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Star BS, van der Slikke EC, van Buiten A, Henning RH, Bouma HR. The Novel Compound SUL-138 Counteracts Endothelial Cell and Kidney Dysfunction in Sepsis by Preserving Mitochondrial Function. Int J Mol Sci 2023; 24:ijms24076330. [PMID: 37047303 PMCID: PMC10094718 DOI: 10.3390/ijms24076330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Sepsis is defined as a dysregulated host response leading to organ dysfunction, which may ultimately result in the patient’s death. Mitochondrial dysfunction plays a key role in developing organ dysfunction in sepsis. In this study, we explored the efficacy of the novel mitochondrial protective compound, SUL-138, in sepsis models in HUVECs and mice. In LPS-challenged HUVECs, SUL-138 preserved mitochondrial membrane potential and oxygen consumption and limited mitochondrial oxidative stress, resulting in increased survival at 48 h. Further, SUL-138 dampened the LPS-induced expression of IL-1β, but not of NLRP3, and IL-18 in HUVECs. Sepsis in mice induced by cecal ligation and puncture (CLP) led to a lower mitochondrial membrane potential and increased levels of mitochondrial oxidative stress in the kidney, which SUL-138 limited. In addition, SUL-138 mitigated the CLP-induced increase in kidney dysfunction markers NGAL and urea. It dampened the rise in kidney expression of IL-6, IL-1β, and ICAM-1, but not TNF-α and E-selectin. Yet, SUL-138 limited the increase in plasma levels of IL-6 and TNF-α of CLP mice. These results demonstrate that SUL-138 supports mitochondrial function, resulting in a limitation of systemic inflammation and preservation of kidney function.
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Wu W, Zhong W, Lin Z, Yan J. Blockade of Indoleamine 2,3-Dioxygenase attenuates lipopolysaccharide-induced kidney injury by inhibiting TLR4/NF-κB signaling. Clin Exp Nephrol 2023; 27:495-505. [PMID: 36922478 DOI: 10.1007/s10157-023-02332-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/16/2023] [Indexed: 03/17/2023]
Abstract
Blockade of indoleamine 2,3-dioxygenase (IDO) has been shown to alleviate lipopolysaccharide (LPS)-induced endotoxic shock and reduce sepsis mortality, but its effect on LPS-induced kidney damage has not been reported. Herein, we established a mouse kidney injury model by intraperitoneal injection of 10 mg/kg LPS and established an in vitro renal tubular epithelial cell injury model by stimulating TCMK-1 cells with 10 mg/L LPS. We found that pretreatment with 1-methyl tryptophan (1-MT), an IDO inhibitor, significantly improved LPS-induced mouse survival, and IDO knockout (KO) mice also had higher survival rates after LPS exposure than wild-type mice. At the same time, IDO KO or pretreatment with 1-MT not only reduced serum creatinine, blood urea nitrogen, renal tubular injury pathological score, but also inflammatory factors and oxidative stress status in serum or kidney of LPS-exposed mice. In vitro, blockade of IDO with 1-MT significantly inhibited LPS-induced apoptosis, inflammation and oxidative stress in TCMK-1 cells. In addition, blockade of IDO significantly inhibited LPS-activated TLR4/NF-κB signaling pathway in kidney of mice or in TCMK-1 cells. In conclusion, our results suggested that blockade of IDO attenuated kidney inflammation, apoptosis and oxidative stress to protect against LPS-induced septic kidney injury via inhibiting the TLR4/NF-κB signaling pathway.
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Affiliation(s)
- Weiguang Wu
- Department of Emergency, Dongguan Binhaiwan Central Hospital, Dongguan City, China
| | - Weixiong Zhong
- Department of Critical Medicine, Shenzhen Luohu District People's Hospital, Shenzhen City, China
| | - Zijing Lin
- Department of Emergency, Dongguan Binhaiwan Central Hospital, Dongguan City, China
| | - Jianhui Yan
- Department of Emergency, Dongguan Binhaiwan Central Hospital, Dongguan City, China.
