1
|
Nemzow L, Phillippi MA, Kanagaraj K, Shuryak I, Taveras M, Wu X, Turner HC. Validation of a blood biomarker panel for machine learning-based radiation biodosimetry in juvenile and adult C57BL/6 mice. Sci Rep 2024; 14:23872. [PMID: 39396080 PMCID: PMC11470949 DOI: 10.1038/s41598-024-74953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 09/30/2024] [Indexed: 10/14/2024] Open
Abstract
Following a large-scale radiological event, timely collection of samples from all potentially exposed individuals may be precluded, and high-throughput bioassays capable of rapid and individualized dose assessment several days post-exposure will be essential for population triage and efficient implementation of medical treatment. The objective of this work was to validate the performance of a biomarker panel of radiosensitive intracellular leukocyte proteins (ACTN1, DDB2, and FDXR) and blood cell counts (CD19+ B-cells and CD3+ T-cells) for retrospective classification of exposure and dose estimation up to 7 days post-exposure in an in-vivo C57BL/6 mouse model. Juvenile and adult C57BL/6 mice of both sexes were total body irradiated with 0, 1, 2, 3, or 4 Gy, peripheral blood was collected 1, 4, and 7-days post-exposure, and individual blood biomarkers were quantified by imaging flow cytometry. An ensemble machine learning platform was used to identify the strongest predictor variables and combine them for biodosimetry outputs. This approach generated successful exposure classification (ROC AUC = 0.94, 95% CI: 0.90-0.97) and quantitative dose reconstruction (R2 = 0.79, RMSE = 0.68 Gy, MAE = 0.53 Gy), supporting the potential utility of the proposed biomarker assay for determining exposure and received dose in an individual.
Collapse
Affiliation(s)
- Leah Nemzow
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA.
| | - Michelle A Phillippi
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Karthik Kanagaraj
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Igor Shuryak
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria Taveras
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Xuefeng Wu
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Helen C Turner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
2
|
Song C, Hu Z, Zhang J. The value of lymphocyte-to-C-reactive protein ratio for predicting clinical outcomes in patients with sepsis in intensive care unit: a retrospective single-center study. Front Mol Biosci 2024; 11:1429372. [PMID: 39347502 PMCID: PMC11427359 DOI: 10.3389/fmolb.2024.1429372] [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: 05/24/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Background The lymphocyte-to-C-reactive protein ratio (LCR) was a novel biomarker of inflammation that had been implicated in various diseases. Nevertheless, the role of LCR in the context of sepsis patients admitted to the Intensive Care Unit (ICU) had not been thoroughly elucidated. This study aimed to determine the significance of the LCR in predicting the prognosis of sepsis patients within ICU. Methods A sample of sepsis patients requiring ICU care was selected from the Affiliated Hospital of Jiangsu University. These patients were then segmented into four quartiles based on their LCR levels. The primary endpoint of the study was 30-day mortality and the secondary endpoint was the occurrence of Acute Kidney Injury (AKI). Survival analysis, via the Kaplan-Meier method and log-rank test, was conducted to assess survival rates. Cox proportional hazards regression and logistic regression models were employed to investigate the association between LCR and clinical outcomes. Additional subgroup analyses were conducted to evaluate the influence of other confounding factors on the relationship between LCR and patient outcomes. Results A total of 1,123 patients were enrolled in this study, with a median age of 75 (65-84) years, and 707 (63.0%) of them were male. The 30-day mortality rate was 28.1%, while the incidence of AKI was 45.6%. A progressive decrease in LCR levels was found to be associated with an increased cumulative incidence of 30-day mortality (log-rank P < 0.001). Multivariable Cox proportional hazards analyses demonstrated that LCR was an independent predictor of 30-day mortality [per 1-unit increase in LCR: HR (95%CI): 0.370 (0.142-0.963); P = 0.042]. Additionally, multivariable logistic regression analysis revealed a significant association between LCR and AKI occurrence [per 1-unit increase in LCR: OR (95%CI): 0.541 (0.307-0.953); P = 0.034]. Furthermore, subgroup analysis indicated a stronger correlation for patients aged over 65 years compared to those aged 65 or younger (p for interaction <0.05) in predicting 30-day mortality or AKI occurrence based on LCR. Conclusion A reduction in LCR was notably linked to 30-day mortality and the occurrence of AKI in sepsis patients. These findings suggested that LCR could potentially serve as a valuable tool in identifying sepsis patients at a heightened risk of adverse outcomes.
Collapse
Affiliation(s)
- Chao Song
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhenkui Hu
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jinhui Zhang
- Department of Critical Care Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| |
Collapse
|
3
|
Lalitha AV, Vasudevan A, Moorthy M, Ramaswamy G. Profiling Molecular Changes of Host Response to Predict Outcome in Children with Septic Shock. Indian J Crit Care Med 2024; 28:879-886. [PMID: 39360202 PMCID: PMC11443272 DOI: 10.5005/jp-journals-10071-24789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/23/2024] [Indexed: 10/04/2024] Open
Abstract
Background Septic shock is associated with high mortality and there is significant heterogeneity in the host response. The aim of this study was to understand the genome-wide expression transcriptomic signatures in children with septic shock and correlate them with outcomes. Methods This was a prospective study conducted on children (aged 1 month to 18 years) admitted to the PICU (June-December 2021) with septic shock. Demographic details, clinical details, and administered treatment were collected. Differential gene expression analysis was performed to understand the genes and pathways affecting in different subjects. Results Fifteen patients were recruited (Septic shock survivors (n = 5), nonsurvivors (n = 5), and non-sepsis controls (n = 5). The median age of the patients in survivors and nonsurvivors was 15 (13, 24) months and 180 (180, 184) months, respectively. The sepsis-survivors vs nonsepsis possessed 983 upregulated and 624 downregulated genes while comparing sepsis nonsurvivors (SNS) with nonsepsis yielded 1,854 upregulated and 1,761 downregulated genes. Further, the lowest number of deregulated genes (383 upregulated and 486 downregulated) were present in SNS compared to sepsis survivors. The major Reactome pathways, found upregulated in SNSs relative to survivors included CD22 mediated B cell receptor (BCR) regulation, scavenging of heme from plasma, and creation of C4 and C2 activators while T cell receptor (TCR) signaling, the common pathway of fibrin clot formation and generation of second messenger molecules were found to be downregulated. Conclusion Mortality-related gene signatures are promising diagnostic biomarkers for pediatric sepsis. How to cite this article Lalitha AV, Vasudevan A, Moorthy M, Ramaswamy G. Profiling Molecular Changes of Host Response to Predict Outcome in Children with Septic Shock. Indian J Crit Care Med 2024;28(9):879-886.
Collapse
Affiliation(s)
- A V Lalitha
- Department of Pediatric Critical Care, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Manju Moorthy
- Department of Research and Development, Theracues Innovations Pvt. Ltd., Bengaluru, Karnataka, India
| | - Gopalakrishna Ramaswamy
- Department of Research and Development, Theracues Innovations Pvt. Ltd., Bengaluru, Karnataka, India
| |
Collapse
|
4
|
Zhang G, Wang T, An L, Hang C, Wang X, Shao F, Shao R, Tang Z. The neutrophil-to-lymphocyte ratio levels over time correlate to all-cause hospital mortality in sepsis. Heliyon 2024; 10:e36195. [PMID: 39253154 PMCID: PMC11381600 DOI: 10.1016/j.heliyon.2024.e36195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024] Open
Abstract
Objective This research aims to investigate the prognosis value using the time-weighted average neutrophil-to-lymphocyte ratio (TWA-NLR) for predicting all-cause hospital mortality among sepsis patients. Data were analyzed through the use of the eICU Collaborative Research Database (eICU-CRD 2.0) as well as Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2). Methods Septic patients from both eICU-CRD 2.0 as well as MIMIC-IV 2.2 databases were included. The neutrophil-to-lymphocyte ratios (NLR) were available for analysis, utilizing complete blood counts obtained on days one, four, and seven following ICU admission. The TWA-NLR was computed at the end of the seven days, and patients were then stratified based on TWA-NLR thresholds. 90-day all-cause mortality during hospitalization was the primary objective, with 60-day all-cause hospital mortality as a secondary objective. The correlation between TWA-NLR and sepsis patients' primary outcome was analyzed using univariable and multivariable Cox proportional hazard regressions. A restricted cubic spline (RCS) analysis was conducted in an attempt to confirm this association further, and subgroup analyses were employed to evaluate the correlation across various comorbidity groups. Results 3921 patients were included from the eICU-CRD 2.0, and the hospital mortality rate was 20.8 %. Both multivariable as well as univariable Cox proportional hazard regression analyses revealed that TWA-NLR was independently correlated with 90-day all-cause hospital mortality, yielding a hazard ratio (HR) of 1.02 (95 % CI 1.01-1.02, P-value<0.01) as well as 1.12 (95 % CI 1.01-1.15, P-value<0.01), respectively. The RCS analysis demonstrated a significant nonlinear relationship between TWA-NLR and 90-day all-cause hospital mortality risk. The study subjects were divided into higher (>10.5) and lower (≤10.5) TWA-NLR cohorts. A significantly decreased incidence of 90-day all-cause hospital mortality (HR = 0.56, 95 % CI 0.48-0.64, P-value<0.01) and longer median survival time (40 days vs 24 days, P-value<0.05) were observed in the lower TWA-NLR cohort. However, septic patients with chronic pulmonary (interaction of P-value = 0.009) or renal disease (interaction of P-value = 0.008) exhibited significant interactive associations between TWA-NLR and 90-day all-cause hospital mortality, suggesting the predictive power of TWA-NLR may be limited in these subgroups. The MIMIC-IV 2.2 was utilized as a validation cohort and exhibited a similar pattern. Conclusion Our findings suggest that TWA-NLR is a powerful and independent prognostic indicator for 90-day all-cause hospital mortality among septic patients, and the TWA-NLR cutoff value may prove a useful method for identifying high-risk septic patients.
Collapse
Affiliation(s)
- Guyu Zhang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Tao Wang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Le An
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - ChenChen Hang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - XingSheng Wang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Fei Shao
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Rui Shao
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| | - Ziren Tang
- Emergency Medicine Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
| |
Collapse
|
5
|
Zhang G, Wang T, An L, Hang C, Wang X, Shao F, Shao R, Tang Z. U-shaped correlation of lymphocyte count with all-cause hospital mortality in sepsis and septic shock patients: a MIMIC-IV and eICU-CRD database study. Int J Emerg Med 2024; 17:101. [PMID: 39187746 PMCID: PMC11346189 DOI: 10.1186/s12245-024-00682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND In sepsis, the relationship between lymphocyte counts and patient outcomes is complex. Lymphocytopenia and lymphocytosis significantly influence survival, illustrating the dual functionality of lymphocytes in responding to infections. This study investigates this complex interaction, focusing on how variations in lymphocyte counts correlate with all-cause hospital mortality among sepsis patients. METHODS This retrospective cohort study analyzed data from two extensive critical care databases: the Medical Information Mart for Intensive Care IV 2.0 (MIMIC-IV 2.0) from Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the eICU Collaborative Research Database (eICU-CRD), which was Multi-center database from over 200 hospitals across the United States conducted by Philips eICU Research Institute. We included adult patients aged 18 years and older who met the Sepsis-3 criteria, characterized by documented or suspected infection and a Sequential Organ Failure Assessment (SOFA) score of 2 or higher. Sepsis patients were categorized into quartiles based on lymphocyte counts. The primary outcome was all-cause mortality in the hospital, with 90 and 60-day all-cause mortality as the secondary outcomes. Univariable and multivariable Cox proportional hazard regressions were utilized to assess lymphocyte counts' impact on hospital mortality. An adjusted restricted cubic spline (RCS) analysis was performed to elucidate this relationship further. Subgroup analyses were also conducted to explore the association across various comorbidity groups among sepsis and septic shock patients. RESULTS Our study included 37,054 patients, with an observed in-hospital mortality rate of 16.6%. Univariable and multivariable Cox proportional hazard regression models showed that lymphocyte counts were independently associated with in-hospital mortality (HR = 1.04, P < 0.01; HR = 1.06, P < 0.01). RCS regression analysis revealed a U-shaped relationship between lymphocyte levels and hospital mortality risk in sepsis and septic shock patients (P for overall < 0.001, P for nonliner < 0.01; P for overall = 0.002, P for nonliner = 0.014). Subgroup analyses revealed that elevated lymphocyte counts correlated with increased hospital mortality among sepsis patients with liver disease and requiring renal replacement therapy (P for overall = 0.021, P for nonliner = 0.158; P for overall = 0.025, P for nonliner = 0.759). These findings suggest that lymphocytes may have enhanced prognostic value in specific subsets of critically ill sepsis patients. CONCLUSION Our findings demonstrate that lymphocyte counts are a significant independent predictor of hospital mortality in sepsis and septic shock patients. We observed a U-shaped association between lymphocyte levels and mortality risk, indicating that high and low counts are linked to increased mortality. This result highlights the complex role of lymphocytes in sepsis outcomes and suggests the need for further investigation into the underlying mechanisms and potential therapeutic approaches. Integrating lymphocyte count assessment into risk stratification algorithms and clinical decision support tools could enhance the early identification of high-risk sepsis patients.
