1
|
Hussein ZA, Abu-Raghif AR, Fawzi HA. The mitigating effect of para-hydroxycinnamic acid in bleomycin-induced pulmonary fibrosis in mice through targeting oxidative, inflammatory and fibrotic pathways. Basic Clin Pharmacol Toxicol 2024; 135:23-42. [PMID: 38745367 DOI: 10.1111/bcpt.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
This study investigated the therapeutic benefits of para-hydroxycinnamic acid in mice with bleomycin-induced lung fibrosis. Forty male BALB/c mice were randomly assigned to four groups: normal, which received 0.9% normal saline; induced, which received a single dose of bleomycin (5 mg/kg) by oropharyngeal challenge; pirfenidone-treated; and para-hydroxycinnamic acid-treated, which challenged with bleomycin and received a daily oral dose of 300 and 50 mg/kg, respectively, from day 7 to day 21. Tissue pro-fibrotic and inflammatory cytokines, oxidative indicators, pulmonary histopathology, immunohistochemistry of fibrotic proteins and the assessment of gene expression by RT-qPCR were evaluated on day 22 after euthanizing animals. Pirfenidone and para-hydroxycinnamic acid managed to alleviate the fibrotic endpoints by statistically improving the weight index, histopathological score and reduced expression of fibrotic-related proteins in immune-stained lung sections, as well as fibrotic markers measured in serum samples. They also managed to alleviate tissue levels of oxidative stress and inflammatory and pro-fibrotic mediators. para-Hydroxycinnamic acid enhanced the expression of crucial genes associated with oxidative stress, inflammation and fibrosis in vivo. para-Hydroxycinnamic acid has demonstrated similar effectiveness to pirfenidone, suggesting it could be a promising treatment for fibrotic lung conditions by inhibiting the TGF-β1/Smad3 pathway or through its anti-inflammatory and antioxidant properties.
Collapse
Affiliation(s)
- Zeena A Hussein
- Department of Pharmacology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
- Department of Pharmacology & Toxicology, College of Pharmacy, Al-Nahrain University, Baghdad, Iraq
| | - Ahmed R Abu-Raghif
- Department of Pharmacology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | | |
Collapse
|
2
|
Pranskunas A, Zaveckiene J, Baranauskas T, Zakarauskaite B, Zykute D, Tamosuitis T. Early association between respiratory mechanics and radiological changes in mechanically ventilated critically ill patients with COVID-19. Intern Emerg Med 2024; 19:1081-1088. [PMID: 38105407 DOI: 10.1007/s11739-023-03500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The chest X-ray (CXR) Brixia scoring system was developed exclusively for COVID-19 severity assessment. However, no association between the score and respiratory mechanics during mechanical ventilation has been examined. Our aim was to evaluate the association between the CXR Brixia score and respiratory mechanics on the first day of mechanical ventilation in critically ill COVID-19 patients. A total of 77 COVID-19 patients who underwent mechanical ventilation and CXR in the ICU setting were retrospectively included. The CXR Brixia scoring system was applied, and respiratory mechanics data were recorded on the first day of invasive mechanical ventilation. Median Simplified Acute Physiologic Score II (SAPSII) and Sequential Organ Failure Assessment (SOFA) scores were 40 (31-54) and 6 (4-8), respectively. The median Brixia score was 14 (11-16). The correlation between the Brixia score and static compliance or driving pressure was significant, at r = -0.38, p < 0.001 and r = 0.33, p = 0.003, respectively. Using multivariable linear regression, the model with the B zone was significantly better associated with static compliance (F = 11.5, R2 = 0.14, p = 0.001) and driving pressure (F = 11.3, R2 = 0.13, p = 0.001). In logistic regression analysis, the Brixia score (OR 1.24; 95% CI 1.07, 1.45; p = 0.005), B zone (OR 2.60; 95% CI 1.30, 5.20; p = 0.007), C zone (OR 2.50; 95% CI 1.23, 5.11; p = 0.012), A zone (OR 2.01; 95% CI 1.16, 3.44; p = 0.012), and D zone (OR 1.84; 95% CI 1.07, 3.17; p = 0.027) significantly predicted a driving pressure > 14 cmH2O. There is a relationship between changes in Brixia-scored chest X-ray images and compliance and driving pressure on the first day of invasive mechanical ventilation. We identified some CXR areas using the Brixia score, and evaluation of the Brixia score may provide additional information for predicting respiratory mechanics.
