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Prithvi D, Kumar N, Kumar A, Kumar A. Role of ulinastatin in steroid-induced pancreatitis. BMJ Case Rep 2024; 17:e260019. [PMID: 38839406 DOI: 10.1136/bcr-2024-260019] [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] [Indexed: 06/07/2024] Open
Abstract
Steroid-induced acute pancreatitis is a rare form of pancreatitis that requires intensive care and has a high morbidity and mortality rate as there is no specific treatment. Management of steroid-induced pancreatitis is generally non-specific and supportive. Here, we are presenting a man in his 40s presented with epigastric pain, fever and vomiting. The patient was diagnosed case of rheumatoid arthritis, for which he was receiving regular 5 mg oral prednisolone therapy. Based on history, and clinical, biochemical and radiological imaging a diagnosis of steroid-induced pancreatitis was made, which was successfully managed with the help of ulinastatin and other supportive treatments. A serine protease inhibitor like ulinastatin may be used early in the clinical management of steroid-induced pancreatitis.
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Affiliation(s)
| | - Neeraj Kumar
- Anaesthesiology and Critical Care, AIIMS, Patna, India
| | - Ajeet Kumar
- Anaesthesiology and Critical Care, AIIMS, Patna, India
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2
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Shi Y, Wen H, Cui J, Qin W. Ulinastatin inhibits microglia activation in spinal cord via P2Y12 receptor in a rat neuropathic pain model. J Histotechnol 2023; 46:39-53. [PMID: 36637388 DOI: 10.1080/01478885.2022.2163792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Ulinastatin, a broad spectrum of serine protease inhibitor, has been found to alleviate neuropathic pain (NPP). However, its mechanism is not completely clear. Here, a sciatic nerve ligation rat model and BV2 microglial cells were used to investigate the effect of Ulinastatin on the activation of microglia and P2Y12 receptors in vivo and in vitro. Levels of P2Y12 receptor and NF-κB (P65) expression in the dorsal horn of the lumbar enlargement region of the spinal cord and BV2 cells were assessed by immunohistochemistry and double-label immunofluorescence assays. Levels of IL-1β and TNF-α in cell culture medium and cerebrospinal fluid (CSF) were examined by ELISA. The results showed that Ulinastatin reduced the release of inflammatory IL-1β and TNF-α by inhibiting the activation of spinal microglia. Ulinastatin down-regulated P2Y12 receptor and NF-κB (P65) expression in the spinal microglia of the chronic constrictive injury model. The results indicated that Ulinastatin may attenuate the activation of spinal microglia after peripheral nerve injury by inhibiting the activation of P2Y12 receptor signal pathway in microglia. NF-kB may play a key role in the mechanism of Ulinastatin.
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Affiliation(s)
- Ying Shi
- Department of Pain Care, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huizhong Wen
- Department of Neurobiology, Army Medical University, Chongqing, China
| | - Jian Cui
- Department of Pain Care, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wanxiang Qin
- Department of Pain Care, Southwest Hospital, Army Medical University, Chongqing, China
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3
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Guo R, Gao S, Feng Y, Mao C, Sheng W. Ulinastatin attenuates spinal cord injury by targeting AMPK/NLRP3 signaling pathway. J Chem Neuroanat 2022; 125:102145. [PMID: 35998795 DOI: 10.1016/j.jchemneu.2022.102145] [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: 07/08/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 10/31/2022]
Abstract
The AMPK and NLRP3 inflammasome signaling pathways are reported to participant in the inflammatory responses following spinal cord injury (SCI). Ulinastatin (ULI) is a urinary trypsin inhibitor with excellent anti-inflammatory effects, but the functions of ULI on SCI are rarely reported. Hence, this study was designed to investigate whether ULI could modulate SCI through regulating the AMPK/NLRP3 signaling pathway. Cell Counting Kit-8 (CCK-8) assays were used to investigate whether ULI had cytotoxic effects on BV-2 cells. Basso-Beattie-Bresnahan (BBB) scale, spinal cord water content detection, hematoxylin-eosin (HE) and Nissl stainings were used to investigate the protective effects of ULI on rat SCI. The expressions of inflammatory cytokines were detected by ELISA and RT-qPCR. The expressions of key proteins of AMPK and NLRP3 inflammasome were analyzed by western blot. The CCK-8 assays indicated that ULI did not significantly influence the viability of BV-2 cells at various concentrations below 10,000 U/ml. It was witnessed that ULI could dramatically inhibit the activation of NLRP3 inflammasome via activating the AMPK signaling pathway, thus relieving inflammatory responses. Besides, the in vivo experiment suggested that treatment with ULI remarkably relieve spinal cord edema, ameliorated spinal cord tissue architecture, and improved neurological function following SCI. The findings indicate that ULI significantly ameliorates neurological function following SCI by regulating the AMPK/NLRP3 inflammasome signaling pathway.
