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Li T, Su D, Lu H, Gao Y, Liu Y, Wang S, Hou Y, Qin K, Que X, Chen X, Qin B, Wang Z, Deng Y. Recombinant human brain natriuretic peptide attenuates ischemic brain injury in mice by inhibiting oxidative stress and cell apoptosis via activation of PI3K/AKT/Nrf2/HO-1 pathway. Exp Brain Res 2023; 241:2751-2763. [PMID: 37847304 DOI: 10.1007/s00221-023-06716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Abstract
Ischemic stroke followed by cerebral artery occlusion is a main cause of chronic disability worldwide. Recombinant human brain natriuretic peptide (rhBNP) has been reported to alleviate sepsis-induced cognitive dysfunction and brain I/R injury. However, the function and molecular mechanisms of rhBNP in ischemic brain injury have not been clarified. For establishment of an animal model of ischemic brain injury, C57BL/6 mice were treated with middle cerebral artery occlusion (MCAO) surgery for 1 h and reperfusion for 24 h. After subcutaneous injection of rhBNP into model mice, neurologic deficits were assessed by evaluating behavior of mice according to Longa scoring system, and TTC staining was utilized to determine the brain infarct size of mice. The levels of oxidative stress markers, superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA), were detected in hippocampal tissues of mice by corresponding kits. Cell apoptosis in hippocampus tissues was examined by TUNEL staining. Protein levels of antioxidant enzymes (HO-1 and NQO1) in cerebral cortex, apoptotic markers (Bax, Bcl-2, and cleaved caspase), and PI3K/AKT pathway-associated factors in hippocampus were tested by western blot analysis. The results revealed that injection of rhBNP decreased neurologic deficit scores, the percent of brain water content, and infarct volume. Additionally, rhBNP downregulated MDA level, upregulated the levels of SOD, CAT, and GSH in hippocampus of mice, and increased protein levels of HO-1 and NQO1 in the cortex. Cell apoptosis in hippocampus tissues of model mice was inhibited by rhBNP which was shown as the reduced TUNEL-positive cells, the decreased Bax, cleaved caspase-3, and cleaved caspase-9 protein levels, and the enhanced Bcl-2 protein level. In addition, rhBNP treatment activated the PI3K/AKT signaling pathway and upregulated the protein levels of HO-1 and NRF2. Overall, rhBNP activates the PI3K/AKT/HO-1/NRF2 pathway to attenuate ischemic brain injury in mice after MCAO by suppression of cell apoptosis and oxidative stress.
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Affiliation(s)
- Tong Li
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - DaJing Su
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - HuaWen Lu
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - YunQing Gao
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - YongGang Liu
- Department of Urology Surgery, Nanning Second People's Hospital, Nanning, 530031, China
| | - ShaoHua Wang
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - YuTing Hou
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - KeMin Qin
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - XianTing Que
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - XiaoPing Chen
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - BaiLing Qin
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - ZiJun Wang
- Department of Neurology, Nanning Second People's Hospital, Nanning, 530031, China
| | - Yan Deng
- Department of Medical Records, Nanning Second People's Hospital, No. 13, Dancun Road, Jiangnan District, Nanning, 530031, Guangxi, China.
