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The CD40 rs1883832 Polymorphism Affects Sepsis Susceptibility and sCD40L Levels. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7497314. [PMID: 29780830 PMCID: PMC5892284 DOI: 10.1155/2018/7497314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/09/2018] [Accepted: 02/14/2018] [Indexed: 01/09/2023]
Abstract
Sepsis is a severe and progressive disease characterized by systemic inflammatory response syndrome (SIRS). CD40 serves as a vital link between immune response and inflammation. This study was designed to investigate the potential association between a functional single-nucleotide polymorphism (SNP) of CD40 (rs1883832) and susceptibility to sepsis. We first performed a case-control study to explore the relationship between the CD40 rs1883832 polymorphism and sepsis. CD40 mRNA expression and protein expression were determined by real-time PCR and western blotting, respectively, in peripheral blood mononuclear cells (PBMCs) from sepsis patients and healthy controls. The plasma sCD40L levels in the two groups were measured by ELISA. The results showed that the frequencies of the TT genotype and the CD40 rs1883832 T allele were significantly higher in sepsis patients than in healthy controls. Plasma sCD40L levels were also significantly increased in sepsis patients. In addition, TT genotype carriers among sepsis patients displayed the highest CD40 expression at both the mRNA and protein levels, accompanied by the highest plasma sCD40L concentrations. In conclusion, the CD40 rs1883832 T allele acts as a risk factor for increased susceptibility to sepsis and may be involved in the process of sepsis through regulation of CD40 expression and plasma sCD40L levels.
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Jiang Y, Feng S, Ji J, Lin Z, Zhang X. Persistent accumulation of circulating monocytic myeloid-derived suppressor cells contributes to post-infectious immunosuppression in renal transplant recipients with bacterial infection: A pilot study. Transpl Immunol 2018; 48:10-17. [PMID: 29477752 DOI: 10.1016/j.trim.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Post-infectious immunosuppression is disadvantageous to patients' long-term outcomes, especially in transplant recipients receiving large doses of immunosuppressants. A growing body of evidence indicates the immunoregulatory ability of myeloid-derived suppressor cells (MDSCs). We herein investigate the characteristics of monocytic-MDSCs (M-MDSCs) in a cohort of renal transplant recipients with/without infection to clarify the potential involvement in post-infectious immunosuppression. METHODS The study prospectively included 28 adult recipients who underwent allogeneic ABO-compatible renal transplant. Blood samples were drawn at day 0, 7, 14, 28, 60 and 90 postoperation. The incidence of infection and treatment strategies were recorded. The frequency and absolute number of peripheral blood M-MDSCs as well as other immune cells were determined by flow cytometry. Immnosuppressive functions of M-MDSCs were analyzed by inhibition of T cells proliferation. mRNA levels of immunosuppressive molecules in sorted M-MDSCs were also examined. RESULTS 7 recipients were diagnosed with bacterial (n = 5) or viral (n = 2) infection and 3/5 of bacterial-infected recipients suffered from secondary infection during further follow-up. In the non-infected group, M-MDSCs numbers increased transiently during the early postoperative period, however, bacterial but not viral infection led to significant and persistent accumulation of M-MDSCs that remained at high levels after anti-infective treatments. M-MDSCs from infected recipients demonstrated potent ability to suppress T cells proliferation in vitro and negatively correlated with lymphocytes in vivo, yet not in the non-infected group. Inducible nitric oxide synthase (iNOS) mRNA levels were higher in sorted M-MDSCs when compared with monocytes, and suppressive activity was reversed by addition of a NOS inhibitor. CONCLUSIONS Circulating M-MDSCs underwent significant and persistent increases after bacterial infection in renal transplant recipients, contributing to post-infectious immunodeficiency. Therefore, special attention should be given to M-MDSCs during the monitoring of immune status and infection management.
