1
|
Fejes R, Rutai A, Juhász L, Poles MZ, Szabó A, Kaszaki J, Boros M, Tallósy SP. Microcirculation-driven mitochondrion dysfunction during the progression of experimental sepsis. Sci Rep 2024; 14:7153. [PMID: 38531957 DOI: 10.1038/s41598-024-57855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
Sepsis is accompanied by a less-known mismatch between hemodynamics and mitochondrial respiration. We aimed to characterize the relationship and time dependency of microcirculatory and mitochondrial functions in a rodent model of intraabdominal sepsis. Fecal peritonitis was induced in rats, and multi-organ failure (MOF) was evaluated 12, 16, 20, 24 or 28 h later (n = 8/group, each) using rat-specific organ failure assessment (ROFA) scores. Ileal microcirculation (proportion of perfused microvessels (PPV), microvascular flow index (MFI) and heterogeneity index (HI)) was monitored by intravital video microscopy, and mitochondrial respiration (OxPhos) and outer membrane (mtOM) damage were measured with high-resolution respirometry. MOF progression was evidenced by increased ROFA scores; microcirculatory parameters followed a parallel time course from the 16th to 28th h. Mitochondrial dysfunction commenced with a 4-h time lag with signs of mtOM damage, which correlated significantly with PPV, while no correlation was found between HI and OxPhos. High diagnostic value was demonstrated for PPV, mtOM damage and lactate levels for predicting MOF. Our findings indicate insufficient splanchnic microcirculation to be a possible predictor for MOF that develops before the start of mitochondrial dysfunction. The adequate subcellular compensatory capacity suggests the presence of mitochondrial subpopulations with differing sensitivity to septic insults.
Collapse
Affiliation(s)
- Roland Fejes
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - Attila Rutai
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - László Juhász
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - Marietta Zita Poles
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - Andrea Szabó
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - József Kaszaki
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary
| | - Mihály Boros
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary.
| | - Szabolcs Péter Tallósy
- Institute of Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, 6720, Hungary.
| |
Collapse
|
2
|
Li J, Yang D, Ge S, Liu L, Huo Y, Hu Z. Identifying hub genes of sepsis-associated and hepatic encephalopathies based on bioinformatic analysis-focus on the two common encephalopathies of septic cirrhotic patients in ICU. BMC Med Genomics 2024; 17:19. [PMID: 38212812 PMCID: PMC10785360 DOI: 10.1186/s12920-023-01774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND In the ICU ward, septic cirrhotic patients are susceptible to suffering from sepsis-associated encephalopathy and/or hepatic encephalopathy, which are two common neurological complications in such patients. However, the mutual pathogenesis between sepsis-associated and hepatic encephalopathies remains unclear. We aimed to identify the mutual hub genes, explore effective diagnostic biomarkers and therapeutic targets for the two common encephalopathies and provide novel, promising insights into the clinical management of such septic cirrhotic patients. METHODS The precious human post-mortem cerebral tissues were deprived of the GSE135838, GSE57193, and GSE41919 datasets, downloaded from the Gene Expression Omnibus database. Furthermore, we identified differentially expressed genes and screened hub genes with weighted gene co-expression network analysis. The hub genes were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway functional enrichment analyses, and protein-protein interaction networks were constructed. Receiver operating characteristic curves and correlation analyses were set up for the hub genes. Finally, we explored principal and common signaling pathways by using Gene Set Enrichment Analysis and the association between the hub genes and immune cell subtype distribution by using CIBERSORT algorithm. RESULTS We identified seven hub genes-GPR4, SOCS3, BAG3, ZFP36, CDKN1A, ADAMTS9, and GADD45B-by using differentially expressed gene analysis and weighted gene co-expression network analysis method. The AUCs of these genes were all greater than 0.7 in the receiver operating characteristic curves analysis. The Gene Set Enrichment Analysis results demonstrated that mutual signaling pathways were mainly enriched in hypoxia and inflammatory response. CIBERSORT indicated that these seven hub genes were closely related to innate and adaptive immune cells. CONCLUSIONS We identified seven hub genes with promising diagnostic value and therapeutic targets in septic cirrhotic patients with sepsis-associated encephalopathy and/or hepatic encephalopathy. Hypoxia, inflammatory, and immunoreaction responses may share the common downstream pathways of the two common encephalopathies, for which earlier recognition and timely intervention are crucial for management of such septic cirrhotic patients in ICU.
Collapse
Affiliation(s)
- Juan Li
- Department of Intensive Care Unit, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Dong Yang
- Department of Emergency (Xiangjiang Hospital), The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Shengmei Ge
- Department of Intensive Care Unit, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Lixia Liu
- Department of Intensive Care Unit, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Yan Huo
- Department of Intensive Care Unit, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China
| | - Zhenjie Hu
- Department of Intensive Care Unit, Hebei Key Laboratory of Critical Disease Mechanism and Intervention, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, China.
| |
Collapse
|
3
|
Wang G, Lian H, Zhang H, Wang X. Microcirculation and Mitochondria: The Critical Unit. J Clin Med 2023; 12:6453. [PMID: 37892591 PMCID: PMC10607663 DOI: 10.3390/jcm12206453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Critical illness is often accompanied by a hemodynamic imbalance between macrocirculation and microcirculation, as well as mitochondrial dysfunction. Microcirculatory disorders lead to abnormalities in the supply of oxygen to tissue cells, while mitochondrial dysfunction leads to abnormal energy metabolism and impaired tissue oxygen utilization, making these conditions important pathogenic factors of critical illness. At the same time, there is a close relationship between the microcirculation and mitochondria. We introduce here the concept of a "critical unit", with two core components: microcirculation, which mainly comprises the microvascular network and endothelial cells, especially the endothelial glycocalyx; and mitochondria, which are mainly involved in energy metabolism but perform other non-negligible functions. This review also introduces several techniques and devices that can be utilized for the real-time synchronous monitoring of the microcirculation and mitochondria, and thus critical unit monitoring. Finally, we put forward the concepts and strategies of critical unit-guided treatment.
Collapse
Affiliation(s)
- Guangjian Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.W.); (H.Z.)
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;
| | - Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.W.); (H.Z.)
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China; (G.W.); (H.Z.)
| |
Collapse
|
4
|
Milanez M, Liberatore A, Nishi E, Bergamaschi C, Campos R, Koh I. Patterns of renal and splanchnic sympathetic vasomotor activity in an animal model of survival to experimental sepsis. Braz J Med Biol Res 2022; 55:e11873. [PMID: 35043862 PMCID: PMC8852156 DOI: 10.1590/1414-431x2021e11873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - E.E. Nishi
- Universidade Federal de São Paulo, Brasil
| | | | | | - I.H.J. Koh
- Universidade Federal de São Paulo, Brasil
| |
Collapse
|
5
|
Exposure to acute normobaric hypoxia results in adaptions of both the macro- and microcirculatory system. Sci Rep 2020; 10:20938. [PMID: 33262355 PMCID: PMC7708486 DOI: 10.1038/s41598-020-77724-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Although acute hypoxia is of utmost pathophysiologic relevance in health and disease, studies on its effects on both the macro- and microcirculation are scarce. Herein, we provide a comprehensive analysis of the effects of acute normobaric hypoxia on human macro- and microcirculation. 20 healthy participants were enrolled in this study. Hypoxia was induced in a normobaric hypoxia chamber by decreasing the partial pressure of oxygen in inhaled air stepwisely (pO2; 21.25 kPa (0 k), 16.42 kPa (2 k), 12.63 kPa (4 k) and 9.64 kPa (6 k)). Macrocirculatory effects were assessed by cardiac output measurements, microcirculatory changes were investigated by sidestream dark-field imaging in the sublingual capillary bed and videocapillaroscopy at the nailfold. Exposure to hypoxia resulted in a decrease of systemic vascular resistance (p < 0.0001) and diastolic blood pressure (p = 0.014). Concomitantly, we observed an increase in heart rate (p < 0.0001) and an increase of cardiac output (p < 0.0001). In the sublingual microcirculation, exposure to hypoxia resulted in an increase of total vessel density, proportion of perfused vessels and perfused vessel density. Furthermore, we observed an increase in peripheral capillary density. Exposure to acute hypoxia results in vasodilatation of resistance arteries, as well as recruitment of microvessels of the central and peripheral microcirculation. The observed macro- and microcirculatory effects are most likely a result from compensatory mechanisms to ensure adequate tissue oxygenation.