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Mohammad S, O’Riordan CE, Verra C, Aimaretti E, Alves GF, Dreisch K, Evenäs J, Gena P, Tesse A, Rützler M, Collino M, Calamita G, Thiemermann C. RG100204, A Novel Aquaporin-9 Inhibitor, Reduces Septic Cardiomyopathy and Multiple Organ Failure in Murine Sepsis. Front Immunol 2022; 13:900906. [PMID: 35774785 PMCID: PMC9238327 DOI: 10.3389/fimmu.2022.900906] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Sepsis is caused by systemic infection and is a major health concern as it is the primary cause of death from infection. It is the leading cause of mortality worldwide and there are no specific effective treatments for sepsis. Gene deletion of the neutral solute channel Aquaporin 9 (AQP9) normalizes oxidative stress and improves survival in a bacterial endotoxin induced mouse model of sepsis. In this study we described the initial characterization and effects of a novel small molecule AQP9 inhibitor, RG100204, in a cecal ligation and puncture (CLP) induced model of polymicrobial infection. In vitro, RG100204 blocked mouse AQP9 H2O2 permeability in an ectopic CHO cell expression system and abolished the LPS induced increase in superoxide anion and nitric oxide in FaO hepatoma cells. Pre-treatment of CLP-mice with RG100204 (25 mg/kg p.o. before CLP and then again at 8 h after CLP) attenuated the hypothermia, cardiac dysfunction (systolic and diastolic), renal dysfunction and hepatocellular injury caused by CLP-induced sepsis. Post-treatment of CLP-mice with RG100204 also attenuated the cardiac dysfunction (systolic and diastolic), the renal dysfunction caused by CLP-induced sepsis, but did not significantly reduce the liver injury or hypothermia. The most striking finding was that oral administration of RG100204 as late as 3 h after the onset of polymicrobial sepsis attenuated the cardiac and renal dysfunction caused by severe sepsis. Immunoblot quantification demonstrated that RG100204 reduced activation of the NLRP3 inflammasome pathway. Moreover, myeloperoxidase activity in RG100204 treated lung tissue was reduced. Together these results indicate that AQP9 may be a novel drug target in polymicrobial sepsis.
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Affiliation(s)
- Shireen Mohammad
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- *Correspondence: Shireen Mohammad, ; Christoph Thiemermann,
| | - Caroline E. O’Riordan
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Chiara Verra
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Eleonora Aimaretti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | | | - Johan Evenäs
- Red Glead Discovery Akiebolag (AB), Lund, Sweden
| | - Patrizia Gena
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari “Aldo Moro”, Bari, Italy
| | - Angela Tesse
- Nantes Université, Instite National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Rescherche Scientifique (CNRS), l’institut du Thorax, Nantes, France
| | - Michael Rützler
- Department of Biochemistry and Structural Biology, Lund University, Lund, Sweden
- Apoglyx Akiebolag (AB), Lund, Sweden
| | - Massimo Collino
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Giuseppe Calamita
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari “Aldo Moro”, Bari, Italy
| | - Christoph Thiemermann
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- *Correspondence: Shireen Mohammad, ; Christoph Thiemermann,
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Gong Y, Dong X, Xu J, Yang W. LncRNA NEAT1 knockdown ameliorates LPS-induced human kidney injury by mediating the miR-330-5p/FOXO3 axis. Int Urol Nephrol 2022; 54:2683-2694. [PMID: 35364751 DOI: 10.1007/s11255-022-03179-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sepsis is a systemic process with multiple inflammatory responses and organ injuries, particularly in the damage of the kidney. Recently, numerous studies suggest that long non-coding RNAs (lncRNAs) are involved in sepsis-related kidney injury. This study aimed to investigate the functional role and mechanism of lncRNA nuclear paraspeckle assembly transcript 1 (NEAT1) in sepsis-related kidney injury. METHODS Cell model of kidney injury was