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Ho PH, Lee YC, Ng CJ, Chaou CH, Chen SY. Assessing the clinical utility of abdominal computed tomography in sepsis patients with unknown origin: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38114. [PMID: 38758906 PMCID: PMC11098218 DOI: 10.1097/md.0000000000038114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.
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Affiliation(s)
- Pei-Hsuan Ho
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan
| | - Yi-Chih Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences; Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City, Taiwan
- Graduate Institute of Clinical Medical Sciences; Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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2
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Na AY, Lee H, Min EK, Paudel S, Choi SY, Sim H, Liu KH, Kim KT, Bae JS, Lee S. Novel Time-dependent Multi-omics Integration in Sepsis-associated Liver Dysfunction. GENOMICS, PROTEOMICS & BIOINFORMATICS 2023; 21:1101-1116. [PMID: 37084954 PMCID: PMC11082264 DOI: 10.1016/j.gpb.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
The recently developed technologies that allow the analysis of each single omics have provided an unbiased insight into ongoing disease processes. However, it remains challenging to specify the study design for the subsequent integration strategies that can associate sepsis pathophysiology and clinical outcomes. Here, we conducted a time-dependent multi-omics integration (TDMI) in a sepsis-associated liver dysfunction (SALD) model. We successfully deduced the relation of the Toll-like receptor 4 (TLR4) pathway with SALD. Although TLR4 is a critical factor in sepsis progression, it is not specified in single-omics analyses but only in the TDMI analysis. This finding indicates that the TDMI-based approach is more advantageous than single-omics analyses in terms of exploring the underlying pathophysiological mechanism of SALD. Furthermore, TDMI-based approach can be an ideal paradigm for insightful biological interpretations of multi-omics datasets that will potentially reveal novel insights into basic biology, health, and diseases, thus allowing the identification of promising candidates for therapeutic strategies.
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Affiliation(s)
- Ann-Yae Na
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Hyojin Lee
- Department of Environmental Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Eun Ki Min
- Department of Environmental Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Sanjita Paudel
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea
| | - So Young Choi
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea
| | - HyunChae Sim
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Kwang-Hyeon Liu
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Ki-Tae Kim
- Department of Environmental Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Jong-Sup Bae
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Sangkyu Lee
- Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Republic of Korea; BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Kyungpook National University, Daegu 41566, Republic of Korea; School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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Liu S, Kohler A, Langer R, Jakob MO, Salm L, Blank A, Beldi G, Jakob SM. Hepatic blood flow regulation but not oxygen extraction capability is impaired in prolonged experimental abdominal sepsis. Am J Physiol Gastrointest Liver Physiol 2022; 323:G348-G361. [PMID: 36044679 DOI: 10.1152/ajpgi.00109.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Impaired oxygen utilization has been proposed to play a significant role in sepsis-induced liver dysfunction, but its magnitude and temporal course during prolonged resuscitation is controversial. The aim of this study is to evaluate the capability of the liver to increase oxygen extraction in sepsis during repeated acute portal vein blood flow reduction. Twenty anesthetized and mechanically ventilated pigs with hepatic hemodynamic monitoring were randomized to fecal peritonitis or controls (n = 10, each). After 8-h untreated sepsis, the animals were resuscitated for three days. The ability to increase hepatic O2 extraction was evaluated by repeated, acute decreases in hepatic oxygen delivery (Do2) via reduction of portal flow. Blood samples for liver function and liver biopsies were obtained repeatedly. Although liver function tests, ATP content, and Do2 remained unaltered, there were signs of liver injury in blood samples and overt liver cell necrosis in biopsies. With acute portal vein occlusion, hepatic Do2 decreased more in septic animals compared with controls [max. decrease: 1.66 ± 0.68 mL/min/kg in sepsis vs. 1.19 ± 0.42 mL/min/kg in controls; portal venous flow (Qpv) reduction-sepsis interaction: P = 0.028]. Hepatic arterial buffer response (HABR) was impaired but recovered after 3-day resuscitation, whereas hepatic oxygen extraction increased similarly during the procedures in both groups (max. increase: 0.27 ± 0.13 in sepsis vs. 0.18 ± 0.09 in controls; all P > 0.05). Our data indicate maintained capacity of the liver to acutely increase O2 extraction, whereas blood flow regulation is transiently impaired with the potential to contribute to liver injury in sepsis.NEW & NOTEWORTHY The capacity to acutely increase hepatic O2 extraction with portal flow reduction is maintained in sepsis with accompanying liver injury, but hepatic blood flow regulation is impaired.
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Affiliation(s)
- Shengchen Liu
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Cardio-thoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rupert Langer
- Institute of Pathology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuel O Jakob
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lilian Salm
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annika Blank
- Institute of Pathology, Triemlispital Zürich, Zürich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ashareyoun H, Chalmeh A, Pourjafar M. Un-fractionated heparin counteracts the systemic inflammatory responses and multiple organ damages caused by endotoxaemia in sheep. Vet Med Sci 2022; 8:1187-1196. [PMID: 34978390 PMCID: PMC9122390 DOI: 10.1002/vms3.720] [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] [Indexed: 11/16/2022] Open
Abstract
Background Endotoxaemia is believed to be a major cause of mortality and there are several therapeutic regimens for the treatment of this situation. Objectives The present experimental study was conducted to evaluate acute phase response, cardiovascular and hepatorenal damages following the treatment of Ovine experimental endotoxaemia model employing unfractionated heparin (UFH). Materials and Methods Twenty clinically healthy 1‐year‐old fat‐tailed ewes were randomly divided into four equal groups, comprising UFH 200, UFH 400, Ctrl+ and Ctrl‐. Lipopolysaccharide (LPS) from Escherichia coli serotype O55:B5 at 0.4 μg/kg was administered intravenously to the ewes. UFH (at 200 and 400 IU/kg) was administrated to the UFH 200 and UFH 400 groups, respectively. All the ewes were evaluated clinically before and 1.5, 3, 4.5, 6 and 24 hours after LPS injection. Blood samplings were also performed at those hours. We measured serum concentrations of haptoglobin, interferon‐gamma, total antioxidant status, malondialdehyde, cardiac lactate dehydrogenase, cardiac troponin‐I, total bilirubin, alanine transaminase and creatinine. Serum concentrations of acute phase response, cardiovascular, hepatic and renal biomarkers and clinical parameters increased significantly following the induction of endotoxaemia in the groups receiving LPS. Results The significantly lowest concentrations of these parameters at hours 4.5 and 6 among the treatment groups belonged to the UFH 400 sheep. Conclusions UFH could act as an anti‐inflammatory mediator by decreasing inflammatory cytokines and acute phase proteins, modulating oxidative stress biomarkers and reducing multiple organ dysfunction following endotoxaemia in a dose–dependent manner. Furthermore, the anti‐inflammatory effects of UFH at 400 IU/kg were significantly higher than another dose. This research examined the effect of two doses of UFH and higher doses may have more anti‐inflammatory effects that require further studies.
