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Niu Z, Wei G, Liang H, Wang X, Yang W, Wei G, Guo J, Chen Y, Tao R, Niu J. Bioinformatics-Led Identification of Potential Biomarkers and Inflammatory Infiltrates in Burn Injury. J Burn Care Res 2023; 44:1382-1392. [PMID: 37022972 DOI: 10.1093/jbcr/irad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 04/07/2023]
Abstract
Burn injury is a life-threatening disease with a poor prognosis. The immune change and underlying mechanisms remain largely unknown. Thus, this study aims to find potential biomarkers and analyze the immune infiltrates after burn injury. Gene expression data of burn patients were obtained from the Gene Expression Omnibus database. Key immune-related genes (IRGs) were screened by differential and least absolute shrinkage and selection operator (LASSO) regression analysis. Based on key IRGs, patients were divided into two clusters by consensus cluster analysis. Immune infiltration was analyzed by the single sample gene set enrichment analysis (GSEA) method and the immune score was calculated by the principal component analysis method. A nomogram model was constructed based on the calculated immune score and clinical features. Finally, the expression of screened key genes was validated by an external cohort and quantitative polymerase chain reaction experiment. Fifty-nine IRGs were differently expressed in burn patients. After LASSO regression analysis, 12 key genes remained, namely AZU1, OLR1, RNASE2, FGF13, NR1D2, NR2E1, TLR5, CAMP, DEFA4, PGLYRP1, CTSG, and CCR3. Then, patients were divided into two clusters. Immune infiltration analysis revealed that more immune cells were infiltrated and more pathways were activated in cluster A, in which patients showed high immune scores. Finally, a nomogram model was constructed and showed high accuracy and reliability. The expression pattern of 12 key genes in an external cohort and clinical samples was in accordance with the theoretical analysis results. In conclusion, this research elucidated the key role of immune response in burns and could be used as a guide for burn treatment.
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Affiliation(s)
- Zehao Niu
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guoxing Wei
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hao Liang
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xin Wang
- PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Wenjuan Yang
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Gang Wei
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jiachang Guo
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yingen Chen
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Heart Center of Xinxiang Medical University, Xinxiang, China
| | - Ran Tao
- Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Niu
- Department of Burns and Plastic surgery, The 83 Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Chen X, Wang K, Li D, Zhao M, Huang B, Su W, Yu D. Genetic and immune crosstalk between severe burns and blunt trauma: A study of transcriptomic data. Front Genet 2022; 13:1038222. [PMID: 36246590 PMCID: PMC9561827 DOI: 10.3389/fgene.2022.1038222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Severe burns and blunt trauma can lead to multiple organ dysfunction syndrome, the leading cause of death in intensive care units. In addition to infection, the degree of immune inflammatory response also affects prognosis. However, the characteristics and clinical relevance of the common mechanisms of these major diseases are still underexplored. Methods: In the present study, we performed microarray data analysis to identify immune-related differentially expressed genes (DEGs) involved in both disease progression in burns and blunt trauma. Six analyses were subsequently performed, including gene enrichment analysis, protein‐protein interaction (PPI) network construction, immune cell infiltration analysis, core gene identification, co-expression network analysis, and clinical correlation analysis. Results: A total of 117 common immune-related DEGs was selected for subsequent analyses. Functional analysis emphasizes the important role of Th17 cell differentiation, Th1 and Th2 cell differentiation, Cytokine-cytokine receptor interaction and T cell receptor signaling pathway in these two diseases. Finally, eight core DEGs were identified using cytoHubba, including CD8A, IL10, CCL5, CD28, LCK, CCL4, IL2RB, and STAT1. The correlation analysis showed that the identified core DEGs were more or less significantly associated with simultaneous dysregulation of immune cells in blunt trauma and sepsis patients. Of these, the downregulation of CD8A and CD28 had a worse prognosis. Conclusion: Our analysis lays the groundwork for future studies to elucidate molecular mechanisms shared in burns and blunt trauma. The functional roles of identified core immune-related DEGs and dysregulated immune cell subsets warrant further in-depth study.
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Affiliation(s)
- Xiaoming Chen
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
| | - Kuan Wang
- Department of Cosmetic Plastic and burns Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Dazhuang Li
- Department of Orthopedics, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Mingyue Zhao
- Department of Periodontology, Affiliated Stomatological Hospital of Zunyi MedicalUniversity, Zunyi, China
| | - Biao Huang
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
| | - Wenxing Su
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
| | - Daojiang Yu
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
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Muire PJ, Schwacha MG, Wenke JC. Systemic T Cell Exhaustion Dynamics Is Linked to Early High Mobility Group Box Protein 1 (HMGB1) Driven Hyper-Inflammation in a Polytrauma Rat Model. Cells 2021; 10:1646. [PMID: 34209240 PMCID: PMC8305113 DOI: 10.3390/cells10071646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/20/2022] Open
Abstract
We previously reported an early surge in high mobility group box protein 1 (HMGB1) levels in a polytrauma (PT) rat model. This study investigates the association of HMGB1 levels in mediating PT associated dysregulated immune responses and its influence on the cellular levels of receptor for advanced glycation end products (RAGE) and toll-like receptor 4 (TLR4). Using the same PT rat model treated with anti-HMGB1 polyclonal antibody, we evaluated changes in circulating inflammatory cytokines, monocytes/macrophages and T cells dynamics and cell surface expression of RAGE and TLR4 at 1, 3, and 7 days post-trauma (dpt) in blood and spleen. Notably, PT rats demonstrating T helper (Th)1 and Th2 cells type early hyper-inflammatory responses also exhibited increased monocyte/macrophage counts and diminished T cell counts in blood and spleen. In blood, expression of RAGE and TLR4 receptors was elevated on CD68+ monocyte/macrophages and severely diminished on CD4+ and CD8+ T cells. Neutralization of HMGB1 significantly decreased CD68+ monocyte/macrophage counts and increased CD4+ and CD8+ T cells, but not γδ+TCR T cells in circulation. Most importantly, RAGE and TLR4 expressions were restored on CD4+ and CD8+ T cells in treated PT rats. Overall, findings suggest that in PT, the HMGB1 surge is responsible for the onset of T cell exhaustion and dysfunction, leading to diminished RAGE and TLR4 surface expression, thereby possibly hindering the proper functioning of T cells.
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Affiliation(s)
- Preeti J. Muire
- Combat Wound Care, US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX 78234, USA;
| | - Martin G. Schwacha
- Division of Trauma and Emergency Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Joseph C. Wenke
- Combat Wound Care, US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX 78234, USA;
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Arslanagic S, Karamehic J. ANALYSIS OF PERIPHERAL BLOOD LYMPHOCYTES IN BURNS OF VARYING DEGREES IN THE ASSESSMENT OF IMMMUNE SUPPRESSION. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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5
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Beckmann N, Huber F, Hanschen M, St Pierre Schneider B, Nomellini V, Caldwell CC. Scald Injury-Induced T Cell Dysfunction Can Be Mitigated by Gr1 + Cell Depletion and Blockage of CD47/CD172a Signaling. Front Immunol 2020; 11:876. [PMID: 32477354 PMCID: PMC7232553 DOI: 10.3389/fimmu.2020.00876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Infection is a common and severe complication of burn injury: Sepsis accounts for 47% of postburn mortality. Burn-induced T cell suppression likely contributes to the increased infection susceptibility in burn patients. However, little is known about the kinetics of T cell dysfunction after burn and its underlying mechanisms. In this study, we show in a murine scald injury model that T cell activation of both CD4+ and CD8+ T cells as well as T cell cytokine production is suppressed acutely and persistently for at least 11 days after burn injury. Purified T cells from scald-injured mice exhibit normal T cell functions, indicating an extrinsically mediated defect. We further show that T cell dysfunction after burn appears to be cell-to-cell contact dependent and can be ameliorated by depletion of myeloid-derived suppressor cells. These cells expand after burn injury, particularly a subset expressing the checkpoint inhibitor CD172a, and infiltrate germinal centers. Expression of CD172a appears to be driven by ingestion of immature reticulocytes. Immature reticulocytes are drastically increased in the spleen of scald mice and may contribute to immunosuppression through more direct mechanisms as well. Overall, our study newly identifies two cell populations, myeloid-derived suppressor cells and immature reticulocytes, as well as the CD47/CD172a-signaling pathways as mediators of T cell suppressors after burn and thus opens up new research opportunities in the search for new therapies to combat increased infection susceptibility and the associated morbidity and mortality in burn victims.
