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Noel JG, Ramser SW, Pitstick L, Goetzman HS, Dale EL, Potter A, Adam M, Potter SS, Gardner JC. IL-1/MyD88-Dependent G-CSF and IL-6 Secretion Mediates Postburn Anemia. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 210:972-980. [PMID: 36779805 PMCID: PMC10038902 DOI: 10.4049/jimmunol.2200785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
The anemia of critical illness (ACI) is a nearly universal pathophysiological consequence of burn injury and a primary reason burn patients require massive quantities of transfused blood. Inflammatory processes are expected to drive postburn ACI and prevent meaningful erythropoietic stimulation through iron or erythropoietin supplementation, but to this day no specific inflammatory pathways have been identified as a critical mechanism. In this study, we examined whether secretion of G-CSF and IL-6 mediates distinct features of postburn ACI and interrogated inflammatory mechanisms that could be responsible for their secretion. Our analysis of mouse and human skin samples identified the burn wound as a primary source of G-CSF and IL-6 secretion. We show that G-CSF and IL-6 are secreted independently through an IL-1/MyD88-dependent mechanism, and we ruled out TLR2 and TLR4 as critical receptors. Our results indicate that IL-1/MyD88-dependent G-CSF secretion plays a key role in impairing medullary erythropoiesis and IL-6 secretion plays a key role in limiting the access of erythroid cells to iron. Importantly, we found that IL-1α/β neutralizing Abs broadly attenuated features of postburn ACI that could be attributed to G-CSF or IL-6 secretion and rescued deficits of circulating RBC counts, hemoglobin, and hematocrit caused by burn injury. We conclude that wound-based IL-1/MyD88 signaling mediates postburn ACI through induction of G-CSF and IL-6 secretion.
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Affiliation(s)
- John G Noel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth W Ramser
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lori Pitstick
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Holly S Goetzman
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elizabeth L Dale
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Potter
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mike Adam
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - S Steven Potter
- Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jason C Gardner
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
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2
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Noel JG, Ramser SW, Pitstick L, Bonamer JP, Mackenzie B, Seu KG, Kalfa TA, Cancelas JA, Gardner JC. M-CSF supports medullary erythropoiesis and erythroid iron demand following burn injury through its activity on homeostatic iron recycling. Sci Rep 2022; 12:1235. [PMID: 35075211 PMCID: PMC8786861 DOI: 10.1038/s41598-022-05360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022] Open
Abstract
M-CSF receptor signaling supports the development and survival of mononuclear phagocytes and is thought to play a role in post burn anemia by promoting myeloid lineage bias. We found M-CSF secretion was increased in burn patients and a murine model of post burn ACI, so we neutralized M-CSF in ACI mice to determine if erythropoiesis was improved. Instead, M-CSF blockade further impaired erythropoiesis and erythroid cells access to iron. M-CSF blockade enhanced inflammatory cytokine secretion, further increased systemic neutrophil counts, and led to tissue iron sequestration that was dependent, in part, on augmented IL-6 secretion which induced hepcidin. Deleterious effects of post burn M-CSF blockade were associated with arrest of an iron recycling gene expression signature in the liver and spleen that included Spi-C transcription factor and heme oxygenase-1, which promote heme metabolism and confer a non-inflammatory tone in macrophages. Hepatic induction of these factors in ACI mice was consistent with a recovery of ferroportin gene expression and reflected an M-CSF dependent expansion and differentiation of Spi-C+ monocytes into Kupffer cells. Together, this data indicates M-CSF secretion supports a homeostatic iron recycling program that plays a key role in the maintenance of erythroid cells access to iron following burn injury.
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Affiliation(s)
- John G Noel
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, 45267, USA
| | - Seth W Ramser
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, 45267, USA
| | - Lori Pitstick
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, 45267, USA
| | - John P Bonamer
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, 45267, USA
| | - Bryan Mackenzie
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, 45267, USA
| | - Katie G Seu
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, 45229, USA
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, 45229, USA
| | - Jose A Cancelas
- Divisions of Pathology and Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, 45229, USA
| | - Jason C Gardner
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, 45267, USA.