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Affiliation(s)
- Hesam Ashareyoun
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Aliasghar Chalmeh
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Mehrdad Pourjafar
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Esmaeili Seraji R, Chalmeh A, Pourjafar M. Low molecular weight heparin reduces acute phase response and multiple organ dysfunction following Ovine experimental endotoxemia model. Vet Immunol Immunopathol 2021; 243:110361. [PMID: 34813996 DOI: 10.1016/j.vetimm.2021.110361] [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: 05/31/2021] [Revised: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Endotoxemia is one of the most common inflammatory situations leading to death of ruminants. Owing to the importance of this condition, several therapeutic regimens have been proposed, evaluated and implemented to treat endotoxemia. It has recently been suggested that low molecular weight heparin may be effective in treating endotoxemia. Thus, the present experimental study was conducted to evaluate the acute phase response and multiple organ dysfunction following the treatment of the Ovine experimental endotoxemia model employing this compound. In this regard, 20 clinically healthy 1-year old Iranian fat-tailed ewes were randomly divided into 4 equal groups, comprising LMWH 50, LMWH 100, Ctrl+, and Ctrl-. Lipopolysaccharide from Escherichia coli serotype O55:B5 at 0.4 μg/kg was intravenously administered to the ewes. Low molecular weight heparin (at 50 and 100 IU/kg) was administrated to LMWH 50 and LMWH 100 groups, respectively. Positive control (Ctrl+) received lipopolysaccharide and treated only by intravenous fluid without any drugs, and negative control (Ctrl-) only received intravenous fluids without lipopolysaccharide or any drugs. All the ewes were clinically evaluated before and 1.5, 3, 4.5, 6 and 24 h after lipopolysaccharide injection, and blood samplings were also performed at those hours. Serum concentrations of serum amyloid A, tumor necrosis factor-alpha, superoxide dismutase, glutathione peroxidase, creatine kinase-MB, homocysteine, total bilirubin, aspartate aminotransferase, and creatinine were measured. Serum concentrations of acute phase proteins, inflammatory cytokines, oxidative stress, cardiovascular, hepatic and renal biomarkers, and clinical parameters were significantly increased following the induction of endotoxemia in the groups receiving lipopolysaccharide. Significantly lower concentration of these markers was observed at 4.5 and 6 h after lipopolysaccharide administration in the sheep treated with LMWH compared to the Ctrl + group. In conclusion, low molecular weight heparin could act as an anti-inflammatory drug by decreasing cytokines and acute phase proteins, modulating oxidative stress biomarkers, and by reducing multiple organ dysfunction following the induction of endotoxemia by Escherichia coli serotype O55:B5 in Iranian fat-tailed sheep in a dose-dependent manner. Furthermore, the anti-inflammatory effects of low molecular weight heparin at 100 IU/kg were significantly higher than 50 IU/kg in the treatment of endotoxemic sheep.
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Affiliation(s)
| | - Aliasghar Chalmeh
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
| | - Mehrdad Pourjafar
- Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Wei S, Bi J, Yang L, Zhang J, Wan Y, Chen X, Wang Y, Wu Z, Lv Y, Wu R. Serum irisin levels are decreased in patients with sepsis, and exogenous irisin suppresses ferroptosis in the liver of septic mice. Clin Transl Med 2020; 10:e173. [PMID: 32997405 PMCID: PMC7522760 DOI: 10.1002/ctm2.173] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sepsis remains a major health issue without an effective therapy. Ferroptosis, an iron-dependent programmed cell death, has been proposed to be related to the pathogenesis of sepsis. Irisin, a myokine released during exercise, improves mitochondrial function under various conditions. Ferroptosis is closely related to mitochondrial function. However, the role of irisin in sepsis-induced ferroptosis and mitochondrial dysfunction in the liver remained unknown. Thus, we hypothesize that irisin treatment suppresses ferroptosis and improves mitochondrial function in sepsis. METHODS To study this, we first explored the role of serum irisin levels in patients with sepsis, and then determined the effect of irisin administration on ferroptosis and mitochondrial function in the liver of septic mice. RESULTS Serum irisin levels were decreased and negatively correlated with the APACHE II scores in patients with sepsis. In mice subjected to cecal ligation and puncture (CLP), exogenous irisin administration suppressed ferroptosis, inhibited inflammatory response, decreased reactive oxygen species (ROS) production, restored abnormal mitochondrial morphology, and increased mtDNA copy number and adenosine triphosphate (ATP) content. The effect of irisin on ferroptosis was confirmed in LPS-treated hepatocytes and CLP-induced septic mice. Inhibition of glutathione peroxidase 4 (GPX4), a central regulator of ferroptosis, reduced irisin's protective effects in LPS-treated hepatocytes and CLP-induced septic mice, while blocking the irisin receptor with RGD peptide or Echistain decreased irisin-induced GPX4 expression. CONCLUSIONS Serum irisin levels are decreased and negatively correlated with disease severity in patients with sepsis, and irisin treatment suppresses ferroptosis and restores mitochondrial function in experimental sepsis. Irisin may offer therapeutic potential in the management of sepsis.
