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Sohal A, Chaudhry H, Dhaliwal A, Singla P, Gupta G, Sharma R, Dukovic D, Prajapati D. Gender differences in esophageal variceal bleeding in the United States. Ann Med 2022; 54:2115-2122. [PMID: 35930410 PMCID: PMC9359179 DOI: 10.1080/07853890.2022.2104920] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Esophageal variceal bleeding is a common reason for hospitalization in patients with cirrhosis. The main objective of this study was to analyze the effects of gender differences on outcomes in hospitalizations related to Esophageal variceal bleeding in the United States. METHODS A retrospective observational cohort study was performed using the National Inpatient Sample (NIS) database for all hospitalizations with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The primary outcome was in-hospital mortality, while secondary outcomes included rate of early endoscopy (defined as less than 1 day), AKI, blood transfusion, sepsis, ICU admission and TIPS (Transjugular Intrahepatic Portosystemic Shunt). We also compared the length of stay and total hospitalization charges. RESULTS We identified a total of 166,760 patients with variceal bleeding of which 32.7% were females. In-hospital mortality was higher in males, 9.91%, compared to females, 8.31% (adjusted odds ratio (aOR): 0.88, p-value=.008, when adjusted for confounding factors). The odds of undergoing an EGD, length of stay, or total hospitalization charges did not differ between the two groups. Compared to men, women had lower odds of receiving TIPS (aOR = 0.83, p-value=.002). CONCLUSION Women hospitalised with esophageal variceal bleeding are at a lower risk of death compared to males. Further research is needed to elucidate the factors associated with this lower risk.
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Affiliation(s)
- Aalam Sohal
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, CA, USA
| | - Armaan Dhaliwal
- Department of Internal Medicine, University of Arizona, South Campus-Tucson, AZ, USA
| | - Piyush Singla
- Dayanand Medical College and Hospital, Punjab, India
| | - Gagan Gupta
- Dayanand Medical College and Hospital, Punjab, India
| | | | - Dino Dukovic
- Ross University School of Medicine, Bridgetown, Barbados
| | - Devang Prajapati
- Department of Gastroenterology and Hepatology, University of California, Fresno, CA, USA
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2
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Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, Moko L, Garces J, Rivera P, Singer K, Fedoriv I, Garcia Z, Kennedy J, Makkapati B, Mukherjee I, Szerszen A, Gross J, Glinik G, Younan D. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare (Basel) 2022; 10:healthcare10081472. [PMID: 36011129 PMCID: PMC9407800 DOI: 10.3390/healthcare10081472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.
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Affiliation(s)
- Shreya Pandya
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Timothy Le
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Seleshi Demissie
- Biostatistics Unit, Feinstein Institutes for Medical Research, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Ahmed Zaky
- Department of Anesthesia, The University of Alabama in Birmingham, Birmingham, AL 35294, USA
| | - Shadi Arjmand
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Nikhil Patel
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Lilamarie Moko
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Juan Garces
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Paula Rivera
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Kiara Singer
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Ivan Fedoriv
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Zachery Garcia
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - James Kennedy
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Bhavana Makkapati
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Indraneil Mukherjee
- Department of Surgery, Division of Minimally Invasive Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Anita Szerszen
- Department of Medicine, Division of Geriatric Medicine, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Jonathan Gross
- Department of Orthopedics, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Galina Glinik
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
| | - Duraid Younan
- The Department of Surgery, Division of Acute Care Surgery, Staten Island University Hospital, Staten Island, New York, NY 10305, USA
- Correspondence:
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Rosenzweig R, Kumar V, Gupta S, Bermeo-Blanco O, Stratton MS, Gumina RJ, Bansal SS. Estrogen Receptor-β Agonists Modulate T-Lymphocyte Activation and Ameliorate Left Ventricular Remodeling During Chronic Heart Failure. Circ Heart Fail 2022; 15:e008997. [PMID: 35730443 DOI: 10.1161/circheartfailure.121.008997] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND CD4+ T cells temporally transition from protective to pathological during ischemic heart failure (HF; 8 weeks postmyocardial infarction). Cellular mechanisms mediating this shift are unknown. METHODS RNA-sequencing of cardiac CD4+ T cells and flow cytometric analysis of immune cells was conducted. RESULTS RNA-sequencing of CD4+ T cells from the failing hearts of male mice indicated activation of ER (estrogen receptor)-α signaling. Flow cytometric analysis showed that ERα in CD4+ T cells decreases significantly at 3-day postmyocardial infarction but increases during HF. To antagonize ERα, we tested a novel ERβ agonist (OSU-ERb-012) to inhibit T cells and blunt left ventricular remodeling. Proliferation assays showed that OSU-ERb-012 dose-dependently inhibited proliferation and proinflammatory cytokine expression in anti-CD3/CD28 stimulated splenic T cells isolated from both the sexes. For in vivo efficacy, 10- to 12-week-old male and ovariectomized female mice were randomized at 4 weeks postmyocardial infarction and treated with either vehicle or drug (60 mg/kg per day; oral). While vehicle-treated HF mice displayed progressive left ventricular dilatation with significantly increased end-systolic and end-diastolic volumes from 4 to 8 weeks postmyocardial infarction, treatment with OSU-ERb-012 significantly blunted these changes and stopped left ventricular remodeling in both the sexes. Reduction in tibia-normalized heart and left ventricular weights, cardiomyocyte hypertrophy and interstitial fibrosis further supported these results. Additionally, OSU-ERb-012 treatment selectively inhibited cardiac, splenic, and circulating CD4+ T cells without affecting other myeloid and lymphoid cells in the HF mice. CONCLUSIONS Our studies indicate that ERβ agonists and OSU-ERb-012, in particular, could be used as selective immunomodulatory drugs to inhibit CD4+ T cells during chronic HF.
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Affiliation(s)
- Rachel Rosenzweig
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.)
| | - Vinay Kumar
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.)
| | - Sahil Gupta
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.)
| | - Oscar Bermeo-Blanco
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.)
| | - Matthew S Stratton
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.)
| | - Richard J Gumina
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. (R.J.G., S.S.B.)
| | - Shyam S Bansal
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus. (R.R., V.K., S.G., O.B.-B., M.S.S., R.J.G., S.S.B.).,Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus. (R.J.G., S.S.B.)
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4
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Elbadawi A, Barssoum K, Megaly M, Rai D, Elsherbeeny A, Mansoor H, Shishehbor MH, Abdel-Latif A, Gulati M, Elgendy IY. Sex Differences in Trends and In-Hospital Outcomes Among Patients With Critical Limb Ischemia: A Nationwide Analysis. J Am Heart Assoc 2021; 10:e022043. [PMID: 34533036 PMCID: PMC8649496 DOI: 10.1161/jaha.121.022043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in-hospital outcomes among patients with CLI are scarce. Methods and Results Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in-hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P<0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in-hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71-0.81) and men (adjusted OR, 0.69; 95% CI, 0.65-0.73). On multivariable analysis adjusting for patient- and hospital-related characteristics as well as revascularization, women had a higher incidence of in-hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. Conclusions In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in-hospital mortality and bleeding complications compared with men. Sex-specific studies and interventions are needed to minimize these gaps among this high-risk population.
