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Xuan C, Cui H, Jin Z, Yue Y, Cao S, Cui S, Xu D. Glutamine ameliorates hyperoxia-induced hippocampal damage by attenuating inflammation and apoptosis via the MKP-1/MAPK signaling pathway in neonatal rats. Front Pharmacol 2023; 14:1096309. [PMID: 36817145 PMCID: PMC9932780 DOI: 10.3389/fphar.2023.1096309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Glutamine (Gln) is an immunomodulatory protein that mediates oxidative stress, inflammation, and apoptosis, but has not been reported in the treatment of hyperoxia (Hyp)-induced brain injury. The aim of this study was to determine whether Gln could improve hyp-induced brain injury in neonatal rats to and later learning and memory dysfunction, and to explore its possible mechanisms. We prepared a model of neonatal rat brain injury caused by normobaric hyperoxia while administered with Gln for 7 days for evaluation. Learning memory function was assessed with the Morris water maze test. Histological analysis, protein expression analysis, oxidative stress and inflammation level analysis were performed using hippocampal tissue. Gln treatment significantly reduced brain tissue water content, oxidative stress levels, microglia activation and inflammatory factor expression, and attenuated tissue damage and apoptosis in the hippocampal region. Gln ameliorates hyp-induced learning, memory impairment in neonatal rats in water maze test. It also increased MKP-1 protein expression and decreased p-p38, p-ERK and p-JNK. Therefore, it is hypothesized that Gln may exert neuroprotective effects by increasing MKP-1 expression to negatively regulate MAPK signaling, with potential cognitive improvement in hyp-induced brain injury.
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Affiliation(s)
- Chouhui Xuan
- Department of Pediatrics, Yanbian University Hospital, Yanji, Jilin, China
| | - Haixia Cui
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, Jilin, China
| | - Zhengyong Jin
- Department of Pediatrics, Yanbian University Hospital, Yanji, Jilin, China
| | - Yuyang Yue
- Department of Dermatology, Yanbian University Hospital, Yanji, Jilin, China
| | - Shuxia Cao
- Department of Center of Morphological Experiment, Yanbian University, Yanji, Jilin, China
| | - Songbiao Cui
- Department of Neurology, Yanbian University Hospital, Yanji, Jilin, China,*Correspondence: Songbiao Cui, ; Dongyuan Xu,
| | - Dongyuan Xu
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China,*Correspondence: Songbiao Cui, ; Dongyuan Xu,
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A High-Fiber Diet or Dietary Supplementation of Acetate Attenuate Hyperoxia-Induced Acute Lung Injury. Nutrients 2022; 14:nu14245231. [PMID: 36558387 PMCID: PMC9783054 DOI: 10.3390/nu14245231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
A high fiber diet (HFD) and dietary supplementation with acetate have been reported to have beneficial effects in a variety of diseases. We investigated the effects of a HFD and acetate supplementation on the gut microbiota and hyperoxia-induced acute lung injury (HALI) in mice. Mice were fed a control diet, HFD, or acetate supplementation for three weeks, and their gut microbiome composition, lung tissues, and bronchoalveolar lavage fluid (BALF) were examined after exposure to ambient air or hyperoxia. Both the HFD and acetate supplementation modified the gut microbiota community and increased the proportion of acetate-producing bacteria in mice exposed to hyperoxia. The HFD and acetate supplementation also increased the abundance of Bacteroides acidifaciens and reduced gut dysbiosis according to the ratio of Firmicutes to Bacteroidetes. Compared with hyperoxia-exposed mice fed a control diet, both the HFD and acetate supplementation significantly increased the survival time while reducing the severity of pulmonary edema and the concentrations of protein and inflammatory mediators in BALF. Moreover, the HFD and acetate supplementation reduced the production of free radicals, attenuated NF-κB signaling activation, and decreased apoptosis in the lung tissues. Overall, this study indicates that a HFD or acetate supplementation reduces the severity of HALI through alterations in the gut microbiota to exert anti-inflammatory effects.