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Affiliation(s)
- Shasha Wei
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Jianbin Bi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
- Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Lifei Yang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
- Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Yafeng Wan
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
- Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Xue Chen
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Yawen Wang
- BioBank, First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Zheng Wu
- Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
- Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative MedicineShaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi ProvinceChina
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Xiao LX, Qi L, Zhang XL, Zhou YQ, Yue HL, Yu ED, Li QY. Liver injury in septic mice were suppressed by a camptothecin-bile acid conjugate via inhibiting NF-κB signaling pathway. Life Sci 2020; 257:118130. [DOI: 10.1016/j.lfs.2020.118130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
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Zhao J, He Y, Xu P, Liu J, Ye S, Cao Y. Serum ammonia levels on admission for predicting sepsis patient mortality at D28 in the emergency department: A 2-center retrospective study. Medicine (Baltimore) 2020; 99:e19477. [PMID: 32176079 PMCID: PMC7220506 DOI: 10.1097/md.0000000000019477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We assessed the predictive value of serum ammonia level on admission for the 28-day mortality of patients with sepsis.We retrospectively included septic patients admitted to the emergency department of West China Hospital, Sichuan University and The Fourth People's Hospital of Zigong city from June 2017 to May 2018. Patients were divided into 2 groups according to 28-day survival. Comparisons of serum ammonia level and sequential organ failure assessment (SOFA) score were made between 2 groups. Multivariate logistic regression models were employed to determine independent risk factors affecting 28-day mortality rate, and receiver operating characteristic (ROC) curve was also used to evaluate the efficacy of risk factors.Total of 316 patients were included into the study, 221 survived to 28 days and 95 were died before 28 days. The 28-day mortality rate was 30.06%. Multivariate logistic regression analyses revealed that the ammonia level, C reactive protein, SOFA score, and the leukocyte were independent risk factors for the 28-day mortality rate. In predicting the 28-day mortality rate, the SOFA score presented an area under the ROC curve (AUC) of 0.815, and the ammonia levels presented the AUC of 0.813.The ammonia level, C reactive protein, SOFA score, and the leukocyte are independent risk factors for 28-day mortality rate in septic patients. Moreover, the serum ammonia and SOFA score have similar predictive values. The serum ammonia level is also a suitable early indicator for prognostic evaluation of patients with sepsis as well.
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Affiliation(s)
- Jie Zhao
- Emergency Department, West China Hospital, Sichuan University, Chengdu
| | - Yarong He
- Emergency Department, West China Hospital, Sichuan University, Chengdu
| | - Ping Xu
- Emergency Department, The Fourth People's Hospital of Zigong City, Zigong
| | - Junzhao Liu
- Emergency Department, West China Hospital, Sichuan University, Chengdu
| | - Sheng Ye
- Emergency Department, West China Hospital, Sichuan University, Chengdu
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, Chengdu
- Disaster Medicine Center, Sichuan University, Chengdu, China
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Fatemi F, Golbodagh A, Hojihosseini R, Dadkhah A, Akbarzadeh K, Dini S, Malayeri MRM. Anti-inflammatory Effects of Deuterium-Depleted Water Plus Rosa Damascena Mill. Essential Oil Via Cyclooxygenase-2 Pathway in Rats. Turk J Pharm Sci 2020; 17:99-107. [PMID: 32454767 DOI: 10.4274/tjps.galenos.2018.24381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/15/2018] [Indexed: 12/29/2022]
Abstract
Objectives Natural medicine has been proposed for treating sepsis worldwide. Therefore, in this study, the effect of deuterium-depleted water (DDW) alone and adjuvant with Rosa damascena Mill. (RD) essential oils was considered through the evaluation of oxidative stress-antioxidant parameters and the expression of cyclooxygenase-2 (COX-2) inflammatory gene in liver damage caused by sepsis. Materials and Methods The rats were randomly divided into 5 groups: 1) laparotomy group; 2) cecal ligation and puncture (CLP) group; 3) DDW (15 ppm and 30 ppm doses) group; 4) DDW (15 ppm and 30 ppm doses) plus RD essential oil (100 mg/kg.bw); 5) indomethacin (2 mg/kg.bw) as a positive control. The treatments were daily administrated for 2 weeks and the CLP model was created on the day 15. Then, the animals were killed and their liver tissue was separated for histopathologic and biochemical assessment. Results Our results demonstrated that the treatment of animals with DDW and DDW plus RD essential oil was effective due to the regulation of the oxidative stress-antioxidant parameters including lipid peroxidation, glutathione (GSH), GSH s-transferases, myeloperoxidase, ferric reducing ability of plasma and inflammatory parameters such as prostaglandin E2 and COX-2. Pathological studies also showed that sepsis led to the liver tissue injuries, which can be reduced by treatments. Conclusion Sepsis caused oxidative stress in the liver tissue, but the administration of DDW and DDW plus RD essential oil can be useful to prevent and heal these injuries.