Collapse
Affiliation(s)
- Guyu Zhang
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Tao Wang
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Le An
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - ChenChen Hang
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - XingSheng Wang
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Fei Shao
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Rui Shao
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Ziren Tang
- Emergency Medicine Clinical Research Center, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
6
|
Vélez-Pinto JF, Garcia-Arranz M, García-Bernal D, García Gómez-Heras S, Villarejo-Campos P, García-Hernández AM, Vega-Clemente L, Jiménez-Galanes S, Guadalajara H, Moraleda JM, García-Olmo D. Therapeutic effect of adipose-derived mesenchymal stem cells in a porcine model of abdominal sepsis. Stem Cell Res Ther 2023; 14:365. [PMID: 38087374 PMCID: PMC10717819 DOI: 10.1186/s13287-023-03588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The term sepsis refers to a complex and heterogeneous syndrome. Although great progress has been made in improving the diagnosis and treatment of this condition, it continues to have a huge impact on morbidity and mortality worldwide. Mesenchymal stem cells are a population of multipotent cells that have immunomodulatory properties, anti-apoptotic effects, and antimicrobial activity. We studied these capacities in a porcine model of peritoneal sepsis. METHODS We infused human adipose-derived mesenchymal stem cells (ADSCs) into a porcine model of peritoneal sepsis. Twenty piglets were treated with antibiotics alone (control group) or antibiotics plus peritoneal infusion of ADSCs at a concentration of 2 × 106 cells/kg or 4 × 106 cells/kg (low- and high-dose experimental groups, respectively). The animals were evaluated at different time points to determine their clinical status, biochemical and hematologic parameters, presence of inflammatory cytokines and chemokines in blood and peritoneal fluid, and finally by histologic analysis of the organs of the peritoneal cavity. RESULTS One day after sepsis induction, all animals presented peritonitis with bacterial infection as well as elevated C-reactive protein, haptoglobin, IL-1Ra, IL-6, and IL-1b. Xenogeneic ADSC infusion did not elicit an immune response, and peritoneal administration of the treatment was safe and feasible. One day after infusion, the two experimental groups showed a superior physical condition (e.g., mobility, feeding) and a significant increase of IL-10 and TGF-β in blood and a decrease of IL-1Ra, IL-1b, and IL-6. After 7 days, all animals treated with ADSCs had better results concerning blood biomarkers, and histopathological analysis revealed a lower degree of inflammatory cell infiltration of the organs of the peritoneal cavity. CONCLUSIONS Intraperitoneal administration of ADSCs as an adjuvant therapy for sepsis improves the outcome and diminishes the effects of peritonitis and associated organ damage by regulating the immune system and reducing intra-abdominal adhesions in a clinically relevant porcine model of abdominal sepsis.
Collapse
Affiliation(s)
- J F Vélez-Pinto
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
| | - M Garcia-Arranz
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain.
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain.
| | - D García-Bernal
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
- Biochemistry, Molecular Biology and Immunology Department, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - S García Gómez-Heras
- Department of Basic Health Science, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain
| | - P Villarejo-Campos
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
| | - A M García-Hernández
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - L Vega-Clemente
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain
| | - S Jiménez-Galanes
- Department of Surgery, Infanta Elena University Hospital, 28342, Valdemoro, Madrid, Spain
| | - H Guadalajara
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - J M Moraleda
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria (IMIB) Pascual Parrilla, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - D García-Olmo
- Surgery Department, Fundación Jiménez Díaz University Hospital, 28033, Madrid, Spain
- New Therapy Laboratory, Health Research Institute of the Jimenez Diaz Foundation (Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz), Avda Reyes Católicos 2, 28040, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| |
Collapse
|
7
|
Domnicu AE, Boia ER, Mogoi M, Manea AM, Marcovici TM, Mărginean O, Boia M. The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis's Presence and Severity in Malnourished Infants-A Single Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1616. [PMID: 37892278 PMCID: PMC10605152 DOI: 10.3390/children10101616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has a deleterious effect on cellular immune competence, the present study characterized the acute-phase response, including hematological indices, in response to sepsis. Among the examined laboratory biomarkers, procalcitonin and neutrophil-to-lymphocyte ratio were the most accurate discriminators between sepsis patients and those with bacterial infection. Moreover, these two parameters showed a gradual increase between sepsis, severe sepsis, and septic shock patients (p < 0.001). Subgroup analysis of the sepsis group revealed positive correlations of NLR with prolonged ICU stay (<0.001), acute organ dysfunction (0.038), mechanical ventilation (<0.001), and fatality (<0.001). In summary, our results suggest that the neutrophil-to-lymphocyte ratio can be used as an auxiliary diagnostic index in discriminating the presence and severity of bacterial sepsis in malnourished infants.
Collapse
Affiliation(s)
- Alina Emilia Domnicu
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
| | - Eugen Radu Boia
- Department IX Surgery I, Discipline ENT, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- ENT Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Mirela Mogoi
- Pediatric Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Aniko-Maria Manea
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
| | - Tamara Marcela Marcovici
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Department of Pediatrics I, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children—BELIVE, 300011 Timisoara, Romania
| | - Marioara Boia
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
| |
Collapse
|
8
|
Nedel W, Deutschendorf C, Portela LVC. Sepsis-induced mitochondrial dysfunction: A narrative review. World J Crit Care Med 2023; 12:139-152. [PMID: 37397587 PMCID: PMC10308342 DOI: 10.5492/wjccm.v12.i3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/08/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023] Open
Abstract
Sepsis represents a deranged and exaggerated systemic inflammatory response to infection and is associated with vascular and metabolic abnormalities that trigger systemic organic dysfunction. Mitochondrial function has been shown to be severely impaired during the early phase of critical illness, with a reduction in biogenesis, increased generation of reactive oxygen species and a decrease in adenosine triphosphate synthesis of up to 50%. Mitochondrial dysfunction can be assessed using mitochondrial DNA concentration and respirometry assays, particularly in peripheral mononuclear cells. Isolation of monocytes and lymphocytes seems to be the most promising strategy for measuring mitochondrial activity in clinical settings because of the ease of collection, sample processing, and clinical relevance of the association between metabolic alterations and deficient immune responses in mononuclear cells. Studies have reported alterations in these variables in patients with sepsis compared with healthy controls and non-septic patients. However, few studies have explored the association between mitochondrial dysfunction in immune mononuclear cells and unfavorable clinical outcomes. An improvement in mitochondrial parameters in sepsis could theoretically serve as a biomarker of clinical recovery and response to oxygen and vasopressor therapies as well as reveal unexplored pathophysiological mechanistic targets. These features highlight the need for further studies on mitochondrial metabolism in immune cells as a feasible tool to evaluate patients in intensive care settings. The evaluation of mitochondrial metabolism is a promising tool for the evaluation and management of critically ill patients, especially those with sepsis. In this article, we explore the pathophysiological aspects, main methods of measurement, and the main studies in this field.
Collapse
Affiliation(s)
- Wagner Nedel
- Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre 91350200, Brazil
- Laboratory of Neurotrauma and Biomarkers, Departamento de Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Brazilian Research in Intensive Care Network-BRICNet, São Paulo 04039-002, Brazil
| | - Caroline Deutschendorf
- Infection Control Committee, Hospital de Clínicas de Porto Alegre, Porto Alegre 90410-000, Brazil
| | - Luis Valmor Cruz Portela
- Laboratory of Neurotrauma and Biomarkers, Departamento de Bioquímica, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| |
Collapse
|
9
|
Tang Y, Wu J, Tian Y, Wang J, Wang M, Zong S, Wan C, Wang M, Zhu J. Predictive value of peripheral lymphocyte subsets for the disease progression in patients with sepsis. Int Immunopharmacol 2023; 117:109922. [PMID: 37012888 DOI: 10.1016/j.intimp.2023.109922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To investigate the predictive value of peripheral lymphocyte subsets for sepsis progression. METHODS Patients with sepsis were divided into the improved group (n = 46) and severe group (n = 39) according to disease progression. Flow cytometric analysis was performed to enumerate absolute counts of peripheral lymphocyte subsets. Logistic regression analyses were conducted to identify clinical factors linked to sepsis progression. RESULTS The absolute counts of peripheral lymphocyte subsets were markedly decreased in septic patients compared with healthy controls. After treatment, the absolute counts of lymphocytes, CD3+ T cells, and CD8+ T cells were restored in the improved group, and reduced in the severe group. Logistic regression analysis indicated that a low CD8+ T cells count was a risk factor for sepsis progression. Receiver operating characteristic curve analysis revealed that CD8+ T cells count had the greatest ability to predict sepsis progression. CONCLUSIONS The absolute counts of CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and natural killer cells were significantly higher in the improved group than the severe group. CD8+ T cells count was predictive of sepsis progression. Lymphopenia and CD8+ T cells depletion were associated with the clinical outcomes of sepsis, suggesting that CD8+ T cells have potential as a predictive biomarker and therapeutic target for patients with sepsis.
Collapse
Affiliation(s)
- Yawei Tang
- Department of Flow Cytometry Center, Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China
| | - Jingxue Wu
- Department of Flow Cytometry Center, Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China
| | - Yao Tian
- Department of Flow Cytometry Center, Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China
| | - Jiao Wang
- Department of Flow Cytometry Center, Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China
| | - Mingjie Wang
- Nanjing Huaixi Medical Technology Co., Ltd., Nanjing, China
| | - Shouyang Zong
- Department of Clinical Laboratory, Jinhu County People's Hospital, Huai'an, China
| | - Changchun Wan
- Department of Clinical Laboratory, Jinhu County People's Hospital, Huai'an, China
| | - Min Wang
- Department of Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China.
| | - Jie Zhu
- Department of Flow Cytometry Center, Clinical Laboratory, the Second Hospital of Dalian Medical University, Dalian, China.
| |
Collapse
|
10
|
Dong X, Tu H, Qin S, Bai X, Yang F, Li Z. Insights into the Roles of B Cells in Patients with Sepsis. J Immunol Res 2023; 2023:7408967. [PMID: 37128298 PMCID: PMC10148744 DOI: 10.1155/2023/7408967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
Sepsis is a life-threatening yet common disease, still posing high mortality worldwide. Sepsis-related deaths primarily occur during immunosuppression; the disease can hamper the numbers and function of B cells, which mediate innate and adaptive immune responses to maintain immune homeostasis. Dysfunction of B cells, along with aggravated immunosuppression, are closely related to poor prognosis. However, B cells in patients with sepsis have garnered little attention. This article focuses on the significance of B-cell subsets, including regulatory B cells, in sepsis and how the counts and function of circulating B cells are affected in patients with sepsis. Finally, potential B-cell-related immunotherapies for sepsis are explored.
Collapse
Affiliation(s)
- Xijie Dong
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hao Tu
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shuang Qin
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangjun Bai
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Fan Yang
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhanfei Li
- Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|
11
|
Martí‐Chillón G, Muntión S, Preciado S, Osugui L, Navarro‐Bailón A, González‐Robledo J, Sagredo V, Blanco JF, Sánchez‐Guijo F. Therapeutic potential of mesenchymal stromal/stem cells in critical-care patients with systemic inflammatory response syndrome. Clin Transl Med 2023; 13:e1163. [PMID: 36588089 PMCID: PMC9806020 DOI: 10.1002/ctm2.1163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite notable advances in the support and treatment of patients admitted to the intensive care unit (ICU), the management of those who develop a systemic inflammatory response syndrome (SIRS) still constitutes an unmet medical need. MAIN BODY Both the initial injury (trauma, pancreatitis, infections) and the derived uncontrolled response promote a hyperinflammatory status that leads to systemic hypotension, tissue hypoperfusion and multiple organ failure. Mesenchymal stromal/stem cells (MSCs) are emerging as a potential therapy for severe ICU patients due to their potent immunomodulatory, anti-inflammatory, regenerative and systemic homeostasis-regulating properties. MSCs have demonstrated clinical benefits in several inflammatory-based diseases, but their role in SIRS needs to be further explored. CONCLUSION In the current review, after briefly overviewing SIRS physiopathology, we explore the potential mechanisms why MSC therapy could aid in the recovery of this condition and the pre-clinical and early clinical evidence generated to date.
