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Association of CD14 rs2569190 polymorphism with mortality in shock septic patients who underwent major cardiac or abdominal surgery: A retrospective study. Sci Rep 2018; 8:2698. [PMID: 29426837 PMCID: PMC5807421 DOI: 10.1038/s41598-018-20766-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/23/2018] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to investigate the relationship between the CD14 rs2569190 polymorphism and death related to septic shock in white European patients who underwent major cardiac or abdominal surgery. We carried out a retrospective study in 205 septic shock patients. The septic shock diagnosis was established by international consensus definitions. The outcome variable was the death within 28, 60 and 90 days after septic shock diagnosis. The CD14 rs2569190 polymorphism was analyzed by Agena Bioscience’s MassARRAY platform. For the genetic association analysis with survival was selected a recessive inheritance model (GG vs. AA/AG). One hundred thirteen out of 205 patients (55.1%) died with a survival median of 39 days (95%CI = 30.6; 47.4). Patients with rs2569190 GG genotype had shorter survival probability than rs2569190 AA/AG genotype at 60 days (62.3% vs 50%; p = 0.035), and 90 days (62.3% vs 52.6%; p = 0.046). The rs2569190 GG genotype was associated with increased risk of septic shock-related death in the first 60 days (adjusted hazard ratio (aHR) = 1.67; p = 0.016) and 90 days (aHR = 1.64; p = 0.020) compared to rs2569190 AA/AG genotype. In conclusion, the presence of CD14 rs2569190 GG genotype was associated with death in shock septic patients who underwent major surgery. Further studies with bigger sample size are required to verify this relationship.
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Antiochos P, Marques-Vidal P, Virzi J, Pagano S, Satta N, Hartley O, Montecucco F, Mach F, Kutalik Z, Waeber G, Vollenweider P, Vuilleumier N. Impact of CD14 Polymorphisms on Anti-Apolipoprotein A-1 IgG-Related Coronary Artery Disease Prediction in the General Population. Arterioscler Thromb Vasc Biol 2017; 37:2342-2349. [DOI: 10.1161/atvbaha.117.309602] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022]
Abstract
Objective—
We aimed to determine whether autoantibodies against apoA-1 (apolipoprotein A-1; anti-apoA-1 IgG) predict incident coronary artery disease (CAD), defined as adjudicated incident myocardial infarction, angina, percutaneous coronary revascularization, or bypass grafting, in the general population. We further investigated whether this association is modulated by a functional CD14 receptor single nucleotide polymorphism.
Approach and Results—
In a prospectively studied, population-based cohort of 5220 subjects (mean age 52.6±10.7 years, 47.4% males), followed over a median period of 5.6 years, subjects positive versus negative for anti-apoA-1 IgG presented a total CAD rate of 3.9% versus 2.8% (
P
=0.077) and a nonfatal CAD rate of 3.6% versus 2.3% (
P
=0.018), respectively. After multivariate adjustment for established cardiovascular risk factors, the hazard ratios of anti-apoA-1 IgG for total and nonfatal CAD were: hazard ratio=1.36 (95% confidence interval, 0.94–1.97;
P
=0.105) and hazard ratio=1.53 (95% confidence interval, 1.03–2.26;
P
=0.034), respectively. In subjects with available genetic data for the C260T
rs2569190
single nucleotide polymorphism in the CD14 receptor gene (n=4247), we observed a significant interaction between anti-apoA-1 IgG and
rs2569190
allele status with regards to CAD risk, with anti-apoA-1 IgG conferring the highest risk for total and nonfatal CAD in non-TT carriers, whereas being associated with the lowest risk for total and nonfatal CAD in TT homozygotes (
P
for interaction =0.011 and
P
for interaction =0.033, respectively).
Conclusions—
Anti-apoA-1 IgG are independent predictors of nonfatal incident CAD in the general population. The strength of this association is dependent on a functional polymorphism of the CD14 receptor gene, a finding suggesting a gene–autoantibody interaction for the development of CAD.
