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Schrijver IT, Théroude C, Roger T. Myeloid-Derived Suppressor Cells in Sepsis. Front Immunol 2019; 10:327. [PMID: 30873175 PMCID: PMC6400980 DOI: 10.3389/fimmu.2019.00327] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/08/2019] [Indexed: 12/16/2022] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) are immature myeloid cells characterized by their immunosuppressive functions. MDSCs expand during chronic and acute inflammatory conditions, the best described being cancer. Recent studies uncovered an important role of MDSCs in the pathogenesis of infectious diseases along with sepsis. Here we discuss the mechanisms underlying the expansion and immunosuppressive functions of MDSCs, and the results of preclinical and clinical studies linking MDSCs to sepsis pathogenesis. Strikingly, all clinical studies to date suggest that high proportions of blood MDSCs are associated with clinical worsening, the incidence of nosocomial infections and/or mortality. Hence, MDSCs are attractive biomarkers and therapeutic targets for sepsis, especially because these cells are barely detectable in healthy subjects. Blocking MDSC-mediated immunosuppression and trafficking or depleting MDSCs might all improve sepsis outcome. While some key aspects of MDSCs biology need in depth investigations, exploring these avenues may participate to pave the way toward the implementation of personalized medicine and precision immunotherapy for patients suffering from sepsis.
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Affiliation(s)
- Irene T Schrijver
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Epalinges, Switzerland
| | - Charlotte Théroude
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Epalinges, Switzerland
| | - Thierry Roger
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Epalinges, Switzerland
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102
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Albert Vega C, Mommert M, Boccard M, Rimmelé T, Venet F, Pachot A, Leray V, Monneret G, Delwarde B, Brengel-Pesce K, Mallet F, Trouillet-Assant S. Source of Circulating Pentraxin 3 in Septic Shock Patients. Front Immunol 2019; 9:3048. [PMID: 30687307 PMCID: PMC6338061 DOI: 10.3389/fimmu.2018.03048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/10/2018] [Indexed: 12/29/2022] Open
Abstract
Sepsis, which is the leading cause of death in intensive care units (ICU), has been acknowledged as a global health priority by the WHO in 2017. Identification of biomarkers allowing early stratification and recognition of patients at higher risk of death is crucial. One promising biomarker candidate is pentraxin-3 (PTX3); initially elevated and persistently increased plasma concentration in septic patients has been associated with increased mortality. PTX3 is an acute phase protein mainly stored in neutrophil granules. These cells are responsible for rapid and prompt release of PTX3 in inflammatory context, but the cellular origin responsible for successive days' elevation in sepsis remains unknown. Upon inflammatory stimulation, PTX3 can also be produced by other cell types, including endothelial and immune cells. As in septic patients immune alterations have been described, we therefore sought to investigate whether such cells participated in the elevation of PTX3 over the first days after septic shock onset. To address this point, PTX3 was measured in plasma from septic shock patients at day 3 after ICU admission as well as in healthy volunteers (HV), and the capacity of whole blood cells to secrete PTX3 after inflammatory stimulation was evaluated ex vivo. A significantly mean higher (100-fold) concentration of plasma PTX3 was found in patients compared to HV, which was likely due to the inflammation-induced initial release of the pre-existing PTX3 reservoir contained in neutrophils. Strikingly, when whole blood was stimulated ex vivo with LPS no significant difference between patients and HV in PTX3 release was found. This was in contrast with TNFα which decreased production was illustrative of the endotoxin tolerance phenomenon occurring in septic patients. Then, the release of PTX3 protein from a HV neutrophil-free PBMC endotoxin tolerance model was investigated. At the transcriptional level, PTX3 seems to be a weakly tolerizable gene similar to TNFα. Conversely, increased protein levels observed in anergy condition reflects a non-tolerizable phenotype, more likely to an anti-inflammatory marker. Hence, altered immune cells still have the ability to produce PTX3 in response to an inflammatory trigger, and therefore circulating white blood cell subset could be responsible of the sustained PTX3 plasma levels over the first days of sepsis setting.
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Affiliation(s)
- Chloé Albert Vega
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Pierre Bénite, France
| | - Marine Mommert
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Pierre Bénite, France
| | - Mathilde Boccard
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Département des Maladies Infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmelé
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University-bioMérieux-Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Fabienne Venet
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University-bioMérieux-Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France
| | - Alexandre Pachot
- Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Pierre Bénite, France
| | - Veronique Leray
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Monneret
- EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University-bioMérieux-Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Hospices Civils de Lyon, Edouard Herriot Hospital, Immunology Laboratory, Lyon, France
| | - Benjamin Delwarde
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Karen Brengel-Pesce
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Pierre Bénite, France
| | - François Mallet
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Pierre Bénite, France.,EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University-bioMérieux-Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Sophie Trouillet-Assant
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon Centre Hospitalier Lyon Sud, Lyon, France.,Faculté de Médecine Lyon Est, Virpath - Université Lyon, CIRI, INSERM U1111, CNRS 5308, ENS, UCBL, Lyon, France
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103
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104
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Zhang L, Qiu C, Yang L, Zhang Z, Zhang Q, Wang B, Wang X. GPR18 expression on PMNs as biomarker for outcome in patient with sepsis. Life Sci 2018; 217:49-56. [PMID: 30503722 DOI: 10.1016/j.lfs.2018.11.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 01/17/2023]
Abstract
AIMS GPR18, a G protein-coupled receptor (GPCR), is involved in bacterial clearance and survival in microbial sepsis. In this study, we examine GPR18 expression on polymorphonuclear neutrophils (PMNs) of patients with sepsis and to determine the potential association with disease severity and outcomes. MAIN METHODS We enrolled 81 patients admitted at the intensive care unit (ICU) with the diagnosis of sepsis. PMNs GPR18 expression was measured by flow cytometry at admission. Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHEII) as well as other biomarker were measured at admission. Cox regression analysis was used to determine the influence of PMNs GPR18 expression on 28-day mortality. KEY FINDINGS Patients with sepsis had a decreased percentage of PMNs bearing GPR18 in comparison with healthy subjects (P < 0.001). Compared with survivors, non-survivors had lower percentage of GPR18-positive PMNs, but higher SOFA, APACHEIIscores, and WBC count. There were inverse correlations between the percentage of GPR18-positive PMNs and APACHEII, SOFA score and C-recreative protein (CRP). Using Kaplan-Meier analysis, high percentage of PMNs expressing GPR18 (≥43.7%) was associated with a preferable 28-day survival (P = 0.004). High percentage of PMNs expressing GPR18 (≥43.7%) was significantly and independently associated with 28-day mortality, with a hazard ratio of 0.36 (P = 0.37). Moreover, LPS-Toll-like receptor (TLR)4 signaling mediated the GPR18 expression on PMNs. SIGNIFICANCE These results indicate that decreased percentage GPR18-positive PMNs is associated with increased severity and poorer outcome of sepsis.
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Affiliation(s)
- Lanqiu Zhang
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Chongyang Qiu
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Lei Yang
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Zhen Zhang
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Qi Zhang
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Botao Wang
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - Ximo Wang
- Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin, 300100, China.