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Affiliation(s)
- Rui Guo
- Department of Spine Surgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang 830054, China.
| | - Shutao Gao
- Department of Spine Surgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang 830054, China.
| | - Ying Feng
- College of Public Health, Xinjiang Medical University, China.
| | - Chao Mao
- Department of Spine Surgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang 830054, China.
| | - Weibin Sheng
- Department of Spine Surgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang 830054, China.
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4
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Mehta Y, Dixit SB, Zirpe K, Sud R, Gopal PB, Koul PA, Mishra VK, Ansari AS, Chamle VS. Therapeutic Approaches in Modulating the Inflammatory and Immunological Response in Patients With Sepsis, Acute Respiratory Distress Syndrome, and Pancreatitis: An Expert Opinion Review. Cureus 2021; 13:e18393. [PMID: 34692364 PMCID: PMC8526068 DOI: 10.7759/cureus.18393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/15/2022] Open
Abstract
Immunomodulation has long been an adjunct approach in treating critically ill patients with sepsis, acute respiratory distress syndrome (ARDS), and acute pancreatitis (AP). Hyperactive immune response with immunopathogenesis leads to organ dysfunction and alters the clinical outcomes in critically ill. Though the immune response in the critically ill might have been overlooked, it has gathered greater attention during this novel coronavirus disease 2019 (COVID-19) pandemic. Modulating hyperactive immune response, the cytokine storm, especially with steroids, has shown to improve the outcomes in COVID-19 patients. In this review, we find that immune response pathogenesis in critically ill patients with sepsis, ARDS, and AP is nearly similar. The use of immunomodulators such as steroids, broad-spectrum serine protease inhibitors such as ulinastatin, thymosin alpha, intravenous immunoglobulins, and therapies such as CytoSorb and therapeutic plasma exchange may help in improving the clinical outcomes in these conditions. As the experience of the majority of physicians in using such therapeutics may be limited, we provide our expert comments regarding immunomodulation to optimize outcomes in patients with sepsis/septic shock, ARDS, and AP.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurugram, IND
| | | | - Kapil Zirpe
- Neurocritical Care, Grant Medical Foundation, Ruby Hall Clinic, Pune, IND
| | - Randhir Sud
- Institute of Digestive & Hepatobiliary Sciences, Medanta - The Medicity, Gurugram, IND
| | - Palepu B Gopal
- Department of Critical Care, Continental Hospitals, Hyderabad, IND
| | - Parvaiz A Koul
- Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Vijay K Mishra
- Medica Institute of Critical Care, Bhagwan Mahavir Medica Superspecialty Hospital, Ranchi, IND
| | - Abdul S Ansari
- Department of Critical Care Services, Nanavati Super Specialty Hospital, Mumbai, IND
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Amere Subbarao S. Cancer vs. SARS-CoV-2 induced inflammation, overlapping functions, and pharmacological targeting. Inflammopharmacology 2021; 29:343-366. [PMID: 33723711 PMCID: PMC7959277 DOI: 10.1007/s10787-021-00796-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/27/2021] [Indexed: 12/15/2022]
Abstract