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Affiliation(s)
- Nadine Beckmann
- Division of Research, Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Franziska Huber
- Experimental Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marc Hanschen
- Experimental Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Vanessa Nomellini
- Division of Research, Shriner's Hospital for Children Cincinnati, Cincinnati, OH, United States.,Division of Trauma Critical Care and Acute Care Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Charles C Caldwell
- Division of Research, Department of Surgery, University of Cincinnati, Cincinnati, OH, United States.,Division of Research, Shriner's Hospital for Children Cincinnati, Cincinnati, OH, United States
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6
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Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
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Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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7
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Jia R, Zhou M, Tuttle CSL, Maier AB. Immune capacity determines outcome following surgery or trauma: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2019; 46:979-991. [PMID: 31781831 PMCID: PMC7593308 DOI: 10.1007/s00068-019-01271-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022]
Abstract
Purpose Immunological functions are altered following physical injury. The magnitude of the immunological response is dependent on the initial injury. However, variability in the immune response exists within and between patients where only some patients are at risk of developing complications such as systemic inflammatory response syndrome after injury. This systematic review and meta-analysis assessed whether lipopolysaccharide (LPS) induced cytokine production capacity of leucocytes can be used as a functional test to predict the risk of developing complications after injury. Methods Medline, Embase and Web of Science were systematically searched to identify articles that investigated the association between LPS induced cytokine production capacity in leucocytes and any clinical outcome after surgery or trauma. Where sufficient information was supplied, a meta-analysis was performed to determine the overall clinical outcomes. Results A total of 25 articles out of 6765 abstracts identified through the literature search were included in this review. Most articles described a positive association between cytokine production capacity and the development of inflammatory complications (n = 15/25). Coincidingly, the meta-analysis demonstrated that TNFα (Hedges g: 0.63, 95% CI 0.23, 1.03), IL-6 (Hedges g: 0.76, 95% CI 0.41, 1.11) and IL-8 (Hedges g: 0.93, 95% CI 0.46, 1.39) production capacity was significantly higher, one day after injury, in patients who developed inflammatory complications compared to patients who did not following trauma or surgical intervention. No significant difference was observed for IL-1β. Conclusion The associations of elevated LPS-induced cytokine production capacity with the risk of developing inflammatory complications are consistent with previous theories that proposed excessive inflammation is accompanied by anti-inflammatory mechanisms that results in a period of immunosuppression and increased risk of secondary complications. However, immunological biomarkers for risk stratification is still a developing field of research where further investigations and validations are required. Electronic supplementary material The online version of this article (10.1007/s00068-019-01271-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruiyi Jia
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Moran Zhou
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Camilla S L Tuttle
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. .,Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrjie Universiteit, Amsterdam, Netherlands.
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8
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Gloor B, Reber HA. Effects of Cytokines and Other Inflammatory Mediators on Human Acute Pancreatitis. J Intensive Care Med 2016. [DOI: 10.1177/088506669801300604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Most episodes of acute pancreatitis are mild, but severe disease complicated by multiple system organ failure develops in up to 20% of cases. In all patients with pancreatitis, the accumulation of leukocytes in pancreatic and extrapancreatic tissue, and the release of various mediators from them and other sites are important determinants of disease severity. Proinflammatory mediators, whose initial job is to limit the local damage, are released early in the disease. However, these mediators can exacerbate the severity of the pancreatitis when they continue to be elaborated in greater amounts or for longer periods than normal. When their actions are blocked or their release is inhibited, the severity of experimental pancreatitis and its associated mortality rate are less. This suggests the possibility that agents that inhibit the release and/or action of these mediators could be beneficial clinically.
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Affiliation(s)
- Beat Gloor
- UCLA School of Medicine, Department of Surgery, Los Angeles, CA
| | - Howard A. Reber
- UCLA School of Medicine, Department of Surgery, Los Angeles, CA
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9
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Cembrzynska-Nowak M, Lalani S, Peters W, Teodorczyk-Injeyan J. Endotoxemia-related attenuation of interleukin-1 secretion in thermally injured patients. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199400100203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examines the effect of post-burn endotoxemia on the capacity for the in vitro induction of interleukin-1 (IL-1)β synthesis by either inflammatory or non-inflammatory stimuli. Adherent cell (AC) cultures from patients with severe burns (n = 14, 25-65% total body surface area) were stimulated with LPS, phorbol ester (TPA) or IL-2 and studied simultaneously with intact or LPS-pretreated preparations from normal donors (n = 9). Levels of spontaneously released IL-1β in unstimulated AC cultures from patients and in LPS-pretreated preparations from normal individuals were highly elevated. However, LPS- and IL-2-related IL-1β production in such cultures was significantly decreased (P < 0.01-0.05). In contrast, in the majority of patients' cultures and LPS-pretreated normal AC preparations, TPA-induced IL-1β production remained relatively unaffected. In all patients studied, reduced capacity for the LPS-induced IL-1 production was observed concurrently with a significant (P < 0.05) elevation in plasma endotoxin content. Diminished secretion of IL-1β coincided also with a profound reduction of IL-2-dependent IFNγ production in patient cultures and in LPS-pretreated normal cultures. Thus, in the burn patient, endotoxemia-related specific desensitization may develop and, combined with other intrinsic mechanisms, restrict the pathophysiological sequelae of continuous bacterial stimulation.
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Affiliation(s)
- M. Cembrzynska-Nowak
- Department of Surgery, University of Toronto, Department of Immunology, and Sunnybrook Health Science Centre, University of Toronto, The Ross Tilley Burn Centre, The Wellesley Hospital, Toronto, Ontario, Canada
| | - S. Lalani
- Department of Surgery, University of Toronto, Department of Immunology, and Sunnybrook Health Science Centre, University of Toronto, The Ross Tilley Burn Centre, The Wellesley Hospital, Toronto, Ontario, Canada
| | - W.J. Peters
- Department of Surgery, University of Toronto, Department of Immunology, and Sunnybrook Health Science Centre, University of Toronto, The Ross Tilley Burn Centre, The Wellesley Hospital, Toronto, Ontario, Canada
| | - J.A. Teodorczyk-Injeyan
- Department of Surgery, University of Toronto, Department of Immunology, and Sunnybrook Health Science Centre, University of Toronto, The Ross Tilley Burn Centre, The Wellesley Hospital, Toronto, Ontario, Canada
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Cavaillon JM, Adib-Conquy M, Cloëz-Tayarani I, Fitting C. Review: Immunodepression in sepsis and SIRS assessed by ex vivo cytokine production is not a generalized phenomenon: a review. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519010070020201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sepsis and non-infectious systemic inflammatory response syndrome (SIRS) are paradoxically associated with an exacerbated production of cytokines, as assessed by their presence in biological fluids, and a diminished ability of circulating leukocytes to produce cytokine upon in vitro activation. In this review, we depict that the observed cellular hyporeactivity is not a global phenomenon and that some signalling pathways are unaltered and allow the cells to respond normally to certain stimuli. Furthermore, we illustrate that during sepsis and SIRS, cells derived from tissues are either fully responsive to ex vivo stimuli or even primed, in contrast to cells derived from hematopoietic compartments (blood, spleen, etc.) which are hyporeactive. In addition to cytokine production, nuclear factor-κB (NF-κB) status within leukocytes can be used as a useful marker of hypo- or hyper-reactivity. We illustrate that the immune-depression reported in sepsis and SIRS patients, often revealed by a diminished capacity of leukocytes to respond to lipopolysaccharide, is not a generalized phenomenon and that SIRS is associated with a compartmentalized responsiveness which involves either anergic or primed cells.
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11
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Cavaillon JM, Adib-Conquy M, Marie C, Fitting C. Hyporesponsiveness in leukocytes in sepsis: in vitro models reveal paradoxical effects of IL-10. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519990050010701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sepsis syndrome is linked with a systemic inflammatory response syndrome (SIRS). This severe inflammation is associated with an immune suppression as illustrated by the reduced capacity of circulating leukocytes to produce cytokines in response to in vitro activation. Non-infectious SIRS such as trauma, burn, hemorrhage or major surgery is also associated with a suppression of the immune system. This phenomenon has been recently termed CARS for compensatory anti-inflammatory response syndrome. We report in vitro experiments which suggest that a well-known anti-inflammatory cytokine, namely IL-10, may, in certain experimental conditions, prime the leukocytes finally leading to an increased cytokine production. We discuss the relevance of this in vitro model to the in vivo situations where immune suppression is limited to the blood compartment (or the hematopoietic organs) whereas, in inflammatory foci within the tissues, cytokine production is increased. Our data suggest that IL-10 may be a causative agent of concomitantly occurring SIRS and CARS.
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12
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Cavaillon JM, Annane D. Invited review: Compartmentalization of the inflammatory response in sepsis and SIRS. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519060120030301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sepsis and systemic inflammatory response syndrome (SIRS) are associated with an exacerbated production of both pro- and anti-inflammatory mediators that are mainly produced within tissues. Although a systemic process, the pathophysiological events differ from organ to organ, and from organ to peripheral blood, leading to the concept of compartmentalization. The nature of the insult ( e.g. burn, hemorrhage, trauma, peritonitis), the cellular composition of each compartment ( e.g . nature of phagocytes, nature of endothelial cells), and its micro-environment ( e.g. local presence of granulocyte-macrophage colony stimulating factor [GM-CSF] in the lungs, low levels of arginine in the liver, release of endotoxin from the gut), and leukocyte recruitment, have a great influence on local inflammation and on tissue injury. High levels of pro-inflammatory mediators ( e.g. interleukin-1 [IL-1], tumor necrosis factor [TNF], gamma interferon [IFN-γ], high mobility group protein-1 [HMGB1], macrophage migration inhibitory factor [MIF]) produced locally and released into the blood stream initiate remote organ injury as a consequence of an organ cross-talk. The inflammatory response within the tissues is greatly influenced by the local delivery of neuromediators by the cholinergic and sympathetic neurons. Acetylcholine and epinephrine contribute with IL-10 and other mediators to the anti-inflammatory compensatory response initiated to dampen the inflammatory process. Unfortunately, this regulatory response leads to an altered immune status of leukocytes that can increase the susceptibility to further infection. Again, the nature of the insult, the nature of the leukocytes, the presence of circulating microbial components, and the nature of the triggering agent employed to trigger cells, greatly influence the immune status of the leukocytes that may differ from one compartment to another. While anti-inflammatory mediators predominate within the blood stream to avoid igniting new inflammatory foci, their presence within tissues may not always be sufficient to prevent the initiation of a deleterious inflammatory response in the different compartments.