Collapse
Affiliation(s)
| | - Sandra Muntión
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Silvia Preciado
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Lika Osugui
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Almudena Navarro‐Bailón
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Javier González‐Robledo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
| | | | - Juan F. Blanco
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
- Department of SurgeryUniversity of SalamancaSalamancaSpain
| | - Fermín Sánchez‐Guijo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| |
Collapse
|
12
|
Developing a new sepsis screening tool based on lymphocyte count, international normalized ratio and procalcitonin (LIP score). Sci Rep 2022; 12:20002. [PMID: 36411279 PMCID: PMC9678875 DOI: 10.1038/s41598-022-16744-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Exploring an effective sepsis screening tool that can be widely implemented is important for improving the prognosis of sepsis worldwide. This study aimed to develop a new simple screening tool for sepsis (LIP scoring system) that includes the peripheral blood lymphocyte count, international normalized ratio, and procalcitonin level. In a single-center, prospective, observational study, 444 acute sepsis inpatients and 444 nonsepsis inpatients were ultimately included based on the Sepsis-3 and exclusion criteria. The differences in the Lym, INR, PCT level and other clinical biomarkers were compared between the two groups. Univariable and multivariable logistic regression analyses and receiver operating characteristic analysis were used to establish a LIP screening tool for sepsis with a combination of biomarkers. The Kappa and McNemar tests were used to evaluate the differences between the LIP screening results (LIP score ≥ 3) and Sepsis-3 criteria (SOFA score ≥ 2). Logistic regression analysis showed that the lymphocyte count, INR, PCT level, platelets, neutrophil/lymphocyte ratio (NLR) and prothrombin time (PT) were independent risk factors for the development of sepsis. The ROC analysis showed that the lymphocyte count, INR, and PCT level had high area under the ROC curve values (AUROC (95% CI): Lym 0.84 (0.810-0.860), INR 0.921 (0.902-0.938), PCT level 0.928 (0.909-0.944)). The LIP tool had satisfactory screening efficacy for sepsis (sensitivity, 92.8%; specificity, 94.1%), and a LIP score equal to or greater than 3 points had good agreement with Sepsis-3 criteria in the diagnosis of sepsis (Kappa = 0862 in the Kappa test and P = 0.512 in the McNemar test). The LIP tool has satisfactory sensitivity and specificity for sepsis screening, and it can be used for rapid screening of patients with sepsis in outpatient and emergency departments or in economically underdeveloped areas with limited resources.
Collapse
|
13
|
T cell dysregulation in inflammatory diseases in ICU. Intensive Care Med Exp 2022; 10:43. [PMID: 36279072 PMCID: PMC9590394 DOI: 10.1186/s40635-022-00471-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Severe inflammatory diseases, including sepsis, are characterized by an impaired host adaptive and innate immunity which results in immunosuppression, responsible for secondary infections and increased morbidity and mortality in critically ill patients. T cells are major actors of the immune system. During post-aggressive immunosuppression, lymphopenia, reduction of innate T cells, changes in T helper cell polarization and regulatory T cell increase are observed. The main mechanisms involved in T cell dysregulation are T cell apoptosis, autophagy deficiency, T cell anergy, T cell exhaustion and T cell metabolic reprogramming. In this review, we describe the alterations of T cell regulation, their mechanisms, and their association with clinical outcomes in severe inflammatory diseases, foremost of which is the sepsis. This review focuses on the alterations of T cell regulation and their mechanisms in severe inflammatory ICU diseases. Lymphopenia, reduction of innate T cells, changes in T helper cell polarization and regulatory T cell increase contribute to secondary immunosuppression in ICU patients.
Collapse
|
14
|
ICU and Sepsis: Role of Myeloid and Lymphocyte Immune Cells. JOURNAL OF ONCOLOGY 2022; 2022:7340266. [PMID: 36199798 PMCID: PMC9527402 DOI: 10.1155/2022/7340266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Sepsis is a severe immune system reaction to infection and a major cause of ICU-related fatalities. Because of the high mortality, high cost of treatment, and complex aetiology of sepsis, sepsis has a huge impact on healthcare. Some of the health complications in sepsis are abnormal cardiac functions, hypoperfusion, hypotension, tissue damage, multiple organ failure, and ultimately death. Individuals with weak immune systems and chronic medical conditions are highly vulnerable to sepsis. In sepsis, a patient shows the extreme immune response in the initial stage while prolonged immunosuppression in the later stages. Sepsis-driven immunosuppression ushers in death because sepsis cases develop secondary infections postrecovery. The later immunocompromised state in sepsis is attributed myeloid-derived suppressor cell upregulation and reduced immune activity displayed by lymphocytes (lymphocyte anergy). As a result, it is currently suggested that regulating the immune response is a better therapeutic approach than focusing on inflammation to improve the immune system's capacity to fight infections. Moreover, finding novel and accurate prognostic biomarkers that can help in rapid sepsis diagnoses and deciding better therapeutic strategies will significantly lower clinical case mortality rates.
Collapse
|
15
|
Kazmi I, Al-Abbasi FA, Afzal M, Nadeem MS, Altayb HN, Gupta G. Phosphodiesterase-4 Inhibitor Roflumilast-Mediated Protective Effect in Sepsis-Induced Late-Phase Event of Acute Kidney Injury: A Narrative Review. Pharmaceuticals (Basel) 2022; 15:ph15070899. [PMID: 35890197 PMCID: PMC9315747 DOI: 10.3390/ph15070899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Severe infections such as viral, bacterial, or fungal sepsis can cause an inflammatory response in the host, leading to organ failure and septic shock—phosphodiesterase-4 (PDE-4) inhibiting related agents from suppressing cyclic adenosine monophosphate (cAMP) degradation. Regulatory organisations have approved some substances in this category to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with chronic bronchitis and a history of COPD exacerbations. Roflumilast has been shown to alleviate inflammatory responses, thus regulating airway inflammation. Additionally, roflumilast therapy dramatically enhanced B-cell lymphoma 2 (Bcl-2) expression, an anti-apoptotic marker lowered in septic animals. Previous research has indicated that roflumilast may help reverse sepsis-induced liver and lung harm, but whether it is also effective in reversing sepsis-induced renal impairment remains unknown. Therefore, this review determines whether roflumilast protects against renal dysfunction, inflammatory response, and apoptosis in sepsis-induced kidney damage. Additionally, we discussed the molecular mechanism through which roflumilast exerts its protective effect to uncover a possible treatment agent for sepsis-induced renal impairment.
Collapse
Affiliation(s)
- Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.A.A.-A.); (M.S.N.); (H.N.A.)
- Correspondence:
| | - Fahad A. Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.A.A.-A.); (M.S.N.); (H.N.A.)
| | - Muhammad Afzal
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakakah 72341, Saudi Arabia;
| | - Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.A.A.-A.); (M.S.N.); (H.N.A.)
| | - Hisham N. Altayb
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.A.A.-A.); (M.S.N.); (H.N.A.)
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura 302017, Jaipur, India;
- Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602105, Tamil Nadu, India
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, Uttarakhand, India
| |
Collapse
|
16
|
Ni L, Bai R, Zhou Q, Yuan C, Zhou LT, Wu X. The correlation between ferroptosis and m6A methylation in patients with acute kidney injury. Kidney Blood Press Res 2022; 47:523-533. [PMID: 35569444 DOI: 10.1159/000524900] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The present research analyzed the correlation between m6A methylation and ferroptosis associated genes (FAGs) in acute kidney injury (AKI) patients. METHODS Bioinformatics analysis of microarray profiles (GSE30718) were performed to select differential expression genes (DEGs). FAGs are derived from systematic analysis of the aberrances and functional implications. The m6A methylation related genes were derived from the molecular characterization and clinical significance of m6A modulators. The multi-gene correlation of ferroptosis and M6A methylation modification were displayed. Then, the CIBERSORT algorithm was used to analyse the proportions of 22 immune cells infiltration. RESULTS In total, 349 DEGs were extracted between the AKI and control samples, among which 172 genes were up-regulated and 177 were down-regulated. FAGs (SLC1A5, CARS, SAT1, ACSL4, NFE2L2, TFRC and MT1G) and m6A methylation related genes (YTHDF3, WTAP and IGF2BP3) were significantly increased in AKI patients (P< 0.05). FAGs (SAT1, ACSL4 and NFE2L2) was positively correlated with the expression level of m6A methylation genes (P< 0.05). NFE2L2 has high diagnostic value, and level of NFE2L2 was negatively correlated with the degree of follicular helper T (TFH) cells infiltration. CONCLUSION Our research could provide a new theoretical basis for the pathogenesis and immune mechanism of AKI.
Collapse
Affiliation(s)
- Lihua Ni
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui Bai
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiuyuan Zhou
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Pathology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Cheng Yuan
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Le-Ting Zhou
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
17
|
Singh Y, Fuloria NK, Fuloria S, Subramaniyan V, Almalki WH, Al-Abbasi FA, Kazmi I, Rajput SS, Joshi N, Gupta G. A European pharmacotherapeutic agent roflumilast exploring integrated preclinical and clinical evidence for SARS CoV-2 mediated inflammation to organ damage. Br J Clin Pharmacol 2022; 88:3562-3565. [PMID: 35352842 PMCID: PMC9111419 DOI: 10.1111/bcp.15328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/18/2022] [Accepted: 03/19/2022] [Indexed: 12/29/2022] Open
Abstract
COVID‐19 has spread globally, affecting almost 160 million individuals. Elderly and pre‐existing patients (such as diabetes, heart disease and asthma) seem more susceptible to severe illness with COVID‐19. Roflumilast was licensed for usage in the European Union in July 2010 as a phosphodiesterase‐4 (PDE4) inhibitor. Under preclinical studies, roflumilast has been shown to decrease bleomycin‐induced lung fibrosis, lung hydroxyproline and right heart thickening. The current study reviewed existing data that the PDE‐4 inhibitor, a roflumilast, protects renal tissues and other major organ systems after COVID‐19 infection by decreasing immune cell infiltration. These immune‐balancing effects of roflumilast were related to a decrease in oxidative and inflammatory burden, caspase‐3 suppression and increased protein kinase A (PKA)/cyclic A.M.P. (cAMP) levels in renal and other organ tissue.
Collapse
Affiliation(s)
- Yogendra Singh
- Department of Pharmacology, Maharishi Arvind College of Pharmacy, Jaipur, India
| | | | | | | | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fahad A Al-Abbasi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Nirmal Joshi
- Amrapali Institute of Pharmacy and Sciences, Haldwani, India
| | - Gaurav Gupta
- Department of Pharmacology, School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India.,Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| |
Collapse
|
18
|
Li X, Liu C, Wang X, Mao Z, Yi H, Zhou F. Comparison of Two Predictive Models of Sepsis in Critically Ill Patients Based on the Combined Use of Inflammatory Markers. Int J Gen Med 2022; 15:1013-1022. [PMID: 35140504 PMCID: PMC8818968 DOI: 10.2147/ijgm.s348797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 01/08/2023] Open
Abstract
Background Sepsis is a systemic inflammatory response due to infection, resulting in organ dysfunction. Timely targeted interventions can improve prognosis. Inflammation plays a crucial role in the process of sepsis. To identify potential sepsis early, we developed and validated a nomogram model and a simple risk scoring model for predicting sepsis in critically ill patients. Methods The medical records of adult patients admitted to our intensive care unit (ICU) from August 2017 to December 2020 were analyzed. Patients were randomly divided into a training cohort (70%) and a validation cohort (30%). A nomogram model was developed through multivariate logistic regression analysis. The continuous variables included in nomogram model were transformed into dichotomous variables. Then, a multivariable logistic regression analysis was performed based on these dichotomous variables, and the odds ratio (OR) for each variable was used to construct a simple risk scoring model. The receiver operating characteristic curves (ROC) were constructed, and the area under the curve (AUC) was calculated. Results A total of 2074 patients were enrolled. Finally, white blood cell (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) were included in our models. The AUC of the nomogram model and the simple risk scoring model were 0.854 and 0.842, respectively. The prediction performance of the two models on sepsis is comparable (p = 0.1298). Conclusion This study combining five commonly available inflammatory markers (WBC, CRP, IL-6, PCT and NLR) developed a nomogram model and a simple risk scoring model to predict sepsis in critically ill patients. Although the prediction performance of the two models is comparable, the simple risk scoring model may be simpler and more practical for clinicians to identify potential sepsis in critically ill patients at an early stage and strategize treatments.
