1
|
Bertozzi G, Ferrara M, Di Fazio A, Maiese A, Delogu G, Di Fazio N, Tortorella V, La Russa R, Fineschi V. Oxidative Stress in Sepsis: A Focus on Cardiac Pathology. Int J Mol Sci 2024; 25:2912. [PMID: 38474158 DOI: 10.3390/ijms25052912] [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: 01/01/2024] [Revised: 02/09/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
This study aims to analyze post-mortem human cardiac specimens, to verify and evaluate the existence or extent of oxidative stress in subjects whose cause of death has been traced to sepsis, through immunohistological oxidative/nitrosative stress markers. Indeed, in the present study, i-NOS, NOX2, and nitrotyrosine markers were higher expressed in the septic death group when compared to the control group, associated with also a significant increase in 8-OHdG, highlighting the pivotal role of oxidative stress in septic etiopathogenesis. In particular, 70% of cardiomyocyte nuclei from septic death specimens showed positivity for 8-OHdG. Furthermore, intense and massive NOX2-positive myocyte immunoreaction was noticed in the septic group, as nitrotyrosine immunostaining intense reaction was found in the cardiac cells. These results demonstrated a correlation between oxidative and nitrosative stress imbalance and the pathophysiology of cardiac dysfunction documented in cases of sepsis. Therefore, subsequent studies will focus on the expression of oxidative stress markers in other organs and tissues, as well as on the involvement of the intracellular pattern of apoptosis, to better clarify the complex pathogenesis of multi-organ failure, leading to support the rationale for including therapies targeting redox abnormalities in the management of septic patients.
Collapse
Affiliation(s)
| | - Michela Ferrara
- SIC Medicina Legale, Via Potito Petrone, 85100 Potenza, Italy
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Aldo Di Fazio
- SIC Medicina Legale, Via Potito Petrone, 85100 Potenza, Italy
| | - Aniello Maiese
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Vittoria Tortorella
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life and Environment Science, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| |
Collapse
|
2
|
Khalid N, Patel PD, Alghareeb R, Hussain A, Maheshwari MV. The Effect of Sepsis on Myocardial Function: A Review of Pathophysiology, Diagnostic Criteria, and Treatment. Cureus 2022; 14:e26178. [PMID: 35891864 PMCID: PMC9306401 DOI: 10.7759/cureus.26178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/29/2022] Open
Abstract
Sepsis remains a worldwide challenge for physicians with many patients admitted to ICUs with septic shock. Septic shock management involves targeted treatment to control infections, reduce end-organ damage, and reverse the injury. Sepsis-induced myocardial dysfunction or septic cardiomyopathy remains an avenue to be explored with regard to underlying pathophysiology and definite treatment guidelines. This article has compiled various studies to explain the possible mechanisms involved in the development of septic cardiomyopathy and the existing diagnostic criteria including radiological and laboratory tests to assess septic cardiomyopathy. Furthermore, the article highlights management options currently available for physicians dealing with myocardial dysfunction secondary to sepsis.
Collapse
Affiliation(s)
- Nabeeha Khalid
- Cardiology, Omar Hospital and Cardiac Centre, Lahore, PAK
| | - Pragnesh D Patel
- Research, St. George's University School of Medicine, St. George's, GRD
| | | | - Afshan Hussain
- Research, Dow Medical College and Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, PAK
| | - Marvi V Maheshwari
- Research, Our Lady of Fatima University College of Medicine, Valenzuela, PHL
| |
Collapse
|
3
|
Myeloid Adherent Cells Are Involved in Hair Loss in the Alopecia Areata Mouse Model. J Investig Dermatol Symp Proc 2020; 20:S16-S21. [PMID: 33099378 DOI: 10.1016/j.jisp.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Alopecia areata (AA), which is defined as an autoimmune hair loss disease, has a serious impact on the quality of life for patients with AA worldwide. In this study, to our knowledge, a previously unreported method of AA induction in C3H mice has been established and validated. Using this method, we showed that dermal injection of 1-3 million of a mixture of skin cells freshly isolated from AA-affected skin induces AA in more than 80% of healthy mice. Contrary to the previous protocol, the induction of AA by this approach does not need any surgical AA skin grafting, cell manipulation, or high number of activated T cells. We also showed that dermal injection of adherent myeloid cells (mainly CD11b+) in healthy mice is as potent as a mixture of none adherent CD3+ T cells and CD19+ B cells in the induction of AA. Interestingly, most of the mice (7 out of 8) that received non-adherent cells developed AA universalis, whereas most of the mice (5 out of 7) that received adherent cells developed patchy AA. Finally, we found a high number of stage-specific embryonic antigen-expressing cells whose expression in monocytes in an inflammatory disease causes the release of inflammatory cytokines, TNF-α and IL-1β, from these cells in AA-affected skin.