Collapse
Affiliation(s)
- Andrius Pranskunas
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania.
| | - Jurgita Zaveckiene
- Department of Radiology, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania
| | - Tautvydas Baranauskas
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania
| | - Beatrice Zakarauskaite
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania
| | - Dalia Zykute
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania
| | - Tomas Tamosuitis
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu G.2, 50161, Kaunas, Lithuania
| |
Collapse
|
3
|
Hussein ZA, Abu-Raghif AR, Tahseen NJ, Rashed KA, Shaker NS, Fawzi HA. Vinpocetine alleviated alveolar epithelial cells injury in experimental pulmonary fibrosis by targeting PPAR-γ/NLRP3/NF-κB and TGF-β1/Smad2/3 pathways. Sci Rep 2024; 14:11131. [PMID: 38750140 PMCID: PMC11096407 DOI: 10.1038/s41598-024-61269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
This study aimed to investigate the potential anti-fibrotic activity of vinpocetine in an experimental model of pulmonary fibrosis by bleomycin and in the MRC-5 cell line. Pulmonary fibrosis was induced in BALB/c mice by oropharyngeal aspiration of a single dose of bleomycin (5 mg/kg). The remaining induced animals received a daily dose of pirfenidone (as a standard anti-fibrotic drug) (300 mg/kg/PO) and vinpocetine (20 mg/kg/PO) on day 7 of the induction till the end of the experiment (day 21). The results of the experiment revealed that vinpocetine managed to alleviate the fibrotic endpoints by statistically improving (P ≤ 0.05) the weight index, histopathological score, reduced expression of fibrotic-related proteins in immune-stained lung sections, as well as fibrotic markers measured in serum samples. It also alleviated tissue levels of oxidative stress and inflammatory and pro-fibrotic mediators significantly elevated in bleomycin-only induced animals (P ≤ 0.05). Vinpocetine managed to express a remarkable attenuating effect in pulmonary fibrosis both in vivo and in vitro either directly by interfering with the classical TGF-β1/Smad2/3 signaling pathway or indirectly by upregulating the expression of Nrf2 enhancing the antioxidant system, activating PPAR-γ and downregulating the NLRP3/NF-κB pathway making it a candidate for further clinical investigation in cases of pulmonary fibrosis.
Collapse
Affiliation(s)
- Zeena A Hussein
- Department of Pharmacology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Nahrain University, Baghdad, Iraq
| | - Ahmed R Abu-Raghif
- Department of Pharmacology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Nibras J Tahseen
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Bayan University, Baghdad, Iraq
| | | | - Nada S Shaker
- Department of Pharmacology and Toxicology, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | | |
Collapse
|
4
|
Naendrup JH, Steinke J, Garcia Borrega J, Stoll SE, Michelsen PO, Assion Y, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome-A Multicenter Propensity Score-Matched Analysis. J Intensive Care Med 2024; 39:84-93. [PMID: 37861125 DOI: 10.1177/08850666231207303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: There are limited and partially contradictory data on the effects of airway pressure release ventilation (APRV) in COVID-19-associated acute respiratory distress syndrome (CARDS). Therefore, we analyzed the clinical outcome, complications, and longitudinal course of ventilation parameters and laboratory values in patients with CARDS, who were mechanically ventilated using APRV. Methods: Respective data from 4 intensive care units (ICUs) were collected and compared to a matched cohort of patients receiving conventional low tidal volume ventilation (LTV). Propensity score matching was performed based on age, sex, blood gas analysis, and APACHE II score at admission, as well as the implementation of prone positioning. Findings: Forty patients with CARDS, who were mechanically ventilated using APRV, and 40 patients receiving LTV were matched. No significant differences were detected for tidal volumes per predicted body weight, peak pressure values, and blood gas analyses on admission, 6 h post admission as well as on day 3 and day 7. Regarding ICU survival, no significant difference was identified between APRV patients (40%) and LTV patients (42%). Median duration of mechanical ventilation and duration of ICU treatment were comparable in both groups. Similar complication rates with respect to ventilator-associated pneumonia, septic shock, thromboembolic events, barotrauma, as well as the necessity for hemodialysis were detected for both groups. Clinical characteristics that were associated with increased mortality in a Cox proportional hazards regression analysis included age (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.04-1.1; P < .001), severe acute respiratory distress syndrome (HR 2.62, 95% CI 1.02-6.7; P = .046) and the occurrence of septic shock (HR 17.18, 95% CI 2.06-143.2; P = .009), but not the ventilation mode. Interpretation: Intensive care unit survival, duration of mechanical ventilation, and ICU treatment as well as ventilation-associated complication rates were equivalent using APRV compared to conventional LTV in patients with CARDS.
