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Lindsay-McGee V, Massey C, Li YT, Clark EL, Psifidi A, Piercy RJ. Characterisation of phenotypic patterns in equine exercise-associated myopathies. Equine Vet J 2024. [PMID: 38965932 DOI: 10.1111/evj.14128] [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: 10/09/2023] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Equine exercise-associated myopathies are prevalent, clinically heterogeneous, generally idiopathic disorders characterised by episodes of myofibre damage that occur in association with exercise. Episodes are intermittent and vary within and between affected horses and across breeds. The aetiopathogenesis is often unclear; there might be multiple causes. Poor phenotypic characterisation hinders genetic and other disease analyses. OBJECTIVES The aim of this study was to characterise phenotypic patterns across exercise-associated myopathies in horses. STUDY DESIGN Historical cross-sectional study, with subsequent masked case-control validation study. METHODS Historical clinical and histological features from muscle samples (n = 109) were used for k-means clustering and validated using principal components analysis and hierarchical clustering. For further validation, a blinded histological study (69 horses) was conducted comparing two phenotypic groups with selected controls and horses with histopathological features characterised by myofibrillar disruption. RESULTS We identified two distinct broad phenotypes: a non-classic exercise-associated myopathy syndrome (EAMS) subtype was associated with practitioner-described signs of apparent muscle pain (p < 0.001), reluctance to move (10.85, p = 0.001), abnormal gait (p < 0.001), ataxia (p = 0.001) and paresis (p = 0.001); while a non-specific classic RER subtype was not uniquely associated with any particular variables. No histological differences were identified between subtypes in the validation study, and no identifying histopathological features for other equine myopathies identified in either subtype. MAIN LIMITATIONS Lack of an independent validation population; small sample size of smaller identified subtypes; lack of positive control myofibrillar myopathy cases; case descriptions derived from multiple independent and unblinded practitioners. CONCLUSIONS This is the first study using computational clustering methods to identify phenotypic patterns in equine exercise-associated myopathies, and suggests that differences in patterns of presenting clinical signs support multiple disease subtypes, with EAMS a novel subtype not previously described. Routine muscle histopathology was not helpful in sub-categorising the phenotypes in our population.
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Affiliation(s)
| | - Claire Massey
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - Ying Ting Li
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - Emily L Clark
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Androniki Psifidi
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Richard J Piercy
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
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Stevens J, Tezel O, Bonnefil V, Hapstack M, Atreya MR. Biological basis of critical illness subclasses: from the bedside to the bench and back again. Crit Care 2024; 28:186. [PMID: 38812006 PMCID: PMC11137966 DOI: 10.1186/s13054-024-04959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
Critical illness syndromes including sepsis, acute respiratory distress syndrome, and acute kidney injury (AKI) are associated with high in-hospital mortality and long-term adverse health outcomes among survivors. Despite advancements in care, clinical and biological heterogeneity among patients continues to hamper identification of efficacious therapies. Precision medicine offers hope by identifying patient subclasses based on clinical, laboratory, biomarker and 'omic' data and potentially facilitating better alignment of interventions. Within the previous two decades, numerous studies have made strides in identifying gene-expression based endotypes and clinico-biomarker based phenotypes among critically ill patients associated with differential outcomes and responses to treatment. In this state-of-the-art review, we summarize the biological similarities and differences across the various subclassification schemes among critically ill patients. In addition, we highlight current translational gaps, the need for advanced scientific tools, human-relevant disease models, to gain a comprehensive understanding of the molecular mechanisms underlying critical illness subclasses.
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Affiliation(s)
- Joseph Stevens
- Division of Immunobiology, Graduate Program, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Oğuzhan Tezel
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Valentina Bonnefil
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45627, USA
| | - Matthew Hapstack
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Mihir R Atreya
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45627, USA.