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Affiliation(s)
- Ayman Elbadawi
- Section of Cardiology Baylor College of Medicine Houston TX
| | - Kirolos Barssoum
- Division of Internal Medicine Rochester General Hospital Rochester NY
| | - Michael Megaly
- Division of Cardiology Department of Medicine University of Arizona College of Medicine Phoenix Phoenix AZ
| | - Devesh Rai
- Division of Internal Medicine Rochester General Hospital Rochester NY
| | - Ahmed Elsherbeeny
- Division of Cardiovascular Medicine University of Texas Medical Branch Galveston TX
| | - Hend Mansoor
- College of Health Sciences Hamad Bin Khalifa University Doha Qatar
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland OH.,Case Western Reserve University School of Medicine Cleveland OH
| | - Ahmed Abdel-Latif
- Gill Heart Institute and Division of Cardiovascular Medicine University of Kentucky and the Lexington VA Medical Center Lexington KY
| | - Martha Gulati
- Division of Cardiology Department of Medicine University of Arizona College of Medicine Phoenix Phoenix AZ
| | - Islam Y Elgendy
- Department of Medicine Weill Cornell Medicine-Qatar Doha Qatar
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5
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Bhatti UF, Remmer H, Williams AM, Biesterveld BE, Russo R, Wakam G, Kemp M, Tagett R, Liu B, Li Y, Alam HB. Assessment of the Cytoprotective Effects of High-Dose Valproic Acid Compared to a Clinically Used Lower Dose. J Surg Res 2021; 266:125-141. [PMID: 33991999 DOI: 10.1016/j.jss.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Valproic acid (VPA) treatment improves survival in animal models of injuries on doses higher than those allowed by Food and Drug Administration (FDA). We investigated the proteomic alterations induced by a single high-dose (140mg/kg) of VPA (VPA140) compared to the FDA-approved dose of 30mg/kg (VPA30) in healthy humans. We also describe the proteomic and transcriptomic changes induced by VPA140 in an injured patient. We hypothesized that VPA140 would induce cytoprotective changes in the study participants. METHODS Serum samples were obtained from healthy subjects randomized to two groups; VPA140 and VPA30 at 3 timepoints: 0h(baseline), 2h, and 24h following infusion(n = 3/group). Samples were also obtained from an injured patient that received VPA140 at 0h, 6h and 24h following infusion. Proteomic analyses were performed using liquid chromatography-mass spectrometry (LC-MS/MS), and transcriptomic analysis was performed using RNA-sequencing. Differentially expressed (DE) proteins and genes were identified for functional annotation and pathway analysis using iPathwayGuide and gene set enrichment analysis (GSEA), respectively. RESULTS For healthy individuals, a dose comparison was performed between VPA140 and VPA30 groups at 2 and 24 h. Functional annotation showed that top biological processes in VPA140 versus VPA30 analysis at 2 h included regulation of fatty acid (P = 0.002) and ATP biosynthesis (P = 0.007), response to hypoxia (P = 0.017), cell polarity regulation (P = 0.031), and sequestration of calcium ions (P = 0.031). Top processes at 24 h in VPA140 versus VPA30 analysis included amino acid metabolism (P = 0.023), collagen catabolism (P = 0.023), and regulation of protein breakdown (P = 0.023). In the injured patient, annotation of the DE proteins in the serum showed that top biological processes at 2 h included neutrophil chemotaxis (P = 0.002), regulation of cellular response to heat (P = 0.008), regulation of oxidative stress (P = 0.008) and regulation of apoptotic signaling pathway (P = 0.008). Top biological processes in the injured patient at 24 h included autophagy (P = 0.01), glycolysis (P = 0.01), regulation of apoptosis (P = 0.01) and neuron apoptotic processes (P = 0.02). CONCLUSIONS VPA140 induces cytoprotective changes in human proteome not observed in VPA30. These changes may be responsible for its protective effects in response to injuries.
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Affiliation(s)
- Umar F Bhatti
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Aaron M Williams
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Ben E Biesterveld
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Rachel Russo
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Glenn Wakam
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael Kemp
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Baoling Liu
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Yongqing Li
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Hasan B Alam
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Department of Surgery, Feinberg School of Medicine/Northwestern University, Chicago, Illinois.
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6
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Petersen S, Simms ER, Guidry C, Duchesne JC. Impact of Hormonal Protection in Blunt and Penetrating Trauma: A Retrospective Analysis of the National Trauma Data Bank. Am Surg 2020. [DOI: 10.1177/000313481307900935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the last decade, gender and age-related hormonal status of trauma patients have been increasingly recognized as outcome factors. In the present study, we examine a large cohort of trauma patients to better appraise the effects of gender and age on patient outcome after blunt and penetrating trauma. We hypothesize that adult females are at lower risk for complications and mortality relative to adult males after both blunt and penetrating trauma. A retrospective analysis was conducted of the National Trauma Data Bank examining hormonally active females for advantages in survival and outcome after blunt and/or penetrating trauma. Over 1.4 million incident trauma cases were identified between 2002 and 2006. Multiple logistic regressions were calculated for associations between gender and outcome, stratified by injury type, age, comorbidity, Injury Severity Score (ISS), and complications. Risk factors associated with mortality in our multiple logistic regression analyses included: penetrating trauma (odds ratio [OR, 2.31; 95% confidence interval [CI], 2.27 to 2.36); adult male (OR, 1.45; 95% CI, 1.41 to 1.49); and ISS 15 or greater (OR, 14.68; 95% CI, 14.38 to 14.98). Adult females demonstrated a survival advantage over adult males (OR, 0.69; 95% CI, 0.67 to 0.71). Adult females with ISS less than 15 demonstrated a distinct survival advantage compared with adult males after both blunt and penetrating trauma. These results warrant further investigation into the role of sex hormones in trauma.
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Affiliation(s)
- Snow Petersen
- Bassett Medical Center, Cooperstown, New York
- Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Eric R. Simms
- Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Chrissy Guidry
- Tulane University School of Medicine, New Orleans, Louisiana; and
- Akron General Medical Center, Akron, Ohio
| | - Juan C. Duchesne
- Tulane University School of Medicine, New Orleans, Louisiana; and
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7
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Effect of dehydroepiandrosterone on the immune function of mice in vivo and in vitro. Mol Immunol 2019; 112:283-290. [PMID: 31228660 DOI: 10.1016/j.molimm.2019.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 01/17/2023]
Abstract
Dehydroepiandrosterone (DHEA) has anti-inflammatory, anti-oxidant and immune-regulating properties, while the mechanism of DHEA actions remains unclear. The present study aims to investigate the effect and possible mechanism of DHEA on immune function of mice in vivo and in vitro. In vivo, a lipopolysaccharide (LPS)-induced experimental inflammation model was constructed to analyze the regulation of DHEA on anti-oxidative and immune function in ICR mice; In vitro, the effects of DHEA on the biological functions of lymphocytes and macrophages were studied. The results showed that DHEA increased the activity of total antioxidant capacity and superoxide dismutase, while it decreased the level of reactive oxygen species in LPS-induced mice. Meanwhile, DHEA increased the proportion of T lymphocytes and decreased that of B lymphocytes in primary cultured spleen lymphocytes, and markedly enhanced the Th1/Th2 ratio in spleen T lymphocytes. Furthermore, DHEA significantly increased the Th1 type cytokine (IL-2 and IFN-α) and decreased the Th2 type cytokine (IL-4 and IL-10) levels in LPS-induced mice or in primary cultured spleen T lymphocytes. In addition, DHEA improved the phagocytic ability, enhanced the NO production and increased the iNOS activity in peritoneal macrophages. Our data indicates that DHEA increases the macrophages function via improving NO content and up-regulating TNF-α expression levels; and it evoked a Th1 immuno-response and repressed a Th2 immuno-response through promoting a shift in Th1/Th2 balance toward Th1-dominant immunity in vivo and in vitro. These results provide substantial evidence on the mechanism of DHEA-mediated immune function and the efficient protection against infectious and inflammatory response in animals and humans.
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8
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Larsen R, Bäckström D, Fredrikson M, Steinvall I, Gedeborg R, Sjoberg F. Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study. Scand J Trauma Resusc Emerg Med 2019; 27:24. [PMID: 30871611 PMCID: PMC6419337 DOI: 10.1186/s13049-019-0597-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/06/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and risk-adjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age. METHODS All hospital admissions for injury in Sweden during the period 2001-2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0-14, 15-50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women. RESULTS Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0-14 years OR 0.56 (95% CI 0.25 to 1.25), 15-50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)). CONCLUSION In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.