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Wang L, Zhong WH, Liu DY, Shen HQ, He ZJ. Metabolic analysis of infants with bronchopulmonary dysplasia under early nutrition therapy: An observational cohort study. Exp Biol Med (Maywood) 2021; 247:470-479. [PMID: 34894806 DOI: 10.1177/15353702211060513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To assess the amino acid and fatty acid metabolite patterns between infants with and without bronchopulmonary dysplasia in different nutritional stages after birth and identify metabolic indicators of bronchopulmonary dysplasia. This was an observational cohort of preterm infants born at a gestational age ≤32 + 6 weeks and with a body weight ≤2000 g. Amino acid and carnitine profiles were measured in dried blood spots (DBSs) during the early nutrition transitional phase using tandem mass spectrometry. Bronchopulmonary dysplasia was defined as oxygen dependence at 36 weeks of postmenstrual age or 28 days after birth. Metabolomic analysis was employed to define metabolites with significant differences, map significant metabolites into pathways, and identify metabolic indicators of bronchopulmonary dysplasia. We evaluated 45 neonates with and 40 without bronchopulmonary dysplasia. Four amino acids and three carnitines showed differences between the groups. Three carnitines (C0, C2, and C6:1) were high in the bronchopulmonary dysplasia group mostly; conversely, all four amino acids (threonine, arginine, methionine, and glutamine (Gln)) were low in the bronchopulmonary dysplasia group. Pathway analysis of these metabolites revealed two pathways with significant changes (p < 0.05). ROC analysis showed Gln/C6:1 at total parenteral nutrition phase had both 80% sensitivity and specificity for predicting the development of bronchopulmonary dysplasia, with an area under the curve of 0.81 (95% confidence interval 0.71-0.89). Amino acid and fatty acid metabolite profiles changed in infants with bronchopulmonary dysplasia after birth during the nutrition transitional period, suggesting that metabolic dysregulation may participate in the development of bronchopulmonary dysplasia. Our findings demonstrate that metabolic indicators are promising for forecasting the occurrence of bronchopulmonary dysplasia among preterm neonates.
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Affiliation(s)
- Li Wang
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China
| | - Wen Hua Zhong
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China.,Department of Neonatology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314001, China
| | - Dan Yang Liu
- Department of Neonatology, Jingan District Zhabei Central Hospital, Shanghai 200070, China
| | - Hai Qing Shen
- Department of Neonatology, International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai 200030, China *These authors have contributed equally to this work
| | - Zhen Juan He
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China
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Pao HP, Liao WI, Tang SE, Wu SY, Huang KL, Chu SJ. Suppression of Endoplasmic Reticulum Stress by 4-PBA Protects Against Hyperoxia-Induced Acute Lung Injury via Up-Regulating Claudin-4 Expression. Front Immunol 2021; 12:674316. [PMID: 34122432 PMCID: PMC8194262 DOI: 10.3389/fimmu.2021.674316] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 12/20/2022] Open
Abstract
Endoplasmic reticulum (ER) stress that disrupts ER function can occur in response to a wide variety of cellular stress factors leads to the accumulation of unfolded and misfolded proteins in the ER. Many studies have shown that ER stress amplified inflammatory reactions and was involved in various inflammatory diseases. However, little is known regarding the role of ER stress in hyperoxia-induced acute lung injury (HALI). This study investigated the influence of ER stress inhibitor, 4-phenyl butyric acid (4-PBA), in mice with HALI. Treatment with 4-PBA in the hyperoxia groups significantly prolonged the survival, decreased lung edema, and reduced the levels of inflammatory mediators, lactate dehydrogenase, and protein in bronchoalveolar lavage fluid, and increased claudin-4 protein expression in lung tissue. Moreover, 4-PBA reduced the ER stress-related protein expression, NF-κB activation, and apoptosis in the lung tissue. In in vitro study, 4-PBA also exerted a similar effect in hyperoxia-exposed mouse lung epithelial cells (MLE-12). However, when claudin-4 siRNA was administrated in mice and MLE-12 cells, the protective effect of 4-PBA was abrogated. These results suggested that 4-PBA protected against hyperoxia-induced ALI via enhancing claudin-4 expression.
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Affiliation(s)
- Hsin-Ping Pao
- The Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Yu Wu
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- The Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Host cell glutamine metabolism as a potential antiviral target. Clin Sci (Lond) 2021; 135:305-325. [PMID: 33480424 DOI: 10.1042/cs20201042] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022]
Abstract
A virus minimally contains a nucleic acid genome packaged by a protein coat. The genome and capsid together are known as the nucleocapsid, which has an envelope containing a lipid bilayer (mainly phospholipids) originating from host cell membranes. The viral envelope has transmembrane proteins that are usually glycoproteins. The proteins in the envelope bind to host cell receptors, promoting membrane fusion and viral entry into the cell. Virus-infected host cells exhibit marked increases in glutamine utilization and metabolism. Glutamine metabolism generates ATP and precursors for the synthesis of macromolecules to assemble progeny viruses. Some compounds derived from glutamine are used in the synthesis of purines and pyrimidines. These latter compounds are precursors for the synthesis of nucleotides. Inhibitors of glutamine transport and metabolism are potential candidate antiviral drugs. Glutamine is also an essential nutrient for the functions of leukocytes (lymphocyte, macrophage, and neutrophil), including those in virus-infected patients. The increased glutamine requirement for immune cell functions occurs concomitantly with the high glutamine utilization by host cells in virus-infected patients. The development of antiviral drugs that target glutamine metabolism must then be specifically directed at virus-infected host cells to avoid negative effects on immune functions. Therefore, the aim of this review was to describe the landscape of cellular glutamine metabolism to search for potential candidates to inhibit glutamine transport or glutamine metabolism.