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105
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Albert-Vega C, Tawfik DM, Trouillet-Assant S, Vachot L, Mallet F, Textoris J. Immune Functional Assays, From Custom to Standardized Tests for Precision Medicine. Front Immunol 2018; 9:2367. [PMID: 30386334 PMCID: PMC6198655 DOI: 10.3389/fimmu.2018.02367] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022] Open
Abstract
The immune response is a dynamic system that maintains the integrity of the body, and more specifically fight against infections. However, an unbalanced host immune response is highlighted in many diseases. Exacerbated responses lead to autoimmune and allergic diseases, whereas, low or inefficient responses favor opportunistic infections and viral reactivations. Conflicting situations may also occur, such as in sepsis where inflammation and compensatory immunosuppression make it difficult to deploy the appropriate drug treatment. Until the current day, assessing the immune profile of patients remains a challenge. This is especially due to the inter-individual variability—a key feature of the immune system—which hinders precise diagnosis, prognosis, and therapeutic stratification. Our incapacity to practically interpret the host response may contribute to a high morbidity and mortality, such as the annual 6 million worldwide deaths in sepsis alone. Therefore, there is a high and increasing demand to assess patient immune function in routine clinical practice, currently met by Immune Functional Assays. Immune Functional Assays (IFA) hold a plethora of potentials that include the precise diagnosis of infections, as well as prediction of secondary and latent infections. Current available products are devoted to indirect pathogen detection such as Mycobacteria tuberculosis interferon gamma release assays (IGRA). In addition, identifying the status and the underlying factors of immune dysfunction (e.g., in septic patients) may guide immune targeted therapies. Tools to monitor and stratify the immune status are currently being studied but they still have many limitations such as technical standardization, biomarkers relevance, systematic interpretation and need to be simplified, in order to set the boundaries of “healthy,” “ill,” and “critically ill” responses. Thus, the design of new tools that give a comprehensive insight into the immune functionality, at the bedside, and in a timely manner represents a leap toward immunoprofiling of patients.
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Affiliation(s)
- Chloé Albert-Vega
- Joint Research Unit, Hospice Civils de Lyon, bioMerieux, Centre Hospitalier Lyon Sud, Pierre-Benite, France
| | - Dina M Tawfik
- Medical Diagnostic Discovery Department, bioMérieux S.A., Grenoble, France.,EA7426 Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux, Lyon, France
| | - Sophie Trouillet-Assant
- Joint Research Unit, Hospice Civils de Lyon, bioMerieux, Centre Hospitalier Lyon Sud, Pierre-Benite, France.,Virologie et Pathologie Humaine - VirPath Team, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Laurence Vachot
- Medical Diagnostic Discovery Department, bioMérieux S.A., Grenoble, France
| | - François Mallet
- Joint Research Unit, Hospice Civils de Lyon, bioMerieux, Centre Hospitalier Lyon Sud, Pierre-Benite, France.,EA7426 Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux, Lyon, France
| | - Julien Textoris
- EA7426 Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux, Lyon, France.,Hospices Civils de Lyon, Department of Anaesthesiology and Critical Care Medicine, Groupement Hospitalier Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France
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106
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Daix T, Guérin E, Tavernier E, Marsaud J, Hacan A, Gauthier F, Piccardo A, Vignon P, Feuillard J, François B. Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:887-894. [DOI: 10.1002/cyto.b.21739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/06/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Daix
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
| | - Estelle Guérin
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Elsa Tavernier
- Inserm CIC1415, Tours Teaching HospitalFrançois Rabelais University Tours France
| | | | - Adélaïde Hacan
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
| | | | - Alessandro Piccardo
- Cardiothoracic and Vascular Surgery UnitDupuytren Teaching Hospital Limoges France
| | - Philippe Vignon
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
| | - Jean Feuillard
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Bruno François
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
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107
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Faulhaber FRS, Faulhaber GAM, Marcondes NA, Procianoy RS, Silveira RC. Expression of neutrophil surface markers in icteric neonates before and after phototherapy. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:895-900. [DOI: 10.1002/cyto.b.21734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Fabrízia Rennó Sodero Faulhaber
- Programa de Pós‐Graduação em Saúde da Criança e do AdolescenteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Serviço de Onco‐Hematologia PediátricaHospital Nossa Senhora da Conceição Porto Alegre Brazil
| | - Gustavo Adolpho Moreira Faulhaber
- Laboratório Zanol Porto Alegre Brazil
- Programa de Pós Graduação em Medicina: Ciências MédicasUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Departmento de Medicina InternaUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | | | - Renato Soibelmann Procianoy
- Programa de Pós‐Graduação em Saúde da Criança e do AdolescenteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Departmento de PediatriaUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Departmento de PediatriaHospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | - Rita C. Silveira
- Programa de Pós‐Graduação em Saúde da Criança e do AdolescenteUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Departmento de PediatriaUniversidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Departmento de PediatriaHospital de Clínicas de Porto Alegre Porto Alegre Brazil
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108
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Shankar-Hari M, Datta D, Wilson J, Assi V, Stephen J, Weir CJ, Rennie J, Antonelli J, Bateman A, Felton JM, Warner N, Judge K, Keenan J, Wang A, Burpee T, Brown AK, Lewis SM, Mare T, Roy AI, Wright J, Hulme G, Dimmick I, Gray A, Rossi AG, Simpson AJ, Conway Morris A, Walsh TS. Early PREdiction of sepsis using leukocyte surface biomarkers: the ExPRES-sepsis cohort study. Intensive Care Med 2018; 44:1836-1848. [PMID: 30291379 DOI: 10.1007/s00134-018-5389-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Reliable biomarkers for predicting subsequent sepsis among patients with suspected acute infection are lacking. In patients presenting to emergency departments (EDs) with suspected acute infection, we aimed to evaluate the reliability and discriminant ability of 47 leukocyte biomarkers as predictors of sepsis (Sequential Organ Failure Assessment score ≥ 2 at 24 h and/or 72 h following ED presentation). METHODS In a multi-centre cohort study in four EDs and intensive care units (ICUs), we standardised flow-cytometric leukocyte biomarker measurement and compared patients with suspected acute infection (cohort-1) with two comparator cohorts: ICU patients with established sepsis (cohort-2), and ED patients without infection or systemic inflammation but requiring hospitalization (cohort-3). RESULTS Between January 2014 and February 2016, we recruited 272, 59 and 75 patients to cohorts 1, 2, and 3, respectively. Of 47 leukocyte biomarkers, 14 were non-reliable, and 17 did not discriminate between the three cohorts. Discriminant analyses for predicting sepsis within cohort-1 were undertaken for eight neutrophil (cluster of differentiation antigens (CD) CD15; CD24; CD35; CD64; CD312; CD11b; CD274; CD279), seven monocyte (CD35; CD64; CD312; CD11b; HLA-DR; CD274; CD279) and a CD8 T-lymphocyte biomarker (CD279). Individually, only higher neutrophil CD279 [OR 1.78 (95% CI 1.23-2.57); P = 0.002], higher monocyte CD279 [1.32 (1.03-1.70); P = 0.03], and lower monocyte HLA-DR [0.73 (0.55-0.97); P = 0.03] expression were associated with subsequent sepsis. With logistic regression the optimum biomarker combination was increased neutrophil CD24 and neutrophil CD279, and reduced monocyte HLA-DR expression, but no combination had clinically relevant predictive validity. CONCLUSIONS From a large panel of leukocyte biomarkers, immunosuppression biomarkers were associated with subsequent sepsis in ED patients with suspected acute infection. CLINICAL TRIAL REGISTRATION NCT02188992.
