = 6), complete small intestinal ischemia was induced by occluding the superior mesenteric artery for 60 min. Groups 1 and 2 were fed with normal laboratory chow for 1 week before the experiments, whereas the animals in group 3 received a special diet containing 1% soybean PC. The intramucosal pH and the difference of the arterial and local PCO2 (PCO2 gap) were detected by indirect tonometry. Intestinal superoxide production and myeloperoxidase (MPO) activity (a marker of tissue leukocyte infiltration) were ascertained on ileal biopsy samples 180 min after reperfusion. The content of methane in the exhaled air was determined by gas chromatography. I/R was characterized by significant tissue acidosis with ROS generation and elevated MPO activity. These changes were accompanied by increased methane production in the exhaled air during reoxygenation. The PC-enriched diet prevented the decrease in intramucosal pH, diminished the intestinal superoxide generation and the MPO activity, and significantly decreased the exhaled methane concentration. The increased dietary uptake of PC exerts an anti-inflammatory influence in the gastrointestinal tract. Exhaled methane is linked to abnormal ROS generation; a decreased methane production is associated with significantly reduced inflammatory activation during I/R.
Collapse
|
988
|
Crandall M, Shapiro MB, West MA. Does splenectomy protect against immune-mediated complications in blunt trauma patients? Mol Med 2009; 15:263-7. [PMID: 19593410 DOI: 10.2119/molmed.2009.00029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 04/02/2009] [Indexed: 12/24/2022] Open
Abstract
Activation of the innate immune system results from severe trauma and the resultant systemic inflammatory response is thought to mediate remote organ injury. In animal models, vagal-mediated innate immune responses have been shown to modulate proinflammatory cytokine release in response to trauma or sepsis. In those models, vagal nerve transaction and splenectomy decreased cytokine release and protected against lung injury and mortality. We hypothesized that, if similar mechanisms are active in humans, patients who require splenectomy for trauma would have better outcomes than injured patients without splenectomy. We performed a retrospective cohort study on 46,858 patients who sustained blunt liver or spleen injury utilizing the 2002 National Trauma Data Bank (NTDB). Blunt trauma patients who underwent splenectomy were compared with all patients with splenic injuries. Demographic parameters and the following outcome variables were compared: mortality, hospital length of stay (LOS), ICU length of stay (ILOS), mean ventilator days (VENT), and incidence of acute respiratory distress syndrome (ARDS). Groups were compared controlling for age, gender, injury severity score (ISS), emergency department (ED) blood pressure, and ED base deficit (BD) using multiple regression analyses. Patients that underwent splenectomy had significantly shorter LOS than patients who were managed nonoperatively or with splenorrhaphy: LOS,15.1 versus 19.3 d, P = 0.002; ILOS, 7.8 versus 10.6 d, P < 0.001; and VENT, 7.1 versus 11.4 d, P < 0.001. Adjusted mortality rates (OR 1.02; 95% CI 0.98-1.05; P = 0.29) and the reported incidence of ARDS were not significantly different between the two groups (2.4% versus 3.6%; P = 0.213). Patients who underwent splenectomy demonstrated better secondary outcomes than patients who were managed nonoperatively or with splenorrhaphy, even when controlling for injury severity and physiologic derangements. It is possible that the improved outcomes seen in the group undergoing splenectomy were due to favorable modulation of the human innate immune inflammatory response after trauma.
Collapse
Affiliation(s)
- Marie Crandall
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois 60611, United States of America.
| | | | | |
Collapse
|
989
|
Pitocco D, Scavone G, Zaccardi F, Gioffrè G, Musella T, Martini F, Manto A, Caputo S, Mancini L, Ghirlanda G. Association among sarcoidosis, type 1 diabetes, and Charcot neuro-osteoarthropathy. Diabetes Care 2009; 32:e45. [PMID: 19336633 PMCID: PMC6898971 DOI: 10.2337/dc08-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Dario Pitocco
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Giuseppe Scavone
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Francesco Zaccardi
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | | | - Tittania Musella
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Francesca Martini
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Andrea Manto
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Salvatore Caputo
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| | - Lorena Mancini
- Diabetic Foot Unit, Agostino Gemelli Hospital, Rome, Italy
| | - Giovanni Ghirlanda
- Department of Clinical Pathology, Catholic University School of Medicine, Rome, Italy
| |
Collapse
|
990
|
Johnston G, Webster N. Cytokines and the immunomodulatory function of the vagus nerve. Br J Anaesth 2009; 102:453-62. [DOI: 10.1093/bja/aep037] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
991
|
Nicolussi EM, Huck S, Lassmann H, Bradl M. The cholinergic anti-inflammatory system limits T cell infiltration into the neurodegenerative CNS, but cannot counteract complex CNS inflammation. Neurobiol Dis 2009; 35:24-31. [PMID: 19344760 DOI: 10.1016/j.nbd.2009.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 03/03/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022] Open
Abstract
Stimulation of the nicotinic alpha7 acetylcholine receptor (nAChRalpha7) by nicotine or acetylcholine initiates the cholinergic anti-inflammatory pathway, a mechanism for neural inhibition of inflammation. The action of this pathway was initially discovered in animal models of endotoxemia and septic shock, and later described in a number of other diseases. Moreover, the action of this pathway is also implied in human degenerative diseases of the central nervous system (CNS) like amyotrophic lateral sclerosis or Alzheimer's disease. In spite of this general interest, little is known about its involvement in regulating T cell entry into, or inflammatory reactions within the CNS. We tested the action of the cholinergic anti-inflammatory pathway in nAChRalpha7-deficient mice and their wildtype counterparts in two different experimental settings: In the facial nerve axotomy model characterized by neurodegeneration and T cell infiltration, and in the experimental autoimmune encephalomyelitis (EAE) model providing a very complex scenario of CNS inflammation and demyelination. We found that the cholinergic anti-inflammatory pathway limits the site-directed influx of activated T cells into the lesioned facial motor nucleus, but cannot counteract CNS inflammation in EAE.