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Affiliation(s)
- Faezeh Fatemi
- Nuclear Science and Technology Research Institute, Materials and Nuclear Fuel Research School, Tehran, Iran
| | - Abbas Golbodagh
- Payame Noor University, Faculty of Sciences, Department of Biochemistry, Tehran, Iran
| | - Reza Hojihosseini
- Payame Noor University, Faculty of Sciences, Department of Biochemistry, Tehran, Iran
| | - Abolfazl Dadkhah
- Islamic Azad University, Qom Branch, Faculty of Medicine, Department of Medicine, Qom, Iran
| | - Kambiz Akbarzadeh
- Mashhad University of Medical Science, Faculty of Medicine, Mashhad, Iran
| | - Salome Dini
- Islamic Azad University, Karaj Branch, Young Researchers and Elite Club, Karaj, Iran
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Rasooli A, Fatemi F, Hajihosseini R, Vaziri A, Akbarzadeh K, Mohammadi Malayeri MR, Dini S, Foroutanrad M. Synergistic effects of deuterium depleted water and Mentha longifolia L. essential oils on sepsis-induced liver injuries through regulation of cyclooxygenase-2. PHARMACEUTICAL BIOLOGY 2019; 57:125-132. [PMID: 30961427 PMCID: PMC6461093 DOI: 10.1080/13880209.2018.1563622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Mentha longifolia L. (Lamiaceae), a traditional medicinal herb, has been highly valued for exhibiting antimicrobial, antioxidant and antispasmodic properties. OBJECTIVE For the first time, the synergetic anti-inflammatory effects of deuterium depleted water (DDW) and M. longifolia essential oils (ML) were investigated in experimental sepsis. MATERIALS AND METHODS Fifty Wistar rats were divided into 5 groups (n = 10): negative control (laparotomy), CLP, treatment groups including the combination of DDWs (15 and 30 ppm) and ML (100 mg/kg b.w) and indomethacin. At 24 h after CLP induction, lipid peroxidation (LP), glutathione (GSH), glutathione in S-transferases (GST), ferric reducing ability of plasma (FRAP), myeloperoxidase (MPO), prostaglandin E2 (PGE2), and COX-2 expression were determined in the plasma and liver tissues. RESULTS Compared with the CLP group, the administration of DDWs and ML significantly (p < 0.05) prevented the increase of LP, COX-2 and PGE2 levels and liver enzymes. Additionally, the decreased levels of FRAP and GSH induced by sepsis were remarkably (p < 0.05) risen by the administration of DDWs and ML in comparison to the CLP group. However, no significant (p > 0.05) differences were observed regarding GST, ALP and bilirubin levels. Our results also proved the synergistic anti-inflammatory activities of the DDWs and ML. The anti-inflammatory effects of the DDWs and ML were confirmed by histopathological studies. DISCUSSION AND CONCLUSIONS The combination of DDWs and ML exerted synergistic anti-inflammatory activity against CLP-induced sepsis possibly through modulating oxidative stress/antioxidant parameters.
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Affiliation(s)
- Azadeh Rasooli
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Faezeh Fatemi
- Materials and Nuclear Fuel Research School, Nuclear Science and Technology Research Institute, Tehran, Iran
| | - Reza Hajihosseini
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Atoosa Vaziri
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Kambiz Akbarzadeh
- Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Salome Dini
- Young Researchers and Elite Club, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Maria Foroutanrad
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
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Rasooli A, Fatemi F, Hajihosseini R, Vaziri A, Akbarzadeh K, Mohammadi Malayeri MR, Dini S, Foroutanrad M. Synergistic effects of deuterium depleted water and Mentha longifolia L. essential oils on sepsis-induced liver injuries through regulation of cyclooxygenase-2. PHARMACEUTICAL BIOLOGY 2019; 57:125-132. [PMID: 30961427 PMCID: PMC6461093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 12/07/2018] [Indexed: 10/12/2023]
Abstract
CONTEXT Mentha longifolia L. (Lamiaceae), a traditional medicinal herb, has been highly valued for exhibiting antimicrobial, antioxidant and antispasmodic properties. OBJECTIVE For the first time, the synergetic anti-inflammatory effects of deuterium depleted water (DDW) and M. longifolia essential oils (ML) were investigated in experimental sepsis. MATERIALS AND METHODS Fifty Wistar rats were divided into 5 groups (n = 10): negative control (laparotomy), CLP, treatment groups including the combination of DDWs (15 and 30 ppm) and ML (100 mg/kg b.w) and indomethacin. At 24 h after CLP induction, lipid peroxidation (LP), glutathione (GSH), glutathione in S-transferases (GST), ferric reducing ability of plasma (FRAP), myeloperoxidase (MPO), prostaglandin E2 (PGE2), and COX-2 expression were determined in the plasma and liver tissues. RESULTS Compared with the CLP group, the administration of DDWs and ML significantly (p < 0.05) prevented the increase of LP, COX-2 and PGE2 levels and liver enzymes. Additionally, the decreased levels of FRAP and GSH induced by sepsis were remarkably (p < 0.05) risen by the administration of DDWs and ML in comparison to the CLP group. However, no significant (p > 0.05) differences were observed regarding GST, ALP and bilirubin levels. Our results also proved the synergistic anti-inflammatory activities of the DDWs and ML. The anti-inflammatory effects of the DDWs and ML were confirmed by histopathological studies. DISCUSSION AND CONCLUSIONS The combination of DDWs and ML exerted synergistic anti-inflammatory activity against CLP-induced sepsis possibly through modulating oxidative stress/antioxidant parameters.
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Affiliation(s)
- Azadeh Rasooli
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Faezeh Fatemi
- Materials and Nuclear Fuel Research School, Nuclear Science and Technology Research Institute, Tehran, Iran
| | - Reza Hajihosseini
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Atoosa Vaziri
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
| | - Kambiz Akbarzadeh
- Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | | | - Salome Dini
- Young Researchers and Elite Club, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Maria Foroutanrad
- Department of Biochemistry, Faculty of Sciences, Payame-e-Noor University, Tehran, Iran
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Dadkhah A, Fatemi F, Rasooli A, Mohammadi Malayeri MR, Torabi F. Assessing the effect of Mentha longifolia essential oils on COX-2 expression in animal model of sepsis induced by caecal ligation and puncture. PHARMACEUTICAL BIOLOGY 2018; 56:495-504. [PMID: 31070531 PMCID: PMC6282450 DOI: 10.1080/13880209.2018.1510972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 06/15/2018] [Accepted: 08/03/2018] [Indexed: 05/16/2023]
Abstract
CONTEXT Mentha longifolia L. (Lamiaceae), a traditional Iranian plant, possesses antimicrobial and antioxidant activities. OBJECTIVE We investigated the potential protective effects of M. longifolia essential oils (E.Os) on caecal ligation and puncture (CLP) induced liver injury. MATERIALS AND METHODS Wistar Albino rats (n = 50) were grouped as follows: (1) a laparotomy group (LAP); (2) a CLP group (CLP); (3) the treatment groups received orally the E.Os (50 and 100 mg/kg b.w) and indomethacin (2 mg/kg b.w) for 2 weeks. The oxidative stress parameters, liver enzymes and prostaglandin E2 (PGE2) level were measured in liver and plasma tissues. The liver was also harvested for the real time PCR of cyclooxygenase (COX-2) expression following histopathological examinations. RESULTS The results indicated that the CLP operation significantly increased lipid peroxidation (LP) [1.79-fold], myeloperoxidase (MPO) [2.76-fold], PGE2 [1.56-fold] besides plasma aspartate aminotransferase (AST) [2.4-fold] and alanine aminotransferase (ALT) activities [2.22-fold], while, markedly reduced glutathione (GSH) [0.63-fold] and ferric reducing ability of plasma (FRAP) levels [0.63-fold]. Even COX2 expression significantly increased in the CLP group as compared to the LAP group. Treatments of rats with the E.Os could return all the hepatic and plasma biomarkers to the normal levels. These results were further confirmed by pathological examination on liver indicating that E.Os could successfully improve the CLP-induced liver injuries. DISCUSSION AND CONCLUSIONS Our findings suggest that E.Os is able to protect liver injuries against sepsis via modulating the oxidative stress parameters concomitant with the suppression of inflammatory reactions such as PGE2 and COX-2.