Collapse
|
6
|
Juhász L, Rutai A, Fejes R, Tallósy SP, Poles MZ, Szabó A, Szatmári I, Fülöp F, Vécsei L, Boros M, Kaszaki J. Divergent Effects of the N-Methyl-D-Aspartate Receptor Antagonist Kynurenic Acid and the Synthetic Analog SZR-72 on Microcirculatory and Mitochondrial Dysfunction in Experimental Sepsis. Front Med (Lausanne) 2020; 7:566582. [PMID: 33330526 PMCID: PMC7729001 DOI: 10.3389/fmed.2020.566582] [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: 05/28/2020] [Accepted: 10/28/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: Sepsis is a dysregulated host response to infection with macro- and microhemodynamic deterioration. Kynurenic acid (KYNA) is a metabolite of the kynurenine pathway of tryptophan catabolism with pleiotropic cell-protective effects under pro-inflammatory conditions. Our aim was to investigate whether exogenously administered KYNA or the synthetic analog SZR-72 affects the microcirculation and mitochondrial function in a clinically relevant rodent model of intraabdominal sepsis. Methods: Male Sprague–Dawley rats (n = 8/group) were subjected to fecal peritonitis (0.6 g kg−1 feces ip) or a sham operation. Septic animals were treated with sterile saline or received ip KYNA or SZR-72 (160 μmol kg−1 each) 16 and 22 h after induction. Invasive monitoring was performed on anesthetized animals to evaluate respiratory, cardiovascular, renal, hepatic and metabolic dysfunctions (PaO2/FiO2 ratio, mean arterial pressure, urea, AST/ALT ratio and lactate levels, respectively) based on the Rat Organ Failure Assessment (ROFA) score. The ratio of perfused vessels (PPV) of the ileal serosa was quantified with the intravital imaging technique. Complex I- and II-linked (CI; CII) oxidative phosphorylation capacities (OXPHOS) and mitochondrial membrane potential (ΔΨmt) were evaluated by High-Resolution FluoRespirometry (O2k, Oroboros, Austria) in liver biopsies. Plasma endothelin-1 (ET-1), IL-6, intestinal nitrotyrosine (NT) and xanthine oxidoreductase (XOR) activities were measured as inflammatory markers. Results: Sepsis was characterized by an increased ROFA score (5.3 ± 1.3 vs. 1.3 ± 0.7), increased ET-1, IL-6, NT and XOR levels, and decreased serosal PPV (65 ± 12% vs. 87 ± 7%), ΔΨmt and CI–CII-linked OXPHOS (73 ± 16 vs. 158 ± 14, and 189 ± 67 vs. 328 ± 81, respectively) as compared to controls. Both KYNA and SZR-72 reduced systemic inflammatory activation; KYNA treatment decreased serosal perfusion heterogeneity, restored PPV (85 ± 11%) and complex II-linked OXPHOS (307 ± 38), whereas SZR-72 improved both CI- and CII-linked OXPHOS (CI: 117 ± 18; CII: 445 ± 107) without effects on PPV 24 h after sepsis induction. Conclusion: Treatment with SZR-72 directly modulates mitochondrial respiration, leading to improved conversion of ADP to ATP, while administration of KYNA restores microcirculatory dysfunction. The results suggest that microcirculatory and mitochondrial resuscitation with KYNA or the synthetic analog SZR-72 might be an appropriate supportive tool in sepsis therapy.
Collapse
Affiliation(s)
- László Juhász
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Attila Rutai
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Roland Fejes
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Szabolcs P Tallósy
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Marietta Z Poles
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Andrea Szabó
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - István Szatmári
- Research Group for Stereochemistry, Institute of Pharmaceutical Chemistry, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Ferenc Fülöp
- Research Group for Stereochemistry, Institute of Pharmaceutical Chemistry, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Hungarian Academy of Sciences (MTA)-University of Szeged (SZTE), Neuroscience Research Group, Szeged, Hungary
| | - Mihály Boros
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - József Kaszaki
- Faculty of Medicine, Institute of Surgical Research, University of Szeged, Szeged, Hungary
| |
Collapse
|
7
|
Dutta A, Das A, Kondziella D, Stachowiak MK. Bioenergy Crisis in Coronavirus Diseases? Brain Sci 2020; 10:E277. [PMID: 32370257 PMCID: PMC7287678 DOI: 10.3390/brainsci10050277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
Coronavirus disease (COVID-19) has been declared as a pandemic by the World Health Organization (WHO).[...].