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3
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Jenkins PM, Al Daoud F, Mercer L, Scholten D, Wong K, Perinjelil V, Majeski K, Cranford J, Elian G, Nigam T, Carto CA, Sachwani-Daswani GR. The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients. J Burn Care Res 2021; 42:1210-1214. [PMID: 33608722 PMCID: PMC8633085 DOI: 10.1093/jbcr/irab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ghaith Elian
- Michigan State University College of Human Medicine
| | - Tina Nigam
- Michigan State University College of Human Medicine
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Plasma TNFα and Unknown Factor/s Potentially Impede Erythroblast Enucleation Obstructing Terminal Maturation of Red Blood Cells in Burn Patients. Shock 2020; 55:766-774. [PMID: 32890311 DOI: 10.1097/shk.0000000000001649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In this study, using burn patient's peripheral blood mononuclear cells (PBMCs), we have shown that the Epo independent stage of terminal enucleation to reticulocyte formation is impeded in the presence of autologous plasma (BP). Furthermore, substitution with allogeneic control plasma (CP) from the healthy individual in place of BP rectified this enucleation defect. The exclusive role of burn microenvironment in late-stage erythropoiesis defect was further demarcated through control healthy human bone marrow cells cultured in the presence of CP, BP, and cytokines. METHODS PBMCs and human bone marrow (huBM) were differentiated ex vivo to enucleated reticulocytes in the presence of required growth factors and 5% CP or BP. Effect of systemic mediators in burn microenvironment like IL-6, IL-15, and TNFα was also explored. Neutralization experiments were carried out by adding varying concentrations (25 ng-400 ng/mL) of Anti-TNFα Ab to either CP+TNFα or BP. RESULTS Reticulocyte proportion and maturation index were significantly improved upon substituting BP with CP during differentiation of burn PBMCs. In the huBM ex vivo culture, addition of IL-6 and IL-15 to CP inhibited the proliferation stages of erythropoiesis, whereas TNFα supplementation caused maximum diminution at erythroblast enucleation stage. Supplementation with anti-TNFα in the BP showed significant but partial restoration in the enucleation process, revealing the possibility of other crucial microenvironmental factors that could impact RBC production in burn patients. CONCLUSION Exogenous TNFα impairs late-stage erythropoiesis by blocking enucleation, but neutralization of TNFα in BP only partially restored terminal enucleation indicating additional plasma factor(s) impair(s) late-stage RBC maturation in burn patients.
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Stage Specific Expression Pattern of Alpha-Hemoglobin-Stabilizing-Protein (AHSP) Portrayed in Erythroblast Chronology. Methods Protoc 2020; 3:mps3030046. [PMID: 32629835 PMCID: PMC7563766 DOI: 10.3390/mps3030046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022] Open
Abstract
During erythropoiesis, the molecular chaperone alpha-hemoglobin-stabilizing protein (AHSP) sequesters free alpha-hemoglobin (αHb) and prevents precipitation of excess αHb. While AHSP is linked to hereditary anemia, the pattern of expression during specific erythroblast stages is poorly understood. We investigated gene and protein expressions of AHSP throughout progressive maturation stages of erythroblasts in biphasic cultures of blood and bone marrow samples from healthy donors. Differentiating erythroblasts were periodically subjected to flow cytometry, Amnis imaging and RT-qPCR analyses. We made parallel in vivo validations from naive murine bone marrow cells. Percentages of AHSP+ erythroblasts, protein expressions and AHSP gene expressions are negligible on culture day 6 (CFU-Es) and progressively increases from culture days 8-12 (peaks on day 12) and declines on day 14. Notably, sub-cellular location of AHSP is both in the cytoplasm and nucleus in the early erythroblasts while in the late stages of maturation AHSP is found predominantly in the nucleus, being expelled with it during enucleation. As both human bone marrow and peripheral blood mononuclear cells (PBMC) derived erythroblasts demonstrated similar expression patterns, sampling of erythroblasts from day 11 cultures could portray erythroblast chronology and provide optimum representative stage specific expression patterns. PBMCs may be suitable for comparison studies of AHSP expression in pathologic erythropoiesi.
