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Li R, Meng M, Chen Y, Pan T, Li Y, Deng Y, Zhang R, Tian R, Xu W, Zheng X, Gong F, Liu J, Tang H, Ding X, Tang Y, Annane D, Chen E, Qu H, Li L. ATP-citrate lyase controls endothelial gluco-lipogenic metabolism and vascular inflammation in sepsis-associated organ injury. Cell Death Dis 2023; 14:401. [PMID: 37414769 PMCID: PMC10325983 DOI: 10.1038/s41419-023-05932-8] [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: 03/05/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Sepsis involves endothelial cell (EC) dysfunction, which contributes to multiple organ failure. To improve therapeutic prospects, elucidating molecular mechanisms of vascular dysfunction is of the essence. ATP-citrate lyase (ACLY) directs glucose metabolic fluxes to de novo lipogenesis by generating acetyl-Co-enzyme A (acetyl-CoA), which facilitates transcriptional priming via protein acetylation. It is well illustrated that ACLY participates in promoting cancer metastasis and fatty liver diseases. Its biological functions in ECs during sepsis remain unclear. We found that plasma levels of ACLY were increased in septic patients and were positively correlated with interleukin (IL)-6, soluble E-selectin (sE-selectin), soluble vascular cell adhesion molecule 1 (sVCAM-1), and lactate levels. ACLY inhibition significantly ameliorated lipopolysaccharide challenge-induced EC proinflammatory response in vitro and organ injury in vivo. The metabolomic analysis revealed that ACLY blockade fostered ECs a quiescent status by reducing the levels of glycolytic and lipogenic metabolites. Mechanistically, ACLY promoted forkhead box O1 (FoxO1) and histone H3 acetylation, thereby increasing the transcription of c-Myc (MYC) to facilitate the expression of proinflammatory and gluco-lipogenic genes. Our findings revealed that ACLY promoted EC gluco-lipogenic metabolism and proinflammatory response through acetylation-mediated MYC transcription, suggesting ACLY as the potential therapeutic target for treating sepsis-associated EC dysfunction and organ injury.
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Affiliation(s)
- Ranran Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Mei Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yinjiaozhi Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yunxin Deng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Ruyuan Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Wen Xu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Xiangtao Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Fangchen Gong
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jie Liu
- National Advanced Medical Engineering Research Center, China State Institute of Pharmaceutical Industry, Shanghai, P.R. China
| | - Haiting Tang
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Xiaowei Ding
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yaoqing Tang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Djillali Annane
- General intensive care unit, Raymond Poincaré Hospital (APHP), Laboratory of Inflammation and Infection U1173, University of Versailles SQY/INSERM 104 bd Raymond Poincaré, 92380, Garches, France
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Lei Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
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2
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Denis M, Dupas T, Persello A, Dontaine J, Bultot L, Betus C, Pelé T, Dhot J, Erraud A, Maillard A, Montnach J, Leroux AA, Bigot-Corbel E, Vertommen D, Rivière M, Lebreton J, Tessier A, Waard MD, Bertrand L, Rozec B, Lauzier B. An O-GlcNAcylomic Approach Reveals ACLY as a Potential Target in Sepsis in the Young Rat. Int J Mol Sci 2021; 22:ijms22179236. [PMID: 34502162 PMCID: PMC8430499 DOI: 10.3390/ijms22179236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis in the young population, which is particularly at risk, is rarely studied. O-GlcNAcylation is a post-translational modification involved in cell survival, stress response and metabolic regulation. O-GlcNAc stimulation is beneficial in adult septic rats. This modification is physiologically higher in the young rat, potentially limiting the therapeutic potential of O-GlcNAc stimulation in young septic rats. The aim is to evaluate whether O-GlcNAc stimulation can improve sepsis outcome in young rats. Endotoxemic challenge was induced in 28-day-old rats by lipopolysaccharide injection (E. Coli O111:B4, 20 mg·kg−1) and compared to control rats (NaCl 0.9%). One hour after lipopolysaccharide injection, rats were randomly assigned to no therapy, fluidotherapy (NaCl 0.9%, 10 mL·kg−1) ± NButGT (10 mg·kg−1) to increase O-GlcNAcylation levels. Physiological parameters and plasmatic markers were evaluated 2h later. Finally, untargeted mass spectrometry was performed to map cardiac O-GlcNAcylated proteins. Lipopolysaccharide injection induced shock with a decrease in mean arterial pressure and alteration of biological parameters (p < 0.05). NButGT, contrary to fluidotherapy, was associated with an improvement of arterial pressure (p < 0.05). ATP citrate lyase was identified among the O-GlcNAcylated proteins. In conclusion, O-GlcNAc stimulation improves outcomes in young septic rats. Interestingly, identified O-GlcNAcylated proteins are mainly involved in cellular metabolism.
