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Cao Z, Zhang Y, Luo JH, Liao WQ, Cheng X, Zhan JH. A bibliometric analysis of publications on burn sepsis using VOSviewer. Front Med (Lausanne) 2022; 9:971393. [PMID: 36186821 PMCID: PMC9515469 DOI: 10.3389/fmed.2022.971393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sepsis is one of the most common complications in burn patients and causes high morbidity, especially in those with severe burns. Nevertheless, there are no formal criteria for diagnosing and treating burn sepsis. Therefore, this bibliometric analysis is applied to reveal research trends in this field and predicts its possible hot spots. Methods We screened relevant literature on burn sepsis that met the inclusion criteria of the Web of Sciences (WOS) database and analyzed publication trends and research hot spots in related fields using VOSviewer software. Results From 1981 to 2022, we screened 2,486 documents that met the requirements and analyzed them bibliometrically. The American scholar Herndon DN had a much higher h-index [47] than other authors. Most published, cited, and h-indexed publications are from the USA (Np: 1193, Nc: 42154, H: 98). The second most publishing country is China, but the second most cited and h-indexed country is Germany. Burns also outperforms other journals in this field (Np: 376, Nc: 8019, H: 46). “Biomarkers” is a newly emerging keyword (cluster “clinical research,” APY was 2018.16), and clinically relevant research in burn sepsis maybe a future research trend. Conclusions Sepsis in burn patients has unique pathophysiological characteristics and the general diagnostic criteria for sepsis lack specificity. Consequently, we must establish a database and construct an intelligent predictive model to help achieve a more individualized and precise early diagnosis and treatment of burn sepsis. This may also be an important development direction for future research in this field.
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Affiliation(s)
- Zhi Cao
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Zhang
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin-Hua Luo
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen-Qiang Liao
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xing Cheng
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Xing Cheng
| | - Jian-Hua Zhan
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Jian-Hua Zhan
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Schneider V, Kruse D, de Mattos IB, Zöphel S, Tiltmann KK, Reigl A, Khan S, Funk M, Bodenschatz K, Groeber-Becker F. A 3D In Vitro Model for Burn Wounds: Monitoring of Regeneration on the Epidermal Level. Biomedicines 2021; 9:1153. [PMID: 34572338 PMCID: PMC8466997 DOI: 10.3390/biomedicines9091153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 01/13/2023] Open
Abstract
Burns affect millions every year and a model to mimic the pathophysiology of such injuries in detail is required to better understand regeneration. The current gold standard for studying burn wounds are animal models, which are under criticism due to ethical considerations and a limited predictiveness. Here, we present a three-dimensional burn model, based on an open-source model, to monitor wound healing on the epidermal level. Skin equivalents were burned, using a preheated metal cylinder. The healing process was monitored regarding histomorphology, metabolic changes, inflammatory response and reepithelialization for 14 days. During this time, the wound size decreased from 25% to 5% of the model area and the inflammatory response (IL-1β, IL-6 and IL-8) showed a comparable course to wounding and healing in vivo. Additionally, the topical application of 5% dexpanthenol enhanced tissue morphology and the number of proliferative keratinocytes in the newly formed epidermis, but did not influence the overall reepithelialization rate. In summary, the model showed a comparable healing process to in vivo, and thus, offers the opportunity to better understand the physiology of thermal burn wound healing on the keratinocyte level.
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Affiliation(s)
- Verena Schneider
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- Translational Center for Regenerative Therapies TLC-RT, Fraunhofer-Institute for Silicate Research ISC, Neunerplatz 2, 97082 Würzburg, Germany
| | - Daniel Kruse
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
| | - Ives Bernardelli de Mattos
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- QRSkin GmbH, Friedrich-Bergius-Ring 15, 97076 Würzburg, Germany
| | - Saskia Zöphel
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- Translational Center for Regenerative Therapies TLC-RT, Fraunhofer-Institute for Silicate Research ISC, Neunerplatz 2, 97082 Würzburg, Germany
| | - Kendra-Kathrin Tiltmann
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- Translational Center for Regenerative Therapies TLC-RT, Fraunhofer-Institute for Silicate Research ISC, Neunerplatz 2, 97082 Würzburg, Germany
| | - Amelie Reigl
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- Translational Center for Regenerative Therapies TLC-RT, Fraunhofer-Institute for Silicate Research ISC, Neunerplatz 2, 97082 Würzburg, Germany
| | - Sarah Khan
- Department for Paediatric Surgery, Nuremberg Hospital, Breslauer Straße 201, 90471 Nürnberg, Germany; (S.K.); (K.B.)
| | - Martin Funk
- EVOMEDIS GmbH, Neue Stiftingtalstrasse 2, 8010 Graz, Austria;
| | - Karl Bodenschatz
- Department for Paediatric Surgery, Nuremberg Hospital, Breslauer Straße 201, 90471 Nürnberg, Germany; (S.K.); (K.B.)
| | - Florian Groeber-Becker
- Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany; (D.K.); (I.B.d.M.); (S.Z.); (K.-K.T.); (A.R.); (F.G.-B.)