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Hasan S, Johnson MC, Kini AR, Baldea AJ, Muthumalaiappan K. A Shift in Myeloid Cell Phenotype via Down Regulation of Siglec-1 in Island Macrophages of Bone Marrow Is Associated With Decreased Late Erythroblasts Seen in Anemia of Critical Illness. Front Med (Lausanne) 2019; 6:260. [PMID: 31824951 PMCID: PMC6880610 DOI: 10.3389/fmed.2019.00260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022] Open
Abstract
Burn injury has been shown to significantly dampen erythropoiesis in both burn patients and in murine models. Our previous findings elucidated the erythropoietin independent defects in red cell development stages involving erythroid progenitor production and late stage erythroblast enucleation processes. We hypothesized that macrophages (MØ) in erythroblast islands (EBI) could be yet another roadblock impeding erythropoiesis following burn injury. Here we highlight that the methodology to study EBI can be achieved with single cell suspensions using a simple technique such as flow cytometry, as obtaining the central erythroblast island macrophages (EBIMØs) of interest is a delicate process. We elucidated the requisite of EBIMØ from the erythroblast as well as the MØ perspective. In addition to the primary erythropoiesis organ, the bone marrow (BM), spleens were also examined for extra-medullary erythropoiesis. Femurs and spleens were harvested from adult mice (B6D2F1) subjected to 15% total body surface area (TBSA) scald burn (B) or sham burn (S). Total bone marrow cells (TBM) and splenocytes were probed for total erythrons, early and late erythroblasts and EBIMØ by flow cytometry. There was only a marginal increase in the number of EBIMØ after burn, but, between the signatures of EBIMØ, Siglec-1 expression (MFI) was reduced by 40% in B with and a parallel 44% decrease in TBM erythrons in the BM. There were more (2.5-fold) EEBs and less LEBs (2.4-fold) per million TBM cells in B; with a corresponding decrease in Siglec-1 and Ly6G expressions in EBIMØ associated with EEB. Conversely, extra-medullary erythropoiesis was robust in spleens from B. Not only were the numbers of EBIMØs increased in B (p < 0.002), both EEBs and LEBs associated with EBIMØ were higher by 30 and 75%, respectively. Importantly, an increase in Siglec-1 and Vcam1 expressing F480+ splenic macrophages was observed after burn injury. Therefore, stagnant EEBs in the BM after burn injury could be due to low Siglec1 expressing EBIMØ, which perhaps impede their maturation into LEBs and reticulocytes. Repercussion of myeloid cell phenotype specific to BM after burn injury could plausibly account for a defective late stage RBC maturation resulting in anemia of critical illness. Summary Sentence: Characterization of erythroblast island macrophages (EBIMØ) in the bone marrow and spleen at different stages of erythropoiesis after burn injury.