Collapse
Affiliation(s)
- Eva-Maria Nicolussi
- Medical University Vienna, Center for Brain Research, Department of Neuroimmunology, Spitalgasse 4, Vienna, Austria
| | | | | | | |
Collapse
|
992
|
Von Känel R, Bellingrath S, Kudielka BM. Association between longitudinal changes in depressive symptoms and plasma fibrinogen levels in school teachers. Psychophysiology 2009; 46:473-80. [PMID: 19298625 DOI: 10.1111/j.1469-8986.2009.00788.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Depression and anxiety previously predicted coronary artery disease (CAD) risk. Inflammation contributes to CAD and shows an association with depression. We followed 57 teachers (mean 49+/-8 years) over 21 months and investigated whether changes in depressive and anxiety symptoms relate to those in the CAD risk and inflammation marker fibrinogen and vice versa. Increase in depressive symptoms and in fibrinogen levels were significantly correlated. While controlling for baseline depression rendered the association between changes in depression and fibrinogen nonsignificant, taking into account baseline fibrinogen levels maintained the predictive value of fibrinogen change for depression change. Anxiety and fibrinogen changes were not significantly correlated. This dynamic relationship between depression and the inflammatory biomarker fibrinogen might advance our knowledge about psychobiological mechanisms underlying both CAD and sickness behavior.
Collapse
Affiliation(s)
- Roland Von Känel
- Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | |
Collapse
|
993
|
Vagus nerve mediates the protective effects of melanocortins against cerebral and systemic damage after ischemic stroke. J Cereb Blood Flow Metab 2009; 29:512-23. [PMID: 19018269 DOI: 10.1038/jcbfm.2008.140] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A vagus nerve-mediated, efferent cholinergic protective pathway activated by melanocortins is operative in circulatory shock and myocardial ischemia. Moreover, melanocortins have neuroprotective effects against brain damage after ischemic stroke. Here we investigated cerebral and systemic pathophysiologic reactions to focal cerebral ischemia in rats induced by intrastriatal microinjection of endothelin-1, and the possible protective role of the melanocortin-activated vagal cholinergic pathway. In the striatum and liver of saline-treated control rats, the activation of extracellular signal-regulated kinases, c-jun N-terminal kinases, and caspase-3, the increase in tumor necrosis factor-alpha (TNF-alpha) concentration and DNA fragmentation, as well as the increase in TNF-alpha plasma levels, occurred 10 and 20 h after the ischemic insult suggesting an activation of inflammatory and apoptotic responses. Treatment with [Nle(4), D-Phe(7)]alpha-melanocyte-stimulating hormone (NDP-alpha-MSH; 3 or 9 h after stroke) suppressed the inflammatory and apoptotic cascades at central and peripheral level. Bilateral vagotomy and pharmacologic blockade of peripheral nicotinic acetylcholine receptors blunted the protective effect of NDP-alpha-MSH. The present results show that focal brain ischemia in rats causes significant effects not only in the brain, but also in the liver. Moreover, our data support the hypothesis that a protective, melanocortin-activated, vagal cholinergic pathway is likely operative in conditions of ischemic stroke.