Inflammation is an intrinsic defence mechanism triggered by the immune system against infection or injury. Chronic inflammation allows the host to recover or adapt through cellular and humoral responses, whereas acute inflammation leads to cytokine storms resulting in tissue damage. In this review, we present the overlapping outcomes of cancer inflammation with virus-induced inflammation. The study emphasises how anti-inflammatory drugs that work against cancer inflammation may work against the inflammation caused by the viral infection. It is established that the cytokine storm induced in response to SARS-CoV-2 infection contributes to disease-associated mortality. While cancer remains the second among the diseases associated with mortality worldwide, cancer patients' mortality rates are often observed upon extended periods after illness, usually ranging from months to years. However, the mortality rates associated with COVID-19 disease are robust. The cytokine storm induced by SARS-CoV-2 infection appeared to be responsible for the multi-organ failure and increased mortality rates. Since both cancer and COVID-19 disease share overlapping inflammatory mechanisms, repurposing some anticancer and anti-inflammatory drugs for COVID-19 may lower mortality rates. Here, we review some of these inflammatory mechanisms and propose some potential chemotherapeutic agents to intervene in them. We also discuss the repercussions of anti-inflammatory drugs such as glucocorticoids and hydroxychloroquine with zinc or antiviral drugs such as ivermectin and remdesivir against SARS-CoV-2 induced cytokine storm. In this review, we emphasise on various possibilities to reduce SARS-CoV-2 induced cytokine storm.
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6
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Su S, Liang T, Zhou X, He K, Li B, Xia X. Qingyi decoction attenuates severe acute pancreatitis in rats via inhibition of inflammation and protection of the intestinal barrier. J Int Med Res 2019; 47:2215-2227. [PMID: 30700190 PMCID: PMC6567787 DOI: 10.1177/0300060518809289] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 09/28/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Qingyi decoction (QYD) has beneficial effects in severe acute pancreatitis (SAP). We assessed the therapeutic effect and mechanisms of QYD in SAP. METHODS A rat model of SAP was induced by pancreatic ductal injection of sodium taurocholate. QYD was administered intragastrically immediately postoperatively and once every 12 hours. Serum amylase, endotoxin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and D-lactate levels were measured at 12, 24, and 48 hours. Histological changes in the pancreas and ileum were analyzed. Expression of nuclear factor kappa-light-chain-enhancer of activated B cells p65 (NF-κB p65), Toll-like receptor 4 (TLR4), and zonula occludens-1 (ZO-1) in the small intestinal mucosa was also assessed. RESULTS Pancreatic tissue showed extracellular space expansion, inflammatory infiltration, vessels with necrotic walls, and hemorrhage. Ileal tissue showed hemorrhage, inflammatory infiltration, and ileal mucosa destruction. These histological features were dramatically improved by QYD. Increased serum levels of amylase, endotoxin, TNF-α, IL-6, and D-lactic acid were significantly decreased by QYD administration. Increased expression of NF-κB p65 and TLR4 and decreased expression of ZO-1 in the ileal mucosa were also restored to normal levels by QYD treatment. CONCLUSION QYD alleviates SAP by reducing intestinal barrier dysfunction, inhibiting intestinal bacteria and endotoxin translocation, and preventing NF-κB activation.