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Affiliation(s)
| | - Djillali Annane
- Service de Réanimation, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
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13
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Namas RA, Mi Q, Namas R, Almahmoud K, Zaaqoq AM, Abdul-Malak O, Azhar N, Day J, Abboud A, Zamora R, Billiar TR, Vodovotz Y. Insights into the Role of Chemokines, Damage-Associated Molecular Patterns, and Lymphocyte-Derived Mediators from Computational Models of Trauma-Induced Inflammation. Antioxid Redox Signal 2015; 23:1370-87. [PMID: 26560096 PMCID: PMC4685502 DOI: 10.1089/ars.2015.6398] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
SIGNIFICANCE Traumatic injury elicits a complex, dynamic, multidimensional inflammatory response that is intertwined with complications such as multiple organ dysfunction and nosocomial infection. The complex interplay between inflammation and physiology in critical illness remains a challenge for translational research, including the extrapolation to human disease from animal models. RECENT ADVANCES Over the past decade, we and others have attempted to decipher the biocomplexity of inflammation in these settings of acute illness, using computational models to improve clinical translation. In silico modeling has been suggested as a computationally based framework for integrating data derived from basic biology experiments as well as preclinical and clinical studies. CRITICAL ISSUES Extensive studies in cells, mice, and human blunt trauma patients have led us to suggest (i) that while an adequate level of inflammation is required for healing post-trauma, inflammation can be harmful when it becomes self-sustaining via a damage-associated molecular pattern/Toll-like receptor-driven feed-forward circuit; (ii) that chemokines play a central regulatory role in driving either self-resolving or self-maintaining inflammation that drives the early activation of both classical innate and more recently recognized lymphoid pathways; and (iii) the presence of multiple thresholds and feedback loops, which could significantly affect the propagation of inflammation across multiple body compartments. FUTURE DIRECTIONS These insights from data-driven models into the primary drivers and interconnected networks of inflammation have been used to generate mechanistic computational models. Together, these models may be used to gain basic insights as well as serving to help define novel biomarkers and therapeutic targets.
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Affiliation(s)
- Rami A. Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajaie Namas
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Khalid Almahmoud
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Akram M. Zaaqoq
- Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania
| | - Othman Abdul-Malak
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nabil Azhar
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judy Day
- Department of Mathematics, University of Tennessee, Knoxville, Tennessee
| | - Andrew Abboud
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy R. Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Joyce C, Kelly J, Sugrue C. A bibliometric analysis of the 100 most influential papers in burns. Burns 2014; 40:30-7. [DOI: 10.1016/j.burns.2013.10.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
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Kovacs EJ, Grabowski KA, Duffner LA, Plackett TP, Gregory MS. Survival and cell mediated immunity after burn injury in aged mice. J Am Aging Assoc 2013; 25:3-9. [PMID: 23604885 DOI: 10.1007/s11357-002-0001-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The elderly are less able to survive burn injury than young healthy individuals. Regardless of age, burn victims often succumb to secondary infections rather than the primary injury. Since immune responses diminish with age, it is likely that aged individuals are predisposed to a poor outcome by virtue of their weak immune system. Elevated production of macrophage-derived mediators, including interleukin-6 (IL-6), may lead to post-injury immunosuppression in young adults. Healthy aged individuals produce high circulating levels of these mediators; therefore, the combination of the age and burn trauma could further suppress immune responses and contribute to the rapid demise of aged burn patients. Herein, the effects of age and burn trauma using a murine scald injury model were examined. After injury, aged mice are less likely to survive, are unable to mount immune responses, and produce more IL-6 when compared to young adult mice given the same size injuries. Enhancing our understanding of the mechanisms responsible for regulating cell-mediated immune responses after injury could lead to the development of therapies designed to treat aged burn patients.
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Affiliation(s)
- Elizabeth J Kovacs
- Immunology and Aging Program, Loyola University Chicago, Maywood, IL ; Department of Cell Biology, Neurobiology, and Anatomy, Loyola University Chicago, Stritch School of Medicine, Building 110, Room 4221, 2160 South First Avenue, Maywood, IL 60153 ; Burn and Shock Trauma Institute, Loyola University Chicago, Maywood, IL ; Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Building 110, Room 4221, 2160 South First Avenue, Maywood, IL 60153
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Boyce BM, Lindsey BA, Clovis NB, Smith S, Hobbs GR, Hubbard DF, Emery SE, Barnett JB, Li B. Additive effects of exogenous IL-12 supplementation and antibiotic treatment in infection prophylaxis. J Orthop Res 2012; 30:196-202. [PMID: 21815205 PMCID: PMC3699881 DOI: 10.1002/jor.21520] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/13/2011] [Indexed: 02/04/2023]
Abstract
The increasing clinical incidence and host risk of open fracture-associated infections, as well as the reduced effectiveness of conventional antibiotics to treat such infections, have driven the development of new therapies for the prophylaxis of open fracture-associated infections. We investigated percutaneous supplementation of a natural cytokine (i.e., interleukin 12p70 or IL-12) at an open fracture site to reduce open fracture-associated infections. We also determined the efficacy of the combination therapy of IL-12 and conventional antibiotic therapy in the prophylaxis of open fracture-associated infections. An open femur fracture infection model was produced by direct inoculation of a clinical isolate of Staphylococcus aureus after creating a femur fracture using rats. The animals were assigned to one of four groups: no drug administration, percutaneous supplementation of IL-12, intraperitoneal administration of the antibiotic ampicillin, or percutaneous IL-12 in combination with intraperitoneal ampicillin. Animals were euthanized at postoperative days 6, 10, 14, and 21. Percutaneous IL-12 led to a reduction in infection at postoperative days 6 and 10. For the first time, exogenous IL-12 was found to have additive effects in the prevention of infection when combined with conventional treatment (i.e., antibiotic therapy). Combination therapy of ampicillin and IL-12 substantially reduced the infection rate at postoperative day 6 and also decreased the time needed for complete inhibition of infection. Therefore, exogenous IL-12, providing a mechanism of protection independent of antibiotic resistance, complements the routine use of antibiotics.
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Affiliation(s)
- Brandon M. Boyce
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Brock A. Lindsey
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Nina B. Clovis
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Suzanne Smith
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Gerald R. Hobbs
- Department of Statistics, West Virginia University, Morgantown, WV 26506, USA
| | - David F. Hubbard
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Sanford E. Emery
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - John B. Barnett
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV 26506, USA
| | - Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA,WVNano Initiative, Morgantown, WV 26506, USA,Correspondence to: Bingyun Li, PhD, Director, Biomaterials, Bioengineering & Nanotechnology Laboratory, Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506-9196, USA, Tel: 1-304-293-1075, Fax: 1-304-293-7070, , URL: http://www.hsc.wvu.edu/som/ortho/nanomedica-group/
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Ching YH, Sutton TL, Pierpont YN, Robson MC, Payne WG. The use of growth factors and other humoral agents to accelerate and enhance burn wound healing. EPLASTY 2011; 11:e41. [PMID: 22084646 PMCID: PMC3212033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Certain cytokines, especially those known as growth factors, have been demonstrated to mediate or modulate burn wound healing. Experimental and clinical evidence suggests that there are therapeutic advantages to the wound healing process when these agents are utilized. Positive effects have been reported for 4 types of wounds seen in the burn patient: partial-thickness wounds, full-thickness wounds, interstices of meshed skin grafts, and skin graft donor sites. METHODS A comprehensive literature search was performed using the MEDLINE, Ovid, and Web of Science databases to identify pertinent articles regarding growth factors and other cytokines in burns and wound healing. RESULTS The current knowledge about cytokine growth factors and their potential therapeutic applications in burn wound healing are discussed and reviewed. CONCLUSIONS Platelet-derived growth factor, fibroblast growth factors, epidermal growth factors, transforming growth factor alpha, vascular endothelial growth factor, insulin-like growth factor I, nerve growth factor, transforming growth factor beta, granulocyte-macrophage colony-stimulating factor, and amnion-derived cellular cytokine solution have all been suggested to enhance the rate and quality of healing in 1 or more of these wounds encountered in burn care.
