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Yang CH, Kao MC, Shih PC, Li KY, Tsai PS, Huang CJ. Simvastatin attenuates sepsis-induced blood-brain barrier integrity loss. J Surg Res 2015; 194:591-598. [DOI: 10.1016/j.jss.2014.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 01/04/2023]
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Yeh CT, Kao MC, Chen CH, Huang CJ. Platonin preserves blood–brain barrier integrity in septic rats. ACTA ACUST UNITED AC 2015; 53:12-5. [DOI: 10.1016/j.aat.2015.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/09/2015] [Indexed: 11/17/2022]
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Rodríguez-González R, Ramos-Nuez Á, Martín-Barrasa JL, López-Aguilar J, Baluja A, Álvarez J, Rocco PRM, Pelosi P, Villar J. Endotoxin-induced lung alveolar cell injury causes brain cell damage. Exp Biol Med (Maywood) 2014; 240:135-42. [PMID: 25135986 DOI: 10.1177/1535370214547156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Sepsis is the most common cause of acute respiratory distress syndrome, a severe lung inflammatory disorder with an elevated morbidity and mortality. Sepsis and acute respiratory distress syndrome involve the release of inflammatory mediators to the systemic circulation, propagating the cellular and molecular response and affecting distal organs, including the brain. Since it has been reported that sepsis and acute respiratory distress syndrome contribute to brain dysfunction, we investigated the brain-lung crosstalk using a combined experimental in vitro airway epithelial and brain cell injury model. Conditioned medium collected from an in vitro lipopolysaccharide-induced airway epithelial cell injury model using human A549 alveolar cells was subsequently added at increasing concentrations (no conditioned, 2%, 5%, 10%, 15%, 25%, and 50%) to a rat mixed brain cell culture containing both astrocytes and neurons. Samples from culture media and cells from mixed brain cultures were collected before treatment, and at 6 and 24 h for analysis. Conditioned medium at 15% significantly increased apoptosis in brain cell cultures 24 h after treatment, whereas 25% and 50% significantly increased both necrosis and apoptosis. Levels of brain damage markers S100 calcium binding protein B and neuron-specific enolase, interleukin-6, macrophage inflammatory protein-2, as well as matrix metalloproteinase-9 increased significantly after treating brain cells with ≥2% conditioned medium. Our findings demonstrated that human epithelial pulmonary cells stimulated with bacterial lipopolysaccharide release inflammatory mediators that are able to induce a translational clinically relevant and harmful response in brain cells. These results support a brain-lung crosstalk during sepsis and sepsis-induced acute respiratory distress syndrome.
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Affiliation(s)
- Raquel Rodríguez-González
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Instituto de Investigación Sanitaria (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, 15706, Spain
| | - Ángela Ramos-Nuez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - José Luis Martín-Barrasa
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain Animal Facility Service, Research Unit, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain
| | - Josefina López-Aguilar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain Critical Care Center, Corporació Sanitaria Parc Taulí, Sabadell, 08208 Barcelona, Spain
| | - Aurora Baluja
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Instituto de Investigación Sanitaria (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, 15706, Spain
| | - Julián Álvarez
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, Instituto de Investigación Sanitaria (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, 15706, Spain
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16126 Genoa, Italy
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain Li Ka Shing Knowledge Institute at the St. Michael's Hospital, Toronto, Ontario M5B 1W8, Canada
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Adam N, Kandelman S, Mantz J, Chrétien F, Sharshar T. Sepsis-induced brain dysfunction. Expert Rev Anti Infect Ther 2013; 11:211-21. [PMID: 23409826 DOI: 10.1586/eri.12.159] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Systemic infection is often revealed by or associated with brain dysfunction, which is characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. Its pathophysiology involves an ischemic process, secondary to impairment of cerebral perfusion and its determinants and a neuroinflammatory process that includes endothelial activation, alteration of the blood-brain barrier and passage of neurotoxic mediators. Microcirculatory dysfunction is common to these two processes. This brain dysfunction is associated with increased mortality, morbidity and long-term cognitive disability. Its diagnosis relies essentially on neurological examination that can lead to specific investigations, including electrophysiological testing or neuroimaging. In practice, cerebrospinal fluid analysis is indisputably required when meningitis is suspected. Hepatic, uremic or respiratory encephalopathy, metabolic disturbances, drug overdose, sedative or opioid withdrawal, alcohol withdrawal delirium or Wernicke's encephalopathy are the main differential diagnoses. Currently, treatment consists mainly of controlling sepsis. The effects of insulin therapy and steroids need to be assessed. Various drugs acting on sepsis-induced blood-brain barrier dysfunction, brain oxidative stress and inflammation have been tested in septic animals but not yet in patients.
