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Mourits VP, Koeken VACM, de Bree LCJ, Moorlag SJCFM, Chu WC, Xu X, Dijkstra H, Lemmers H, Joosten LAB, Wang Y, van Crevel R, Netea MG. BCG-Induced Trained Immunity in Healthy Individuals: The Effect of Plasma Muramyl Dipeptide Concentrations. J Immunol Res 2020; 2020:5812743. [PMID: 32626788 PMCID: PMC7312554 DOI: 10.1155/2020/5812743] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023] Open
Abstract
BCG vaccination protects not only against tuberculosis but also against heterologous infections. This effect differs between individuals, yet the factors responsible for this variation are unknown. BCG-induced nonspecific protection is, at least partially, mediated by innate immune reprogramming (trained immunity), which can be induced by the muramyl dipeptide (MDP) component of peptidoglycans. We aimed to study whether differential release of MDP in healthy individuals may explain variability of their response to BCG vaccination. Circulating MDP concentrations were increased up to three months after BCG vaccination. MDP concentrations at baseline, but not their increase postvaccination, positively correlated with the induction of trained immunity and not with mycobacteria-induced T-cell responses. Interestingly, MDP concentrations correlated with inflammatory markers in the circulation. In conclusion, circulating MDP concentrations are associated with the strength of trained immunity responses and thus influence the biological effects of BCG vaccination. This study increases our understanding about the role of MDP in BCG-induced trained immunity, which might help to optimize vaccine efficacy and explore novel applications of BCG vaccination.
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Affiliation(s)
- Vera P. Mourits
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - Valerie A. C. M. Koeken
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - L. Charlotte J. de Bree
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, 2300 Copenhagen, Denmark
- Odense Patient Data Explorative Network, University of Southern Denmark/Odense University Hospital, 5000 Odense, Denmark
| | - Simone J. C. F. M. Moorlag
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - Wern Cui Chu
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Queenstown, Singapore 138673
| | - Xiaoli Xu
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Queenstown, Singapore 138673
| | - Helga Dijkstra
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - Heidi Lemmers
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Yue Wang
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Queenstown, Singapore 138673
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore 119228
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences (RIMLS) and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 Nijmegen, Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, 53115 Bonn, Germany
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Mumby S, Ramakrishnan L, Evans TW, Griffiths MJD, Quinlan GJ. Methemoglobin-induced signaling and chemokine responses in human alveolar epithelial cells. Am J Physiol Lung Cell Mol Physiol 2013; 306:L88-100. [PMID: 24142518 DOI: 10.1152/ajplung.00066.2013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diffuse alveolar hemorrhage is characterized by the presence of red blood cells and free hemoglobin in the alveoli and complicates a number of serious medical and surgical lung conditions including the pulmonary vasculitides and acute respiratory distress syndrome. In this study we investigated the hypothesis that exposure of human alveolar epithelial cells to hemoglobin and its breakdown products regulates chemokine release via iron- and oxidant-mediated activation of the transcription factor NF-κB. Methemoglobin alone stimulated the release of IL-8 and MCP-1 from A549 cells via activation of the NF-κB pathway; additionally, IL-8 required ERK activation and MCP-1 required JNK activation. Neither antioxidants nor iron chelators and knockdown of ferritin heavy and light chains affected these responses, indicating that iron and reactive oxygen species are not involved in the response of alveolar epithelial cells to methemoglobin. Incubation of primary cultures of human alveolar type 2 cells with methemoglobin resulted in a similar pattern of chemokine release and signaling pathway activation. In summary, we have shown for the first time that methemoglobin induced chemokine release from human lung epithelial cells independent of iron- and redox-mediated signaling involving the activation of the NF-κB and MAPK pathways. Decompartmentalization of hemoglobin may be a significant proinflammatory stimulus in a variety of lung diseases.
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Affiliation(s)
- Sharon Mumby
- Unit of Critical Care, Royal Brompton and Harefield NHS Foundation Trust Hospital, Sydney St., London SW3 6NP, UK.