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Affiliation(s)
- Shirin Hasan
- Health Sciences Division, Department of Surgery, Loyola University Chicago, Maywood, IL, United States.,Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, United States
| | - Maria Camargo Johnson
- Health Sciences Division, Department of Surgery, Loyola University Chicago, Maywood, IL, United States.,Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, United States
| | - Ameet R Kini
- Health Sciences Division, Department of Pathology, Loyola University Chicago, Maywood, IL, United States
| | - Anthony J Baldea
- Health Sciences Division, Department of Surgery, Loyola University Chicago, Maywood, IL, United States
| | - Kuzhali Muthumalaiappan
- Health Sciences Division, Department of Surgery, Loyola University Chicago, Maywood, IL, United States.,Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL, United States
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7
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Deregulated iron metabolism in bone marrow from adenine-induced mouse model of chronic kidney disease. Int J Hematol 2018; 109:59-69. [DOI: 10.1007/s12185-018-2531-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
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8
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Hasan S, Mosier MJ, Conrad P, Szilagyi A, Gamelli RL, Muthumalaiappan K. Terminal Maturation of Orthochromatic Erythroblasts Is Impaired in Burn Patients. J Burn Care Res 2018; 39:286-294. [PMID: 28570310 PMCID: PMC5709235 DOI: 10.1097/bcr.0000000000000592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/07/2017] [Accepted: 05/01/2017] [Indexed: 12/19/2022]
Abstract
Mechanisms of erythropoietin (Epo)-resistant anemia in burn patients are poorly understood. We have recently found that administering a nonselective beta 1,2-adrenergic blocker propranolol (PR) was effective in reversing myelo-erythroid commitment through MafB regulation and increase megakaryocyte erythrocyte progenitors in burn patients' peripheral blood mononuclear cell (PBMC)-derived ex vivo culture system. Having known that Epo-dependent proliferation of early erythroblasts is intact after burn injury, here we inquired whether or not Epo-independent maturation stage of erythropoiesis is affected by burn injury and the relative role of PR on late-stage erythropoiesis. While majority of erythropoiesis occurs in the bone marrow, maturation into reticulocytes is crucial for their release into sinusoids to occupy the peripheral circulation for which enucleation is vital. peripheral blood mononuclear cells (PBMCs) from burn patients were extended beyond commitment and proliferation stages to late maturation stage in ex vivo culture to understand the role of PR in burn patients. Burn impedes late maturation of orthochromatic erythroblasts into reticulocytes by restricting the enucleation step. Late-stage erythropoiesis is impaired in burn patients irrespective of PR treatment. Further, substituting the microenvironment with control plasma (homologous) in place of autologous plasma rescues the conversion of orthochromatic erythroblasts to reticulocytes. Results show promise in formulating interventions to regulate late-stage erythropoiesis, which can be used in combination with PR to reduce the number of transfusions.
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Affiliation(s)
- Shirin Hasan
- Department of Surgery, Health Sciences Division, Loyola University Chicago, Maywood, IL
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Michael J Mosier
- Department of Surgery, Health Sciences Division, Loyola University Chicago, Maywood, IL
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Peggie Conrad
- Department of Surgery, Health Sciences Division, Loyola University Chicago, Maywood, IL
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Andrea Szilagyi
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Richard L Gamelli
- Department of Surgery, Health Sciences Division, Loyola University Chicago, Maywood, IL
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
| | - Kuzhali Muthumalaiappan
- Department of Surgery, Health Sciences Division, Loyola University Chicago, Maywood, IL
- Health Sciences Division, Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, IL
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9
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Hasan S, Mosier MJ, Szilagyi A, Gamelli RL, Muthumalaiappan K. Discrete β-adrenergic mechanisms regulate early and late erythropoiesis in erythropoietin-resistant anemia. Surgery 2017; 162:901-916. [PMID: 28716301 PMCID: PMC5675564 DOI: 10.1016/j.surg.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/07/2017] [Accepted: 06/03/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anemia of critical illness is resistant to exogenous erythropoietin. Packed red blood cells transfusions is the only treatment option, and despite related cost and morbidity, there is a need for alternate strategies. Erythrocyte development can be divided into erythropoietin-dependent and erythropoietin-independent stages. We have shown previously that erythropoietin-dependent development is intact in burn patients and the erythropoietin-independent early commitment stage, which is regulated by β1/β2-adrenergic mechanisms, is compromised. Utilizing the scald burn injury model, we studied erythropoietin-independent late maturation stages and the effect of β1/β2, β-2, or β-3 blockade in burn mediated erythropoietin-resistant anemia. METHODS Burn mice were randomized to receive daily injections of propranolol (nonselective β1/β2 antagonist), nadolol (long-acting β1/β2 antagonist), butoxamine (selective β2 antagonist), or SR59230A (selective β3 antagonist) for 6 days after burn. Total bone marrow cells were characterized as nonerythroid cells, early and late erythroblasts, nucleated orthochromatic erythroblasts and enucleated reticulocyte subsets using CD71, Ter119, and Syto-16 by flow cytometry. Multipotential progenitors were probed for MafB expressing cells. RESULTS Although propranolol improved early and late erythroblasts, only butoxamine and selective β3-antagonist administrations were positively reflected in the peripheral blood hemoglobin and red blood cells count. While burn impeded early commitment and late maturation stages, β1/β2 antagonism increased the early erythroblasts through commitment stages via β2 specific MafB regulation. β3 antagonism was more effective in improving overall red blood cells through late maturation stages. CONCLUSION The study unfolds novel β2 and β3 adrenergic mechanisms orchestrating erythropoietin resistant anemia after burn, which impedes both the early commitment stage and the late maturation stages, respectively.