Collapse
Affiliation(s)
- Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14260, USA
| | - Abhijit Das
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Michal K. Stachowiak
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY 14203, USA;
| |
Collapse
|
8
|
Endothelin A and B Receptors: Potential Targets for Microcirculatory-Mitochondrial Therapy in Experimental Sepsis. Shock 2019; 54:87-95. [DOI: 10.1097/shk.0000000000001414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Herminghaus A, Papenbrock H, Eberhardt R, Vollmer C, Truse R, Schulz J, Bauer I, Weidinger A, Kozlov AV, Stiban J, Picker O. Time-related changes in hepatic and colonic mitochondrial oxygen consumption after abdominal infection in rats. Intensive Care Med Exp 2019; 7:4. [PMID: 30623256 PMCID: PMC6325055 DOI: 10.1186/s40635-018-0219-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Evidence suggests that early adaptive responses of hepatic mitochondria occur in experimentally induced sepsis. Little is known about both colonic mitochondrial function during abdominal infection and long-term changes in mitochondrial function under inflammatory conditions. We hypothesize that hepatic and colonic mitochondrial oxygen consumption changes time-dependently after sterile laparotomy and in the course of abdominal infection. The aim of the present study was to investigate the hepatic and colonic mitochondrial respiration after sterile laparotomy and abdominal infection over up to 96 h. Methods After approval of the local Animal Care and Use Committee, 95 Wistar rats were randomized into 8 groups (n = 11–12): 1–4 sham (laparotomy only) and 5–8 colon ascendens stent peritonitis (CASP). Healthy, unoperated animals served as controls (n = 9). The mitochondrial respiration in colon and liver homogenates was assessed 24, 48, 72, and 96 h after surgery. Mitochondrial oxygen consumption was determined using a Clark-type electrode. State 2 (oxygen consumption in the presence of the substrates for complexes I and II) and state 3 respiration (ADP dependent) were assessed. The respiratory control ratio (RCR state 3/state 2) and ADP/O ratio (ADP added/oxygen consumed) were calculated for both complexes. Data are presented as means ± SD, two-way ANOVA followed by Tukey’s post hoc test. Results Hepatic RCR was initially (after 24 h) elevated in both operated groups; after 48 h only, the septic group was elevated compared to controls. In CASP groups, the hepatic ADP/O ratio for complex I was elevated after 24 h (vs. controls) and after 48 h (vs. sham) but declined after 72 h (vs. controls). The ADP/O ratio for complex II stayed unchanged over the time period until 96 h. The colonic RCR and ADP/O did not change over time after sham or CASP operation. Conclusion Hepatic, but not colonic, mitochondrial respiration is increased in the initial phase (until 48 h) and normalizes in the longer course of time (until 96 h) of abdominal infection. Electronic supplementary material The online version of this article (10.1186/s40635-018-0219-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Herminghaus
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Henrike Papenbrock
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Rebecca Eberhardt
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christian Vollmer
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Richard Truse
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Schulz
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Inge Bauer
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Adelheid Weidinger
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, AUVA Research Center, Donaueschingenstraße 13, 1200, Wien, Austria
| | - Andrey V Kozlov
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, AUVA Research Center, Donaueschingenstraße 13, 1200, Wien, Austria
| | - Johnny Stiban
- Department of Biology and Biochemistry, Birzeit University, Birzeit, Ramallah, Palestine
| | - Olaf Picker
- Department of Anaesthesiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| |
Collapse
|
10
|
Herminghaus A, Eberhardt R, Truse R, Schulz J, Bauer I, Picker O, Vollmer C. Nitroglycerin and Iloprost Improve Mitochondrial Function in Colon Homogenate Without Altering the Barrier Integrity of Caco-2 Monolayers. Front Med (Lausanne) 2018; 5:291. [PMID: 30460235 PMCID: PMC6232762 DOI: 10.3389/fmed.2018.00291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
Abstract
Locally applied nitroglycerin [nitric oxide (NO) donor] and iloprost (analog of prostacyclin PGI2) improve regional gastric oxygenation and nitroglycerin preserves gastric mucosal barrier integrity. This suggests direct effects of these substances on oxygenation and barrier function. The aim of this study was to analyze the effect of iloprost and nitroglycerin on intestinal mitochondrial function and on mucosal barrier function in vitro. Mitochondrial oxygen consumption (respirometry) was determined in colon homogenates from 16 healthy rats before (baseline) and 15 min after incubation with nitroglycerin (25 and 250 μg/ml) and iloprost (0.1 and 1 μg/ml). State 2 (substrate-dependent oxygen consumption) and state 3 respiration (ADP-dependent oxygen consumption) were assessed and ADP/O ratio (ADP added/oxygen consumed) for complex I and II were calculated. For permeability measurement we used the Caco-2 monolayer. Fluorescein sulfonic acid (FS) (200 μg/ml) and the drugs were administered into the apical compartment of the transwell chamber. After 48 h, FS translocation was assessed as basolateral/apical FS. Both concentrations of nitroglycerin and iloprost reduced state 3 by stimulation via both complexes. Iloprost increased ADP/O ratio after stimulation via both complexes at both concentrations. Nitroglycerin increased ADP/O ratio at the higher concentration (250 μg/ml) after stimulation via complex I and at the lower concentration (25 μg/ml) via complex II. Neither nitroglycerin nor iloprost influenced FS translocation. Iloprost and nitroglycerin reduce the maximal mitochondrial respiration and improve the efficacy of oxidative phosphorylation in colon homogenates. Both drugs have no direct influence on mucosal barrier integrity of Caco-2 monolayers.
Collapse
Affiliation(s)
- Anna Herminghaus
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Rebecca Eberhardt
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Richard Truse
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Jan Schulz
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Inge Bauer
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Olaf Picker
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| | - Christian Vollmer
- Department of Anaesthesiology, University of Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
11
|
You B, Zhang YL, Luo GX, Dang YM, Jiang B, Huang GT, Liu XZ, Yang ZC, Chen Y, Chen J, Yuan ZQ, Yin SP, Peng YZ. Early application of continuous high-volume haemofiltration can reduce sepsis and improve the prognosis of patients with severe burns. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:173. [PMID: 29980222 PMCID: PMC6035411 DOI: 10.1186/s13054-018-2095-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/15/2018] [Indexed: 12/21/2022]
Abstract
Background In the early stage of severe burn, patients often exhibit a high level of inflammatory mediators in blood and are likely to develop sepsis. High-volume haemofiltration (HVHF) can eliminate these inflammatory mediators. We hypothesised that early application of HVHF may be beneficial in reducing sepsis and improving the prognosis of patients with severe burns. Methods Adults patients with burns ≥ 50% total burn surface area (TBSA) and in whom the sum of deep partial and full-thickness burn areas was ≥ 30% were enrolled in this randomised prospective study, and they were divided into control (41 cases) and HVHF (41 cases) groups. Patients in the control group received standard management for major burns, whereas the HVHF group additionally received HVHF treatment (65 ml/kg/h for 3 consecutive days) within 3 days after burn. The incidence of sepsis and mortality, some laboratory data, levels of inflammatory cytokines in the blood, HLA-DR expression on CD14+ peripheral blood monocytes, the proportion of CD25+Foxp3+ in CD4+ T lymphocytes, and the counts of CD3+, CD4+ and CD8+ T lymphocytes were recorded within 28 days post-burn. Results The incidence of sepsis, septic shock and duration of vasopressor treatment were decreased significantly in the HVHF group. In addition, in the subgroup of patients with burns ≥ 80% TBSA, the 90-day mortality showed significant decreases in the HVHF group. The ratio of arterial oxygen partial pressure to the fraction of inspiration oxygen was improved after HVHF treatment. In the patients who received HVHF treatment, the blood levels of inflammatory cytokines, including tumour necrosis factor-α, interleukin (IL)-1β, IL-6 and IL-8, as well as the blood level of procalcitonin were found to be lower than in the control group. Moreover, higher HLA-DR expression on CD14+ monocytes and a lower proportion of CD25+Foxp3+ in CD4+ T lymphocytes were observed in the patients in the HVHF group. Conclusions Early application of HVHF benefits patients with severe burns, especially for those with a greater burn area (≥ 80% TBSA), decreasing the incidence of sepsis and mortality. This effect may be attributed to its early clearance of inflammatory mediators and the recovery of the patient’s immune status. Trial registration Chinese Clinical Trial Register, ChiCTR-TRC-12002616. Registered on 24 October 2012. Electronic supplementary material The online version of this article (10.1186/s13054-018-2095-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bo You
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiothoracic Surgery, No. 324 Hospital of PLA, Chongqing, China
| | - Yu Long Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Plastic Surgery, No. 474 Hospital of PLA, Urumqi, China
| | - Gao Xing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yong Ming Dang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Bei Jiang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Guang Tao Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Zhu Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zi Chen Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yu Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jing Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi Qiang Yuan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Su Peng Yin
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| | - Yi Zhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
| |
Collapse
|
12
|
Tafner PFDA, Chen FK, Rabello R, Corrêa TD, Chaves RCDF, Serpa A. Recent advances in bedside microcirculation assessment in critically ill patients. Rev Bras Ter Intensiva 2018; 29:238-247. [PMID: 28977264 PMCID: PMC5496759 DOI: 10.5935/0103-507x.20170033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022] Open
Abstract
Parameters related to macrocirculation, such as the mean arterial pressure, central venous pressure, cardiac output, mixed venous saturation and central oxygen saturation, are commonly used in the hemodynamic assessment of critically ill patients. However, several studies have shown that there is a dissociation between these parameters and the state of microcirculation in this group of patients. Techniques that allow direct viewing of the microcirculation are not completely disseminated, nor are they incorporated into the clinical management of patients in shock. The numerous techniques developed for microcirculation assessment include clinical assessment (e.g., peripheral perfusion index and temperature gradient), laser Doppler flowmetry, tissue oxygen assessment electrodes, videomicroscopy (orthogonal polarization spectral imaging, sidestream dark field imaging or incident dark field illumination) and near infrared spectroscopy. In the near future, the monitoring and optimization of tissue perfusion by direct viewing and microcirculation assessment may become a goal to be achieved in the hemodynamic resuscitation of critically ill patients.