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Affiliation(s)
- Yiu-Hei Ching
- aInstitute for Tissue Regeneration, Repair, & Rehabilitation Bay Pines VA Health Care System, Bay Pines, FL,bDivision of Plastic Surgery University of South Florida, Tampa
| | - Thomas L. Sutton
- aInstitute for Tissue Regeneration, Repair, & Rehabilitation Bay Pines VA Health Care System, Bay Pines, FL
| | - Yvonne N. Pierpont
- aInstitute for Tissue Regeneration, Repair, & Rehabilitation Bay Pines VA Health Care System, Bay Pines, FL,bDivision of Plastic Surgery University of South Florida, Tampa
| | | | - Wyatt G. Payne
- aInstitute for Tissue Regeneration, Repair, & Rehabilitation Bay Pines VA Health Care System, Bay Pines, FL,bDivision of Plastic Surgery University of South Florida, Tampa,Correspondence:
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Kubecova M, Kolostova K, Pinterova D, Kacprzak G, Bobek V. Cimetidine: An anticancer drug? Eur J Pharm Sci 2011; 42:439-44. [DOI: 10.1016/j.ejps.2011.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/14/2010] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
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Plackett TP, Gamelli RL, Kovacs EJ. Gender-based differences in cytokine production after burn injury: a role of interleukin-6. J Am Coll Surg 2009; 210:73-8. [PMID: 20123335 DOI: 10.1016/j.jamcollsurg.2009.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 09/09/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender-specific differences have been found in the survival of patients after a burn injury. Using a murine model of burn injury, suppression of cell-mediated immunity occurs in a gender-specific manner. Immunosuppression correlated with elevated circulating interleukin-6. This study examines gender differences in cytokine production after injury and the role of interleukin-6. STUDY DESIGN A murine model of dorsal scald injury was used to examine differences in splenocyte production of interleukin-2, interleukin-4, and interferon-gamma in male versus female mice, and cytokine production in interleukin-6-deficient male mice. RESULTS At 24 hours after burn injury, there was substantially greater suppression of T-helper 1 cytokine production in male mice than in female mice. Interleukin-6-deficient male mice had improved cytokine production relative to wild-type mice. CONCLUSIONS Suppression of the cell-mediated immune response in male mice correlated with lower T-helper 1 cytokine production, compared with female mice. Additionally, immune response and cytokine production is improved by interleukin-6 deficiency.
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Affiliation(s)
- Timothy P Plackett
- Department of General Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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21
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Emergence of the USA300 strain of methicillin-resistant Staphylococcus aureus in a burn-trauma unit. J Burn Care Res 2009; 29:790-7. [PMID: 18695604 DOI: 10.1097/bcr.0b013e3181848b8f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300, is a major pathogen in the outpatient setting. We suspected that USA300 had been introduced into our burn-trauma unit (BTU) when three burn patients presented with numerous simultaneous abscesses. We did molecular typing on 206 MRSA isolates from all patients on the BTU who had MRSA isolated from either nares cultures or clinical specimens obtained between April 11, 2002 and October 24, 2006. We reviewed medical records for all patients who had USA300 and for 75 control patients. Twenty-five of 206 (12.1%) patients who were colonized (n = 3) or infected (n = 22) with MRSA had USA300. Thirteen patients had abscesses drained surgically and eight had necrotizing fasciitis excised. Seven patients had burns (mean burn size 11.8 +/- 3.4%), of who four (66.7%) acquired numerous simultaneous (3-33) abscesses. Fourteen patients acquired USA300 outside of the BTU, and three acquired this strain on the BTU. Cases were more likely to have been hospitalized or to have had an operation in the 6 months before they were hospitalized than were controls (P = .001 for both). To our knowledge, this is the first study to describe numerous simultaneous MRSA abscesses in burn patients. The MRSA strain USA300 may be introduced onto burn units from the community by patients admitted with skin and soft tissue infections, especially abscesses and necrotizing fasciitis. Burn patients may be at risk for numerous abscesses with USA300, because they have open wounds and their immune systems may be compromised.
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22
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Allgöwer M, Schoenenberger GA, Sparkes BG. Pernicious effectors in burns. Burns 2008; 34 Suppl 1:S1-55. [DOI: 10.1016/j.burns.2008.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2007] [Indexed: 11/30/2022]
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Song M, Pinsky MR, Kellum JA. Heat shock factor 1 inhibits nuclear factor-kappaB nuclear binding activity during endotoxin tolerance and heat shock. J Crit Care 2008; 23:406-15. [PMID: 18725048 DOI: 10.1016/j.jcrc.2007.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 08/15/2007] [Accepted: 09/24/2007] [Indexed: 11/29/2022]
Abstract
RATIONALE Sepsis, endotoxin tolerance, and heat shock (HS) all display down-regulation of innate immunity. We hypothesize that HS factor 1 (HSF-1) induces competitive inhibition of nuclear factor-kappaB (NF-kappaB)-induced signal transduction in both endotoxin tolerance and HS. OBJECTIVES We compared endotoxin tolerance and HS in RAW 264.7 cells. We transfected cells with an HS protein 70 (HSP70) plasmid to test whether HSP70 is the mediator of HS-induced NF-kappaB inhibition. We studied the effects of endotoxin stimulation and HS, both separately and together, on "wild-type" cells, cells transfected with the HSP70 plasmid, and cells transfected with vehicle. FINDINGS Heat shock protein 70 plasmid-transfected cells had increased HSP70 expression and demonstrated decreased nitric oxide (NO) release and inducible NO synthase messenger RNA expression in response to endotoxin compared with wild-type and empty plasmid-transfected cells. Heat shock completely abolished subsequent NO and inducible NO synthase messenger RNA expression in wild-type cells. Heat shock factor 1 reached maximum expression 60 to 90 minutes after HS. Heat shock protein 70-transfected cells still displayed endotoxin-induced NF-kappaB nuclear binding, whereas endotoxin tolerance, HS, and exposure to HSF-1, but not exposure to an unrelated promoter, inhibited NF-kappaB nuclear binding. CONCLUSIONS Endotoxin tolerance and HS appear to share a common immune suppressive effect, possibly through HSF-1-mediated competitive inhibition of NF-kappaB nuclear binding.
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Affiliation(s)
- Mingchen Song
- The Mechanisms and Novel Therapies for Resuscitation and Acute Illness Laboratories, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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Miller AC, Rashid RM, Elamin EM. The "T" in trauma: the helper T-cell response and the role of immunomodulation in trauma and burn patients. ACTA ACUST UNITED AC 2008; 63:1407-17. [PMID: 18212667 DOI: 10.1097/ta.0b013e31815b839e] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The immune system undergoes numerous changes after traumatic and burn injuries, including a down-regulation of the TH1 response and up-regulation of the TH2 response. METHODS The PubMed, Medline, and Ovid search engines were queried for relevant human studies. Bibliographies were also meticulously reviewed. RESULTS An interesting and potentially clinically relevant pattern of immune dysregulation exists after injury. The type 1 T-helper cell (TH1) response is suppressed as illustrated by diminished interleukin (IL)-2, interferon (IFN)-gamma, and IL-12 levels after major injury. The enhancement of the TH2 response is marked by elevated IL-10 and IL-4. Certain cytokine profiles, ratios, and polymorphisms may help identify patients at increased risk of systemic inflammatory response syndrome (SIRS), sepsis, multiple organ failure (MOF), and deep venous thrombosis. The most promising prognostic indicators to date are decreased production of the IL-12, elevated IL-10, soluble IL-2 receptor-a (sIL-2Ra), and IL-18 levels, IL-18 promoter polymorphisms, the IL-6:IL-10 ratio, and the degree of TH1 suppression as measured by diminished IL-2 and IFN-gamma. The Cytokine sections are subdivided into basic science, human studies, animal studies (when necessary), and directed therapeutics. The outcomes of sepsis, SIRS, or MOF are generally discussed together. CONCLUSIONS T-cell-specific immunologic changes occur after major injury. Identification of those TH1/TH2 cytokine profiles associated with worse prognosis may one day allow clinicians to risk stratify injured patients and identify those at increased risk of developing SIRS, sepsis, MOF, and deep venous thrombosis. Immune-targeted therapies may eventually serve as effective treatments in the acute setting to decrease morbidity and mortality, and to improve the management and prognosis of those patients at risk for developing postinjury complications.
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Affiliation(s)
- Andrew C Miller
- Department of Emergency Medicine and Internal Medicine, The State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York, USA.
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Abstract
Sepsis is a leading cause of death in pediatric intensive care units. There is growing evidence that lymphocytes play a pivotal role in mediating the microvascular dysfunction during sepsis. The objective of this study was to define the role of different subsets of lymphocytes in mediating the hepatic microvascular alterations elicited by cecal ligation and puncture (CLP), an experimental model of sepsis. Intravital video microscopy was used to quantify leukocyte and platelet adhesion in the hepatic microcirculation of wild type (WT) mice, immunodeficient SCID mice, SCID mice reconstituted with CD3+ cells, and mice deficient either in B-cells, CD4+- or CD8+-T-cells subjected to CLP. Blood cell counts, and serum concentrations of ALT and different cytokines (TNF-alpha, IL-10, MCP-1, IL-6, IFN-gamma and IL-12) were also monitored in these groups. CLP (at 6 h) caused a significantly increased adhesion of leukocytes and platelets in WT mice, compared to WT sham mice (P < 0.05). In SCID mice, the adhesion of blood cells in terminal hepatic venules was significantly decreased compared to WT-CLP mice, whereas the values in CD3+ cell-reconstituted SCID-mice, B-cell-deficient and CD4+- and CD8+-T-cell deficient mice did not differ from WT-CLP mice. ALT levels were significantly elevated only in the SCID group, when compared to WT-sham and WT-CLP mice. These findings indicate that lymphocytes mediate the microvascular dysfunction, but protect against the hepatocellular injury associated with murine sepsis.