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Affiliation(s)
- Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Tiancheng Liang
- Department of First Surgery, Luzhou Traditional Chinese Medicine Hospital, Luzhou, Sichuan, P.R. China
| | - Xiang Zhou
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Kai He
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Bo Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Xianming Xia
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
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7
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Hu Q, He T, Sun Y, Wang F, Wu J. Effect of fast-track surgery on inflammatory response and immune function in patients with laparoscopic distal gastrectomy. Eur Surg 2019. [DOI: 10.1007/s10353-019-0572-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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8
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Wang Y, Li L. Predicative values of C-reactive protein for the therapeutic effects of ulinastatin combined with somatostatin in severe acute pancreatitis and for the severity of gastrointestinal failure. Exp Ther Med 2018; 16:3165-3171. [PMID: 30233671 DOI: 10.3892/etm.2018.6577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/02/2018] [Indexed: 02/02/2023] Open
Abstract
Severe acute pancreatitis (SAP) is a serious systemic disease with high mortality. Ulinastatin is a drug widely used for patients with SAP and multiple organ failure syndrome. The present study aimed to investigate the capacity of the serum C-reactive protein (CRP) levels to predict the therapeutic effects of ulinastatin combined with somatostatin as well as determine the severity of SAP. SAP patients were treated with ulinastatin combined with somatostatin and serum CRP levels were measured. The computed tomography severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) and gastrointestinal failure scores were used to determine the therapeutic effects. All patients were assigned to the effective group and the ineffective group. Receiver operating characteristic curve analysis was performed to determine the sensitivity and specificity of CRP levels in predicting the severity of SAP and patient prognosis. Logistic regression analysis was adopted to investigate the factors influencing the therapeutic effects. Prior to and after treatment, serum CRP levels in patients of the effective and ineffective groups were significantly different. After treatment, serum CRP levels in patients of the effective group exhibited a more obvious reduction. The sensitivity and specificity of serum CRP levels in predicting the therapeutic effects of ulinastatin combined with somatostatin in SAP patients upon hospital admission were 0.813 and 0.934, respectively. Serum CRP levels were positively correlated with APACHE II, CTSI and gastrointestinal failure scores of SAP patients. The logistic regression demonstrated that serum albumin, creatinine and CRP levels on admission were factors influencing the therapeutic effects of ulinastatin combined with somatostatin in SAP patients. These results indicate that serum CRP levels may have a predictive value regarding the therapeutic effects of ulinastatin combined with somatostatin and are an indicator of the severity of gastrointestinal failure in SAP.
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Affiliation(s)
- Yinjia Wang
- Intensive Care Unit, The First People's Hospital of Kunming, Kunming, Yunnan 650224, P.R. China
| | - Li Li
- Intensive Care Unit, The First People's Hospital of Kunming, Kunming, Yunnan 650224, P.R. China
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9
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Ji J, Hong X, Su L, Liu Z. Proteomic identification of hippocalcin and its protective role in heatstroke-induced hypothalamic injury in mice. J Cell Physiol 2018; 234:3775-3789. [PMID: 30256386 DOI: 10.1002/jcp.27143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
Abstract
Heatstroke is a devastating condition that is characterized by severe hyperthermia and central nervous system dysfunction. However, the mechanism of thermoregulatory center dysfunction of the hypothalamus in heatstroke is unclear. In this study, we established a heatstroke mouse model and a heat-stressed neuronal cellular model on the pheochromocytoma-12 (PC12) cell line. These models revealed that HS promoted obvious neuronal injury in the hypothalamus, with high pathological scores. In addition, PC12 cell apoptosis was evident by decreased cell viability, increased caspase-3 activity, and high apoptosis rates. Furthermore, 14 differentially expressed proteins in the hypothalamus were analyzed by fluorescence two-dimensional difference gel electrophoresis and identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Expression changes in hippocalcin (HPAC), a downregulated neuron-specific calcium-binding protein, were confirmed in the hypothalamus of the heatstroke mice and heat-stressed PC12 cells by immunochemistry and western blot. Moreover, HPAC overexpression and HPAC-targeted small interfering RNA experiments revealed that HPAC functioned as an antiapoptotic protein in heat-stressed PC12 cells and hypothalamic injury. Lastly, ulinastatin (UTI), a cell-protective drug that is clinically used to treat patients with heatstroke, was used in vitro and in vivo to confirm the role of HPAC; UTI inhibited heat stress (HS)-induced downregulation of HPAC expression, protected hypothalamic neurons and PC12 cells from HS-induced apoptosis and increased heat tolerance in the heatstroke animals. In summary, our study has uncovered and demonstrated the protective role of HPAC in heatstroke-induced hypothalamic injury in mice.
