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Ackland GL, Van Duijvenboden S, Abbott TE, Gutierrez del Arroyo A, Wilson MJ, David AL. Interleukin-1 receptor antagonist, mode of analgesia and risk of Caesarean delivery after onset of labour: a Mendelian randomisation analysis. Br J Anaesth 2022; 128:89-97. [PMID: 34802694 PMCID: PMC8787778 DOI: 10.1016/j.bja.2021.09.039] [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: 05/15/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Lower circulating levels of the anti-inflammatory cytokine interleukin-1 receptor antagonist (IL-1ra) are associated with intrapartum inflammation and epidural analgesia-related maternal fever, both of which increase the rate of obstetric interventions. We hypothesised that genetic variants determining IL-1ra levels would be associated with Caesarean delivery rates after the onset of labour. METHODS We performed Mendelian randomisation analyses in parous women ≥16 yr old who received either non-neuraxial or neuraxial analgesia for their first two labours (UK Biobank). We used an established genetic score (calculated as 0-4, determined by the presence/absence of rs6743376 and rs1542176 alleles), in which the complete absence of both alleles causes the lowest IL-1ra levels. The primary outcome was Caesarean delivery after the onset of labour (odds ratio [OR]: 95% confidence intervals). RESULTS There were 7731 women (mean [standard deviation] age at first birth: 25 [5] yr) who had complete genetic scores and delivery data. For women who received non-neuraxial analgesia, Caesarean delivery rates were different across allele scores (χ2=12.4; P=0.015): 104/596 (17.4%) women with zero allele score underwent Caesarean delivery, compared with 654/5015 (13.0%) with allele score ≥1 (OR 1.41; 1.12-1.77). For women who had neuraxial analgesia, Caesarean delivery was not different across allele scores, ranging from 18.1% to 20.8% (χ2=0.29; P=0.99). Caesarean delivery was independent of type of analgesia for 818/7731 (10.6%) women with zero allele scores (OR 0.93; 0.63-1.39), but was higher in women receiving neuraxial analgesia with allele scores ≥1 (OR 1.55; 1.35-1.79; P<0.001). CONCLUSIONS Mendelian randomisation analysis suggests that higher IL-1ra levels are associated with reduced Caesarean delivery rate. Neuraxial analgesia appears to disrupt this link. CLINICAL TRIAL REGISTRATION UK Biobank study 62745.
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Affiliation(s)
- Gareth L. Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK,Corresponding author.
| | | | - Tom E.F. Abbott
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ana Gutierrez del Arroyo
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Matthew J. Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna L. David
- Elizabeth Garret Anderson Institute for Women's Health, University College London, London, UK
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2
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Brien ME, Gaudreault V, Hughes K, Hayes DJL, Heazell AEP, Girard S. A Systematic Review of the Safety of Blocking the IL-1 System in Human Pregnancy. J Clin Med 2021; 11:jcm11010225. [PMID: 35011965 PMCID: PMC8745599 DOI: 10.3390/jcm11010225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Blockade of the interleukin-1 (IL-1) pathway has been used therapeutically in several inflammatory diseases including arthritis and cryopyrin-associated periodic syndrome (CAPS). These conditions frequently affect women of childbearing age and continued usage of IL-1 specific treatments throughout pregnancy has been reported. IL-1 is involved in pregnancy complications and its blockade could have therapeutic potential. We systematically reviewed all reported cases of IL-1 blockade in human pregnancy to assess safety and perinatal outcomes. We searched several databases to find reports of specific blockade of the IL-1 pathway at any stage of pregnancy, excluding broad spectrum or non-specific anti-inflammatory intervention. Our literature search generated 2439 references of which 22 studies included, following extensive review. From these, 88 different pregnancies were assessed. Most (64.8%) resulted in healthy term deliveries without any obstetrical/neonatal complications. Including pregnancy exposed to Anakinra or Canakinumab, 12 (15.0%) resulted in preterm birth and one stillbirth occurred. Regarding neonatal complications, 2 cases of renal agenesis (2.5%) were observed, and 6 infants were diagnosed with CAPS (7.5%). In conclusion, this systematic review describes that IL-1 blockade during pregnancy is not associated with increased adverse perinatal outcomes, considering that treated women all presented an inflammatory disease associated with elevated risk of pregnancy complications.