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Affiliation(s)
- Georg Singer
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
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Lederer JA, Brownstein BH, Lopez MC, Macmillan S, Delisle AJ, Macconmara MP, Choudhry MA, Xiao W, Lekousi S, Cobb JP, Baker HV, Mannick JA, Chaudry IH. Comparison of longitudinal leukocyte gene expression after burn injury or trauma-hemorrhage in mice. Physiol Genomics 2007; 32:299-310. [PMID: 17986522 DOI: 10.1152/physiolgenomics.00086.2007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A primary objective of the large collaborative project entitled "Inflammation and the Host Response to Injury" was to identify leukocyte genes that are differentially expressed after two different types of injury in mouse models and to test the hypothesis that both forms of injury would induce similar changes in gene expression. We report here the genes that are expressed in white blood cells (WBCs) and in splenocytes at 2 h, 1 day, 3 days, and 7 days after burn and sham injury or trauma-hemorrhage (T-H) and sham T-H. Affymetrix Mouse Genome 430 2.0 GeneChips were used to profile gene expression, and the results were analyzed by dCHIP, BRB Array Tools, and Ingenuity Pathway Analysis (IPA) software. We found that the highest number of genes differentially expressed following burn injury were at day 1 for both WBCs (4,989) and for splenocytes (4,715) and at day 1 for WBCs (1,167) and at day 3 for splenocytes (1,117) following T-H. The maximum overlap of genes that were expressed after both forms of injury were at day 1 in WBCs (136 genes) and at day 7 in splenocytes (433 genes). IPA revealed that the cell-to-cell signaling, cell death, immune response, antiapoptosis, and cell cycle control pathways were affected most significantly. In summary, this report provides a database of genes that are modulated in WBCs and splenocytes at sequential time points after burn or T-H in mice and reveals that relatively few leukocyte genes are expressed in common after these two forms of injury.
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Affiliation(s)
- James A Lederer
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USA.
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Downregulation of Immune Signaling Genes in Patients With Large Surface Burn Injury. J Burn Care Res 2007; 28:879-87. [DOI: 10.1097/bcr.0b013e318159a41e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Venet F, Chung CS, Monneret G, Huang X, Horner B, Garber M, Ayala A. Regulatory T cell populations in sepsis and trauma. J Leukoc Biol 2007; 83:523-35. [PMID: 17913974 DOI: 10.1189/jlb.0607371] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sepsis syndrome remains the leading cause of mortality in intensive care units. It is now believed that along with the body's hyperinflammatory response designated to eliminate the underlying pathogen, mechanisms are initiated to control this initial response, which can become deleterious and result in immune dysfunctions and death. A similar state of immune suppression has been described after numerous forms of severe trauma/injury. Although the evidence for immune dysfunctions after sepsis has grown, much remains to be understood about mechanisms underpinning its development and how it acts to increase the morbid state of the critically ill patient. In this context, although the majority of clinical and basic science conducted so far has focused on the roles of myeloid cell populations, the contribution of T lymphocytes and in particular, of regulatory T cells has been somewhat ignored. The studies presented here support the concept that regulatory T lymphocytes (CD4+CD25+ regulatory, gammadelta, and NK T cells) play a role in the control of immune responses and are affected by injury and sepsis. This may be related to their capacity to interact with components of the innate and adaptive immune responses and to their ability to be activated nonspecifically by bacterial products and/or cytokines and to regulate through direct cell-cell and/or soluble mediators. It is our hope that a better understanding of the mechanism through which those rare lymphocyte subsets exert such a profound effect on the immune response may help in improving our ability not only to diagnose but also to treat the critically ill individual.
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Affiliation(s)
- Fabienne Venet
- Division of Surgical Research, Rhode Island Hospital/Brown University, 593 Eddy Street, Providence, RI 02903, USA
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Abstract
Numerous studies have described that an initial injury alters immune function, disposing the injured subject to infectious complications. The mechanisms by which an initial injury primes the subject, exacerbating the responses to a second injury, remain unclear; however, inflammatory cytokines have been implicated. The development of "2-hit" models has allowed investigators to determine the role of inflammatory mediators in susceptibility to infection after injury. A high incidence rate of pneumonia after burn injury and a significant increase in postburn mortality led us to develop models of either Gram-positive (Streptococcus pneumoniae) or Gram-negative (Klebsiella pneumoniae) sepsis after burn injury on 40% of total body surface area in rodents. In this present model, we used adult Sprague-Dawley rats to evaluate cardiac function in vitro (using Langendorff method) and myocardial inflammation (myocyte secretion of cytokines measured using enzyme-linked immunosorbent assay) after burn complicated by sepsis. Either burn injury alone or sepsis alone produced myocardial inflammatory responses and contractile dysfunction. Either Gram-negative or Gram-positive infection exacerbated the myocardial inflammation (increased myocyte secretion of tumor necrosis factor alpha, interleukin 1beta, and interleukin 6) above that which occurred with burn alone or with infection alone. Burn complicated by sepsis exacerbated the myocardial contraction and relaxation defects observed with either sepsis alone or burn alone. Inasmuch as sepsis, which occurs after a previous injury, increases myocardial inflammation/dysfunction and mortality, the development of therapeutic strategies that either decrease inflammatory response to the initial injury or provide cardiac support during the postinjury period may improve the outcome in injured patients who are at risk for developing sepsis.
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Affiliation(s)
- Jureta W Horton
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75235-9136, USA.
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Nakano T, Araki K, Nakatani H, Kobayashi M, Sugimoto T, Furuya Y, Matsuoka T, Jin T, Hanazaki K. Effects of geldanamycin and thalidomide on the Th1/Th2 cytokine balance in mice subjected to operative trauma. Surgery 2007; 141:490-500. [PMID: 17383526 DOI: 10.1016/j.surg.2006.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 10/12/2006] [Accepted: 10/14/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Persistence of postoperative immune dysfunction is a critical problem because it increases the risk of serious infectious complications. The mechanisms of the immune dysfunction that occur initially after non-thermal operative injury remain to be fully elucidated. METHODS Two mouse models of operative trauma (simple laparotomy to represent minor operative injury and ileocecal resection to represent major operative injury) were used to define the characteristics of initial cytokine synthesis. Geldanamycin and thalidomide were independently added intraperitoneally before and after operative injury to examine the effect on postoperative immune dysfunction. Mice were sacrificed at scheduled times (3, 6, 12, and 24 h after operative injury) and TNF-alpha, IL-2, IL-4, and IL-10 were analyzed. Spleen was used for intracellular cytokines and RT-PCR. Sera were used for ELISA. RESULTS Major operative injury caused an initial upregulation of IL-10 synthesis with delayed synthesis of TNF-alpha and IL-2. Minor operative injury caused an early induction of IL-2 synthesis preceded by an initial induction of IL-4 synthesis. GA caused a specific early upregulation of TNF-alpha mRNA expression and intracellular TNF-alpha synthesis. The GA and THD groups showed early serum IL-2 production with reduction of IL-10 mRNA expression and intracellular IL-10 synthesis in the early post-operative phase. CONCLUSIONS Major and minor operative injury showed different Th1/Th2 cytokine patterns in the initial post-operative period. Geldanamycin and thalidomide improved the Th1/Th2 imbalance independently after major operative injury.
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Affiliation(s)
- Takumi Nakano
- Department of Tumor Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.
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31
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MacConmara MP, Maung AA, Fujimi S, McKenna AM, Delisle A, Lapchak PH, Rogers S, Lederer JA, Mannick JA. Increased CD4+ CD25+ T regulatory cell activity in trauma patients depresses protective Th1 immunity. Ann Surg 2006; 244:514-23. [PMID: 16998360 PMCID: PMC1856576 DOI: 10.1097/01.sla.0000239031.06906.1f] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS Peripheral blood was withdrawn from 19 consenting adult patients (35.1 +/- 16.3 years of age) with Injury Severity Scores (ISS) 36.6 +/- 13.9 on days 1 and 7 after trauma and from 5 healthy individuals. CD4 T cells were purified and sorted into Treg (CD25(high)) and Treg-depleted populations. After activation of cells with anti-CD3/CD28 antibody, production of the TH1-type cytokine IFNgamma, TH2-type cytokines (IL-4 and IL-5), and the inhibitory cytokine IL-10 was measured using cytometric bead arrays. Treg activity was measured by in vitro suppression of autologous CD4 T cell proliferation. RESULTS All patients survived, 9 (47%) developed infection postinjury. IFNgamma production by patient CD4 T cells was decreased on day 1 and day 7, when compared with healthy controls. However, when Tregs were depleted from the CD4 T cells, the IFNgamma production increased to control levels. Tregs were the chief source of IL-4 and IL-5 as well as IL-10. Treg suppression of T cell proliferation increased significantly from day 1 to day 7 after injury. CONCLUSIONS We demonstrate for the first time that human Tregs are increased in potency after severe injury. Most significantly, Tregs are important mediators of the suppression of T cell activation and the reduction in TH1 cytokine production found after injury.