Collapse
|
994
|
Huang LZ, Parameswaran N, Bordia T, Michael McIntosh J, Quik M. Nicotine is neuroprotective when administered before but not after nigrostriatal damage in rats and monkeys. J Neurochem 2009; 109:826-37. [PMID: 19250334 DOI: 10.1111/j.1471-4159.2009.06011.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nicotine reduces dopaminergic deficits in parkinsonian animals when administered before nigrostriatal damage. Here we tested whether nicotine is also beneficial when given to rats and monkeys with pre-existing nigrostriatal damage. Rats were administered nicotine before and after a unilateral 6-hydroxydopamine lesion of the medial forebrain bundle, and the results compared with those in which rats received nicotine only after lesioning. Nicotine pre-treatment attenuated behavioral deficits and lessened lesion-induced losses of the striatal dopamine transporter, and alpha6beta2* and alpha4beta2* nicotinic receptors (nAChRs). By contrast, nicotine administered 2 weeks after lesioning, when 6-hydroxydopamine-induced neurodegenerative effects are essentially complete, did not improve these same measures. Similar results were observed in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned monkeys. Nicotine did not enhance striatal markers when administered to monkeys with pre-existing nigrostriatal damage, in contrast to previous data that showed improvements when nicotine was given to monkeys before lesioning. These combined findings in two animal models suggest that nicotine is neuroprotective rather than neurorestorative against nigrostriatal damage. Receptor studies with (125)I-alpha-conotoxinMII and the alpha-conotoxinMII analog E11A were next performed to determine whether nicotine treatment pre- or post-lesioning differentially affected expression of alpha6alpha4beta2* and alpha6(nonalpha4)beta2* nAChR subtypes in striatum. The observations suggest that protection against nigrostriatal damage may be linked to striatal alpha6alpha4beta2* nAChRs.
Collapse
Affiliation(s)
- Luping Z Huang
- Basic Research Department, The Parkinson's Institute, Sunnyvale, California 94085, USA
| | | | | | | | | |
Collapse
|
995
|
The Consequences of Cardiac Autonomic Dysfunction in Multiple Organ Dysfunction Syndrome. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
996
|
Flierl MA, Rittirsch D, Nadeau BA, Sarma JV, Day DE, Lentsch AB, Huber-Lang MS, Ward PA. Upregulation of phagocyte-derived catecholamines augments the acute inflammatory response. PLoS One 2009; 4:e4414. [PMID: 19212441 PMCID: PMC2636885 DOI: 10.1371/journal.pone.0004414] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/16/2008] [Indexed: 11/18/2022] Open
Abstract
Following our recent report that phagocytic cells (neutrophils, PMNs, and macrophages) are newly discovered sources of catecholamines, we now show that both epinephrine and norepinephrine directly activate NFkappaB in macrophages, causing enhanced release of proinflammatory cytokines (TNFalpha, IL-1beta, IL-6). Both adrenal-intact (AD+) and adrenalectomized (ADX) rodents were used, because ADX animals had greatly enhanced catecholamine release from phagocytes, facilitating our efforts to understand the role of catecholamines released from phagocytes. Phagocytes isolated from adrenalectomized rats displayed enhanced expression of tyrosine-hydroxylase and dopamine-beta-hydroxylase, two key enzymes for catecholamine production and exhibited higher baseline secretion of norepinephrine and epinephrine. The effects of upregulation of phagocyte-derived catecholamines were investigated in two models of acute lung injury (ALI). Increased levels of phagocyte-derived catecholamines were associated with intensification of the acute inflammatory response, as assessed by increased plasma leak of albumin, enhanced myeloperoxidase content in lungs, augmented levels of proinflammatory mediators in bronchoalveolar lavage fluids, and elevated expression of pulmonary ICAM-1 and VCAM-1. In adrenalectomized rats, development of ALI was enhanced and related to alpha(2)-adrenoceptors engagement but not to involvement of mineralocorticoid or glucocorticoid receptors. Collectively, these data demonstrate that catecholamines are potent inflammatory activators of macrophages, upregulating NFkappaB and further downstream cytokine production of these cells. In adrenalectomized animals, which have been used to further assess the role of catecholamines, there appears to be a compensatory increase in catecholamine generating enzymes and catecholamines in macrophages, resulting in amplification of the acute inflammatory response via engagement of alpha(2)-adrenoceptors.