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Affiliation(s)
- Shirin Hasan
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL
| | - Michael J Mosier
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL
| | - Andrea Szilagyi
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL
| | - Richard L Gamelli
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL
| | - Kuzhali Muthumalaiappan
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, IL; Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL.
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10
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Thermal injury of the skin induces G-CSF-dependent attenuation of EPO-mediated STAT signaling and erythroid differentiation arrest in mice. Exp Hematol 2017; 56:16-30. [PMID: 28867537 DOI: 10.1016/j.exphem.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/13/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Abstract
Inflammation-mediated impairment of erythropoiesis plays a central role in the development of the anemia of critical illness (ACI). ACI develops despite elevation of endogenous erythropoietin (EPO), does not respond to exogenous erythropoietin (EPO) supplementation, and contributes significantly to transfusion requirements in burned patients. We have reported previously that the reduction of red blood cell mass in the bone marrow of a burn-injured ACI mouse model is granulocyte colony-stimulating factor (G-CSF) dependent. Given that elevated G-CSF levels also have been associated with lower hemoglobin levels and increased transfusion requirements in trauma victims, we postulated that G-CSF mediates postburn EPO resistance. In ACI mice, we found that bone marrow erythroid differentiation, viability, and proliferation are impaired after thermal injury of the skin. These changes in the marrow were associated with attenuated phosphorylation of known EPO-responsive signaling nodes, signal transducer and activator of transcription 5 (STAT5) Y694 and STAT3 S727, in bone marrow erythroid cells and developed despite highly elevated levels of endogenous EPO. Severely blunted STAT5 Y694 phosphorylation in bone marrow erythroid cells after exogenous EPO supplementation confirmed that EPO signaling was impaired in ACI mice. Importantly, parenteral administration of anti-G-CSF largely rescued postburn bone marrow erythroid differentiation arrest and EPO signaling in erythroid cells. Together, these data provide strong evidence for a role for G-CSF in the development of ACI after burn injury through suppression of EPO signaling in bone marrow erythroid cells.
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11
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Hasan S, Johnson NB, Mosier MJ, Shankar R, Conrad P, Szilagyi A, Gamelli RL, Muthumalaiappan K. Myelo-erythroid commitment after burn injury is under β-adrenergic control via MafB regulation. Am J Physiol Cell Physiol 2016; 312:C286-C301. [PMID: 28031160 PMCID: PMC5401945 DOI: 10.1152/ajpcell.00139.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/12/2022]
Abstract
Severely injured burn patients receive multiple blood transfusions for anemia of critical illness despite the adverse consequences. One limiting factor to consider alternate treatment strategies is the lack of a reliable test platform to study molecular mechanisms of impaired erythropoiesis. This study illustrates how conditions resulting in a high catecholamine microenvironment such as burns can instigate myelo-erythroid reprioritization influenced by β-adrenergic stimulation leading to anemia. In a mouse model of scald burn injury, we observed, along with a threefold increase in bone marrow LSK cells (linneg Sca1+cKit+), that the myeloid shift is accompanied with a significant reduction in megakaryocyte erythrocyte progenitors (MEPs). β-Blocker administration (propranolol) for 6 days after burn, not only reduced the number of LSKs and MafB+ cells in multipotent progenitors, but also influenced myelo-erythroid bifurcation by increasing the MEPs and reducing the granulocyte monocyte progenitors in the bone marrow of burn mice. Furthermore, similar results were observed in burn patients' peripheral blood mononuclear cell-derived ex vivo culture system, demonstrating that commitment stage of erythropoiesis is impaired in burn patients and intervention with propranolol (nonselective β1,2-adrenergic blocker) increases MEPs. Also, MafB+ cells that were significantly increased following standard burn care could be mitigated when propranolol was administered to burn patients, establishing the mechanistic regulation of erythroid commitment by myeloid regulatory transcription factor MafB. Overall, results demonstrate that β-adrenergic blockers following burn injury can redirect the hematopoietic commitment toward erythroid lineage by lowering MafB expression in multipotent progenitors and be of potential therapeutic value to increase erythropoietin responsiveness in burn patients.