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Affiliation(s)
- Robert Larsen
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden. .,Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linkoping University, S-58185, Linkoping, Sweden. .,Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.
| | - Denise Bäckström
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.,Life Regiment Hussars, K3, Karlsborg, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Rolf Gedeborg
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Folke Sjoberg
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden.,Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linkoping University, S-58185, Linkoping, Sweden.,Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
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9
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Silva M, Silva S, Santos T, Soares P, Andrade A, Cadena M, Cadena P. Avaliação do impacto causado pela disponibilidade de 17β-estradiol livre ou complexado à β-ciclodextrina no ambiente aquático sobre Oreochromis niloticus (tilápia). ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Foram avaliados os efeitos tóxicos do hormônio 17β-estradiol (E2) livre e complexado à β-ciclodextrina (CD) sobre o comportamento e a fisiologia de tilápia (Oreochromis niloticus). Os peixes foram observados por 30 dias, em dois estágios do desenvolvimento (alevino e juvenil), pelo método ad libitum, para a confecção de um etograma. Posteriormente, juvenis foram divididos em três grupos: controle e expostos ao E2 (10ng/L) livre e complexado à β-ciclodextrina (β-CD:E2) por 90 dias. Foram avaliados o comportamento pelo método de varredura instantânea, o consumo de ração, o ganho de peso e a mortalidade em diferentes intervalos. Os alevinos e os juvenis apresentaram frequências de exibição comportamentais diferentes (P<0,05) nos eventos: Afastar (4,7±1,3 e 3,6±0,6%) e Ondulação de repulsão (2,3±0,9 e 1,3±1,0%). Os juvenis expostos ao complexo β-CD:E2 apresentaram aumento (P<0,05) na exibição dos comportamentos agressivos, como Afastar, Ataque caudal, Confronto prolongado, Perseguição, Fuga, e menor mortalidade, quando comparados ao grupo exposto ao E2 livre e controle. Pode-se concluir que a complexação do E2 com a β-CD alterou a toxicidade do E2, pois promoveu um aumento na frequência de exibição dos comportamentos agressivos e interferiu na mortalidade dos animais.
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Affiliation(s)
- M.C.G. Silva
- Universidade Federal Rural de Pernambuco, Brazil
| | | | - T.P. Santos
- Universidade Federal Rural de Pernambuco, Brazil
| | | | | | | | - P.G. Cadena
- Universidade Federal Rural de Pernambuco, Brazil
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10
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Subramani K, Lu S, Warren M, Chu X, Toque HA, Caldwell RW, Diamond MP, Raju R. Mitochondrial targeting by dichloroacetate improves outcome following hemorrhagic shock. Sci Rep 2017; 7:2671. [PMID: 28572638 PMCID: PMC5453974 DOI: 10.1038/s41598-017-02495-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 04/12/2017] [Indexed: 12/16/2022] Open
Abstract
Hemorrhagic shock is a leading cause of death in people under the age of 45 and accounts for almost half of trauma-related deaths. In order to develop a treatment strategy based on potentiating mitochondrial function, we investigated the effect of the orphan drug dichloroacetate (DCA) on survival in an animal model of hemorrhagic shock in the absence of fluid resuscitation. Hemorrhagic shock was induced in rats by withdrawing 60% of the blood volume and maintaining a hypotensive state. The studies demonstrated prolonged survival of rats subjected to hemorrhagic injury (HI) when treated with DCA. In separate experiments, using a fluid resuscitation model we studied mitochondrial functional alterations and changes in metabolic networks connected to mitochondria following HI and treatment with DCA. DCA treatment restored cardiac mitochondrial membrane potential and tissue ATP in the rats following HI. Treatment with DCA resulted in normalization of several metabolic and molecular parameters including plasma lactate and p-AMPK/AMPK, as well as Ach-mediated vascular relaxation. In conclusion we demonstrate that DCA can be successfully used in the treatment of hemorrhagic shock in the absence of fluid resuscitation; therefore DCA may be a good candidate in prolonged field care following severe blood loss.
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Affiliation(s)
- Kumar Subramani
- Department of Laboratory Sciences, Augusta University, Augusta, GA, 30912, United States of America
| | - Sumin Lu
- Department of Laboratory Sciences, Augusta University, Augusta, GA, 30912, United States of America
| | - Marie Warren
- Department of Laboratory Sciences, Augusta University, Augusta, GA, 30912, United States of America
| | - Xiaogang Chu
- Department of Laboratory Sciences, Augusta University, Augusta, GA, 30912, United States of America
| | - Haroldo A Toque
- Department of Pharmacology and Toxicology, Augusta University, Augusta, GA, 30912, United States of America
| | - R William Caldwell
- Department of Pharmacology and Toxicology, Augusta University, Augusta, GA, 30912, United States of America
| | - Michael P Diamond
- Department of Obstetrics and Gynaecology, Augusta University, Augusta, GA, 30912, United States of America
| | - Raghavan Raju
- Department of Laboratory Sciences, Augusta University, Augusta, GA, 30912, United States of America. .,Department of Surgery, Augusta University, Augusta, GA, 30912, United States of America. .,Department of Biochemistry and Molecular Biology, Augusta University, Augusta, GA, 30912, United States of America.
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11
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Bhoi S, Tiwari S, Kumar M. What's New in Critical Illness and Injury Science? Estrogen: Is it a new therapeutic paradigm for trauma-hemorrhagic shock? Int J Crit Illn Inj Sci 2016; 6:53. [PMID: 27308249 PMCID: PMC4901825 DOI: 10.4103/2229-5151.183021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sanjeev Bhoi
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India
| | - Shreshtha Tiwari
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar
- Department of Emergency Medicine, Jai Prakash Narayan Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India
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12
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Ayub A, Poulose N, Raju R. Resveratrol Improves Survival and Prolongs Life Following Hemorrhagic Shock. Mol Med 2015; 21:305-12. [PMID: 25879628 DOI: 10.2119/molmed.2015.00013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/13/2015] [Indexed: 11/06/2022] Open
Abstract
Resveratrol has been shown to potentiate mitochondrial function and extend longevity; however, there is no evidence to support whether resveratrol can improve survival or prolong life following hemorrhagic shock. We sought to determine whether (a) resveratrol can improve survival following hemorrhage and resuscitation and (b) prolong life in the absence of resuscitation. Using a hemorrhagic injury (HI) model in the rat, we describe for the first time that the naturally occurring small molecule, resveratrol, may be an effective adjunct to resuscitation fluid. In a series of three sets of experiments we show that resveratrol administration during resuscitation improves survival following HI (p < 0.05), resveratrol and its synthetic mimic SRT1720 can significantly prolong life in the absence of resuscitation fluid (<30 min versus up to 4 h; p < 0.05), and resveratrol as well as SRT1720 restores left ventricular function following HI. We also found significant changes in the expression level of mitochondria-related transcription factors Ppar-α and Tfam, as well as Pgc-1α in the left ventricular tissues of rats subjected to HI and treated with resveratrol. The results indicate that resveratrol is a strong candidate adjunct to resuscitation following severe hemorrhage.
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Affiliation(s)
- Ahmar Ayub
- Department of Laboratory Sciences, Georgia Regents University, Augusta, Georgia, United States of America
| | - Ninu Poulose
- Department of Laboratory Sciences, Georgia Regents University, Augusta, Georgia, United States of America
| | - Raghavan Raju
- Department of Laboratory Sciences, Georgia Regents University, Augusta, Georgia, United States of America.,Department of Surgery, Georgia Regents University, Augusta, Georgia, United States of America.,Department of Biochemistry and Molecular Biology, Georgia Regents University, Augusta, Georgia, United States of America
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13
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Anti-HMGB1 monoclonal antibody ameliorates immunosuppression after peripheral tissue trauma: attenuated T-lymphocyte response and increased splenic CD11b (+) Gr-1 (+) myeloid-derived suppressor cells require HMGB1. Mediators Inflamm 2015; 2015:458626. [PMID: 25709155 PMCID: PMC4325468 DOI: 10.1155/2015/458626] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/10/2014] [Indexed: 01/13/2023] Open
Abstract
Although tissue-derived high mobility group box 1 (HMGB1) is involved in many aspects of inflammation and tissue injury after trauma, its role in trauma-induced immune suppression remains elusive. Using an established mouse model of peripheral tissue trauma, which includes soft tissue and fracture components, we report here that treatment with anti-HMGB1 monoclonal antibody ameliorated the trauma-induced attenuated T-cell responses and accumulation of CD11b+Gr-1+ myeloid-derived suppressor cells in the spleens seen two days after injury. Our data suggest that HMGB1 released after tissue trauma contributes to signaling pathways that lead to attenuation of T-lymphocyte responses and enhancement of myeloid-derived suppressor cell expansion.