Collapse
Affiliation(s)
- Michael A. Flierl
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Daniel Rittirsch
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Brian A. Nadeau
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - J. Vidya Sarma
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Danielle E. Day
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Alex B. Lentsch
- The Laboratory of Trauma, Sepsis & Inflammation Research, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Markus S. Huber-Lang
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Ulm Medical School, Ulm, Germany
| | - Peter A. Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail:
| |
Collapse
|
997
|
Hofer S, Steppan J, Wagner T, Funke B, Lichtenstern C, Martin E, Graf BM, Bierhaus A, Weigand MA. Central sympatholytics prolong survival in experimental sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R11. [PMID: 19196475 PMCID: PMC2688128 DOI: 10.1186/cc7709] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 01/15/2009] [Accepted: 02/06/2009] [Indexed: 12/17/2022]
Abstract
Introduction One of the main causes of death in European and US intensive care units is sepsis. It involves a network of pro-inflammatory cytokines such as TNF-α, IL-1β and IL-6. Furthermore, there is an up regulation of transcription factors such as nuclear factor (NF) κB. It has previously been shown that clonidine is able to significantly reduce pro-inflammatory cytokines in surgical patients. We therefore hypothesise that the clinically used central alpha-2 agonist clonidine has the ability to improve survival in experimental sepsis by inhibiting the sympathetic tone and consequently inhibiting the pro-inflammatory cytokine release. Methods To investigate this therapeutic potential of clonidine in a prospective randomised laboratory investigation we used a murine model of caecal ligation and puncture (CLP) induced sepsis. Animals receiving pre-emptive injections were treated with either clonidine (5 μg/kg) or dexmedetomidine (40 μg/kg) 12 and 1 hours before the operation, as well as 1, 6 and 12 hours afterwards. Another group of animals only received clonidine (5 μg/kg) 1, 6 and 12 hours after the operation, while the pre-emptive injections were normal saline. The control groups received solvent injections at the respective time points. Results Pre-emptive administration of a central sympatholytic significantly reduced mortality (clonidine: p = 0.015; dexmedetomidine: p = 0.029), although postoperative administration of clonidine failed to significantly prolong survival. Furthermore pre-emptive administration of clonidine significantly attenuated the cytokine response after CLP-induced sepsis (mIL-1beta: p = 0.017; mIL-6: p < 0.0001; mTNF-α: p < 0.0001), preserved blood pressure control (p = 0.024) and down-regulated the binding activity of NF-κB. There were no changes in the pro-inflammatory cytokine response when peripheral blood was incubated with lipopolysaccharide alone compared with incubation with clonidine (10-4 M) plus LPS (p > 0.05). Conclusions Our results demonstrate that the pre-emptive administration of either clonidine or dexmedetomidine have the ability to successfully improve survival in experimental sepsis. Furthermore, there seems to be a connection between the central muscarinic network and the vagal cholinergic response. By down-regulating pro-inflammatory mediators sympatholytics may be a useful adjunct sedative in patients with a high risk for developing sepsis.
Collapse
Affiliation(s)
- Stefan Hofer
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
998
|
Mabley JG, Pacher P, Szabo C. Activation of the cholinergic antiinflammatory pathway reduces ricin-induced mortality and organ failure in mice. Mol Med 2009; 15:166-72. [PMID: 19209239 DOI: 10.2119/molmed.2008.00105] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 02/04/2009] [Indexed: 11/06/2022] Open
Abstract
Exposure to ricin, either by accident through ingestion of castor oil plant seeds or intentionally through its use as a bioweapon, invariably leads to multiple organ damage and death. Currently there is only a vaccine in advanced development to ricin, but no other antidote. Ricin causes systemic inflammation with increased proinflammatory cytokine release and subsequent multiple organ failure, particularly kidney and liver dysfunction. Activation of the cholinergic antiinflammatory pathway, specifically through the alpha7 nicotinic acetylcholine receptor (either indirectly through vagus nerve stimulation or directly through nicotine treatment) reduces proinflammatory gene expression. This activation also increases release of proinflammatory chemokines and cytokines, and has proven effective in a variety of inflammatory diseases. The aim of this study was to investigate whether nicotine treatment protected against ricin toxicity in mice. Male Balb/c mice exposed to ricin had increased serum levels of the inflammatory cytokine tumor necrosis factor-alpha and markers of both kidney (blood urea nitrogen, creatine) and liver (alanine tranaminase) dysfunction, with a subsequent increase in mortality. Nicotine administration 2 h after ricin injection significantly delayed and reduced ricin-induced mortality, an effect coupled with reduced serum levels of tumor necrosis factor-alpha and markers of kidney and liver dysfunction. Both the kidney and liver had markedly increased cellular oxidative stress following ricin exposure, an effect attenuated by nicotine administration. In conclusion, these data demonstrate that in cases of ricin poisoning, activation of the cholinergic antiinflammatory pathway may prove beneficial by reducing organ damage, delaying mortality, and allowing for a greater chance of survival.
Collapse
Affiliation(s)
- Jon G Mabley
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.
| | | | | |
Collapse
|
999
|
Lowry SF. 2008 Surgical Infection Society Presidential Address The Value of Connections. Surg Infect (Larchmt) 2009. [DOI: 10.1089/sur.2009.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen F. Lowry
- Department of Surgery, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
1000
|
Breivik T, Gundersen Y, Gjermo P, von Hörsten S, Opstad PK. Nicotinic acetylcholine receptor activation mediates nicotine-induced enhancement of experimental periodontitis. J Periodontal Res 2009; 44:110-6. [DOI: 10.1111/j.1600-0765.2008.01095.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|