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Affiliation(s)
- Abolfazl Dadkhah
- Department of Medicine, Faculty of Medicine, Qom Branch, Islamic Azad University, Qom, Iran
| | - Faezeh Fatemi
- Materials and Nuclear Fuel Research School, Nuclear Science and Technology Research Institute, Tehran, Iran
| | - Azadeh Rasooli
- Department of Biochemistry, Faculty of Science, Payame-e-Noor University, Tehran, Iran
| | | | - Fatemeh Torabi
- Department of Physiology, Faculty of Science, Qom Branch, Islamic Azad University, Qom, Iran
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Bakalli I. Liver Dysfunction in Severe Sepsis from Respiratory Syncytial Virus. J Pediatr Intensive Care 2018; 7:110-114. [PMID: 31073482 PMCID: PMC6260355 DOI: 10.1055/s-0037-1612609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022] Open
Abstract
A 1-month-old child was admitted at our pediatric intensive care unit (PICU) in a very critical state with generalized cyanosis, grunting, high fever, tachypnea, tachycardia, severe hypotension with capillary refill time > 5 seconds, and no palpable pulse. The child was apparently doing well until a few hours before admission. On admission to PICU, his clinical diagnosis was consistent with severe sepsis with his sequential organ failure assessment scores of 7 to 8 points. We started rapid restoration of circulation with aggressive volume replacement and empiric antimicrobial therapy. Despite optimal supportive therapy, the patient showed severe liver injury leading to liver failure, making the treatment more challenging. His simplex real-time reverse transcriptase polymerase chain reaction assay and enzyme linked immune sorbent assay documented respiratory syncytial virus (RSV) infection. Through our case report we would like to highlight the extrapulmonary manifestations of RSV infections and the importance of liver dysfunction during sepsis.
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Affiliation(s)
- Ilirjana Bakalli
- Department of Pediatrics, Pediatric Intensive Care Unit, UHC “Mother Theresa,” Tirana, Albania
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14
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Tao X, Li K, Wang J, Zhang L, Li W, Kan B, Yu G, Jian X. Tetramethylpyrazine can ameliorate hepatocellular mitochondrial dysfunction by decreasing the inflammatory response and increasing AQP8 protein expression in septic rats. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x17731003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sepsis, which could lead to mitochondrial dysfunction and cellular energy loss, always induces acute liver injury and has a high mortality rate. Tetramethylpyrazine (TMP) is an active extract from the Chinese herb Ligusticum chuanxiong and exhibits anti-sepsis activity. In this study, a rat sepsis model was first established via cecal ligation and puncture (CLP). Then, 48 Sprague Dawley male rats were randomly divided into four groups (12 rats in each group): control group (C), sepsis group (S), TMP treatment group (T), and TMP prevention group (P). Serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), mitochondrial aspartate aminotransferase (mAST), and adenosine triphosphate (ATP) levels and mitochondrial membrane potential (MMP) were measured and used as indicators of hepatic dysfunction severity and mitochondrial function. In addition, the activities of Na+-K+-ATPase, Mg2+-ATPase, Ca2+-ATPase, and Ca2+-Mg2+-ATPase in the mitochondrial membrane, the expression level of AQP8 and some inflammatory factors, and the level of oxidative stress were measured to explore potential mechanisms. We found that AQP8 accepts signals from inflammatory factors upon stimulation and during various infections, and low AQP8 expression levels could result in further downstream mitochondrial dysfunction. In conclusion, our data demonstrated that TMP could ameliorate hepatocellular mitochondrial dysfunction by decreasing the inflammatory response and increasing AQP8 protein expression.
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Affiliation(s)
- Xiaogen Tao
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, China
- Intensive Care Unit (ICU), Anhui Provincial Hospital Affiliated Anhui Medical University, Hefei, China
| | - Kun Li
- Intensive Care Unit (ICU), Anhui Provincial Hospital Affiliated Anhui Medical University, Hefei, China
| | - Jinquan Wang
- Intensive Care Unit (ICU), Anhui Provincial Hospital Affiliated Anhui Medical University, Hefei, China
| | - Lin Zhang
- Intensive Care Unit (ICU), Anhui Provincial Hospital Affiliated Anhui Medical University, Hefei, China
| | - Wei Li
- School of Pharmacy, University College London, London, UK
| | - Baotian Kan
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, China
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Lv Y, Wang J, Xu D, Liao S, Li P, Zhang Q, Yang M, Kong L. Comparative study of single/combination use of Huang-Lian-Jie-Du decoction and berberine on their protection on sepsis induced acute liver injury by NMR metabolic profiling. J Pharm Biomed Anal 2017; 145:794-804. [PMID: 28822346 DOI: 10.1016/j.jpba.2017.07.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
Abstract
Sepsis is a serious clinical disease with a high mortality rate all around the world. Liver organ dysfunction is an important sign for the severity and outcome of sepsis in patients. In this study, 1H NMR-based metabolomics approach and biochemical assays were applied to investigate the metabolic profiling for cecal ligation and puncture (CLP) induced acute liver injury, the therapeutical effect of single/combination use of Huang-Lian-Jie-Du decoction (HLJDD) and berberine, and the interaction of them. Metabolomics analysis revealed significant perturbations in livers of septic rats, which could be ameliorated by HLJDD, berberine and their combination treatment. Berberine could better rectified glycolysis and nucleic acid metabolism in the liver. HLJDD had exceptional better anti-inflammatory, antibacterial and antioxidative effects than berberine. The interaction of berberine and HLJDD could further strengthen the anti-inflammation and anti-oxidation, but with poor effect on amino acids metabolism. These findings highlighted the feasibility of the integrated NMR based metabolomics approach to understand the pathogenesis of diseases, the action mechanisms of therapy and the herb-drug interaction.