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Affiliation(s)
- Malcolm P MacConmara
- Department of Surgery (Immunology), Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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32
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Santiago F, Bueno P, Olmedo C, Comino A, Hassan L, Ferrón-Celma I, Muffak K, Serradilla M, Mansilla A, Ramia JM, Villar JM, Garrote D, Ramirez A, Ferrón JA. Time course of intraoperative cytokine levels in liver transplant recipients. Transplant Proc 2006; 38:2492-4. [PMID: 17097978 DOI: 10.1016/j.transproceed.2006.08.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We evaluated the levels of several cytokines (interleukin [IL]-2, IL-4, IL-6, IL-10, tumor necrosis factor [TNF]-alpha, and interferon [IFN]-gamma) in plasma samples obtained before surgical intervention (T0) and during intraoperative liver transplantation: after induction of anesthesia (I-1), 15 minutes of anhepatic phase (I-2), 5 minutes before reperfusion (I-3), 10 minutes after reperfusion (I-4), 20 minutes after reperfusion (I-5), 60 minutes after reperfusion (I-6), and 1 hour after liver transplantation (I-7). Cytokine levels were determined using a technique which combines ELISA technique and flow cytometry. The study was approved by the local clinical research (ethics) committee. Written informed consent was obtained from patients' relatives. Twenty patients (14 men, 6 women) aged 23 to 61 years, recipients of a liver transplantation were studied. The cytokine IL-2 plasma values were maintained during the whole study period, with a slight increase at 15 minutes of anhepatic phase (I-2). IL-4 showed a peak value 20 minutes after reperfusion (I-5). IL-6 increased its plasma value starting at 15 minutes of anhepatic phase (I-2), maintaining high concentrations during the whole intraoperative period. IL-10 increased progressively, reaching a maximum 1 hour after transplantation (I-7). TNF-alpha reached maximum plasma levels 20 minutes after reperfusion (I-5), whereas IFN-gamma showed a peak at 15 minutes of anhepatic phase (I-2). Our results indicate that the anhepatic phase (I-2) is the earliest phase during which proinflammatory and anti-inflammatory cytokines, such as IL-6 and IL-10, respectively, are involved during liver transplantation. We conclude that IL-6 is the first cytokine involved in the inflammatory response during liver transplantation.
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Affiliation(s)
- F Santiago
- Anesthesiology Service, Virgen de las Nieves University Hospital, Granada, Spain
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Rea S, O'Sullivan ST. The polymerase chain reaction and its application to clinical plastic surgery. J Plast Reconstr Aesthet Surg 2006; 59:113-21. [PMID: 16703854 DOI: 10.1016/j.bjps.2005.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Molecular biology has become an essential component in many fields of modern medical research, including plastic surgery. Research into the molecular mechanisms underlying many disease processes offer increased understanding of the pathogenesis of disease and provide exciting therapeutic possibilities. Yet for many clinicians, the presentation of much research into molecular biological processes is couched in confusing terminology and based on scientific techniques, the basis of which are frequently difficult for the clinician to understand. The purpose of this review is to present an introduction to some of the molecular biological techniques currently in use, namely the polymerase chain reaction (PCR) and explore its applications to different aspects of plastic surgery. This review explores the role PCR now plays in all aspects of modern plastic surgery practise, with particular emphasis on normal and abnormal wound healing, the diagnosis of craniofacial anomalies, the diagnosis and treatment of cancer including melanoma and squamous cell carcinoma of the head and neck, and burns.
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Affiliation(s)
- S Rea
- Department of Plastic and Reconstructive Surgery, Cork University Hospital Wilton, Cork, Ireland.
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Abstract
Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
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Affiliation(s)
- Deirdre Church
- Calgary Laboratory Services, 9-3535 Research Rd. N.W., Calgary, Alberta, Canada T2L 2K8.
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Abstract
Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.
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Horton J, Maass D, White J, Sanders B. Effect of Aspiration Pneumonia-Induced Sepsis on Post-Burn Cardiac Inflammation and Function in Mice. Surg Infect (Larchmt) 2006; 7:123-35. [PMID: 16629602 DOI: 10.1089/sur.2006.7.123] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Numerous studies have found that burn injury alters immune function, predisposing the subject to infectious complications. We developed a mouse model of burn injury complicated by either gram-positive or gram-negative infection and hypothesized that post-burn infection would exacerbate the myocardial cytokine responses and contractile dysfunction characteristic of either sepsis alone or burn alone. METHODS Adult C57 BL6 mice were given burn injury over 40% of the total body surface area and conventional fluid resuscitation (lactated Ringer's solution, 4 mL/kg/% burn) followed on day 7 by intratracheal administration of 1 x 10(5) cfu of either Streptococcus pneumoniae or Klebsiella pneumoniae or saline. Mice received fluid resuscitation (2 mL of lactated Ringer's intraperitoneally) again after bacterial challenge. Cardiomyocyte cytokine secretion and the contractile function of isolated hearts (Langendorff perfusion) were examined in vitro 24 h after bacterial challenge. RESULTS Infectious challenge seven days after burn injury exaggerated the inflammatory cytokine responses over those observed with either burn alone or gram-positive or gram-negative infection alone (tumor necrosis factor-alpha: sham, 72 +/- 9 pg/mL; burn alone, 176 +/- 6 pg/mL, Klebsiella pneumoniae alone, 337 +/- 8 pg/mL; Streptococcus pneumoniae alone, 184 +/- 2 pg/mL; burn + Klebsiella, 476 +/- 14 pg/mL; burn + Streptococcus, 351 +/- 6 pg/mL). Myocardial contractile depression was evident in the burn alone, infection alone, and burn plus infection groups, regardless of the organism selected to produce pneumonia-related sepsis. CONCLUSIONS Gram-negative or gram-positive infection exacerbated the myocardial inflammation seen with burn alone or infection alone. The availability of a mouse model of burn injury complicated by pneumonia-related sepsis will allow use of genetically engineered mice to examine further the mechanisms by which burn injury increases susceptibility to infection.
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MESH Headings
- Animals
- Burns/complications
- Burns/physiopathology
- Cytokines/biosynthesis
- Disease Models, Animal
- Female
- Heart/physiopathology
- Klebsiella Infections/complications
- Klebsiella Infections/microbiology
- Klebsiella pneumoniae
- Male
- Mice
- Mice, Inbred C57BL
- Myocardial Contraction
- Myocarditis/complications
- Myocarditis/physiopathology
- Myocytes, Cardiac/immunology
- Myocytes, Cardiac/metabolism
- Pneumonia, Aspiration/complications
- Pneumonia, Aspiration/microbiology
- Pneumonia, Aspiration/physiopathology
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/microbiology
- Sepsis/complications
- Sepsis/microbiology
- Ventricular Function, Left
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Affiliation(s)
- Jureta Horton
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Abstract
Immediate and early trauma death rates are determined by "first hits" such as hypoxia, hypotension and organ injury, while late mortality correlates closely with "second hits" such as infection. An imbalance between the early systemic inflammatory response (SIRS), and the later compensatory counter-inflammatory response (CARS), is considered to be responsible for much post-traumatic morbidity and mortality. From a clinical perspective, this remains a significant healthcare problem, which has stimulated decades of experimental and clinical research aimed at understanding the functional effects of injury on the immune system. This review describes the impact of injury on the innate and adaptive immune systems. Though it is worth noting that the features of the immune response to injury overlap in many areas with immune dysregulation in sepsis, we attempt here to elucidate the mechanism by which injury predisposes to infection rather than to describe the alterations in host immunity consequent to established sepsis.
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Affiliation(s)
- N Ni Choileain
- Department of Surgery, Cork University Hospital, Ireland.
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Chen G, Du H, Xu D, Peng S, Wang J. Development of an immunoassay kit for detecting the alteration of serum B cell activating factor in thermally injured mice. Mol Cell Biochem 2005; 281:185-8. [PMID: 16328971 DOI: 10.1007/s11010-006-0952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 07/14/2005] [Indexed: 10/25/2022]
Abstract
B cell activating factor (BAFF), a member of the family of tumor necrosis factor (TNF) ligands, is essential for the development of peripheral mature, long lived B lymphocytes. Previous studies were almost related to the function or mechanism of BAFF protein and there is little report about BAFF expression in thermally injured animals. Here, we developed a special ELISA kit to study the change of BAFF expression in thermally injured mouse model. It was shown that BAFF expression changed in double-phase. Peripheral BAFF level dropped rapidly after thermal injury and at 24 h of scald it was only 1/4 compared with that of the control group, 24 h later it began to rise up slowly and then returned to the normal level comparable to the control at 120 h.