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Zheng W, Liu B, Hu W, Cui Y. Effects of transport stress on pathological injury and main heat shock protein expression in the respiratory system of goats. J Anim Physiol Anim Nutr (Berl) 2020; 105:1-13. [PMID: 32744367 DOI: 10.1111/jpn.13430] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/01/2020] [Accepted: 06/18/2020] [Indexed: 12/29/2022]
Abstract
The aim of the present study was to investigate the pathological injury and the expression of heat shock proteins in the caprine lung, trachea and bronchus under transport stress. 12 healthy male goats were selected and randomly divided into three groups. The control group (non-transported group), 2 hr transport-treated group and 6 hr transport-treated group. Morphological changes as well as the expression of heat shock proteins (HSPs, mainly HSP27, HSP70 and HSP90) in three parts of the respiratory tract were examined. Our results showed swollen mucosa and congestive blood vessels in mucous layer and submucosa, inflammatory cell infiltration as well as degeneration and necrosis of mucosal epithelial cells in trachea and bronchus of the transport-treated groups. The epithelial cells were degenerated, and the exfoliated cells and debris could be seen in the alveolar cavity. The results of immunohistochemistry showed that HSP27 and HSP70 were strongly expressed in tracheal and bronchial epithelium, glandular epithelium, vascular endothelium and bronchiole epithelium. And the amount of positive inflammatory cells was increased in transport-treated groups. Western blot results indicated that the expression of all three proteins had no obvious difference among the three groups in bronchi (p > .05). In trachea, there was no significant difference in the expression of heat shock proteins among the three groups except that the expression of HSP70 which was obviously higher in the two transported groups than the control group (p < .05). The expression level of HSP70 in the 2 hr transport-treated group was significantly higher than the 6 hr group (p < .05) and control groups (p < .05). However, there was no significant difference in the expression level of HSP27 and HSP90 in three groups (p > .05). In conclusion, our data showed that transport stress could damage the caprine respiratory system.
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Affiliation(s)
- Wenya Zheng
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China.,College of Life Science and Resources and Environment, Yichun University, Yichun, China
| | - Ben Liu
- College of Life Science and Resources and Environment, Yichun University, Yichun, China.,Jiangxi Lvke Agriculture and Animal Husbandry Technology Co. Ltd, Yichun, China
| | - Wei Hu
- College of Life Science and Resources and Environment, Yichun University, Yichun, China
| | - Yan Cui
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
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Mercel A, Tsihlis ND, Maile R, Kibbe MR. Emerging therapies for smoke inhalation injury: a review. J Transl Med 2020; 18:141. [PMID: 32228626 PMCID: PMC7104527 DOI: 10.1186/s12967-020-02300-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background Smoke inhalation injury increases overall burn mortality by up to 20 times. Current therapy remains supportive with a failure to identify an optimal or targeted treatment protocol for smoke inhalation injury. The goal of this review is to describe emerging therapies that are being developed to treat the pulmonary pathology induced by smoke inhalation injury with or without concurrent burn injury. Main body A comprehensive literature search was performed using PubMed (1995–present) for therapies not approved by the U.S. Food and Drug Administration (FDA) for smoke inhalation injury with or without concurrent burn injury. Therapies were divided based on therapeutic strategy. Models included inhalation alone with or without concurrent burn injury. Specific animal model, mechanism of action of medication, route of administration, therapeutic benefit, safety, mortality benefit, and efficacy were reviewed. Multiple potential therapies for smoke inhalation injury with or without burn injury are currently under investigation. These include stem cell therapy, anticoagulation therapy, selectin inhibition, inflammatory pathway modulation, superoxide and peroxynitrite decomposition, selective nitric oxide synthase inhibition, hydrogen sulfide, HMG-CoA reductase inhibition, proton pump inhibition, and targeted nanotherapies. While each of these approaches shows a potential therapeutic benefit to treating inhalation injury in animal models, further research including mortality benefit is needed to ensure safety and efficacy in humans. Conclusions Multiple novel therapies currently under active investigation to treat smoke inhalation injury show promising results. Much research remains to be conducted before these emerging therapies can be translated to the clinical arena.