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Affiliation(s)
- Manu Shankar-Hari
- School of Immunology & Microbial Sciences, Kings College, London, UK. .,Guy's and St Thomas' NHS Foundation Trust, London, SE17EH, UK.
| | - Deepankar Datta
- MRC Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Julie Wilson
- School of Immunology & Microbial Sciences, Kings College, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, SE17EH, UK
| | - Valentina Assi
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - Christopher J Weir
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jillian Rennie
- MRC Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Jean Antonelli
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anthony Bateman
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer M Felton
- MRC Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Noel Warner
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Kevin Judge
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Jim Keenan
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Alice Wang
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Tony Burpee
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Alun K Brown
- Guy's and St Thomas' NHS Foundation Trust, London, SE17EH, UK
| | - Sion M Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, SE17EH, UK
| | - Tracey Mare
- Guy's and St Thomas' NHS Foundation Trust, London, SE17EH, UK
| | - Alistair I Roy
- Becton-Dickinson Bioscience, Franklin Lakes, NJ, USA.,Integrated Critical Care Unit, Sunderland Royal Hospital, Sunderland, UK
| | - John Wright
- Emergency Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gillian Hulme
- Flow Cytometry Core Facility Laboratory, Faculty of Medical Sciences, Centre for Life, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Dimmick
- Flow Cytometry Core Facility Laboratory, Faculty of Medical Sciences, Centre for Life, Newcastle University, Newcastle upon Tyne, UK
| | - Alasdair Gray
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.,Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Adriano G Rossi
- MRC Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - A John Simpson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Conway Morris
- University Division of Anesthesia, Department of Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Timothy S Walsh
- MRC Centre for Inflammation Research, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK.,Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
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109
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Multilateral Functional Alterations of Human Neutrophils in Sepsis: From the Point of Diagnosis to the Seventh Day. Shock 2018; 48:629-637. [PMID: 28430717 DOI: 10.1097/shk.0000000000000883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neutrophil functional changes caused by sepsis itself and their time-course variation have not been fully elucidated because previous studies targeted patients who had received therapeutic interventions. We explored the multilateral functions of circulating neutrophils in patients with severe sepsis or septic shock who had not yet undergone interventions, and followed their changes. Patients were treated based on the Surviving Sepsis Campaign Guidelines 2012. Neutrophil functions were evaluated on days 0 (before therapeutic intervention), 3, and 7 in 59 septic patients. The clinical severity score (APACHE II and SOFA) and serum pro-/anti-inflammatory cytokine concentrations of the patients were significantly increased on day 0 and normalized on day 3. However, neutrophil priming state, estimated by measuring the fMLP-stimulated reactive oxygen species, was significantly elevated on day 0, further augmented on day 3, and then returned to day 0 levels on day 7 despite general resolution of the inflammatory response. The expression of CXC chemokine receptor 2 and paired immunoglobulin-like receptor α, assessed as surrogate markers of transmigration and adhesion potency, was suppressed most strongly on day 0 and gradually recovered. To conclude, contrary to the patient's clinical course, neutrophil priming state was augmented most strongly at 3 days after diagnosis of sepsis. Impaired transmigration and excessive adhesion potency were observed most prominently at diagnosis. These observations would partially explain the mechanism of development of multiple organ dysfunction of the host who is subjected to a secondary insult, and may provide an important perspective for the implementation of additional immune-modulating therapy in sepsis.
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110
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ter Haar NM, Tak T, Mokry M, Scholman RC, Meerding JM, de Jager W, Verwoerd A, Foell D, Vogl T, Roth J, Leliefeld PHC, van Loosdregt J, Koenderman L, Vastert SJ, de Roock S. Reversal of Sepsis-Like Features of Neutrophils by Interleukin-1 Blockade in Patients With Systemic-Onset Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2018; 70:943-956. [DOI: 10.1002/art.40442] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/01/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Nienke M. ter Haar
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
| | - Tamar Tak
- University Medical Center Utrecht and Utrecht University; Utrecht The Netherlands
| | - Michal Mokry
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
| | - Rianne C. Scholman
- University Medical Center Utrecht and Utrecht University; Utrecht The Netherlands
| | - Jenny M. Meerding
- University Medical Center Utrecht and Utrecht University; Utrecht The Netherlands
| | - Wilco de Jager
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
| | - Anouk Verwoerd
- University Medical Center Utrecht and Utrecht University; Utrecht The Netherlands
| | - Dirk Foell
- University of Muenster; Muenster Germany
| | | | | | | | - Jorg van Loosdregt
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
| | - Leo Koenderman
- University Medical Center Utrecht and Utrecht University; Utrecht The Netherlands
| | - Sebastiaan J. Vastert
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
| | - Sytze de Roock
- University Medical Center Utrecht; Wilhelmina Children's Hospital and Utrecht University; Utrecht The Netherlands
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111
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Sepsis Induces a Dysregulated Neutrophil Phenotype That Is Associated with Increased Mortality. Mediators Inflamm 2018; 2018:4065362. [PMID: 29849488 PMCID: PMC5925119 DOI: 10.1155/2018/4065362] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/29/2018] [Indexed: 01/18/2023] Open
Abstract
Background Neutrophil dysfunction in sepsis has been implicated in the pathogenesis of multiorgan failure; however, the role of neutrophil extracellular traps (NETs) remains uncertain. We aimed to determine the sequential changes in ex vivo NETosis and its relationship with mortality in patients with sepsis and severe sepsis. Methods This was a prospective observational cohort study enrolling 21 healthy age-matched controls and 39 sepsis and 60 severe sepsis patients from acute admissions to two UK hospitals. Patients had sequential bloods for the ex vivo assessment of NETosis in response to phorbol-myristate acetate (PMA) using a fluorometric technique and chemotaxis using time-lapse video microscopy. Continuous data was tested for normality, with appropriate parametric and nonparametric tests, whilst categorical data was analysed using a chi-squared test. Correlations were performed using Spearman's rho. Results Ex vivo NETosis was reduced in patients with severe sepsis, compared to patients with sepsis and controls (p = 0.002). PMA NETosis from patients with septic shock was reduced further (p < 0.001) compared to controls. The degree of metabolic acidosis correlated with reduced NETosis (p < 0.001), and this was replicated when neutrophils from healthy donors were incubated in acidotic media. Reduced NETosis at baseline was associated with an increased 30-day (p = 0.002) and 90-day mortality (p = 0.014) in sepsis patients. These findings were accompanied by defects in neutrophil migration and delayed apoptosis. Resolution of sepsis was not associated with the return to baseline levels of NETosis or migration. Conclusions Sepsis induces significant changes in neutrophil function with the degree of dysfunction corresponding to the severity of the septic insult which persists beyond physiological recovery from sepsis. The changes induced lead to the failure to effectively contain and eliminate the invading pathogens and contribute to sepsis-induced immunosuppression. For the first time, we demonstrate that reduced ex vivo NETosis is associated with poorer outcomes from sepsis.