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Affiliation(s)
- Yihang Jiang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, NO. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China
| | - Sujuan Feng
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, NO. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China
| | - Jiawei Ji
- Graduate School of Capital Medical University, NO. 10 You An Men Wai Xi Tou Tiao, Fengtai District, Beijing 100069, China
| | - Zhemin Lin
- Graduate School of Capital Medical University, NO. 10 You An Men Wai Xi Tou Tiao, Fengtai District, Beijing 100069, China
| | - Xiaodong Zhang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, NO. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China.
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Sauer M, Richter G, Altrichter J, Wild T, Doß F, Mencke T, Ehler J, Doß S, Koch S, Schubert A, Nöldge-Schomburg G, Mitzner SR. Effects of Bioreactor-Oxygenation During Extracorporeal Granulocytes Treatment in Septic Patients. Ther Apher Dial 2018; 22:389-398. [PMID: 29418067 DOI: 10.1111/1744-9987.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Abstract
A granulocyte bioreactor for the extracorporeal treatment was developed to enhance the immune cell function in patients with severe sepsis. The influence of oxygenation on the used cells was tested in a prospective clinical study. Ten patients with severe sepsis were treated twice with the granulocyte bioreactor. The used cells were screened for functionality; values of blood gases, glucose and lactate were obtained from the recirculating bioreactor circuit. Five patients were treated with an oxygenator setup (Oxy group), five without oxygenator (Non-Oxy group). The overall in-hospital mortality was 50%. Significantly lower values of oxygen saturation, partial oxygen pressure, lactate, oxyburst and phagocytosis were seen in the Non-Oxy group compared with the Oxy group in the bioreactor circuit. Further studies with this approach are encouraged and should focus on the influence of oxygenation on production of reactive oxygen species and cytokines of used cells.
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Affiliation(s)
- Martin Sauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Georg Richter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Thomas Wild
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Fanny Doß
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Thomas Mencke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Sandra Doß
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Stephanie Koch
- Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
| | - Anton Schubert
- Department of Surgery, University Hospital of Rostock, Rostock, Germany
| | - Gabriele Nöldge-Schomburg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock, Rostock, Germany
| | - Steffen R Mitzner
- Department of Medicine (Division of Nephrology), University Hospital of Rostock, Rostock, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Rostock, Germany
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104
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The Effects of Ex Vivo Administration of Granulocyte-Macrophage Colony-Stimulating Factor and Endotoxin on Cytokine Release of Whole Blood Are Determined by Priming Conditions. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9834512. [PMID: 29387728 PMCID: PMC5745690 DOI: 10.1155/2017/9834512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/16/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023]
Abstract
Background Lipopolysaccharide- (LPS-) induced tumour necrosis factor alpha (TNFα) secretion in critically ill patients can be considered as a measure of immune responsiveness. It can be enhanced by granulocyte-macrophage colony stimulating factor (GM-CSF). We investigated the effect of GM-CSF on ex vivo stimulated cytokine production using various preincubation regimens in healthy donors and patients with sepsis. Results The maxima for the stimuli occurred 3 hours after stimulation. In donors, there was an increase (p < 0.001) of LPS-induced TNFα levels following incubation with GM-CSF. The simultaneous incubation with GM-CSF and LPS caused an inhibition of TNFα production (p < 0.001). Postincubation with GM-CSF did not yield any difference. In patients, preincubation with GM-CSF yielded an enhanced ex vivo TNFα-response when TNFα levels were low. Patients with increased TNFα concentrations did not show a GM-CSF stimulation effect. The GM-CSF preincubation yielded an increase of IL-8 production in patients and donors. Conclusions This study demonstrates the immune-modulating properties of GM-CSF depending on the absence or presence of LPS or systemic TNFα. The timing of GM-CSF administration may be relevant for the modulation of the immune system in sepsis. The lack of stimulation in patients with high TNFα may represent endotoxin tolerance.