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3
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Sato K, Wildi K, Chan J, Palmieri C, Obonyo NG, Heinsar S, Liu K, Livingstone S, Sato N, Ainola C, Abbate G, Bouquet M, Wilson E, Passmore M, Hyslop K, Platts DG, Suen J, Bassi GL, Fraser JF. A novel speckle-tracking echocardiography parameter assessing left ventricular afterload. Eur J Clin Invest 2024; 54:e14106. [PMID: 37822060 DOI: 10.1111/eci.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Left ventricular stroke work index (LVSWI) and afterload-related cardiac performance (ACP) consider left ventricular (LV) afterload and could be better prognosticators in septic cardiomyopathy. However, their invasive nature prevents their routine clinical applications. This study aimed to investigate (1) whether a proposed speckle-tracking echocardiography parameter, Pressure-Strain Product (PSP), can non-invasively predict catheter-based LVSWI, ACP and serum lactate in an ovine model of septic cardiomyopathy; and (2) whether PSP can distinguish the sub-phenotypes of acute respiratory distress syndrome (ARDS) with or without sepsis-like conditions. METHODS Sixteen sheep with ARDS were randomly assigned to either (1) sepsis-like (n = 8) or (2) non-sepsis-like (n = 8) group. Each ARDS and sepsis-like condition was induced by intravenous infusion of oleic acid and lipopolysaccharide, respectively. Pulmonary artery catheter-based LVSWI (the product of stroke work index, mean arterial pressure and .0136), ACP (the percentage of cardiac output measured to cardiac output predicted as normal) and serum lactate were measured simultaneously with transthoracic echocardiography. Two PSP indices were calculated by multiplying the mean arterial blood pressure and either global circumferential strain (PSPcirc) or radial strain (PSPrad). RESULTS PSPcirc showed a significant correlation with LVSWI (r2 = .66, p < .001) and ACP (r2 = .82, p < .001) in the sepsis-like group. Although PSP could not distinguish subphenotypes, PSPcirc predicted LVSWI (AUC .86) and ACP (AUC .88), and PSPrad predicted serum lactate (AUC .75) better than LV ejection fraction, global circumferential and radial strain. CONCLUSIONS A novel PSP has the potential to non-invasively predict catheter-based LVSWI and ACP, and was associated with serum lactate in septic cardiomyopathy.
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Affiliation(s)
- Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jonathan Chan
- Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Griffith University, School of Medicine, Brisbane, Queensland, Australia
| | - Chiara Palmieri
- The University of Queensland, School of Veterinary Science, Gatton, Australia
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- DeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Mahé Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Emily Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Margaret Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David G Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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4
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Wildi K, Colombo SM, McGuire D, Ainola C, Heinsar S, Sato N, Sato K, Liu K, Bouquet M, Wilson E, Passmore M, Hyslop K, Livingstone S, Di Feliciantonio M, Strugnell W, Palmieri C, Suen J, Li Bassi G, Fraser J. An appraisal of lung computer tomography in very early anti-inflammatory treatment of two different ovine ARDS phenotypes. Sci Rep 2024; 14:2162. [PMID: 38272980 PMCID: PMC10810785 DOI: 10.1038/s41598-024-52698-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
Mortality and morbidity of Acute Respiratory Distress Syndrome (ARDS) are largely unaltered. A possible new approach to treatment of ARDS is offered by the discovery of inflammatory subphenotypes. In an ovine model of ARDS phenotypes, matching key features of the human subphenotypes, we provide an imaging characterization using computer tomography (CT). Nine animals were randomized into (a) OA (oleic acid, hypoinflammatory; n = 5) and (b) OA-LPS (oleic acid and lipopolysaccharides, hyperinflammatory; n = 4). 48 h after ARDS induction and anti-inflammatory treatment, CT scans were performed at high (H) and then low (L) airway pressure. After CT, the animals were euthanized and lung tissue was collected. OA-LPS showed a higher air fraction and OA a higher tissue fraction, resulting in more normally aerated lungs in OA-LPS in contrast to more non-aerated lung in OA. The change in lung and air volume between H and L was more accentuated in OA-LPS, indicating a higher recruitment potential. Strain was higher in OA, indicating a higher level of lung damage, while the amount of lung edema and histological lung injury were largely comparable. Anti-inflammatory treatment might be beneficial in terms of overall ventilated lung portion and recruitment potential, especially in the OA-LPS group.