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Affiliation(s)
- Shirin Hasan
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Nicholas B Johnson
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Michael J Mosier
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Ravi Shankar
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Peggie Conrad
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Andrea Szilagyi
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Richard L Gamelli
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and.,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
| | - Kuzhali Muthumalaiappan
- Department of Surgery, Loyola University Chicago, Health Sciences Division, Maywood, Illinois; and .,Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, Illinois
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12
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Johnson NB, Posluszny JA, He LK, Szilagyi A, Gamelli RL, Shankar R, Muthumalaiappan K. Perturbed MafB/GATA1 axis after burn trauma bares the potential mechanism for immune suppression and anemia of critical illness. J Leukoc Biol 2016; 100:725-736. [PMID: 26992433 DOI: 10.1189/jlb.1a0815-377r] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022] Open
Abstract
Patients who survive initial burn injury are susceptible to nosocomial infections. Anemia of critical illness is a compounding factor in burn patients that necessitates repeated transfusions, which further increase their susceptibility to infections and sepsis. Robust host response is dependent on an adequate number and function of monocytes/macrophages and dendritic cells. In addition to impaired RBC production, burn patients are prone to depletion of dendritic cells and an increase in deactivated monocytes. In steady-state hematopoiesis, RBCs, macrophages, and dendritic cells are all generated from a common myeloid progenitor within the bone marrow. We hypothesized in a mouse model of burn injury that an increase in myeloid-specific transcription factor V-maf musculoaponeurotic fibrosarcoma oncogene homolog B at the common myeloid progenitor stage steers their lineage potential away from the megakaryocyte erythrocyte progenitor production and drives the terminal fate of common myeloid progenitors to form macrophages vs. dendritic cells, with the consequences being anemia, monocytosis, and dendritic cell deficits. Results indicate that, even though burn injury stimulated bone marrow hematopoiesis by increasing multipotential stem cell production (LinnegSca1poscKitpos), the bone marrow commitment is shifted away from the megakaryocyte erythrocyte progenitor and toward granulocyte monocyte progenitors with corresponding alterations in peripheral blood components, such as hemoglobin, hematocrit, RBCs, monocytes, and granulocytes. Furthermore, burn-induced V-maf musculoaponeurotic fibrosarcoma oncogene homolog B in common myeloid progenitors acts as a transcriptional activator of M-CSFR and a repressor of transferrin receptors, promoting macrophages and inhibiting erythroid differentiations while dictating a plasmacytoid dendritic cell phenotype. Results from small interfering RNA and gain-of-function (gfp-globin transcription factor 1 retrovirus) studies indicate that targeted interventions to restore V-maf musculoaponeurotic fibrosarcoma oncogene homolog B/globin transcription factor 1 balance can mitigate both immune imbalance and anemia of critical illness.