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105
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Abstract
Despite several decades of focused investigation, sepsis remains a major cause of mortality in critically ill patients. Advancements in intensive care have enabled more patients to survive the acute phase of sepsis than previously, but a growing number of them progress to chronic critical illness. The failure of previous randomized clinical trials of anti-inflammatory agents to show any pro-survival benefit in septic patients underscores current thought that simple anti-inflammatory strategies are ineffective because the inhibitory effect of anti-inflammatory agents undermines the immune response to pathogens. New strategies with the dual capability of ameliorating inflammation in organs while stimulating antimicrobial activity are eagerly awaited. On the other hand, the metabolic alterations associated with systemic inflammatory response, including mitochondrial dysfunction and metabolic shift, are closely linked through a nexus of signaling pathways and signaling molecules. Preventing these metabolic derangements may be an alternative way to control excessive inflammation, an intriguing possibility that has not been fully explored. New insight into the molecular pathogenesis of sepsis and sepsis-associated chronic critical illness has led to the recognition of septic cachexia, a life-threatening form of metabolic inflammatory complex associated with multiple organ dysfunction. The potential for septic cachexia to serve as a novel target disease state to improve the clinical outcome of septic patients is discussed in this review.
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Affiliation(s)
- Masao Kaneki
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Charlestown, Massachusetts
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106
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Winkler MS, Rissiek A, Priefler M, Schwedhelm E, Robbe L, Bauer A, Zahrte C, Zoellner C, Kluge S, Nierhaus A. Human leucocyte antigen (HLA-DR) gene expression is reduced in sepsis and correlates with impaired TNFα response: A diagnostic tool for immunosuppression? PLoS One 2017; 12:e0182427. [PMID: 28771573 PMCID: PMC5542660 DOI: 10.1371/journal.pone.0182427] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 07/18/2017] [Indexed: 12/14/2022] Open
Abstract
Background Sepsis is defined as a dysregulated immune response to infection. Impaired immune response in sepsis, often described as endotoxin tolerance, is characterized by unresponsiveness of monocytes on lipopolysaccharide (LPS) stimulation to release tumor necrosis factor α (TNFα). Furthermore, decreased monocyte surface protein expression of human leucocyte antigen DR (HLA-DR) is a marker for changes of the innate immune response during sepsis. Quantitative polymerase chain reaction (qPCR) and flow-cytometry (FACS) have been used to measure protein or gene expression of HLA-DR. We aimed to determine whether changes in mRNA expression of HLA-DR are associated with impaired TNFα response in human sepsis. Methods Surface protein together with mRNA expression of HLA-DR were measured by FACS and qPCR in a cohort of 9 sepsis patients and compared to 10 pre-operative control patients in a prospective study. In addition, 20 patients with post-surgical inflammation, 20 patients with sepsis or septic shock were included and TNFα was determined following ex vivo stimulation of whole blood with 500 pg/mL LPS. Total RNA was prepared from whole blood and subjected to qPCR analysis for expression analysis of HLA-DR alpha (HLA-DRA) to correlate TNFα response with HLA-DRA expression. Results Patients with sepsis presented higher numbers of monocytes in peripheral blood (P<0.001) but decreased surface protein and mRNA HLA-DR levels when compared to controls. In all patients mRNA expression of HLA-DRA was decreased by approximately 70% compared to controls (P<0.01) and was lowest in patients with sepsis or septic shock (P<0.01). TNFα response to LPS was decreased in all patients (median 319 pg/mL versus controls 1256 pg/mL; P<0.01) and lowest in patients with sepsis or septic shock (median 128 pg/mL; P<0.01). HLA-DRA correlated positively with TNFα response in all study participants (r +0.60, P<0.001) and within patients (r +0.67, P<0.001). The TNFα:HLA-DRA ratio correlated negatively with severity and the Sequential Organ Failure Assessment (SOFA) score (Spearman’s rho -0.59, P<0.001) Conclusion In this study, HLA-DRA expression was associated with a functional assay of the innate immune response. Future interventional studies aimed at the immune response during sepsis could make use of these methods for optimizing target groups based on biological plausibility and intervention effectiveness.