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Affiliation(s)
- Guangyu Chen
- Laboratory of Molecular Genetics, Beijing Institute of Basic Medical Sciences, Beijing, China
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Cavaillon JM, Adrie C, Fitting C, Adib-Conquy M. Reprogramming of circulatory cells in sepsis and SIRS. ACTA ACUST UNITED AC 2005. [PMID: 16263005 DOI: 10.1177/09680519050110050901] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Immune status is altered in patients with sepsis or non-infectious systemic inflammatory response syndrome (SIRS). Reduced ex-vivo TNF production by endotoxin-activated monocytes has been regularly reported. This observation is reminiscent of the phenomenon of endotoxin tolerance, and the term 'leukocyte reprogramming' well defines this phenomenon. This review will outline that the hyporesponsiveness of circulating leukocytes is not a generalized phenomenon in sepsis and SIRS. Indeed, the nature of the insult (i.e. infectious versus non-infectious SIRS; under anesthesia [surgery] or not [trauma, burn]), the nature of the activator used to trigger leukocytes (i.e. different Toll-like receptor ligands or whole bacteria), the nature of the cell culture (i.e. isolated monocytes versus peripheral blood mononuclear cells versus whole blood assays), and the nature of the analyzed cytokines (e.g. IL-1beta versus IL-1ra; TNF versus IL-10) have a profound influence on the outcome of the response.
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Affiliation(s)
- J-M Cavaillon
- UP Cytokines and Inflammation, Institut Pasteur, Paris, France.
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Abstract
Septic shock, the most severe complication of sepsis, is a deadly disease. In recent years, exciting advances have been made in the understanding of its pathophysiology and treatment. Pathogens, via their microbial-associated molecular patterns, trigger sequential intracellular events in immune cells, epithelium, endothelium, and the neuroendocrine system. Proinflammatory mediators that contribute to eradication of invading microorganisms are produced, and anti-inflammatory mediators control this response. The inflammatory response leads to damage to host tissue, and the anti-inflammatory response causes leucocyte reprogramming and changes in immune status. The time-window for interventions is short, and treatment must promptly control the source of infection and restore haemodynamic homoeostasis. Further research is needed to establish which fluids and vasopressors are best. Some patients with septic shock might benefit from drugs such as corticosteroids or activated protein C. Other therapeutic strategies are under investigation, including those that target late proinflammatory mediators, endothelium, or the neuroendocrine system.
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Affiliation(s)
- Djillali Annane
- Service de Réanimation, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint Quentin en Yvelines, Garches, France.
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Horton JW, Maass DL, White J, Sanders B. Myocardial inflammatory responses to sepsis complicated by previous burn injury. Surg Infect (Larchmt) 2004; 4:363-77. [PMID: 15012863 PMCID: PMC1403836 DOI: 10.1089/109629603322761427] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is generally accepted that an initial injury such as burn trauma alters immune function such that a second insult increases the morbidity and mortality over that observed with each individual insult. We have shown previously that either burn trauma or sepsis promotes cardiomyocyte secretion of TNF-alpha and IL-1beta, cytokines that have been shown to produce myocardial contractile dysfunction. This study determined whether a previous burn injury (given eight days prior to sepsis) (1) provides a preconditioning phenomenon, decreasing inflammatory responses to a second insult or (2) exacerbates inflammatory response observed with either injury alone. METHODS Anesthetized Sprague-Dawley rats were given either burn injury over 40% total body surface area, sepsis alone (intratracheal S. pneumoniae, 4 x 10(6) colony forming units) or sepsis eight days after burn; all rats received lactated Ringer's solution. Hearts harvested 24 h after onset of sepsis alone or sepsis plus eight-day burn were used to (1) isolate cardiomyocytes (collagenase) or (2) assess contractile function (Langendorff). Cardiomyocytes loaded with 2 microg/mL Fura-2AM or sodium-binding benzofuran isophthalate were used to measure intracellular calcium and sodium concentrations (Nikon inverted microscope, Grooney optics, InCyt Im2 Fluorescence Imaging System). Additional cardiomyocytes were used to measure myocyte-secreted TNFalpha, IL-1, IL-6, IL-10 (pg/ml, ELISA). RESULTS Either burn trauma alone or sepsis alone promoted TNF-alpha, IL-1beta, nitric oxide, IL6 and IL-10 secretion by cardiomyocytes (p < 0.05). Producing aspiration-related pneumonia eight days postburn produced myocardial pro- and anti-inflammatory responses and increased myocyte Ca2+/Na+ concentrations to a significantly greater degree than the responses observed after either insult alone. CONCLUSIONS A previous burn injury alters myocardial inflammatory responses, predisposing the burn-injured subject to exaggerated inflammation, which correlates with greater myocardial dysfunction.
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Affiliation(s)
- Jureta W Horton
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas 75390-9160, USA.
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Kovacs EJ, Plackett TP, Witte PL. Estrogen replacement, aging, and cell-mediated immunity after injury. J Leukoc Biol 2004; 76:36-41. [PMID: 14761938 DOI: 10.1189/jlb.1103538] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We recently demonstrated that aged mice are less likely to survive following traumatic injury and are more immunosuppressed than young mice who sustain comparable injuries. Immunosuppression in severely injured patients and in rodent models of burn injury is associated with a marked elevation in proinflammatory cytokines, including interleukin-6 (IL-6). We reported that after sustaining a moderate-size scald injury, aged mice have higher circulating levels of IL-6 than young, injured mice. As proestrus levels of estrogen have been reported to boost immune responses and attenuate IL-6 production, in the present study, we went on to determine if estrogen replacement in aged female mice restored cellular immunity and proinflammatory cytokine production. After injury, in placebo-treated, aged animals, there was a >75% suppression in the delayed-type hypersensitivity response relative to placebo-treated, sham-injured, aged mice (P<0.05). In contrast, estrogen supplementation before injury yielded a partial recovery in this response, such that the mice were suppressed by only 40% relative to sham-injured, aged mice (P<0.05). There was a fourfold increase in the circulating level of IL-6 in burn-injured, aged mice who received placebo hormone replacement relative to sham-injured mice given placebo (P<0.05). This level of cytokine was lowered by nearly 50% in aged, estrogen-treated mice. Most remarkably, estrogen replacement improved survival from 42% (in the absence of estrogen) to 70% in aged, burn-injured mice. Further investigation will be needed to determine if age- and gender-specific therapies are needed for the treatment of all trauma patients.
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Affiliation(s)
- Elizabeth J Kovacs
- Neurobiology, and Anatomy, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Building 110, Room 4237, 2160 South First Avenue, Maywood, IL 60513, USA.
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Murphy TJ, Paterson HM, Mannick JA, Lederer JA. Injury, sepsis, and the regulation of Toll-like receptor responses. J Leukoc Biol 2003; 75:400-7. [PMID: 14557385 DOI: 10.1189/jlb.0503233] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although we tend to think that the immune system has evolved to protect the host from invading pathogens and to discriminate between self and nonself, there must also be an element of the immune system that has evolved to control the response to tissue injury. Moreover, these potential immune-regulatory pathways controlling the injury response have likely coevolved in concert with self and nonself discriminatory immune-regulatory networks with a similar level of complexity. From a clinical perspective, severe injury upsets normal immune function and can predispose the injured patient to developing life-threatening infectious complications. This remains a significant health care problem that has driven decades of basic and clinical research aimed at defining the functional effects of injury on the immune system. This review and update on our ongoing research efforts addressing the immunological response to injury will highlight some of the most recent advances in our understanding of the impact that severe injury has on the innate and adaptive immune system focusing on phenotypic changes in innate immune cell responses to Toll-like receptor stimulation.
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Affiliation(s)
- Thomas J Murphy
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Murphy T, Paterson H, Rogers S, Mannick JA, Lederer JA. Use of intracellular cytokine staining and bacterial superantigen to document suppression of the adaptive immune system in injured patients. Ann Surg 2003; 238:401-10; discussion 410-1. [PMID: 14501506 PMCID: PMC1422703 DOI: 10.1097/01.sla.0000086661.45300.14] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the percentages of major T lymphocyte subsets in the circulating peripheral blood mononuclear cell population in patients with major traumatic injury at early and late time points and to determine the expression of coreceptors and cytokine production by these T cell subsets. SUMMARY BACKGROUND DATA Prior studies suggest that serious injury in humans suppresses the adaptive immune system as revealed by diminished proliferation and altered cytokine production in response to polyclonal T cell activation. However, the contribution of individual cell types to this immune dysfunction has not been well characterized. METHODS The percentage of circulating CD4+ and CD8+ T cells and the relative density of CD4 and CD8 coreceptor expression was determined by flow cytometry in 17 consecutive trauma patients (injury severity score > 20) within 24 hours of injury and at day 7. Intracellular expression of the cytokines interleukin 2 (IL-2), interferon gamma (IFNgamma), IL-4, and IL-10 were also studied after stimulation with bacterial superantigen (SEB). Patients were compared with age- and sex-matched controls and to themselves for differences between early and late cytokine expression. RESULTS The percentage of circulating CD4+ and CD8+ T cells was decreased versus controls at day 1 and further decreased by day 7 following injury. CD4 and CD8 cell surface expression was also decreased at days 1 and 7. CD4+ T cells in injured patients responded to SEB activation with decreased expression of IFNgamma and IL-2 on day 1 versus controls (P < 0.05) and of all 4 cytokines by day 7 (P < 0.05), while CD8+ T cells showed diminished expression of IFNgamma and IL-2 only at both time points. When day 1 and day 7 cytokine expression results were compared in the same patients, CD4+ T cells showed diminished expression of IFNgamma, IL-2, and IL-4 by day 7 (P < 0.05), but maintained expression of IL-10. CD8 T cells showed diminished expression of IFNgamma only. CONCLUSIONS Severe injury induces a loss of circulating CD4+ and CD8+ T lymphocytes and diminished coreceptor expression by these cells. Both T cell subsets show progressive loss of immunostimulatory cytokine production with maintenance of potentially suppressive IL-10 production. These events may have negative consequences for host defense.