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Affiliation(s)
- Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- The University of Queensland, Brisbane, Australia.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniel McGuire
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Chermside, QLD, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
| | - Mahé Bouquet
- The University of Queensland, Brisbane, Australia
| | - Emily Wilson
- The University of Queensland, Brisbane, Australia
| | - Margaret Passmore
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Marianna Di Feliciantonio
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Wendy Strugnell
- The University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Chermside, QLD, Australia
| | - Chiara Palmieri
- School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- The University of Queensland, Brisbane, Australia.
- St Andrews War Memorial Hospital, Intensive Care Unit, Spring Hill, QLD, Australia.
- The Wesley Hospital, Intensive Care Unit, Auchenflower, QLD, Australia.
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- The University of Queensland, Brisbane, Australia
- St Andrews War Memorial Hospital, Intensive Care Unit, Spring Hill, QLD, Australia
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5
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Wildi K, Livingstone S, Ainola C, Colombo SM, Heinsar S, Sato N, Sato K, Bouquet M, Wilson E, Abbate G, Passmore M, Hyslop K, Liu K, Wang X, Palmieri C, See Hoe LE, Jung JS, Ki K, Mueller C, Laffey J, Pelosi P, Li Bassi G, Suen J, Fraser J. Application of anti-inflammatory treatment in two different ovine Acute Respiratory Distress Syndrome injury models: a preclinical randomized intervention study. Sci Rep 2023; 13:17986. [PMID: 37863994 PMCID: PMC10589361 DOI: 10.1038/s41598-023-45081-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
Whilst the presence of 2 subphenotypes among the heterogenous Acute Respiratory Distress Syndrome (ARDS) population is becoming clinically accepted, subphenotype-specific treatment efficacy has yet to be prospectively tested. We investigated anti-inflammatory treatment in different ARDS models in sheep, previously shown similarities to human ARDS subphenotypes, in a preclinical, randomized, blinded study. Thirty anesthetized sheep were studied up to 48 h and randomized into: (a) OA: oleic acid (n = 15) and (b) OA-LPS: oleic acid and subsequent lipopolysaccharide (n = 15) to achieve a PaO2/FiO2 ratio of < 150 mmHg. Then, animals were randomly allocated to receive treatment with methylprednisolone or erythromycin or none. Assessed outcomes were oxygenation, pulmonary mechanics, hemodynamics and survival. All animals reached ARDS. Treatment with methylprednisolone, but not erythromycin, provided the highest therapeutic benefit in Ph2 animals, leading to a significant increase in PaO2/FiO2 ratio by reducing pulmonary edema, dead space ventilation and shunt fraction. Animals treated with methylprednisolone displayed a higher survival up to 48 h than all others. In animals treated with erythromycin, there was no treatment benefit regarding assessed physiological parameters and survival in both phenotypes. Treatment with methylprednisolone improves oxygenation and survival, more so in ovine phenotype 2 which resembles the human hyperinflammatory subphenotype.