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Affiliation(s)
- Jingjing Ji
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.,Departement of Pathophysiology, Southern Medical University, Guangzhou, China
| | - Xinxin Hong
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.,Department of Graduate School, Guangzhou University of Chinese Medicine, China
| | - Lei Su
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Guangzhou Military Command, Guangzhou, China
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10
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Liu W, Liu Z, Zhang W, Cai S. Ulinastatin protects the lungs of COPD rats through the HMGB1/TLR4 signaling pathway. Oncol Lett 2018; 16:4057-4063. [PMID: 30128028 DOI: 10.3892/ol.2018.9123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to investigate the protective mechanism of ulinastatin against lung injury. Rat models with chronic obstructive pulmonary disease (COPD) were used to provide guidance for the medical treatment of this disease. The rats were divided into three groups: A control group, a model group and an experimental group (each, n=10). With the exception of the control group, all of the rats were prepared as models of COPD, using the composite molding method of smoking and intratracheal instillation of lipopolysaccharide. The rats in the model group all received a conventional treatment, while the rats in the experimental group received ulinastatin. A small animal lung function detector was used to examine lung function. The forced expiratory volume/sec (FEV) was negatively correlated with the protein expression levels of Toll-like receptor 4 (TLR4) and high mobility group box protein 1 (HMGB1). Real-time fluorescence quantitative polymerase chain reaction and western blot analyses were used to detect TLR4, MyD88 (myeloid differentiation factor 88), TRAF-6 (TNF receptor-associated factor 6), LOX-1 (lectin-type oxidized LDL receptor 1) and HMGB1 mRNA, along with their protein expression levels. The lung function of rats in the model group was significantly decreased compared with in the control group (P<0.05). In the experimental group the lung function was significantly greater, when compared with in the model group; however, it remained lower than in the control group. The mRNA and protein expression levels of TLR4, MyD88, TRAF-6, LOX-1 and HMGB1 were significantly higher in the model group than in the control and experimental groups; however, levels in the experimental group were significantly higher when compared with in the control group (P<0.05). The TLR4 and HMGB1 expression levels were positively correlated in all groups, which indicated involvement of the HMGB1/TLR4 signaling pathway. The FEV was negatively correlated with the protein expression levels of TLR4 and HMGB1. Thus, the protective effect of ulinastatin in the lungs of rats with COPD is associated with changes in the HMGB1/TLR4 signaling pathway.
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Affiliation(s)
- Wei Liu
- Chronic Airway Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Zhiguang Liu
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Weidong Zhang
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan 410005, P.R. China
| | - Shaoxi Cai
- Chronic Airway Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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11
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Lagoo JY, D'Souza MC, Kartha A, Kutappa AM. Role of Ulinastatin, a trypsin inhibitor, in severe acute pancreatitis in critical care setting: A retrospective analysis. J Crit Care 2018; 45:27-32. [PMID: 29413719 DOI: 10.1016/j.jcrc.2018.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/04/2018] [Accepted: 01/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the clinical utility of Ulinastatin, a multifunctional serine protease inhibitor, in the management of severe acute pancreatitis. MATERIALS AND METHODS We conducted a retrospective analysis of the archived data of adult patients diagnosed with acute pancreatitis and admitted to surgical intensive care unit with one or more end organ dysfunction. The patients were divided into two groups depending on whether they did or did not receive ulinastatin. Outcome variables namely in-hospital mortality, development of new-onset organ dysfunction, resolution of existing organ dysfunction by Day 5 and length of hospital stay were compared. RESULTS Forty-eight patients, 25 who received Ulinastatin (Ulinastatin group) and 23 who did not (Control group) were analyzed. The in-hospital mortality was significantly lower in the Ulinastatin group (16% vs 69.6%; p = 0.0003). Significantly smaller proportion of patients (24% vs 73.9%; p = 0.0005) developed new-onset organ dysfunction in the ulinastatin group by day 5. Resolution of existing organ dysfunctions by day 5 was more frequent in the ulinastatin group. Duration of hospital stay was similar in the two groups. CONCLUSION Ulinastatin treatment was associated with improved outcomes in patients with severe acute pancreatitis.