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Affiliation(s)
- Alexandra Mercel
- Department of Surgery, University of North Carolina at Chapel Hill, 4041 Burnett Womack, 101 Manning Drive, CB# 7050, Chapel Hill, NC, 27599-7050, USA
| | - Nick D Tsihlis
- Department of Surgery, University of North Carolina at Chapel Hill, 4041 Burnett Womack, 101 Manning Drive, CB# 7050, Chapel Hill, NC, 27599-7050, USA
| | - Rob Maile
- Department of Surgery, University of North Carolina at Chapel Hill, 4041 Burnett Womack, 101 Manning Drive, CB# 7050, Chapel Hill, NC, 27599-7050, USA.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Melina R Kibbe
- Department of Surgery, University of North Carolina at Chapel Hill, 4041 Burnett Womack, 101 Manning Drive, CB# 7050, Chapel Hill, NC, 27599-7050, USA. .,Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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8
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Huang Z, Liu H, Zhang X, Wen G, Zhu C, Zhao Y, Niu W, Qin Y, Chen H, Bai C, Liu G. Transcriptomic analysis of lung tissues after hUC-MSCs and FTY720 treatment of lipopolysaccharide-induced acute lung injury in mouse models. Int Immunopharmacol 2018; 63:26-34. [PMID: 30064040 DOI: 10.1016/j.intimp.2018.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 01/05/2023]
Abstract
Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) refer to acute and progressive hypoxic respiratory failure caused by non-cardiogenic factors, which is a common condition occurring in critically ill patients with widespread pulmonary inflammation. Use of a single medication or target cannot treat ALI/ARDS. Mesenchymal stem cells (MSCs) and FTY720, as an analogue of sphingosine-1-phosphate (S1P), can mitigate lipopolysaccharide (LPS)-induced inflammatory lung injury. In this investigation, the clinical efficacy of MSCs alone, FTY720 alone, and a MSC and FTY720 combination in the treatment of LPS-induced lung injury was evaluated in mouse models. The experimental results demonstrated that both MSCs and FTY720 alleviate lung injuries in mice. The combined application of MSCs and FTY720 yielded higher clinical efficacy in mitigating lung injuries compared with use of MSCs or FTY720 alone. Transcriptomic analysis was performed using an Agilent gene expression chip. By analyzing the differences in gene expression of lung tissues between treated and non-treated ALI/ARDS mice, Gene Ontology and Pathway terms related to ALI/ARDS treatment were identified. Moreover, the target genes which might play a pivotal role in the treatment of ALI/ARDS were also detected, thus providing a theoretical basis for multi-target or multi-drug combined treatment of ALI/ARDS and lay a solid foundation for clinical treatment of ALI/ARDS.
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Affiliation(s)
- Zihao Huang
- Institute of Physical Science and Information Technology, Anhui University, Hefei, 230601, People's Republic of China; Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Huiying Liu
- Department of Respiratory and Critical Care Diseases, 307 Hospital of PLA, Beijing, 100071, People's Republic of China
| | - Xia Zhang
- Institute of Physical Science and Information Technology, Anhui University, Hefei, 230601, People's Republic of China; Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Guoxia Wen
- Institute of Physical Science and Information Technology, Anhui University, Hefei, 230601, People's Republic of China; Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Chen Zhu
- Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Yanbin Zhao
- Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Wenkai Niu
- Department of Respiratory and Critical Care Diseases, 307 Hospital of PLA, Beijing, 100071, People's Republic of China
| | - Yanhong Qin
- Department of Respiratory and Critical Care Diseases, 307 Hospital of PLA, Beijing, 100071, People's Republic of China
| | - Huipeng Chen
- Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Changqing Bai
- Department of Respiratory and Critical Care Diseases, 307 Hospital of PLA, Beijing, 100071, People's Republic of China.
| | - Gang Liu
- Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China.
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9
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Ma L, Zhou P, Neu J, Lin HC. Potential Nutrients for Preventing or Treating Bronchopulmonary Dysplasia. Paediatr Respir Rev 2017; 22:83-88. [PMID: 27843119 DOI: 10.1016/j.prrv.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/01/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a frequent complication occurring in extremely preterm infants. Despite recent advances in newborn medicine, the incidence of BPD does not appear to have changed markedly, and specific treatments and prevention strategies are still lacking. Nutrition plays an important role in normal lung development and maturation. Malnutrition may delay somatic growth and new alveoli development, thus aggravating pulmonary injury involved in the pathogenesis of BPD. However, few nutrients have been investigated for their potential to mitigate the pathogenesis of BPD. In this article, we reviewed the recent progress in research on potential nutrients useful for the prevention or treatment of BPD, including glutamine, cysteine and N-acetylcysteine, L-arginine and L-citrulline, long chain polyunsaturated fatty acids (LCPUFAs), inositol, selenium, and some antioxidant vitamins including vitamin A. Current evidence shows that vitamin A and LCPUFA can prevent BPD, and that L-citrulline might provide a new method to treat chronic pulmonary hypertension associated with BPD in premature infants. The effects of other nutrients on BPD prevention need to be further studied.
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Affiliation(s)
- Liya Ma
- Department of Neonatology, Shenzhen Baoan Maternal and Child Health Hospital, China.
| | - Ping Zhou
- Department of Neonatology, Shenzhen Baoan Maternal and Child Health Hospital, China.
| | - Josef Neu
- Department of Pediatrics, University of Florida, U.S.A..