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Affiliation(s)
- Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
- The University of Queensland, Brisbane, Australia.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Mahé Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Emily Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Margaret Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Xiaomeng Wang
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chiara Palmieri
- The University of Queensland, School of Veterinary Science, Gatton, Australia
| | - Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Katrina Ki
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Christian Mueller
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - John Laffey
- Galway University Hospitals, University of Galway, Galway, Ireland
| | - Paolo Pelosi
- Anesthesiology and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
- Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane, Australia
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6
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Papathanakos G, Andrianopoulos I, Xenikakis M, Papathanasiou A, Koulenti D, Blot S, Koulouras V. Clinical Sepsis Phenotypes in Critically Ill Patients. Microorganisms 2023; 11:2165. [PMID: 37764009 PMCID: PMC10538192 DOI: 10.3390/microorganisms11092165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis, defined as the life-threatening dysregulated host response to an infection leading to organ dysfunction, is considered as one of the leading causes of mortality worldwide, especially in intensive care units (ICU). Moreover, sepsis remains an enigmatic clinical syndrome, with complex pathophysiology incompletely understood and a great heterogeneity both in terms of clinical expression, patient response to currently available therapeutic interventions and outcomes. This heterogeneity proves to be a major obstacle in our quest to deliver improved treatment in septic critical care patients; thus, identification of clinical phenotypes is absolutely necessary. Although this might be seen as an extremely difficult task, nowadays, artificial intelligence and machine learning techniques can be recruited to quantify similarities between individuals within sepsis population and differentiate them into distinct phenotypes regarding not only temperature, hemodynamics or type of organ dysfunction, but also fluid status/responsiveness, trajectories in ICU and outcome. Hopefully, we will eventually manage to determine both the subgroup of septic patients that will benefit from a therapeutic intervention and the correct timing of applying the intervention during the disease process.
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Affiliation(s)
- Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Ioannis Andrianopoulos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QL 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Stijn Blot
- Department of Internal Medicine & Pediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Vasilios Koulouras
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
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7
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See Hoe LE, Li Bassi G, Wildi K, Passmore MR, Bouquet M, Sato K, Heinsar S, Ainola C, Bartnikowski N, Wilson ES, Hyslop K, Skeggs K, Obonyo NG, Shuker T, Bradbury L, Palmieri C, Engkilde-Pedersen S, McDonald C, Colombo SM, Wells MA, Reid JD, O'Neill H, Livingstone S, Abbate G, Haymet A, Jung JS, Sato N, James L, He T, White N, Redd MA, Millar JE, Malfertheiner MV, Molenaar P, Platts D, Chan J, Suen JY, McGiffin DC, Fraser JF. Donor heart ischemic time can be extended beyond 9 hours using hypothermic machine perfusion in sheep. J Heart Lung Transplant 2023; 42:1015-1029. [PMID: 37031869 DOI: 10.1016/j.healun.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND The global shortage of donor hearts available for transplantation is a major problem for the treatment of end-stage heart failure. The ischemic time for donor hearts using traditional preservation by standard static cold storage (SCS) is limited to approximately 4 hours, beyond which the risk for primary graft dysfunction (PGD) significantly increases. Hypothermic machine perfusion (HMP) of donor hearts has been proposed to safely extend ischemic time without increasing the risk of PGD. METHODS Using our sheep model of 24 hours brain death (BD) followed by orthotopic heart transplantation (HTx), we examined post-transplant outcomes in recipients following donor heart preservation by HMP for 8 hours, compared to donor heart preservation for 2 hours by either SCS or HMP. RESULTS Following HTx, all HMP recipients (both 2 hours and 8 hours groups) survived to the end of the study (6 hours after transplantation and successful weaning from cardiopulmonary bypass), required less vasoactive support for hemodynamic stability, and exhibited superior metabolic, fluid status and inflammatory profiles compared to SCS recipients. Contractile function and cardiac damage (troponin I release and histological assessment) was comparable between groups. CONCLUSIONS Overall, compared to current clinical SCS, recipient outcomes following transplantation are not adversely impacted by extending HMP to 8 hours. These results have important implications for clinical transplantation where longer ischemic times may be required (e.g., complex surgical cases, transport across long distances). Additionally, HMP may allow safe preservation of "marginal" donor hearts that are more susceptible to myocardial injury and facilitate increased utilization of these hearts for transplantation.
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Affiliation(s)
- Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia.