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Affiliation(s)
| | - Anne Rissiek
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Priefler
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Robbe
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Bauer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinne Zahrte
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zoellner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Vijayan AL, Vanimaya, Ravindran S, Saikant R, Lakshmi S, Kartik R, G M. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care 2017; 5:51. [PMID: 28794881 PMCID: PMC5543591 DOI: 10.1186/s40560-017-0246-8] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/21/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Sepsis is a global healthcare problem, characterized by whole body inflammation in response to microbial infection, which leads to organ dysfunction. It is becoming a frequent complication in hospitalized patients. Early and differential diagnosis of sepsis is needed critically to avoid unnecessary usage of antimicrobial agents and for proper antibiotic treatments through the screening of biomarkers that sustains with diagnostic significance. MAIN BODY OF ABSTRACT Current targeting conventional markers (C-reactive protein, white blood cell, tumour necrosis factor-α, interleukins, etc.) are non-specific for diagnosing sepsis. Procalcitonin (PCT), a member of the calcitonin super family could be a critical tool for the diagnosis of sepsis. But to distinguish between bacterial versus viral infections, procalcitonin alone may not be effective. Rapid elevation in the concentration of procalcitonin and other newly emerging biomarkers during an infection and its correlation with severity of illness makes it an ideal biomarker for bacterial infection. Beside this, the procalcitonin levels can be used for monitoring response to antimicrobial therapy, diagnosis of secondary inflammations, diagnosis of renal involvement in paediatric urinary tract infection, etc. The present article summarizes the relevance of procalcitonin in the diagnosis of sepsis and how it can be useful in determining the therapeutic approaches. CONCLUSION Further studies are needed to better understand the application of PCT in the diagnosis of sepsis, differentiating between microbial and non-microbial infection cases and determining the therapeutic approaches for sepsis.
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Affiliation(s)
- Ashitha L. Vijayan
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - Vanimaya
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - Shilpa Ravindran
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - R. Saikant
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - S. Lakshmi
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - R. Kartik
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
| | - Manoj. G
- Diagnostic Products Division, Corporate R&D Centre, HLL Lifecare Limited, Akkulam, Sreekariyam (P.O), Trivandrum, Kerala India
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108
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Human Myeloid-derived Suppressor Cells are Associated With Chronic Immune Suppression After Severe Sepsis/Septic Shock. Ann Surg 2017; 265:827-834. [PMID: 27163951 DOI: 10.1097/sla.0000000000001783] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We hypothesized that after sepsis in humans, MDSCs will be persistently increased, functionally immunosuppressive, and associated with adverse clinical outcomes. BACKGROUND Cancer and sepsis have surprisingly similar immunologic responses and equally dismal long term consequences. In cancer, increased myeloid-derived suppressor cells (MDSCs) induce detrimental immunosuppression, but little is known about the role of MDSCs after sepsis. METHODS Blood was obtained from 74 patients within 12 hours of severe sepsis/septic shock (SS/SS), and at set intervals out to 28 days, and also in 18 healthy controls. MDSCs were phenotyped for cell surface receptor expression and enriched by cell sorting. Functional and genome-wide expression analyses were performed. Multiple logistic regression analysis was conducted to determine if increased MDSC appearance was associated with in-hospital and long-term outcomes. RESULTS After SS/SS, CD33CD11bHLA-DR MDSCs were dramatically increased out to 28 days (P < 0.05). When co-cultured with MDSCs from SS/SS patients, antigen-driven T-cell proliferation and TH1/TH2 cytokine production were suppressed (P < 0.05). Additionally, septic MDSCs had suppressed HLA gene expression and up-regulated ARG1 expression (P < 0.05). Finally, SS/SS patients with persistent increased percentages of blood MDSCs had increased nosocomial infections, prolonged intensive care unit stays, and poor functional status at discharge (P < 0.05). CONCLUSIONS After SS/SS in humans, circulating MDSCs are persistently increased, functionally immunosuppressive, and associated with adverse outcomes. This novel observation warrants further studies. As observed in cancer immunotherapy, MDSCs could be a novel component in multimodality immunotherapy targeting detrimental inflammation and immunosuppression after SS/SS to improve currently observed dismal long-term outcomes.