| | - Hung-Chih Lin
- Department of Pediatrics, Children's Hospital and School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Chen Y, Li Q, Liu Y, Shu L, Wang N, Wu Y, Sun X, Wang L. Attenuation of hyperoxia-induced lung injury in neonatal rats by 1α,25-Dihydroxyvitamin D3. Exp Lung Res 2015; 41:344-52. [PMID: 26151083 DOI: 10.3109/01902148.2015.1039668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mounting evidence suggests that Toll-like receptor (TLRs) plays an important role in oxidative stress and is implicated in the pathogenesis of hyperoxic lung injury. 1α,25-Dihydroxyvitamin D3 (1,25(OH)2D3), the hormonally active form of vitamin D, not only plays an essential role in mineral balance, but also possesses immunomodulatory and antioxidant properties. Besides, Vitamin D3 is involved in the regulation of TLRs signaling. The present study was designed to investigate whether 1,25(OH)2D3 attenuates hyperoxia-induced lung injury by regulating TLRs signaling in neonatal rats. METHODS Pups were divided into four groups: normoxia control group (NC), normoxia plus 1,25(OH)2D3 treatment group (ND), hyperoxia control group (HC), and hyperoxia plus 1,25(OH)2D3 treatment group (HD). Lung tissues were collected for histological examination and detection of mRNA and protein expressions. RESULTS Treatment of hyperoxia-exposed animals with 1,25(OH)2D3 resulted in significantly increased body weight and reduced hyperoxia-induced lung injury. Moreover, 1,25(OH)2D3 significantly downregulated the expression of TLR4, NF-κB, and the inflammatory cytokines TNF-α, IL-1β, and IL-6. CONCLUSIONS 1,25(OH)2D3 could attenuate hyperoxia-induced lung injury in neonatal rats, possibly by regulating TLR4/NF-κB signaling.
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Affiliation(s)
- Yan Chen
- 1Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
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Fernandez-Bustamante A, Agazio A, Wilson P, Elkins N, Domaleski L, He Q, Baer KA, Moss AFD, Wischmeyer PE, Repine JE. Brief Glutamine Pretreatment Increases Alveolar Macrophage CD163/Heme Oxygenase-1/p38-MAPK Dephosphorylation Pathway and Decreases Capillary Damage but Not Neutrophil Recruitment in IL-1/LPS-Insufflated Rats. PLoS One 2015; 10:e0130764. [PMID: 26147379 PMCID: PMC4493112 DOI: 10.1371/journal.pone.0130764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/23/2015] [Indexed: 02/06/2023] Open
Abstract
Background Glutamine (GLN) attenuates acute lung injury (ALI) but its effect on alveolar macrophages is unknown. We hypothesized that GLN pretreatment would induce the anti-inflammatory CD163/heme oxygenase (HO)-1/p38-MAPK dephosphorylation pathway in alveolar macrophages and reduce ALI in rats insufflated with interleukin-1 (IL-1) and lipopolysaccharide (LPS). Methods Male Sprague-Dawley rats were randomized to the following groups: GLN-IL-1/LPS-, GLN+IL-1/LPS-, GLN-IL-1/LPS+, and GLN+IL-1/LPS+. GLN pretreatment was given via gavage (1g/kg L-alanyl-L-glutamine) daily for 2 days. ALI was subsequently induced by insufflating 50ng IL-1 followed by 5mg/kg E.coli LPS. After 24h, bronchoalveolar lavage (BAL) protein, lactate dehydrogenase (LDH) and neutrophil concentrations were analyzed. BAL alveolar macrophage CD163+ expression, HO-1 and p38-MAPK concentrations were measured, as well as alveolar macrophage tumor necrosis factor (TNF)-α and interleukin (IL)-10 concentrations. Histology and immunofluorescence studies were also performed. Results Following IL-1/LPS insufflation, GLN pretreated rats had significantly decreased BAL protein and LDH concentrations, but not BAL neutrophil counts, compared to non-GLN pretreated rats. The number of alveolar macrophages and the number of CD163+ macrophages were significantly increased in GLN pretreated IL-1/LPS-insufflated rats compared to non-GLN pretreated, IL-1/LPS-insufflated rats. GLN pretreatment before IL-1/LPS also significantly increased HO-1 concentrations and dephosphorylated p38-MAPK levels but not cytokine levels in alveolar macrophages. Immunofluorescence localized CD163 and HO-1 in alveolar macrophages. Conclusion Short-term GLN pretreatment activates the anti-inflammatory CD163/HO-1/p38-MAPK dephosphorylation pathway of alveolar macrophages and decreases capillary damage but not neutrophil recruitment in IL-1/LPS-insufflated rats.