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14
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Vogelzang JL, van Stralen KJ, Noordzij M, Diez JA, Carrero JJ, Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG, Hoitsma A, Leivestad T, de Meester J, Metcalfe W, Palsson R, Postorino M, Ravani P, Vanholder R, Wallner M, Wanner C, Groothoff JW, Jager KJ. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant 2015; 30:1028-37. [PMID: 25637641 DOI: 10.1093/ndt/gfv007] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/01/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Infections and malignancies are the most common non-cardiovascular causes of death in patients on chronic renal replacement therapy (RRT). Here, we aimed to quantify the mortality risk attributed to infections and malignancies in dialysis patients and kidney transplant recipients when compared with the general population by age group and sex. METHODS We followed 168 156 patients included in the ERA-EDTA registry who started RRT in 1993-2007 until 1 January 2012. Age- and cause-specific mortality rates per 1000 person-years (py) and mortality rate ratios (MRRs) compared with the European general population (WHO) were calculated. To identify risk factors, we used Cox regression. RESULTS Infection-related mortality was increased 82-fold in dialysis patients and 32-fold in transplant recipients compared with the general population. Female sex, diabetes, cancer and multisystem disease were associated with an increased risk of infection-related mortality. The sex difference was most pronounced for dialysis patients aged 0-39 years, with women having a 32% (adjusted HR 1.32 95% CI 1.09-1.60) higher risk of infection-related mortality than men. Mortality from malignancies was 2.9 times higher in dialysis patients and 1.7 times higher in transplant recipients than in the general population. Cancer and multisystem disease as primary causes of end-stage renal disease were associated with higher mortality from malignancies. CONCLUSION Infection-related mortality is highly increased in dialysis and kidney transplant patients, while the risk of malignancy-related death is moderately increased. Young women on dialysis may deserve special attention because of their high excess risk of infection-related mortality. Further research into the mechanisms, prevention and optimal treatment of infections in this vulnerable population is required.
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Affiliation(s)
- Judith L Vogelzang
- ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Juan J Carrero
- Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Cecile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine Cedex, Paris, France
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrik Finne
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Denis Fouque
- Service de Néphrologie-Dialyse-Nutrition, Hospices Civils de Lyon, Lyon, France
| | - James G Heaf
- Department of Nephrology B, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Andries Hoitsma
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Torbjørn Leivestad
- Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Johan de Meester
- Department of Nephrology, Dialysis & Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium
| | | | - Runolfur Palsson
- Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Maurizio Postorino
- U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Pietro Ravani
- Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, AL, Canada
| | | | - Manfred Wallner
- Department of Internal Medicine IV - Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
| | - Jaap W Groothoff
- Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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15
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Estrus cycle status defined by vaginal cytology does not correspond to fluctuations of circulating estrogens in female mice. Shock 2014; 41:145-53. [PMID: 24434417 DOI: 10.1097/shk.0000000000000070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gender-oriented studies in shock, trauma, and/or sepsis require accurate monitoring of hormonal fluctuations as estrogens may influence various end points. Yet, monitoring is challenging in small laboratory animals: e.g., despite its subjectivity, vaginal smears are the major method for determination of estrus cycle phases in mice. Using female mice of different age, we aimed to (a) characterize general age-related changes in systemic estrogens and (b) examine the utility of determination of the estrus cycle by vaginal smears and/or impedance simultaneously comparing them with oscillation of systemic estrogens. In this study, 3-, 15-, and 20-month-old mice underwent vaginal smear and impedance examination each morning for 22 days. Ten hours after each morning checkup, feces were collected, and a second vaginal smear performed. Blood was collected on days 15 and 22. In 3-month-old females, estrus (by smears) was three times more frequent than in older mice, but mean concentrations of plasma and fecal estrogens never decreased with age. Collectively (not individually) plotted fecal estrogens values increased in the proestrus/estrus interphase (by smears) in 3-month-old mice only. Impedance typically peaked (4.5 Ω in 3-month-old mice) in the estrus phase, and only the prediction of estrus (highest area under the curve = 0.87 in 3-month-old) but not of other phases was possible. Regardless of age, individual cycle phase (by smears) never correlated with corresponding fecal estrogens, and estrus could not be predicted. In conclusion, while the fecal estrogens oscillation and frequency of estrus phase were affected by age, the systemic hormone release persisted. In mice, vaginal cytology did not reflect changes of systemic (fecal) estrogens, whereas impedance accurately identified estrus. The flaws and advantages of the examined monitoring methods should be considered in the design of future shock studies.
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16
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Efficacy of 17α-ethynylestradiol-3-sulfate for severe hemorrhage in minipigs in the absence of fluid resuscitation. J Trauma Acute Care Surg 2014; 76:1409-16. [PMID: 24854309 DOI: 10.1097/ta.0000000000000237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Of the potentially survivable US battlefield deaths from 2001 to 2011, 80% to 91% were caused by severe hemorrhage. We subjected minipigs to acute severe blood loss, administered a single dose of 17α-ethynylestradiol-3-sulfate (EE-3-SO4) without resuscitative fluids, and determined survival as well as cardiovascular, biochemical, and physiologic response parameters. METHODS Following controlled removal of 60% circulating blood volume over 1 hour, minipigs received EE-3-SO4 at 0, 1, 3, or 5-mg/mL saline per kilogram of body weight in Experiment 1 (n = 25) and 0-, 0.1-, 0.3-, or 1-mg/mL saline per kilogram in Experiment 2 (n = 23). Survival times and response parameters were recorded for the next 6 hours. RESULTS Median survival times of the minipigs receiving 1 mg/kg (257 minutes and 360 minutes) were 1.8 times and 5 times those of the control group (140 minutes and 65 minutes) in Experiments 1 and 2, respectively. For both experiments combined, the log-rank p value was 0.0002, and the number of animals alive at 6 hours was 6 (50%) of 12 in the 1-mg/kg groups versus 0 (0%) of 12 in the control groups. Early increases in glucose, lactate, potassium, and phosphate as well as decreases in bicarbonate and mean arterial pressure correlated with shorter survival times. CONCLUSION Administration of a single dose of 1-mg/kg EE-3-SO4 in 1-mL/kg of saline following severe hemorrhage increased survival in 60% acutely bled minipigs by 3.5-fold. Slightly elevated blood pressure values, more physiologic values of oxidative phosphorylation parameters, and lower elevations of possible tissue necrosis parameters correlated with longer survival time. These results support the further product development of EE-3-SO4 for the indication of severe hemorrhage when standard resuscitative fluids are not available.
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17
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Jian B, Yang S, Chaudry IH, Raju R. Resveratrol restores sirtuin 1 (SIRT1) activity and pyruvate dehydrogenase kinase 1 (PDK1) expression after hemorrhagic injury in a rat model. Mol Med 2014; 20:10-6. [PMID: 24395567 DOI: 10.2119/molmed.2013.00077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/17/2013] [Indexed: 02/06/2023] Open
Abstract
Severe hemorrhage leads to decreased blood flow to tissues resulting in decreased oxygen and nutrient availability affecting mitochondrial function. A mitoscriptome profiling study demonstrated alteration in several genes related to mitochondria, consistent with the mitochondrial functional decline observed after trauma hemorrhage (T-H). Our experiments led to the identification of sirtuin 1 (SIRT1) as a potential target in T-H. Administration of resveratrol (a naturally occurring polyphenol and activator of SIRT1) after T-H improved left ventricular function and tissue ATP levels. Our hypothesis was that mitochondrial function after T-H depends on SIRT1 activity. In this study, we evaluated the activity of SIRT1, a mitochondrial functional modulator, and the mitochondrial-glycolytic balance after T-H. We determined the changes in protein levels of pyruvate dehydrogenase kinase (PDK)-1 and nuclear c-Myc, peroxisome proliferator-activated receptor-γ coactivator (PGC)-1α and NF-E2-related factor (NRF)2 after T-H and after treatment with resveratrol or a combination of sirtinol (a SIRT1 inhibitor) and resveratrol. We have also tested the activity of mitochondrial complex 1. SIRT1 enzyme activity was significantly decreased after T-H, whereas resveratrol treatment restored the activity. We found elevated PDK1 and c-Myc levels and decreased PGC-1α, NRF2 and mitochondrial complex I activity after T-H. The reduced SIRT1 activity after T-H may be related to declining mitochondrial function, since resveratrol was able to reinstate SIRT1 activity and mitochondrial function. The elevated level of PDK1 (an inhibitor of pyruvate dehydrogenase complex) after T-H indicates a possible shift in cellular energetics from mitochondria to glycolysis. In conclusion, SIRT1 modulation alters left ventricular function after T-H through regulation of cellular energetics.