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Affiliation(s)
- Yan Lv
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Junsong Wang
- Center for Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiao Ling Wei Street, Nanjing 210094, PR China.
| | - Dingqiao Xu
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Shanting Liao
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Pei Li
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Qian Zhang
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Minghua Yang
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China
| | - Lingyi Kong
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, Department of Natural Medicinal Chemistry, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing 210009, PR China.
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Abstract
Sepsis and septic shock are characterized by life-threatening organ dysfunction caused by a dysregulated host response to infection. The liver has a central role during sepsis, and is essential to the regulation of immune defence during systemic infections by mechanisms such as bacterial clearance, acute-phase protein or cytokine production and metabolic adaptation to inflammation. However, the liver is also a target for sepsis-related injury, including hypoxic hepatitis due to ischaemia and shock, cholestasis due to altered bile metabolism, hepatocellular injury due to drug toxicity or overwhelming inflammation, as well as distinct pathologies such as secondary sclerosing cholangitis in critically ill patients. Hence, hepatic dysfunction substantially impairs the prognosis of sepsis and serves as a powerful independent predictor of mortality in the intensive care unit. Sepsis is particularly problematic in patients with liver cirrhosis (who experience increased bacterial translocation from the gut and impaired microbial defence) as it can trigger acute-on-chronic liver failure - a syndrome with high short-term mortality. Here, we review the importance of the liver as a guardian, modifier and target of sepsis, the factors that contribute to sepsis in patients with liver cirrhosis and new therapeutic strategies.
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17
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Gaddam RR, Fraser R, Badiei A, Chambers S, Cogger VC, Le Couteur DG, Ishii I, Bhatia M. Cystathionine-Gamma-Lyase Gene Deletion Protects Mice against Inflammation and Liver Sieve Injury following Polymicrobial Sepsis. PLoS One 2016; 11:e0160521. [PMID: 27518439 PMCID: PMC4982653 DOI: 10.1371/journal.pone.0160521] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/19/2016] [Indexed: 01/13/2023] Open
Abstract
Background Hydrogen sulfide (H2S), produced by the activity of cystathionine-gamma-lyase (CSE), is a key mediator of inflammation in sepsis. The liver sinusoidal endothelial cells (LSECs) are important target and mediator of sepsis. The aim of this study was to investigate the role of CSE-derived H2S on inflammation and LSECs fenestrae in caecal-ligation and puncture (CLP)-induced sepsis using CSE KO mice. Methods Sepsis was induced by CLP, and mice (C57BL/6J, male) were sacrificed after 8 hours. Liver, lung, and blood were collected and processed to measure CSE expression, H2S synthesis, MPO activity, NF-κB p65, ERK1/2, and cytokines/chemokines levels. Diameter, frequency, porosity and gap area of the liver sieve were calculated from scanning electron micrographs of the LSECs. Results An increased CSE expression and H2S synthesizing activity in the liver and lung of wild-type mice following CLP-induced sepsis. This was associated with an increased liver and lung MPO activity, and increased liver and lung and plasma levels of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β, and the chemokines MCP-1 and MIP-2α. Conversely, CSE KO mice had less liver and lung injury and reduced inflammation following CLP-induced sepsis as evidenced by decreased levels of H2S synthesizing activity, MPO activity, and pro-inflammatory cytokines/chemokines production. Extracellular-regulated kinase (ERK1/2) and nuclear factor-κB p65 (NF-κB) became significantly activated after the CLP in WT mice but not in CSE KO mice. In addition, CLP-induced damage to the LSECs, as indicated by increased defenestration and gaps formation in the LSECs compared to WT sham control. CSE KO mice showed decreased defenestration and gaps formation following sepsis. Conclusions Mice with CSE (an H2S synthesising enzyme) gene deletion are less susceptible to CLP-induced sepsis and associated inflammatory response through ERK1/2-NF-κB p65 pathway as evidenced by reduced inflammation, tissue damage, and LSECs defenestration and gaps formation.