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109
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Ma S, Xu Q, Deng B, Zheng Y, Tian H, Wang L, Ding F. Granulocyte and monocyte adsorptive apheresis ameliorates sepsis in rats. Intensive Care Med Exp 2017; 5:18. [PMID: 28342161 PMCID: PMC5366986 DOI: 10.1186/s40635-017-0129-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/08/2017] [Indexed: 01/07/2023] Open
Abstract
Background Overwhelming activation of granulocytes and monocytes is central to inflammatory responses during sepsis. Granulocyte and monocyte adsorptive apheresis (GMA) is an extracorporeal leukocyte apheresis device filled with cellulose acetate beads and selectively adsorbs granulocytes and monocytes from the peripheral blood. Methods In this study, septic rats received the GMA treatment for 2 h at 18 h after cecal ligation and puncture. Results GMA selectively adsorbed activated neutrophils and monocytes from the peripheral blood, reduced serum inflammatory cytokine expression, and seemed to improve organ injuries and animal survival. GMA potentially reduced lung injury by alleviating the infiltration of inflammatory cells and the secretion of cytokines. Conclusions This study showed that selective granulocyte and monocyte adsorption with cellulose acetate beads might ameliorate cecal ligation and puncture (CLP)-induced sepsis and improve survival and organ function.
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Affiliation(s)
- Shuai Ma
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qingqing Xu
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Bo Deng
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yin Zheng
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Hongyan Tian
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Li Wang
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Feng Ding
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
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a-Lactose Improves the Survival of Septic Mice by Blockade of TIM-3 Signaling to Prevent NKT Cell Apoptosis and Attenuate Cytokine Storm. Shock 2017; 47:337-345. [DOI: 10.1097/shk.0000000000000717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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111
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Martín S, Pérez A, Aldecoa C. Sepsis and Immunosenescence in the Elderly Patient: A Review. Front Med (Lausanne) 2017; 4:20. [PMID: 28293557 PMCID: PMC5329014 DOI: 10.3389/fmed.2017.00020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/15/2017] [Indexed: 12/27/2022] Open
Abstract
Sepsis is a prevalent, serious medical condition with substantial mortality and a significant consumption of health-care resources. Its incidence has increased around 9% annually in general population over the last years and specially in aged patients group. Several risk factors such as comorbidities, preadmission status, malnutrition, frailty, and an impared function in the immune system called immunosenescence are involved in the higher predisposition to sepsis in the elderly patients. Immunosenescence status consists in a functional impairment in both cell-mediated immunity and humoral immune responses and increases not only the risk for develop sepsis but also lead to more severe presentation of infection and may be is also related with a higher mortality. There is a also a concern about to admit patients in the intensive care units taking into account that the outcome of elderly patients is poorer compared to younger people. Nevertheless, the management of septic elderly patients does not differ substantially from younger people. In addition, the quality of life in septic elderly survivors is also lower than in younger people. But age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients.
