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Hong S, Jian C, Wang H, Wang X, Xing L, Qiao L. Effects of different doses of methylprednisolone therapy on acute respiratory distress syndrome: results from animal and clinical studies. BMC Pulm Med 2022; 22:348. [PMID: 36114531 PMCID: PMC9482269 DOI: 10.1186/s12890-022-02148-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background The optimal dose of glucocorticoids for acute respiratory distress syndrome (ARDS) is uncertain. This study aimed to evaluate the effects of different doses of methylprednisolone on sepsis-induced acute lung injury (ALI) rats and a cohort of moderate and severe ARDS patients. Methods ALI rats, challenged with lipopolysaccharide, were randomly received intraperitoneal injection of normal saline (model group) and different doses of methylprednisolone (0.5, 2, 8 mg/kg, named as low-, moderate- and high-dose group, respectively) for 5 days. The body weight changes of rats, inflammatory factors in bronchoalveolar lavage fluid (BALF), lung wet/dry ratio, histopathological score, and the mRNA expressions of glucocorticoid receptor α (GRα), GRβ and nuclear factor-κB (NF-κB) were measured. Forty moderate and severe ARDS patients were treated with standard of care or plus different doses of methylprednisolone (40, 80, 120 mg/day, named as low-, moderate- and high-dose group, respectively) for 5 days. Clinical outcomes were PaO2/FiO2 ratio and C-reactive protein (CRP) level at day 5, intubation rate, hospital stay, 28-day mortality, and adverse events rate. Results In animal experiment, different doses of methylprednisolone could increase the body weight of rats, and reduce inflammatory factors in BALF and the degree of lung injury compared with model group. The efficacy of methylprednisolone at moderate-dose was better than that at low-dose, but was equivalent to that at high-dose, which was consistent with the differential changes in the mRNA expression of GRα, GRβ and NF-κB. In clinical study, the moderate-dose group was associated with higher PaO2/FiO2 ratio and lower CRP level. No significant difference in other clinical outcomes among groups was detected. Conclusions This study showed that the efficacy of methylprednisolone in ARDS treatment was not always dose-dependent due to the differential regulation of related receptors. The moderate-dose of methylprednisolone may be the potential optimal dose for ARDS treatment, which needs to be further verified by larger clinical trials.
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Meduri GU, Annane D, Confalonieri M, Chrousos GP, Rochwerg B, Busby A, Ruaro B, Meibohm B. Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS. Intensive Care Med 2020; 46:2284-2296. [PMID: 33150472 PMCID: PMC7641258 DOI: 10.1007/s00134-020-06289-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022]
Abstract
Current literature addressing the pharmacological principles guiding glucocorticoid (GC) administration in ARDS is scant. This paucity of information may have led to the heterogeneity of treatment protocols and misinterpretation of available findings. GCs are agonist compounds that bind to the GC receptor (GR) producing a pharmacological response. Clinical efficacy depends on the magnitude and duration of exposure to GR. We updated the meta-analysis of randomized trials investigating GC treatment in ARDS, focusing on treatment protocols and response. We synthesized the current literature on the role of the GR in GC therapy including genomic and non-genomic effects, and integrated current clinical pharmacology knowledge of various GCs, including hydrocortisone, methylprednisolone and dexamethasone. This review addresses the role dosage, timing of initiation, mode of administration, duration, and tapering play in achieving optimal response to GC therapy in ARDS. Based on RCTs’ findings, GC plasma concentration–time profiles, and pharmacodynamic studies, optimal results are most likely achievable with early intervention, an initial bolus dose to achieve close to maximal GRα saturation, followed by a continuous infusion to maintain high levels of response throughout the treatment period. In addition, patients receiving similar GC doses may experience substantial between-patient variability in plasma concentrations affecting clinical response. GC should be dose-adjusted and administered for a duration targeting clinical and laboratory improvement, followed by dose-tapering to achieve gradual recovery of the suppressed hypothalamic–pituitary–adrenal (HPA) axis. These findings have practical clinical relevance. Future RCTs should consider these pharmacological principles in the study design and interpretation of findings.
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Affiliation(s)
- Gianfranco Umberto Meduri
- Memphis Veterans Affairs Medical Center Research Service, Departments of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. .,Pulmonary, Critical Care, and Sleep Medicine Service and Research Service, Memphis Veterans Affairs Medical Center, 1030 Jefferson Avenue, Suite room #CW444, Memphis, TN, 38104, USA.