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Affiliation(s)
| | - Robin Fraser
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Alireza Badiei
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Stephen Chambers
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Victoria C Cogger
- Centre for Education and Research on Ageing, Alzheimers and Ageing Institute, Biogerentology, ANZAC Research Institute, University of Sydney, Sydney and Concord Hospital, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Alzheimers and Ageing Institute, Biogerentology, ANZAC Research Institute, University of Sydney, Sydney and Concord Hospital, Sydney, Australia
| | - Isao Ishii
- Department of Biochemistry, Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Madhav Bhatia
- Department of Pathology, University of Otago, Christchurch, New Zealand
- * E-mail:
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18
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Olsen HG, Kjelgaard-Hansen M, Tveden-Nyborg P, Birck MM, Hammelev KP, Vegge A, Aalbæk B, Leifsson PS, Jensen HE, Iburg T, Heegaard PMH, Nielsen OL. Modelling severe Staphylococcus aureus sepsis in conscious pigs: are implications for animal welfare justified? BMC Res Notes 2016; 9:99. [PMID: 26879530 PMCID: PMC4755015 DOI: 10.1186/s13104-016-1888-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A porcine model of haematogenous Staphylococcus aureus sepsis has previously been established in our research group. In these studies, pigs developed severe sepsis including liver dysfunction during a 48 h study period. As pigs were awake during the study, animal welfare was challenged by the severity of induced disease, which in some cases necessitated humane euthanasia. A pilot study was therefore performed in order to establish the sufficient inoculum concentration and application protocol needed to produce signs of liver dysfunction within limits of our pre-defined humane endpoints. METHODS Four pigs received 1 × 10(8) cfu/kg BW of S. aureus, and two controls were sham inoculated with saline. A fixed infusion rate of 3 mL/min was used, while the inoculum concentration, i.e., the dose volume, was changed between the pigs. The following dose volumes were used: 10 mL (n = 1), 20 mL (n = 2), and 30 mL (n = 1), corresponding to infusion durations of 3.33, 6.66, and 10 min at dose rates of 3 × 10(7), 1.5 × 10(7), and 1 × 10(7) cfu/min/kg BW, respectively. Blood samples were drawn for complete blood count, clinical chemistry, and inflammatory markers before and every 6 h after inoculation. Prior to euthanasia, a galactose elimination capacity test was performed to assess liver function. Pigs were euthanised 48 h post inoculation for necropsy and histopathological evaluation. RESULTS While infusion times of 6.66 min, and higher, did not induce liver dysfunction (n = 3), the infusion time of 3.33 min (n = 1) caused alterations in parameters similar to what had been seen in our previous studies, i.e., increasing bilirubin and aspartate aminotransferase, as well as histopathological occurrence of intravascular fibrin split products in the liver. This pig was however euthanised after 30 h, according to humane endpoints. CONCLUSIONS A usable balance between scientific purpose and animal welfare could not be achieved, and we therefore find it hard to justify further use of this conscious porcine sepsis model. In order to make a model of translational relevance for human sepsis, we suggest that future model versions should use long-term anaesthesia.
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Affiliation(s)
- Helle G Olsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Mads Kjelgaard-Hansen
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark. .,Novo Nordisk, Måløv, Denmark.
| | - Pernille Tveden-Nyborg
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Malene M Birck
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Karsten P Hammelev
- Department of Experimental Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Andreas Vegge
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark. .,Novo Nordisk, Måløv, Denmark.
| | - Bent Aalbæk
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Páll S Leifsson
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Henrik E Jensen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Tine Iburg
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark. .,National Veterinary Institute, Technical University of Denmark, Frederiksberg, Denmark.
| | - Peter M H Heegaard
- National Veterinary Institute, Technical University of Denmark, Frederiksberg, Denmark.
| | - Ole L Nielsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
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Interaction Effects of Acute Kidney Injury, Acute Respiratory Failure, and Sepsis on 30-Day Postoperative Mortality in Patients Undergoing High-Risk Intraabdominal General Surgical Procedures. Anesth Analg 2015; 121:1536-46. [DOI: 10.1213/ane.0000000000000915] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Hepatic hepcidin protects against polymicrobial sepsis in mice by regulating host iron status. Anesthesiology 2015; 122:374-86. [PMID: 25264597 DOI: 10.1097/aln.0000000000000466] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hepcidin is a master regulator of iron metabolism primarily produced by the liver. Markedly increased hepcidin levels have been observed in septic individuals, while decreased hepatic hepcidin expression has been demonstrated in liver diseases that tend to develop into sepsis. However, the role of liver hepcidin in sepsis remains unknown. METHODS Mouse hepatic hepcidin expression was silenced using adenovirus-mediated hepcidin-specific short hairpin RNA injected via the tail vein. Sepsis was induced by cecal ligation and puncture, and the outcome (n = 23 for hepcidin knockdown mice, n = 15 for controls) and pathogenic changes (n = 5) related to sepsis were evaluated. The impact of alteration of iron status on the survival rate of hepatic hepcidin knockdown mice (n = 18 to 19) was also investigated. RESULTS Disruption of liver hepcidin expression increased serum iron level (537.8 ± 28.1 μg/dl [mean ± SD] vs. 235.9 ± 62.2 μg/dl; P < 0.05) and reduced iron content in the spleen macrophages at the steady state. Hepatic hepcidin knockdown mice not only showed increased 7-day mortality (73.9% vs. 46.7%; P < 0.05), but also had exacerbated organ damage and oxidative stress, as well as compromised host inflammatory responses and bacterial clearance at 24 h after polymicrobial sepsis. Treating the hepatic hepcidin knockdown mice with low-iron diet plus iron chelation decreased systemic iron content (serum level: 324.0 ± 67.4 μg/dl vs. 517.4 ± 13.4 μg/dl; P < 0.05) and rescued the mice from lethal sepsis (7-day survival: 36.8% vs. 83.3%; P < 0.01). CONCLUSIONS Hepatic hepcidin plays an important role in sepsis through regulation of iron metabolism. The findings may have potential therapeutic implications for liver diseases in which hepcidin expression is decreased.
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Markwart R, Condotta SA, Requardt RP, Borken F, Schubert K, Weigel C, Bauer M, Griffith TS, Förster M, Brunkhorst FM, Badovinac VP, Rubio I. Immunosuppression after sepsis: systemic inflammation and sepsis induce a loss of naïve T-cells but no enduring cell-autonomous defects in T-cell function. PLoS One 2014; 9:e115094. [PMID: 25541945 PMCID: PMC4277344 DOI: 10.1371/journal.pone.0115094] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022] Open
Abstract
Sepsis describes the life-threatening systemic inflammatory response (SIRS) of an organism to an infection and is the leading cause of mortality on intensive care units (ICU) worldwide. An acute episode of sepsis is characterized by the extensive release of cytokines and other mediators resulting in a dysregulated immune response leading to organ damage and/or death. This initial pro-inflammatory burst often transits into a state of immune suppression characterised by loss of immune cells and T-cell dysfunction at later disease stages in sepsis survivors. However, despite these appreciations, the precise nature of the evoked defect in T-cell immunity in post-acute phases of SIRS remains unknown. Here we present an in-depth functional analysis of T-cell function in post-acute SIRS/sepsis. We document that T-cell function is not compromised on a per cell basis in experimental rodent models of infection-free SIRS (LPS or CpG) or septic peritonitis. Transgenic antigen-specific T-cells feature an unaltered cytokine response if challenged in vivo and ex vivo with cognate antigens. Isolated CD4(+)/CD8(+) T-cells from post-acute septic animals do not exhibit defects in T-cell receptor-mediated activation at the the level of receptor-proximal signalling, activation marker upregulation or expansion. However, SIRS/sepsis induced transient lymphopenia and gave rise to an environment of immune attenuation at post acute disease stages. Thus, systemic inflammation has an acute impact on T-cell numbers and adaptive immunity, but does not cause major cell-autonomous enduring functional defects in T-cells.