Collapse
Affiliation(s)
| | | | - Roberto Rabello
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Thiago Domingos Corrêa
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | | | - Ary Serpa
- Unidade de Terapia Intensiva Adulto, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| |
Collapse
|
13
|
Chisholm KI, Ida KK, Davies AL, Tachtsidis I, Papkovsky DB, Dyson A, Singer M, Duchen MR, Smith KJ. Hypothermia protects brain mitochondrial function from hypoxemia in a murine model of sepsis. J Cereb Blood Flow Metab 2016; 36:1955-1964. [PMID: 26661160 PMCID: PMC5094296 DOI: 10.1177/0271678x15606457] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022]
Abstract
Sepsis is commonly associated with brain dysfunction, but the underlying mechanisms remain unclear, although mitochondrial dysfunction and microvascular abnormalities have been implicated. We therefore assessed whether cerebral mitochondrial dysfunction during systemic endotoxemia in mice increased mitochondrial sensitivity to a further bioenergetic insult (hyoxemia), and whether hypothermia could improve outcome. Mice (C57bl/6) were injected intraperitoneally with lipopolysaccharide (LPS) (5 mg/kg; n = 85) or saline (0.01 ml/g; n = 47). Six, 24 and 48 h later, we used confocal imaging in vivo to assess cerebral mitochondrial redox potential and cortical oxygenation in response to changes in inspired oxygen. The fraction of inspired oxygen (FiO2) at which the cortical redox potential changed was compared between groups. In a subset of animals, spontaneous hypothermia was maintained or controlled hypothermia induced during imaging. Decreasing FiO2 resulted in a more reduced cerebral redox state around veins, but preserved oxidation around arteries. This pattern appeared at a higher FiO2 in LPS-injected animals, suggesting an increased sensitivity of cortical mitochondria to hypoxemia. This increased sensitivity was accompanied by a decrease in cortical oxygenation, but was attenuated by hypothermia. These results suggest that systemic endotoxemia influences cortical oxygenation and mitochondrial function, and that therapeutic hypothermia can be protective.
Collapse
Affiliation(s)
| | - Keila K Ida
- Institute of Neurology, University College London, UK.,Anaesthesiology LIM-8, Medical School, University of São Paulo, Brazil
| | | | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, UK
| | - Dmitri B Papkovsky
- School of Biochemistry and Cell Biology, University College Cork, Ireland
| | - Alex Dyson
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, UK
| | | | | |
Collapse
|
14
|
Early alterations in platelet mitochondrial function are associated with survival and organ failure in patients with septic shock. J Crit Care 2015; 31:63-7. [PMID: 26511963 DOI: 10.1016/j.jcrc.2015.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/18/2015] [Accepted: 10/02/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective of the study is to determine if changes in platelet mitochondrial function in patients with sepsis are present early after presentation and the association of these changes with clinical outcomes and systemic metabolic function. MATERIALS AND METHODS This is a prospective observational cohort study of a convenience sample of patients with severe sepsis. Mitochondrial function of intact, nonpermeabilized platelets suspended in their own plasma was estimated using high-resolution respirometry. Unstimulated basal respiration, oligomycin-induced state 4, and maximal respiratory rate after serial titrations of carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone were measured. Organ failure was estimated using Sequential Organ Failure Assessment score, and patients were followed up until 28 days to determine survival. Lactate levels were measured in all patients, and a subset of patients had lactate/pyruvate (L/P) ratios measured. RESULTS Twenty-eight patients were enrolled, 21 of whom survived. Initial Sequential Organ Failure Assessment score and lactate levels were 8.5 (interquartile range [IQR], 6-10) and 2.3 (IQR, 1.2-3.5) respectively, whereas the median L/P ratio was 23.4 (IQR, 15.2-38). Basal and maximal respiratory rates were significantly higher among nonsurvivors compared to survivors (P = .02 and P = .04), whereas oligomycin-induced state 4 respiration was not statistically different between groups (P = .15). We found a significant association between maximal respiration and organ failure (P = .03) and both basal and maximal rates with initial lactate level (P = .04, P = .02), but not with L/P ratio. CONCLUSIONS Differences in platelet mitochondrial function between survivors and nonsurvivors are present very early in the hospital course and are associated with organ failure and lactate.
Collapse
|
15
|
Herminghaus A, Barthel F, Heinen A, Beck C, Vollmer C, Bauer I, Weidinger A, Kozlov A, Picker O. Severity of polymicrobial sepsis modulates mitochondrial function in rat liver. Mitochondrion 2015; 24:122-8. [DOI: 10.1016/j.mito.2015.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 01/14/2023]
|
16
|
Calzavacca P, May CN, Bellomo R. Glomerular haemodynamics, the renal sympathetic nervous system and sepsis-induced acute kidney injury. Nephrol Dial Transplant 2014; 29:2178-2184. [DOI: 10.1093/ndt/gfu052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
17
|
Hviid CVB, Samulin Erdem J, Drechsler S, Weixelbaumer K, Ahmed MS, Attramadal H, Redl H, Bahrami S, Osuchowski MF, Aasen AO. The matricellular "cysteine-rich protein 61" is released from activated platelets and increased in the circulation during experimentally induced sepsis. Shock 2014; 41:233-40. [PMID: 24430538 DOI: 10.1097/shk.0000000000000105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sepsis and sepsis-induced organ dysfunction remain lethal and common conditions among intensive care patients. Accumulating evidence suggests that the matricellular Cyr61/CCN1 (cysteine-rich, angiogenic-inducer, 61) protein is involved in the regulation of inflammatory responses and possesses organ-protective capabilities in diseases of an inflammatory etiology. However, its regulation in sepsis remains largely unexplored. The present study provides a comprehensive description of CCN1 regulation in the circulation and vital organs during experimentally induced sepsis with developing organ dysfunction. Female CD-1 mice served as baseline controls or were subjected to cecal ligation and puncture (CLP) for 18 to 96 h, and CCN1 regulation was analyzed in selected organs and in the circulation. A 5-, 5-, and 3-fold increases in circulating CCN1 protein were observed at 18, 48, and 96 h after CLP, respectively. Hepatic and pulmonary CCN1 mRNA expression was down-regulated by 80%, 60%, and 55% and 85%, 80%, and 65% at 18, 48, and 96 h after CLP and undetectable in circulating white blood cells. To identify a potential source for the circulating protein, mouse and human platelets were explored and revealed to contain CCN1. Human platelets were stimulated by thrombin and a specific PAR1 agonist (SFLLRN) in vitro. Both agonists induced an instant CCN1 release, and the effect of SFLLRN was blocked by the specific antagonist RWJ56110. The current study demonstrates that experimental sepsis is associated with a robust increase in circulating CCN1 protein levels and a paradoxical downregulation of CCN1 mRNA expression in vital organs. It provides evidence that CCN1 is released from activated platelets, suggesting that platelets constitute a novel source for CCN1 release to the circulation during sepsis.