Collapse
Affiliation(s)
- Xiaoming Li
- Medical School of Chinese PLA, Beijing, People’s Republic of China
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chao Liu
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiaoli Wang
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Hongyu Yi
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Correspondence: Feihu Zhou, Critical Care Medicine, The First Medical Centre, Chinese People’s Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People’s Republic of China, Tel +86-10-66938148, Fax +86-10-88219862, Email
| |
Collapse
|
19
|
Lambe G, Mansukhani D, Khodaiji S, Shetty A, Rodrigues C, Kapadia F. Immune Modulation and Cytomegalovirus Reactivation in Sepsis-induced Immunosuppression: A Pilot Study. Indian J Crit Care Med 2022; 26:53-61. [PMID: 35110845 PMCID: PMC8783232 DOI: 10.5005/jp-journals-10071-24079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Sepsis is a life-threatening condition caused due to dysregulated immune response to an infection and progressive immunosuppression. Reactivation of cytomegalovirus (CMV) occurs frequently in sepsis and is found associated with adverse outcomes. The study objective was to evaluate the association between incidence of CMV reactivation and immune alteration in sepsis-induced immunosuppression in patients with prolonged sepsis. Patients and methods Patients admitted to intensive care unit (ICU), with severe sepsis and CMV immunoglobulin G (IgG) seropositivity, were prospectively enrolled. Other manifest immune suppression causes were excluded. Samples were collected on enrolment and further once a week until day 21 or death/discharge. CMV viral load was quantified using qPCR. Lymphocyte subset analysis (CD3+, CD4+, CD8+, CD19+, CD16+/CD56+, and CD25+CD127− regulatory T cells), human leukocyte antigen-DR isotype (HLA-DR) expression on monocytes, programmed death-1 (PD-1) expression on T lymphocytes, and proinflammatory (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ)), anti-inflammatory cytokines levels (IL-2, IL-4, and IL-10) were analyzed by flow cytometry as markers for immunosuppression. Results A total of 25 CMV IgG-positive patients and 11 healthy controls were included. CMV reactivation occurred in 20 patients. Patients with CMV reactivation had T-cell lymphopenia. PD-1 expression on CD4+ and CD8+ T cells was markedly elevated (p <0.02) in CMV-reactivated patients compared to nonreactivated patients. HLA-DR expression was significantly low on monocytes in all septic patients (p <0.01) compared to healthy controls. IL-6 levels showed elevation at day 7, whereas IL-10 was found to be significantly higher from day 0 in CMV-reactivated group. Conclusion Our study concluded that immune suppression markers and cytokine levels in patients with severe sepsis were found to be significantly associated with the incidence of CMV reactivation. How to cite this article Lambe G, Mansukhani D, Khodaiji S, Shetty A, Rodrigues C, Kapadia F. Immune Modulation and Cytomegalovirus Reactivation in Sepsis-induced Immunosuppression: A Pilot Study. Indian J Crit Care Med 2022;26(1):53–61.
Collapse
Affiliation(s)
- Gaurav Lambe
- Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India; Department of Critical Care, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Dia Mansukhani
- Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Shanaz Khodaiji
- Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
- Shanaz Khodaiji, Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India, Phone: +91 9820551848, e-mail:
| | - Anjali Shetty
- Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Camilla Rodrigues
- Department of Laboratory Medicine, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Farhad Kapadia
- Department of Intensive Care, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
20
|
Li T, Qi M, Dong G, Li X, Xu Z, Wei Y, Feng Y, Ren C, Wang Y, Yang J. Clinical Value of Prognostic Nutritional Index in Prediction of the Presence and Severity of Neonatal Sepsis. J Inflamm Res 2022; 14:7181-7190. [PMID: 34992413 PMCID: PMC8710072 DOI: 10.2147/jir.s343992] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose The prognostic nutritional index (PNI) is a common indicator of nutritional and inflammatory status and is associated with various diseases such as cancer, cardiovascular diseases and infectious diseases. However, to date, no study has concentrated on the role of PNI in assessing and predicting the presence and severity of neonatal sepsis. Therefore, the present study aimed to explore the association of the PNI with the presence and severity of neonatal sepsis. Materials and Methods A total of 1196 neonates with suspected sepsis were enrolled in this study and their complete clinical and laboratory data were collected. PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Multivariate logistic regression analysis was performed to identify the risk factors for the presence and severity of neonatal sepsis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PNI. All statistical analyses were performed using the statistical package SPSS 24.0. Results PNI was lower in neonates with sepsis and decreased significantly with the severity of sepsis. The correlation analysis demonstrated that the PNI was negatively correlated with the levels of the inflammatory marker procalcitonin (PCT) and C-reactive protein (CRP), and the length of hospital stay. Multivariate logistic regression analysis revealed that the PNI was independently and inversely associated with the presence and severity of neonatal sepsis. The area under the ROC curve of the PNI was 0.64 (95% confidence interval (CI): 0.61–0.67, P < 0.001) for severe sepsis and 0.69 (95% CI: 0.60–0.78, P < 0.001) for septic shock. In addition, our data revealed that PNI was also independently correlated with the length of hospital stay. Conclusion PNI is an independent predictor for the presence and severity of neonatal sepsis.
Collapse
Affiliation(s)
- Tiewei Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Minglu Qi
- Department of Emergency Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Geng Dong
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Xiaojuan Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yulei Wei
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yichuang Feng
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Chong Ren
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yaguo Wang
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| |
Collapse
|
21
|
Ohyagi M, Nagata T, Ihara K, Yoshida-Tanaka K, Nishi R, Miyata H, Abe A, Mabuchi Y, Akazawa C, Yokota T. DNA/RNA heteroduplex oligonucleotide technology for regulating lymphocytes in vivo. Nat Commun 2021; 12:7344. [PMID: 34937876 PMCID: PMC8695577 DOI: 10.1038/s41467-021-26902-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Manipulating lymphocyte functions with gene silencing approaches is promising for treating autoimmunity, inflammation, and cancer. Although oligonucleotide therapy has been proven to be successful in treating several conditions, efficient in vivo delivery of oligonucleotide to lymphocyte populations remains a challenge. Here, we demonstrate that intravenous injection of a heteroduplex oligonucleotide (HDO), comprised of an antisense oligonucleotide (ASO) and its complementary RNA conjugated to α-tocopherol, silences lymphocyte endogenous gene expression with higher potency, efficacy, and longer retention time than ASOs. Importantly, reduction of Itga4 by HDO ameliorates symptoms in both adoptive transfer and active experimental autoimmune encephalomyelitis models. Our findings reveal the advantages of HDO with enhanced gene knockdown effect and different delivery mechanisms compared with ASO. Thus, regulation of lymphocyte functions by HDO is a potential therapeutic option for immune-mediated diseases.
Collapse
MESH Headings
- Administration, Intravenous
- Adoptive Transfer
- Animals
- Demyelinating Diseases/genetics
- Demyelinating Diseases/immunology
- Demyelinating Diseases/pathology
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Endocytosis/drug effects
- Female
- Gene Expression Regulation
- Gene Silencing
- Graft vs Host Disease/genetics
- Graft vs Host Disease/immunology
- Humans
- Integrin alpha4/genetics
- Integrin alpha4/metabolism
- Jurkat Cells
- Lymphocytes/metabolism
- Male
- Mice, Inbred C57BL
- Nucleic Acid Heteroduplexes/administration & dosage
- Nucleic Acid Heteroduplexes/metabolism
- Nucleic Acid Heteroduplexes/pharmacokinetics
- Nucleic Acid Heteroduplexes/pharmacology
- Oligonucleotides/administration & dosage
- Oligonucleotides/metabolism
- Oligonucleotides/pharmacokinetics
- Oligonucleotides/pharmacology
- RNA/metabolism
- RNA, Long Noncoding/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Spinal Cord/pathology
- Tissue Distribution/drug effects
- Mice
Collapse
Affiliation(s)
- Masaki Ohyagi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Nagata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kensuke Ihara
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kie Yoshida-Tanaka
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rieko Nishi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Miyata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Abe
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yo Mabuchi
- Department of Biochemistry and Biophysics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chihiro Akazawa
- Department of Biochemistry and Biophysics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan.
| |
Collapse
|
22
|
Metabolic syndrome improves cardiovascular dysfunction and survival during cecal ligation and puncture-induced mild sepsis in mice. Life Sci 2021; 286:120033. [PMID: 34627775 DOI: 10.1016/j.lfs.2021.120033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 12/21/2022]
Abstract
AIMS Sepsis is a potentially fatal systemic inflammatory response and its underlying pathophysiology is still poorly understood. Studies suggest that obesity, a component of metabolic syndrome (MS), is associated with sepsis survival. Therefore, this study focused on investigating the influence of MS on mortality and cardiovascular dysfunction induced by sublethal cecal ligation and puncture (SL-CLP). MAIN METHODS Newborn Swiss mice received monosodium glutamate (MSG) (4 mg kg-1 day-1, s.c.) during the first 5 d of life for MS induction, while the control pups received equimolar saline solution. On the 75th day, SL-CLP was used to induce mild sepsis (M-CLP) in the MS (MS-M-CLP) and control (SAL-M-CLP) mice. The effect of MS on sepsis in mice was assessed by determining the survival rate and quantification of nitric oxide (NO) in the plasma, and associating this data with hematological and cardiovascular parameters. KEY FINDINGS MS improved the survival of septic mice, preventing impairment to hematological and cardiovascular parameters. In addition, MS attenuated plasmatic NO increase, which is a typical feature of sepsis. SIGNIFICANCE These findings provide new insights into the relationship between obesity and mild sepsis in mice, thus revealing an approach in favor of the "obesity paradox."
Collapse
|
23
|
Shen DS, Yan C, Liang Y, Chen KH, Zhu XD. Prognostic Significance of Circulating Lymphocyte Subsets Before Treatment in Patients with Nasopharyngeal Carcinoma. Cancer Manag Res 2021; 13:8109-8120. [PMID: 34737639 PMCID: PMC8558319 DOI: 10.2147/cmar.s334094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose We set out to explore the prognostic value of circulating lymphocyte subsets in patients with nasopharyngeal carcinoma (NPC) before treatment and to investigate changes in lymphocyte subsets resulting from chemoradiotherapy. Patients and Methods This retrospective study included 677 patients with non-metastatic NPC. The cutoff value of lymphocyte subsets was determined by the receiver operating characteristic curve (ROC), and the prognostic significance of lymphocyte subsets was evaluated by the Log rank test and Cox proportional hazards model. The endpoints were overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). Differences in lymphocyte subsets before and after chemoradiotherapy were analyzed by Wilcoxon signed rank test. Results NPC patients with high levels of CD19+ B cells (>9.55%) had better 5-year OS (90.4% VS 76.8%, P < 0.001), 5-year PFS (85.3% VS 71.6%, P < 0.001) and 5-year DMFS (94% VS 86.8%, P = 0.002) than patients with low levels of CD19+ B cells. Patients with high levels of CD4+ T cells (> 37.05%) had better 5-year PFS (83% VS 74.2%, P = 0.015) and better 5-year DMFS (95.8% VS 86.7%, P < 0.001) than those with low levels of CD4+ T cells. Multivariate analyses indicated that CD19+ B cell was an independent prognostic factor for OS, PFS and DMFS in NPC. And CD4+ T cell was an independent prognostic factor for PFS and DMFS. Within 1 month after chemoradiotherapy, the percentages of CD4+ T cells, CD19+ B cells, and the CD4/CD8 ratio decreased significantly, while the percentages of CD8+ T cells increased significantly. Conclusion NPC patients with low levels of CD19+ B cells or CD4+ T cells before treatment have a poor prognosis. In addition, chemoradiotherapy may reduce the body’s immune function in NPC patients.