| | - Djillali Annane
- Department of Critical Care, Raymond Poincaré Hospital (AP-HP), Laboratory Infection and Inflammation, U1173, Faculty of Health Science Simone Veil, University of Versailles SQY, University Paris Saclay, INSERM, FHU SEPSIS, RHU RECORDS, Versailles, France
| | - Marco Confalonieri
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Amanda Busby
- Health Research Methods Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Barbara Ruaro
- Pulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Bernd Meibohm
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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Meduri GU, Siemieniuk RAC, Ness RA, Seyler SJ. Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS. J Intensive Care 2018; 6:53. [PMID: 30155260 PMCID: PMC6109298 DOI: 10.1186/s40560-018-0321-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022] Open
Abstract
An updated meta-analysis incorporating nine randomized trials (n = 816) investigating low-to-moderate dose prolonged glucocorticoid treatment in acute respiratory distress syndrome (ARDS) show moderate-to-high quality evidence that glucocorticoid therapy is safe and reduces (i) time to endotracheal extubation, (ii) duration of hospitalization, and (iii) mortality (number to treat to save one life = 7), and increases the number of days free from (i) mechanical ventilation, (ii) intensive care unit stay, and (iii) hospitalization. Recent guideline suggests administering methylprednisolone in patients with early moderate-to-severe (1 mg/kg/day) and late persistent (2 mg/kg/day) ARDS (conditional recommendation based on moderate quality of evidence).
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Affiliation(s)
- Gianfranco Umberto Meduri
- 1Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Memphis Veterans Affairs Medical Center (111), 1030 Jefferson Avenue, Suite room #CW444, Memphis, TN 38104 USA
| | - Reed A C Siemieniuk
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada.,3Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Rachel A Ness
- 4Department of Pharmacy, Memphis Veterans Affairs Medical Center, Memphis, TN USA
| | - Samuel J Seyler
- 5Department of Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, TN USA
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Zeng S, Qiao H, Lv XW, Fan D, Liu T, Xie D. High-dose dexamethasone induced LPS-stimulated rat alveolar macrophages apoptosis. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3097-3104. [PMID: 29123381 PMCID: PMC5661847 DOI: 10.2147/dddt.s147014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prolonged administration of an excessive dose of corticosteroids proved to be harmful for patients with acute lung injury (ALI). A previous study has found that repeated administration of an excessive dose of methylprednisolone reduced alveolar macrophages (AMs) in bronchoalveolar lavage fluid (BALF) with an unknown mechanism. This study aimed to investigate the effect of excessive use of dexamethasone (Dex) on BALF AMs in vitro. Transmission electron microscopy and DNA fragmentation analysis demonstrated that 10-4 and 10-5 M Dex induced lipopolysaccharide-stimulated rat AMs apoptosis with downregulation of tumor necrosis factor-α, interleukin (IL)-12 and upregulation of IL-10, transforming growth factor-β. These results indicated that apoptosis might be a novel contribution involved in the detrimental effect of excessive dose of Dex clinically used to treat ALI.
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Affiliation(s)
- Si Zeng
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu
| | - Hui Qiao
- Department of Anesthesiology, The Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Xue-Wen Lv
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu
| | - Dan Fan
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu
| | - Tong Liu
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu
| | - Dongli Xie
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu
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Sun Y, Du YJ, Zhao H, Zhang GX, Sun N, Li XJ. Protective effects of ulinastatin and methylprednisolone against radiation-induced lung injury in mice. JOURNAL OF RADIATION RESEARCH 2016; 57:505-511. [PMID: 27342837 PMCID: PMC5045072 DOI: 10.1093/jrr/rrw036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/29/2015] [Accepted: 02/19/2016] [Indexed: 06/06/2023]
Abstract
The effectiveness of ulinastatin and methylprednisolone in treating pathological changes in mice with radiation-induced lung injury (RILI) was evaluated. Forty C57BL/6 female mice received whole-chest radiation (1.5 Gy/min for 12 min) and were randomly allocated into Group R (single radiation, n = 10), Group U (ulinastatin treatment, n = 10), Group M (methylprednisolone treatment, n = 10), or Group UM (ulinastatin and methylprednisolone treatment, n = 10). Another 10 untreated mice served as controls (Group C). Pathological changes in lung tissue, pulmonary interstitial area density (PIAD) and expression levels of transforming growth factor β1 (TGF-β1) and tumor necrosis factor α (TNF-α) in lung tissue, serum and bronchoalveolar lavage fluid were determined. Alleviation of pathological changes in lung tissue was observed in Groups U, M and UM. Treatment with ulinastatin, methylprednisolone or both effectively delayed the development of fibrosis at 12 weeks after radiation. Ulinastatin, methylprednisolone or both could alleviate the radiation-induced increase in the PIAD (P < 0.05 or P < 0.01). Treatment with ulinastatin, methylprednisolone or both significantly reduced the expression of TNF-α, but not TGF-β1, at 9 weeks after radiation compared with Group R (P < 0.01). Ulinastatin and /: or methylprednisolone effectively decreased the level of TNF-α in lung tissue after RILI and inhibited both the inflammatory response and the development of fibrosis.