- Translational Center for Regenerative Therapies TLC-RT, Fraunhofer-Institute for Silicate Research ISC, Neunerplatz 2, 97082 Würzburg, Germany
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Willis ML, Mahung C, Wallet SM, Barnett A, Cairns BA, Coleman LG, Maile R. Plasma extracellular vesicles released after severe burn injury modulate macrophage phenotype and function. J Leukoc Biol 2021; 111:33-49. [PMID: 34342045 DOI: 10.1002/jlb.3mia0321-150rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Extracellular vesicles (EVs) have emerged as key regulators of immune function across multiple diseases. Severe burn injury is a devastating trauma with significant immune dysfunction that results in an ∼12% mortality rate due to sepsis-induced organ failure, pneumonia, and other infections. Severe burn causes a biphasic immune response: an early (0-72 h) hyper-inflammatory state, with release of damage-associated molecular pattern molecules, such as high-mobility group protein 1 (HMGB1), and proinflammatory cytokines (e.g., IL-1β), followed by an immunosuppressive state (1-2+ wk post injury), associated with increased susceptibility to life-threatening infections. We have reported that early after severe burn injury HMGB1 and IL-1β are enriched in plasma EVs. Here we tested the impact of EVs isolated after burn injury on phenotypic and functional consequences in vivo and in vitro using adoptive transfers of EV. EVs isolated early from mice that underwent a 20% total body surface area burn injury (burn EVs) caused similar hallmark cytokine responses in naïve mice to those seen in burned mice. Burn EVs transferred to RAW264.7 macrophages caused similar functional (i.e., cytokine secretion) and immune gene expression changes seen with their associated phase of post-burn immune dysfunction. Burn EVs isolated early (24 h) induced MCP-1, IL-12p70, and IFNγ, whereas EVs isolated later blunted RAW proinflammatory responses to bacterial endotoxin (LPS). We also describe significantly increased HMGB1 cargo in burn EVs purified days 1 to 7 after injury. Thus, burn EVs cause immune outcomes in naïve mice and macrophages similar to findings after severe burn injury, suggesting EVs promote post-burn immune dysfunction.
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Affiliation(s)
- Micah L Willis
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cressida Mahung
- North Carolina Jaycee Burn Center Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shannon M Wallet
- Adams School of Dentistry, Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra Barnett
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bruce A Cairns
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leon G Coleman
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Maile
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,North Carolina Jaycee Burn Center Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Effect of TNF-α Concentration on Selected Clinical Parameters of Swine After Burns. J Vet Res 2018; 62:335-340. [PMID: 30584613 PMCID: PMC6296001 DOI: 10.2478/jvetres-2018-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The study aimed to observe TNF-α serum concentration as well as changes in respiration rate, body temperature, and pulse rate in burn victims during 84 h post burn. Material and Methods A total of 30 healthy pigs were divided into two groups: A, the test group and N, the control group. The experimental group suffered burns to 30% of the body surface, and after infliction of the burns both groups were closely monitored. Results The biggest increase in TNF-α serum concentration in the test subjects occurred around the 6th h of the study, and the second biggest increase took place between 12th and 36th h. In the 36th h, TNF-α was 2.5 times more concentrated in serum in the test group than in the control group. In the test group, the biggest increase in respiration rate occurred up to the 6th h post burn, on average up to 29/min. In the 12th h post burn, the mean pulse rate in the test group was 133/min and dropped to the lowest value in the 72nd h of the experiment. A gradual increase in body temperature up to 41.72°C was observed up to the 30th h post burn and decreased to a significant value of 40.74°C by the 84th h of the study. Conclusion In a period of a pronounced rise in TNF-α serum concentration, this parameter, pulse rate, and respiration rate are highly correlated and are also influenced by multiple inflammation forming factors.
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Bergquist M, Hästbacka J, Glaumann C, Freden F, Huss F, Lipcsey M. The time-course of the inflammatory response to major burn injury and its relation to organ failure and outcome. Burns 2018; 45:354-363. [PMID: 30274808 DOI: 10.1016/j.burns.2018.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
Burn injury causes major inflammatory activation and cytokine release, however, the temporal resolution of the acute and sub-acute inflammatory response has not yet been fully delineated. To this end, we have quantified 20 inflammatory mediators in plasma from 44 adult patients 0-21 days after burn injury and related the time course of these mediators to % total body surface area (TBSA) burned, clinical parameters, organ failure and outcome. Of the cytokines analyzed in these patients, interleukin 6 (IL-6), IL-8, IL-10 and monocyte chemoattractant protein 1 (MCP-1) correlated to the size of the injury at 24-48h after burn injury. In our study, the concentration of IL-10 had prognostic value in patients with burn injury both measured at admission and at 24-48h after injury. However, simple demographic data such as age, % burned TBSA, inhalation injury and their combination, the Baux score and modified Baux score, outperform most of the cytokines, with the exception of IL-8 and MCP-1 levels on admission, in predicting death.