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Affiliation(s)
- Manon Denis
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Pediatric Intensive Care Unit, CHU de Nantes, F-44000 Nantes, France
| | - Thomas Dupas
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Antoine Persello
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- InFlectis BioScience, F-44000 Nantes, France
| | - Justine Dontaine
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
| | - Laurent Bultot
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
| | - Charlotte Betus
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Thomas Pelé
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Justine Dhot
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Sanofi R&D, 1 Avenue Pierre Brossolette, F-44000 Chilly Mazarin, France
| | - Angélique Erraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Anaïs Maillard
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Jérôme Montnach
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Aurélia A. Leroux
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- University Animal Hospital, Oniris Ecole Nationale Vétérinaire, Agroalimentaire et de l’Alimentation Nantes Atlantique, F-44000 Nantes, France
| | | | - Didier Vertommen
- Université Catholique de Louvain, de Duve Institute, Mass Spectrometry Platform, B-1200 Brussels, Belgium;
| | - Matthieu Rivière
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Jacques Lebreton
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Arnaud Tessier
- Université de Nantes, CNRS, Chimie et Interdisciplinarité: Synthèse, Analyse, Modélisation (CEISAM), UMR CNRS 6230, Faculté des Sciences et des Techniques, F-44000 Nantes, France; (M.R.); (J.L.); (A.T.)
| | - Michel De Waard
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Luc Bertrand
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, B-1200 Brussels, Belgium; (J.D.); (L.B.); (L.B.)
- WELBIO, B-1200 Brussels, Belgium
| | - Bertrand Rozec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
| | - Benjamin Lauzier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, F-44000 Nantes, France; (M.D.); (T.D.); (A.P.); (C.B.); (T.P.); (J.D.); (A.E.); (A.M.); (J.M.); (A.A.L.); (M.D.W.); (B.R.)
- Correspondence: E-mail: ; Tel.: +33-2-28-08-01-57
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3
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Verberk SGS, van der Zande HJP, Baardman J, de Goede KE, Harber KJ, Keuning ED, Lambooij JM, Otto F, Zawistowska-Deniziak A, de Vries HE, de Winther MPJ, Guigas B, Van den Bossche J. Myeloid ATP Citrate Lyase Regulates Macrophage Inflammatory Responses In Vitro Without Altering Inflammatory Disease Outcomes. Front Immunol 2021; 12:669920. [PMID: 33981315 PMCID: PMC8107722 DOI: 10.3389/fimmu.2021.669920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/07/2021] [Indexed: 12/30/2022] Open
Abstract
Macrophages are highly plastic, key regulators of inflammation. Deregulation of macrophage activation can lead to excessive inflammation as seen in inflammatory disorders like atherosclerosis, obesity, multiple sclerosis and sepsis. Targeting intracellular metabolism is considered as an approach to reshape deranged macrophage activation and to dampen the progression of inflammatory disorders. ATP citrate lyase (Acly) is a key metabolic enzyme and an important regulator of macrophage activation. Using a macrophage-specific Acly-deficient mouse model, we investigated the role of Acly in macrophages during acute and chronic inflammatory disorders. First, we performed RNA sequencing to demonstrate that Acly-deficient macrophages showed hyperinflammatory gene signatures in response to acute LPS stimulation in vitro. Next, we assessed endotoxin-induced peritonitis in myeloid-specific Acly-deficient mice and show that, apart from increased splenic Il6 expression, systemic and local inflammation were not affected by Acly deficiency. Also during obesity, both chronic low-grade inflammation and whole-body metabolic homeostasis remained largely unaltered in mice with Acly-deficient myeloid cells. Lastly, we show that macrophage-specific Acly deletion did not affect the severity of experimental autoimmune encephalomyelitis (EAE), an experimental model of multiple sclerosis. These results indicate that, despite increasing inflammatory responses in vitro, macrophage Acly deficiency does not worsen acute and chronic inflammatory responses in vivo. Collectively, our results indicate that caution is warranted in prospective long-term treatments of inflammatory disorders with macrophage-specific Acly inhibitors. Together with our earlier observation that myeloid Acly deletion stabilizes atherosclerotic lesions, our findings highlight that therapeutic targeting of macrophage Acly can be beneficial in some, but not all, inflammatory disorders.