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Affiliation(s)
- Bixi Jian
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Shaolong Yang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Irshad H Chaudry
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Raghavan Raju
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Alhan E, Cinel A, Türkyilmaz S, Erçin C, Kural B, Usta A. Effects of 17ß-Estradiol on the Acute Necrotizing Pancreatitis after Onset in Rats. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate the influence of 17ß-estradiol (E2) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. Rats were divided into six groups as sham + saline, sham + single dose E2 (SDE2), sham + multiple dose E2 (MDE2), ANP + saline, ANP + SDE2, and ANP + MDE2. ANP in rats was induced by glycodeoxycholic acid. The extent of acinar cell injury, mortality, systemic cardiorespiratory variables, functional capillary density (FCD), renal/hepatic functions, and changes in some enzyme markers for pancreatic and lung tissue were investigated during ANP in rats. The induction of ANP resulted in a significant increase in the mortality rate, pancreatic necrosis, and serum activity of amylase, alanine aminotransferase (ALT), interleukin (IL)-6, lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, serum concentration of urea, and tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and a significant decrease in concentrations of calcium, blood pressure, urine output, p02, and functional capillary density (FCD). The use of E2 did not alter these changes. E2 demonstrated no effect on the course of ANP in rats. Therefore, it has no value in the treatment during acute pancreatitis.
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Affiliation(s)
- E. Alhan
- Department of Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - A. Cinel
- Department of Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - S. Türkyilmaz
- Department of Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - C. Erçin
- Department of Pathology, Kocaeli University, Kocaeli, Turkey
| | - B.V. Kural
- Department of Biochemistry, Karadeniz Technical University, Trabzon, Turkey
| | - A. Usta
- Department of Surgery, Karadeniz Technical University, Trabzon, Turkey
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What's new in Shock? September 2013. Shock 2013; 40:163-5. [PMID: 23949390 DOI: 10.1097/shk.0b013e3182a3d400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lu CW, Liu LC, Hsieh YC, Yang LH, Chen RJ, Hsieh CH. Increased admission serum estradiol level is correlated with high mortality in patients with severe acute pancreatitis. J Gastroenterol 2013; 48:374-81. [PMID: 22825551 DOI: 10.1007/s00535-012-0636-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/22/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sexual dimorphism in critical diseases has been documented. Severe acute pancreatitis is a disease with high mortality. We hypothesized that admission sex hormone levels may be used as an early predictor of outcome in these patients. METHODS A prospective cohort of patients with severe acute pancreatitis admitted to the intensive care unit for at least 48 h were enrolled (n = 62). Serum levels of estradiol, progesterone, and testosterone were determined on admission. The association of sex hormone levels and various disease severity scoring systems with patient outcome was analyzed. RESULTS There was no difference in overall mortality between the sexes. However, estradiol was significantly elevated in nonsurvivors (39 vs. 206 pg/mL, p < 0.001). The estradiol level was the best single-variable predictor of mortality (area under the curve 0.97), followed by the sequential organ failure assessment score, the multiple organ dysfunction score, and the acute physiology and chronic health care evaluation II (APACHE II) score. A serum estradiol level of 102 pg/mL was both sensitive and specific to predict mortality. There were no differences between survivors and non-survivors in terms of age, body mass index, or progesterone and testosterone levels. CONCLUSIONS Admission serum estradiol level is a good marker of disease severity and predictor of death in patients with severe acute pancreatitis.
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Affiliation(s)
- Chih-Wei Lu
- Department of Emergency, Nantou Christian Hospital, Nantou, Taiwan, ROC
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Ritzel RM, Capozzi LA, McCullough LD. Sex, stroke, and inflammation: the potential for estrogen-mediated immunoprotection in stroke. Horm Behav 2013; 63:238-53. [PMID: 22561337 PMCID: PMC3426619 DOI: 10.1016/j.yhbeh.2012.04.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/13/2012] [Accepted: 04/14/2012] [Indexed: 01/05/2023]
Abstract
Stroke is the third leading cause of death and the primary cause of disability in the developed world. Experimental and clinical data indicate that stroke is a sexually dimorphic disease, with males demonstrating an enhanced intrinsic sensitivity to ischemic damage throughout most of their lifespan. The neuroprotective role of estrogen in the female brain is well established, however, estrogen exposure can also be deleterious, especially in older women. The mechanisms for this remain unclear. Our current understanding is based on studies examining estrogen as it relates to neuronal injury, yet cerebral ischemia also induces a robust sterile inflammatory response involving local and systemic immune cells. Despite the potent anti-inflammatory effects of estrogen, few studies have investigated the contribution of estrogen to sex differences in the inflammatory response to stroke. This review examines the potential role for estrogen-mediated immunoprotection in ischemic injury.
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Affiliation(s)
- Rodney M Ritzel
- University of Connecticut Health Center, Department of Neuroscience, Farmington, CT 06030, USA
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Kawasaki T, Chaudry IH. The effects of estrogen on various organs: therapeutic approach for sepsis, trauma, and reperfusion injury. Part 1: central nervous system, lung, and heart. J Anesth 2012; 26:883-91. [DOI: 10.1007/s00540-012-1425-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
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Jian B, Yang S, Chaudry IH, Raju R. Resveratrol improves cardiac contractility following trauma-hemorrhage by modulating Sirt1. Mol Med 2012; 18:209-14. [PMID: 22113495 DOI: 10.2119/molmed.2011.00365] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/15/2011] [Indexed: 01/22/2023] Open
Abstract
Mitochondria play a critical role in metabolic homeostasis of a cell. Our recent studies, based on the reported interrelationship between c-Myc and Sirt1 (mammalian orthologue of yeast sir2 [silent information regulator 2]) expression and their role in mitochondrial biogenesis and function, demonstrated a significant downregulation of Sirt1 protein expression and an upregulation of c-Myc following trauma-hemorrhage (T-H). Activators of Sirt1 are known to improve mitochondrial function and the naturally occurring polyphenol resveratrol (RSV) has been shown to significantly increase Sirt1 activity by increasing its affinity to both NAD+ and the acetylated substrate. In this study we tested the salutary effect of RSV following T-H and its influence on Sirt1 expression. Rats were subjected to T-H or sham operation. RSV (8 mg/kg body weight, intravenously) or vehicle was administered 10 min after the onset of resuscitation, and the rats were killed 2 h following resuscitation. Sirtinol, a Sirt1 inhibitor, was administered 5 min prior to RSV administration. Cardiac contractility (±dP/dt) was measured and heart tissue was tested for Sirt1, Pgc-1α, c-Myc, cytosolic cytochrome C expression and ATP level. Left ventricular function, after T-H, was improved (P < 0.05) following RSV treatment, with significantly elevated expression of Sirt1 (P < 0.05) and Pgc-1α (P < 0.05), and decreased c-Myc (P < 0.05). We also observed significantly higher cardiac ATP content, declined cytosolic cytochrome C and decreased plasma tumor necrosis factor-α in the T-H-RSV group. The salutary effect due to RSV was abolished by sirtinol, indicating a Sirt1-mediated effect. We conclude that RSV may be a useful adjunct to resuscitation fluid following T-H.
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Affiliation(s)
- Bixi Jian
- Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Pan Z, Chang C. Gender and the regulation of longevity: implications for autoimmunity. Autoimmun Rev 2011; 11:A393-403. [PMID: 22182796 DOI: 10.1016/j.autrev.2011.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For humans and other animals, gender has an influence not only on their physical attributes, but also on life span. In humans, females have a longer life span than males. The reasons for this are not entirely clear. The role of gender in the regulation of longevity may be linked to gender specific genetic differences, including the expression of sex hormone patterns and the changes in these patterns during an individual's lifetime. In addition, the effect of sex hormones on other physiologic responses to environmental influences on cellular stress and oxidative damage may play a role in longevity. Gender can impact many disease states, including autoimmune diseases, and the factors that affect the development of autoimmune diseases and the regulation of longevity may share common mechanistic pathways. Other factors that may play a role include telomere and telomerase related differences, caloric restriction and changes in mitochondrial DNA. Inflammatory and regulatory pathways such as insulin/IGF signaling and Target of Rapamycin (TOR) signaling may also play a role in longevity and aging-related diseases such as Alzheimer's. The role of gender differences in the regulation of these pathways or factors is not entirely clear. The role of X-chromosome inactivation in longevity has also yet to be fully elucidated.