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Affiliation(s)
- Maria Bergquist
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johanna Hästbacka
- Intensive Care Medicine, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christian Glaumann
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Filip Freden
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- The Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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Hazeldine J, Hampson P, Lord JM. The diagnostic and prognostic value of systems biology research in major traumatic and thermal injury: a review. BURNS & TRAUMA 2016; 4:33. [PMID: 27672669 PMCID: PMC5030723 DOI: 10.1186/s41038-016-0059-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/09/2016] [Indexed: 01/12/2023]
Abstract
As secondary complications remain a significant cause of morbidity and mortality amongst hospitalised trauma patients, the need to develop novel approaches by which to identify patients at risk of adverse outcome is becoming increasingly important. Centred on the idea that patients who experience “poor” outcome post trauma elicit a response to injury that is distinct from those who experience “good” outcome, tailored therapeutics is an emerging concept aimed at improving current treatment regimens by promoting patient-specific therapies. Making use of recent advancements in the fields of genomics, proteomics and metabolomics, numerous groups have undertaken a systems-based approach to analysing the acute immune and inflammatory response to major traumatic and thermal injury in an attempt to uncover a single or combination of biomarkers that can identify patients at risk of adverse outcome. Early results are encouraging, with all three approaches capable of discriminating patients with “good” outcome from those who develop nosocomial infections, sepsis and multiple organ failure, with differences apparent in blood samples acquired as early as 2 h post injury. In particular, genomic data is proving to be highly informative, identifying patients at risk of “poor” outcome with a higher degree of sensitivity and specificity than statistical models built upon data obtained from existing anatomical and physiological scoring systems. Here, focussing predominantly upon human-based research, we provide an overview of the findings of studies that have investigated the immune and inflammatory response to major traumatic and thermal injury at the genomic, protein and metabolite level, and consider both the diagnostic and prognostic potential of these approaches.
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Affiliation(s)
- Jon Hazeldine
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
| | - Peter Hampson
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK ; Healing Foundation Centre for Burns Research, Queen Elizabeth Hospital, Birmingham, B15 2WB UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
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Emara S. Prognostic indicators in acute burned patients–a review. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Alam SMS, Kalam MA, Munna MS, Munshi SK, Noor R. Isolation of pathogenic microorganisms from burn patients admitted in Dhaka Medical College and Hospital and demonstration of their drug-resistance traits. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60596-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wu HP, Chung K, Lin CY, Jiang BY, Chuang DY, Liu YC. Associations of T helper 1, 2, 17 and regulatory T lymphocytes with mortality in severe sepsis. Inflamm Res 2013; 62:751-63. [PMID: 23670410 PMCID: PMC3712133 DOI: 10.1007/s00011-013-0630-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022] Open
Abstract
Objective and design T helper 17 (Th17) and regulatory T (Treg) lymphocytes might play important roles in patients with severe sepsis. The association of Th17 or Treg lymphocytes with survival is also unclear. Methods Eighty-seven patients with severe sepsis were enrolled from our intensive care units between August 2008 and July 2010. Leukocyte antigens and clinical data were determined on day 1 in all patients and on day 7 in first-year patients. Results The percentages in peripheral blood mononuclear cells (PBMCs) and circulatory counts of CD4+ and CD8+ lymphocytes in survivors were higher than those in non-survivors. Th1/CD4+ ratios and circulatory Th1 lymphocyte counts in survivors were higher than in non-survivors. Absolute counts of Th17 and Treg lymphocytes in survivors were higher than in non-survivors. The percentages of CD4+ and CD8+ in survivors’ PBMCs were increased after 6 days. Th17/CD4+ ratios and circulatory Th17 lymphocyte counts in survivors were increased after 6 days. Conclusions Higher Th1 differentiation and total CD4+ T lymphocyte counts were associated with higher survival. The association of circulatory Th17 and Treg lymphocytes with mortality in severe sepsis may be due to the change in total CD4+ T lymphocytes. In survivors, Th17 differentiation and counts were restored.