Collapse
|
4
|
Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature. Diagnostics (Basel) 2020; 10:diagnostics10100849. [PMID: 33092081 PMCID: PMC7590167 DOI: 10.3390/diagnostics10100849] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to allow a correct and definite post-mortem diagnosis. The review was conducted searching in PubMed and Scopus databases, and using variable combinations of the keywords "post mortem sepsis diagnosis", "macroscopic signs", "morphology", "histology", "immunohistochemical markers", "biochemical markers", and "forensic microbiology". The article selection was carried out following specific inclusion and exclusion criteria. A total of 44 works was identified, providing data on morphological aspects of the organs examined, histological findings, immunohistochemical and biochemical markers, and cultural assays. The review findings suggested that the post-mortem diagnosis of sepsis can be achieved by a combination of data obtained from macroscopic and microscopic analysis and microbial investigations, associated with the increased levels of at least two of three biochemical and/or immunohistochemical markers evaluated simultaneously on blood samples.
Collapse
|
5
|
La Russa R, Maiese A, Viola RV, De Matteis A, Pinchi E, Frati P, Fineschi V. Searching for highly sensitive and specific biomarkers for sepsis: State-of-the-art in post-mortem diagnosis of sepsis through immunohistochemical analysis. Int J Immunopathol Pharmacol 2019; 33:2058738419855226. [PMID: 31179790 PMCID: PMC6558548 DOI: 10.1177/2058738419855226] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The autoptical observations commonly ascribed to sepsis deal with unspecific
general and local signs of inflammation or ischemia, such as myocardial
inflammation, pulmonary edema and infiltration, cerebral swallowing, and tubular
necrosis in the kidney. In the two last decades, some studies have been carried
out to implement immunohistochemical markers for post-mortem diagnosis. All of
these target molecules are specifically up-regulated or down-regulated during
systemic inflammatory responses, especially for infective causes. Among these,
we found some antigens expressed on leukocyte surfaces (very late antigen-4
(VLA-4), cluster differentiation-15 (CD15)), enzyme contained in neutrophils
granules (lysozyme (LZ), lactoferrin (LF)), endothelial markers and junctions
(E-selectin, vascular endothelial cadherin (VE-cadherin)), and soluble factors
(vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNFα),
procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1
(s-TREM-1)). All of these showed potential reliability in differentiating sepsis
cases from controls. Further studies are needed to provide a concrete validation
for a combination of markers on specific organ samples in order to reach a
post-mortem diagnosis of sepsis also in the absence of clinical records.
