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Tsao FHC, Li Z, Amessoudji AW, Jawdat D, Sadat M, Arabi Y, Meyer KC. The Role of Serum Albumin and Secretory Phospholipase A2 in Sepsis. Int J Mol Sci 2024; 25:9413. [PMID: 39273360 PMCID: PMC11395451 DOI: 10.3390/ijms25179413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/16/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
Sepsis is caused by a dysregulated host response to an infection that leads to cascading cell death and eventually organ failure. In this study, the role of inflammatory response serum secretory phospholipase A2 (sPLA2) and albumin in sepsis was investigated by determining the activities of the two proteins in serial serum samples collected on different days from patients with sepsis after enrollment in the permissive underfeeding versus standard enteral feeding protocols in an intensive care unit. Serum sPLA2 and albumin showed an inverse relationship with increasing sPLA2 activity and decreasing albumin membrane-binding activity in patients with evolving complications of sepsis. The activities of sPLA2 and albumin returned to normal values more rapidly in the permissive underfeeding group than in the standard enteral feeding group. The inverse sPLA2-albumin activity relationship suggests a complex interplay between these two proteins and a regulatory mechanism underlying cell membrane phospholipid homeostasis in sepsis. The decreased albumin-membrane binding activity in patients' serum was due to its fatty acid-binding sites occupied by pre-bound fatty acids that might alter albumin's structure, binding capacities, and essential functions. The sPLA2-albumin dual serum assays may be useful in determining whether nutritional intervention effectively supports the more rapid recovery of appropriate immune responses in critically ill patients with sepsis.
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Affiliation(s)
- Francis H. C. Tsao
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA (K.C.M.)
| | - Zhanhai Li
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI 53792, USA;
| | - Amy W. Amessoudji
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA (K.C.M.)
| | - Dunia Jawdat
- Saudi Stem Cells Donor Registry and Cord Blood Bank, King Abdullah International Medical Research Center, College of medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11481, Saudi Arabia;
| | - Musharaf Sadat
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia; (M.S.); (Y.A.)
| | - Yaseen Arabi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia; (M.S.); (Y.A.)
| | - Keith C. Meyer
- Departments of Medicine, Division of Pulmonary and Critical Care Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA (K.C.M.)
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Zhu B, Zhou R, Qin J, Li Y. Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis. Biomedicines 2024; 12:447. [PMID: 38398049 PMCID: PMC10886935 DOI: 10.3390/biomedicines12020447] [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: 01/15/2024] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. Methods: We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case-control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. Results: A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48-1.65, I2 = 92.8%, p < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74-0.79, I2 = 83.7%, p = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68-0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59-0.7) and a summary specificity of 0.7 (95% CI 0.64-0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values' assessments among sepsis, severe sepsis and septic shock patients. Conclusions: This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.
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Affiliation(s)
| | | | | | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, China; (B.Z.); (R.Z.); (J.Q.)
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Borra SD, Morkar DN. Study of Phospholipase A2 Levels and Its Comparison With Procalcitonin Levels in Patients With Sepsis Admitted in a Tertiary Care Hospital, Karnataka, India. Cureus 2023; 15:e50890. [PMID: 38249263 PMCID: PMC10799635 DOI: 10.7759/cureus.50890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Sepsis is a complicated host response to infection involving organ failure which ultimately causes death of the host. Procalcitonin (PCT) is an effective marker used to diagnose sepsis but until now, there has been no ideal marker for sepsis. Phospholipase A2 (PLA2) also increases infections; however, only a few studies have assessed its capacity as a biomarker to diagnose sepsis. Thus, we aimed to examine PLA2 and compare its diagnostic capacity and accuracy with PCT as a biomarker of sepsis. MATERIAL AND METHODS Our study was a hospital-oriented cross-sectional study. Our study group included 80 patients of both sexes older than 18 years, meeting the quick sequential organ failure assessment (qSOFA) or systemic inflammatory response syndrome (SIRS) criteria of ≥2, hospitalized in a tertiary care hospital in Karnataka, India from January 2021 to December 2021. Out of them, 59 were found to have sepsis. Samples of all the patients were evaluated for relevant parameters, and data were statistically analyzed using SPSS v21 running on Windows 10. The statistical significance was set at p-value <0.05. RESULTS The mean PCT and PLA2 were significantly raised in sepsis patients compared to non-sepsis patients. Out of 59 septic patients, 45.76% had positive blood cultures, and 16.95% had positive urine culture reports. In blood cultures, the most common Gram-positive organism found was Staphylococcus, and the most common Gram-negative organism was Enterobacter. In urine cultures, Escherichia coli was the most common species. PLA2 was significantly higher in patients with bacterial etiology and Gram-positive cultures. The diagnostic capability, sensitivity, specificity, and accuracy of PLA2 were demonstrably higher than those of PCT. CONCLUSION Our study proves that PLA2 is a much better and more efficient biomarker in sepsis than PCT. The diagnostic capacity and accuracy of PLA2 clearly surpass PCT, so using PLA2 in sepsis as a biomarker can help clinicians in deciding on timely and appropriate management to speed the recovery of patients.