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Affiliation(s)
- Marie-Eve Brien
- Ste-Justine Hospital Research Center, Montreal, QC H3T 1C5, Canada; (M.-E.B.); (V.G.); (K.H.)
| | - Virginie Gaudreault
- Ste-Justine Hospital Research Center, Montreal, QC H3T 1C5, Canada; (M.-E.B.); (V.G.); (K.H.)
| | - Katia Hughes
- Ste-Justine Hospital Research Center, Montreal, QC H3T 1C5, Canada; (M.-E.B.); (V.G.); (K.H.)
| | - Dexter J. L. Hayes
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; (D.J.L.H.); (A.E.P.H.)
| | - Alexander E. P. Heazell
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; (D.J.L.H.); (A.E.P.H.)
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Universite de Montreal, Montreal, QC H3T 1J4, Canada
- Department of Obstetrics and Gynecology, Department of Immunology, Mayo Clinic, Rochester, MN 55902, USA
- Correspondence: ; Tel.: +1-507-284-0545
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3
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Eyenga P, Roussel D, Rey B, Ndille P, Teulier L, Eyenga F, Romestaing C, Morel J, Gueguen-Chaignon V, Sheu SS. Mechanical ventilation preserves diaphragm mitochondrial function in a rat sepsis model. Intensive Care Med Exp 2021; 9:19. [PMID: 33825987 PMCID: PMC8025065 DOI: 10.1186/s40635-021-00384-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/24/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To describe the effect of mechanical ventilation on diaphragm mitochondrial oxygen consumption, ATP production, reactive oxygen species (ROS) generation, and cytochrome c oxidase activity and content, and their relationship to diaphragm strength in an experimental model of sepsis. METHODS A cecal ligation and puncture (CLP) protocol was performed in 12 rats while 12 controls underwent sham operation. Half of the rats in each group were paralyzed and mechanically ventilated. We performed blood gas analysis and lactic acid assays 6 h after surgery. Afterwards, we measured diaphragm strength and mitochondrial oxygen consumption, ATP and ROS generation, and cytochrome c oxidase activity. We also measured malondialdehyde (MDA) content as an index of lipid peroxidation, and mRNA expression of the proinflammatory interleukin-1β (IL-1β) in diaphragms. RESULTS CLP rats showed severe hypotension, metabolic acidosis, and upregulation of diaphragm IL-1β mRNA expression. Compared to sham controls, spontaneously breathing CLP rats showed lower diaphragm force and increased susceptibility to fatigue, along with depressed mitochondrial oxygen consumption and ATP production and cytochrome c oxidase activity. These rats also showed increased mitochondrial ROS generation and MDA content. Mechanical ventilation markedly restored mitochondrial oxygen consumption and ATP production in CLP rats; lowered mitochondrial ROS production by the complex 3; and preserved cytochrome c oxidase activity. CONCLUSION In an experimental model of sepsis, early initiation of mechanical ventilation restores diaphragm mitochondrial function.