Collapse
Affiliation(s)
- Jan-Hendrik Naendrup
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jonathan Steinke
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jorge Garcia Borrega
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Sandra Emily Stoll
- Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
| | - Per Ole Michelsen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz Hospital Cologne, Cologne, Germany
| | - Yannick Assion
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Porz am Rhein Hospital Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Dennis Alexander Eichenauer
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Matthias Kochanek
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Boris Böll
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| |
Collapse
|
5
|
Ma A, Wang B, Cheng J, Dong M, Li Y, Wei C, Zhou Y, Xue Y, Gao H, Zhao L, Li S, Qin Y, Zhang M, Wu Q, Yang J, Kang Y. Effects of airway pressure release ventilation on multi-organ injuries in severe acute respiratory distress syndrome pig models. BMC Pulm Med 2022; 22:468. [PMID: 36476475 PMCID: PMC9730639 DOI: 10.1186/s12890-022-02238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extra-pulmonary multi-organ failure in patients with severe acute respiratory distress syndrome (ARDS) is a major cause of high mortality. Our purpose is to assess whether airway pressure release ventilation (APRV) causes more multi-organ damage than low tidal volume ventilation (LTV). METHODS Twenty one pigs were randomized into control group (n = 3), ARDS group (n = 3), LTV group (n = 8) and APRV group (n = 7). Severe ARDS model was induced by repeated bronchial saline lavages. Pigs were ventilated and monitored continuously for 48 h. Respiratory data, hemodynamic data, serum inflammatory cytokines were collected throughout the study. Histological injury and apoptosis were assessed by two pathologists. RESULTS After severe ARDS modeling, pigs in ARDS, LTV and APRV groups experienced significant hypoxemia and reduced lung static compliance (Cstat). Oxygenation recovered progressively after 16 h mechanical ventilation (MV) in LTV and APRV group. The results of the repeated measures ANOVA showed no statistical difference in the PaO2/FiO2 ratio between the APRV and LTV groups (p = 0.54). The Cstat showed a considerable improvement in APRV group with statistical significance (p < 0.01), which was significantly higher than in the LTV group since 16 h (p = 0.04). Histological injury scores showed a significantly lower injury score in the middle and lower lobes of the right lung in the APRV group compared to LTV (pmiddle = 0.04, plower = 0.01), and no significant increase in injury scores for extra-pulmonary organs, including kidney (p = 0.10), small intestine (p = 1.0), liver (p = 0.14, p = 0.13) and heart (p = 0.20). There were no significant differences in serum inflammatory cytokines between the two groups. CONCLUSION In conclusion, in the experimental pig models of severe ARDS induced by repetitive saline lavage, APRV improved lung compliance with reduced lung injury of middle and lower lobes, and did not demonstrate more extra-pulmonary organ injuries as compared with LTV.
Collapse
Affiliation(s)
- Aijia Ma
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Bo Wang
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Jiangli Cheng
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Meiling Dong
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Yang Li
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Canzheng Wei
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Yongfang Zhou
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Yang Xue
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Hui Gao
- grid.412901.f0000 0004 1770 1022Department of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan Province China
| | - Lican Zhao
- grid.412901.f0000 0004 1770 1022Department of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan Province China
| | - Siyu Li
- grid.412901.f0000 0004 1770 1022Department of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan Province China
| | - Yiwei Qin
- grid.414880.1Department of Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province China
| | - Mengni Zhang
- grid.412901.f0000 0004 1770 1022Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province China
| | - Qin Wu
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Jing Yang
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| | - Yan Kang
- grid.412901.f0000 0004 1770 1022Department of Critical Care Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041 Sichuan Province China
| |
Collapse
|