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Affiliation(s)
- Zhen Pan
- Nemours/A.I duPont Hospital for children, Division of Allergy, Asthma and Immunology, USA
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Sharawy N, Pavlovic D, Wendt M, Cerny V, Lehmann C. Evaluation of the effects of gender and estradiol treatment on the intestinal microcirculation during experimental sepsis. Microvasc Res 2011; 82:397-403. [DOI: 10.1016/j.mvr.2011.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/18/2011] [Accepted: 06/21/2011] [Indexed: 11/28/2022]
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Klemcke HG, Joe B, Rose R, Ryan KL. Life or death? A physiogenomic approach to understand individual variation in responses to hemorrhagic shock. Curr Genomics 2011; 12:428-42. [PMID: 22379396 PMCID: PMC3178911 DOI: 10.2174/138920211797248574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/29/2011] [Accepted: 07/06/2011] [Indexed: 11/22/2022] Open
Abstract
Severe hemorrhage due to trauma is a major cause of death throughout the world. It has often been observed that some victims are able to withstand hemorrhage better than others. For decades investigators have attempted to identify physiological mechanisms that distinguish survivors from nonsurvivors for the purpose of providing more informed therapies. As an alternative approach to address this issue, we have initiated a research program to identify genes and genetic mechanisms that contribute to this phenotype of survival time after controlled hemorrhage. From physiogenomic studies using inbred rat strains, we have demonstrated that this phenotype is a heritable quantitative trait, and is therefore a complex trait regulated by multiple genes. Our work continues to identify quantitative trait loci as well as potential epigenetic mechanisms that might influence survival time after severe hemorrhage. Our ultimate goal is to improve survival to traumatic hemorrhage and attendant shock via regulation of genetic mechanisms and to provide knowledge that will lead to genetically-informed personalized treatments.
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Affiliation(s)
- Harold G Klemcke
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
| | - Bina Joe
- Physiological Genomics Laboratory, Department of Physiology and Pharmacology, University of Toledo College of Medicine, Toledo, OH 43614, USA
| | - Rajiv Rose
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
| | - Kathy L Ryan
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
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Peterson CY, Osen HB, Tran Cao HS, Yu PT, Chang DC. The battle of the sexes: women win out in gastrointestinal surgery. J Surg Res 2011; 170:e23-8. [PMID: 21693379 DOI: 10.1016/j.jss.2011.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/25/2011] [Accepted: 04/05/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women have been shown to have worse outcomes compared with men after cardiac surgery, but fare better after traumatic injury. No study considers the impact of gender on outcomes after major gastrointestinal surgery. We hypothesize that the physiologic insults of a major abdominal operation are similar to an injury model; therefore, women will have improved outcomes. MATERIAL AND METHODS We performed a retrospective review of the NIS database from 1998 to 2007. Patients undergoing major gastrointestinal surgery were identified by ICD-9 procedure codes: esophageal (42.4), gastric (43.5-43.9), small intestine (45.6), large intestine (45.7-45.8 and 17.3), rectal (48.4-48.6), hepatic (50.2-50.3), biliary (51.3 and 51.6), and pancreatic (52.5-52.7). Exclusion criteria included age over 60 y and under 18 y, multiple operations, and a sexual developmental disorder (25.52, 75.27, and 25.9). The primary outcome measure was in-hospital death. RESULTS A total of 307,124 patients were identified, of whom 50.3% were women. Overall, there were 6574 (2.14%) deaths; 2.45% of men and 1.84% of women died (P < 0.001). In multivariate analysis, women were 21.1% less likely to die than men (OR = 0.789, 95% CI = 0.74-0.84). When subset analysis was performed, women had improved mortality in the following types of surgery: gastric (OR = 0.751, 95% CI = 0.60-0.94), small intestine (OR = 0.704, 95% CI = 0.63-0.79), large intestine (OR = 0.845, 95% CI = 0.77--0.93), hepatic (OR = 0.562, 95% CI = 0.41-0.77), and pancreatic (OR = 0.658, 95% CI = 0.49-0.89, see Fig. 1). CONCLUSIONS Our study demonstrates that women may have improved outcomes after some types of major gastrointestinal surgery; however, the mechanism by which this occurs is unclear. Future studies are needed to further evaluate this interesting phenomenon.
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Affiliation(s)
- Carrie Y Peterson
- Department of Surgery, University of California, San Diego, California 92103-8401, USA
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Jian B, Yang S, Chen D, Chaudry I, Raju R. Influence of aging and hemorrhage injury on Sirt1 expression: possible role of myc-Sirt1 regulation in mitochondrial function. Biochim Biophys Acta Mol Basis Dis 2011; 1812:1446-51. [PMID: 21554952 DOI: 10.1016/j.bbadis.2011.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 02/02/2023]
Abstract
Trauma-hemorrhage (T-H) causes hypoxia and organ dysfunction. Mitochondrial dysfunction is a major factor for cellular injury due to T-H. Aging also has been known to cause progressive mitochondrial dysfunction. In order to study the effect of aging on T-H-induced mitochondrial dysfunction, we recently developed a rodent mitochondrial genechip with probesets representing mitochondrial and nuclear genes contributing to mitochondrial structure and function. Using this chip we recently identified signature mitochondrial genes altered following T-H in 6 and 22 month old rats; augmented expression of the transcription factor c-myc was the most pronounced. Based on reports of c-myc-IL6 collaboration and c-myc-Sirt1 negative regulation, we further investigated the expression of these regulatory factors with respect to aging and injury. Rats of ages 6 and 22 months were subjected to T-H or sham operation and left ventricular tissues were tested for cytosolic cytochrome c, mtDNA content, Sirt1 and mitochondrial biogenesis factors Foxo1, Ppara and Nrf-1. We observed increased cardiac cytosolic cytochrome c (sham vs T-H, p<0.03), decreased mitochondrial DNA content (sham vs T-H, p<0.05), and decreased Sirt1 expression (sham vs TH, p<0.05) following T-H and with progressing age. Additionally, expression of mitochondrial biogenesis regulating transcription factors Foxo1 and Nrf-1 was also decreased with T-H and aging. Based upon these observations we conclude that Sirt1 expression is negatively modulated by T-H causing downregulation of mitochondrial biogenesis. Thus, induction of Sirt1 is likely to produce salutary effects following T-H induced injury and hence, Sirt1 may be a potential molecular target for translational research in injury resolution.
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Affiliation(s)
- Bixi Jian
- Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Jian B, Yang S, Chen D, Zou L, Chatham JC, Chaudry I, Raju R. Aging influences cardiac mitochondrial gene expression and cardiovascular function following hemorrhage injury. Mol Med 2010; 17:542-9. [PMID: 21193900 DOI: 10.2119/molmed.2010.00195] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 12/21/2010] [Indexed: 01/07/2023] Open
Abstract
Cardiac dysfunction and mortality associated with trauma and sepsis increase with age. Mitochondria play a critical role in the energy demand of cardiac muscles, and thereby on the function of the heart. Specific molecular pathways responsible for mitochondrial functional alterations after injury in relation to aging are largely unknown. To further investigate this, 6- and 22-month-old rats were subjected to trauma-hemorrhage (T-H) or sham operation and euthanized following resuscitation. Left ventricular tissue was profiled using our custom rodent mitochondrial gene chip (RoMitochip). Our experiments demonstrated a declined left ventricular performance and decreased alteration in mitochondrial gene expression with age following T-H and we have identified c-Myc, a pleotropic transcription factor, to be the most upregulated gene in 6- and 22-month-old rats after T-H. Following T-H, while 142 probe sets were altered significantly (39 up and 103 down) in 6-month-old rats, only 66 were altered (30 up and 36 down) in 22-month-old rats; 36 probe sets (11 up and 25 down) showed the same trend in both groups. The expression of c-Myc and cardiac death promoting gene Bnip3 were increased, and Pgc1-α and Ppar-α a decreased following T-H. Eleven tRNA transcripts on mtDNA were upregulated following T-H in the aged animals, compared with the sham group. Our observations suggest a c-myc-regulated mitochondrial dysfunction following T-H injury and marked decrease in age-dependent changes in the transcriptional profile of mitochondrial genes following T-H, possibly indicating cellular senescence. To our knowledge, this is the first report on mitochondrial gene expression profile following T-H in relation to aging.