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3
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Cox KH, Cox ME, Woo-Rasberry V, Hasty DL. Pathways involved in the synergistic activation of macrophages by lipoteichoic acid and hemoglobin. PLoS One 2012; 7:e47333. [PMID: 23071790 PMCID: PMC3468568 DOI: 10.1371/journal.pone.0047333] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
Abstract
Lipoteichoic acid (LTA) is a Gram-positive cell surface molecule that is found in both a cell-bound form and cell-free form in the host during an infection. Hemoglobin (Hb) can synergize with LTA, a TLR2 ligand, to potently activate macrophage innate immune responses in a TLR2- and TLR4-dependent way. At low levels of LTA, the presence of Hb can result in a 200-fold increase in the secretion of IL-6 following macrophage activation. Six hours after activation, the macrophage genes that are most highly up-regulated by LTA plus Hb activation compared to LTA alone are cytokines, chemokines, receptors and interferon-regulated genes. Several of these genes exhibit a unique TLR4-dependent increase in mRNA levels that continued to rise more than eight hours after stimulation. This prolonged increase in mRNA levels could be the result of an extended period of NF-κB nuclear localization and the concurrent absence of the NF-κB inhibitor, IκBα, after stimulation with LTA plus Hb. Dynasore inhibition experiments indicate that an endocytosis-dependent pathway is required for the TLR4-dependent up-regulation of IL-6 secretion following activation with LTA plus Hb. In addition, interferon-β mRNA is present after activation with LTA plus Hb, suggesting that the TRIF/TRAM-dependent pathway may be involved. Hb alone can elicit the TLR4-dependent secretion of TNF-α from macrophages, so it may be the TLR4 ligand. Hb also led to secretion of high mobility group box 1 protein (HMGB1), which synergized with LTA to increase secretion of IL-6. The activation of both the TLR2 and TLR4 pathways by LTA plus Hb leads to an enhanced innate immune response.
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Affiliation(s)
- Kathleen H. Cox
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Michelle E. Cox
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Virginia Woo-Rasberry
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - David L. Hasty
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
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4
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Creteur J, Vincent JL. Potential uses of hemoglobin-based oxygen carriers in critical care medicine. Crit Care Clin 2009; 25:311-24, Table of Contents. [PMID: 19341911 DOI: 10.1016/j.ccc.2008.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hemoglobin-based oxygen carriers (HBOCs) were initially developed to provide an alternative to blood transfusion. With the realization that hemoglobin solutions not only are red blood cell substitutes but also have a number of additional properties, including hemodynamic effects related to their oncotic and nitric oxide-scavenging effects, the broader concept of "hemoglobin therapeutics" was born. Promising effects on oxygen transport and the microcirculation need to be confirmed, and the results of studies with newer, second-generation HBOCs are eagerly awaited. In the meantime, possible adverse effects need to be carefully evaluated before HBOCs can be widely used in the ICU, emergency room, or prehospital setting.
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Affiliation(s)
- Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
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5
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van der Meer JHM, Netea MG, Dinarello CA. Modulation of muramyl dipeptide stimulation of cytokine production by blood components. Clin Exp Immunol 2009; 156:428-33. [PMID: 19438594 DOI: 10.1111/j.1365-2249.2009.03926.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Muramyl dipeptide (MDP) is the minimal active fragment of peptidoglycan of the cell wall of Gram-positive bacteria, with potential beneficial effects as a vaccine adjuvant. Peptidoglycans and MDP are recognized by the intracellular receptor NOD2 (nucleotide-binding oligomerization domain 2), leading to production of proinflammatory cytokines. In the present study, it is shown that, despite stimulatory effects on isolated human mononuclear cells, MDP does not stimulate production of tumour necrosis factor-alpha, interleukin-1beta or interleukin-6 in a whole-blood assay. However, MDP retains synergistic effects on lipopolysaccharide-induced cytokines in whole blood. Screening tests of NOD2 function based on whole-blood stimulation should therefore employ strategies based on the synergistic effects of MDP on Toll-like receptor-induced cytokine production. Plasma was not responsible for the inhibition of MDP in whole blood. The inhibition of MDP stimulation was dependent upon cellular components, with erythrocyte-derived haemoglobin and neutrophils collaborating in the inhibition of MDP effects in whole blood.