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Affiliation(s)
- Nicolas Adam
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital, University of Versailles Saint-Quentin en Yvelines, 104 Boulevard Raymond Poincaré, 92380 Garches, France
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Abstract
Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood-brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke's encephalopathy. Modulation of microglial activation, prevention of blood-brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors.
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Simen AA, Bordner KA, Martin MP, Moy LA, Barry LC. Cognitive dysfunction with aging and the role of inflammation. Ther Adv Chronic Dis 2012; 2:175-95. [PMID: 23251749 DOI: 10.1177/2040622311399145] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As the average lifespan continues to climb because of advances in medical care, there is a greater need to understand the factors that contribute to quality of life in the elderly. The capacity to live independently is highly significant in this regard, but is compromised by cognitive dysfunction. Aging is associated with decreases in cognitive function, including impairments in episodic memory and executive functioning. The prefrontal cortex appears to be particularly vulnerable to the effects of advancing age. Although the mechanism of age-related cognitive decline is not yet known, age-related inflammatory changes are likely to play a role. New insights from preclinical and clinical research may give rise to novel therapeutics which may have efficacy in slowing or preventing cognitive decline with advancing age.
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Affiliation(s)
- Arthur A Simen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Zheng Y, Gun'ko VM, Howell CA, Sandeman SR, Phillips GJ, Kozynchenko OP, Tennison SR, Ivanov AE, Mikhalovsky SV. Composites with macroporous poly(vinyl alcohol) cryogels with attached activated carbon microparticles with controlled accessibility of a surface. ACS APPLIED MATERIALS & INTERFACES 2012; 4:5936-5944. [PMID: 23088424 DOI: 10.1021/am301577c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A set of glutaraldehyde (GA) cross-linked poly(vinyl alcohol)/activated carbon (PVA/GA/AC) composites prepared in the form of monolithic rods using a cryogelation technique and studied using adsorption, mercury porosimetry, scanning electron microscopy (SEM), and quantum chemistry methods display porosity similar to that of PVA/GA cryogel at a high GA content (content ratio GA/AC = 1 and GA/PVA = 0.2). GA cross-linked PVA multilayer coverage is an effective barrier for adsorption on AC particles. Variations in surface chemistry (AC initial and oxidized in air at 300 °C for 12 h) and content (14-62.5%w/w) of ACs in PVA/GA/AC composites relatively weakly affect their textural characteristics at a high GA content (specific surface area S(BET) < 120 m²/g, pore volume V(p) < 0.35 cm³/g). However, PVA/GA/AC composite rods formed with a lower concentration of GA (content ratio GA/AC = 1/6 and GA/PVA = 1/10) have significantly greater S(BET) (∼500 m²/g) and V(p) (>0.55 cm³/g) values because of improved accessibility of the AC surface. This provides better adsorption of methylene blue as a probe compound.
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Affiliation(s)
- Yishan Zheng
- School of Pharmacy & Biomolecular Sciences, University of Brighton, Brighton BN2 4GJ, UK
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Encéphalopathie associée au sepsis. Rev Neurol (Paris) 2011; 167:195-204. [DOI: 10.1016/j.neurol.2010.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 04/20/2010] [Accepted: 07/07/2010] [Indexed: 02/05/2023]
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Des pathologies encéphaliques à connaître — L'encéphalopathie associée au sepsis et ses diagnostics différentiels. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Checinski A, Polito A, Friedman D, Siami S, Annane D, Sharshar T. Sepsis-associated encephalopathy and its differential diagnosis. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sepsis-associated encephalopathy (SAE) is defined as a diffuse cerebral dysfunction resulting from the systemic inflammatory response to an infection without direct infestation of the CNS. Although the pathophysiology of SAE is as yet unknown, some mechanisms have been suggested that involve BBB disruption as a consequence of proinflammatory mediators’ effects on endothelial cells. This leads to an increased passage of neurotoxic and proinflammatory mediators into the brain parenchyma, as well as an impairment of the movements of oxygen and metabolites through the BBB. Both neurons and glial cells are affected, resulting in neural functioning and neurotransmission impairment. The clinical translation of this process is an alteration of consciousness and awareness. SAE is a frequent condition in septic patients. Despite being considered reversible, SAE appears to be associated with long-term cognitive impairment. Detection and diagnosis can be challenging; it requires daily neurological assessment with the assistance of clinical scores. Use of biomarkers and neurophysiological testing is discussed. The aim of this article is to provide practical tools for detection of SAE, as well as an updated overview of its pathophysiology and therapeutic perspectives.