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Affiliation(s)
- Yu Sun
- Intensive Care Unit, Cancer Hospital of Jilin Province, Changchun 130021, China
| | - Yu-Jun Du
- Department of Nephrology, Bethune First Hospital of Jilin University, Changchun 130021, China
| | - Hui Zhao
- Intensive Care Unit, Cancer Hospital of Jilin Province, Changchun 130021, China
| | - Guo-Xing Zhang
- Intensive Care Unit, Cancer Hospital of Jilin Province, Changchun 130021, China
| | - Ni Sun
- Intensive Care Unit, Cancer Hospital of Jilin Province, Changchun 130021, China
| | - Xiu-Jiang Li
- Intensive Care Unit, Cancer Hospital of Jilin Province, Changchun 130021, China
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Demir F, Güzel A, Kat C, Karadeniz C, Akdemir U, Okuyucu A, Gacar A, Özdemir S, Güvenç T. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats. Braz J Med Biol Res 2014; 47:766-72. [PMID: 25098616 PMCID: PMC4143204 DOI: 10.1590/1414-431x20144021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/22/2014] [Indexed: 11/25/2022] Open
Abstract
Cardiac contusion is a potentially fatal complication of blunt chest trauma. The
effects of a combination of quercetin and methylprednisolone against trauma-induced
cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided
into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated
with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following
days), treated with quercetin (50 mg·kg−1·day−1), and treated
with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and
tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings
were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and
P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with
methylprednisolone, quercetin, and the combination of methylprednisolone and
quercetin compared to the rats without therapy, but a statistical significance was
found only with the combination therapy (P=0.001 and P=0.011, respectively).
Histopathological degeneration and necrosis scores were statistically lower in the
methylprednisolone and quercetin combination group compared to the group treated only
with methylprednisolone (P=0.017 and P=0.007, respectively). However, only
degeneration scores were lower in the combination therapy group compared to the group
treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity
scores were decreased in all treatment groups compared to the untreated groups
(P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of
quercetin and methylprednisolone can be used for the specific treatment of cardiac
contusion.
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Affiliation(s)
- F Demir
- Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbak?r, Turkey
| | - A Güzel
- Department of Pediatrics, Faculty of Medicine, Ondokuz May?s University, Samsun, Turkey
| | - C Kat
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz May?s University, Samsun, Turkey
| | - C Karadeniz
- Pediatric Cardiology Services, Behçet Uz Children's Hospital, ?zmir, Turkey
| | - U Akdemir
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz May?s University, Samsun, Turkey
| | - A Okuyucu
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz May?s University, Samsun, Turkey
| | - A Gacar
- Department of Pathology, Faculty of Veterinary Medicine, Ondokuz May?s University, Samsun, Turkey
| | - S Özdemir
- Department of Pediatrics, Faculty of Medicine, Ondokuz May?s University, Samsun, Turkey
| | - T Güvenç
- Department of Pathology, Faculty of Veterinary Medicine, Ondokuz May?s University, Samsun, Turkey
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Akdemir HU, Güzel A, Katı C, Duran L, Alaçam H, Gacar A, Güvenç T, Murat N, Sişman B. The evaluation of different treatment protocols for trauma-induced lung injury in rats. J Thorac Dis 2014; 6:66-73. [PMID: 24605218 DOI: 10.3978/j.issn.2072-1439.2013.12.54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/30/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lung contusion is an important factor that affects mortality and morbidity of lung injury after blunt chest trauma (BCT). The present study aims to evaluate the effectiveness of different treatment regimens on BCT-induced lung injury. METHODS A total of 35 Sprague Dawley rats were divided into five experimental groups (n=7): sham, control; BCT; BCT + MP, BCT group treated with methylprednisolone (MP; 30 mg/kg on first day and 3 mg/kg/d on the following days); BCT + Q, BCT group treated with quercetin (Q; 50 mg/kg/d for seven days); and BCT + MP + Q, BCT group treated with the same doses of MP and Q. Serum Clara Cell Protein-16 (CC-16), thiobarbituric acid reactive substances (TBARS), and superoxide dismutase (SOD) levels were analyzed to determine histopathological changes in the lung tissues. RESULTS Elevated serum CC-16 and TBARS levels and reduced serum SOD levels were found in the BCT group compared to the Sham group. There was a significant change in the serum CC-16 levels in the BCT + MP group compared to the Sham group. Serum TBARS levels were significantly lower in the BCT + MP and BCT + Q group compared to the BCT group. The combined therapy regimen yielded significantly decreased CC-16 levels and increased serum SOD levels compared to the individual treatment groups. Serum TBARS levels did not significantly differ between the BCT + MP + Q group and the other treatment groups. Compared to the BCT + MP + Q group, the BCT + MP group showed significantly lower alveolar edema (AED) and alveolar exudate (AEX) scores, while the BCT + Q group showed significantly lower peribronchial inflammatory cell infiltration (PICI) and AED scores. CONCLUSIONS The combined usage of quercetin and low dose MP treatment after initial high dose MP at the early stage of lung injury after BCT is more effective.
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Affiliation(s)
- Hızır Ufuk Akdemir
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Aygül Güzel
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Celal Katı
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Latif Duran
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Hasan Alaçam
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayhan Gacar
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Tolga Güvenç
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Naci Murat
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Bülent Sişman
- 1 Faculty of Medicine, Department of Emergency Medicine, 2 Faculty of Medicine, Department of Chest Diseases, 3 Faculty of Medicine, Department of Medical Biochemistry, 4 Faculty of Veterinary Medicine, Department of Pathology, 5 Department of Industrial Engineering, Ondokuz Mayıs University, Samsun, Turkey
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