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Affiliation(s)
- J H M van der Meer
- Division of Infectious Diseases, University of Colorado Health Sciences Center, Denver, CO 80602, USA
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6
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Liang X, Lin T, Sun G, Beasley-Topliffe L, Cavaillon JM, Warren HS. Hemopexin down-regulates LPS-induced proinflammatory cytokines from macrophages. J Leukoc Biol 2009; 86:229-35. [PMID: 19395472 DOI: 10.1189/jlb.1208742] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Detection of LPS in tissues is an integral component of innate immunity that acts to protect against invasion by Gram-negative bacteria. Plasma down-regulates LPS-induced cytokine production from macrophages, thereby limiting systemic inflammation in blood and distant tissues. To identify the protein(s) involved in this process, we used classical biochemical chromatographic techniques to identify fractions of mouse sera that suppress LPS-induced TNF from bone marrow-derived macrophages (BMDMs). Fractionation yielded microgram quantities of a protein that was identified by MS to be hemopexin (Hx). Mouse Hx purified on hemin-agarose beads and rhHx decreased the production of cytokines from BMDMs and peritoneal macrophages induced by LPS. Preincubation of LPS with Hx did not affect the activity of LPS on LAL, whereas preincubation of Hx with macrophages followed by washing resulted in decreased activity of these cells in response to LPS, suggesting that Hx acts on macrophages rather than LPS. Heme-free Hx did not stimulate HO-1 in the macrophages. Purified Hx also decreased TNF and IL-6 from macrophages induced by the synthetic TLR2 agonist Pam3Cys. Our data suggest that Hx, which is an acute-phase protein that increases during inflammation, limits TLR4 and TLR2 agonist-induced macrophage cytokine production directly through a mechanism distinct from HO-1.
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Affiliation(s)
- Xueya Liang
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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7
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VanderMolen C, Malkevich N, Philbin N, Rice J, Collier S, Hall C, Ahlers S, McCarron R, Freilich D, McGwin G, Pearce LB. Immune effects of decreasing low-molecular weight hemoglobin components of hemoglobin-based oxygen carriers (HBOC) in a swine model of severe controlled hemorrhagic shock. ACTA ACUST UNITED AC 2008; 35:507-17. [PMID: 17922315 DOI: 10.1080/10731190701586228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hemoglobin-based oxygen carriers (HBOCs) show potential as safe, efficacious, pre-hospital resuscitation fluids. The major criticism of HBOC-201 is its vasoactive property, attributed partially to low-molecular weight (low-MW) tetrameric/dimeric (TD) hemoglobin (Hb) in HBOC solution. Here we sought to determine whether resuscitation with decreasing concentrations of low-MW Hb component of HBOC affects immune responses in hemorrhagic swine. 28 anesthetized swine underwent a soft muscle crush and controlled hemorrhage of 55% blood volume, followed by resuscitation with HBOC containing 31%, 2%, or 0.4% low-MW Hb in four 10 ml/kg infusions at 20, 30, 45 and 60 minutes before hospital arrival at 75 minutes. IL-10, cell activation and adhesion markers and CD4:CD8 ratio remained unchanged in all 3 groups compared to baseline. Leukocyte apoptosis was equally elevated across all groups. Purification from 31% to 0.4% low-MW Hb in HBOC solution did not alter immune effects in a swine model of severe controlled hemorrhagic shock.
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Affiliation(s)
- C VanderMolen
- Naval Medical Research Center, Combat Casualty Department, Silver Spring, MD 20910-7500, USA
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Gorczynski RM, Alexander C, Bessler W, Brandenburg K, Fournier K, Hoffmann P, Mach JP, Mueller S, Rietschel ET, Terzioglu E, Ulmer AJ, Waelli T, Zahringer U, Khatri I. Role of MIF and glutathione, in association with fetal ovine globin chain (Hbγ) and LPS, in induction of TNFα from cells of young and aged mice, and PBL from healthy human populations. Immunol Lett 2006; 105:140-9. [PMID: 16540177 DOI: 10.1016/j.imlet.2006.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 02/03/2006] [Indexed: 11/18/2022]
Abstract
Previous reports from our group have established that the fetal ovine gamma globin chain (Hbgamma) and LPS can synergize in the induction of pro-inflammatory cytokines, especially TNFalpha, from mouse and human leukocytes. A fetal sheep liver extract (FSLE) which was observed to have marked immunoregulatory properties in vivo and in vitro had independently been observed to contain significant amounts of each of these molecules. However, the biological activity of this extract (hereafter FSLE) was not explained solely by its content of Hbgamma and LPS, and independent analysis confirmed also the presence of migration inhibitory factor, MIF, and glutathione in FSLE. We have investigated whether MIF and the cellular anti-oxidant glutathione can further synergize with Hbgamma and LPS in TNFalpha induction from human cells in vitro, and mouse cells activated in vivo/in vitro. Our data show that indeed there is evidence for such a synergy. Treatment or mouse cells with FSLE produced an enhanced TNFalpha production which could be inhibited independently both by anti-Hbgamma and by anti-MIF, and optimally by a combination of these reagents.
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Affiliation(s)
- R M Gorczynski
- Department of Surgery, University Health Network, Toronto, Ontario, Canada.