Collapse
Affiliation(s)
- Claus Vinter B Hviid
- *Institute for Surgical Research, Oslo University Hospital HF-Rikshospitalet; †Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and ‡Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Vaskó A, Siró P, László I, Szatmári S, Molnár L, Fülesdi B, Molnár C. Assessment of cerebral tissue oxygen saturation in septic patients during acetazolamide provocation - a near infrared spectroscopy study. ACTA ACUST UNITED AC 2014; 101:32-9. [PMID: 24631793 DOI: 10.1556/aphysiol.101.2014.1.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Sepsis-associated encephalopathy is a multifactorially determined process of the brain parenchyma. Among other factors, vasogenic causes have been shown to play a role in its development. The aim of the present work was to assess whether cerebral tissue oxygen saturation is influenced by administration of acetazolamide in septic patients compared to controls. PATIENTS AND METHODS 15 patients with severe sepsis and 10 healthy controls were studied. Cerebral oxygen saturation was assessed by INVOS 51 OOC Cerebral Oxymeter (NIRS) before and after administration of 15 mg/kg BW acetazolamide in both groups. RESULTS The maximal rise that has been found in the partial pressure of CO(2) in the arterial blood of septic patients after administration of acetazolamide was from 35 ± 5 mmHg to 41.1 ± 6.3 mmHg. For the partial pressure of O(2) the observed increase was from 123.7 ± 47.1 mmHg to 139.9 ± 49 mmHg. Vasodilatory stimulus resulted in a similar maximal increase in cerebral oxygen saturation in septic patients and in controls (8.9 ± 6.5% for septic patients and 9.2 ± 4.6% for healthy persons, respectively). CONCLUSIONS Cerebral vasoreactivity to acetazolamide is preserved in patients with severe sepsis.
Collapse
Affiliation(s)
- A Vaskó
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - P Siró
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - I László
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - Sz Szatmári
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - L Molnár
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - Béla Fülesdi
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| | - Cs Molnár
- University of Debrecen Department of Anesthesiology and Intensive Care, Health and Medical Science Centre Nagyerdei krt. 98 H-4032 Debrecen Hungary
| |
Collapse
|
19
|
Koning NJ, Simon LE, Asfar P, Baufreton C, Boer C. Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass. Am J Physiol Heart Circ Physiol 2014; 307:H967-75. [PMID: 25063797 DOI: 10.1152/ajpheart.00397.2014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previously we showed that cardiopulmonary bypass (CPB) during cardiac surgery is associated with reduced sublingual microcirculatory perfusion and oxygenation. It has been suggested that impaired microcirculatory perfusion may be paralleled by increased heterogeneity of flow in the microvascular bed, possibly leading to arteriovenous shunting. Here we investigated our hypothesis that acute hemodynamic disturbances during extracorporeal circulation indeed lead to microcirculatory heterogeneity with hyperdynamic capillary perfusion and reduced systemic oxygen extraction. In this single-center prospective observational study, patients undergoing cardiac surgery with (n = 18) or without (n = 13) CPB were included. Perioperative microcirculatory perfusion was assessed sublingually with sidestream darkfield imaging, and recordings were quantified for microcirculatory heterogeneity and hyperdynamic capillary perfusion. The relationship with hemodynamic and oxygenation parameters was analyzed. Microcirculatory heterogeneity index increased substantially after onset of CPB [0.5 (0.0-0.9) to 1.0 (0.3-1.3); P = 0.031] but not during off-pump surgery. Median capillary red blood cell (RBC) velocity increased intraoperatively in the CPB group only [1,600 (913-2,500 μm/s) vs. 380 (190-480 μm/s); P < 0.001], with 31% of capillaries supporting high RBC velocities (>2,000 μm/s). Hyperdynamic microcirculatory perfusion was associated with reduced arteriovenous oxygen difference and systemic oxygen consumption during and after CPB. The current study provides the first direct human evidence for a microvascular shunting phenomenon through hyperdynamic capillaries following acute physiological disturbances after onset of CPB. The hypothesis of impaired systemic oxygen offloading caused by hyperdynamic capillaries was supported by reduced blood arteriovenous oxygen difference and low systemic oxygen extraction associated with CPB.
Collapse
Affiliation(s)
- Nick J Koning
- Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands; Departments of Integrated Neurovascular Biology, Institut National de la Santé et de la Recherche Médicale U1083, Centre National de la Recherche Scientifique UMR 6214;
| | - Lotte E Simon
- Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Pierre Asfar
- Departments of Integrated Neurovascular Biology, Institut National de la Santé et de la Recherche Médicale U1083, Centre National de la Recherche Scientifique UMR 6214; Réanimation Médicale et Médicine Hyperbare, LUNAM University, Université d'Angers, Angers, France
| | - Christophe Baufreton
- Cardiovascular Surgery, LUNAM University, Université d'Angers, Angers, France; and
| | - Christa Boer
- Department of Anesthesiology. Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
20
|
Wang X, Qin W, Qiu X, Cao J, Liu D, Sun B. A novel role of exogenous carbon monoxide on protecting cardiac function and improving survival against sepsis via mitochondrial energetic metabolism pathway. Int J Biol Sci 2014; 10:777-88. [PMID: 25076854 PMCID: PMC4115198 DOI: 10.7150/ijbs.9220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/06/2014] [Indexed: 01/01/2023] Open
Abstract
Septic cardiac dysfunction is the main cause of death in septic patients. Here we investigate whether exogenous carbon monoxide can protect cardiac function and improve survival against sepsis by interfering with mitochondrial energetic metabolism. Male C57BL/6 mice were subjected to cecal ligation and puncture to induce sepsis. Exogenous carbon monoxide delivered from Tricarbonyldichlororuthenium (II) dimer (carbon monoxide releasing molecule II, 8mg/kg) was used intravenously as intervention. We found that carbon monoxide significantly improved cardiac function (LVEF 80.26 ± 2.37% vs. 71.21 ± 1.37%, P < 0.001; LVFS 43.52 ± 1.92% vs. 34.93 ± 1.28%, P < 0.001) and increased survival rate of septic mice (63% vs. 25%, P < 0.01). This phenomenon might be owing to the beneficial effect of carbon monoxide on abolishing the elevation of cardiac enzyme activity, cytokines levels and apoptosis rate, then attenuating cardiac injury in septic mice. Meanwhile, carbon monoxide significantly reversed the loss of mitochondrial number, effectively inhibited cardiac mitochondrial damage in septic mice by modulating glucose uptake, adenosine triphosphate and lactate content. Furthermore upregulation of peroxisome proliferator-activated receptor-γ coactivator-1α, nuclear respiratory factor 1 and mitochondrial transcription factor A genes in cardiac tissue were revealed in septic mice treated with carbon monoxide. Taken together, the results indicate that exogenous carbon monoxide effectively modulated mitochondrial energetic metabolisms by interfering with expression of peroxisome proliferator-activated receptor-γ coactivator-1α, nuclear respiratory factor 1 and mitochondrial transcription factor A genes, consequently exerted an important improvement in sepsis-induced cardiac dysfunction.