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Affiliation(s)
- Jui Yeshavant Lagoo
- Department of Anaesthesia and Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka 560034, India
| | - Moses Charles D'Souza
- Department of Anaesthesia and Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka 560034, India.
| | - Anandajith Kartha
- Department of Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682016, India
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12
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Ji J, Gu Z, Li H, Su L, Liu Z. Cryptdin-2 predicts intestinal injury during heatstroke in mice. Int J Mol Med 2017; 41:137-146. [PMID: 29115396 PMCID: PMC5746321 DOI: 10.3892/ijmm.2017.3229] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022] Open
Abstract
Intestinal injury-induced bacterial translocation and endotoxemia are important in the pathophysiological process of heatstroke. However, the underlying mechanism remains to be fully elucidated. Previous studies using 2D-gel electrophoresis found that defensin-related cryptdin-2 (Cry-2), an intestinal α-defensin, is upregulated in intestinal tissues during heatstroke in mice, and that treatment with ulinastatin, a multivalent enzyme inhibitor, reduced heat-induced acute lung injury. To investigate the association between Cry-2 and heat stress (HS)-induced intestinal injury and the probable protective role of ulinastatin, the present study examined the intestinal expression of Cry-2 via histopathologic analysis and reverse transcription-quantitative polymerase chain reaction analysis in mice with heatstroke. The heat-stressed mice were exposed to different core temperatures and cooling treatments, and intestinal pathological changes and Chiu scores were determined. Chemical markers of intestinal injury, serum and intestinal concentrations of diamine oxidase (DAO) and D-lactic acid (D-Lac), and serum and intestinal concentrations of Cry-2 were also determined. Correlations were analyzed using Spearman's correlation analysis. It was found that HS upregulated the expression of Cry-2, and the serum and intestinal concentrations of Cry-2 were correlated with the severity of HS-induced intestinal damage, indicated by pathology scores and concentrations of DAO and D-lac. Ulinastatin protected the intestines from HS-induced injury and downregulated the expression of Cry-2, which was also correlated with the extent of intestinal injury. Therefore, ulinastatin administration may be beneficial for patients with heatstroke, and Cry-2 may be a novel predictor of HS-induced intestinal injury.
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Affiliation(s)
- Jingjing Ji
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Zhengtao Gu
- Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Hui Li
- Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Lei Su
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
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13
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Shi Y, Qin W, Nie F, Wen H, Lu K, Cui J. Ulinastatin attenuates neuropathic pain via the ATP/P2Y2 receptor pathway in rat models. Gene 2017; 627:263-270. [PMID: 28652182 DOI: 10.1016/j.gene.2017.06.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022]
Abstract
Ulinastatin, a serine protease inhibitor, which has anti-inflammatory properties and neuroprotective effects, is used to treat acute inflammatory disorders. Recent evidence indicates that administration of ulinastatin alleviates pain in rat model of neuropathic pain (NPP). However, its effect on NPP and the underlying mechanism requires further study. In this study, we evaluated the role of intrathecal administration of ulinastatin in rats with sciatic nerve ligation and observed the effect of ulinastatin on the ATP/P2Y2 receptor pathway. We performed mechanical and thermal sensitivity measurements, immunohistochemistry and double-label immunofluoresence studies to evaluate P2Y2 receptor and adenosine 5'-monophosphate-activated protein kinase (AMPK) expression in the dorsal horn of the lumbar enlargement region of the spinal cord, and a luciferase assay for the detection of ATP levels in the cerebrospinal fluid. The results showed that ulinastatin prevented the development of mechanical allodynia and thermal hypersensitivity in the rat sciatic nerve ligation model. Ulinastatin reduced the level of extracellular ATP, down-regulated P2Y2 receptor and AMPK expression in the spinal dorsal horn of the chronic constrictive injury model. We found that increased expression of P2Y2 receptor in microglia was likely involved in the activation of microglia after nerve injury, and ulinastatin inhibited the abnormal microglia activation in the dorsal horn after nerve injury. These findings demonstrated that ulinastatin might be a potential and effective drug for the treatment of NPP via the suppression of the ATP/P2Y2 receptor pathway.