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Uniting Care Hospitals, Intensive Care Units St Andrew's War Memorial Hospital and The Wesley Hospital, Brisbane, Queensland, Australia; Wesley Medical Research, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Queensland, Australia
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kris Skeggs
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom; Initiative to Develop African Research Leaders (IDeAL), Kilifi, Kenya
| | - Tristan Shuker
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lucy Bradbury
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chiara Palmieri
- School of Veterinary Science, Faculty of Science, University of Queensland, Gatton, Queensland, Australia
| | | | - Charles McDonald
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Anesthesia and Perfusion, The Prince Charles Hospital, Queensland, Australia
| | - Sebastiano M Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matthew A Wells
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Janice D Reid
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Hollier O'Neill
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Haymet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jae-Seung Jung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lynnette James
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ting He
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Meredith A Redd
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Institute for Molecular Bioscience, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Maximillian V Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Molenaar
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan Chan
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David C McGiffin
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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8
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Chotalia M, Patel JM, Bangash MN, Parekh D. Cardiovascular Subphenotypes in ARDS: Diagnostic and Therapeutic Implications and Overlap with Other ARDS Subphenotypes. J Clin Med 2023; 12:jcm12113695. [PMID: 37297890 DOI: 10.3390/jcm12113695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction is commonly implicated, there is no consensus definition for its diagnosis, and left ventricular function is neglected. There is a need to identify the homogenous subgroups within ARDS, that have a similar pathobiology, which can then be treated with targeted therapies. Haemodynamic clustering analyses in patients with ARDS have identified two subphenotypes of increasingly severe right ventricular injury, and a further subphenotype of hyperdynamic left ventricular function. In this review, we discuss how phenotyping the cardiovascular system in ARDS may align with haemodynamic pathophysiology, can aid in optimally defining right ventricular dysfunction and can identify tailored therapeutic targets for shock in ARDS. Additionally, clustering analyses of inflammatory, clinical and radiographic data describe other subphenotypes in ARDS. We detail the potential overlap between these and the cardiovascular phenotypes.
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Affiliation(s)
- Minesh Chotalia
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Jaimin M Patel
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Mansoor N Bangash
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
| | - Dhruv Parekh
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham B15 2SQ, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK
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9
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Battaglini D, Cruz F, Robba C, Pelosi P, Rocco PRM. Failed clinical trials on COVID-19 acute respiratory distress syndrome in hospitalized patients: common oversights and streamlining the development of clinically effective therapeutics. Expert Opin Investig Drugs 2022; 31:995-1015. [PMID: 36047644 DOI: 10.1080/13543784.2022.2120801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has put a strain on global healthcare systems. Despite admirable efforts to develop rapidly new pharmacotherapies, supportive treatments remain the standard of care. Multiple clinical trials have failed due to design issues, biased patient enrollment, small sample sizes, inadequate control groups, and lack of long-term outcomes monitoring. AREAS COVERED This narrative review depicts the current situation around failed and success COVID-19 clinical trials and recommendations in hospitalized patients with COVID-19, oversights and streamlining of clinically effective therapeutics. PubMed, EBSCO, Cochrane Library, and WHO and NIH guidelines were searched for relevant literature up to 5 August 2022. EXPERT OPINION The WHO, NIH, and IDSA have issued recommendations to better clarify which drugs should be used during the different phases of the disease. Given the biases and high heterogeneity of published studies, interpretation of the current literature is difficult. Future clinical trials should be designed to standardize clinical approaches, with appropriate organization, patient selection, addition of control groups, and careful identification of disease phase to reduce heterogeneity and bias and should rely on the integration of scientific societies to promote a consensus on interpretation of the data and recommendations for optimal COVID-19 therapies.