Collapse
Affiliation(s)
- Xu Wang
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Weiting Qin
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Xuefeng Qiu
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Jie Cao
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Dadong Liu
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Bingwei Sun
- Department of Burn and Plastic Surgery, Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu Province, China
| |
Collapse
|
21
|
Stoyanoff TR, Todaro JS, Aguirre MV, Zimmermann MC, Brandan NC. Amelioration of lipopolysaccharide-induced acute kidney injury by erythropoietin: Involvement of mitochondria-regulated apoptosis. Toxicology 2014; 318:13-21. [DOI: 10.1016/j.tox.2014.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 01/20/2023]
|
22
|
Wijnands KAP, Hoeksema MA, Meesters DM, van den Akker NMS, Molin DGM, Briedé JJ, Ghosh M, Köhler SE, van Zandvoort MAMJ, de Winther MPJ, Buurman WA, Lamers WH, Poeze M. Arginase-1 deficiency regulates arginine concentrations and NOS2-mediated NO production during endotoxemia. PLoS One 2014; 9:e86135. [PMID: 24465919 PMCID: PMC3897658 DOI: 10.1371/journal.pone.0086135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/04/2013] [Indexed: 12/15/2022] Open
Abstract
Rationale and objective Arginase-1 is an important component of the intricate mechanism regulating arginine availability during immune responses and nitric oxide synthase (NOS) activity. In this study Arg1fl/fl/Tie2-Cretg/− mice were developed to investigate the effect of arginase-1 related arginine depletion on NOS2- and NOS3-dependent NO production and jejunal microcirculation under resting and endotoxemic conditions, in mice lacking arginase-1 in endothelial and hematopoietic cells. Methods and Results Arginase-1-deficient mice as compared with control mice exhibited higher plasma arginine concentration concomitant with enhanced NO production in endothelial cells and jejunal tissue during endotoxemia. In parallel, impaired jejunal microcirculation was observed in endotoxemic conditions. Cultured bone-marrow-derived macrophages of arginase-1 deficient animals also presented a higher inflammatory response to endotoxin than control littermates. Since NOS2 competes with arginase for their common substrate arginine during endotoxemia, Nos2 deficient mice were also studied under endotoxemic conditions. As Nos2−/− macrophages showed an impaired inflammatory response to endotoxin compared to wild-type macrophages, NOS2 is potentially involved. A strongly reduced NO production in Arg1fl/fl/Tie2-Cretg/− mice following infusion of the NOS2 inhibitor 1400W further implicated NOS2 in the enhanced capacity to produce NO production Arg1fl/fl/Tie2-Cretg/− mice. Conclusions Reduced arginase-1 activity in Arg1fl/fl/Tie2-Cretg/− mice resulted in increased inflammatory response and NO production by NOS2, accompanied by a depressed microcirculatory flow during endotoxemia. Thus, arginase-1 deficiency facilitates a NOS2-mediated pro-inflammatory activity at the expense of NOS3-mediated endothelial relaxation.
Collapse
Affiliation(s)
- Karolina A. P. Wijnands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
| | - Marten A. Hoeksema
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dennis M. Meesters
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nynke M. S. van den Akker
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Physiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniel G. M. Molin
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Physiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacob J. Briedé
- Department of Toxicogenomics, Maastricht University Medical Centre, Maastricht, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mitrajit Ghosh
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Genetics & cell Biology, Section Molecular Cell Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - S. Eleonore Köhler
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Anatomy & Embryology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marc A. M. J. van Zandvoort
- CARIM Cardiovascular Research Institute of Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Genetics & cell Biology, Section Molecular Cell Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Menno P. J. de Winther
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wim A. Buurman
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Wouter H. Lamers
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Anatomy & Embryology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| |
Collapse
|
23
|
Stübs CC, Picker O, Schulz J, Obermiller K, Barthel F, Hahn AM, Bauer I, Beck C. Acute, short-term hypercapnia improves microvascular oxygenation of the colon in an animal model of sepsis. Microvasc Res 2013; 90:180-6. [DOI: 10.1016/j.mvr.2013.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/25/2013] [Accepted: 07/22/2013] [Indexed: 12/13/2022]
|
24
|
Navarrete ML, Cerdeño MC, Serra MC, Conejero R. [Mitochondrial and microcirculatory distress syndrome in the critical patient. Therapeutic implications]. Med Intensiva 2013; 37:476-84. [PMID: 24018281 DOI: 10.1016/j.medin.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/21/2013] [Accepted: 03/01/2013] [Indexed: 01/20/2023]
Abstract
Mitochondrial and microcirculatory distress syndrome (MMDS) can occur during systemic inflammatory response syndrome (SIRS), and is characterized by cytopathic tissue hypoxia uncorrected by oxygen transport optimization, and associated with an acquired defect in the use of oxygen and energy production in mitochondria, leading to multiple organ dysfunction (MOD). We examine the pathogenesis of MMDS, new diagnostic methods, and recent therapeutic approaches adapted to each of the three phases in the evolution of the syndrome. In the initial phase, the aim is prevention and early reversal of mitochondrial dysfunction. Once the latter is established, the aim is to restore flow of the electron chain, mitochondrial respiration, and to avoid cellular energy collapse. Finally, in the third (resolution) stage, treatment should focus on stimulating mitochondrial biogenesis and the repair or replacement of damaged mitochondria.
Collapse
Affiliation(s)
- M L Navarrete
- Servicio de Medicina Intensiva, Hospital Universitario San Juan, San Juan, Alicante, España
| | | | | | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW To describe the incidence, major risk factors, and the clinical, electrophysiological, and histological features of critical illness myopathy (CIM). Major pathogenetic mechanisms and long-term consequences of CIM are also reviewed. RECENT FINDINGS CIM is frequently associated with critical illness polyneuropathy (CIP), and may have a relevant impact on patients' outcome. CIM has an earlier onset than CIP, and recovery is faster. Loss of myosin filaments on muscle biopsy is important to diagnose CIM, and has a good prognosis. Critical illness, use of steroids, and immobility concur in causing CIM. SUMMARY A rationale diagnostic approach to CIM using clinical, electrophysiological, and muscle biopsy investigations is important to plan adequate therapy and to predict recovery.