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112
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Wang X, Qin W, Zhang Y, Zhang H, Sun B. Endotoxin promotes neutrophil hierarchical chemotaxis via the p38-membrane receptor pathway. Oncotarget 2018; 7:74247-74258. [PMID: 27655676 PMCID: PMC5342050 DOI: 10.18632/oncotarget.12093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/10/2016] [Indexed: 01/09/2023] Open
Abstract
Neutrophils are the most abundant leukocytes in peripheral blood and play critical a role in bacterial infection, tumor immunity and wound repair. Clarifying the process of neutrophil chemotaxis to target sites of immune activity has been a focus of increased interest within the past decade. In bacterial infectious foci, neutrophils migrate toward the bacterial-derived chemoattractant N-formyl-Met-Leu-Phe (fMLP) and ignore other intermediary chemoattractants to arrive at the area of infection. Using an under agarose chemotaxis assay, we observed that the bacterial fMLP-induced neutrophil chemotaxis signal overrode interleukin 8 (IL-8)- and leukotriene B4 (LTB4)-induced chemotaxis signals. Moreover, in the presence of bacterial lipopolysaccharide (LPS), the fMLP-induced hierarchical chemotaxis signal was enhanced. Further studies revealed that LPS increased the membrane expression of the fMLP receptor, formyl peptide receptor 1 (FPR1). However, expression levels of the membrane receptors for IL-8 and LTB4 were decreased by LPS administration. A human Phospho-mitogen-activated protein kinase (MAPK) proteome array showed that the p38 pathway was significantly activated by LPS stimulation. Moreover, p38 was responsible for the altered expression of neutrophil membrane chemoattractant receptors. Inhibition of neutrophil p38 restored LPS-improved hierarchical chemotaxis. Taken together, these data indicate that endotoxin promotes neutrophil hierarchical chemotaxis via the p38-membrane receptor pathway.
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Affiliation(s)
- Xu Wang
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Weiting Qin
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Yisen Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Huafeng Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Bingwei Sun
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
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Halbgebauer R, Schmidt CQ, Karsten CM, Ignatius A, Huber-Lang M. Janus face of complement-driven neutrophil activation during sepsis. Semin Immunol 2018; 37:12-20. [PMID: 29454576 DOI: 10.1016/j.smim.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 12/28/2022]
Abstract
During local and systemic inflammation, the complement system and neutrophil granulocytes are activated not only by pathogens, but also by released endogenous danger signals. It is recognized increasingly that complement-mediated neutrophil activation plays an ambivalent role in sepsis pathophysiology. According to the current definition, the onset of organ dysfunction is a hallmark of sepsis. The preceding organ damage can be caused by excessive complement activation and neutrophil actions against the host, resulting in bystander injury of healthy tissue. However, in contrast, persistent and overwhelming inflammation also leads to a reduction in neutrophil responsiveness as well as complement components and thus may render patients at enhanced risk of spreading infection. This review provides an overview on the molecular and cellular processes that link complement with the two-faced functional alterations of neutrophils in sepsis. Finally, we describe novel tools to modulate this interplay beneficially in order to improve outcome.
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Affiliation(s)
- R Halbgebauer
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Hospital, Helmholtzstr. 8/1, 89081 Ulm, Germany.
| | - C Q Schmidt
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, Ulm University, Helmholtzstr. 20, 89081 Ulm, Germany.
| | - C M Karsten
- Institute for Systemic Inflammation Research, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany.
| | - A Ignatius
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Helmholtzstr. 14, 89081 Ulm, Germany.
| | - M Huber-Lang
- Institute of Clinical and Experimental Trauma Immunology, Ulm University Hospital, Helmholtzstr. 8/1, 89081 Ulm, Germany.
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114
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Hibbert JE, Currie A, Strunk T. Sepsis-Induced Immunosuppression in Neonates. Front Pediatr 2018; 6:357. [PMID: 30555806 PMCID: PMC6281766 DOI: 10.3389/fped.2018.00357] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/02/2018] [Indexed: 12/13/2022] Open
Abstract
Neonates, especially those born preterm, are at increased risk of sepsis and adverse long-term effects associated with infection-related inflammation. Distinct neonatal immune responses and dysregulated inflammation are central to this unique susceptibility. The traditional separation of sepsis into an initial hyper-inflammatory response followed by hypo-inflammation is continually under review with new developments in this area of research. There is evidence to support the association of mortality in the early acute phase of sepsis with an overwhelming hyper-inflammatory immune response. Emerging evidence from adults suggests that hypo- and hyper-inflammation can occur during any phase of sepsis and that sepsis-immunosuppression is associated with increased mortality, morbidity, and risk to subsequent infection. In adults, sepsis-induced immunosuppression (SII) is characterised by alterations of innate and adaptive immune responses, including, but not limited to, a prominent bias toward anti-inflammatory cytokine secretion, diminished antigen presentation to T cells, and reduced activation and proliferation of T cells. It is unclear if sepsis-immunosuppression also plays a role in the adverse outcomes associated with neonatal sepsis. This review will focus on exploring if key characteristics associated with SII in adults are observed in neonates with sepsis.
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Affiliation(s)
- Julie E Hibbert
- Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia
| | - Andrew Currie
- Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia.,School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | - Tobias Strunk
- Centre for Neonatal Research and Education, University of Western Australia, Perth, WA, Australia.,Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, WA, Australia
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Abstract
During critical illness, dramatic alterations in neutrophil biology are observed including abnormalities of granulopoeisis and lifespan, cell trafficking and antimicrobial effector functions. As a result, neutrophils transition from powerful antimicrobial protectors into dangerous mediators of tissue injury and organ dysfunction. In this article, the role of neutrophils in the pathogenesis of critical illness (sepsis, trauma, burns and others) will be explored, including pathological changes to neutrophil function during critical illness and the utility of monitoring aspects of the neutrophil phenotype as biomarkers for diagnosis and prognostication. Lastly, we review findings from clinical trials of therapies that target the harmful effects of neutrophils, providing a bench-to-bedside perspective on neutrophils in critical illness.
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Identification of potential transcriptomic markers in developing pediatric sepsis: a weighted gene co-expression network analysis and a case-control validation study. J Transl Med 2017; 15:254. [PMID: 29237456 PMCID: PMC5729245 DOI: 10.1186/s12967-017-1364-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/08/2017] [Indexed: 01/23/2023] Open
Abstract
Background Sepsis represents a complex disease with the dysregulated inflammatory response and high mortality rate. The goal of this study was to identify potential transcriptomic markers in developing pediatric sepsis by a co-expression module analysis of the transcriptomic dataset. Methods Using the R software and Bioconductor packages, we performed a weighted gene co-expression network analysis to identify co-expression modules significantly associated with pediatric sepsis. Functional interpretation (gene ontology and pathway analysis) and enrichment analysis with known transcription factors and microRNAs of the identified candidate modules were then performed. In modules significantly associated with sepsis, the intramodular analysis was further performed and “hub genes” were identified and validated by quantitative real-time PCR (qPCR) in this study. Results 15 co-expression modules in total were detected, and four modules (“midnight blue”, “cyan”, “brown”, and “tan”) were most significantly associated with pediatric sepsis and suggested as potential sepsis-associated modules. Gene ontology analysis and pathway analysis revealed that these four modules strongly associated with immune response. Three of the four sepsis-associated modules were also enriched with known transcription factors (false discovery rate-adjusted P < 0.05). Hub genes were identified in each of the four modules. Four of the identified hub genes (MYB proto-oncogene like 1, killer cell lectin like receptor G1, stomatin, and membrane spanning 4-domains A4A) were further validated to be differentially expressed between septic children and controls by qPCR. Conclusions Four pediatric sepsis-associated co-expression modules were identified in this study. qPCR results suggest that hub genes in these modules are potential transcriptomic markers for pediatric sepsis diagnosis. These results provide novel insights into the pathogenesis of pediatric sepsis and promote the generation of diagnostic gene sets. Electronic supplementary material The online version of this article (10.1186/s12967-017-1364-8) contains supplementary material, which is available to authorized users.