Collapse
Affiliation(s)
- Raffaele La Russa
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,2 IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | - Aniello Maiese
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Rocco Valerio Viola
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra De Matteis
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Pinchi
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,2 IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| | - Vittorio Fineschi
- 1 Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,2 IRCSS Neuromed Mediterranean Neurological Institute, Pozzilli, Italy
| |
Collapse
|
6
|
Maiese A, Manetti F, La Russa R, Di Fazio N, De Matteis A, Frati P, Fineschi V. Septic myocardial calcification: A case report. J Forensic Leg Med 2019; 65:45-47. [PMID: 31100653 DOI: 10.1016/j.jflm.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/30/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
The histological findings in the heart in cases of fatal sepsis can show myocytolysis, interstitial fibrosis, necrotic contraction band, mononuclear infiltrates, and interstitial edema, which can be used in post mortem diagnosis of sepsis. Septic myocardial calcification is a very rare condition, and only a few cases have been reported in the literature. In general, the pathogenesis of the myocardial calcification has not been well clarified, but two pathogenic mechanisms have been universally recognized: metastatic or dystrophic. We present a rare case of sepsis-related myocardial calcification. Here we report a case involving a 72-year-old white male who was admitted to a hospital for a polytrauma caused by a motorbike accident. On the 110th day of hospitalization, the patient was diagnosed with a septic process and a subsequent transesophageal echocardiogram revealed the presence of a calcification on the right atrial wall. According to the medical history of the patient there were no systemic factors predisposing to calcium crystals deposition in tissues. Patient died due to multi-organ failure in the course of multimicrobial septic shock during the 149th day. The autopsy revealed both the presence of a greenish-brown formation and a greater consistency of the right atrial wall. The histological investigation of the right atrium wall showed a wide calcification area localized at subendocardial level, which contained fibrin deposition and was surrounded by fibrotic tissue.
Collapse
Affiliation(s)
- Aniello Maiese
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Federico Manetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Nicola Di Fazio
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Alessandra De Matteis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Paola Frati
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy.
| |
Collapse
|
7
|
Maiese A, Bolino G, Mastracchio A, Frati P, Fineschi V. An immunohistochemical study of the diagnostic value of TREM-1 as marker for fatal sepsis cases. Biotech Histochem 2018; 94:159-166. [PMID: 30388897 DOI: 10.1080/10520295.2018.1535138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Triggering receptor expressed on myeloid cells-1 (TREM-1) is produced and up-regulated by exposure of myeloid cells to lipopolysaccharides or other components of either bacterial or fungal origin, which causes it to be strongly expressed on phagocytes that accumulate in inflamed areas. Because TREM-1 participates in septic shock and in amplifying the inflammatory response to bacterial and fungal infections, we believe it could be an immunohistochemical marker for postmortem diagnosis of sepsis. We tested the anti-TREM-1 antibody in 28 cases of death by septic shock and divided them into two groups. The diagnosis was made according to the criteria of the Surviving Sepsis Campaign. In all cases, blood cultures were positive. The first group was comprised subjects that presented high ante-mortem serum procalcitonin and the soluble form of TREM-1 (s-TREM-1) values. The second group comprised subjects in which s-TREM-1 was not measured ante-mortem. We used samples of brain, heart, lung, liver and kidney for each case to test the anti-TREM-1 antibody. A semiquantitative evaluation of the immunohistochemical findings was made. In lung samples, we found immunostaining in the cells of the monocyte line in 24 of 28 cases, which suggests that TREM-1 is produced principally by cells of the monocyte line. In liver tissue, we found low TREM-staining in the hepatocyte cytoplasm, duct epithelium, the portal-biliary space and blood vessel. In kidney tissue samples, we found the TREM-1 antibody immunostaining in glomeruli and renal tubules. We also found TREM-1 staining in the lumen of blood vessels. Immunohistochemical staining using the anti-TREM-1 antibody can be useful for postmortem diagnosis of sepsis.
Collapse
Affiliation(s)
- A Maiese
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy.,b IRCCS Neuromed , Pozzilli , Italy
| | - G Bolino
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy
| | - A Mastracchio
- c Medical UOC Pathology Local Health Agency Rome/6 , University of Rome "Tor Vergata" , Rome , Italy
| | - P Frati
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy.,b IRCCS Neuromed , Pozzilli , Italy
| | - V Fineschi
- a Department of Anatomical, Histological, Forensic and Orthopaedic Sciences , Sapienza University of Rome , Rome , Italy.,b IRCCS Neuromed , Pozzilli , Italy
| |
Collapse
|