Collapse
|
26
|
Evans RG, Ince C, Joles JA, Smith DW, May CN, O'Connor PM, Gardiner BS. Haemodynamic influences on kidney oxygenation: Clinical implications of integrative physiology. Clin Exp Pharmacol Physiol 2013; 40:106-22. [DOI: 10.1111/1440-1681.12031] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/21/2012] [Accepted: 11/15/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Roger G Evans
- Department of Physiology; Monash University; Melbourne; Victoria; Australia
| | - Can Ince
- Department of Translational Physiology; Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension; University Medical Center; Utrecht; The Netherlands
| | - David W Smith
- School of Computer Science and Software Engineering; The University of Western Australia; Perth; Western Australia; Australia
| | - Clive N May
- Florey Institute of Neuroscience and Mental Health; University of Melbourne; Melbourne; Victoria; Australia
| | - Paul M O'Connor
- Department of Physiology; Georgia Health Sciences University; Augusta; GA; USA
| | - Bruce S Gardiner
- School of Computer Science and Software Engineering; The University of Western Australia; Perth; Western Australia; Australia
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW Numerous implementation studies have demonstrated the benefit of bundled care in the initial treatment of patients with severe sepsis and septic shock, but the relative value of each component of these bundles remains uncertain. Recent studies have attempted to further define the optimal supportive and adjunctive treatments for these patients. RECENT FINDINGS The choice of optimal intravenous resuscitation fluid for the emergency treatment of severe sepsis remains uncertain. Albumin appears safe, although safety concerns have arisen regarding the use of hydroxyethyl starch. Norepinephrine and vasopressin appear superior to dopamine as vasopressors of choice. Several studies have successfully incorporated lactate clearance into resuscitation strategies, albeit with differing protocols. Although corticosteroids may hasten improvement, there does not appear to be a mortality benefit in heterogeneous patients with sepsis, leaving their role uncertain. SUMMARY Recent negative studies have questioned the role of previously promising adjunctive treatments. However, recent clinical trials and meta-analytic data continue to refine the relative importance of various components of sepsis bundles.
Collapse
|
28
|
Dick TE, Molkov YI, Nieman G, Hsieh YH, Jacono FJ, Doyle J, Scheff JD, Calvano SE, Androulakis IP, An G, Vodovotz Y. Linking Inflammation, Cardiorespiratory Variability, and Neural Control in Acute Inflammation via Computational Modeling. Front Physiol 2012; 3:222. [PMID: 22783197 PMCID: PMC3387781 DOI: 10.3389/fphys.2012.00222] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/03/2012] [Indexed: 01/10/2023] Open
Abstract
Acute inflammation leads to organ failure by engaging catastrophic feedback loops in which stressed tissue evokes an inflammatory response and, in turn, inflammation damages tissue. Manifestations of this maladaptive inflammatory response include cardio-respiratory dysfunction that may be reflected in reduced heart rate and ventilatory pattern variabilities. We have developed signal-processing algorithms that quantify non-linear deterministic characteristics of variability in biologic signals. Now, coalescing under the aegis of the NIH Computational Biology Program and the Society for Complexity in Acute Illness, two research teams performed iterative experiments and computational modeling on inflammation and cardio-pulmonary dysfunction in sepsis as well as on neural control of respiration and ventilatory pattern variability. These teams, with additional collaborators, have recently formed a multi-institutional, interdisciplinary consortium, whose goal is to delineate the fundamental interrelationship between the inflammatory response and physiologic variability. Multi-scale mathematical modeling and complementary physiological experiments will provide insight into autonomic neural mechanisms that may modulate the inflammatory response to sepsis and simultaneously reduce heart rate and ventilatory pattern variabilities associated with sepsis. This approach integrates computational models of neural control of breathing and cardio-respiratory coupling with models that combine inflammation, cardiovascular function, and heart rate variability. The resulting integrated model will provide mechanistic explanations for the phenomena of respiratory sinus-arrhythmia and cardio-ventilatory coupling observed under normal conditions, and the loss of these properties during sepsis. This approach holds the potential of modeling cross-scale physiological interactions to improve both basic knowledge and clinical management of acute inflammatory diseases such as sepsis and trauma.
Collapse
Affiliation(s)
- Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University Cleveland, OH, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Heyman SN, Evans RG, Rosen S, Rosenberger C. Cellular adaptive changes in AKI: mitigating renal hypoxic injury. Nephrol Dial Transplant 2012; 27:1721-8. [DOI: 10.1093/ndt/gfs100] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Hviid CVB, Erdem JS, Kunke D, Ahmed SM, Kjeldsen SF, Wang YY, Attramadal H, Aasen AO. The matri-cellular proteins 'cysteine-rich, angiogenic-inducer, 61' and 'connective tissue growth factor' are regulated in experimentally-induced sepsis with multiple organ dysfunction. Innate Immun 2012; 18:717-26. [PMID: 22334618 DOI: 10.1177/1753425912436764] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Organ failure is a severe complication in sepsis for which the pathophysiology remains incompletely understood. Recently, the matri-cellular cysteine-rich, angiogenic induced, 61 (Cyr61/CCN1); connective tissue growth factor (Ctgf/CCN2); and nephroblastoma overexpressed gene (Nov/CCN3) (CCN)-protein family have been attributed organ-protective properties. Their expression is sensitive to mediators of sepsis pathophysiology but a potential role in sepsis remains elusive. To provide an initial assessment, 50 rats were subjected to 18 h of cecal-ligation and puncture or sham operation. Hepatic and pulmonary CCN1 mRNA displayed an average 7.4- and 3.3-fold induction, while its cardiac expression was unchanged. The changes coincided with excessive hepatic and pulmonary inflammatory gene activation and a restricted cardiac inflammation. Furthermore, hepatocytes displayed a dosage-dependent CCN1 mRNA response in vitro, supporting a cytokine-mediated CCN1 regulation in sepsis. CCN2 mRNA was 2.2-fold induced in the liver, while 2.0-fold and 1.4-fold repressed in the heart and lung. Meanwhile, it did not respond to TNF-α exposure in vitro, which indicates different means of regulation than for CCN1. Taken together, this study provides the first evidence for multi-organ regulation of CCN1 and CCN2 in early stages of sepsis, and implies the eruption of inflammatory mediators as a potential mechanism behind the observed CCN1 regulation.
Collapse
Affiliation(s)
- Claus V B Hviid
- Institute for Surgical Research, Oslo University Hospital HF, Oslo, Norway.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Fülesdi B, Szatmári S, Antek C, Fülep Z, Sárkány P, Csiba L, Molnár C. Cerebral vasoreactivity to acetazolamide is not impaired in patients with severe sepsis. J Crit Care 2012; 27:337-43. [PMID: 22227080 DOI: 10.1016/j.jcrc.2011.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/29/2011] [Accepted: 11/03/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The pathophysiology of sepsis-associated encephalopathy (SAE) is not entirely clear, but one of the possible underlying mechanisms is the alteration of the cerebral microvascular function. The aim of the present work was to test whether cerebral vasomotor reactivity is impaired in patients with severe sepsis. METHODS Patients fulfilling the criteria of clinical sepsis and showing at least 2 organ dysfunctions were included (n = 16). Nonseptic healthy persons without previous diseases affecting cerebral vasoreactivity served as controls (n = 16). Transcranial Doppler blood flow velocities were measured at rest and at 5, 10, 15, and 20 minutes after intravenous administration of 15 mg/kg acetazolamide. The time course of the acetazolamide effect on cerebral blood flow velocity (cerebrovascular reactivity [CVR]) and the maximal vasodilatory effect of acetazolemide (cerebrovascular reserve capacity [CRC]) were compared among the groups. RESULTS Absolute blood flow velocities after administration of the vasodilator drug did not differ between control and septic patients. Assessment of the time course of the vasomotor reaction showed that patients with sepsis reacted in a similar fashion to the vasodilatory stimulus than control persons. When assessing the maximal vasodilatory ability of the cerebral arterioles to acetazolamide during vasomotor testing, we found that there was no difference in vasodilatory ability between septic and healthy subjects (CRC controls, 54.8% ± 11.1%; CRC sepsis-associated encephalopathy, 61.1% ± 34.4%; P = .49). CONCLUSIONS We conclude that cerebrovascular reactivity is not impaired in patients with severe sepsis. It is conceivable that cerebral vasoreactivity may be differently involved at different severity stages of the septic process.