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Affiliation(s)
- Huang-Pin Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 204, Taiwan ROC
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Kim HS, Kim JH, Yim H, Kim D. Changes in the levels of interleukins 6, 8, and 10, tumor necrosis factor alpha, and granulocyte-colony stimulating factor in Korean burn patients: relation to burn size and postburn time. Ann Lab Med 2012; 32:339-44. [PMID: 22950069 PMCID: PMC3427821 DOI: 10.3343/alm.2012.32.5.339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 06/08/2012] [Accepted: 07/06/2012] [Indexed: 01/27/2023] Open
Abstract
Background Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. Methods Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. Results Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-α, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. Conclusions These findings indicate that IL-6, IL-8, IL-10, TNF-α, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
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Affiliation(s)
- Hyun Soo Kim
- Department of Laboratory Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Wu HP, Shih CC, Lin CY, Hua CC, Chuang DY. Serial increase of IL-12 response and human leukocyte antigen-DR expression in severe sepsis survivors. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R224. [PMID: 21939530 PMCID: PMC3334770 DOI: 10.1186/cc10464] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/05/2011] [Accepted: 09/22/2011] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sepsis-induced immunosuppression may result in death. The mechanisms of immune suppression include loss of macrophage and monocyte expression of the major histocompatibility complex, increased anti-inflammatory cytokine expression and decreased expression of proinflammatory cytokines. In this study, we sought to determine the mechanisms of immune suppression in severe sepsis by repeated detection. METHODS We designed this prospective observational study to measure monocyte human leukocyte antigen (HLA)-DR expression, plasma cytokine levels and cytokine responses on days 1 and 7 in stimulated peripheral blood mononuclear cells (PBMCs) of healthy controls and patients with severe sepsis. RESULTS Of the 35 enrolled patients, 23 survived for 28 days and 12 died, 6 of whom died within 7 days. Plasma levels of IL-1β, IL-6, IL-10, IL-17, transforming growth factor (TGF)-β1 and TNF-α were higher, but plasma IL-12 level was lower in septic patients than those in controls. Day 1 plasma levels of IL-1β, IL-6, IL-10 and TGF-β1 in nonsurvivors were higher than those in survivors. Day 7 plasma IL-10 levels in nonsurvivors were higher than in survivors. IL-1β response was higher, but IL-12 and TNF-α responses were lower in septic patients than in controls. Day 1 IL-6 response was lower, but day 1 TGF-β1 response was higher in nonsurvivors than in survivors. Plasma IL-6 and IL-10 levels were decreased in survivors after 6 days. IL-6 response was decreased in survivors after 6 days, but IL-12 response was increased. Monocyte percentage was higher, but positive HLA-DR percentage in monocytes and mean fluorescence intensity (MFI) of HLA-DR were lower in septic patients than in controls. MFI of HLA-DR was increased in survivors after 6 days. CONCLUSIONS Monocyte HLA-DR expression and IL-12 response from PBMCs are restored in patients who survive severe sepsis.
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Affiliation(s)
- Huang-Pin Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, 204, Taiwan.
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Tropism, cytotoxicity, and inflammatory properties of two envelope genes of murine leukemia virus type-endogenous retroviruses of C57BL/6J mice. Mediators Inflamm 2011; 2011:509604. [PMID: 21772664 PMCID: PMC3134291 DOI: 10.1155/2011/509604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 03/09/2011] [Indexed: 12/16/2022] Open
Abstract
Envelope (env) proteins of certain endogenous retroviruses (ERVs) participate in various pathophysiological processes. In this study, we characterized pathophysiologic properties of two murine leukemia virus-type ERV (MuLV-ERV) env genes cloned from the ovary of C57BL/6J mice. The two env genes (named ENVOV1 and ENVOV2), with 1,926 bp coding region, originated from two MuLV-ERV loci on chromosomes 8 and 18, respectively. ENVOV1 and ENVOV2 were ~75 kDa and predominantly expressed on the cell membrane. They were capable of producing pseudotype murine leukemia virus virions. Tropism trait and infectivity of ENVOV2 were similar to the polytropic env; however, ENVOV1 had very low level of infectivity. Overexpression of ENVOV2, but not ENVOV1, exerted cytotoxic effects and induced expression of COX-2, IL-1β, IL-6, and iNOS. These findings suggest that the ENVOV1 and ENVOV2 are capable of serving as an env protein for virion assembly, and they exert differential cytotoxicity and modulation of inflammatory mediators.