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Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol 2017; 14:121-137. [PMID: 29225343 DOI: 10.1038/nrneph.2017.165] [Citation(s) in RCA: 475] [Impact Index Per Article: 67.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sepsis is defined as a life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Sepsis can induce acute kidney injury and multiple organ failures and represents the most common cause of death in the intensive care unit. Sepsis initiates a complex immune response that varies over time, with the concomitant occurrence of both pro-inflammatory and anti-inflammatory mechanisms. As a result, most patients with sepsis rapidly display signs of profound immunosuppression, which is associated with deleterious consequences. Scientific advances have highlighted the role of metabolic failure, epigenetic reprogramming, myeloid-derived suppressor cells, immature suppressive neutrophils and immune alterations in primary lymphoid organs (the thymus and bone marrow) in sepsis. An improved understanding of the mechanisms underlying this immunosuppression as well as of the similarities between sepsis-induced immunosuppression and immune defects in cancer or immunosenescence has led to novel therapeutic strategies aimed at stimulating immune function in patients with sepsis. Trials assessing the therapeutic benefit of IL-7, granulocyte-macrophage colony-stimulating factor (GM-CSF) and antibodies against programmed cell death protein 1 (PD1) and programmed cell death 1 ligand 1 (PDL1) for the treatment of sepsis are in progress. The reappraisal of sepsis pathophysiology has also resulted in a novel approach to the design of clinical trials evaluating sepsis treatments, based on an evaluation of the immune status and biomarker-based stratification of patients.
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Affiliation(s)
- Fabienne Venet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Immunology Department, Flow Division, 69003 Lyon, France.,Equipe d'Accueil 7426, Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon - bioMérieux, Hôpital Edouard Herriot, 69003 Lyon, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Immunology Department, Flow Division, 69003 Lyon, France.,Equipe d'Accueil 7426, Pathophysiology of Injury-Induced Immunosuppression, Université Claude Bernard Lyon 1, Hospices Civils de Lyon - bioMérieux, Hôpital Edouard Herriot, 69003 Lyon, France
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Abstract
Vitamin C is an essential micronutrient for humans, with pleiotropic functions related to its ability to donate electrons. It is a potent antioxidant and a cofactor for a family of biosynthetic and gene regulatory enzymes. Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C supports epithelial barrier function against pathogens and promotes the oxidant scavenging activity of the skin, thereby potentially protecting against environmental oxidative stress. Vitamin C accumulates in phagocytic cells, such as neutrophils, and can enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing. It is also needed for apoptosis and clearance of the spent neutrophils from sites of infection by macrophages, thereby decreasing necrosis/NETosis and potential tissue damage. The role of vitamin C in lymphocytes is less clear, but it has been shown to enhance differentiation and proliferation of B- and T-cells, likely due to its gene regulating effects. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. In turn, infections significantly impact on vitamin C levels due to enhanced inflammation and metabolic requirements. Furthermore, supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. Prophylactic prevention of infection requires dietary vitamin C intakes that provide at least adequate, if not saturating plasma levels (i.e., 100–200 mg/day), which optimize cell and tissue levels. In contrast, treatment of established infections requires significantly higher (gram) doses of the vitamin to compensate for the increased inflammatory response and metabolic demand.
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Pfortmueller CA, Meisel C, Fux M, Schefold JC. Assessment of immune organ dysfunction in critical illness: utility of innate immune response markers. Intensive Care Med Exp 2017; 5:49. [PMID: 29063386 PMCID: PMC5653680 DOI: 10.1186/s40635-017-0163-0] [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: 08/03/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022] Open
Abstract
In critically ill patients, organ dysfunctions are routinely assessed, monitored, and treated. Mounting data show that substantial critical illness-induced changes in the immune system can be observed in most ICU patients and that not only "hyper-inflammation" but also persistence of an anti-inflammatory phenotype (as in sepsis-associated immunosuppression) is associated with increased morbidity and mortality. Despite common perception, changes in functional immunity cannot be adequately assessed by routine inflammatory biomarkers such as C-reactive protein, procalcitonin, or numerical analysis of leukocyte (sub)-counts. Cytokines appear also not suited due to their short half-life and pleiotropy, their unexclusive origin from immune cells, and their potential to undergo antagonization by circulating inactivating molecules. Thus, beyond leukocyte quantification and use of routine biomarkers, direct assessment of immune cell function seems required to characterize the immune systems' status. This may include determination of, e.g., ex vivo cellular cytokine release, phagocytosis activity, and/or antigen-presenting capacity. In this regard, standardized flow-cytometric assessment of the major histocompatibility-II complex human leukocyte antigen (-D related) (HLA-DR) has gained particular interest. Monocytic HLA-DR (mHLA-DR) controls the interplay between innate and adaptive immunity and may serve as a "global" biomarker of injury-associated immunosuppression, and its decreased expression is associated with adverse clinical outcomes (e.g., secondary infection risk, mortality). Importantly, recent data demonstrate that injury-associated immunosuppression can be reversed-opening up new therapeutic avenues in affected patients. Here we discuss the potential scientific and clinical value of assessment of functional immunity with a focus on monocytes/macrophages and review the current state of knowledge and potential perspectives for affected critically ill patients.
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Affiliation(s)
- Carmen Andrea Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Christian Meisel
- Department of Medical Immunology, Charité University Hospital Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Immunology, Labor Berlin Charité Vivantes, Sylter Strasse 2, 13353, Berlin, Germany
| | - Michaela Fux
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Scapini P, Marini O, Tecchio C, Cassatella MA. Human neutrophils in the saga of cellular heterogeneity: insights and open questions. Immunol Rev 2017; 273:48-60. [PMID: 27558327 DOI: 10.1111/imr.12448] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent findings have uncovered novel fascinating aspects of the biology of neutrophils, which ultimately attribute to these cells a broader role in inflammation and immunity. One aspect that is currently under intensive investigation is the notion of neutrophil 'heterogeneity'. Studies examining neutrophils in a variety of acute and chronic inflammatory conditions report, in fact, the recovery of CD66b(+) cells displaying neutrophil-like morphology at different degrees of maturation/activation, able to exert either immunosuppressive or proinflammatory properties. These heterogeneous populations of mature and immature neutrophils are indicated with a variety of names, including 'low density neutrophils (LDNs)', 'low density granulocytes (LDGs)', 'granulocytic-myeloid derived suppressor cells (G-MDSCs)', and immunosuppressive neutrophils. However, due to the lack of discrete markers that can unequivocally allow their specific identification and isolation, the precise phenotype and function of all these presumably novel, neutrophil-like, populations have not been correctly defined yet. Aim of this article is to summarize current knowledge on the mature and immature neutrophil populations described to date, featuring immunosuppressive or proinflammatory properties, often defined as 'subsets', as well as to critically discuss unresolved issues in the field.