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Affiliation(s)
- Suma D Borra
- Internal Medicine, Jawaharlal Nehru Medical College and Hospital, Belagavi, IND
| | - Dnyanesh N Morkar
- Internal Medicine, Jawaharlal Nehru Medical College and Hospital, Belagavi, IND
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Kozlov AV, Grillari J. Pathogenesis of Multiple Organ Failure: The Impact of Systemic Damage to Plasma Membranes. Front Med (Lausanne) 2022; 9:806462. [PMID: 35372390 PMCID: PMC8964500 DOI: 10.3389/fmed.2022.806462] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Multiple organ failure (MOF) is the major cause of morbidity and mortality in intensive care patients, but the mechanisms causing this severe syndrome are still poorly understood. Inflammatory response, tissue hypoxia, immune and cellular metabolic dysregulations, and endothelial and microvascular dysfunction are the main features of MOF, but the exact mechanisms leading to MOF are still unclear. Recent progress in the membrane research suggests that cellular plasma membranes play an important role in key functions of diverse organs. Exploration of mechanisms contributing to plasma membrane damage and repair suggest that these processes can be the missing link in the development of MOF. Elevated levels of extracellular phospholipases, reactive oxygen and nitrogen species, pore-forming proteins (PFPs), and dysregulation of osmotic homeostasis occurring upon systemic inflammatory response are the major extracellular inducers of plasma membrane damage, which may simultaneously operate in different organs causing their profound dysfunction. Hypoxia activates similar processes, but they predominantly occur within the cells targeting intracellular membrane compartments and ultimately causing cell death. To combat the plasma membrane damage cells have developed several repair mechanisms, such as exocytosis, shedding, and protein-driven membrane remodeling. Analysis of knowledge on these mechanisms reveals that systemic damage to plasma membranes may be associated with potentially reversible MOF, which can be quickly recovered, if pathological stimuli are eliminated. Alternatively, it can be transformed in a non-resolving phase, if repair mechanisms are not sufficient to deal with a large damage or if the damage is extended to intracellular compartments essential for vital cellular functions.
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Affiliation(s)
- Andrey V Kozlov
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation With AUVA, LBG, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Medical University of Vienna, Vienna, Austria.,Laboratory of Navigational Redox Lipidomics and Department of Human Pathology, IM Sechenov Moscow State Medical University, Vienna, Austria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation With AUVA, LBG, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Medical University of Vienna, Vienna, Austria.,Institute of Molecular Biotechnology, University of Natural Resources and Life Sciences, Vienna, Austria
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Geng H, Vilms Pedersen S, Ma Y, Haghighi T, Dai H, Howes PD, Stevens MM. Noble Metal Nanoparticle Biosensors: From Fundamental Studies toward Point-of-Care Diagnostics. Acc Chem Res 2022; 55:593-604. [PMID: 35138817 PMCID: PMC7615491 DOI: 10.1021/acs.accounts.1c00598] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Noble metal nanoparticles (NMNPs) have become firmly established as effective agents to detect various biomolecules with extremely high sensitivity. This ability stems from the collective oscillation of free electrons and extremely large electric field enhancement under exposure to light, leading to various light-matter interactions such as localized surface plasmon resonance (LSPR) and surface-enhanced Raman scattering. A remarkable feature of NMNPs is their customizability by mechanisms such as particle etching, growth, and aggregation/dispersion, yielding distinct color changes and excellent opportunities for colorimetric biosensing in user-friendly assays and devices. They are readily functionalized with a large variety of capping agents and biomolecules, with resultant bioconjugates often possessing excellent biocompatibility, which can be used to quantitatively detect analytes from physiological fluids. Furthermore, they can possess excellent catalytic properties that can achieve significant signal amplification through mechanisms such as the catalytic transformation of colorless substrates to colored reporters. The various excellent attributes of NMNP biosensors have put them in the spotlight for developing high-performance in vitro diagnostic (IVD) devices that are particularly well-suited to mitigate the societal threat that infectious diseases pose. This threat continues to dominate the global health care landscape, claiming millions of lives annually. NMNP IVDs possess the potential to sensitively detect infections even at very early stages with affordable and field-deployable devices, which will be key to strengthening infectious disease management. This has been the major focal point of current research, with a view to new avenues for early multiplexed detection of infectious diseases with portable devices such as smartphones, especially in resource-limited settings.In this Account, we provide an overview of our original inspiration and efforts in NMNP-based assay development, together with some more sophisticated IVD assays by ourselves and many others. Our work in the area has led to our recent efforts in developing IVDs for high-profile infectious diseases, including Ebola and HIV. We emphasize that integration with digital platforms represents an opportunity to establish and efficiently manage widespread testing, tracking, epidemiological intelligence, and data sharing backed by community participation. We highlight how digital technologies can address the limitations of conventional diagnostic technologies at the point of care (POC) and how they may be used to abate and contain the spread of infectious diseases. Finally, we focus on more recent integrations of noble metal nanoparticles with Raman spectroscopy for accurate, noninvasive POC diagnostics with improved sensitivity and specificity.