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Affiliation(s)
- Panagiotis Antiochos
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Pedro Marques-Vidal
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Julien Virzi
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Sabrina Pagano
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Nathalie Satta
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Oliver Hartley
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Fabrizio Montecucco
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - François Mach
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Zoltan Kutalik
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Gerard Waeber
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Peter Vollenweider
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
| | - Nicolas Vuilleumier
- From the Department of Internal Medicine, University Hospital of Lausanne, Switzerland (P.A., P.M.-V., G.W., P.V.); Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Switzerland (J.V., S.P., N.S., F. Montecucco, N.V.); Department of Human Protein Sciences, Faculty of Medicine, (J.V., S.P., N.S., N.V.), Department of Pathology and Immunology, Faculty of Medicine (O.H.), and Division of Cardiology, Foundation for Medical Researches,
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3
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Abstract
Sepsis and multiple organ dysfunction syndrome (MODS) is common in the surgical intensive care unit. Sepsis involves infection and the patient's immune response. Timely recognition of sepsis and swift application of evidence-based interventions is critical to the success of therapy. This article reviews the nature of the septic process, existing definitions of sepsis, and current evidence-based treatment strategies for sepsis and MODS. An improved understanding of the process of sepsis and its relation to MODS has resulted in clinical definitions and scoring systems that allow for the quantification of disease severity and guidelines for treatment.
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Wu Q, Xu X, Ren J, Liu S, Liao X, Wu X, Hu D, Wang G, Gu G, Kang Y, Li J. Association between the -159C/T polymorphism in the promoter region of the CD14 gene and sepsis: a meta-analysis. BMC Anesthesiol 2017; 17:11. [PMID: 28122493 PMCID: PMC5264438 DOI: 10.1186/s12871-017-0303-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/16/2017] [Indexed: 02/05/2023] Open
Abstract
Background The association between CD14-159C/T polymorphism and sepsis has been assessed but results of current studies appeared conflicting and inconstant. This analysis was aimed to determine whether the CD14-159C/T polymorphism confers susceptibility to sepsis or is associated with increased risk of death from sepsis. Method The authors conducted a comprehensive search of PubMed, EMBASE, ISI Web of Science, Cochrane library, ScienceDirect, Wiley Online Library and CNKI databases according to a prespecified protocol. Language limits were restricted to English and Chinese. Two reviewers independently selected the articles and extracted relevant data onto standardized forms. Disagreements were settled by discussion and suggestions from senior consultants. The strength of association were evaluated by odds ratio (OR) and 95% confidence interval (CI). Studies failed to fit the Hardy-Weinberg-Equilibrium were excluded. Results The research identified a total of 2317 full-text articles of which 14 articles met the predefined inclusion criteria. Meta-analysis was performed for allele frequency of C versus T, as well as genotypes CC + CT versus TT (dominant model), CC versus TT + CT (recessive model), CT versus TT and CC versus TT (additive model). All control samples were in Hardy-Weinberg proportion. No significant association between CD14-159C/T polymorphism and sepsis susceptibility or mortality were detected in the overall population. Nonetheless, subgroup analysis of Asian ethnicity revealed significant association between the CD14-159C/T polymorphism and susceptibility to sepsis in additive model (CC versus TT: OR = 0.52, 95% CI 0.29–0.92, p = 0.03) and recessive model (CC versus CT + TT: OR = 0.50, 95% CI 0.30–0.84, p = 0.009). Of note, three out of the five papers included in the subgroup focused exclusively on burn ICU patients. Conclusions This meta-analysis demonstrated that CD14-159C/T polymorphism is likely to be associated with susceptibility to sepsis in Asian population, especially for the TT genotype. However, bias may rise for etiologic reasons because the majority of subjects in the subgroup came from burn ICU. CD14-159C/T polymorphism is not relevant to sepsis mortality in any genetic models, regardless of the ethnicities. Due to the exploratory nature of the study, no adjustment for multiple testing was adopted, and therefore the results should be interpreted with precaution. Well-designed studies with larger sample size and more ethnic groups are required to further validate the results. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0303-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qin Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China.,Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaomeng Xu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Jianan Ren
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China.