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Abstract
High-mobility group box protein 1 (HMGB1) is a nuclear protein that may be released actively from monocytes and macrophages or passively from necrotic or damaged cells. Several experimental data suggest that burn injury is accompanied by elevated plasma HMGB, but there are only few data available about its changes in burned patients. The aim of this study was to follow the time course and the prognostic value of plasma HMGB1 and cytokine changes in patients with severe burn injury affecting more than 10% of body surface area (n = 26). Blood samples were taken on admission and on the following 5 days. Plasma HMGB1 concentration was measured by the enzyme-linked immunosorbent assay method, whereas IL-6, IL-8, and IL-10 were assayed by the cytometric bead array kit. The HMGB1 and IL-10 concentrations were elevated on admission and gradually decreased thereafter. Significant differences were observed between survivors and nonsurvivors in HMGB1 (P < 0.01) and IL-10 (P < 0.001) concentrations on admission with higher levels in nonsurvivors. IL-6 and IL-8 started to increase markedly from day 2. Positive correlation (r = 0.669, P < 0.01) was found between burned body surface and HMGB1 on admission. Receiver operating characteristic analysis of data on admission showed that at a level of 16 ng/mL, HMGB1 indicated lethality, with 75.0% sensitivity and 85.7% specificity. Using the cutoff level of 14 pg/mL, IL-10 predicted intensive care unit mortality, with 85.7% sensitivity and 84.2% specificity. Very early HMGB1 and IL-10 release may have an important impact on the immune function of patients after burn trauma.
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Time course of pro- and anti-inflammatory cytokine levels in patients with burns—Prognostic value of interleukin-10. Burns 2010; 36:483-94. [DOI: 10.1016/j.burns.2009.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/07/2009] [Accepted: 10/13/2009] [Indexed: 11/23/2022]
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Berry PA, Antoniades CG, Hussain MJ, McPhail MJW, Bernal W, Vergani D, Wendon JA. Admission levels and early changes in serum interleukin-10 are predictive of poor outcome in acute liver failure and decompensated cirrhosis. Liver Int 2010; 30:733-40. [PMID: 20456041 DOI: 10.1111/j.1478-3231.2010.02219.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIM Immunoparesis contributes to prognosis in acute liver failure (ALF) and decompensated cirrhosis, a phenomenon thought to be mediated by the anti-inflammatory cytokine interleukin (IL)-10. We investigated the prognostic value of admission IL-10 levels and their evolution during the early phase of treatment in intensive care, in comparison to the pro-inflammatory cytokines IL-6 and tumour necrosis factor (TNF)-alpha. METHODS We measured these cytokines within 48 h of admission in 51 ALF and 39 decompensated cirrhosis patients admitted to intensive care, and obtained follow-up measurement a median of 2 days later in 35 patients. RESULTS Levels of all cytokines were higher in those with a poor outcome. IL-10 performed as well as TNF-alpha and IL-6 in the whole cohort (area under receiver operator curve 0.73 vs 0.66 and 0.72). However IL-10 outperfomed pro-inflammatory cytokines in the subgroups with ALF (0.80 vs 0.63 and 0.70) and acetaminophen-induced ALF (0.92 vs 0.67 and 0.81). Levels of all cytokines rose significantly in non-surviving patients (n=15); IL-10 by a factor of 2, TNF-alpha by 2.6 and IL-6 by 1.13. No significant changes were seen in the surviving patients. In ALF, IL-10 was an independent predictor of outcome in multivariate analysis. CONCLUSION The magnitude of the compensatory anti-inflammatory response at admission, and its development during the early phase of treatment, predicts outcome as well as the pro-inflammatory response in acute hepatic syndromes and supports a vital role for this immunological phenomenon in the outcome of these patients.
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Affiliation(s)
- P A Berry
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, UK.
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17
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Abstract
Neutrophils are key effectors of the innate immune response. Reduction of neutrophil migration to infection sites is associated with a poor outcome in sepsis. We have demonstrated a failure of neutrophil migration in lethal sepsis. Together with this failure, we observed more bacteria in both peritoneal exudates and blood, followed by a reduction in survival rate. Furthermore, neutrophils obtained from severe septic patients displayed a marked reduction in chemotactic response compared with neutrophils from healthy subjects. The mechanisms of neutrophil migration failure are not completely understood. However, it is known that they involve systemic Toll-like receptor activation by bacteria and/or their products and result in excessive levels of circulating cytokines/chemokines. These mediators acting together with LPS stimulate expression of iNOS that produces high amounts of NO, which in turn mediates the failure of neutrophil migration. NO reduced expression of CXCR2 on neutrophils and the levels of adhesion molecules on both endothelial cells and neutrophils. These events culminate in decreased endothelium-leukocyte interactions, diminished neutrophil chemotactic response, and neutrophil migration failure. Additionally, the NO effect, at least in part, is mediated by peroxynitrite. In this review, we summarize what is known regarding the mechanisms of neutrophil migration impairment in severe sepsis.