Collapse
Affiliation(s)
- De-Song Shen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Chang Yan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Yu Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China.,Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, People's Republic of China
| |
Collapse
|
24
|
Polilli E, Esposito JE, Frattari A, Trave F, Sozio F, Ferrandu G, Di Iorio G, Parruti G. Circulating lymphocyte subsets as promising biomarkers to identify septic patients at higher risk of unfavorable outcome. BMC Infect Dis 2021; 21:780. [PMID: 34372784 PMCID: PMC8351421 DOI: 10.1186/s12879-021-06481-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early recognition of patients hospitalized for sepsis at higher risk of poor clinical outcome is a mandatory task and many studies suggested that indicators of the immune status may be useful for this purpose. We performed a retrospective, monocentric cohort study to evaluate whether lymphocyte subsets may be useful in predicting in-hospital mortality of septic patients. METHODS Data of all consecutive patients with a diagnosis of sepsis at discharge and an available peripherical blood lymphocyte subset (CD4, CD8, CD16/CD56 and CD19) analysis at hospital entry were retrospectively collected between January 2015 and August 2018. Clinical characteristics of patients, past medical history and other laboratory parameters were also considered. RESULTS Two-hundred-seventy-eight septic patients, 171 (61.5%) males, mean age 63.2 ± 19.6 years, were enrolled. Total counts of lymphocytes, CD4 T cells, CD8 T cells and B cells were found significantly lower in deceased than in surviving patients. At univariate analyses, CD4 T cells/µL (OR 0.99 for each incremental unit, 95%CI 0.99-1.10, p < 0.0001), age (OR 1.06, 95%CI 1.04-1.09, p < 0.0001), procalcitonin (OR 1.01, 95%CI 1.01-1.02, p < 0.0001) and female gender (OR 2.81, 95%CI 1.49-5.28, p = 0.001) were associated with in-hospital mortality. When a dichotomic threshold of < 400/µL for CD4 T cells as a dependent variable was considered in multivariate models, age (OR 1.04; 95%CI 1.01-1.09, p = 0.018); female gender (OR 3.18; 95%CI 1.40-7.20, p = 0.006), qSOFA (OR 4.00, 95%CI 1.84-8.67, p < 0.001) and CD4 T cells < 400/µL (OR 5.3; 95%CI 1.65-17.00, p = 0.005) were the independent predictors. CONCLUSIONS In adjunct to biomarkers routinely determined for the prediction of prognosis in sepsis, CD4 T lymphocytes, measured at hospital entry, may be useful in identifying patients at higher risk of in-hospital death.
Collapse
Affiliation(s)
- Ennio Polilli
- Clinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | | | | | - Francesca Trave
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Federica Sozio
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | | | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
| |
Collapse
|
25
|
Gupta K, Pandey S, Singh R, Kumari A, Sen P, Singh G. Roflumilast improves resolution of sepsis-induced acute kidney injury by retarding late phase renal interstitial immune cells infiltration and leakage in urinary sediments. Fundam Clin Pharmacol 2021; 36:114-132. [PMID: 34212425 DOI: 10.1111/fcp.12711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 06/25/2021] [Indexed: 12/21/2022]
Abstract
Some evidence has demonstrated that both inflammation and immune cell dysregulation are coincident at late phase (post 24 h) of sepsis. The present study was designed to determine the pathological role of hyperinflammation and renal immune cells mobilization during late phase of sepsis induced acute kidney injury (S-AKI) and tests the pharmacological effects of PDE-4 inhibitor on these events. Sepsis was induced by cecal ligation puncture and renal function, oxidative-inflammatory stress biomarkers were assessed after 24 h. PDE-4 inhibitor was administered for 7 days prior to induction of S-AKI. Renal immune cells infiltration during sepsis was analyzed by H&E staining and papanicolaou staining method was used for detecting leukocytes and cast in urinary sediments, periodic acid schiff (PAS) staining was used for detection of brush border loss. AKI developed 24 h post sepsis insult as depicted by increase in serum creatinine, blood urea nitrogen (BUN), renal oxidative stress, and elevated inflammatory biomarkers levels. Moreover, septic rats displayed increased bacterial load, renal expression of phosphodiesterase-4B, 4D isoforms, enhanced vascular permeability, caspase-3 and myeloperoxidase activity, electrolyte imbalance, reduced Na+ K+ ATPase activity, declined cAMP levels, increased interstitial leukocyte infiltration, and leakage in urinary sediments along with histological alterations. Pre-treatment with roflumilast at high dose completely prevented the various AKI associated manifestations in septic rats. Renal hyper-inflammation and leukocyte infiltration was detected in late phase of S-AKI. Roflumilast pre-treatment resolved sepsis induced renal dysfunction and histological damage by suppressing late phase renal immune cells invasion and anti-inflammatory effects mediated by up-regulation of renal cAMP levels.
Collapse
Affiliation(s)
- Kirti Gupta
- Department of Pharmacy, Maharishi Markandeshwar University, Ambala, India
| | - Sneha Pandey
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Ragini Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Abha Kumari
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | - Pallavi Sen
- Department of Pharmacology, ISF College of Pharmacy, Moga, India
| | | |
Collapse
|
26
|
Su MI, Liu CW. Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia. PLoS One 2021; 16:e0252030. [PMID: 34043672 PMCID: PMC8158906 DOI: 10.1371/journal.pone.0252030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/08/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.
Collapse
Affiliation(s)
- Min-I. Su
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Wei Liu
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
27
|
Jarczak D, Kluge S, Nierhaus A. Sepsis-Pathophysiology and Therapeutic Concepts. Front Med (Lausanne) 2021; 8:628302. [PMID: 34055825 PMCID: PMC8160230 DOI: 10.3389/fmed.2021.628302] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a life-threatening condition and a global disease burden. Today, the heterogeneous syndrome is defined as severe organ dysfunction caused by a dysregulated host response to infection, with renewed emphasis on immune pathophysiology. Despite all efforts of experimental and clinical research during the last three decades, the ability to positively influence course and outcome of the syndrome remains limited. Evidence-based therapy still consists of basic causal and supportive measures, while adjuvant interventions such as blood purification or targeted immunotherapy largely remain without proof of effectiveness so far. With this review, we aim to provide an overview of sepsis immune pathophysiology, to update the choice of therapeutic approaches targeting different immunological mechanisms in the course of sepsis and septic shock, and to call for a paradigm shift from the pathogen to the host response as a potentially more promising angle.
Collapse
Affiliation(s)
- Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
28
|
β-Sitosterol Alters the Inflammatory Response in CLP Rat Model of Sepsis by Modulation of NF κB Signaling. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5535562. [PMID: 33997001 PMCID: PMC8105092 DOI: 10.1155/2021/5535562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/29/2021] [Accepted: 04/17/2021] [Indexed: 11/20/2022]
Abstract
Purpose Sepsis originates from the host inflammatory response, especially to bacterial infections, and is considered one of the main causes of death in intensive care units. Various agents have been developed to inhibit mediators of the inflammatory response; one prospective agent is β-sitosterol (βS), a phytosterol with a structure similar to cholesterol. This study is aimed at evaluating the effects of βS on the biomarkers of inflammation and liver function in cecal ligation and puncture- (CLP-) induced septic rats. Methods Thirty male Wistar rats were divided equally into six groups as follows: sham, CLP, CLP+dexamethasone (DX, 0.2 mg/kg), CLP+βS (1 mg/kg), CLP+imipenem (IMI, 20 mg/kg), and CLP+IMI (20 mg/kg)+βS (1 mg/kg). Serum levels of IL-1β, IL-6, IL-10, AST, ALT, and liver glutathione (GSH) were assessed by ELISA. Liver expression levels of TNF-α and NF-κBi mRNAs were evaluated by RT-qPCR. Results Serum concentrations of IL-1β, IL-6, IL-10, ALT, and AST and mRNA levels of TNF-α and NF-κBi were all significantly higher in septic rats than in normal rats (p < 0.05). Liver GSH content was markedly lower in the CLP group than that in the sham group. βS-treated rats had remarkably lower levels of IL-1β, IL-6, IL-10, TNF-α, NF-κBi, AST, and ALT (51.79%, 62.63%, 41.46%, 54.35%, 94.37%, 95.30%, 34.87%, and 46.53% lower, respectively) and greater liver GSH content (35.71% greater) compared to the CLP group (p < 0.05). Conclusion βS may play a protective role in the septic process by mitigating inflammation. This effect is at least partly mediated by inhibition of the NF-κB signaling pathway. Thus, βS can be considered as a supplementary treatment in septic patients.
Collapse
|
29
|
Aretha D, Leukaditou K, Fligou F, Akinosoglou K, Spyridonidis A, Nikolopoulou A, Assimakopoulos SF. Correlation of Immunoglobulins and Lymphocytes Levels With the Clinical and Microbiological Response of Septic Patients With Gram-Negative Bacteremia. J Clin Med Res 2021; 13:64-72. [PMID: 33613801 PMCID: PMC7869565 DOI: 10.14740/jocmr4409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/30/2020] [Indexed: 11/11/2022] Open
Abstract
Background Immunoglobulins (Igs) and cells of the innate and adaptive immune systems play a critical role in a host's response to sepsis. The aim of this study was to investigate the possible differences in the levels of Igs, white blood cells (WBCs), and T and B lymphocytes cells in relation to the microbiological and clinical responses of patients with sepsis or septic shock from carbapenem non-susceptible Gram-negative bacteria (CnS-GNB). Methods This pilot cohort study involved 24 hospitalized patients with sepsis or septic shock due to bacteremia from CnS-GNB. The microbiological and clinical responses of the patients were evaluated in relation to their blood levels of IgA, IgE, IgM and IgG, as well as WBCs and subpopulations of T and B cells upon sepsis diagnosis. A microbiological response was determined as clearance of bacteremia at 14 days of active antibiotic treatment for the isolated bacterial pathogen. Clinical response was defined as the resolution of all clinical and laboratory signs of infection and sepsis at 14 days of active antibiotic treatment for the isolated pathogen. Results From the 24 patients included in the study 18 (75%) and six patients (25%) presented and did not present microbiological response respectively, while 16 patients presented clinical response (64%) and eight patients (36%) did not have clinical response. The levels of the Igs did not show statistically significant differences between patients with sepsis from CnS-GNB bacteremia who exhibited microbiological or clinical response. There were also no statistically significant differences in the levels of WBCs and the subpopulations of T and B cells levels for these patients (P > 0.05). According to this pilot study, peripheral blood Igs and lymphocyte subpopulations levels do not affect the clinical and microbiological response of septic patients with bacteremia from CnS-GNB. Conclusions In patients with sepsis or septic shock from CnSGNB, there were no differences in the levels of Igs, circulating WBCs and T and B cells subpopulations between those with microbiological or clinical response and non-responders.
Collapse
Affiliation(s)
- Diamanto Aretha
- Intensive Care Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Katerina Leukaditou
- Intensive Care Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Fotini Fligou
- Intensive Care Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Karolina Akinosoglou
- Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| | | | | | - Stelios F Assimakopoulos
- Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| |
Collapse
|
30
|
Ferdjallah A, Young JAH, MacMillan ML. A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Front Pediatr 2021; 9:634449. [PMID: 34386464 PMCID: PMC8353083 DOI: 10.3389/fped.2021.634449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.
Collapse
Affiliation(s)
- Asmaa Ferdjallah
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Transplant Infectious Disease, University of Minnesota, Minneapolis, MN, United States
| | - Margaret L MacMillan
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
31
|
Association of Neutrophil-Lymphocyte Ratio and the Presence of Neonatal Sepsis. J Immunol Res 2020; 2020:7650713. [PMID: 33344658 PMCID: PMC7728472 DOI: 10.1155/2020/7650713] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
The neutrophil–lymphocyte ratio (NLR) is an emerging risk factor of sepsis that is receiving increasing attention. However, the relationship between NLR and the presence of sepsis in neonates is poorly studied. Here, we retrospectively recruited 1480 neonates and collected and analyzed relevant clinical and laboratory data. According to the International Pediatric Sepsis Consensus, 737 neonates were diagnosed with sepsis, and 555 neonates were suspected for having infection. Neonates with hyperbilirubinemia (n = 188) served as controls. Neonates with sepsis had significantly elevated neutrophil counts and NLR (P < 0.001). The proportion of neonates with sepsis increased significantly from 41.6% when NLR < 0.91 to 66.2% when NLR > 1.88 group (P < 0.001). Multiple logistic regression analysis showed that NLR was an independent risk factor for the presence of neonatal sepsis. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value NLR for predicting the presence of neonatal sepsis was 1.62 (area under curve (AUC) = 0.63, 95% CI 0.60–0.66, P < 0.001). In conclusion, our data suggest that elevated NLR levels are associated with a higher neonatal sepsis risk.