| | - Song Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuwen Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Dong Hu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Gefei Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Guosheng Gu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
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5
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Mansur A, Liese B, Steinau M, Ghadimi M, Bergmann I, Tzvetkov M, Popov AF, Beissbarth T, Bauer M, Hinz J. The CD14 rs2569190 TT Genotype Is Associated with an Improved 30-Day Survival in Patients with Sepsis: A Prospective Observational Cohort Study. PLoS One 2015; 10:e0127761. [PMID: 26020644 PMCID: PMC4447461 DOI: 10.1371/journal.pone.0127761] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/20/2015] [Indexed: 12/29/2022] Open
Abstract
According to previous investigations, CD14 is suggested to play a pivotal role in initiating and perpetuating the pro-inflammatory response during sepsis. A functional polymorphism within the CD14 gene, rs2569190, has been shown to impact the pro-inflammatory response upon stimulation with lipopolysaccharide, a central mediator of inflammation in sepsis. In this study, we hypothesized that the strong pro-inflammatory response induced by the TT genotype of CD14 rs2569190 may have a beneficial effect on survival (30-day) in patients with sepsis. A total of 417 adult patients with sepsis (and of western European descent) were enrolled into this observational study. Blood samples were collected for rs2569190 genotyping. Patients were followed over the course of their stay in the ICU, and the 30-day mortality risk was recorded as the primary outcome parameter. Sepsis-related organ failure assessment (SOFA) scores were quantified at sepsis onset and throughout the observational period to monitor organ failure as a secondary variable. Moreover, organ support-free days were evaluated as a secondary outcome parameter. TT-homozygous patients were compared to C-allele carriers. Kaplan-Meier survival analysis revealed a higher 30-day mortality risk among C-allele carriers compared with T homozygotes (p = 0.0261). To exclude the effect of potential confounders (age, gender, BMI and type of infection) and covariates that varied at baseline with a p-value < 0.2 (e.g., comorbidities), we performed multivariate Cox regression analysis to examine the survival time. The CD14 rs2569190 C allele remained a significant covariate for the 30-day mortality risk in the multivariate analysis (hazard ratio, 2.11; 95% CI, 1.08-4.12; p = 0.0282). The 30-day mortality rate among C allele carriers was 23%, whereas the T homozygotes had a mortality rate of 13%. Additionally, an analysis of organ-specific SOFA scores revealed a significantly higher SOFA-Central nervous system score among patients carrying the C allele compared with T-homozygous patients (1.9±1.1 and 1.6±1.0, respectively; p = 0.0311). In conclusion, CD14 rs2569190 may act as a prognostic variable for the short-term outcome (30-day survival) in patients with sepsis.