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Affiliation(s)
- Patrizia Scapini
- Division of General Pathology, University of Verona, Verona, Italy
| | - Olivia Marini
- Division of General Pathology, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Division of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
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Rol ML, Venet F, Rimmele T, Moucadel V, Cortez P, Quemeneur L, Gardiner D, Griffiths A, Pachot A, Textoris J, Monneret G. The REAnimation Low Immune Status Markers (REALISM) project: a protocol for broad characterisation and follow-up of injury-induced immunosuppression in intensive care unit (ICU) critically ill patients. BMJ Open 2017; 7:e015734. [PMID: 28637738 PMCID: PMC5726091 DOI: 10.1136/bmjopen-2016-015734] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The host response to septic shock is dynamic and complex. A sepsis-induced immunosuppression phase has recently been acknowledged and linked to bad outcomes and increased healthcare costs. Moreover, a marked suppression of the immune response has also been partially described in patients hospitalized in intensive care unit (ICU) for severe trauma or burns. It has been hypothesized that immune monitoring could enable identification of patients who might most benefit from novel, adjunctive immune-stimulating therapies. However, there is currently neither a clear definition for such injury-induced immunosuppression nor a stratification biomarker compatible with clinical constraints. METHODS AND ANALYSIS We set up a prospective, longitudinal single-centre clinical study to determine the incidence, severity and persistency of innate and adaptive immune alterations in ICU patients. We optimized a workflow to describe and follow the immunoinflammatory status of 550 patients (septic shock, severe trauma/burn and major surgery) during the first 2 months after their initial injury. On each time point, two immune functional tests will be performed to determine whole-blood TNF-α production in response to ex vivo lipopolysaccharide stimulation and the T lymphocyte proliferation in response to phytohaemagglutinin. In addition, a complete immunophenotyping using flow cytometry including monocyte HLA-DR expression and lymphocyte subsets will be obtained. New markers (ie, levels of expression of host mRNA and viral reactivation) will be also evaluated. Reference intervals will be determined from a cohort of 150 age-matched healthy volunteers. This clinical study will provide, for the first time, data describing the immune status of severe ICU patients over time. ETHICS AND DISSEMINATION Ethical approval has been obtained from the institutional review board (no 69HCL15_0379) and the French National Security agency for drugs and health-related products. Results will be disseminated through presentations at scientific meetings and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER Clinicaltrials.gov Registration number: NCT02638779. Pre-results.
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Affiliation(s)
- Mary-Luz Rol
- BIOASTER Technology Research Institute, Lyon, France
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
| | - Fabienne Venet
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
- Immunology Laboratory, Hospices Civils de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Rimmele
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
- Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Virginie Moucadel
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy-l'Étoile, France
| | | | | | | | | | - Alexandre Pachot
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy-l'Étoile, France
| | - Julien Textoris
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
- Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon - Université Claude Bernard Lyon 1, Lyon, France
- Medical Diagnostic Discovery Department (MD3), bioMérieux, Marcy-l'Étoile, France
| | - Guillaume Monneret
- EA7426 “Pathophysiology of Injury-induced immunosuppression”, Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux, Lyon, France
- Immunology Laboratory, Hospices Civils de Lyon - Université Claude Bernard Lyon 1, Lyon, France
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Reber LL, Gillis CM, Starkl P, Jönsson F, Sibilano R, Marichal T, Gaudenzio N, Bérard M, Rogalla S, Contag CH, Bruhns P, Galli SJ. Neutrophil myeloperoxidase diminishes the toxic effects and mortality induced by lipopolysaccharide. J Exp Med 2017; 214:1249-1258. [PMID: 28385925 PMCID: PMC5413333 DOI: 10.1084/jem.20161238] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 01/30/2017] [Accepted: 03/01/2017] [Indexed: 01/01/2023] Open
Abstract
Neutrophils have crucial antimicrobial functions but are also thought to contribute to tissue injury upon exposure to bacterial products, such as lipopolysaccharide (LPS). To study the role of neutrophils in LPS-induced endotoxemia, we developed a new mouse model, PMNDTR mice, in which injection of diphtheria toxin induces selective neutrophil ablation. Using this model, we found, surprisingly, that neutrophils serve to protect the host from LPS-induced lethal inflammation. This protective role was observed in conventional and germ-free animal facilities, indicating that it does not depend on a particular microbiological environment. Blockade or genetic deletion of myeloperoxidase (MPO), a key neutrophil enzyme, significantly increased mortality after LPS challenge, and adoptive transfer experiments confirmed that neutrophil-derived MPO contributes importantly to protection from endotoxemia. Our findings imply that, in addition to their well-established antimicrobial properties, neutrophils can contribute to optimal host protection by limiting the extent of endotoxin-induced inflammation in an MPO-dependent manner.
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Affiliation(s)
- Laurent L Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, U1222, 75015 Paris, France
| | - Caitlin M Gillis
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, U1222, 75015 Paris, France
| | - Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
| | - Friederike Jönsson
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, U1222, 75015 Paris, France
| | - Riccardo Sibilano
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
| | - Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
| | - Marion Bérard
- Animalerie Centrale, Institut Pasteur, 75015 Paris, France
| | - Stephan Rogalla
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA 94305
- Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305
| | - Christopher H Contag
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA 94305
- Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA 94305
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305
- Department of Bioengineering, Stanford University School of Medicine, Stanford, CA 94305
| | - Pierre Bruhns
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, 75015 Paris, France
- Institut National de la Santé et de la Recherche Médicale, U1222, 75015 Paris, France
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA 94305
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305
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Mature CD10+ and immature CD10− neutrophils present in G-CSF–treated donors display opposite effects on T cells. Blood 2017; 129:1343-1356. [DOI: 10.1182/blood-2016-04-713206] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 12/19/2016] [Indexed: 01/02/2023] Open
Abstract
Key Points
CD10 as a marker discriminating mature from immature neutrophils within heterogeneous neutrophil populations in pathological settings. Immunosuppressive mature CD66b+CD10+ and immunostimulatory immature CD66b+CD10− neutrophils coexist in G-CSF–treated donors.
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Shen XF, Cao K, Jiang JP, Guan WX, Du JF. Neutrophil dysregulation during sepsis: an overview and update. J Cell Mol Med 2017; 21:1687-1697. [PMID: 28244690 PMCID: PMC5571534 DOI: 10.1111/jcmm.13112] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022] Open
Abstract
Sepsis remains a leading cause of death worldwide, despite advances in critical care, and understanding of the pathophysiology and treatment strategies. No specific therapy or drugs are available for sepsis. Neutrophils play a critical role in controlling infection under normal conditions, and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated mediators and signal pathways involved which govern the survival, migration and antimicrobial function of neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically diagnose and/or predict the outcome of sepsis.