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Li N, Ma RH, Zhang EF, Ge F, Fang DY, Zhang J, Zhang YN, Gao Y, Hou LC, Jin HX. Interferon-induced transmembrane protein 3 in the hippocampus: a potential novel target for the therapeutic effects of recombinant human brain natriuretic peptide on sepsis-associated encephalopathy. Front Mol Neurosci 2023; 16:1182005. [PMID: 37602193 PMCID: PMC10436203 DOI: 10.3389/fnmol.2023.1182005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Objective This study aims to explore whether interferon-induced transmembrane protein 3 (IFITM3) is involved in recombinant human brain natriuretic peptide (rhBNP)-mediated effects on sepsis-induced cognitive dysfunction in mice. Methods The cellular localization and expression level of IFITM3 in the hippocampus were detected. The IFITM3 overexpression was achieved using an intracranial stereotactic system to inject an adeno-associated virus into the hippocampal CA1 region of mice. Field experiments, an elevated plus maze, and conditioned fear memory tests assessed the cognitive impairment in rhBNP-treated septic mice. Finally, in the hippocampus of septic mice, terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) staining and Immunoblot were used to detect changes in the protein expression of cleaved Caspase-8 and cleaved Caspase-3 in apoptosis-related pathways, and toll-like receptor 4 (TLR4) and nuclear factor κB (NF-κB) p65 in inflammatory pathways. Results Fourteen days after cecal ligation and puncture (CLP) surgery, IFITM3 localized in the plasma membrane and cytoplasm of the astrocytes in the hippocampus of septic mice, partially attached to the perivascular and neuronal surfaces, but not expressed in the microglia. The expression of IFITM3 was increased in the astrocytes and neurons in the hippocampus of septic mice, which was selectively inhibited by the administration of rhBNP. Overexpression of IFITM3 resulted in elevated anxiety levels and long-term learning and memory dysfunction, completely abolished the therapeutic effect of rhBNP on cognitive impairment in septic mice, and induced an increase in the number of neuronal apoptosis in the hippocampal CA1 region. The expression levels of cleaved Caspase-3 and cleaved Caspase-8 proteins were significantly increased in the hippocampus, but the expression levels of TLR4 and NF-κB p65 were not increased. Conclusion The activation of IFITM3 may be a potential new target for treating sepsis-associated encephalopathy (SAE), and it may be one of the key anti-apoptotic mechanisms in rhBNP exerting its therapeutic effect, providing new insight into the clinical treatment of SAE patients.
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Affiliation(s)
- Nan Li
- Department of Emergency Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
- Department of Anesthesiology and Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Rui-Hang Ma
- Department of Emergency Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Er-Fei Zhang
- Department of Anesthesiology and Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Anesthesiology, The Affiliated Hospital of Yan’an University, Yan’an, Shaanxi, China
| | - Feng Ge
- Department of Emergency Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - De-Yu Fang
- Department of Chemistry, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China
| | - Jing Zhang
- Department of Intensive Care Unit, Yue Bei People’s Hospital, The Affiliated Hospital of Shantou University, Shaoguan, Guangdong, China
| | - Yan-Ning Zhang
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan Gao
- Department of Emergency Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Li-Chao Hou
- Department of Anesthesiology and Critical Care Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Anesthesiology, Xiang’an Hospital of Xiamen University, Xiamen, Fujian, China
| | - Hong-Xu Jin
- Department of Emergency Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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Ferlini L, Gaspard N. What's new on septic encephalopathy? Ten things you need to know. Minerva Anestesiol 2023; 89:217-225. [PMID: 35833857 DOI: 10.23736/s0375-9393.22.16689-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sepsis associated encephalopathy (SAE) is a frequent complication of sepsis and is associated with a higher risk of short-term mortality and long-term cognitive impairment. The EEG is a sensitive complement of the clinical examination that can also detect and quantify encephalopathy and identify features with prognostic value, such as lack of reactivity. Moreover, despite their effect on outcome is still debated, the EEG is the only tool to detect non-convulsive seizures which can occur in a septic setting. Understanding the pathophysiology of SAE is fundamental to define potential therapeutic targets. Neuroinflammation plays an important role in the development of SAE and many blood and imaging biomarkers have recently shown a promising ability to distinguish SAE form non-SAE patient. In recent years, some interesting mediators of inflammation were successfully targeted in animal models, with a significant reduction in the neuroinflammation and in sepsis-induced cognitive decline. However, the complexity of the host response to sepsis currently limits the use of immunomodulation therapies in humans. Alteration in regulatory systems of cerebral blood flow, namely cerebral autoregulation (CA) and neurovascular coupling, contribute to SAE development. Nowadays, clinicians have access to different tools to assess them at the bedside and CA-based blood pressure protocols should be implemented to optimize cerebral perfusion. Its inauspicious consequences, its complex physiopathology and the lack of efficacious treatment make of SAE a highly active research subject.