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Affiliation(s)
- Denise Battaglini
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy
| | - Fernanda Cruz
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chiara Robba
- Policlinico San Martino, IRCCS per l'Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Paolo Pelosi
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy.,Policlinico San Martino, IRCCS per l'Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,COVID-19 Virus Network from Ministry of Science, Technology, and Innovation, Brazilian Council for Scientific and Technological Development, and Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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10
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Battaglini D, Robba C, Pelosi P, Rocco PRM. Treatment for acute respiratory distress syndrome in adults: A narrative review of phase 2 and 3 trials. Expert Opin Emerg Drugs 2022; 27:187-209. [PMID: 35868654 DOI: 10.1080/14728214.2022.2105833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Ventilatory management and general supportive care of acute respiratory distress syndrome (ARDS) in the adult population have led to significant clinical improvements, but morbidity and mortality remain high. Pharmacologic strategies acting on the coagulation cascade, inflammation, oxidative stress, and endothelial cell injury have been targeted in the last decade for patients with ARDS, but only a few of these have shown potential benefits with a meaningful clinical response and improved patient outcomes. The lack of availability of specific pharmacologic treatments for ARDS can be attributed to its complex pathophysiology, different risk factors, huge heterogeneity, and difficult classification into specific biological phenotypes and genotypes. AREAS COVERED In this narrative review, we briefly discuss the relevance and current advances in pharmacologic treatments for ARDS in adults and the need for the development of new pharmacological strategies. EXPERT OPINION Identification of ARDS phenotypes, risk factors, heterogeneity, and pathophysiology may help to design clinical trials personalized according to ARDS-specific features, thus hopefully decreasing the rate of failed clinical pharmacologic trials. This concept is still under clinical investigation and needs further development.
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Affiliation(s)
- Denise Battaglini
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Chiara Robba
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Paolo Pelosi
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco G1-014, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.,COVID-19 Virus Network from Ministry of Science, Technology, and Innovation, Brazilian Council for Scientific and Technological Development, and Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Wildi K, Bouquet M, Ainola C, Livingstone S, Colombo SM, Heinsar S, Sato N, Sato K, Wilson E, Abbate G, Passmore MR, Hyslop K, Liu K, Li Bassi G, Suen JY, Fraser JF. Differential Protein Expression among Two Different Ovine ARDS Phenotypes-A Preclinical Randomized Study. Metabolites 2022; 12:metabo12070655. [PMID: 35888779 PMCID: PMC9319228 DOI: 10.3390/metabo12070655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/25/2023] Open
Abstract
Despite decades of comprehensive research, Acute Respiratory Distress Syndrome (ARDS) remains a disease with high mortality and morbidity worldwide. The discovery of inflammatory subphenotypes in human ARDS provides a new approach to study the disease. In two different ovine ARDS lung injury models, one induced by additional endotoxin infusion (phenotype 2), mimicking some key features as described in the human hyperinflammatory group, we aim to describe protein expression among the two different ovine models. Nine animals on mechanical ventilation were included in this study and were randomized into (a) phenotype 1, n = 5 (Ph1) and (b) phenotype 2, n = 4 (Ph2). Plasma was collected at baseline, 2, 6, 12, and 24 h. After protein extraction, data-independent SWATH-MS was applied to inspect protein abundance at baseline, 2, 6, 12, and 24 h. Cluster analysis revealed protein patterns emerging over the study observation time, more pronounced by the factor of time than different injury models of ARDS. A protein signature consisting of 33 proteins differentiated among Ph1/2 with high diagnostic accuracy. Applying network analysis, proteins involved in the inflammatory and defense response, complement and coagulation cascade, oxygen binding, and regulation of lipid metabolism were activated over time. Five proteins, namely LUM, CA2, KNG1, AGT, and IGJ, were more expressed in Ph2.
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Affiliation(s)
- Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- Correspondence:
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Sebastiano Maria Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Department of Anaesthesia and Intensive Care Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Emily Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Margaret R. Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
- Medical Faculty, Queensland University of Technology, Brisbane 4059, Australia
- Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane 4001, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia; (M.B.); (C.A.); (S.L.); (S.M.C.); (S.H.); (N.S.); (K.S.); (E.W.); (G.A.); (M.R.P.); (K.H.); (K.L.); (G.L.B.); (J.Y.S.); (J.F.F.)