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Affiliation(s)
- Xiao-Fei Shen
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ke Cao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin-Peng Jiang
- Department of Rehabilitation Medicine, PLA Army General Hospital, Beijing, China
| | - Wen-Xian Guan
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun-Feng Du
- Department of General Surgery, PLA Army General Hospital, Beijing, China
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125
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Demaret J, Gossez M, Venet F, Monneret G. Intracellular Flow Cytometry Improvements in Clinical Studies. Methods Mol Biol 2017; 1524:315-327. [PMID: 27815912 DOI: 10.1007/978-1-4939-6603-5_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Flow cytometry has become a basic of biological research and clinical diagnostics, and its application has been crucial to numerous advances in immunology and cell biology. However, several issues remain when considering intracellular stainings, especially in the context of a daily routine use and in multicenter clinical research protocols including large cohorts of patients. The requirements for multiple protocol steps are not only time-consuming but also frequently associated with high cell loss and nonspecific binding or reduced fluorescence. These drawbacks make standardized intracellular flow cytometry use in multicenter studies struggling. As a consequence, intracellular flow cytometry has mostly remained a tool for experimental and clinical research. In the current chapter, we will complete flow cytometry protocols described in the previous edition by presenting novel intracellular protocols usable in clinic. These present with many advantages including shorter time-to-results, one-step whole blood procedures, lyse-no-wash-no-centrifuge protocols, improved staining quality, and lyophilized coated reagents in ready-to-use tubes. This opens novel perspectives for standardization and feasibility in clinical studies, for drug efficacy monitoring and for patients' stratification within a context of personalized medicine. Here, we present illustrative examples taken from septic patients' immunomonitoring. We consider the evaluation of myeloperoxidase and lactoferrin expressions in neutrophils, FOXP3 lymphocyte expression, and STAT5 phosphorylation in lymphocyte subsets.
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Affiliation(s)
- Julie Demaret
- Immunology Laboratory, Hospices Civils de Lyon, E. Herriot Hospital, Pavillon E, 5 Place d'Arsonval, Lyon, Cedex 03, 69437, France
- EA Pathophysiology of Injury-induced Immunosuppression (PI3-University Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Lyon, France
| | - Morgane Gossez
- Immunology Laboratory, Hospices Civils de Lyon, E. Herriot Hospital, Pavillon E, 5 Place d'Arsonval, Lyon, Cedex 03, 69437, France
- EA Pathophysiology of Injury-induced Immunosuppression (PI3-University Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Lyon, France
| | - Fabienne Venet
- Immunology Laboratory, Hospices Civils de Lyon, E. Herriot Hospital, Pavillon E, 5 Place d'Arsonval, Lyon, Cedex 03, 69437, France
- EA Pathophysiology of Injury-induced Immunosuppression (PI3-University Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Lyon, France
| | - Guillaume Monneret
- Immunology Laboratory, Hospices Civils de Lyon, E. Herriot Hospital, Pavillon E, 5 Place d'Arsonval, Lyon, Cedex 03, 69437, France.
- EA Pathophysiology of Injury-induced Immunosuppression (PI3-University Claude Bernard Lyon 1-Hospices Civils de Lyon-bioMérieux), Lyon, France.
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126
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Grégoire M, Tadié JM, Uhel F, Gacouin A, Piau C, Bone N, Le Tulzo Y, Abraham E, Tarte K, Zmijewski JW. Frontline Science: HMGB1 induces neutrophil dysfunction in experimental sepsis and in patients who survive septic shock. J Leukoc Biol 2016; 101:1281-1287. [PMID: 27965385 DOI: 10.1189/jlb.5hi0316-128rr] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/12/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022] Open
Abstract
Sepsis is accompanied by the initial activation of proinflammatory pathways and long-lasting immunosuppression that appears to contribute to late-occurring mortality. Although high-mobility group box 1 (HMGB1) is involved in many aspects of inflammation, its role in sepsis-induced immune suppression remains unclear. In this study, we examined HMGB1's contribution to neutrophil NADPH oxidase activity dysfunction and associated neutrophil-dependent bacterial clearance in mice subjected to sepsis and in patients who survive septic shock. Using a murine model of polymicrobial septic peritonitis, we demonstrated that treatment with anti-HMGB1 Ab significantly diminished sepsis-induced dysfunction of neutrophil NADPH oxidase activity. In a subsequent set of experiments, we found that blocking HMGB1 preserved the ability of neutrophils from patients recovering from septic shock to activate NADPH oxidase. Taken together, our data suggest that HMGB1 accumulation in the late phase of sepsis plays a specific role in the development of postsepsis immunosuppression and specifically affects neutrophil-dependent antibacterial defense mechanisms. Thus, blocking HMGB1 may be a promising therapeutic intervention to diminish the adverse effects of sepsis-induced immunosuppression.
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Affiliation(s)
- Murielle Grégoire
- Unité Mixte de Recherche (UMR) U917, INSERM, Rennes, France.,UMR U917, Université Rennes 1, Rennes, France.,Etablissement Français du sang, UMR U917, Rennes, France.,Suivi Immunologique des Thérapeutiques Innovantes, Pole de Biologie, Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
| | - Jean-Marc Tadié
- Unité Mixte de Recherche (UMR) U917, INSERM, Rennes, France; .,UMR U917, Université Rennes 1, Rennes, France.,Etablissement Français du sang, UMR U917, Rennes, France.,Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.,Centre d'Investigation Clinique (CIC) 1414, INSERM, Rennes, France
| | - Fabrice Uhel
- Unité Mixte de Recherche (UMR) U917, INSERM, Rennes, France.,UMR U917, Université Rennes 1, Rennes, France.,Etablissement Français du sang, UMR U917, Rennes, France.,Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.,Centre d'Investigation Clinique (CIC) 1414, INSERM, Rennes, France
| | - Arnaud Gacouin
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.,Centre d'Investigation Clinique (CIC) 1414, INSERM, Rennes, France
| | - Caroline Piau
- Service de Bactériologie, CHU Rennes, Rennes, France
| | - Nathaniel Bone
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; and
| | - Yves Le Tulzo
- Unité Mixte de Recherche (UMR) U917, INSERM, Rennes, France.,UMR U917, Université Rennes 1, Rennes, France.,Etablissement Français du sang, UMR U917, Rennes, France.,Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France.,Centre d'Investigation Clinique (CIC) 1414, INSERM, Rennes, France
| | - Edward Abraham
- Office of the Dean, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Karin Tarte
- Unité Mixte de Recherche (UMR) U917, INSERM, Rennes, France.,UMR U917, Université Rennes 1, Rennes, France.,Etablissement Français du sang, UMR U917, Rennes, France.,Suivi Immunologique des Thérapeutiques Innovantes, Pole de Biologie, Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
| | - Jaroslaw W Zmijewski
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; and
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127
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Morton B, Mitsi E, Pennington SH, Reiné J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB. Augmented Passive Immunotherapy with P4 Peptide Improves Phagocyte Activity in Severe Sepsis. Shock 2016; 46:635-641. [PMID: 27488089 DOI: 10.1097/shk.0000000000000715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Antimicrobial resistance threatens to undermine treatment of severe infection; new therapeutic strategies are urgently needed. Preclinical work shows that augmented passive immunotherapy with P4 peptide increases phagocytic activity and shows promise as a novel therapeutic strategy. Our aim was to determine ex vivo P4 activity in a target population of patients admitted to critical care with severe infection. METHODS We prospectively recruited UK critical care unit patients with severe sepsis and observed clinical course (≥3 months postdischarge). Blood samples were taken in early (≤48 h postdiagnosis, n = 54), latent (7 days postdiagnosis, n = 39), and convalescent (3-6 months postdiagnosis, n = 18) phases of disease. The primary outcome measure was killing of opsonized Streptococcus pneumoniae by neutrophils with and without P4 peptide stimulation. We also used a flow cytometric whole blood phagocytosis assay to determine phagocyte association and oxidation of intraphagosomal reporter beads. RESULTS P4 peptide increased neutrophil killing of opsonized pneumococci by 8.6% (confidence interval 6.35-10.76, P < 0.001) in all phases of sepsis, independent of infection source and microbiological status. This represented a 54.9% increase in bacterial killing compared with unstimulated neutrophils (15.6%) in early phase samples. Similarly, P4 peptide treatment significantly increased neutrophil and monocyte intraphagosomal reporter bead association and oxidation, independent of infection source. CONCLUSIONS We have extended preclinical work to demonstrate that P4 peptide significantly increases phagocytosis and bacterial killing in samples from a target patient population with severe sepsis. This study supports the rationale for augmented passive immunotherapy as a therapeutic strategy in severe sepsis.