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Affiliation(s)
- Lorenzo Ferlini
- Department of Neurology, Hôpital Erasme, University of Brussels, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Hôpital Erasme, University of Brussels, Brussels, Belgium -
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Tian M, Wang W, Wang K, Jin P, Lenahan C, Wang Y, Tan J, Wen H, Deng S, Zhao F, Gong Y. Dexmedetomidine alleviates cognitive impairment by reducing blood-brain barrier interruption and neuroinflammation via regulating Th1/Th2/Th17 polarization in an experimental sepsis model of mice. Int Immunopharmacol 2021; 101:108332. [PMID: 34785141 DOI: 10.1016/j.intimp.2021.108332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 02/05/2023]
Abstract
Clinical studies have shown that dexmedetomidine (DEX) reduces mortality and inflammation in patients with sepsis, and ameliorates cognitive decline in both postoperative and critical care patients. This study aims to explain the neuroprotective effects provided by DEX in mice with cecal ligation and puncture (CLP)-induced polymicrobial sepsis. Mice were treated with DEX intraperitoneally three times every two hours after CLP. The survival rate, body weight, and clinical scores were recorded each day. Morris water maze (MWM) and fear conditioning tests were used to evaluate cognitive function. Blood brain barrier (BBB) permeability, hippocampal inflammation, hippocampal neural apoptosis, and T helper (Th) cell subgroups were assessed. Furthermore, Atipamezole was used to verify that the potential neuroprotective effects in the sepsis-associated encephalopathy (SAE) were mediated by DEX. Compared with the Sham group, CLP mice showed significant cognitive impairment, BBB interruption, excessive neuroinflammation, and neuronal apoptosis. These detrimental effects of CLP were attenuated by DEX. Furthermore, we found that DEX corrects peripheral Th1/Th2/Th17 shift and reduces proinflammatory cytokines in the hippocampus. Additionally, atipamezole prevented DEX's protective effect. Taken together, DEX alleviates cognitive impairments by reducing blood-brain barrier interruption and neuroinflammation by regulating Th1/Th2/Th17 polarization.
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Affiliation(s)
- Mi Tian
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wei Wang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Kai Wang
- Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Peng Jin
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Cameron Lenahan
- Burrell college of Osteopathic Medicine, Las Cruses, NM 88003 United States
| | - Yao Wang
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jiaying Tan
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Huimei Wen
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shuixiang Deng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Feng Zhao
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
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McKechnie DG, Papacosta AO, Lennon LT, Welsh P, Whincup PH, Wannamethee SG. Inflammatory markers and incident heart failure in older men: the role of NT-proBNP. Biomark Med 2021; 15:413-425. [PMID: 33709785 PMCID: PMC8559131 DOI: 10.2217/bmm-2020-0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: To determine the relationship between baseline inflammation (CRP and IL-6) with natriuretic peptide (NP) activity (measured by NT-proBNP) and incident heart failure (HF) in older men. Methods & results: In the British Regional Heart Study, 3569 men without prevalent myocardial infarction or HF were followed for mean 16.3 years; 327 developed HF. Baseline CRP and IL-6 were significantly and positively associated with NT-proBNP. Those in the highest CRP and IL-6 quartiles had an elevated risk of HF after age and BMI adjustment (HR = 1.42 [1.01–1.98] and 1.71 [1.24–2.37], respectively), which markedly attenuated after NT-proBNP adjustment (HR = 1.15 [0.81–1.63] and 1.25 [0.89–1.75], respectively). Conclusion: NP activity is associated with pro-inflammatory biomarkers and may explain the link between inflammation and incident HF. Inflammation describes the body’s natural response to infections, injuries and toxins. Inflammation is a helpful response in the short term, but it is thought that long-lasting inflammation – for example, due to illnesses such as diabetes or obesity – may have harmful effects. Previous