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Affiliation(s)
- Ashham Mansur
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
- * E-mail:
| | - Benjamin Liese
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Maximilian Steinau
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center, Georg August University, Goettingen, Germany
| | - Ingo Bergmann
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Mladen Tzvetkov
- Institute of Clinical Pharmacology, University Medical Center, Georg August University, Goettingen, Germany
| | - Aron Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield Hospital, Harefield, London, United Kingdom
| | - Tim Beissbarth
- Department of Medical Statistics, University Medical Center, Georg August University, Goettingen, Germany
| | - Martin Bauer
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - José Hinz
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
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6
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Wang H, Wei Y, Zeng Y, Qin Y, Xiong B, Qin G, Li J, Hu D, Qiu X, Sooranna SR, Pinhu L. The association of polymorphisms of TLR4 and CD14 genes with susceptibility to sepsis in a Chinese population. BMC MEDICAL GENETICS 2014; 15:123. [PMID: 25394369 PMCID: PMC4411696 DOI: 10.1186/s12881-014-0123-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/23/2014] [Indexed: 02/27/2023]
Abstract
Background Sepsis is now the leading cause of death in the non-cardiovascular intensive care unit (ICU). Recent research suggests that sepsis is likely to be due to an interaction between genetic and environmental factors. Genetic mutations of toll-like receptor 4 (TLR4) and cluster of differentiation 14 (CD14) genes are involved in the immune and (or) inflammatory response. These may contribute to the susceptibility to sepsis in patients. This study was designed to evaluate whether the TLR4 and cluster CD14 gene polymorphisms are associated with susceptibility to sepsis. Methods The single nucleotide polymorphisms (SNPs) of TLR4 (rs10759932, rs11536889, rs7873784, rs12377632, rs1927907, rs1153879) and CD14 (rs2569190 and rs2563298) in patients with sepsis and control subjects in the Guangxi Province were analyzed by using the polymerase chain reaction-single base extension (PCR-SBE) and DNA sequencing methods. Results The rs11536889 polymorphism in TLR4 and rs2563298 polymorphism in CD14 were significantly associated with the risk of sepsis when compared to the control group. The frequencies of rs11536889 and rs2563298 polymorphisms in the group with sepsis were higher than that in the control group (OR = 1.430, 95% CI, 1.032-1.981, P<0.05; OR = 2.454, 95% CI, 1.458-4.130, P<0.05, respectively). Followed up haplotype analysis suggested that there were two haplotypes in which increased risk factors for sepsis were indicated. Conclusions The rs11536889 polymorphism in TLR4 and rs2563298 polymorphism in CD14, and two haplotypes were associated with increased susceptibility to sepsis.
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Affiliation(s)
- Haiyan Wang
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Yesheng Wei
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Yi Zeng
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Yueqiu Qin
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Bin Xiong
- Intensive Care Unit, the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, 530021, Guangxi, PR China.
| | - Gang Qin
- Intensive Care Unit, Minzu Hospital of Guangxi Zhuang Autonomous Region, 323 Mingxiu East Road, Nanning, 530021, Guangxi, PR China.
| | - Jun Li
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Donghai Hu
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Xiaowen Qiu
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
| | - Suren R Sooranna
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK.
| | - Liao Pinhu
- Intensive Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, No.18 Zhongshan Road II, Baise, 533099, Guangxi, PR China.
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7
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Zhang AQ, Yue CL, Gu W, Du J, Wang HY, Jiang J. Association between CD14 promoter -159C/T polymorphism and the risk of sepsis and mortality: a systematic review and meta-analysis. PLoS One 2013; 8:e71237. [PMID: 23990939 PMCID: PMC3747171 DOI: 10.1371/journal.pone.0071237] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023] Open
Abstract
Background Recent studies on the association between CD14-159C/T polymorphism and sepsis showed inconclusive results. Accordingly, we conducted a comprehensive literature search and a meta-analysis to determine whether the CD14-159C/T polymorphism conferred susceptibility to sepsis or was associated with increased risk of death from sepsis. Methodology Data were collected from the following electronic databases: PubMed, Embase, Medline, Web of Knowledge, and HuGE Navigator, with the last report up to June 15, 2012. The odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of association. We summarized the data on the association between CD14-159C/T polymorphism and sepsis in the overall population and subgroup by ethnicity and sepsis subtype. Principal Findings A total of 16 studies on sepsis morbidity (1369 cases and 2382 controls) and 4 studies on sepsis mortality (731 sepsis patients) met the inclusion criteria for meta-analysis. Overall analysis showed no strong evidences of association with sepsis susceptibility under any genetic model. However, slight associations were found in Asian populations (dominant model: OR = 1.38, 95%CI = 0.96–1.98, P = 0.08) and septic shock patients (dominant model: OR = 1.72, 95%CI 1.05–2.83, P = 0.03; allelic model: OR = 1.52, 95%CI 1.09–2.12, P = 0.01) in the stratified analysis. Moreover, there was borderline association between CD14-159C/T and sepsis mortality under the dominant genetic model (OR = 1.44, 95%CI = 0.98–2.11, P = 0.06). Conclusions/Significance This meta-analysis suggests that the CD14-159C/T polymorphism may not be a significant susceptibility factor in the risk of sepsis and mortality. Only weak associations were observed in Asian populations and septic shock patients. More studies based on larger sample sizes and homogeneous sepsis patients are needed to confirm these findings.