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Antoniades CG, Berry PA, Wendon JA, Vergani D. The importance of immune dysfunction in determining outcome in acute liver failure. J Hepatol 2008; 49:845-61. [PMID: 18801592 DOI: 10.1016/j.jhep.2008.08.009] [Citation(s) in RCA: 253] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute liver failure (ALF) shares striking similarities with septic shock with regard to the features of systemic inflammation, progression to multiple organ dysfunction and functional immunoparesis. While the existence of opposing systemic pro- and anti-inflammatory profiles resulting in organ failure and immune dysfunction are well recognised in septic shock, characterization of these processes in ALF has only recently been described. This review explores the evolution of the systemic inflammation in acute liver failure, its relation to disease progression, exacerbation of liver injury and development of innate immune dysfunction and extra-hepatic organ failure as sequelae. Defects in innate immunity are described in hepatic and extra-hepatic compartments. Clinical studies measuring levels of pro- and anti-inflammatory cytokines and expression of the antigen presentation molecule HLA-DR on monocytes, in combination with ex-vivo experiments, demonstrate that the persistence of a compensatory anti-inflammatory response syndrome, leading to functional monocyte deactivation, is a central event in the evolution of systemic immune dysfunction. Accurate immune profiling in ALF may permit the development of immunomodulatory strategies in order to improve outcome in this condition.
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Sikora JP, Chlebna-Sokół D, Andrzejewska E, Chrul S, Polakowska E, Wysocka A, Sikora A. Clinical evaluation of proinflammatory cytokine inhibitors (sTNFR I, sTNFR II, IL-1 ra), anti-inflammatory cytokines (IL-10, IL-13) and activation of neutrophils after burn-induced inflammation. Scand J Immunol 2008; 68:145-52. [PMID: 18702744 DOI: 10.1111/j.1365-3083.2008.02126.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study was aimed at evaluating the involvement of sTNFR I, sTNFR II, IL-1 ra, IL-10, IL-13 and reactive oxygen species (ROS) in systemic inflammatory response syndrome (SIRS) development in severely burned children and at assessing the prognostic value of the immunological markers studied. The study comprised 37 patients (17 burned children and 20 controls). Serum levels of the markers determined by means of ELISA and respiratory burst of neutrophils as well as p55 and p75 tumour necrosis factor-alpha (TNF-alpha) receptor expression using flow cytometry were evaluated twice. The burned children presented significantly higher levels of IL-10 and cytokine inhibitors within the first 6-24 h after injury compared with controls (P < 0.05). The decreased oxygen metabolism of neutrophils and increased TNF-alpha receptor expression were found on admission. Moreover, a significant decrease in initially high sTNFR I, sTNFR II, IL-1 ra, IL-10, IL-13 concentrations (P < 0.05) and reduced expression of TNF-alpha receptors (P < 0.05) were observed after burn therapy, whereas ROS generation evidently augmented (P < 0.05). Four of our children who developed hypovolaemic shock revealed a significantly lower ROS generation and higher concentrations of soluble TNF-alpha receptors and IL-1 ra together with IL-10, IL-13 compared with children with good outcome (P < 0.05). Our results revealed the involvement of both ROS, soluble TNF-alpha receptors and IL-1 ra in the development of SIRS in burned children; their monitoring allows for an assessment of the systemic inflammatory reaction activity. The neutrophil BURSTTEST and IL-1 ra might have been clinically helpful markers of SIRS prognosis.
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Affiliation(s)
- J P Sikora
- Department of Paediatric Propaedeutics and Bone Metabolic Diseases, Medical University of Łódź, University Clinical Hospital No. 4, Łódź, Poland.
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20
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21
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Wong HR, Cvijanovich N, Wheeler DS, Bigham MT, Monaco M, Odoms K, Macias WL, Williams MD. Interleukin-8 as a stratification tool for interventional trials involving pediatric septic shock. Am J Respir Crit Care Med 2008; 178:276-82. [PMID: 18511707 DOI: 10.1164/rccm.200801-131oc] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RATIONALE Interventional clinical trials involving children with septic shock would benefit from an efficient preenrollment stratification strategy. OBJECTIVES To test the predictive value of interleukin (IL)-8 for 28-day mortality in pediatric septic shock. METHODS A training data set (n = 40) identified a serum IL-8 of greater than 220 pg/ml as having a 75% sensitivity and specificity for predicting 28-day mortality. This cutoff was then subjected to a series of validation steps. MEASUREMENTS AND MAIN RESULTS Subjects were drawn from two large, independent pediatric septic shock databases. Prospective application of the IL-8 cutoff to validation data set 1 (n = 139) demonstrated 78% sensitivity and 64% specificity for 28-day mortality. A serum IL-8 level of 220 pg/ml or less, however, had a negative predictive value for 28-day mortality of 95% in validation data set 1, which was subsequently applied to an independently generated data set of children with septic shock (validation set 2, n = 193). A serum IL-8 level of 220 pg/ml or less had a negative predictive value for 28-day mortality of 94% when applied to validation set 2. CONCLUSIONS A serum IL-8 level of 220 pg/ml or less, obtained within 24 hours of admission, predicts a high likelihood of survival in children with septic shock. We propose that IL-8 can be used to exclude such patients from interventional clinical trials and ultimately derive a study population with a more favorable risk to benefit ratio when subjected to a study agent.