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Affiliation(s)
- Ana Fernandez-Bustamante
- Department of Anesthesiology, University of Colorado SOM, Aurora, Colorado, United States of America; Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Amanda Agazio
- Department of Anesthesiology, University of Colorado SOM, Aurora, Colorado, United States of America; Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Paul Wilson
- Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Nancy Elkins
- Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Luke Domaleski
- Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Qianbin He
- Department of Anesthesiology, University of Colorado SOM, Aurora, Colorado, United States of America; Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Kaily A Baer
- Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
| | - Angela F D Moss
- Adult and Child Center for Health Outcomes and Delivery Science (ACCORDS), University of Colorado SOM, Aurora, Colorado, United States of America
| | - Paul E Wischmeyer
- Department of Anesthesiology, University of Colorado SOM, Aurora, Colorado, United States of America
| | - John E Repine
- Department of Medicine, University of Colorado SOM, Aurora, Colorado, United States of America; Webb-Waring Center, University of Colorado SOM, Aurora, Colorado, United States of America
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12
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Chen CM, Cheng KC, Li CF, Zhang H. The protective effects of glutamine in a rat model of ventilator-induced lung injury. J Thorac Dis 2015; 6:1704-13. [PMID: 25589963 DOI: 10.3978/j.issn.2072-1439.2014.11.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/24/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The mortality rate of patients with acute respiratory distress syndrome (ARDS) is still high despite the use of protective ventilatory strategies. We sought to examine the pharmacological effects of glutamine (GLN) in a two-hit model of endotoxin-induced inflammation followed by ventilator-induced lung injury (VILI). We hypothesized that the administration of GLN ameliorates the VILI. METHODS Sprague-Dawley rats were anesthetized and given lipopolysaccharide (LPS) intratracheally as a first hit to induce lung inflammation, followed 24 h later by a second hit of mechanical ventilation (MV) with either low tidal volume (6 mL/kg) with 5 cmH2O of positive end-expiratory pressure (PEEP) or high tidal volume (22 mL/kg) with zero PEEP for 4 h. GLN or lactated Ringer's solution as the placebo was administered intravenously 15 min prior to MV. RESULTS In the LPS-challenged rats ventilated with high tidal volume, the treatment with GLN improved lung injury indices, lung mechanics and cytokine responses compared with the placebo group. CONCLUSIONS The administration of GLN given immediately prior to MV may be beneficial in the context of reducing VILI.
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Affiliation(s)
- Chin-Ming Chen
- 1 Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan ; 2 Department of Critical Care Medicine, Chi-Mei Medical Center and Chang Jung Christian University, Tainan, Taiwan ; 3 Section of Respiratory Care, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan ; 4 Department of Safety Health and Environment Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan ; 5 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan ; 6 Keenan Research Center for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kuo-Chen Cheng
- 1 Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan ; 2 Department of Critical Care Medicine, Chi-Mei Medical Center and Chang Jung Christian University, Tainan, Taiwan ; 3 Section of Respiratory Care, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan ; 4 Department of Safety Health and Environment Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan ; 5 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan ; 6 Keenan Research Center for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Chien-Feng Li
- 1 Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan ; 2 Department of Critical Care Medicine, Chi-Mei Medical Center and Chang Jung Christian University, Tainan, Taiwan ; 3 Section of Respiratory Care, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan ; 4 Department of Safety Health and Environment Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan ; 5 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan ; 6 Keenan Research Center for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Haibo Zhang
- 1 Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy & Science, Tainan, Taiwan ; 2 Department of Critical Care Medicine, Chi-Mei Medical Center and Chang Jung Christian University, Tainan, Taiwan ; 3 Section of Respiratory Care, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan ; 4 Department of Safety Health and Environment Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan ; 5 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan ; 6 Keenan Research Center for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Lai CC, Liu WL, Chen CM. Glutamine attenuates acute lung injury caused by acid aspiration. Nutrients 2014; 6:3101-16. [PMID: 25100435 PMCID: PMC4145297 DOI: 10.3390/nu6083101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/14/2014] [Accepted: 07/24/2014] [Indexed: 01/11/2023] Open
Abstract
Inadequate ventilator settings may cause overwhelming inflammatory responses associated with ventilator-induced lung injury (VILI) in patients with acute respiratory distress syndrome (ARDS). Here, we examined potential benefits of glutamine (GLN) on a two-hit model for VILI after acid aspiration-induced lung injury in rats. Rats were intratracheally challenged with hydrochloric acid as a first hit to induce lung inflammation, then randomly received intravenous GLN or lactated Ringer's solution (vehicle control) thirty min before different ventilator strategies. Rats were then randomized to receive mechanical ventilation as a second hit with a high tidal volume (TV) of 15 mL/kg and zero positive end-expiratory pressure (PEEP) or a low TV of 6 mL/kg with PEEP of 5 cm H2O. We evaluated lung oxygenation, inflammation, mechanics, and histology. After ventilator use for 4 h, high TV resulted in greater lung injury physiologic and biologic indices. Compared with vehicle treated rats, GLN administration attenuated lung injury, with improved oxygenation and static compliance, and decreased respiratory elastance, lung edema, extended lung destruction (lung injury scores and lung histology), neutrophil recruitment in the lung, and cytokine production. Thus, GLN administration improved the physiologic and biologic profiles of this experimental model of VILI based on the two-hit theory.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying Dist., Tainan 73657 Taiwan.
| | - Wei-Lun Liu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying Dist., Tainan 73657 Taiwan.
| | - Chin-Ming Chen
- Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan.