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Affiliation(s)
- P. Eyenga
- Center for Translational Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107 USA
- Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - D. Roussel
- Laboratoire d’Ecologie des Hydrosystèmes Naturels et Anthropisés, UMR 5023, Université de Lyon, Université Lyon1, CNRS, 69622 Villeurbanne, France
| | - B. Rey
- Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, Université de Lyon, Université Lyon1, CNRS, 69622 Villeurbanne, France
| | - P. Ndille
- Département de Chirurgie, Centre Hospitalier D’Ebomé, Kribi, Cameroun
| | - L. Teulier
- Laboratoire d’Ecologie des Hydrosystèmes Naturels et Anthropisés, UMR 5023, Université de Lyon, Université Lyon1, CNRS, 69622 Villeurbanne, France
| | - F. Eyenga
- Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - C. Romestaing
- Laboratoire d’Ecologie des Hydrosystèmes Naturels et Anthropisés, UMR 5023, Université de Lyon, Université Lyon1, CNRS, 69622 Villeurbanne, France
| | - J. Morel
- Service de réanimation chirurgicale, CHU de Saint Etienne, 42000 Saint Etienne, France
| | - V. Gueguen-Chaignon
- Protein Science Facility, ENS de Lyon, Inserm, US8, SFR Biosciences UMS 3444 - CNRS Université Claude Bernard Lyon 1, 69007 Lyon, France
| | - S-S. Sheu
- Center for Translational Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107 USA
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4
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Aldecoa-Bilbao V, Balcells-Esponera C, Herranz Barbero A, Borràs-Novell C, Izquierdo Renau M, Iriondo Sanz M, Salvia Roigés M. Lung ultrasound for early surfactant treatment: Development and validation of a predictive model. Pediatr Pulmonol 2021; 56:433-441. [PMID: 33369257 DOI: 10.1002/ppul.25216] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
Abstract
AIM To develop and validate a feasible predictive model for early surfactant treatment in very preterm infants (VPI) admitted with respiratory distress syndrome (RDS). METHODS Preterm infants less than 32 weeks of gestation with RDS and stabilized with noninvasive ventilation in delivery room were recruited (January 2018-April 2020). Clinical data, chest X-ray (CXR) score, respiratory support, oxygen saturation/fraction of inspired oxygen ratio (SF ratio), lung ultrasound (LUS) score, and diaphragmatic thickening fraction (DTF) were recorded at 60-120 min of life. Oxygen threshold for surfactant administration was fraction of inspired oxygen more than 30%; ultrasound findings were blinded. Logistic regression models using a stepwise selection of variables were developed in the derivation cohort. Coefficients from these models were applied to the validation cohort and a diagnostic performance was calculated. RESULTS A total of 144 VPI with a mean gestational age of 28.7 ± 2.2 weeks were included (94 into the derivation cohort, 50 into the validation cohort); 37 required surfactant treatment (25.7%). Gestational age, SF ratio, LUS score, CXR score, and Silverman score were related to surfactant administration (R2 = .823). Predictors included in the final model for surfactant administration were SF ratio and LUS score (R2 = .783) with an area under the receiver operating characteristic (AUC) = 0.97 (95% confidence interval [CI]: 0.93-1.00) in the derivation cohort and an AUC = 0.95 (95% CI: 0.85-0.99) in the validation cohort. By applying our predictive model, 26 patients (70.2%) would have been treated with surfactant earlier than 2 h of life. CONCLUSION The predictive model showed a high diagnostic performance and could be of value to optimize early respiratory management in VPI with RDS.
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Affiliation(s)
- Victoria Aldecoa-Bilbao
- Department of Neonatology, Hospital Clínic Barcelona. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Carla Balcells-Esponera
- Department of Neonatology, Hospital Sant Joan de Déu. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Ana Herranz Barbero
- Department of Neonatology, Hospital Clínic Barcelona. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Cristina Borràs-Novell
- Department of Neonatology, Hospital Clínic Barcelona. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- Department of Neonatology, Hospital Sant Joan de Déu. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Martín Iriondo Sanz
- Department of Neonatology, Hospital Sant Joan de Déu. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona (UB), Barcelona, Spain
| | - MªDolors Salvia Roigés
- Department of Neonatology, Hospital Clínic Barcelona. BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
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5