studies have found that people with higher levels of inflammatory molecules in the blood seem to be more likely to develop heart failure (HF) later on. The amount of fluid in the body is controlled, in part, by molecules in the blood known as ‘natriuretic peptides' (NPs). People with HF have much higher levels of NPs in their blood, and these are used to help diagnose HF. There are suggestions that inflammation and natriuretic peptides are linked to one another. Using a sample of men aged 60–79 years, who did not have HF, we compared blood markers of inflammation and NPs at a baseline examination. Men with higher blood inflammatory markers tended to have higher blood NP levels. We then followed these men up for an average of 16.3 years. Men with higher blood inflammatory markers at baseline were more likely to develop HF, as expected, even after accounting for differences in age and BMI. However, when we accounted for NP levels at baseline, the increased risk of HF with inflammation disappeared. This suggests that NP activity is important in the relationship between inflammation and the risk of HF. Future studies should account for this when examining the link. It is possible that NPs or, more likely, whatever is driving their release, may explain why people with inflammation are more likely to get HF.
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Affiliation(s)
- Douglas Gj McKechnie
- Department of Primary Care & Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care & Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care & Population Health, University College London, London, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
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Tauber SC, Djukic M, Gossner J, Eiffert H, Brück W, Nau R. Sepsis-associated encephalopathy and septic encephalitis: an update. Expert Rev Anti Infect Ther 2020; 19:215-231. [PMID: 32808580 DOI: 10.1080/14787210.2020.1812384] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sepsis-associated encephalopathy (SAE) and septic encephalitis (SE) are associated with increased mortality, long-term cognitive impairment, and focal neurological deficits. AREAS COVERED The PUBMED database was searched 2016-2020. The clinical manifestation of SAE is delirium, SE additionally is characterized by focal neurological symptoms. SAE is caused by inflammation with endothelial/microglial activation, increase of permeability of the blood-brain-barrier, hypoxia, imbalance of neurotransmitters, glial activation, axonal, and neuronal loss. Septic-embolic (SEE) and septic-metastatic encephalitis (SME) are characterized by focal ischemia (SEE) and small abscesses (SME). The continuum between SAE, SME, and SEE is documented by imaging techniques and autopsies. The backbone of treatment is rapid optimum antibiotic therapy. Experimental approaches focus on modulation of inflammation, stabilization of the blood-brain barrier, and restoration of membrane/mitochondrial function. EXPERT OPINION The most promising diagnostic approaches are new imaging techniques. The most important measure to fight delirium remains establishment of daily structure and adequate sensory stimuli. Dexmedetomidine and melatonin appear to reduce the frequency of delirium, their efficacy in SAE and SE remains to be established. Drugs already licensed for other indications or available as food supplements which may be effective in SAE are statins, L-DOPA/benserazide, β-hydroxybutyrate, palmitoylethanolamide, and tetracyclines or other bactericidal non-lytic antibiotics.
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Affiliation(s)
- Simone C Tauber
- Department of Neurology, Rheinisch-Westfälische Technische Hochschule (RWTH) , Aachen, Germany
| | - Marija Djukic
- Institute of Neuropathology, University Medical Center , Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende , Göttingen, Germany
| | - Johannes Gossner
- Department of Diagnostic and Interventional Radiology, Protestant Hospital Göttingen-Weende , Göttingen, Germany
| | - Helmut Eiffert
- Amedes MVZ for Laboratory Medicine, Medical Microbiology and Infectiology , Göttingen, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center , Göttingen, Germany
| | - Roland Nau
- Institute of Neuropathology, University Medical Center , Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende , Göttingen, Germany
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