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Bao XC, Fang YQ, You P, Zhang S, Ma J. Protective role of peroxisome proliferator-activated receptor β/δ in acute lung injury induced by prolonged hyperbaric hyperoxia in rats. Respir Physiol Neurobiol 2014; 199:9-18. [PMID: 24780550 DOI: 10.1016/j.resp.2014.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
Abstract
Peroxisome proliferator-activated receptor (PPAR)-β/δ is a transcription factor that belongs to the PPAR family, but the role of PPAR-β/δ in acute lung injury (ALI) induced by hyperbaric oxygen is unknown. In this study we investigated if PPAR-β/δ activation protects from hyperoxia-induced ALI in a rat model. ALI was induced by prolonged hyperbaric oxygen (HBO2) (2.3ATA, 100% O2) for 8h. Administration of PPAR-β/δ agonist GW0742 (0.3mg/kg, i.p.) at 1 and 6h prior to HBO2 exposure significantly reduced the (1) lung injury, (2) proinflammatory cytokines (TNF-α, IL-1β, IL-6), (3) apoptosis (Bax/Bcl-2, cleaved-caspase-3 and TUNEL), (4) nuclear factor (NF)-κB expression level and DNA binding activity in the nucleus, and (5) extracellular signal-regulated kinase (ERK)1/2 phosphorylation and markedly elevated (6) superoxide dismutase and glutathione peroxidase activities as well as (7) IκB expression. However, administration of the PPAR-β/δ antagonist GSK0660 abolished these protective effects. These findings indicate that activation of PPAR-β/δ ameliorates hyperoxia-induced ALI in rats by up-regulating antioxidant enzyme activity as well as suppressing inflammation and apoptosis.
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Affiliation(s)
- Xiao-Chen Bao
- Department of Diving Medicine, Institute of Naval Medical Research, Shanghai 200433, China
| | - Yi-Qun Fang
- Department of Diving Medicine, Institute of Naval Medical Research, Shanghai 200433, China.
| | - Pu You
- Department of Diving Medicine, Institute of Naval Medical Research, Shanghai 200433, China
| | - Shi Zhang
- Department of Diving Medicine, Institute of Naval Medical Research, Shanghai 200433, China
| | - Jun Ma
- Department of Diving Medicine, Institute of Naval Medical Research, Shanghai 200433, China
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15
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Li W, Qiu X, Wang J, Li H, Sun Y, Zhang F, Jin H, Fu J, Xia Z. The therapeutic efficacy of glutamine for rats with smoking inhalation injury. Int Immunopharmacol 2013; 16:248-53. [PMID: 23499678 DOI: 10.1016/j.intimp.2013.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 02/27/2013] [Accepted: 02/27/2013] [Indexed: 11/26/2022]
Abstract
Smoke inhalation injury represents a major cause of mortality in burn patients and is associated with a high incidence of pulmonary complications. Glutamine (GLN) is considered a conditionally essential amino acid during critical illness and injury. However, whether GLN could attenuate lung injury caused by smoke inhalation is still unknown. The purpose of this study is to investigate whether GLN has a beneficial effect on smoke inhalation induced lung injury. In our present work, rats were equally randomized into three groups: Sham group (ambient air inhalation plus GLN treatment), Control group (smoke inhalation plus physiological saline) and GLN treatment group (smoke inhalation injury plus GLN treatment). At sampling, bronchoalveolar lavage fluid was performed to determine total protein concentration and pro-inflammatory cytokine levels. Lung tissues were collected for wet/dry ratio, histopathology, hydroxyproline and Western blotting measurement. Our results exhibited that GLN attenuated the lung histopathological alterations, improved pulmonary oxygenation, and mitigated pulmonary edema. At 28days post-injury, GLN mitigated smoke inhalation-induced excessive collagen deposition as evidence by Masson-Goldner trichrome staining and hydroxyproline content. GLN mitigated smoke inhalation-induced lung inflammatory response, and further prevented the activity of NF-kappa-B. More importantly, results from Western blotting and Immunohistochemistry exhibited that GLN enhanced the expression of HSF-1, HSP-70 and HO-1 in lung tissues. Our data demonstrated that GLN protected rats against smoke inhalation-induced lung injury and its protective mechanism seems to involve in inhibition inflammatory response and enhancing HSP expression.
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Affiliation(s)
- Wuquan Li
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai, China
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16
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Peng ZY, Zhou F, Wang HZ, Wen XY, Nolin TD, Bishop JV, Kellum JA. The anti-oxidant effects are not the main mechanism for glutamine's protective effects on acute kidney injury in mice. Eur J Pharmacol 2013; 705:11-9. [PMID: 23454558 DOI: 10.1016/j.ejphar.2013.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/02/2013] [Accepted: 02/07/2013] [Indexed: 12/22/2022]
Abstract
Acute kidney injury (AKI) is a common problem characterized by an inflammatory response in the kidney and oxidative stress. However, there are no interventions to prevent AKI. Glutamine is an important precursor of glutathione and has also been shown to induce heat shock proteins (HSP). Thus, glutamine may affect both oxidative stress and inflammation. This study was to explore the effects of glutamine pretreatment on nephrotoxic AKI and to investigate the underlying mechanisms. First, the effects of alternate doses of glutamine were compared in CD-1 mice with AKI induced with folic acid intra-peritoneal injection. Then the effects of glutamine quercetin (an HSP inhibitor), and quercetin+glutamine, were compared in the same AKI model. AKI were assessed with plasma creatinine, urine neutrophil gelatinase-associated lipocalin, and renal histology. Inflammatory response was monitored with renal tumor necrosis factor (TNF-α), chemkines (CXCL1 and CCL2) contents, and neutrophil infiltration. Oxidative injury was detected with reduced glutathione, malondialdehyde, and protein thiol. Glutamine provided dose-dependent renal protection. Pretreatment with quercetin, which was showed to inhibit HSP-70 expression, abolished glutamine's renal-protective effects. Quercetin also abrogated glutamine's beneficial effects on renal TNF-α, chemokines, and neutrophil infiltration. However, quercetin did not affect glutamine's anti-oxidative effects. These results suggest that glutamine's renal-protective effects are mainly related to its activation of HSP-70, which mitigates inflammatory response, renal neutrophil infiltration and subsequent AKI. Regulating neutrophil infiltration might be a potential therapeutic target for AKI.