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Affiliation(s)
- Ben Morton
- *Aintree University Hospital NHS Foundation Trust, Liverpool, UK †Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK ‡Clinical Infection, Microbiology and Immunology, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK §Local Comprehensive Research Network, Northwest Coast, Liverpool, UK ||Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK ¶Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia #Clinical Infection, Microbiology and Immunology, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
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128
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Demaret J, Venet F, Plassais J, Cazalis MA, Vallin H, Friggeri A, Lepape A, Rimmelé T, Textoris J, Monneret G. Identification of CD177 as the most dysregulated parameter in a microarray study of purified neutrophils from septic shock patients. Immunol Lett 2016; 178:122-30. [DOI: 10.1016/j.imlet.2016.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/31/2022]
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129
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Patera AC, Drewry AM, Chang K, Beiter ER, Osborne D, Hotchkiss RS. Frontline Science: Defects in immune function in patients with sepsis are associated with PD-1 or PD-L1 expression and can be restored by antibodies targeting PD-1 or PD-L1. J Leukoc Biol 2016; 100:1239-1254. [PMID: 27671246 DOI: 10.1189/jlb.4hi0616-255r] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/01/2016] [Accepted: 08/26/2016] [Indexed: 12/20/2022] Open
Abstract
Sepsis is a heterogeneous syndrome comprising a highly diverse and dynamic mixture of hyperinflammatory and compensatory anti-inflammatory immune responses. This immune phenotypic diversity highlights the importance of proper patient selection for treatment with the immunomodulatory drugs that are entering clinical trials. To better understand the serial changes in immunity of critically ill patients and to evaluate the potential efficacy of blocking key inhibitory pathways in sepsis, we undertook a broad phenotypic and functional analysis of innate and acquired immunity in the same aliquot of blood from septic, critically ill nonseptic, and healthy donors. We also tested the ability of blocking the checkpoint inhibitors programmed death receptor-1 (PD-1) and its ligand (PD-L1) to restore the function of innate and acquired immune cells. Neutrophil and monocyte function (phagocytosis, CD163, cytokine expression) were progressively diminished as sepsis persisted. An increasing frequency in PD-L1+-suppressor phenotype neutrophils [low-density neutrophils (LDNs)] was also noted. PD-L1+ LDNs and defective neutrophil function correlated with disease severity, consistent with the potential importance of suppressive neutrophil populations in sepsis. Reduced neutrophil and monocyte function correlated both with their own PD-L1 expression and with PD-1 expression on CD8+ T cells and NK cells. Conversely, reduced CD8+ T cell and NK cell functions (IFN-γ production, granzyme B, and CD107a expression) correlated with elevated PD-L1+ LDNs. Importantly, addition of antibodies against PD-1 or PD-L1 restored function in neutrophil, monocyte, T cells, and NK cells, underlining the impact of the PD-1:PD-L1 axis in sepsis-immune suppression and the ability to treat multiple deficits with a single immunomodulatory agent.
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Affiliation(s)
- Andriani C Patera
- Infectious Disease and Vaccines Department, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Anne M Drewry
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Chang
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Evan R Beiter
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dale Osborne
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Richard S Hotchkiss
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
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130
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Munford RS. Endotoxemia-menace, marker, or mistake? J Leukoc Biol 2016; 100:687-698. [PMID: 27418356 DOI: 10.1189/jlb.3ru0316-151r] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/27/2016] [Indexed: 01/19/2023] Open
Abstract
Endotoxemia is in its scientific ascendancy. Never has blood-borne, Gram-negative bacterial endotoxin (LPS) been invoked in the pathogenesis of so many diseases-not only as a trigger for septic shock, once its most cited role, but also as a contributor to atherosclerosis, obesity, chronic fatigue, metabolic syndrome, and many other conditions. Finding elevated plasma endotoxin levels has been essential supporting evidence for each of these links, yet the assays used to detect and quantitate endotoxin have important limitations. This article describes several assays for endotoxin in plasma, reviews what they do and do not measure, and discusses why LPS heterogeneity, LPS trafficking pathways, and host LPS inactivation mechanisms should be considered when interpreting endotoxin assay results.
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Affiliation(s)
- Robert S Munford
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA
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131
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Bermejo-Martin JF, Andaluz-Ojeda D, Almansa R, Gandía F, Gómez-Herreras JI, Gomez-Sanchez E, Heredia-Rodríguez M, Eiros JM, Kelvin DJ, Tamayo E. Defining immunological dysfunction in sepsis: A requisite tool for precision medicine. J Infect 2016; 72:525-36. [PMID: 26850357 DOI: 10.1016/j.jinf.2016.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Immunological dysregulation is now recognised as a major pathogenic event in sepsis. Stimulation of immune response and immuno-modulation are emerging approaches for the treatment of this disease. Defining the underlying immunological alterations in sepsis is important for the design of future therapies with immuno-modulatory drugs. METHODS Clinical studies evaluating the immunological response in adult patients with Sepsis and published in PubMed were reviewed to identify features of immunological dysfunction. For this study we used key words related with innate and adaptive immunity. RESULTS Ten major features of immunological dysfunction (FID) were identified involving quantitative and qualitative alterations of [antigen presentation](FID1), [T and B lymphocytes] (FID2), [natural killer cells] (FID3), [relative increase in T regulatory cells] (FID4), [increased expression of PD-1 and PD-ligand1](FID5), [low levels of immunoglobulins](FID6), [low circulating counts of neutrophils and/or increased immature forms in non survivors](FID7), [hyper-cytokinemia] (FID8), [complement consumption] (FID9), [defective bacterial killing by neutrophil extracellular traps](FID10). CONCLUSIONS This review article identified ten major features associated with immunosuppression and immunological dysregulation in sepsis. Assessment of these features could help in utilizing precision medicine for the treatment of sepsis with immuno-modulatory drugs.
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Affiliation(s)
- Jesús F Bermejo-Martin
- Infection and Immunity Medical Investigation Unit (IMI), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - David Andaluz-Ojeda
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - Raquel Almansa
- Infection and Immunity Medical Investigation Unit (IMI), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - Francisco Gandía
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - Jose Ignacio Gómez-Herreras
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - Esther Gomez-Sanchez
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - María Heredia-Rodríguez
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - Jose Maria Eiros
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
| | - David J Kelvin
- Division of Experimental Therapeutics, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Sezione di Microbiologia Sperimentale e Clinica, Dipartimento di Scienze Biomediche, Universita' degli Studi di Sassari, Piazza Università, 21, 07100 Sassari SS, Italy; International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, 515041 Guangdong Province, PR China.
| | - Eduardo Tamayo
- Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
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