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Affiliation(s)
- Anthony Checinski
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Andrea Polito
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Diane Friedman
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - Shidasp Siami
- Department of Intensive Care Medicine, Hospital of Sud Essonne, Etampes, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré, 92380 Garches, France
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Feng X, Zhang F, Dong R, Wang H, Liu J, Liu X, Li W, Yao J, Xu J, Yu B. Effects of hydroxyethyl starch (130kD) on brain inflammatory response and outcome during normotensive sepsis. Int Immunopharmacol 2010; 10:859-64. [DOI: 10.1016/j.intimp.2010.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/11/2010] [Accepted: 04/26/2010] [Indexed: 12/11/2022]
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Abstract
Sepsis is often complicated by an acute and reversible deterioration of mental status, which is associated with increased mortality and is consistent with delirium but can also be revealed by a focal neurologic sign. Sepsis-associated encephalopathy is accompanied by abnormalities of electroencephalogram and somatosensory-evoked potentials, increased in biomarkers of brain injury (i.e., neuron-specific enolase, S-100 beta-protein) and, frequently, by neuroradiological abnormalities, notably leukoencephalopathy. Its mechanism is highly complex, resulting from both inflammatory and noninflammatory processes that affect all brain cells and induce blood-brain barrier breakdown, dysfunction of intracellular metabolism, brain cell death, and brain injuries. Its diagnosis relies essentially on neurologic examination that can lead one to perform specific neurologic tests. Electroencephalography is required in the presence of seizure; neuroimaging in the presence of seizure, focal neurologic signs or suspicion of cerebral infection; and both when encephalopathy remains unexplained. In practice, cerebrospinal fluid analysis should be performed if there is any doubt of meningitis. Hepatic, uremic, or respiratory encephalopathy, metabolic disturbances, drug overdose, withdrawal of sedatives or opioids, alcohol withdrawal delirium, and Wernicke's encephalopathy are the main differential diagnoses of sepsis-associated encephalopathy. Patient management is based mainly on controlling infection, organ system failure, and metabolic homeostasis, at the same time avoiding neurotoxic drugs.
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Taccone FS, Castanares-Zapatero D, Peres-Bota D, Vincent JL, Berre’ J, Melot C. Cerebral Autoregulation is Influenced by Carbon Dioxide Levels in Patients with Septic Shock. Neurocrit Care 2009; 12:35-42. [DOI: 10.1007/s12028-009-9289-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Flierl MA, Stahel PF, Rittirsch D, Huber-Lang M, Niederbichler AD, Hoesel LM, Touban BM, Morgan SJ, Smith WR, Ward PA, Ipaktchi K. Inhibition of complement C5a prevents breakdown of the blood-brain barrier and pituitary dysfunction in experimental sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R12. [PMID: 19196477 PMCID: PMC2688129 DOI: 10.1186/cc7710] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 01/12/2009] [Accepted: 02/06/2009] [Indexed: 12/12/2022]
Abstract
Introduction Septic encephalopathy secondary to a breakdown of the blood-brain barrier (BBB) is a known complication of sepsis. However, its pathophysiology remains unclear. The present study investigated the effect of complement C5a blockade in preventing BBB damage and pituitary dysfunction during experimental sepsis. Methods Using the standardised caecal ligation and puncture (CLP) model, Sprague-Dawley rats were treated with either neutralising anti-C5a antibody or pre-immune immunoglobulin (Ig) G as a placebo. Sham-operated animals served as internal controls. Results Placebo-treated septic rats showed severe BBB dysfunction within 24 hours, accompanied by a significant upregulation of pituitary C5a receptor and pro-inflammatory cytokine expression, although gene levels of growth hormone were significantly attenuated. The pathophysiological changes in placebo-treated septic rats were restored by administration of neutralising anti-C5a antibody to the normal levels of BBB and pituitary function seen in the sham-operated group. Conclusions Collectively, the neutralisation of C5a greatly ameliorated pathophysiological changes associated with septic encephalopathy, implying a further rationale for the concept of pharmacological C5a inhibition in sepsis.
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Affiliation(s)
- Michael A Flierl
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
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Siami S, Polito A, Sharshar T. Sepsis-associated Encephalopathy. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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