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Affiliation(s)
- Zhi-Yong Peng
- The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
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Lehmann C, Pavlovic D, Zhou J, Wuttke U, Saeger D, Spassov A, Hung O, Cerny V, Witter T, Whynot S, Suchner U, Alteheld B, Stehle P, Gründling M. Intravenous free and dipeptide-bound glutamine maintains intestinal microcirculation in experimental endotoxemia. Nutrition 2012; 28:588-93. [PMID: 22222295 DOI: 10.1016/j.nut.2011.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The administration of glutamine (Gln), which is depleted in critical illness, is associated with an improvement of gut metabolism, structure, and function. The aim of the present study was to evaluate the effects of intravenous Gln and its galenic formulation, l-alanyl-l-glutamine dipeptide (AlaGln), on the intestinal microcirculation during experimental endotoxemia using intravital fluorescence microscopy. Gln or AlaGln administration was performed as pretreatment or post-treatment, respectively. To identify further the underlying mechanisms, amino acid levels were studied. METHODS Sixty male Lewis rats were randomly divided into six groups (n = 10/group): control, LPS (lipopolysaccharide 5 mg/kg intravenously), Gln/LPS (LPS animals pretreated with Gln 0.75 g/kg Gln intravenously), AlaGln/LPS (LPS animals pretreated with AlaGln intravenously, 0.75 g/kg Gln content), LPS/Gln (LPS animals post-treated with Gln 0.75 g/kg intravenously), and LPS/AlaGln (LPS animals post-treated with AlaGln intravenously, 0.75 g/kg Gln content). Two hours after the endotoxin challenge, the microcirculation of the terminal ileum was studied using intravital fluorescence microscopy. Blood samples were drawn at the beginning, during, and the end of the experiment to determine the amino acid levels. RESULTS The Gln and AlaGln pre- and post-treatment, respectively, prevented the LPS-induced decrease in the functional capillary density of the intestinal muscular and mucosal layers (P < 0.05). The number of adherent leukocytes in the submucosal venules was significantly attenuated after the Gln and AlaGln pre- and post-treatment (P < 0.05). CONCLUSION The Gln and AlaGln administrations improved the intestinal microcirculation by increasing the functional capillary density of the intestinal wall and decreasing the submucosal leukocyte activation.
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Affiliation(s)
- Christian Lehmann
- Department of Anesthesia, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
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Peng CK, Huang KL, Wu CP, Li MH, Hu YT, Hsu CW, Tsai SH, Chu SJ. Glutamine protects ischemia-reperfusion induced acute lung injury in isolated rat lungs. Pulm Pharmacol Ther 2010; 24:153-61. [PMID: 20688185 DOI: 10.1016/j.pupt.2010.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/01/2010] [Accepted: 07/16/2010] [Indexed: 12/24/2022]
Abstract
Glutamine has been used to treat a number of diseases via modulating the inflammatory response. The purpose of this study is to investigate whether glutamine has a beneficial effect in ischemia-reperfusion (IR) induced acute lung injury in an isolated rat lung model. Typical acute lung injury in rats was successfully induced by 60 min of ischemia and 60 min of reperfusion. At the end of experiment, bronchoalveolar lavage fluid (BALF), perfusate and lung tissues were collected to evaluate the degree of lung injury. Glutamine (20 mM) was administrated before ischemia or after ischemia. IR caused a significant increase in the capillary filtration coefficient; lung weight gain; lung weight to body weight ratio; wet to dry weight ratio; pulmonary arterial pressure; and protein concentration and lactate dehydrogenase level in BALF. Tumor necrosis factor-α and cytokine induced neutrophil chemoattractant-1 in perfusate, and malondialdehyde levels, carbonyl content and myeloperoxidase activities in lung tissue were also significantly increased. In addition, the lung tissues showed increased septal thickness and neutrophil infiltration. Furthermore, NF-κB activity and degradation of IκB-α were significantly increased in the lungs. Treatment with glutamine before ischemia or after ischemia significantly decreased the increase in these parameters. Our study showed that glutamine treatment decreased IR-induced acute lung injury. The protective mechanism may be due to the inhibition of NF-κB activation and the attenuation of oxidative stress.
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Affiliation(s)
- Chung-Kan Peng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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