- Medical Faculty, The University of Queensland, St. Lucia, Brisbane 4067, Australia
- Uniting Care Hospitals, St Andrews War Memorial and The Wesley Intensive Care Units, Brisbane 4001, Australia
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12
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Wildi K, Hyslop K, Millar J, Livingstone S, Passmore MR, Bouquet M, Wilson E, LiBassi G, Fraser JF, Suen JY. Validation of Messenger Ribonucleic Acid Markers Differentiating Among Human Acute Respiratory Distress Syndrome Subgroups in an Ovine Model of Acute Respiratory Distress Syndrome Phenotypes. Front Med (Lausanne) 2022; 9:961336. [PMID: 35865167 PMCID: PMC9295897 DOI: 10.3389/fmed.2022.961336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The discovery of biological subphenotypes in acute respiratory distress syndrome (ARDS) might offer a new approach to ARDS in general and possibly targeted treatment, but little is known about the underlying biology yet. To validate our recently described ovine ARDS phenotypes model, we compared a subset of messenger ribonucleic acid (mRNA) markers in leukocytes as reported before to display differential expression between human ARDS subphenotypes to the expression in lung tissue in our ovine ARDS phenotypes model (phenotype 1 (Ph1): hypoinflammatory; phenotype 2 (Ph2): hyperinflammatory). Methods We studied 23 anesthetized sheep on mechanical ventilation with observation times between 6 and 24 h. They were randomly allocated to the two phenotypes (n = 14 to Ph1 and n = 9 to Ph2). At study end, lung tissue was harvested and preserved in RNAlater. After tissue homogenization in TRIzol, total RNA was extracted and custom capture and reporter probes designed by NanoString Technologies were used to measure the expression of 14 genes of interest and the 6 housekeeping genes on a nCounter SPRINT profiler. Results Among the 14 mRNA markers, in all animals over all time points, 13 markers showed the same trend in ovine Ph2/Ph1 as previously reported in the MARS cohort: matrix metalloproteinase 8, olfactomedin 4, resistin, G protein-coupled receptor 84, lipocalin 2, ankyrin repeat domain 22, CD177 molecule, and transcobalamin 1 expression was higher in Ph2 and membrane metalloendopeptidase, adhesion G protein-coupled receptor E3, transforming growth factor beta induced, histidine ammonia-lyase, and sulfatase 2 expression was higher in Ph1. These expression patterns could be found when different sources of mRNA – such as blood leukocytes and lung tissue – were compared. Conclusion In human and ovine ARDS subgroups, similar activated pathways might be involved (e.g., oxidative phosphorylation, NF-κB pathway) that result in specific phenotypes.
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Affiliation(s)
- Karin Wildi
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Cardiovascular Research Group, Basel, Switzerland
- *Correspondence: Karin Wildi,
| | - Kieran Hyslop
- Critical Care Research Group, Brisbane, QLD, Australia
| | - Jonathan Millar
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Samantha Livingstone
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Margaret R. Passmore
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mahé Bouquet
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Emily Wilson
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Gianluigi LiBassi
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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13
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See Hoe LE, Wildi K, Obonyo NG, Bartnikowski N, McDonald C, Sato K, Heinsar S, Engkilde-Pedersen S, Diab S, Passmore MR, Wells MA, Boon AC, Esguerra A, Platts DG, James L, Bouquet M, Hyslop K, Shuker T, Ainola C, Colombo SM, Wilson ES, Millar JE, Malfertheiner MV, Reid JD, O'Neill H, Livingstone S, Abbate G, Sato N, He T, von Bahr V, Rozencwajg S, Byrne L, Pimenta LP, Marshall L, Nair L, Tung JP, Chan J, Haqqani H, Molenaar P, Li Bassi G, Suen JY, McGiffin DC, Fraser JF. A clinically relevant sheep model of orthotopic heart transplantation 24 h after donor brainstem death. Intensive Care Med Exp 2021; 9:60. [PMID: 34950993 PMCID: PMC8702587 DOI: 10.1186/s40635-021-00425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Heart transplantation (HTx) from brainstem dead (BSD) donors is the gold-standard therapy for severe/end-stage cardiac disease, but is limited by a global donor heart shortage. Consequently, innovative solutions to increase donor heart availability and utilisation are rapidly expanding. Clinically relevant preclinical models are essential for evaluating interventions for human translation, yet few exist that accurately mimic all key HTx components, incorporating injuries beginning in the donor, through to the recipient. To enable future assessment of novel perfusion technologies in our research program, we thus aimed to develop a clinically relevant sheep model of HTx following 24 h of donor BSD.