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9
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Gorczynski RM, Alexander C, Bessler W, Fournier K, Hoffmann P, Mach JP, Rietschel ET, Song L, Waelli T, Westphal O, Zahringer U, Khatri I. Analysis of interaction of cloned human and/or sheep fetal hemoglobin γ-chain and LPS in augmenting induction of inflammatory cytokine production in vivo and in vitro. Immunol Lett 2005; 100:120-9. [PMID: 16154492 DOI: 10.1016/j.imlet.2005.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 02/28/2005] [Accepted: 03/04/2005] [Indexed: 11/22/2022]
Abstract
We have reported earlier that purified preparations of sheep fetal hemoglobin, but not adult hemoglobin, in concert with non-stimulatory doses of lipopolysaccharide (LPS) (lipid A), act cooperatively to regulate in vitro production of a number of cytokines, including TNFalpha, TGFbeta and IL-6 from murine and human leukocytes. Following in vivo treatment of mice with the same combination of hemoglobin and LPS, harvested spleen or peritoneal cells showed a similar augmented capacity to release these cytokines into culture supernatants. We report below that genetically cloned gamma-chain of human or sheep fetal hemoglobin, but not cloned alpha- or beta-chains, can produce this cooperative effect, as indeed can HPLC purified, heme-free, gamma-chains derived from cord blood fetal hemoglobin, and that purified haptoglobin completely abolishes the cooperative interaction.
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Affiliation(s)
- R M Gorczynski
- Departments of Surgery, University Health Network, Toronto, Ontario, Canada
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10
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Gorczynski RM, Alexander C, Bessler W, Fournier K, Hoffmann P, Mach JP, Manuel J, Ramakrishna V, Rietschel ET, Song L, Waelli T, Westphal O, Zahringer U. Characterization of an interaction between fetal hemoglobin and lipid A of LPS resulting in augmented induction of cytokine production in vivo and in vitro. Int Immunopharmacol 2005; 4:1859-72. [PMID: 15531301 DOI: 10.1016/j.intimp.2004.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 08/23/2004] [Accepted: 08/24/2004] [Indexed: 11/29/2022]
Abstract
A previously described extract of sheep fetal liver was reported to reverse many of the cytokine changes associated with aging in mice, including an augmented spleen cell ConA-stimulated production of IL-4 and decreased production of IL-2. Similar effects were not seen with adult liver preparations. These changes were observed in various strains of mice, including BALB/c, DBA/2 and C57BL/6, using mice with ages ranging from 8 to 110 weeks. Preliminary characterization of this crude extract showed evidence for the presence of Hb gamma chain, as well as of lipid A of LPS. We show below that purified preparations of sheep fetal Hb, but not adult Hb, in concert with suboptimally stimulating doses of LPS (lipid A), cooperate in the regulation of production of a number of cytokines, including TNFalpha and IL-6, in vitro. Furthermore, isolated fresh spleen or peritoneal cells from animals treated in vivo with the same combination of Hb and LPS, showed an augmented capacity to produce these cytokines on further culture in vitro. Evidence was also obtained for a further interaction between CLP, LPS and fetal Hb itself in this augmented cytokine production. These data suggest that some of the functional activities in the fetal liver extract reported earlier can be explained in terms of a novel immunomodulatory role of a mixture of LPS (lipid A) and fetal Hb.
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Affiliation(s)
- R M Gorczynski
- Department of Surgery, University Health Network, Toronto, Canada.
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11
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Spolarics Z, Condon MR, Siddiqi M, Machiedo GW, Deitch EA. Red blood cell dysfunction in septic glucose-6-phosphate dehydrogenase-deficient mice. Am J Physiol Heart Circ Physiol 2004; 286:H2118-26. [PMID: 14751857 DOI: 10.1152/ajpheart.01085.2003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G-6-PDH) deficiency is the most common known human genetic polymorphism. This study tested the hypothesis that G-6-PDH deficiency worsens sepsis-induced erythrocyte dysfunction. Sepsis (24 h) was induced by cecal ligation and puncture in wild-type (WT) and G-6-PDH-deficient (G-6-PDH activity 15% of WT) mice. Erythrocyte responses were tested in whole blood as well as in subpopulations of circulating erythrocytes. Whereas erythrocyte deformability was similar in unchallenged deficient and WT animals, sepsis decreased erythrocyte deformability that was more pronounced in deficient than WT animals. Sepsis also resulted in anemia and hemolysis in deficient compared with WT animals. Mean corpuscular hemoglobin content and erythrocyte deformability decreased in younger erythrocyte subpopulations from septic deficient compared with WT animals. Sepsis decreased the reduced-to-oxidized glutathione ratio in erythrocytes from both deficient and WT animals; however, plasma glutathione increased more in deficient than in WT animals. Erythrocyte content of band 3 associated with the cytoskeleton was elevated in deficient compared with WT erythrocytes. The antioxidant N-acetyl-l-cysteine in vivo alleviated the sepsis-induced decrease in erythrocyte deformability in deficient animals compared with sham-operated control animals. This study demonstrates that a mild degree of G-6-PDH deficiency (comparable to the human class III G-6-PDH deficiencies) worsens erythrocyte dysfunction during sepsis. Increased erythrocyte rigidity and tendency for hemolysis together with alterations in band 3-spectrin interactions may contribute to the immunomodulatory effects of G-6-PDH deficiency observed after major trauma and infections in humans.