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Affiliation(s)
- Robby Markwart
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | | | - Robert P. Requardt
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Farina Borken
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Katja Schubert
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Cynthia Weigel
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Michael Bauer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Dept. for Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Thomas S. Griffith
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, United States of America
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Martin Förster
- Clinic of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Frank M. Brunkhorst
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | | | - Ignacio Rubio
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Institute of Molecular Cell Biology, Center for Molecular Biomedicine, Jena University Hospital, Jena, Germany
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McCurdy TR, Patrick AL, Eltringham-Smith LJ, Bhakta V, Sheffield WP, Fox-Robichaud AE. Alpha-1 acid glycoprotein reduces hepatic leukocyte recruitment in murine models of either early endotoxemia or early sepsis. Microcirculation 2014; 21:74-83. [PMID: 23941548 DOI: 10.1111/micc.12081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 08/09/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To characterize the effect of systemically administered AGP on early leukocyte recruitment in the livers of endotoxemic or septic mice and to determine whether this is influenced by LPS sequestration. METHODS Endotoxemia was induced in C57Bl/6 mice via intraperitoneal injection of LPS. Sepsis was induced in mice by cecal ligation and perforation. AGP (165 mg/kg) or saline (20 mL/kg) or HAS (200 mg/kg) was administered immediately after surgery or LPS injection and the hepatic microcirculation was examined by intravital microscopy at four hour. RESULTS Leukocyte adhesion in the PSV was reduced by treatment with AGP in mice subjected to either LPS or CLP protocols compared to either saline or HAS treatment. AGP-treated mice also had significantly higher sinusoidal flow in both models. Pre-incubation of LPS with AGP reduced the ability of LPS to recruit leukocytes to the liver microcirculation. CONCLUSIONS AGP was more effective in limiting hepatic inflammation and maintaining perfusion than saline or HAS, in both endotoxemic and septic mice. AGP sequestration of LPS may contribute to its anti-inflammatory effects.
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Affiliation(s)
- Teresa R McCurdy
- Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Canadian Blood Services Research and Development, Hamilton, Ontario, Canada
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Wang D, Yin Y, Yao Y. Advances in sepsis-associated liver dysfunction. BURNS & TRAUMA 2014; 2:97-105. [PMID: 27602369 PMCID: PMC5012093 DOI: 10.4103/2321-3868.132689] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 05/06/2023]
Abstract
Recent studies have revealed liver dysfunction as an early event in sepsis. Sepsis-associated liver dysfunction is mainly resulted from systemic or microcirculatory disturbances, spillovers of bacteria and endotoxin (lipopolysaccharide, LPS), and subsequent activation of inflammatory cytokines as well as mediators. Three main cell types of the liver which contribute to the hepatic response in sepsis are Kupffer cells (KCs), hepatocytes and liver sinusoidal endothelial cells (LSECs). In addition, activated neutrophils, which are also recruited to the liver and produce potentially destructive enzymes and oxygen-free radicals, may further enhance acute liver injury. The clinical manifestations of sepsis-associated liver dysfunction can roughly be divided into two categories: Hypoxic hepatitis and jaundice. The latter is much more frequent in the context of sepsis. Hepatic failure is traditionally considered as a late manifestation of sepsis-induced multiple organ dysfunction syndrome. To date, no specific therapeutics for sepsis-associated liver dysfunction are available. Treatment measure is mainly focused on eradication of the underlying infection and management for severe sepsis. A better understanding of the pathophysiology of liver response in sepsis may lead to further increase in survival rates.
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Affiliation(s)
- Dawei Wang
- Department of Microbiology and Immunology, Burns Institute, First Hospital Affiliated to the Chinese PLA General Hospital, No.51 Fucheng Road, Haidian District, Beijing, 100048 China
- Department of ICU, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Yimei Yin
- Department of ICU, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Yongming Yao
- Department of Microbiology and Immunology, Burns Institute, First Hospital Affiliated to the Chinese PLA General Hospital, No.51 Fucheng Road, Haidian District, Beijing, 100048 China
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Abstract
PURPOSE OF REVIEW Sepsis elicits profound changes in the concentrations of plasma proteins synthesized by liver parenchymal cells referred to as acute-phase proteins. Mechanisms controlling this orchestrated response include release of cytokines that induce acute-phase proteins, while other 'house-keeping' genes are downregulated. RECENT FINDINGS Although some acute-phase proteins help to control damage, functions of many other acute-phase reactants remain obscure. Changes in acute-phase gene expression are primarily subject to transcriptional regulation and can be comprehensively monitored by array techniques. Emerging evidence from such strategies implies that in addition to a 'common host response' also highly specific pathways are induced in specific disease contexts. Applying a systems biology approach to the integrated response of the hepatocyte to infection would suggest that the reprogramming of metabolic functions occurs in parallel with a severity-dependent disruption of phase I and II biotransformation and canalicular transport, that is, excretory failure. Although traditionally bilirubin serves to monitor excretion, emerging evidence suggests that bile acids indicate liver dysfunction with higher sensitivity and specificity. SUMMARY Sepsis induces reprogramming of the hepatic transcriptome. This includes induction of adaptive acute-phase proteins but also repression of phase I, II metabolism and transport with important implications for monitoring and pharmacotherapy.
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