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Affiliation(s)
- Hector R Wong
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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22
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Zhuang Y, Zhang YP, Ma SY. Protective effect of Fab' in immunoglobulin Y against lipopolysaccharide on intestinal mucosa during the early stage in severely burned gut-derived endotoxemia mice. Shijie Huaren Xiaohua Zazhi 2008; 16:1402-1406. [DOI: 10.11569/wcjd.v16.i13.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the protective effect of Fab' against endotoxin on intestinal mucosa during the early stage in severely burned gut-derived endotoxemia mice, and to explore a new method for preventing and curing burn sepsis.
METHODS: The severely burned gut-derived endotoxemia mice model was used, and the mice were divided into 3 groups: control group (group A), burn group (group B) and Fab' treatment group (group C). At the 6th, 12th, 24th and 48th h after burn injury, the levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-10 (IL-10) were determined by enzyme-linked immunosorbent assay. Intestinal tissues were collected for pathological examination.
RESULTS: In comparison with those in group A, the levels of serum TNF-α, IL-1β and IL-10 in group B increased significantly and reached the peak 24 h after burn injury (TNF-α: 242.06 ± 3.93 ng/L vs 14.98 ± 1.13 ng/L; IL-1β: 37.86 ± 5.88 ng/L vs 14.39 ± 2.43 ng/L; IL-10: 324.78 ± 65.82 ng/L vs 97.63 ± 20.48 ng/L; all P < 0.01). The levels of TNF-α, IL-1β and IL-10 at 6, 12, 24 and 48 h in group C (6 h: 99.69 ± 10.67, 19.19 ± 1.17, 160.44 ± 24.99 ng/L; 12 h: 172.07 ± 22.47, 22.29 ± 3.32, 185.44 ± 22.30 ng/L; 24 h: 125.98 ± 6.93, 28.39 ± 2.59, 237.11 ± 30.28 ng/L; 48 h: 107.88 ± 5.24, 26.23 ± 2.51, 207.86 ± 20.35 ng/L) were significantly different from those in group B (all P < 0.05). Pathological examination showed a lower degree of intestinal mucosal injury in group C than in compared with group B.
CONCLUSION: The Fab' against endotoxin can significantly decrease the level of serum TNF-α, IL-1β and IL-10 during the early stage in severely burned gut-derived endotoxemia mice, and consequently alleviate the endotoxin-induced injury.
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Abstract
Numerous studies have described that an initial injury alters immune function, disposing the injured subject to infectious complications. The mechanisms by which an initial injury primes the subject, exacerbating the responses to a second injury, remain unclear; however, inflammatory cytokines have been implicated. The development of "2-hit" models has allowed investigators to determine the role of inflammatory mediators in susceptibility to infection after injury. A high incidence rate of pneumonia after burn injury and a significant increase in postburn mortality led us to develop models of either Gram-positive (Streptococcus pneumoniae) or Gram-negative (Klebsiella pneumoniae) sepsis after burn injury on 40% of total body surface area in rodents. In this present model, we used adult Sprague-Dawley rats to evaluate cardiac function in vitro (using Langendorff method) and myocardial inflammation (myocyte secretion of cytokines measured using enzyme-linked immunosorbent assay) after burn complicated by sepsis. Either burn injury alone or sepsis alone produced myocardial inflammatory responses and contractile dysfunction. Either Gram-negative or Gram-positive infection exacerbated the myocardial inflammation (increased myocyte secretion of tumor necrosis factor alpha, interleukin 1beta, and interleukin 6) above that which occurred with burn alone or with infection alone. Burn complicated by sepsis exacerbated the myocardial contraction and relaxation defects observed with either sepsis alone or burn alone. Inasmuch as sepsis, which occurs after a previous injury, increases myocardial inflammation/dysfunction and mortality, the development of therapeutic strategies that either decrease inflammatory response to the initial injury or provide cardiac support during the postinjury period may improve the outcome in injured patients who are at risk for developing sepsis.
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Affiliation(s)
- Jureta W Horton
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75235-9136, USA.