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Affiliation(s)
- Zoltán Spolarics
- Dept. of Surgery, UMDNJ-New Jersey Medical School, 185 South Orange Ave., MSB G-626, Newark, NJ 07103, USA.
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12
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Abstract
OBJECTIVE To review current knowledge about cell-free hemoglobin solutions. DATA SOURCE A computerized MEDLINE search was used to retrieve all studies concerning cell-free hemoglobin solutions from 1990 to 2003. The reference lists of all available review articles and primary studies were also reviewed to identify references not identified in the computerized search. STUDY SELECTION All clinical and experimental studies involving cell-free hemoglobin solutions were included. DATA EXTRACTION From the selected studies, information was obtained regarding the experimental model or the study population in which cell-free hemoglobin solutions were investigated, the type of cell-free hemoglobin solution used, their deleterious or beneficial effects, and their possible indications. DATA SYNTHESIS In many studies, hemoglobin solutions were considered as efficient resuscitative agents and good alternatives to red blood cell transfusion, owing to their marked vasopressor effect, coupled with their capacity to improve the microcirculation and rapidly restore metabolic parameters. The main problems identified include excessive systemic vasoconstriction and oxidative damage. Initial enthusiasm in the development of hemoglobin solutions has been tempered recently by the negative results of a U.S. multicenter trial studying the early infusion of diaspirin cross-linked hemoglobin in trauma patients. Nevertheless, the properties of diaspirin cross-linked hemoglobin (and particularly the strong vasopressor effects) cannot be attributed to all hemoglobin solutions, and results of new clinical studies are eagerly awaited to evaluate the potential benefit of such solutions in the management of trauma patients. CONCLUSIONS Today, we are aware of the effects of the first generation of blood substitutes. Further research is ongoing into newer solutions. One area of interest is the development of new molecular structures to decrease nitric oxide binding, thus minimizing any adverse events and maximizing potential benefits. Nevertheless, possible adverse effects need to be carefully evaluated before these agents can be widely administered.
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Affiliation(s)
- Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium
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Augusto LA, Synguelakis M, Espinassous Q, Lepoivre M, Johansson J, Chaby R. Cellular antiendotoxin activities of lung surfactant protein C in lipid vesicles. Am J Respir Crit Care Med 2003; 168:335-41. [PMID: 12773323 DOI: 10.1164/rccm.200212-1440oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The respiratory system is continuously exposed to airborne particles containing lipopolysaccharide. Our laboratory established previously that the hydrophobic surfactant protein C (SP-C) binds to lipopolysaccharide and to one of its cellular receptors, CD14. Here we examined the influence of SP-C, and of a synthetic analog, on some cellular in vitro effects of lipopolysaccharide. When associated with vesicles of dipalmitoylphosphatidylcholine, SP-C inhibits the binding of a tritium-labeled lipopolysaccharide to the macrophage cell line RAW 264.7. Under similar conditions of presentation, SP-C inhibits the mitogenic effect of lipopolysaccharide on mouse splenocytes, and inhibits the lipopolysaccharide-induced production of tumor necrosis factor-alpha by peritoneal and alveolar macrophages, and of nitric oxide by RAW 264.7 cells. In contrast, tumor necrosis factor-alpha production induced by a lipopeptide, and nitric oxide production induced by picolinic acid, were not affected by SP-C. The lipopolysaccharide-binding capacity of SP-C is resistant to peroxynitrite, a known mediator of acute lung injury formed by reaction of nitric oxide with superoxide anions. These results indicate that SP-C may play a role in lung defense; SP-C resists degradation under inflammatory conditions and traps lipopolysaccharide, preventing it from inducing production of noxious mediators in alveolar cells.
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Affiliation(s)
- Luis A Augusto
- Laboratory of Nitrogen Oxides Inflammation and Immunity, UMR-8619, Université de Paris-Sud, Orsay, France
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