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Affiliation(s)
- An-qiang Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cai-li Yue
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Gu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Juan Du
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Hai-yan Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jianxin Jiang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
- * E-mail:
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8
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Fallavena PRV, de Jesus Borges T, Paskulin DD, Thurow HS, de Oliveira Paludo FJ, Dos Santos Froes C, Graebin P, Dias FS, de Toledo Nóbrega O, Alho CS. The synergy of -260T T CD14 and -308GG TNF-α genotypes in survival of critically ill patients. Scand J Immunol 2013; 77:62-8. [PMID: 23036097 DOI: 10.1111/sji.12002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022]
Abstract
Literature suggests that the analysis of several polymorphic genetic markers is more informative than the analysis of a single polymorphism. In this study, we tested whether the shared inheritance of TLR2 and TLR4 and TNF-α allelic variants may act in synergy with -260C>T CD14 SNP on the outcome from critical conditions. We monitored 524 critically ill patients from South Brazilian, daily from the ICU admission to their discharge from hospital, or death. Our results revealed that TLR2, TLR4 or TNF-α SNPs alone did not show a significant role in the outcome from critical illness. However, when we performed a combined analysis with the CD14 inheritance, we detected a significant higher survivor rate in -260TT CD14/-308GG TNF-α individuals (P = 0.037). In the adjusted analysis including the main clinical predictors to mortality, we observed that -260TT/-308GG double-genotype was a significant protective factor towards survival (P = 0.046). An increased probability for survival of -260TT/-308GG was also observed by 'pathway genetic load' analysis (unweighted: P = 0.041; weighted: P = 0.036). When we applied a hazard function analysis with the -260TT/-308GG variable as a discriminating factor, -260TT/-308GG patients group had, in fact, a higher survivor rate (P = 0.024). Connected to the beneficial effect of -260TT CD14, the -308GG TNF-α genotype was protective against the reported over expression of TNF-α caused by -308A rare allele. Results support the hypothesis that the interaction between -260C>T CD14 and -308G>A TNF-α functional SNPs may be synergistically influencing the outcome of critically ill patients.
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Affiliation(s)
- P R V Fallavena
- Faculdade de Biociências (FABIO), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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9
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Abstract
The number of genetic polymorphisms shown to play a role in sepsis continues to increase. At the same time, platforms for genetic sequencing and expression analysis are being refined, allowing unprecedented data generation. International databases may soon facilitate synchrony of genotypic and phenotypic data using enormous numbers of septic patients. If this occurs, 2 strategies for investigating polymorphisms in sepsis are likely to gain favor. In the first strategy, sepsis will continue to be viewed as a single entity. High-throughput genetic techniques will be used to evaluate numerous polymorphisms, each with fractional disease responsibility. Nongenetic variables, such as pathogen characteristics, underlying host medical conditions, and type and timing of resuscitation, will be considered cofactors. Using this approach, principal components that predict susceptibility to and outcomes during sepsis are likely to be identified. In the second strategy, sepsis will be divided into subtypes based on the concentration of specific variables. Categories will be based on features like the presence or absence of specific polymorphisms, gram-positive or gram-negative staining of causative organisms, age and comorbid conditions of the host, recent administration of chemotherapeutic agents, and hospital setting (ie, community vs teaching institution). Each category will be used to create homogenous sepsis subgroups for detailed evaluation. This approach will increase the odds of finding single dominant factors responsible for predilection and/or outcome within well-defined groups among those with sepsis. Several elements will be essential for the success of both these strategies. Firstly, databases that are extremely detailed will have to be generated. Secondly, better clinical information technology systems will be needed to facilitate large-scale phenotyping. Thirdly, standardization of protocols will need to take place to ensure uniformity of data sets. If the rapid advances in technology and informatics continue, they may catalyze paradigm shifts with regard to how clinicians address sepsis. Clinicians may change their focus from aggressive uniform treatment strategies to rapid stratification and subcategorization, with subsequent aggressive targeted therapeutic interventions. Advances in technology have the potential to change our primary goal in sepsis from rapid treatment to prevention for those most at risk. The cost savings to the US health care systems from such changes could be substantial.