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Affiliation(s)
- Silvia Martín
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Alba Pérez
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Cesar Aldecoa
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega, Valladolid, Spain; University of Valladolid Medical School, Valladolid, Spain
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Ghrenassia E, Guihot A, Dong Y, Robinet P, Fontaine T, Lacombe K, Lescot T, Meyohas MC, Elbim C. First Report of CD4 Lymphopenia and Defective Neutrophil Functions in a Patient with Amebiasis Associated with CMV Reactivation and Severe Bacterial and Fungal Infections. Front Microbiol 2017; 8:203. [PMID: 28243230 PMCID: PMC5303735 DOI: 10.3389/fmicb.2017.00203] [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] [Received: 09/30/2016] [Accepted: 01/27/2017] [Indexed: 11/20/2022] Open
Abstract
We report the case of a patient with acute necrotizing colitis due to invasive amebiasis associated with CD4 lymphopenia and impaired neutrophil responses. The course of the disease was characterized by CMV reactivation and severe and recurrent bacterial and fungal infections, which might be related to the decreased CD4 T cell count and the impaired functional capacities of neutrophils, respectively. The clinical outcome was positive with normalization of both CD4 cell count and neutrophil functions.
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Affiliation(s)
- Etienne Ghrenassia
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Amélie Guihot
- Département d'Immunologie, AP-HP, Hôpital Pitié-SalpêtrièreParis, France; DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
| | - Yuan Dong
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Saint-Antoine, UMR-S 938 Paris, France
| | - Pauline Robinet
- DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
| | | | - Karine Lacombe
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Thomas Lescot
- Unité de Réanimation Chirurgicale Digestive, Département D'anesthésie et de Réanimation Chirurgicale, AP-HP, Hôpital Saint-Antoine Paris, France
| | - Marie-Caroline Meyohas
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales Paris, France
| | - Carole Elbim
- DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universités, UPMC Univ Paris 06Paris, France; Institut National de la Santé et de la Recherche Médicale, U1135, Centre d'Immunologie et des Maladies Infectieuses-ParisParis, France
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113
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Rodewohl A, Scholbach J, Leichsenring A, Köberle M, Lange F. Age-dependent cellular reactions of the human immune system of humanized NOD scid gamma mice on LPS stimulus. Innate Immun 2017; 23:258-275. [PMID: 28162006 DOI: 10.1177/1753425917690814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Despite sepsis being a life-threatening disease, targeted drugs that improve the therapy of affected patients are still lacking. Infants and adults differ in the maturity level of their immune system and this results in distinct reactions to Gram-negative bacteria. To study reactions of human immune cells in vivo, we used NOD scid gamma mice transplanted with human CD34+ stem cells to engraft a functional human immune system. Human cells undergo differentiation and maturation in these mice after transplantation and, accordingly, animals were divided into two groups: 8-13 wk and 15-22 wk after transplantation. Endotoxemia was induced by injecting LPS. Six h later, mice were euthanized. In both groups, LPS stimulation induced a decrease of CD14+ monocytes in peripheral blood, an up-regulation of activation markers on different cell subsets such as myeloid dendritic cells, and a release of the human cytokines TNF-α, IL-6 and IL-10. However, significant differences were detected with regard to the amounts of released cytokines, and 8-13-wk-old mice produced more IL-6, while PTX3 was mainly released by 15-22-wk-old animals. Thus, here we provide a potential model for preclinical research of sepsis in infants and adults.