Collapse
|
32
|
Nierhaus A, Berlot G, Kindgen-Milles D, Müller E, Girardis M. Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis. Ann Intensive Care 2020; 10:132. [PMID: 33026597 PMCID: PMC7538847 DOI: 10.1186/s13613-020-00740-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high in those with septic shock. Intravenous immunoglobulins represent a promising therapy to modulate both the pro- and anti-inflammatory processes and can contribute to the elimination of pathogens. In this context, there is evidence of the benefits of immunoglobulin M (IgM)- and immunoglobulin A (IgA)-enriched immunoglobulin therapy for sepsis. This manuscript aims to summarize current relevant data to provide expert opinions on best practice for the use of an IgM- and IgA-enriched immunoglobulin (Pentaglobin) in adult patients with sepsis. Main text Sepsis patients with hyperinflammation and patients with immunosuppression may benefit most from treatment with IgM- and IgA-enriched immunoglobulin (Pentaglobin). Patients with hyperinflammation present with phenotypes that manifest throughout the body, whilst the clinical characteristics of immunosuppression are less clear. Potential biomarkers for hyperinflammation include elevated procalcitonin, interleukin-6, endotoxin activity and C-reactive protein, although thresholds for these are not well-defined. Convenient biomarkers for identifying patients in a stage of immune-paralysis are still matter of debate, though human leukocyte antigen–antigen D related expression on monocytes, lymphocyte count and viral reactivation have been proposed. The timing of treatment is potentially more critical for treatment efficacy in patients with hyperinflammation compared with patients who are in an immunosuppressed stage. Due to the lack of evidence, definitive dosage recommendations for either population cannot be made, though we suggest that patients with hyperinflammation should receive an initial bolus at a rate of up to 0.6 mL (30 mg)/kg/h for 6 h followed by a continuous maintenance rate of 0.2 mL (10 mg)/kg/hour for ≥ 72 h (total dose ≥ 0.9 g/kg). For immunosuppressed patients, dosage is more conservative (0.2 mL [10 mg]/kg/h) for ≥ 72 h, without an initial bolus (total dose ≥ 0.72 g/kg). Conclusions Two distinct populations that may benefit most from Pentaglobin therapy are described in this review. However, further clinical evidence is required to strengthen support for the recommendations given here regarding timing, duration and dosage of treatment.
Collapse
Affiliation(s)
- Axel Nierhaus
- University Medical Center Hamburg, Hamburg, Germany. .,Dep. of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | | | | | | | | |
Collapse
|
33
|
Liang G, Wu R, Jiang L, Liu Y, Mao G, Huang Z, Qi L, Jiang H. The role of lipoprotein-associated phospholipase A2 in acute kidney injury of septic mice. Transl Androl Urol 2020; 9:2192-2199. [PMID: 33209683 PMCID: PMC7658152 DOI: 10.21037/tau-20-1173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background This experiment aimed to investigate the role and mechanism of lipoprotein-associated phospholipase A2 (Lp-PLA2) in kidney injury in septic mice induced by cecal ligation and perforation (CLP). Methods Male BALB/c mice were randomly divided into two groups: sham-operation group (Sham group) and septic group (CLP group). The septic model was simulated by cecal ligation and puncture method, but only cecal ligation was used for the sham operation group. The whole serum and renal tissue samples of the mice were collected 24 hours after modeling in both groups. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of renal tissue, the renal injury score was recorded, and the creatinine (Cr) and blood urea nitrogen (BUN) levels were detected by automatic biochemical analyzer, while the serum Lp-PLA2 level was detected by enzyme-linked immunosorbent assay (ELISA). The 7-day survival rate and the survival curve of the two groups were statistically analyzed. Results Compared with the Sham group, the pathological score of renal injury in the CLP Group was higher, the level of Lp-PLA2 in serum was significantly increased (all P<0.01), and the expression of Lp-PLA2 in renal tissue was significantly elevated (all P<0.01). Furthermore, the 7-day survival rate of the Sham group was 90%, while that of CLP group was 25%. Conclusions The expression level of Lp-PLA2 in blood and kidney tissue of septic mice was increased and correlated with prognosis. However, the predictive value of Lp-PLA2 for prognosis in septic mice needs further study.
Collapse
Affiliation(s)
- Guiwen Liang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Ruo Wu
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Lan Jiang
- Department of Gastroenterology, First People's Hospital of Zhangjiagang City, Zhangjiagang, China
| | - Yanfang Liu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Guomin Mao
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhongwei Huang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Lei Qi
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Haiyan Jiang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
34
|
Cheng Z, Abrams ST, Toh J, Wang SS, Wang Z, Yu Q, Yu W, Toh CH, Wang G. The Critical Roles and Mechanisms of Immune Cell Death in Sepsis. Front Immunol 2020; 11:1918. [PMID: 32983116 PMCID: PMC7477075 DOI: 10.3389/fimmu.2020.01918] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022] Open
Abstract
Sepsis was first described by the ancient Greek physicians over 2000 years ago. The pathophysiology of the disease, however, is still not fully understood and hence the mortality rate is still unacceptably high due to lack of specific therapies. In the last decade, great progress has been made by shifting the focus of research from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS). Sepsis has been re-defined as infection-induced MODS in 2016. How infection leads to MODS is not clear, but what mediates MODS becomes the major topic in understanding the molecular mechanisms and developing specific therapies. Recently, the mechanism of infection-induced extensive immune cell death which releases a large quantity of damage-associated molecular patterns (DAMPs) and their roles in the development of MODS as well as immunosuppression during sepsis have attracted much attention. Growing evidence supports the hypothesis that DAMPs, including high-mobility group box 1 protein (HMGB1), cell-free DNA (cfDNA) and histones as well as neutrophil extracellular traps (NETs), may directly or indirectly contribute significantly to the development of MODS. Here, we provide an overview of the mechanisms and consequences of infection-induced extensive immune cell death during the development of sepsis. We also propose a pivotal pathway from a local infection to eventual sepsis and a potential combined therapeutic strategy for targeting sepsis.
Collapse
Affiliation(s)
- Zhenxing Cheng
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Medical School, Southeast University, Nanjing, China
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Julien Toh
- Wirral University Teaching Hospitals NHS Foundation Trust, Wirral, United Kingdom
| | | | - Zhi Wang
- Medical School, Southeast University, Nanjing, China
| | - Qian Yu
- Medical School, Southeast University, Nanjing, China
| | - Weiping Yu
- Medical School, Southeast University, Nanjing, China
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,Medical School, Southeast University, Nanjing, China
| |
Collapse
|
35
|
Byrnes D, Masterson CH, Artigas A, Laffey JG. Mesenchymal Stem/Stromal Cells Therapy for Sepsis and Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med 2020; 42:20-39. [PMID: 32767301 DOI: 10.1055/s-0040-1713422] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sepsis and acute respiratory distress syndrome (ARDS) constitute devastating conditions with high morbidity and mortality. Sepsis results from abnormal host immune response, with evidence for both pro- and anti-inflammatory activation present from the earliest phases. The "proinflammatory" response predominates initially causing host injury, with later-phase sepsis characterized by immune cell hypofunction and opportunistic superinfection. ARDS is characterized by inflammation and disruption of the alveolar-capillary membrane leading to injury and lung dysfunction. Sepsis is the most common cause of ARDS. Approximately 20% of deaths worldwide in 2017 were due to sepsis, while ARDS occurs in over 10% of all intensive care unit patients and results in a mortality of 30 to 45%. Given the fact that sepsis and ARDS share some-but not all-underlying pathophysiologic injury mechanisms, the lack of specific therapies, and their frequent coexistence in the critically ill, it makes sense to consider therapies for both conditions together. In this article, we will focus on the therapeutic potential of mesenchymal stem/stromal cells (MSCs). MSCs are available from several tissues, including bone marrow, umbilical cord, and adipose tissue. Allogeneic administration is feasible, an important advantage for acute conditions like sepsis or ARDS. They possess diverse mechanisms of action of relevance to sepsis and ARDS, including direct and indirect antibacterial actions, potent effects on the innate and adaptive response, and pro-reparative effects. MSCs can be preactivated thereby potentiating their effects, while the use of their extracellular vesicles can avoid whole cell administration. While early-phase clinical trials suggest safety, considerable challenges exist in moving forward to phase III efficacy studies, and to implementation as a therapy should they prove effective.
Collapse
Affiliation(s)
- Declan Byrnes
- Department of Anaesthesia, School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.,Regenerative Medicine Institute (REMEDI), CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Claire H Masterson
- Department of Anaesthesia, School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.,Regenerative Medicine Institute (REMEDI), CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Antonio Artigas
- Critical Care Center, Corporació Sanitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - John G Laffey
- Department of Anaesthesia, School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.,Regenerative Medicine Institute (REMEDI), CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.,Department of Anaesthesia, SAOLTA University Health Group, Galway University Hospitals, Galway, Ireland
| |
Collapse
|
36
|
Jarczak D, Kluge S, Nierhaus A. Use of Intravenous Immunoglobulins in Sepsis Therapy-A Clinical View. Int J Mol Sci 2020; 21:E5543. [PMID: 32756325 PMCID: PMC7432410 DOI: 10.3390/ijms21155543] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction, defined by a dysregulated host immune response to infection. During sepsis, the finely tuned system of immunity, inflammation and anti-inflammation is disturbed in a variety of ways. Both pro-inflammatory and anti-inflammatory pathways are upregulated, activation of the coagulation cascade and complement and sepsis-induced lymphopenia occur. Due to the manifold interactions in this network, the use of IgM-enriched intravenous immunoglobulins seems to be a promising therapeutic approach. Unfortunately, there is still a lack of evidence-based data to answer the important questions of appropriate patient populations, optimal timing and dosage of intravenous immunoglobulins. With this review, we aim to provide an overview of the role of immunoglobulins, with emphasis on IgM-enriched formulations, in the therapy of adult patients with sepsis and septic shock.
Collapse
Affiliation(s)
| | | | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (D.J.); (S.K.)
| |
Collapse
|
37
|
Clinical spectrum of intra-abdominal abscesses in patients admitted to the emergency department. Australas Emerg Care 2020; 23:6-10. [DOI: 10.1016/j.auec.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022]
|
38
|
Hyzy RC, McSparron J. ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease. EVIDENCE-BASED CRITICAL CARE 2020. [PMCID: PMC7121823 DOI: 10.1007/978-3-030-26710-0_80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hematopoietic stem cell transplant (HSCT) is an essential treatment modality for many malignant and non-malignant hematologic diseases. Advances in HSCT techniques have dramatically decreased peri-transplant morbidity and mortality, but it remains a high-risk procedure, and a significant number of patients will require critical care during the transplant process. Complications of HSCT are both infectious and non-infectious, and the intensivist must be familiar with common infections, the management of neutropenic sepsis and septic shock, the management of respiratory failure in the immunocompromised host, and a plethora of HSCT-specific complications. Survival from critical illness after HSCT is improving, but the mortality rate remains unacceptably high. Continued research and optimization of critical care provision in this population should continue to improve outcomes.
Collapse
Affiliation(s)
- Robert C. Hyzy
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
| | - Jakob McSparron
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
39
|
Neutropenic Fever in the Intensive Care Unit. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7121977 DOI: 10.1007/978-3-319-74588-6_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Neutropenic fever is a common and potentially life-threatening condition in patients treated for cancer. Rapid initiation of appropriate antimicrobial therapy is necessary to decrease the risk of mortality. Most infections are due to gram-positive organisms, but the mortality rate is higher for gram-negative infections. Multidrug-resistant organisms are an emerging threat to neutropenic patients. Increasing data suggest that the pathophysiology of neutropenic fever and neutropenic sepsis is substantially different from non-neutropenic fever and sepsis. Additional research is needed to both further elucidate the pathogenesis of neutropenic fever and to develop additional effective antimicrobials.
Collapse
|
40
|
Sumanth MS, Abhilasha KV, Jacob SP, Chaithra VH, Basrur V, Willard B, McIntyre TM, Prabhu KS, Marathe GK. Acute phase protein, α - 1- acid glycoprotein (AGP-1), has differential effects on TLR-2 and TLR-4 mediated responses. Immunobiology 2019; 224:672-680. [PMID: 31239174 DOI: 10.1016/j.imbio.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 01/16/2023]
Abstract
Alpha-1-acid glycoprotein (AGP-1) is a major positive acute phase glycoprotein with unknown functions that likely play a role in inflammation. We tested its involvement in a variety of inflammatory responses using human AGP-1 purified to apparent homogeneity and confirmed its identity by immunoblotting and mass spectrometry. AGP-1 alone upregulated MAPK signaling in murine peritoneal macrophages. However, when given in combination with TLR ligands, AGP-1 selectively augmented MAPK activation induced by ligands of TLR-2 (Braun lipoprotein) but not TLR-4 (lipopolysaccharide). In vivo treatment of AGP-1 in a murine model of sepsis with or without TLR-2 or TLR-4 ligands, selectively potentiated TLR-2-mediated mortality, but was without significant effect on TLR-4-mediated mortality. Furthermore, in vitro, AGP-1 selectively potentiated TLR-2 mediated adhesion of human primary immune cell, neutrophils. Hence, our studies highlight a new role for the acute phase protein AGP-1 in sepsis via its interaction with TLR-2 signaling mechanisms to selectively promote responsiveness to one of the two major gram-negative endotoxins, contributing to the complicated pathobiology of sepsis.