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Affiliation(s)
- Ying Shi
- Department of Pain Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; Department of Anesthesia, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wanxiang Qin
- Department of Pain Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Fachuan Nie
- Department of Pain Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Huizhong Wen
- Department of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Kaizhi Lu
- Department of Anesthesia, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Jian Cui
- Department of Pain Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Pan Y, Fang H, Lu F, Pan M, Chen F, Xiong P, Yao Y, Huang H. Ulinastatin ameliorates tissue damage of severe acute pancreatitis through modulating regulatory T cells. J Inflamm (Lond) 2017; 14:7. [PMID: 28344516 PMCID: PMC5360080 DOI: 10.1186/s12950-017-0154-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/14/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ulinastatin or urinary trypsin inhibitor (UTI) has been shown to ameliorate the inflammatory response induced by experimental severe acute pancreatitis (SAP) and hence reduce the mortality, however the mechanism of its action remains incompletely understood. We have investigated the effect of ulinastatin on regulatory T-cells (Tregs) in an established rat model of SAP. METHODS We established a rat SAP model by injecting 5% Na-taurocholate into the pancreatic duct and treated the SAP rats with ulinastatin with different dose level (5000, 10000, 30000 U/kg) through intraperitoneal injection at 0, 6 and 12 h. RESULTS We showed that the tissue damage of pancreas and the mortality of the SAP rats were significantly reduced by ulinastatin. We also showed that in the SAP rats the frequencies of CD4+ T cells and Tregs, as well as the expressions of TGF-β1, CTLA-4, and Foxp3 were decreased in the SAP animals while IL-1β, IL-10 and TNF-α were significantly increased. Treatment with ulinastatin up-regulated the proportion of Tregs in CD4+ T cells and the expression of IL-10, Foxp3 and CTLA-4 in the SAP rats in a dose dependence fashion, while down-regulating the levels of L-1β and TNF-α, myeloperoxidase (MPO) activity. CONCLUSIONS Our findings suggest that ulinastatin alleviates inflammatory response and tissue damage in SAP rats by increasing the proportion of Tregs. Our study provides a new mechanism for the beneficial effect of ulinastatin in SAP rat model.
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Affiliation(s)
- Yu Pan
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
| | - Haizong Fang
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
| | - Fengchun Lu
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
| | - Minggui Pan
- Department of Oncology and Hematology, Kaiser Permanente Medical Center, 710 Lawrence Expressway, Santa Clara, CA 95051 USA
| | - Fei Chen
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
| | | | - Yi Yao
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
| | - Heguang Huang
- General Surgery Department, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001 People’s Republic of China
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Liu YF, Liu SH, Zeng XT. Efficacy of different routes of administration of magnesium sulfate in treatment of severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2016; 24:3045-3050. [DOI: 10.11569/wcjd.v24.i19.3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical effects of different routes of administration of magnesium sulfate in the treatment of severe acute pancreatitis (SAP).
METHODS: Fifty-six patients diagnosed with SAP were randomly divided into an oral magnesium sulfate treatment group and a venous magnesium sulfate treatment group. Blood tests, liver and kidney function, electrolytes, blood and urine amylase, and glucose were monitored. C-reaction protein (CRP), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score and abdominal pressure were determined. Blood gas analysis and abdominal ultrasound or CT were performed. Time to first defecation and time to relief of abdominal pain and distension were recorded. The rates of requiring blood filtration and operation, serious complications, and total duration of hospitalization were also recorded.
RESULTS: After defecation, blood and urine amylase and abdominal pressure significantly declined, and CRP gradually decreased in both groups (P < 0.05). Compared with the venous magnesium sulfate treatment group, blood and urine amylase, CRP, abdominal pressure, and APACHE-Ⅱ score were significantly lower in the oral magnesium sulfate treatment group (P < 0.05). Time to first defecation, time to relief of abdominal distention and abdominal pain, rate of the need for blood filtration and surgical treatment, rate of complications, and total duration of hospitalization were significantly lower in the oral treatment group than in the venous treatment group (P < 0.05).
CONCLUSION: Compared with intravenous infusion of magnesium sulfate, oral magnesium sulfate can effectively reduce intra-abdominal pressure, the inflammatory response, and the rate of serious complications in SAP, thus improving the cure rate.
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