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Affiliation(s)
- Hongya Geng
- Department of Materials, Department of Bioengineering, and Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, U.K
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm 171 77, Sweden
| | - Simon Vilms Pedersen
- Department of Materials, Department of Bioengineering, and Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Yun Ma
- Department of Materials, Department of Bioengineering, and Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Tabasom Haghighi
- Department of Materials, Department of Bioengineering, and Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Hongliang Dai
- School of Environmental and Chemical Engineering, Jiangsu University of Science and Technology, Zhenjiang 212003, China
| | - Philip D Howes
- Division of Mechanical Engineering and Design, School of Engineering, London South Bank University, London SE1 0AA, U.K
| | - Molly M Stevens
- Department of Materials, Department of Bioengineering, and Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, U.K
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm 171 77, Sweden
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Scott KF, Mann TJ, Fatima S, Sajinovic M, Razdan A, Kim RR, Cooper A, Roohullah A, Bryant KJ, Gamage KK, Harman DG, Vafaee F, Graham GG, Church WB, Russell PJ, Dong Q, de Souza P. Human Group IIA Phospholipase A 2-Three Decades on from Its Discovery. Molecules 2021; 26:molecules26237267. [PMID: 34885848 PMCID: PMC8658914 DOI: 10.3390/molecules26237267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Phospholipase A2 (PLA2) enzymes were first recognized as an enzyme activity class in 1961. The secreted (sPLA2) enzymes were the first of the five major classes of human PLA2s to be identified and now number nine catalytically-active structurally homologous proteins. The best-studied of these, group IIA sPLA2, has a clear role in the physiological response to infection and minor injury and acts as an amplifier of pathological inflammation. The enzyme has been a target for anti-inflammatory drug development in multiple disorders where chronic inflammation is a driver of pathology since its cloning in 1989. Despite intensive effort, no clinically approved medicines targeting the enzyme activity have yet been developed. This review catalogues the major discoveries in the human group IIA sPLA2 field, focusing on features of enzyme function that may explain this lack of success and discusses future research that may assist in realizing the potential benefit of targeting this enzyme. Functionally-selective inhibitors together with isoform-selective inhibitors are necessary to limit the apparent toxicity of previous drugs. There is also a need to define the relevance of the catalytic function of hGIIA to human inflammatory pathology relative to its recently-discovered catalysis-independent function.
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Affiliation(s)
- Kieran F. Scott
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
- Correspondence: ; Tel.: +61-2-8738-9026
| | - Timothy J. Mann
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
| | - Shadma Fatima
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
- School of Biotechnology and Biological Sciences, University of New South Wales (UNSW Sydney), Sydney, NSW 2052, Australia;
| | - Mila Sajinovic
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
| | - Anshuli Razdan
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
| | - Ryung Rae Kim
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (R.R.K.); (W.B.C.)
| | - Adam Cooper
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Aflah Roohullah
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Katherine J. Bryant
- School of Photovoltaic and Renewable Energy Engineering, UNSW Sydney, Sydney, NSW 2052, Australia;
| | - Kasuni K. Gamage
- School of Science, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.K.G.); (D.G.H.)
| | - David G. Harman
- School of Science, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.K.G.); (D.G.H.)
| | - Fatemeh Vafaee
- School of Biotechnology and Biological Sciences, University of New South Wales (UNSW Sydney), Sydney, NSW 2052, Australia;
- UNSW Data Science Hub, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Garry G. Graham
- Department of Clinical Pharmacology, St Vincent’s Hospital Sydney, Darlinghurst, NSW 2010, Australia;
- School of Medical Sciences, UNSW Sydney, Sydney, NSW 2052, Australia
| | - W. Bret Church
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (R.R.K.); (W.B.C.)
| | - Pamela J. Russell
- Australian Prostate Cancer Research Centre—QUT, Brisbane, QLD 4102, Australia;
| | - Qihan Dong
- Chinese Medicine Anti-Cancer Evaluation Program, Greg Brown Laboratory, Central Clinical School and Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Paul de Souza
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (T.J.M.); (S.F.); (A.C.); (A.R.); (P.d.S.)
- Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; (M.S.); (A.R.)
- School of Medicine, UNSW Sydney, Sydney, NSW 2052, Australia
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