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Passmore MR, Byrne L, Obonyo NG, See Hoe LE, Boon AC, Diab SD, Dunster KR, Bisht K, Tung JP, Fauzi MH, Narula M, Pedersen SE, Esguerra-Lallen A, Simonova G, Sultana A, Anstey CM, Shekar K, Maitland K, Suen JY, Fraser JF. Inflammation and lung injury in an ovine model of fluid resuscitated endotoxemic shock. Respir Res 2018; 19:231. [PMID: 30466423 PMCID: PMC6249903 DOI: 10.1186/s12931-018-0935-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Sepsis is a multi-system syndrome that remains the leading cause of mortality and critical illness worldwide, with hemodynamic support being one of the cornerstones of the acute management of sepsis. We used an ovine model of endotoxemic shock to determine if 0.9% saline resuscitation contributes to lung inflammation and injury in acute respiratory distress syndrome, which is a common complication of sepsis, and investigated the potential role of matrix metalloproteinases in this process. Methods Endotoxemic shock was induced in sheep by administration of an escalating dose of lipopolysaccharide, after which they subsequently received either no fluid bolus resuscitation or a 0.9% saline bolus. Lung tissue, bronchoalveolar fluid (BAL) and plasma were analysed by real-time PCR, ELISA, flow cytometry and immunohistochemical staining to assess inflammatory cells, cytokines, hyaluronan and matrix metalloproteinases. Results Endotoxemia was associated with decreased serum albumin and total protein levels, with activated neutrophils, while the glycocalyx glycosaminoglycan hyaluronan was significantly increased in BAL. Quantitative real-time PCR studies showed higher expression of IL-6 and IL-8 with saline resuscitation but no difference in matrix metalloproteinase expression. BAL and tissue homogenate levels of IL-6, IL-8 and IL-1β were elevated. Conclusions This data shows that the inflammatory response is enhanced when a host with endotoxemia is resuscitated with saline, with a comparatively higher release of inflammatory cytokines and endothelial/glycocalyx damage, but no change in matrix metalloproteinase levels.
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Affiliation(s)
- Margaret R Passmore
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia. .,University of Queensland, Brisbane, Australia.
| | - Liam Byrne
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Australian National University, Canberra, Australia
| | - Nchafatso G Obonyo
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Louise E See Hoe
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Ai-Ching Boon
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Sara D Diab
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Kimble R Dunster
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Kavita Bisht
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Mohd H Fauzi
- Department of Emergency Medicine, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Monica Narula
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Sanne E Pedersen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Arlanna Esguerra-Lallen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Gabriela Simonova
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Annette Sultana
- Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Chris M Anstey
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,Sunshine Coast University Hospital Intensive Care, Birtinya, Australia
| | - Kiran Shekar
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Wellcome Trust Centre for Clinical Tropical Medicine and Department of Paediatrics, Faculty of Medicine, Imperial College, London, UK
| | - Jacky Y Suen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Rd, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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6
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Karisnan K, Mahzabin T, Bakker AJ, Song Y, Noble PB, Pillow JJ, Pinniger GJ. Gestational age at time of in utero lipopolysaccharide exposure influences the severity of inflammation-induced diaphragm weakness in lambs. Am J Physiol Regul Integr Comp Physiol 2017; 314:R523-R532. [PMID: 29212808 DOI: 10.1152/ajpregu.00150.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The preterm diaphragm is functionally immature compared with its term counterpart. In utero inflammation further exacerbates preterm diaphragm dysfunction. We hypothesized that preterm lambs are more vulnerable to in utero inflammation-induced diaphragm dysfunction compared with term lambs. Pregnant ewes received intra-amniotic (IA) injections of saline or 10 mg lipopolysaccharide (LPS) 2 or 7 days before delivery at 121 days (preterm) or ∼145 days (term) of gestation. Diaphragm contractile function was assessed in vitro. Plasma cytokines, diaphragm myosin heavy chain (MHC) isoforms, and oxidative stress were evaluated. Maximum diaphragm force in preterm control lambs was significantly lower (22%) than in term control lambs ( P < 0.001). Despite similar inflammatory cytokine responses to in utero LPS exposure, diaphragm function in preterm and term lambs was affected differentially. In term lambs, maximum force after a 2-day LPS exposure was significantly lower than in controls (by ~20%, P < 0.05). In preterm lambs, maximum forces after 2-day and 7-day LPS exposures were significantly lower than in controls (by ~30%, P < 0.05). Peak twitch force after LPS exposure was significantly lower in preterm than in controls, but not in term lambs. In term lambs, LPS exposure increased the proportion of MHC-I fibers, increased twitch contraction times, and increased fatigue resistance relative to controls. In preterm diaphragm, the cross-sectional area of embryonic MHC fibers was significantly lower after 7-day versus 2-day LPS exposures. We conclude that preterm lambs are more vulnerable to IA LPS-induced diaphragm dysfunction than term lambs. In utero inflammation exacerbates diaphragm dysfunction and may increase susceptibility to postnatal respiratory failure.