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MESH Headings
- ATP Citrate (pro-S)-Lyase/genetics
- ATP Citrate (pro-S)-Lyase/metabolism
- Animals
- Cells, Cultured
- Cytokines/genetics
- Cytokines/metabolism
- Diet, High-Fat
- Encephalomyelitis, Autoimmune, Experimental/chemically induced
- Encephalomyelitis, Autoimmune, Experimental/enzymology
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Inflammation/enzymology
- Inflammation/etiology
- Inflammation/genetics
- Inflammation/immunology
- Inflammation Mediators/metabolism
- Lipopolysaccharides
- Macrophages/enzymology
- Macrophages/immunology
- Mice, Inbred C57BL
- Mice, Knockout
- Myelin-Oligodendrocyte Glycoprotein
- Obesity/complications
- Peptide Fragments
- Peritonitis/chemically induced
- Peritonitis/enzymology
- Peritonitis/genetics
- Peritonitis/immunology
- Phenotype
- Signal Transduction
- Mice
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Affiliation(s)
- Sanne G. S. Verberk
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Jeroen Baardman
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kyra E. de Goede
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Karl J. Harber
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eelco D. Keuning
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joost M. Lambooij
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Frank Otto
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Anna Zawistowska-Deniziak
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
- Witold Stefański Institute of Parasitology, Polish Academy of Sciences, Warsaw, Poland
| | - Helga E. de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Menno P. J. de Winther
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bruno Guigas
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan Van den Bossche
- Department of Molecular Cell Biology and Immunology, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Wang C, Zhu X, Cui Y, Miao H, Xu Y, Xiong X, Tang X, Shao L, Zhang Y. Serum proteome-wide identified ATP citrate lyase as a novel informative diagnostic and prognostic biomarker in pediatric sepsis: A pilot study. IMMUNITY INFLAMMATION AND DISEASE 2020; 9:389-397. [PMID: 33378581 PMCID: PMC8127565 DOI: 10.1002/iid3.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022]
Abstract
Introduction ATP citrate lyase (ACLY) is involved in lipid metabolism and inflammatory response in immune cells. However, the serum level of ACLY and its clinical relevance in sepsis is totally unknown. Methods We conducted a prospective pilot study in patients with sepsis admitted to pediatric intensive care unit (PICU) from January 2018 to December 2018. Results Higher levels of ACLY were detected in sera of pediatric patients with sepsis than that of healthy children. The area under the receiver operating characteristic curve (AUC) of ACLY for diagnosis of sepsis was 0.855 (95% confidence interval [CI]: 0757–0.952), and an AUC of ACLY for predicting PICU mortality was 0.770 (95% CI: 0.626–0.915). ACLY levels ≤21 ng/ml on PICU admission predicted an unfavorable prognosis among patients with sepsis with a sensitivity of 87.5% and a specificity of 67.6%. Moreover, serum ACLY levels were correlated to platelet count, IL‐18 levels, and monocyte counts in pediatric patients with sepsis, implying the potential roles of ACLY in immunometabolic regulation in sepsis. Conclusions ACLY is firstly identified in sera of patients with sepsis. Serum ACLY level is an additional diagnostic and prognostic biomarker in pediatric patients with sepsis.
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Affiliation(s)
- Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.,Clinical Research Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Zhu
- Department of Pediatric Critical Care Medicine, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yaya Xu
- Department of Pediatric Critical Care Medicine, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Xi Xiong
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomeng Tang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Lujing Shao
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.,Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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