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Affiliation(s)
- Anja Rodewohl
- 1 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,2 Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Johanna Scholbach
- 1 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,3 Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Anna Leichsenring
- 1 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Margarethe Köberle
- 1 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,2 Translational Centre for Regenerative Medicine, University of Leipzig, Leipzig, Germany
| | - Franziska Lange
- 1 Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
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Zhou M, Yang WL, Aziz M, Ma G, Wang P. Therapeutic effect of human ghrelin and growth hormone: Attenuation of immunosuppression in septic aged rats. Biochim Biophys Acta Mol Basis Dis 2017; 1863:2584-2593. [PMID: 28115288 DOI: 10.1016/j.bbadis.2017.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 12/12/2022]
Abstract
Sepsis is a leading cause of mortality in intensive care units, and is more common in the geriatric population. The control of hyperinflammation has been suggested as a therapeutic approach in sepsis, but to date clinical trials utilizing this strategy have not lead to an effective treatment. In addition to hyperinflammation, patients with sepsis often experience a state of immunosuppression, which serves as an important determinant for increased morbidity and mortality. We previously used aged animals to demonstrate the effectiveness of combined treatment with human ghrelin (Ghr) and human growth hormone (GH) in improving organ injury and survival in septic animals. Here, we hypothesized that combined treatment with Ghr and GH could improve immune function in septic aged animals. Male 24-month-old rats were subjected to cecal ligation and puncture (CLP) for sepsis induction. Human Ghr (80nmol/kg BW) plus GH (50μg/kg BW) or vehicle (normal saline) was administrated subcutaneously at 5h after CLP. The ex vivo production of TNF-α, IL-6 and IL-10 to LPS-stimulation, as well as TNF-α, IL-6, IL-10 and IFN-γ production to anti-CD3/anti-CD28 antibody-stimulation, in splenocytes isolated 20h after CLP, was significantly decreased compared to production of these cytokines in splenocytes from sham animals. The production of cytokines from splenocytes isolated from septic animals that received the combined treatment, however, was significantly higher than from those isolated from vehicle-treated septic animals. Combined treatment prevented the loss of splenic CD4+ and CD8+ T cells in septic aged rats, and reduced lymphocyte apoptosis. Combined treatment also inhibited an increase in the regulatory T cell (Treg) population and expression of the immune co-inhibitory molecule PD-1 in the spleens of septic aged rats. In contrast, expression of HLA-DR was increased after combined treatment with Ghr and GH. Based on these findings, we conclude that co-administration of Ghr and GH is a promising therapeutic tool for reversing immunosuppression caused by sepsis in the geriatric population. This article is part of a Special Issue entitled: Immune and Metabolic Alterations in Trauma and Sepsis edited by Dr. Raghavan Raju.
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Affiliation(s)
- Mian Zhou
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Weng-Lang Yang
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA; Department of Surgery, Hofstra Northwell School of Medicine, Manhasset, NY 11030, USA.
| | - Monowar Aziz
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Gaifeng Ma
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
| | - Ping Wang
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA; Department of Surgery, Hofstra Northwell School of Medicine, Manhasset, NY 11030, USA.
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Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, Yoon H, Cha WC, Sim MS. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2016; 35:234-239. [PMID: 27806894 DOI: 10.1016/j.ajem.2016.10.055] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We evaluated the associations between the neutrophil-to-lymphocyte ratio (NLR) or changes in NLR and outcomes in septic patients. METHODS Patients who met the criteria for severe sepsis or septic shock were categorized into five groups according to the quintile of initial NLR value. We defined two risk groups according to NLR value and changes in NLR during the first two days (defined as the persistently low NLR group and the persistently high NLR group). The primary outcome was 28-day mortality. RESULTS A total of 1395 patients were included. The median initial NLR values from Quintile 1 to Quintile 5 were as follows: 0.2 (IQR [interquartile range], 0.1-0.7), 3.4 (IQR, 2.6-4.7), 8.6 (IQR, 7.1-9.9), 15.4 (IQR, 13.3-17.8), and 31.0 (IQR, 24.6-46.8), respectively. The 28-day mortality values for the same groups were as follows: 24.4%, 12.2%, 11.1%, 11.8%, and 16.1% (P<.01). Cox regression analysis showed that inclusion in Quintile 1 or Quintile 5 was a significant risk factor predicting 28-day mortality compared to Quintile 3 (adjusted hazard ratio [HR]: 1.79 (95% confidence interval [CI], 1.15-2.78) in Quintile 1; 1.67 (95% CI, 1.04-2.66) in Quintile 5). The analysis indicated that persistently low NLR (adjusted HR: 2.25, 95% CI, 1.63-3.11) and persistently high NLR (adjusted HR: 2.65, 95% CI, 1.64-4.29) were significant risk factors. CONCLUSIONS In summary, the initial NLR measured at ED admission was independently associated with 28-day mortality in patients with severe sepsis and septic shock. In addition, change in NLR may prove to be a valuable prognostic marker.