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Affiliation(s)
- Kanakeswary Karisnan
- School of Human Sciences, The University of Western Australia , Crawley , Australia.,School of Medicine, Perdana University -Royal College of Surgeons in Ireland , Selangor , Malaysia
| | - Tanzila Mahzabin
- School of Human Sciences, The University of Western Australia , Crawley , Australia
| | - Anthony J Bakker
- School of Human Sciences, The University of Western Australia , Crawley , Australia
| | - Yong Song
- School of Human Sciences, The University of Western Australia , Crawley , Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia , Crawley , Australia.,School of Medicine, Perdana University -Royal College of Surgeons in Ireland , Selangor , Malaysia
| | - Peter B Noble
- School of Human Sciences, The University of Western Australia , Crawley , Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia , Crawley , Australia
| | - J Jane Pillow
- School of Human Sciences, The University of Western Australia , Crawley , Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia , Crawley , Australia
| | - Gavin J Pinniger
- School of Human Sciences, The University of Western Australia , Crawley , Australia
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7
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Passmore MR, Fung YL, Simonova G, Foley SR, Dunster KR, Diab SD, Tung JP, Minchinton RM, McDonald CI, Anstey CM, Shekar K, Fraser JF. Inflammation and lung injury in an ovine model of extracorporeal membrane oxygenation support. Am J Physiol Lung Cell Mol Physiol 2016; 311:L1202-L1212. [PMID: 27815258 DOI: 10.1152/ajplung.00296.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/02/2016] [Indexed: 02/01/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment for patients with severe refractory cardiorespiratory failure. Exposure to the ECMO circuit is thought to trigger/exacerbate inflammation. Determining whether inflammation is the result of the patients' underlying pathologies or the ECMO circuit is difficult. To discern how different insults contribute to the inflammatory response, we developed an ovine model of lung injury and ECMO to investigate the impact of smoke-induced lung injury and ECMO in isolation and cumulatively on pulmonary and circulating inflammatory cells, cytokines, and tissue remodeling. Sheep receiving either smoke-induced acute lung injury (S-ALI) or sham injury were placed on veno-venous (VV) ECMO lasting either 2 or 24 h, with controls receiving conventional ventilation only. Lung tissue, bronchoalveolar fluid, and plasma were analyzed by RT-PCR, immunohistochemical staining, and zymography to assess inflammatory cells, cytokines, and matrix metalloproteinases. Pulmonary compliance decreased in sheep with S-ALI placed on ECMO with increased numbers of infiltrating neutrophils, monocytes, and alveolar macrophages compared with controls. Infiltration of neutrophils was also observed with S-ALI alone. RT-PCR studies showed higher expression of matrix metalloproteinases 2 and 9 in S-ALI plus ECMO, whereas IL-6 was elevated at 2 h. Zymography revealed higher levels of matrix metalloproteinase 2. Circulating plasma levels of IL-6 were elevated 1-2 h after commencement of ECMO alone. These data show that the inflammatory response is enhanced when a host with preexisting pulmonary injury is placed on ECMO, with increased infiltration of neutrophils and macrophages, the release of inflammatory cytokines, and upregulation of matrix metalloproteinases.
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Affiliation(s)
- Margaret R Passmore
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia;
| | - Yoke L Fung
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia.,School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Gabriela Simonova
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia; and
| | - Samuel R Foley
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
| | - Kimble R Dunster
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Sara D Diab
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia; and
| | - Robyn M Minchinton
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
| | - Charles I McDonald
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
| | - Chris M Anstey
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia.,Department of Critical Care Medicine, Nambour General Hospital, Nambour, Australia
| | - Kiran Shekar
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane, Australia
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