Collapse
Affiliation(s)
- Mosale Seetharam Sumanth
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysuru, 570006, Karnataka, India
| | | | - Shancy Petsel Jacob
- Division of Allergy and Immunology, University of Utah, Salt Lake City, UT, 84113, USA
| | | | - Venkatesha Basrur
- Department of Pathology, University of Michigan Medical School, Ann Arbor, 48109, MI, USA
| | - Belinda Willard
- Research Core Services, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Thomas M McIntyre
- Department of Cellular & Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - K Sandeep Prabhu
- Department of Veterinary and Biomedical Sciences, Center for Molecular Immunology and Infectious Disease and Center for Molecular Toxicology and Carcinogenesis, 115 Henning Building, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Gopal K Marathe
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysuru, 570006, Karnataka, India; Department of Studies in Molecular Biology, University of Mysore, Manasagangothri, Mysuru, 570006, Karnataka, India.
| |
Collapse
|
41
|
Niu B, Zhou F, Su Y, Wang L, Xu Y, Yi Z, Wu Y, Du H, Ren G. Different Expression Characteristics of LAG3 and PD-1 in Sepsis and Their Synergistic Effect on T Cell Exhaustion: A New Strategy for Immune Checkpoint Blockade. Front Immunol 2019; 10:1888. [PMID: 31440257 PMCID: PMC6693426 DOI: 10.3389/fimmu.2019.01888] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The impairment of immunity characterized by T cell exhaustion is the main cause of death in patients with sepsis after the acute phase. Although PD-1 blockade is highly touted as a promising treatment for improving prognosis, the role of PD-1 plays in sepsis and particularly its different roles in different periods are still very limited. A recent study revealed LAG3 can resist the therapeutic effect of PD-1 blockade in tumor, which inspired us to understand their role in sepsis. We enrolled 26 patients with acute sepsis from 422 candidates using strict inclusion criteria. Follow-up analysis revealed that the expression levels of PD-1 were rapidly increased in the early stage of sepsis but did not change significantly as infection continued (P < 0.05). However, the expression of LAG3 was contrary to that of PD-1. Compared with LAG3 or PD-1 single-positive T cells, T cells coexpressing LAG3 and PD-1 were significantly exhausted (P < 0.05). The proportion of coexpressing T cells was negatively correlated with the total number of lymphocytes (r = −0.653, P = 0.0003) and positively correlated with the SOFA score (r = 0.712, P < 0.0001). In addition, the higher the proportion of coexpressing T cells was, the longer the hospital stay and the higher the mortality. These results showed that LAG3 and PD-1 had a potential synergistic effect in regulating the gradual exhaustion of T cells in sepsis, which seriously affected the clinical prognosis of patients. Therefore, LAG3 and PD-1 double-positive T cells are an important indicator for immunity detection and prognostic evaluation. In the future, precision therapy may pay more attention to the different expression patterns of these two molecules.
Collapse
Affiliation(s)
- Bailin Niu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fachun Zhou
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanxin Su
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Wang
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Xu
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziying Yi
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yushen Wu
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimin Du
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guosheng Ren
- Chongqing Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
42
|
Victims or Culprits, B Cells May Serve as Markers for Mortality Risk and Targeted Therapy in Sepsis. Crit Care Med 2019; 45:1951-1952. [PMID: 29028700 DOI: 10.1097/ccm.0000000000002670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Lendak DF, Mihajlović DM, Novakov-Mikić AS, Boban JM, Ubavić M, Brkić SV. APRIL and sTACI could be predictors of multiorgan dysfunction syndrome in sepsis. Virulence 2018; 9:946-953. [PMID: 29781374 PMCID: PMC7000195 DOI: 10.1080/21505594.2018.1462636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 12/29/2022] Open
Abstract
Although the role of B cells in sepsis immunoregulation has become an interesting topic, there is lack of data on the role of B cell function regulators in prediction of multiorgan dysfunction syndrome (MODS). The aim of this study was to evaluate the prognostic value of A Proliferation Inducing Ligand (APRIL) and soluble Transmembrane Activator and CAML Interactor Protein (sTACI), the main B cell function regulators, in prediction of MODS development within the first 48 h after admission to intensive care unit, among septic patients. We included 112 patients with sepsis, treated at Clinic for Infectious Diseases and Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia. Plasma concentrations of APRIL and sTACI were determined at the admission and potential development of MODS was confirmed in the first 48 h. Concentrations of APRIL (p = 0.003) and sTACI (p<0.001) were higher in patients who developed MODS (n = 30). ROC curve analysis showed that AUC for sTACI (AUC = 0.764) was greater than that for procalcitonin (AUC = 0.719) and APRIL (AUC = 0.673) in MODS development prediction. Multivariate regression analysis showed that sTACI, as an anti-inflammatory biomarker stimulating the apoptosis of B cells, was the only independent predictor of MODS, beside SOFA score. Elevated level of sTACI could be the alarm for the increased B cell apoptosis and development of immune paralysis. Including these biomarkers into predictive scores specific for septic patients may potentially improve their sensitivity and specificity. Measurement of their concentrations dynamics could contribute to better assessment of sepsis evolution and timely introduction of immunomodulatory therapy.
Collapse
Affiliation(s)
- Dajana F. Lendak
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad; Clinic for Infectious Diseases, Clinical centre of Vojvodina; Hajduk Veljkova 3, Novi Sad, Serbia
| | - Dunja M. Mihajlović
- Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine, University of Novi Sad; Emergency Center, Clinical centre of Vojvodina, Hajduk Veljkova 3, Novi Sad, Serbia
| | - Aleksandra S. Novakov-Mikić
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Novi Sad; Clinical Center of Vojvodina, Clinic of Gynecology and Obstetrics, Hajduk Veljkova 1, Novi Sad, Serbia
| | - Jasmina M. Boban
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 1, Novi Sad, Serbia
| | - Milan Ubavić
- Health Care Institution for Laboratory Diagnostics „Medlab“, Ilije Ognjanovića 1, Novi Sad, Serbia
| | - Snežana V. Brkić
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad; Clinic for Infectious Diseases, Clinical centre of Vojvodina; Hajduk Veljkova 3, Novi Sad, Serbia
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad, Clinic for Infectious Diseases, Clinical centre of Vojvodina, Hajduk Veljkova 1, Novi Sad, Serbia
| |
Collapse
|
44
|
Frattari A, Polilli E, Primiterra V, Savini V, Ursini T, Di Iorio G, Parruti G. Analysis of peripheral blood lymphocyte subsets in critical patients at ICU admission: A preliminary investigation of their role in the prediction of sepsis during ICU stay. Int J Immunopathol Pharmacol 2018; 32:2058738418792310. [PMID: 30114952 PMCID: PMC6100127 DOI: 10.1177/2058738418792310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A better knowledge of factors predicting the development of sepsis in patients
hospitalized in intensive care unit (ICU) might help deploy more targeted
preventive and therapeutic strategies. In addition to the known clinical and
demographic predictors of septic syndromes, in this study, we investigated
whether measuring T and B lymphocyte subsets upon admission in the ICU may help
individualize the prediction of ensuing sepsis during ICU stay. Between May 2015
and December 2016, we performed a prospective cohort study evaluating peripheral
blood lymphocyte T-CD4+ (T-helper cells), T-CD8+ (cytotoxic T-cells), T-CD56 +
(natural killer cells), and T-CD19+ (B-lymphocytes), using flow cytometry on
blood samples collected 2 days after admission in the ICU. We enrolled 176
patients, 65.3% males, with mean age of 61.1 ± 15.4 years. At univariate
analyses, higher percentages of CD19 B-cells were significantly associated with
ensuing sepsis (20.5% (15.7–27.7)% vs 16.9% (11.3–22)%, P = 0.0001), whereas median interquartile range (IQR) proportions
of CD4 T-cells (41.2% (33.4–50.6)% vs 40% (35–47)%, P = 0.5), CD8 T-cells (21.1% (15.8–28.2)% vs 19.6% (14.6–25.1)%,
P = 0.2) and CD56 T-cells (1.7% (0.9–3.1)% vs
1.45% (0.7–2.3)%, P = 0.4) did not reveal any
significant association. An unexpected, highly significant inverse correlation
of CD8 T-cells and CD19 B-cells proportions, however, was observed, suggesting
that patients with lower CD19 and higher CD8 proportions might be somehow
protected from ensuing sepsis. We therefore studied the ability of the CD8/CD19
ratio to predict ensuing sepsis in our sample. In final models of multivariate
logistic regression, the following independent associations were found: previous
antibiotic exposure (odds ratio (OR): 3.8 (95% confidence interval (CI):
1.35–10.87), P = 0.01), isolation of at least one
multi-drug resistant organism at any time during ICU stay (OR: 8.4 (95% CI:
3.47–20.6), P < 0.0001), decreasing age (OR:
0.9 (95% CI: 0.93–0.99), P = 0.02) and a CD8/CD19
ratio >2.2 (OR: 10.3 (95% CI: 1.91–55.36), P = 0.007). Our data provide preliminary evidence that immune
characterization of critically ill patients on ICU admission may help
personalize the prediction of ensuing sepsis during their ICU stay. Further
polycentric evaluation of the true potential of this new tool is warranted.
Collapse
Affiliation(s)
| | - Ennio Polilli
- 2 Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy
| | | | - Vincenzo Savini
- 3 Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy
| | - Tamara Ursini
- 4 Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy
| | | | - Giustino Parruti
- 4 Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy
| |
Collapse
|
45
|
Bonde A, Kirial R, Svenningsen P, Sillesen M. The effect of fluid resuscitation strategy on monocyte and T-cell surface markers. J Surg Res 2018; 230:20-27. [PMID: 30100035 DOI: 10.1016/j.jss.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite initial lifesaving benefits, posttraumatic resuscitation strategies have been associated with immunologic complications leading to systemic inflammatory response syndrome, sepsis, multiple organ failure, and late trauma death. Nevertheless, the direct effect on immunologic surface markers remains inadequately described. We hypothesized that changes in monocyte and T-cell surface markers were associated with initial posttraumatic fluid resuscitation. MATERIALS AND METHODS Data were extracted from the inflammation and host response to injury (Glue Grant) study. Blood samples were drawn from 492 patients on days 0, 1, 4, 7, 14, and 28 and analyzed for 31 monocyte and T-cell surface markers. Resuscitation strategies during the initial 48 h were quantified, including transfusion of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and crystalloids. Longitudinal surface marker concentration changes were quantified by the calculation of a within-patient signal intensity change and were associated with resuscitation strategy while controlling confounders. P-values were post hoc corrected using the false detection rate q-value. RESULTS The monocyte surface marker (CD83) trajectory (as measured by a within-patient signal intensity change) was found to be positively associated with volume of PRBCs transfused (q = 0.002) and negatively associated with the transfused volume of FFP (q = 0.004). T-cell surface marker (CD3) was found to be negatively associated with volume of PRBCs transfused (q = 854 × 10-9) and positively associated with the transfused volume of FFP (q = 0.022). Platelets and crystalloid transfusion volumes were not associated with any surface marker trajectories. CONCLUSIONS PRBC and FFP transfusion was associated with opposing effects on CD3 and CD83 trajectories, which may in part explain some of the protective effects of a high FFP:PRBC ratio in trauma-related resuscitation.