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Affiliation(s)
- Allen Namath
- Division of Pulmonary and Critical Care Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
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Genetic polymorphisms and posttraumatic complications. Comp Funct Genomics 2011; 2010:814086. [PMID: 21274447 PMCID: PMC3025375 DOI: 10.1155/2010/814086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 12/23/2010] [Indexed: 01/02/2023] Open
Abstract
Major trauma is the leading cause of death in young adults. Despite advances in prehospital system and treatment in hospital, mortality rates have not improved significantly over the past decades. Victims of severe injuries who survive the initial hours have great risk for additional life-threatening complicaitons, including uncontrollable infection (sepsis) and multiple organ dysfunction syndrome (MODS). Single nucleotide polymorphisms (SNPs) have been shown to affect susceptibility to the course of numerous diseases. Accumulating evidence suggests that genetic backgrounds also play important roles in posttraumatic complications. Genetic polymorphisms may become powerful biomarkers for diagnosis and prognosis of trauma-induced complications. Recent advances in studies on associations between genetic polymorphisms and sepsis or MODS have led to better understanding of posttraumatic complications. Here we summarise recent findings on genetic variations in molecules of the innate immune system and other systems as well as their connection with susceptibility to posttraumatic complications.
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Waterer GW, Bruns AHW. Genetic risk of acute pulmonary infections and sepsis. Expert Rev Respir Med 2010; 4:229-38. [PMID: 20406089 DOI: 10.1586/ers.10.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The focus of this review is the genetic influence on pneumonia and sepsis. A large number of polymorphisms in a diverse collection of genes have been identified as potential candidates to explain the genetic variability in susceptibility to acute pulmonary infection and its adverse outcomes. Unfortunately, apart from polymorphisms in mannose-binding lectin, CD14 and the IgG2 receptor, there is little consensus on which polymorphisms are truly important. As well as discussing some of the major published findings, this review will focus on the reasons for failure to make more progress. We will also address the issues for future research, particularly the need to address the limitations of past studies, including the grouping of patients with different pathogens, as the relationship between genotype and phenotype may be highly pathogen dependent. Finally, our approach to reporting genetic studies needs to change to minimize the number of publications of spurious findings.
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Affiliation(s)
- Grant W Waterer
- School of Medicine and Pharmacology, University of Western Australia, Level 4 MRF Building, Royal Perth Hospital, GPO Box X2213, Perth 6847, Australia.
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Freeman BD, Kennedy CR, Frankel HL, Clarridge B, Bolcic-Jankovic D, Iverson E, Shehane E, Celious A, Zehnbauer BA, Buchman TG. Ethical considerations in the collection of genetic data from critically ill patients: what do published studies reveal about potential directions for empirical ethics research? THE PHARMACOGENOMICS JOURNAL 2010; 10:77-85. [PMID: 19997084 PMCID: PMC2860600 DOI: 10.1038/tpj.2009.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 09/30/2009] [Accepted: 11/04/2009] [Indexed: 01/07/2023]
Abstract
Critical illness trials involving genetic data collection are increasingly commonplace and pose challenges not encountered in less acute settings, related in part to the precipitous, severe and incapacitating nature of the diseases involved. We performed a systematic literature review to understand the nature of such studies conducted to date, and to consider, from an ethical perspective, potential barriers to future investigations. We identified 79 trials enrolling 24 499 subjects. Median (interquartile range) number of participants per study was 263 (116.75-430.75). Of these individuals, 16 269 (66.4%) were Caucasian, 1327 (5.4%) were African American, 1707 (7.0%) were Asian Pacific Islanders and 139 (0.6%) were Latino. For 5020 participants (20.5%), ethnicity was not reported. Forty-eight studies (60.8%) recruited subjects from single centers and all studies examined a relatively small number of genetic markers. Technological advances have rendered it feasible to conduct clinical studies using high-density genome-wide scanning. It will be necessary for future critical illness trials using these approaches to be of greater scope and complexity than those so far reported. Empirical research into issues related to greater ethnic inclusivity, accuracy of substituted judgment and specimen stewardship may be essential for enabling the conduct of such trials.