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Affiliation(s)
- Thomas Murphy
- Department of Surgery, Julian and Eunice Cohen Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Shelley O, Murphy T, Paterson H, Mannick JA, Lederer JA. Interaction between the innate and adaptive immune systems is required to survive sepsis and control inflammation after injury. Shock 2003; 20:123-9. [PMID: 12865655 DOI: 10.1097/01.shk.0000079426.52617.00] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substantial clinical and laboratory research has revealed that major injury causes abnormalities in both the innate and adaptive immune systems. However, the relative importance of each of these systems in the immune dysfunction after injury is poorly understood and difficult to establish by clinical studies alone. Rag1 (-/-) C57BL/6 mice (Rag1), which lack an adoptive immune system, and immune-sufficient wild-type (WT) C57BL/6 mice underwent 25% total body surface area burn injury or sham injury under anesthesia and were subjected to cecal ligation and puncture (CLP) at day 10 postinjury, a time of high CLP mortality in this model. To test the effect of adaptive immune deficiency on inflammatory cytokine production after injury, adaptive cell-depleted splenocytes from sham and burn WT and Rag1 mice were stimulated with LPS, and TNF-alpha and IL-6 production were assayed at days 1 and 7 postinjury. Intracellular expression of TNFalpha and IL-6 by F4/80 macrophages was also assessed on day 7 by intracellular cytokine staining. Finally, Rag1 animals were reconstituted with WT splenocytes, and the effect of such reconstitution on CLP survival and cytokine production was determined. Survival of sham WT animals after CLP was significantly higher (P < 0.01) than survival of burn WT and Rag1 sham and burn animals, all of which had equivalently low survival. Reconstitution of Rag1 animals with WT splenocytes restored CLP survival to WT sham levels. Splenocytes from Rag1 burn mice showed significantly augmented cytokine production when compared with WT burn mice on day 7 (P < 0.05). Reconstitution of Rag1 mice with WT splenocytes at the time of injury returned cytokine production to WT levels. Intracellular cytokine expression in F4/80 macrophages was increased to a similar degree after burn, but not sham burn injury in Rag1, reconstituted Rag1 and WT animals. These studies demonstrate that the adaptive immune system is necessary for protection from polymicrobial sepsis and plays a significant role in regulating the inflammatory response to injury.
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Affiliation(s)
- Odhran Shelley
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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Ikuta SI, Ono S, Kinoshita M, Tsujimoto H, Yamauchi A, Mochizuki H. Interleukin-18 concentration in the peritoneal fluid correlates with the severity of peritonitis. Am J Surg 2003; 185:550-5. [PMID: 12781884 DOI: 10.1016/s0002-9610(03)00080-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interleukin (IL)-18 is a novel cytokine that has recently been characterized as an inducer of interferon-gamma (IFN-gamma). The aim of this study was to investigate the clinical significance of peritoneal IL-18 concentrations in patients with peritonitis. METHODS We measured IL-18, IFN-gamma, and IL-10 concentrations in the peritoneal fluid of 28 patients undergoing laparotomy for peritonitis. Correlations between the peritoneal cytokine concentrations and the severity of illness determined by systemic inflammatory response syndrome (SIRS) criteria, Acute Physiological and Chronic Health Evaluation II (APACHE II) score, peritoneal fluid bacterial culture results, subsequent development of organ failure, and length of hospital stay were assessed. RESULTS Interleukin-18 concentration was significantly increased in patients who developed SIRS, in those with culture-positive peritonitis, and in those who developed organ failure, as compared with the other patients. Interleukin-10 concentration, which was also significantly increased in patients with culture-positive peritonitis, showed a close correlation with IL-18 concentration. Although a weak correlation was observed between IL-18 and IFN-gamma concentrations, IFN-gamma concentrations did not show any association with patients' clinical parameters. However, the IFN-gamma/IL-18 ratio was significantly lower in patients with an APACHE II >/=10, and in those with culture-positive peritonitis, as compared with the other patients. BACKGROUND Peritoneal IL-18 concentration increased in response to intraperitoneal bacterial infection and seemed to reflect the severity of peritonitis. However, the capacity of IL-18 to produce IFN-gamma may be altered depending on the severity of peritonitis.
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Affiliation(s)
- Shin-ichi Ikuta
- Department of Surgery I, National Defense Medical College, Namiki 3-2, Tokorozawa, 359-8513, Saitama, Japan
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Shelley O, Murphy T, Lederer JA, Mannick JA, Rodrick ML. Mast cells and resistance to peritoneal sepsis after burn injury. Shock 2003; 19:513-8. [PMID: 12785005 DOI: 10.1097/.01.shk0000055239.25446.2d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A mouse model of burn injury demonstrates increasing mortality to an infectious challenge in the form of cecal ligation and puncture (CLP) reaching a peak at 10 days after injury. Because it is widely believed that peritoneal mast cells play an important role in the defense against peritoneal sepsis, we wished to explore the possibility that peritoneal mast cell dysfunction contributed to increased CLP mortality after burn injury. Kit(W-v) C57BL/6 mice, which were shown to lack peritoneal mast cells by cytospin and flow cytometry, and normal littermate control animals were subjected to 25% burn or sham burn injury and 10 days later underwent CLP. Burn injured Kit(W-v) and normal littermates had a high CLP mortality when compared with sham-injured Kit(W-v) and normal littermates (P < 0.003), but the sham- and burn-injured Kit(W-v) and normal littermate animals did not differ from one another with respect to CLP mortality. This result prompted a comparison of CLP mortality in untreated WBB6F1 Kit(W/W-v) mice, known to be mast cell deficient, and normal littermate controls, as well as untreated C57BL/6 Kit(W-v) and normal littermates. The WBB6F1 Kit(W/W-v) mice showed significantly increased mortality after CLP as compared with the littermate controls (P = 0.03), whereas both C57BL/6 Kit(W-v) and littermate controls had very low mortality after CLP. A study of peritoneal cell populations 24 h after CLP failed to reveal an obvious cause for the difference in CLP survival between the two mast cell-deficient strains. Tumor necrosis factor-alpha (TNF-alpha) measurements in peritoneal fluid showed appreciable amounts of TNF-alpha in the littermate controls of both strains and little in the fluid obtained from the mast cell-deficient animals of both strains. We conclude that peritoneal mast cell dysfunction is unlikely to be a major cause of decreased resistance to peritoneal sepsis in burn-injured animals and that the importance of peritoneal mast cells in combating peritoneal sepsis in the mouse appears to be strain dependent.
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Affiliation(s)
- Odhran Shelley
- Department of Surgery, Julian and Eunice Cohen Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Mannick JA. 15th Annual Semmelweis Lecture Surgical Infection Society-Europe. Injury-induced immune dysfunction: is the lymphocyte irrelevant? Surg Infect (Larchmt) 2003; 3:297-302. [PMID: 12697077 DOI: 10.1089/109629602762539526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pratt VC, Tredget EE, Clandinin MT, Field CJ. Alterations in lymphocyte function and relation to phospholipid composition after burn injury in humans. Crit Care Med 2002; 30:1753-61. [PMID: 12163788 DOI: 10.1097/00003246-200208000-00013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lymphocyte functions are dependent on fatty acid composition of membranes, and impaired functions can predispose patients to infection after burn injury. The current study was designed to describe changes in lymphocyte-phospholipid composition and lymphocyte-related immune functions from early to late recovery time points after burn injury. DESIGN Prospective observational. SETTING Firefighter's Burn Treatment Center, University of Alberta Hospital, Edmonton, Alberta, Canada. PATIENTS Subjects (n = 10) with >10% total body surface burn area. MEASUREMENTS AND MAIN RESULTS Blood was drawn from subjects at specific time points (0 days to >50 days) after burn injury. Fatty acid composition of the major phospholipid classes of isolated lymphocytes was determined by using gas liquid chromatography. Lymphocyte phenotypes and proliferation ([(3)H]-thymidine uptake and interleukin-2 and interferon-gamma production) in response to mitogens were determined. Lymphocyte phospholipid 20:4n-6 content was 30% to 60% lower early compared with late postburn time points (p <.001). Interferon-gamma production by stimulated cells was found to negatively correlate with n-3 content (r =.7, p =.008). The expression of CD25 on antigen-mature CD8+ cells was associated with higher proliferative responses (r =.88, p <.004). Proportion of CD8+ cells was lower, and the proportion of activated monocytes was higher early compared with late postburn (p <.05). Natural killer cell cytotoxicity was low early after burn and increased with recovery. CONCLUSIONS The results of this preliminary study suggest that immune activation occurs between the second and third week after burn injury, which is associated with changes in 20:4n-6 and n-3 fatty acid content of lymphocyte phospholipid. This study suggests that there is release or impaired synthesis of 20:4n-6 early after burn injury that may be related to functional changes in immune cells.
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Affiliation(s)
- Vera C Pratt
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Ed-monton, Alberta, Canada
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Affiliation(s)
- J A Mannick
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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