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Affiliation(s)
- Bixi Jian
- Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Hazeldine J, Arlt W, Lord JM. Dehydroepiandrosterone as a regulator of immune cell function. J Steroid Biochem Mol Biol 2010; 120:127-36. [PMID: 20060904 DOI: 10.1016/j.jsbmb.2009.12.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 12/16/2009] [Accepted: 12/23/2009] [Indexed: 12/16/2022]
Abstract
Dehydroepiandrosterone (DHEA) is a C19 steroid of adrenal origin. Notably, its secretion declines with age, a phenomenon referred to as the "adrenopause". For many years, the physiological significance of DHEA remained elusive. However, many studies have now shown that DHEA has significant immune modulatory function, exhibiting both immune stimulatory and anti-glucocorticoid effects. Although several of these studies are limited by the fact that they were carried out in rodents, who are incapable of adrenal DHEA production, and therefore have very low circulating levels of this steroid, evidence from the study of immune cells is now accumulating to suggest a role for DHEA in regulating human immunity. This ability to regulate immune function has raised interest in the therapeutic potential of DHEA as a treatment for the immunological abnormalities that arise in subjects with low circulating levels of this hormone. This has included attempts at reversing the impaired immune response of older individuals to vaccination and restoring immune regulation in patients with chronic autoimmune disease. This review summarises the reported effects of DHEA on immune function and discusses the therapeutic potential of this steroid in geriatric medicine and particularly in age-related disease with an immune component.
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Affiliation(s)
- Jon Hazeldine
- MRC Centre for Immune Regulation, Birmingham University Medical School, UK
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Candore G, Balistreri CR, Colonna-Romano G, Lio D, Listì F, Vasto S, Caruso C. Gender-Related Immune-Inflammatory Factors, Age-Related Diseases, and Longevity. Rejuvenation Res 2010; 13:292-7. [DOI: 10.1089/rej.2009.0942] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Giuseppina Candore
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Carmela Rita Balistreri
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Giuseppina Colonna-Romano
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Domenico Lio
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Florinda Listì
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Sonya Vasto
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
| | - Calogero Caruso
- Immunesenescence Unit, Department of Pathobiology and Biomedical Methodology, University of Palermo, Italy
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Doucet D, Badami C, Palange D, Bonitz RP, Lu Q, Xu DZ, Kannan KB, Colorado I, Feinman R, Deitch EA. Estrogen receptor hormone agonists limit trauma hemorrhage shock-induced gut and lung injury in rats. PLoS One 2010; 5:e9421. [PMID: 20195535 PMCID: PMC2828476 DOI: 10.1371/journal.pone.0009421] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/01/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute lung injury (ALI) and the development of the multiple organ dysfunction syndrome (MODS) is a major cause of death in trauma patients. Earlier studies in trauma hemorrhagic shock (T/HS) have documented that splanchnic ischemia leading to gut inflammation and loss of barrier function is an initial triggering event that leads to gut-induced ARDS and MODS. Since sex hormones have been shown to modulate the response to T/HS and proestrous (PE) females are more resistant to T/HS-induced gut and distant organ injury, the goal of our study was to determine the contribution of estrogen receptor (ER)alpha and ERbeta in modulating the protective response of female rats to T/HS-induced gut and lung injury. METHODS/PRINCIPAL FINDINGS The incidence of gut and lung injury was assessed in PE and ovariectomized (OVX) female rats subjected to T/HS or trauma sham shock (T/SS) as well as OVX rats that were administered estradiol (E2) or agonists for ERalpha or ERbeta immediately prior to resuscitation. Marked gut and lung injury was observed in OVX rats subjected to T/HS as compared to PE rats or E2-treated OVX rats subjected to T/HS. Both ERalpha and ERbeta agonists were equally effective in limiting T/HS-induced morphologic villous injury and bacterial translocation, whereas the ERbeta agonist was more effective than the ERalpha agonist in limiting T/HS-induced lung injury as determined by histology, Evan's blue lung permeability, bronchoalevolar fluid/plasma protein ratio and myeloperoxidase levels. Similarly, treatment with either E2 or the ERbeta agonist attenuated the induction of the intestinal iNOS response in OVX rats subjected to T/HS whereas the ERalpha agonist was only partially protective. CONCLUSIONS/SIGNIFICANCE Our study demonstrates that estrogen attenuates T/HS-induced gut and lung injury and that its protective effects are mediated by the activation of ERalpha, ERbeta or both receptors.
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Affiliation(s)
- Danielle Doucet
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Chirag Badami
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - David Palange
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - R. Paul Bonitz
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Qi Lu
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Da-Zhong Xu
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Kolenkode B. Kannan
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Iriana Colorado
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Rena Feinman
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
| | - Edwin A. Deitch
- Department of Surgery, University of Medicine & Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, Newark, New Jersey, United States of America
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Estrogenic hormone modulation abrogates changes in red blood cell deformability and neutrophil activation in trauma hemorrhagic shock. ACTA ACUST UNITED AC 2010; 68:35-41. [PMID: 20065755 DOI: 10.1097/ta.0b013e3181bbbddb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decreased red blood cell (RBC) deformability and activation of neutrophils (polymorphonuclear leukocytes [PMN]) after trauma-hemorrhagic shock (T/HS) have been implicated in the development of multiple organ dysfunction. Experimentally, female animals seemed to be protected from the effects of T/HS, at least in part, because of elevated estrogen levels. Thus, we examined the relative role of estrogen receptor (ER)-alpha and -beta in this protective response. METHODS To accomplish this goal, RBC deformability and neutrophil respiratory burst activity were measured in several groups of hormonally intact or ovariectomized (OVX) female rats subjected to T/HS (laparotomy plus hemorrhage to an MAP of 30 mm Hg to 35 mm Hg for 90 minutes) or trauma-sham shock (T/SS) and 3 hours of reperfusion. These groups included rats receiving vehicle, estradiol, or either an ER-alpha agonist or an ER-beta agonist administered at the end of the shock period just before volume resuscitation. RESULTS RBC deformability and neutrophil activation were similar among all the T/SS groups and were not different from that observed in the non-OVX female rats subjected to T/HS. In contrast, RBC deformability was reduced and neutrophil activation was increased in the OVX, T/HS female rats as compared with the T/SS groups or the non-OVX, T/HS rats. The administration of estrogen to the T/HS, OVX rats returned RBC and neutrophil function to normal. Both the ER-alpha and -beta agonist partially, but not completely, protected the OVX rats from T/HS-induced loss of RBC deformability, whereas only the ER-beta agonist prevented the increase in neutrophil activation. CONCLUSIONS The protective effects of estrogen on T/HS-induced RBC deformability are mediated, at least in part, via activation of both ER-alpha and -beta, whereas ER-beta activation is involved in limiting T/HS-induced neutrophil activation.
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Duriancik DM, Hoag KA. The identification and enumeration of dendritic cell populations from individual mouse spleen and Peyer's patches using flow cytometric analysis. Cytometry A 2009; 75:951-9. [DOI: 10.1002/cyto.a.20794] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Brøchner AC, Toft P. Pathophysiology of the systemic inflammatory response after major accidental trauma. Scand J Trauma Resusc Emerg Med 2009; 17:43. [PMID: 19754938 PMCID: PMC2757019 DOI: 10.1186/1757-7241-17-43] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 09/15/2009] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of the present study was to describe the pathophysiology of the systemic inflammatory response after major trauma and the timing of final reconstructive surgery. Methods An unsystematic review of the medical literature was performed and articles pertaining to the inflammatory response to trauma were obtained. The literature selected was based on the preference and clinical expertise of authors. Discussion The inflammatory response consists of hormonal metabolic and immunological components and the extent correlates with the magnitude of the tissue injury. After trauma and uncomplicated surgery a delicate balance between pro- and anti-inflammatory mediators is observed. Trauma patients are, however, often exposed, not only to the trauma, but to several events in the form of initial surgery and later final reconstructive surgery. In this case immune paralysis associated with increased risk of infection might develop. The inflammatory response is normalized 3 weeks following trauma. It has been proposed that the final reconstructive surgery should be postponed until the inflammatory response is normalized. This statement is however not based on clinical trials. Conclusion Postponement of final reconstructive surgery until the inflammatory is normalized should be based on prospective randomized trials.
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Affiliation(s)
- Anne Craveiro Brøchner
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark.