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Affiliation(s)
| | - Joseph A Posluszny
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
| | - Li K He
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
| | - Andrea Szilagyi
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
| | - Richard L Gamelli
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
| | - Ravi Shankar
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
| | - Kuzhali Muthumalaiappan
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Burn and Shock Trauma Research Institute, Loyola University Chicago, Chicago, Illinois, USA; and
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Wijayalath W, Majji S, Villasante EF, Brumeanu TD, Richie TL, Casares S. Humanized HLA-DR4.RagKO.IL2RγcKO.NOD (DRAG) mice sustain the complex vertebrate life cycle of Plasmodium falciparum malaria. Malar J 2014; 13:386. [PMID: 25266106 PMCID: PMC4197321 DOI: 10.1186/1475-2875-13-386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/18/2014] [Indexed: 12/28/2022] Open
Abstract
Background Malaria is a deadly infectious disease affecting millions of people in tropical and sub-tropical countries. Among the five species of Plasmodium parasites that infect humans, Plasmodium falciparum accounts for the highest morbidity and mortality associated with malaria. Since humans are the only natural hosts for P. falciparum, the lack of convenient animal models has hindered the understanding of disease pathogenesis and prompted the need of testing anti-malarial drugs and vaccines directly in human trials. Humanized mice hosting human cells represent new pre-clinical models for infectious diseases that affect only humans. In this study, the ability of human-immune-system humanized HLA-DR4.RagKO.IL2RγcKO.NOD (DRAG) mice to sustain infection with P. falciparum was explored. Methods Four week-old DRAG mice were infused with HLA-matched human haematopoietic stem cells (HSC) and examined for reconstitution of human liver cells and erythrocytes. Upon challenge with infectious P. falciparum sporozoites (NF54 strain) humanized DRAG mice were examined for liver stage infection, blood stage infection, and transmission to Anopheles stephensi mosquitoes. Results Humanized DRAG mice reconstituted human hepatocytes, Kupffer cells, liver endothelial cells, and erythrocytes. Upon intravenous challenge with P. falciparum sporozoites, DRAG mice sustained liver to blood stage infection (average 3–5 parasites/microlitre blood) and allowed transmission to An. stephensi mosquitoes. Infected DRAG mice elicited antibody and cellular responses to the blood stage parasites and self-cured the infection by day 45 post-challenge. Conclusions DRAG mice represent the first human-immune-system humanized mouse model that sustains the complex vertebrate life cycle of P. falciparum without the need of exogenous injection of human hepatocytes/erythrocytes or P. falciparum parasite adaptation. The ability of DRAG mice to elicit specific human immune responses to P. falciparum parasites may help deciphering immune correlates of protection and to identify protective malaria antigens.
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Affiliation(s)
| | | | | | | | | | - Sofia Casares
- US Military Malaria Vaccine Program, Naval Medical Research Center/Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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Ji Z, Li X, Fromowitz M, Mutter-Rottmayer E, Tung J, Smith MT, Zhang L. Formaldehyde induces micronuclei in mouse erythropoietic cells and suppresses the expansion of human erythroid progenitor cells. Toxicol Lett 2014; 224:233-9. [PMID: 24188930 PMCID: PMC3891867 DOI: 10.1016/j.toxlet.2013.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
Although formaldehyde (FA) has been classified as a human leukemogen, the mechanisms of leukemogenesis remain elusive. Previously, using colony-forming assays in semi-solid media, we showed that FA exposure in vivo and in vitro was toxic to human hematopoietic stem/progenitor cells. In the present study, we have applied new liquid in vitro erythroid expansion systems to further investigate the toxic effects of FA (0-150 μM) on cultured mouse and human hematopoietic stem/progenitor cells. We determined micronucleus (MN) levels in polychromatic erythrocytes (PCEs) differentiated from mouse bone marrow. We measured cell growth, cell cycle distribution, and chromosomal instability, in erythroid progenitor cells (EPCs) expanded from human peripheral blood mononuclear cells. FA significantly induced MN in mouse PCEs and suppressed human EPC expansion in a dose-dependent manner, compared with untreated controls. In the expanded human EPCs, FA slightly increased the proportion of cells in G2/M at 100 μM and aneuploidy frequency in chromosomes 7 and 8 at 50 μM. Our findings provide further evidence of the toxicity of FA to hematopoietic stem/progenitor cells and support the biological plausibility of FA-induced leukemogenesis.
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Affiliation(s)
| | | | - Michele Fromowitz
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720
| | - Elizabeth Mutter-Rottmayer
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720
| | - Judy Tung
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720
| | - Martyn T. Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720
| | - Luoping Zhang
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720
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