Collapse
Affiliation(s)
- Béla Fülesdi
- Department of Anaesthesiology and Intensive Care, Neurology, University of Debrecen, Health and Medical Science Centre, Debrecen, Hungary.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Sepsis is a clinical entity in which complex inflammatory and physiological processes are mobilized, not only across a range of cellular and molecular interactions, but also in clinically relevant physiological signals accessible at the bedside. There is a need for a mechanistic understanding that links the clinical phenomenon of physiologic variability with the underlying patterns of the biology of inflammation, and we assert that this can be facilitated through the use of dynamic mathematical and computational modeling. An iterative approach of laboratory experimentation and mathematical/computational modeling has the potential to integrate cellular biology, physiology, control theory, and systems engineering across biological scales, yielding insights into the control structures that govern mechanisms by which phenomena, detected as biological patterns, are produced. This approach can represent hypotheses in the formal language of mathematics and computation, and link behaviors that cross scales and domains, thereby offering the opportunity to better explain, diagnose, and intervene in the care of the septic patient.
Collapse
Affiliation(s)
- Gary An
- Department of Surgery, University of Chicago, Chicago, IL 60637
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219
| | - Rami A. Namas
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| | - Yoram Vodovotz
- Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213
| |
Collapse
|
33
|
Christensen M. Mixed venous oxygen saturation monitoring revisited: thoughts for critical care nursing practice. Aust Crit Care 2011; 25:78-90. [PMID: 22112670 DOI: 10.1016/j.aucc.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 07/21/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO(2)). PURPOSE The aim of this paper is to put forward the notion that SvO(2) provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO(2). RELEVANCE TO CLINICAL PRACTICE SvO(2) monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO(2) monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO(2)) might be an attractive alternative to SvO(2) because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO(2) is less accurate than SvO(2) and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO(2) and SvO(2) and this is dependent on the presenting disease, in some cases SvO(2) will be significantly lower than ScvO(2). CONCLUSION Whilst newer technologies have been developed to continuously measure cardiac output, SvO(2) monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO(2) or blood samples obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO(2), trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO(2) will be approximately 16% lower.
Collapse
Affiliation(s)
- Martin Christensen
- Clinical Research Centre, MD11, 10 Medical Drive, Singapore, 117597, Singapore.
| |
Collapse
|
34
|
Sepsis: Something old, something new, and a systems view. J Crit Care 2011; 27:314.e1-11. [PMID: 21798705 DOI: 10.1016/j.jcrc.2011.05.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/08/2011] [Accepted: 05/19/2011] [Indexed: 01/01/2023]
Abstract
Sepsis is a clinical syndrome characterized by a multisystem response to a microbial pathogenic insult consisting of a mosaic of interconnected biochemical, cellular, and organ-organ interaction networks. A central thread that connects these responses is inflammation that, while attempting to defend the body and prevent further harm, causes further damage through the feed-forward, proinflammatory effects of damage-associated molecular pattern molecules. In this review, we address the epidemiology and current definitions of sepsis and focus specifically on the biologic cascades that comprise the inflammatory response to sepsis. We suggest that attempts to improve clinical outcomes by targeting specific components of this network have been unsuccessful due to the lack of an integrative, predictive, and individualized systems-based approach to define the time-varying, multidimensional state of the patient. We highlight the translational impact of computational modeling and other complex systems approaches as applied to sepsis, including in silico clinical trials, patient-specific models, and complexity-based assessments of physiology.
Collapse
|
35
|
Subbe CP. Centile-based Early Warning Scores derived from statistical distributions of vital signs. Resuscitation 2011; 82:969-70. [PMID: 21680077 DOI: 10.1016/j.resuscitation.2011.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
|
36
|
Chelazzi C, Villa G, De Gaudio AR. Cardiorenal syndromes and sepsis. Int J Nephrol 2011; 2011:652967. [PMID: 21603105 PMCID: PMC3097051 DOI: 10.4061/2011/652967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/25/2011] [Accepted: 01/28/2011] [Indexed: 12/15/2022] Open
Abstract
The cardiorenal syndrome is a clinical and pathophysiological entity defined as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common, that is, the septic cardiorenal syndrome. The aim of this paper is to describe the pathophysiology and clinical features of septic cardiorenal syndrome in light of the actual clinical and experimental evidence. In particular, the importance of systemic and intrarenal endothelial dysfunction, alterations of kidney perfusion, and myocardial function, organ “crosstalk” and ubiquitous inflammatory injury have been extensively reviewed in light of their role in cardiorenal syndrome etiology. Treatment includes early and targeted optimization of hemodynamics to reverse systemic hypotension and restore urinary output. In case of persistent renal impairment, renal replacement therapy may be used to remove cytokines and restore renal function.
Collapse
Affiliation(s)
- C Chelazzi
- Section of Anesthesiology and Intensive Care, Department of Critical Care, University of Florence, Padiglione Cliniche Chirurgiche, Viale Morgagni 85, 50134 Florence, Italy
| | | | | |
Collapse
|
37
|
Goligorsky MS. Endothelial progenitors in sepsis: vox clamantis in deserto? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:142. [PMID: 21489327 PMCID: PMC3219363 DOI: 10.1186/cc10105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In this issue of Critical Care, Patschan and colleagues present a study of endothelial progenitor cells (EPCs) in patients with sepsis. The importance of this study is in focusing attention on several frequently ignored aspects of sepsis. Among those are the phenomenon of microvascular dysfunction, which is potentially responsible for profound metabolic perturbations at the tissue level, and the role of endothelial progenitors in repair processes. Other important aspects of the study are the regenerative capacity of mobilized EPCs and the dissociation between the numerical value and clonogenic competence. Attempting to restore the competence to EPCs should be a priority in the future.
Collapse
Affiliation(s)
- Michael S Goligorsky
- Departments of Medicine, Pharmacology, and Physiology, Renal Research Institute, New York Medical College, Valhalla, NY 10595, USA.
| |
Collapse
|
38
|
Legrand M, Klijn E, Payen D, Ince C. The response of the host microcirculation to bacterial sepsis: does the pathogen matter? J Mol Med (Berl) 2010; 88:127-33. [PMID: 20119709 PMCID: PMC2832870 DOI: 10.1007/s00109-009-0585-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 11/25/2009] [Accepted: 12/21/2009] [Indexed: 12/05/2022]
Abstract
Sepsis results from the interaction between a host and an invading pathogen. The microcirculatory dysfunction is now considered central in the development of the often deadly multiple organ dysfunction syndrome in septic shock patients. The microcirculatory flow shutdown and flow shunting leading to oxygen demand and supply mismatch at the cellular level and the local activation of inflammatory pathways resulting from the leukocyte–endothelium interactions are both features of the sepsis-induced microcirculatory dysfunction. Although the host response through the inflammatory and immunologic response appears to be critical, there are also evidences that Gram-positive and Gram-negative bacteria can exert different effects at the microcirculatory level. In this review we discuss available data on the potential bacterial-specific microcirculatory alterations observed during sepsis.
Collapse
Affiliation(s)
- Matthieu Legrand
- Department of Intensive Care, Erasmus Medical Center, Erasmus University of Rotterdam, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|