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Estrogen suppresses cardiac IL-6 after trauma-hemorrhage via a hypoxia-inducible factor 1 alpha-mediated pathway. Shock 2009; 31:354-8. [PMID: 18791496 DOI: 10.1097/shk.0b013e3181862fdd] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiac dysfunction is a major concern after trauma-hemorrhage, and increased IL-6 is one of the underlying causes for producing the dysfunction. Studies have shown that administration of 17beta-estradiol (estrogen) after trauma-hemorrhage normalized cardiac IL-6 levels and restored cardiac functions under those conditions. Because hypoxia-inducible factor (HIF) 1 alpha is expressed during hypoxia and cellular stress and up-regulates the expression of IL-6, we hypothesized that HIF-1 alpha induces the increased cardiac IL-6 after trauma-hemorrhage and that estrogen suppresses this induction. To examine this, C3H/HeN mice were subjected to trauma-hemorrhage or sham operation. Vehicle, the HIF-alpha inhibitor YC-1 [3-(5'-hydroxymethyl-2'-furyl)-1-benzylindazole, a novel activator of platelet guanylate cyclase], or estrogen was administered to trauma-hemorrhage and sham groups during resuscitation. Mice were killed at 2 h after resuscitation, and cardiac IL-6, HIF-1 alpha, and nuclear factor (NF) kappaB activities were measured. IL-6, NF-kappaB, and HIF-1 alpha levels were markedly elevated after trauma-hemorrhage; all of these parameters were normalized by estrogen as well as YC-1 administration after trauma-hemorrhage. Because elevated IL-6 levels after trauma-hemorrhage were decreased with YC-1 treatment, it indicates that IL-6 expression in cardiomyocytes is induced via HIF-1 alpha. In addition, estrogen decreased the elevated HIF-1 alpha, NF-kappaB, and IL-6 levels after trauma-hemorrhage. These results indicate that the beneficial effects of estrogen on cardiac function after trauma-hemorrhage seem to be mediated by the inhibition of HIF-1 alpha expression and activity.
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Effects of Transport Stress, Sex, and Weaning Weight on Postweaning Performance in Pigs. ACTA ACUST UNITED AC 2009. [DOI: 10.15232/s1080-7446(15)30700-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Sex is increasingly recognized as a major factor in the outcome of patients who have trauma and sepsis. Moreover, sex steroids influence chemokine/adhesion molecule expression and neutrophil accumulation. Heat shock proteins, heat shock factor 1, and peroxisome proliferator-activated receptor [gamma] coactivator 1 are regulated by the estrogen receptors and consequently contribute to organ protection after trauma-hemorrhage. Additionally, sex steroids regulate inflammatory cytokines, leading to increased morbidity and mortality. This article deals with trauma-hemorrhage and examines the following: 1) the evidence for sex differences; 2) the mechanisms by which sex hormones affect organ protection; 3) the tissue-specific effect of sex hormone receptors; and 4) the effect of genomic and nongenomic (i.e. membrane-initiated steroid signaling) pathways of sex hormones after trauma. The available information indicates that sex steroids modulate cardiovascular responses after trauma. Thus, alteration or modulation of the prevailing hormone milieu at the time of injury seems to be a novel therapeutic option for improving outcome after injury
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Flohé SB, Flohé S, Schade FU. Invited review: deterioration of the immune system after trauma: signals and cellular mechanisms. Innate Immun 2009; 14:333-44. [PMID: 19039057 DOI: 10.1177/1753425908100016] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Multiple trauma leads to a deterioration of the immune system. On the one hand, hyperinflammation mediates remote organ damage and may lead to multi-organ failure. On the other hand, immunosuppression develops and promotes an enhanced risk to acquire infectious complications after trauma. The mechanisms that underlie these opposing consequences of trauma are not yet completely understood. There is increasing evidence that endogenous danger signals that derive from destroyed tissues play a role in trauma-induced immune dysfunction. Here, we give an overview on the common animal models that are used to investigate trauma-induced pathology, potential signals and cellular mechanisms that support the imbalance between inflammation and counter-regulation after trauma.
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Affiliation(s)
- Stefanie B Flohé
- Surgical Research, Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Abstract
Dehydroepiandrosterone (DHEA) is a weak androgen that exerts pleomorphic effects on the immune system. The hormone has no known receptor, and consequently, its mechanism of action on immunocompetent cells remains poorly understood. Interestingly, serum levels of DHEA are decreased in patients with inflammatory diseases including lupus, and these levels seem to correlate inversely with disease activity. Following encouraging studies demonstrating beneficial effects of DHEA supplementation in murine lupus models, several clinical studies have tested the effect of DHEA in lupus patients. DHEA treatment could improve overall quality-of-life assessment measures and glucocorticoid requirements in some lupus patients with mild to moderate disease; however, DHEA's effect on disease activity in lupus patients remains controversial. Long-term safety studies are required in light of the reported effect of DHEA supplementation in lowering high-density lipoprotein cholesterol in lupus patients.
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Jian B, Hsieh CH, Chen J, Choudhry M, Bland K, Chaudry I, Raju R. Activation of endoplasmic reticulum stress response following trauma-hemorrhage. Biochim Biophys Acta Mol Basis Dis 2008; 1782:621-6. [PMID: 18801427 DOI: 10.1016/j.bbadis.2008.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 08/15/2008] [Accepted: 08/19/2008] [Indexed: 11/18/2022]
Abstract
Hemorrhagic trauma leads to organ dysfunction, sepsis and death. There is abnormal production of proinflammatory cytokines by Kupffer cells, tissue hypoxia and liver injury following trauma-hemorrhage. The physiological conditions consequent to trauma-hemorrhage are consistent with factors necessary to initiate endoplasmic reticulum (ER) stress and unfolded protein response. However, the contribution of ER stress to apoptosis and liver injury after trauma-hemorrhage is not known. In the present study ER stress was investigated in mice that underwent trauma-hemorrhage or sham operation. Expressions of endoplasmic reticulum stress proteins Bip, ATF6, PERK, IRE1alpha, and PDI were significantly elevated in the liver after trauma-hemorrhage compared to the controls. The ER stress associated proapoptotic transcription factor CHOP protein expression was also significantly elevated in trauma-hemorrhage group. Consistent with this, enhanced DNA fragmentation was observed, confirming apoptosis, in the liver following trauma-hemorrhage. These results demonstrate the initiation of ER stress and its role in apoptosis and liver injury, subsequent to hemorrhagic trauma.
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Affiliation(s)
- Bixi Jian
- Center for Surgical Research, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Moeinpour F, Choudhry MA, de Figueiredo LFP, Bland KI, Chaudry IH. Estradiol's salutary effects on keratinocytes following trauma-hemorrhage are mediated by estrogen receptor (ER)-alpha and ER-beta. Mol Med 2008; 14:689-96. [PMID: 18769638 DOI: 10.2119/2008-00068.moeinpour] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 08/18/2008] [Indexed: 11/06/2022] Open
Abstract
Although administration of 17beta-estradiol (estrogen) following trauma-hemorrhage attenuates the elevation of cytokine production and mitogen-activated protein kinase (MAPK) activation in epidermal keratinocytes, whether the salutary effects of estrogen are mediated by estrogen receptor (ER)-alpha or ER-beta is not known. To determine which estrogen receptor is the mediator, we subjected C3H/HeN male mice to trauma-hemorrhage (2-cm midline laparotomy and bleeding of the animals to a mean blood pressure of 35 mmHg and maintaining that pressure for 90 min) followed by resuscitation with Ringer's lactate (four times the shed blood volume). At the middle of resuscitation we subcutaneously injected ER-alpha agonist propyl pyrazole triol (PPT; 5 microg/kg), ER-beta agonist diarylpropionitrile (DPN; 5 microg/kg), estrogen (50 microg/kg), or ER antagonist ICI 182,780 (150 microg/kg). Two hours after resuscitation, we isolated keratinocytes, stimulated them with lipopolysaccharide for 24 h (5 microg/mL for maximum cytokine production), and measured the production of interleukin (IL)-6, IL-10, IL-12, and TNF-alpha and the activation of MAPK. Keratinocyte cytokine production markedly increased and MAPK activation occurred following trauma-hemorrhage but were normalized by administration of estrogen, PPT, and DPN. PPT and DPN administration were equally effective in normalizing the inflammatory response of keratinocytes, indicating that both ER-alpha and ER-beta mediate the salutary effects of estrogen on keratinocytes after trauma-hemorrhage.
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Affiliation(s)
- Fariba Moeinpour
- Center for Surgical Research and Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA
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