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Juschten J, Ingelse SA, Maas MAW, Girbes ARJ, Juffermans NP, Schultz MJ, Tuinman PR. Antithrombin plus alpha-1 protease inhibitor does not affect coagulation and inflammation in two murine models of acute lung injury. Intensive Care Med Exp 2019; 7:36. [PMID: 31346884 PMCID: PMC6658634 DOI: 10.1186/s40635-019-0240-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 01/23/2023] Open
Abstract
Background In acute respiratory distress syndrome (ARDS), uncontrolled production of activators of coagulation and proinflammatory mediators results in a shift from an adequate local innate immune response to hypercoagulability and inflammation. This study aimed to investigate whether the protease inhibitors antithrombin (AT) and alpha-1 protease inhibitor (A1PI) may attenuate an exaggerated pulmonary immune response. Methods Lung injury was induced either by single intranasal administration of lipopolysaccharide (LPS) (5 mg/kg) in BALB/c mice or by combination of an intravenous injection of LPS (10 mg/kg) with subsequent injurious ventilation using high tidal volumes (12–15 ml/kg) for 4 h in RccHan Wistar rats. Animals received either a single bolus of AT (250 IU/kg) or A1PI (60 mg/kg) alone or in combination, with or without intravenous low-dose heparin (100 U/kg). Control animals received saline. Additional controls received neither LPS, nor ventilation, nor treatment. Endpoints were local and systemic markers of coagulation, e.g., thrombin–antithrombin complexes (TATc), and inflammation, e.g., interleukin-6. Results Both lung injury models resulted in a pronounced immune response within the pulmonary compartment shown by elevated levels of markers of coagulation and inflammation. The two-hit lung injury model also induced profound systemic coagulopathy and inflammation. Monotherapy with AT or A1PI did not reduce pulmonary coagulopathy or inflammation in any lung injury model. Nor did combination therapy with AT and A1PI result in a decrease of coagulation or inflammatory parameters. AT markedly reduced systemic levels of TATc in the two-hit lung injury model. Systemic inflammation was not affected by the different interventions. Additional administration of heparin did not lead to macroscopic bleeding incidences. Conclusions In two different murine models of acute lung injury, neither single therapy with AT or A1PI nor combination of both agents attenuates the pronounced pulmonary coagulation or inflammatory response.
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Affiliation(s)
- Jenny Juschten
- Department of Intensive Care, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands. .,Research VUmc Intensive Care (REVIVE), Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands. .,Department of Intensive Care, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands. .,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands.
| | - Sarah Anne Ingelse
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands.,Emma Children's Hospital-Pediatric Intensive Care Unit, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Martinus Adrianus Wilhelmus Maas
- Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Armand Roelof Johan Girbes
- Department of Intensive Care, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands
| | - Nicole Petra Juffermans
- Department of Intensive Care, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Marcus Josephus Schultz
- Department of Intensive Care, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Pieter Roel Tuinman
- Department of Intensive Care, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands.,Research VUmc Intensive Care (REVIVE), Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands
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Abstract
This report aims to facilitate the implementation of the Three Rs (replacement, reduction, and refinement) in the use of animal models or procedures involving sepsis and septic shock, an area where there is the potential of high levels of suffering for animals. The emphasis is on refinement because this has the greatest potential for immediate implementation. Specific welfare issues are identified and discussed, and practical measures are proposed to reduce animal use and suffering as well as reducing experimental variability and increasing translatability. The report is based on discussions and submissions from a nonregulatory expert working group consisting of veterinarians, animal technologists, and scientists with expert knowledge relevant to the field.
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