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Horton J, Maass D, White J, Sanders B. Effect of Aspiration Pneumonia-Induced Sepsis on Post-Burn Cardiac Inflammation and Function in Mice. Surg Infect (Larchmt) 2006; 7:123-35. [PMID: 16629602 DOI: 10.1089/sur.2006.7.123] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Numerous studies have found that burn injury alters immune function, predisposing the subject to infectious complications. We developed a mouse model of burn injury complicated by either gram-positive or gram-negative infection and hypothesized that post-burn infection would exacerbate the myocardial cytokine responses and contractile dysfunction characteristic of either sepsis alone or burn alone. METHODS Adult C57 BL6 mice were given burn injury over 40% of the total body surface area and conventional fluid resuscitation (lactated Ringer's solution, 4 mL/kg/% burn) followed on day 7 by intratracheal administration of 1 x 10(5) cfu of either Streptococcus pneumoniae or Klebsiella pneumoniae or saline. Mice received fluid resuscitation (2 mL of lactated Ringer's intraperitoneally) again after bacterial challenge. Cardiomyocyte cytokine secretion and the contractile function of isolated hearts (Langendorff perfusion) were examined in vitro 24 h after bacterial challenge. RESULTS Infectious challenge seven days after burn injury exaggerated the inflammatory cytokine responses over those observed with either burn alone or gram-positive or gram-negative infection alone (tumor necrosis factor-alpha: sham, 72 +/- 9 pg/mL; burn alone, 176 +/- 6 pg/mL, Klebsiella pneumoniae alone, 337 +/- 8 pg/mL; Streptococcus pneumoniae alone, 184 +/- 2 pg/mL; burn + Klebsiella, 476 +/- 14 pg/mL; burn + Streptococcus, 351 +/- 6 pg/mL). Myocardial contractile depression was evident in the burn alone, infection alone, and burn plus infection groups, regardless of the organism selected to produce pneumonia-related sepsis. CONCLUSIONS Gram-negative or gram-positive infection exacerbated the myocardial inflammation seen with burn alone or infection alone. The availability of a mouse model of burn injury complicated by pneumonia-related sepsis will allow use of genetically engineered mice to examine further the mechanisms by which burn injury increases susceptibility to infection.
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MESH Headings
- Animals
- Burns/complications
- Burns/physiopathology
- Cytokines/biosynthesis
- Disease Models, Animal
- Female
- Heart/physiopathology
- Klebsiella Infections/complications
- Klebsiella Infections/microbiology
- Klebsiella pneumoniae
- Male
- Mice
- Mice, Inbred C57BL
- Myocardial Contraction
- Myocarditis/complications
- Myocarditis/physiopathology
- Myocytes, Cardiac/immunology
- Myocytes, Cardiac/metabolism
- Pneumonia, Aspiration/complications
- Pneumonia, Aspiration/microbiology
- Pneumonia, Aspiration/physiopathology
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/microbiology
- Sepsis/complications
- Sepsis/microbiology
- Ventricular Function, Left
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Affiliation(s)
- Jureta Horton
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Zhang P, Quinton LJ, Gamble L, Bagby GJ, Summer WR, Nelson S. The granulopoietic cytokine response and enhancement of granulopoiesis in mice during endotoxemia. Shock 2005; 23:344-52. [PMID: 15803058 DOI: 10.1097/01.shk.0000158960.93832.de] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In response to bacterial infection, the production of neutrophils by the bone marrow is accelerated. This study investigated the granulopoietic cytokine response and granulopoiesis during endotoxemia. Male Balb/c mice were intravenously challenged with lipopolysaccharide (LPS, 20 microg in 100 microL of saline per mouse). Control animals received saline alone. In a separate set of experiments, i.v. murine granulocyte colony-stimulating factor (G-CSF; 20 microg/kg) or vehicle (5% dextrose) was administered to mice. Endotoxemia caused a marked increase in G-CSF, keratinocyte-derived chemokine (KC), and macrophage inflammatory protein-2 (MIP-2) in the plasma and bone marrow between 1 and 4 h after the challenge. G-CSF, KC, and MIP-2 mRNA expression was also upregulated in the lung, liver, spleen, and bone marrow between 1 and 4 h after i.v. LPS. Intravenous administration of G-CSF caused a significant increase in G-CSF concentration in the plasma and bone marrow without upregulating G-CSF mRNA expression in the bone marrow. The levels of phospho-signal transducers and activators of transcription 3 and phospho-p44/42 mitogen-activated protein kinase were elevated in bone marrow cells at 30 min and 4 h after i.v. G-CSF and LPS, respectively. Granulocyte-macrophage colony-forming unit counts were significantly increased in the bone marrow, spleen, and blood at 48 h post-i.v. LPS or G-CSF. These data show that extramedullary organs produce granulopoietic cytokines in response to LPS. Because the tissue mass in extramedullary organs far exceeds that in the bone marrow, extramedullary production of these cytokines likely play a critical role in the regulation of the host's granulopoietic response to endotoxemia.
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Affiliation(s)
- Ping Zhang
- Department of Medicine, Section of Pulmonary/Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112-1393, USA
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