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Affiliation(s)
- Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Rim Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Jeung YJ, Kim HG, Ahn J, Lee HJ, Lee SB, Won M, Jung CR, Im JY, Kim BK, Park SK, Son MJ, Chung KS. Shikonin induces apoptosis of lung cancer cells via activation of FOXO3a/EGR1/SIRT1 signaling antagonized by p300. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2016; 1863:2584-2593. [PMID: 27452907 DOI: 10.1016/j.bbamcr.2016.07.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/23/2016] [Accepted: 07/19/2016] [Indexed: 01/23/2023]
Abstract
Shikonin derivatives exert powerful cytotoxic effects including induction of apoptosis. Here, we demonstrate the cytotoxic efficacy of shikonin in vivo in xenograft models, which did not affect body weight as well as its reduction of cell viability in vitro using several non-small cell lung cancer (NSCLC) cell lines. We found that inhibition of AKT by shikonin activated the forkhead box (FOX)O3a/early growth response protein (EGR)1 signaling cascade and enhanced the expression of the target gene Bim, leading to apoptosis in lung cancer cells. Overexpression of wild-type or a constitutively active mutant of FOXO3a enhanced shikonin-induced Bim expression. The NAD+-dependent histone deacetylase sirtuin (SIRT)1 amplified the pro-apoptotic effect by deacetylating FOXO3a, which induced EGR1 binding to the Bim promoter and activated Bim expression. Meanwhile, PI3K/AKT activity was enhanced, whereas that of FOXO3a was reduced and p300 was upregulated by treatment with a sublethal dose of shikonin. FOXO3a acetylation was enhanced by p300 overexpression, while shikonin-induced Bim expression was suppressed by p300 overexpression, which promoted cell survival. FOXO3a acetylation was increased by p300 overexpression and treatment with SIRT1 inhibitor, improving cell survival. In addition, shikonin-induced FOXO3a nuclear localization was blocked by AKT activation and SIRT1 inhibition, which blocked Bim expression and conferred resistance to the cytotoxic effects of shikonin. The EGR1 increase induced by shikonin was restored by pretreatment with SIRT1 inhibitor. These results suggest that shikonin induces apoptosis in some lung cancer cells via activation of FOXO3a/EGR1/SIRT1 signaling, and that AKT and p300 negatively regulate this process via Bim upregulation.
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Affiliation(s)
- Yun-Ji Jeung
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea; Department of Biochemistry, Chungnam National University Medical School, Daejeon 301-747, Republic of Korea
| | - Han-Gyeul Kim
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea; Functional Genomics, Korea University of Science and Technology (UST), Daejeon, 305-806, Republic of Korea
| | - Jiwon Ahn
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Ho-Joon Lee
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Sae-Bhom Lee
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Misun Won
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Cho-Rock Jung
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Joo-Young Im
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Bo-Kyung Kim
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea
| | - Seung-Kiel Park
- Department of Biochemistry, Chungnam National University Medical School, Daejeon 301-747, Republic of Korea
| | - Myung Jin Son
- Stem Cell Research Center, KRIBB, Daejeon 34141, Republic of Korea; Functional Genomics, Korea University of Science and Technology (UST), Daejeon, 305-806, Republic of Korea.
| | - Kyung-Sook Chung
- Biomedical Translational Research Center, KRIBB, Daejeon 34141, Republic of Korea; Functional Genomics, Korea University of Science and Technology (UST), Daejeon, 305-806, Republic of Korea.
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WHAT'S NEW IN SHOCK? MARCH 2016. Shock 2016; 45:239-40. [PMID: 26871661 DOI: 10.1097/shk.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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