Methods BSD donors (vs. sham neurological injury, 4/group) were hemodynamically supported and monitored for 24 h, followed by heart preservation with cold static storage. Bicaval orthotopic HTx was performed in matched recipients, who were weaned from cardiopulmonary bypass (CPB), and monitored for 6 h. Donor and recipient blood were assayed for inflammatory and cardiac injury markers, and cardiac function was assessed using echocardiography. Repeated measurements between the two different groups during the study observation period were assessed by mixed ANOVA for repeated measures.
Results Brainstem death caused an immediate catecholaminergic hemodynamic response (mean arterial pressure, p = 0.09), systemic inflammation (IL-6 - p = 0.025, IL-8 - p = 0.002) and cardiac injury (cardiac troponin I, p = 0.048), requiring vasopressor support (vasopressor dependency index, VDI, p = 0.023), with normalisation of biomarkers and physiology over 24 h. All hearts were weaned from CPB and monitored for 6 h post-HTx, except one (sham) recipient that died 2 h post-HTx. Hemodynamic (VDI - p = 0.592, heart rate - p = 0.747) and metabolic (blood lactate, p = 0.546) parameters post-HTx were comparable between groups, despite the observed physiological perturbations that occurred during donor BSD. All p values denote interaction among groups and time in the ANOVA for repeated measures. Conclusions We have successfully developed an ovine HTx model following 24 h of donor BSD. After 6 h of critical care management post-HTx, there were no differences between groups, despite evident hemodynamic perturbations, systemic inflammation, and cardiac injury observed during donor BSD. This preclinical model provides a platform for critical assessment of injury development pre- and post-HTx, and novel therapeutic evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-021-00425-4.
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Affiliation(s)
- Louise E See Hoe
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. .,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. .,School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia.
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK.,Initiative to Develop African Research Leaders (IDeAL), Kilifi, Kenya
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Charles McDonald
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Second Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Sanne Engkilde-Pedersen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Research and Development, Australian Red Cross Lifeblood, Brisbane, QLD, Australia
| | - Sara Diab
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Margaret R Passmore
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Matthew A Wells
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | - Ai-Ching Boon
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Arlanna Esguerra
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Research and Development, Australian Red Cross Lifeblood, Brisbane, QLD, Australia
| | - David G Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lynnette James
- Department of Cardiac Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kieran Hyslop
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tristan Shuker
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sebastiano M Colombo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Emily S Wilson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Maximillian V Malfertheiner
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Regensburg, Germany
| | - Janice D Reid
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Hollier O'Neill
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Samantha Livingstone
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gabriella Abbate
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Noriko Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Ting He
- Department of Cardiac Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Viktor von Bahr
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sacha Rozencwajg
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Pitié-Salpêtrière University Hospital, Paris, France
| | - Liam Byrne
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,The Canberra Hospital Intensive Care, Garran, ACT, Australia.,Australia National University, Canberra, ACT, Australia
| | - Leticia P Pimenta
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Lachlan Marshall
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Cardiac Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital, Brisbane, QLD, Australia
| | - Lawrie Nair
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital, Brisbane, QLD, Australia
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Research and Development, Australian Red Cross Lifeblood, Brisbane, QLD, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jonathan Chan
- Prince Charles Hospital, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Southport, QLD, Australia
| | - Haris Haqqani
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Prince Charles Hospital, Brisbane, QLD, Australia
| | - Peter Molenaar
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - David C McGiffin
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.,Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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