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Affiliation(s)
- B D Freeman
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
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Fallavena PRV, Borges TJ, Paskulin DD, Paludo FJO, Goetze TB, de Oliveira JR, Nóbrega OT, Dias FS, Alho CS. The Influences of CD14 −260C>T Polymorphism on Survival in ICU Critically Ill Patients. Immunol Invest 2009; 38:797-811. [DOI: 10.3109/08820130903258818] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sutherland AM, Walley KR. Bench-to-bedside review: Association of genetic variation with sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:210. [PMID: 19439056 PMCID: PMC2689454 DOI: 10.1186/cc7702] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Susceptibility and response to infectious disease is, in part, heritable. Initial attempts to identify the causal genetic polymorphisms have not been entirely successful because of the complexity of the genetic, epigenetic, and environmental factors that influence susceptibility and response to infectious disease and because of flaws in study design. Potential associations between clinical outcome from sepsis and many inflammatory cytokine gene polymorphisms, innate immunity pathway gene polymorphisms, and coagulation cascade polymorphisms have been observed. Confirmation in large, well conducted, multicenter studies is required to confirm current findings and to make them clinically applicable. Unbiased investigation of all genes in the human genome is an emerging approach. New, economical, high-throughput technologies may make this possible. It is now feasible to genotype thousands of tag single nucleotide polymorphisms across the genome in thousands of patients, thus addressing the issues of small sample size and bias in selecting candidate polymorphisms and genes for genetic association studies. By performing genome-wide association studies, genome-wide scans of nonsynonymous single nucleotide polymorphisms, and testing for differential allelic expression and copy number polymorphisms, we may yet be able to tease out the complex influence of genetic variation on susceptibility and response to infectious disease.
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de Aguiar BB, Girardi I, Paskulin DD, de Franca E, Dornelles C, Dias FS, Bonorino C, Alho CS. CD14 expression in the first 24h of sepsis: effect of -260C>T CD14 SNP. Immunol Invest 2009; 37:752-69. [PMID: 18991094 DOI: 10.1080/08820130802403242] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sepsis is defined as systemic inflammation caused by infection. The membrane bound CD14 (mCD14) or the soluble form (sCD14) play a crucial role facing Gram-negative and Gram-positive sepsis since they are pattern recognition receptors of the innate immune response enabling cells to produce inflammatory cytokines against bacterial infections. A -260C>T single nucleotide polymorphism (SNP) was detected in the promoter modulating the CD14 gene expression. We hypothesized that the CD14 expression depends of the genetic inheritance of -260C>T CD14 SNP and it is modulated by sepsis condition. We investigated human CD14 expression on early sepsis diagnosis (in vivo) and after LPS stimulation (in vitro), and determined the -260C>T CD14 SNP. We found that TT homozygotes showed higher mCD14 density (p = 0.0207), but not different sCD14 levels when compared to the CT+CC genotypes. Monocyte mCD14 density and sCD14 serum levels in our sample of early 14 septic patients were significantly higher than normal 30 controls (p<0.0001). Our results suggest that the -260TT CD14 genotype is associated with higher monocyte mCD14, but not sCD14 expression, and that in the first 24 h after sepsis diagnosis, both monocyte mCD14 density and sCD14 levels are elevated, similarly to what is observed in vitro upon challenge with LPS.
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Affiliation(s)
- Bibiana Butkus de Aguiar
- Faculdade de Biociências and Hospital São Lucas (HSL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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