Collapse
Affiliation(s)
- Alexander Bonde
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Kirial
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Svenningsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Institute for Inflammation Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| |
Collapse
|
46
|
Lendak DF, Mihajlović DM, Novakov-Mikić AS, Mitić IM, Boban JM, Brkić SV. The role of TNF-α superfamily members in immunopathogenesis of sepsis. Cytokine 2018; 111:125-130. [PMID: 30142533 DOI: 10.1016/j.cyto.2018.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Members of TNFα superfamily, A proliferation inducing ligand (APRIL), B-cell activating factor (BAFF) and Transmembrane activator and calcium cyclophylin interactor (TACI) are main regulators of B-cell function. The aim of this study was to evaluate concentrations of APRIL, BAFF and soluble TACI (sTACI) receptor in septic patients compared to healthy controls and compare concentrations of these biomarkers depending on sepsis severity and outcome. MATERIALS AND METHODS A total of 115 septic patients and 30 healthy volunteers were included and concentrations of APRIL, BAFF and sTACI were determined in all subjects at the admission (ELISA R&D Systems tests). Concentrations of these biomarkers in function of sepsis severity (sepsis n = 94 and septic shock n = 21) and outcome (lethal n = 40, recovery n = 75) were tested, as well as correlations with APACHE II and SOFA scores, immunoglobulins, complement, PCT and CRP concentrations. RESULTS Concentrations of all three biomarkers were significantly increased in septic patients compared to controls (AUCAPRIL = 0.982, AUCBAFF = 0.873, AUCsTACI = 0.683). Higher concentrations of APRIL and sTACI (p = 0.033, p = 0.037), and lower concentrations of BAFF (p = 0.005) were observed in patients with septic shock compared to sepsis. BAFF concentrations correlated positively with IgM, C3 and C4 levels. sTACI and APRIL were shown to be predictors of lethal outcome (p = 0.003, p = 0.049). CONCLUSIONS Concentrations of observedTNFα superfamily members are significantly increased in septic patients, confirming their role in sepsis pathogenesis.Higher concentrations of anti-inflammatory sTACI receptor correlated with severity of sepsis and poorer prognosis, thus potentially indicating domination of anti-inflammatory response in septic patients with worse outcome.
Collapse
Affiliation(s)
- Dajana F Lendak
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Clinical Centre of Vojvodina, Novi Sad, Serbia.
| | - Dunja M Mihajlović
- Clinical Centre of Vojvodina, Novi Sad, Serbia; Department of Anestesiology and Perioerative Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandra S Novakov-Mikić
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Department of Internal Medicine (Immunology), Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Igor M Mitić
- Clinical Centre of Vojvodina, Novi Sad, Serbia; Department of Internal Medicine (Immunology), Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Jasmina M Boban
- Department for Radiology, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia; Center for Imaging Diagnostics, Institute of Oncology, Sremska Kamenica, Serbia
| | - Snežana V Brkić
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Clinical Centre of Vojvodina, Novi Sad, Serbia
| |
Collapse
|
47
|
Oliva-Martin MJ, Sanchez-Abarca LI, Rodhe J, Carrillo-Jimenez A, Vlachos P, Herrera AJ, Garcia-Quintanilla A, Caballero-Velazquez T, Perez-Simon JA, Joseph B, Venero JL. Caspase-8 inhibition represses initial human monocyte activation in septic shock model. Oncotarget 2018; 7:37456-37470. [PMID: 27250033 PMCID: PMC5122324 DOI: 10.18632/oncotarget.9648] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/17/2016] [Indexed: 12/12/2022] Open
Abstract
In septic patients, the onset of septic shock occurs due to the over-activation of monocytes. We tested the therapeutic potential of directly targeting innate immune cell activation to limit the cytokine storm and downstream phases. We initially investigated whether caspase-8 could be an appropriate target given it has recently been shown to be involved in microglial activation. We found that LPS caused a mild increase in caspase-8 activity and that the caspase-8 inhibitor IETD-fmk partially decreased monocyte activation. Furthermore, caspase-8 inhibition induced necroptotic cell death of activated monocytes. Despite inducing necroptosis, caspase-8 inhibition reduced LPS-induced expression and release of IL-1β and IL-10. Thus, blocking monocyte activation has positive effects on both the pro and anti-inflammatory phases of septic shock. We also found that in primary mouse monocytes, caspase-8 inhibition did not reduce LPS-induced activation or induce necroptosis. On the other hand, broad caspase inhibitors, which have already been shown to improve survival in mouse models of sepsis, achieved both. Thus, given that monocyte activation can be regulated in humans via the inhibition of a single caspase, we propose that the therapeutic use of caspase-8 inhibitors could represent a more selective alternative that blocks both phases of septic shock at the source.
Collapse
Affiliation(s)
- Maria Jose Oliva-Martin
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBiS)-/CSIC/Universidad de Sevilla, Sevilla, Spain.,Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | | | - Johanna Rodhe
- Instituto de Biomedicina de Sevilla (IBiS)-/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Alejandro Carrillo-Jimenez
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| | - Pinelopi Vlachos
- Instituto de Biomedicina de Sevilla (IBiS)-/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Antonio Jose Herrera
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| | - Albert Garcia-Quintanilla
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| | | | - Jose Antonio Perez-Simon
- Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Bertrand Joseph
- Instituto de Biomedicina de Sevilla (IBiS)-/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Jose Luis Venero
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| |
Collapse
|
48
|
Huang Z, Jiang H, Cui X, Liang G, Chen Y, Wang T, Sun Z, Qi L. Elevated serum levels of lipoprotein‑associated phospholipase A2 predict mortality rates in patients with sepsis. Mol Med Rep 2017; 17:1791-1798. [PMID: 29138849 DOI: 10.3892/mmr.2017.8034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 01/09/2017] [Indexed: 11/06/2022] Open
Abstract
Sepsis remains one of the leading contributors to mortality rates in the intensive care unit (ICU) and emergency intensive care unit (EICU). Therefore, any treatments against the agents which produce sepsis in a medical emergency, are welcome. Elevated serum levels of lipoprotein‑associated phospholipase A2 (Lp‑PLA2) have been reported in a small cohort of patients with inflammation. The present study evaluated serum levels of Lp‑PLA2 in patients with sepsis and investigated the role of Lp‑PLA2 in sepsis. The investigation involved the selection of 151 patients with sepsis admitted to the emergency department of the Affiliated Hospital of Nantong University (Nantong, China) and 30 healthy controls. All patients (39 with sepsis, 55 with severe sepsis and 57 with septic shock) were examined on admission to the EICU. A complete blood count was performed, and serum levels of Lp‑PLA2, C‑reactive protein, procalcitonin, and interleukin 6, sequential organ failure (SOFA) scores and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were determined on hospital admission. The EICU and overall mortality rates were evaluated at baseline. The present study also assessed various laboratory parameters, clinical data and inflammatory cytokines. The patient follow up duration was 90 days. The data suggested that the serum levels of Lp‑PLA2 on admission to the EICU in patients with sepsis were elevated, compared with those in healthy controls. The concentrations of Lp‑PLA2 were correlated with the severity of disease, and were significantly associated with experimental markers of inflammation and established prognostic scores. In the total cohort, persistently elevated levels of Lp‑PLA2 on admission for EICU treatment was a predictor of poor prognosis, and provided superior diagnostic use, compared with the prognostic scoring systems, including SOFA or APACHE II scores. Taken together, the results suggested that Lp‑PLA2, with respect to other markers of inflammation, may have a role as a prognostic marker in sepsis, and provide background evidence for further trials to evaluate the clinical and pathophysiologic roles of Lp‑PLA2 in sepsis. Persistently elevated serum concentrations of Lp‑PLA2 indicated an unfavorable outcome in patients with sepsis. In addition, the results indicated the potential role of Lp‑PLA2 as a prognostic biomarker in patients with sepsis during the early course of EICU treatment.
Collapse
Affiliation(s)
- Zhongwei Huang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Haiyan Jiang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiaohui Cui
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Guiwen Liang
- Department of Geriatric Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Yu Chen
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Ting Wang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Zhichao Sun
- Medical College, Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Lei Qi
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| |
Collapse
|
49
|
Schmidt AI, Kühlbrey C, Lauch R, Wolff-Vorbeck G, Chikhladze S, Hopt UT, Wittel UA. The predominance of a naive T helper cell subset in the immune response of experimental acute pancreatitis. Pancreatology 2017; 17:209-218. [PMID: 28258935 DOI: 10.1016/j.pan.2017.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/10/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In necrotizing acute pancreatitis (NAP), systemic inflammatory response syndrome (SIRS) and the compensatory anti-inflammatory response syndrome (CARS) decide overall outcome and mortality. In patients, low lymphocyte counts were found, but T-helper cells seemed to conversely increase. Our aim was to further categorize T-helper cells within the context of NAP induced SIRS and CARS. METHODS NAP was induced by injection of sodium-taurocholate into the common bile duct of male BALB/c mice; sham treated animals received saline infusion. The animals were sacrificed at 6, 12, 24 and 48 h later. Lymphocytes from blood, liver and spleen were isolated and examined by flow cytometry. Staining was performed for CD4, CD8, CD19, CD45RB, CD25, CD69, and CD152. CD4+ cells were sorted for their CD45RB expression and sought for gene regulation associated to TH1/TH2 cells by quantitative RT-PCR. RESULTS In NAP, CD4+ was solely increased in all compartments. CD8+ remained without substantial alterations. CD45RB showed significant expression in RBhigh in T-helper cells, confirmed by the CD45RBhigh/low ratio (Liver, 24 h: NAP 2.2, SHAM 0.6; p < 0.001). CD45RBhigh and -low cells were not associated to patterns of TH1/TH2 expression. In NAP, CCR4 expression was significantly decreased within RBhigh cells (fold change: 0.04, p < 0.05), while TLR6 showed significant overexpression (fold change: 2.36, p < 0.05). CONCLUSION T-helper cells increase in NAP, leaning towards CD45RBhigh expression. They resemble naive T-cells, in which NAP leads to expression profiles associated with an innate immune response. This suggests new findings in immunological pathomechanisms of NAP.
Collapse
Affiliation(s)
- Andrea I Schmidt
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Christian Kühlbrey
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Robert Lauch
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Guido Wolff-Vorbeck
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Sophia Chikhladze
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Ulrich T Hopt
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany
| | - Uwe A Wittel
- Department of General and Visceral Surgery, Universitätsklinik Freiburg, Freiburg, Germany.
| |
Collapse
|
50
|
Lakshmikanth CL, Jacob SP, Kudva AK, Latchoumycandane C, Yashaswini PSM, Sumanth MS, Goncalves-de-Albuquerque CF, Silva AR, Singh SA, Castro-Faria-Neto HC, Prabhu SK, McIntyre TM, Marathe GK. Escherichia coli Braun Lipoprotein (BLP) exhibits endotoxemia - like pathology in Swiss albino mice. Sci Rep 2016; 6:34666. [PMID: 27698491 PMCID: PMC5048175 DOI: 10.1038/srep34666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/15/2016] [Indexed: 02/08/2023] Open
Abstract
The endotoxin lipopolysaccharide (LPS) promotes sepsis, but bacterial peptides also promote inflammation leading to sepsis. We found, intraperitoneal administration of live or heat inactivated E. coli JE5505 lacking the abundant outer membrane protein, Braun lipoprotein (BLP), was less toxic than E. coli DH5α possessing BLP in Swiss albino mice. Injection of BLP free of LPS purified from E. coli DH5α induced massive infiltration of leukocytes in lungs and liver. BLP activated human polymorphonuclear cells (PMNs) ex vivo to adhere to denatured collagen in serum and polymyxin B independent fashion, a property distinct from LPS. Both LPS and BLP stimulated the synthesis of platelet activating factor (PAF), a potent lipid mediator, in human PMNs. In mouse macrophage cell line, RAW264.7, while both BLP and LPS similarly upregulated TNF-α and IL-1β mRNA; BLP was more potent in inducing cyclooxygenase-2 (COX-2) mRNA and protein expression. Peritoneal macrophages from TLR2−/− mice significantly reduced the production of TNF-α in response to BLP in contrast to macrophages from wild type mice. We conclude, BLP acting through TLR2, is a potent inducer of inflammation with a response profile both common and distinct from LPS. Hence, BLP mediated pathway may also be considered as an effective target against sepsis.
Collapse
Affiliation(s)
| | - Shancy Petsel Jacob
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | - Avinash Kundadka Kudva
- Department of Veterinary and Biomedical Sciences, Center for Molecular Immunology and Infectious Disease and Center for Molecular Toxicology and Carcinogenesis, 115 Henning Building, The Pennsylvania State University, University Park, PA 16802, USA
| | - Calivarathan Latchoumycandane
- Department of Cellular and Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | | | - Mosale Seetharam Sumanth
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | | | - Adriana R Silva
- Laboratótio de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Sridevi Annapurna Singh
- Department of Protein Chemistry &Technology, Central Food Technological Research Institute/CSIR, Mysore - 570 020, Karnataka, India
| | - Hugo C Castro-Faria-Neto
- Laboratótio de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Sandeep Kumble Prabhu
- Department of Veterinary and Biomedical Sciences, Center for Molecular Immunology and Infectious Disease and Center for Molecular Toxicology and Carcinogenesis, 115 Henning Building, The Pennsylvania State University, University Park, PA 16802, USA
| | - Thomas M McIntyre
- Department of Cellular and Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Gopal Kedihithlu Marathe
- Department of Studies in Biochemistry, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| |
Collapse
|