constructed in human kidney 2 (HK-2) cells with the treatment of lipopolysaccharide (LPS). The expression of NEAT1 was measured by quantitative real-time PCR (qRT-PCR). Cell viability was examined using CCK-8 assay. Flow cytometry was performed to detect cell apoptosis, and apoptosis-related proteins were quantified by western blot. The release of proinflammatory cytokines was assessed by ELISA. Oxidative stress was assessed by the levels of SOD and MDA using kits. The putative relationship between miR-330-5p and NEAT1 or FOXO3 was confirmed using dual-luciferase reporter assay, RIP assay and pull-down assay. RESULT The expression of NEAT1 was increased in LPS-treated HK-2 cells. LPS exposure promoted apoptotic rate, inflammatory responses and oxidative stress in HK-2 cells, which were largely ameliorated by NEAT1 knockdown. MiR-330-5p was verified as a target of NEAT1, and miR-330-5p inhibition reversed the effects of NEAT1 knockdown in LPS-treated HK-2 cells. Moreover, FOXO3 was a target of miR-330-5p, and miR-330-5p restoration-blocked cell apoptosis, inflammation and oxidative stress in LPS-treated HK-2 cells were recovered by FOXO3 overexpression. CONCLUSION NEAT1 downregulation meliorated LPS-induced HK-2 cell injuries partly by regulating the miR-330-5p/FOXO3 pathway.
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Affiliation(s)
- Yi Gong
- Department of Cardiology and Macrovascular Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
| | - Xiao Dong
- Department of Cardiology and Macrovascular Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Jianjun Xu
- Department of Cardiology and Macrovascular Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Wei Yang
- Department of Cardiology and Macrovascular Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
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Haertel F, Reisberg D, Peters M, Nuding S, Schulze PC, Werdan K, Ebelt H. Predicting the Need for Renal Replacement Therapy Using a Vascular Occlusion Test and Tissue Oxygen Saturation in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. J Clin Med 2022; 11:jcm11051420. [PMID: 35268511 PMCID: PMC8911273 DOI: 10.3390/jcm11051420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Acute kidney injury (AKI) is associated with an increased mortality in critically ill patients, especially in patients with multiorgan dysfunction syndrome (MODS). In daily clinical practice, the grading of AKI follows the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In most cases, a relevant delay occurs frequently between the onset of AKI and detectable changes in creatinine levels as well as clinical symptoms. The aim of the present study was to examine whether a near infrared spectroscopy (NIRS)-based, non-invasive ischemia–reperfusion test (vascular occlusion test (VOT)) together with unprovoked (under resting conditions) tissue oxygen saturation (StO2) measurements, contain prognostic information in the early stage of MODS regarding the developing need for renal replacement therapy (RRT). Methods: Within a period of 18 months, patients at the medical intensive care unit of a tertiary university hospital with newly developed MODS (≤24 h after diagnosis, APACHE II score ≥20) were included in our study. The VOT occlusion slope (OS) and recovery slope (RS) were recorded in addition to unprovoked StO2. StO2 was determined non-invasively in the area of the thenar muscles using a bedside NIRS device. The VOT was carried out by inflating a blood pressure cuff on the upper arm. AKI stages were determined by the changes in creatinine levels, urinary output, and/or the need for RRT according to KDIGO. Results: 56 patients with MODS were included in the study (aged 62.5 ± 14.4 years, 40 men and 16 women, APACHE II score 34.5 ± 6.4). Incidences of the different AKI stages were: no AKI, 16.1% (n = 9); AKI stage I, 19.6% (n = 11); AKI stage II, 25% (n = 14); AKI stage III, 39.3% (n = 22). Thus, 39.3% of the patients (n = 22) developed the need for renal replacement therapy (AKI stage III). These patients had a significantly higher mortality over 28 days (RRT, 72% (n = 16/22) vs. no RRT, 44% (n = 15/34); p = 0.03). The mean unprovoked StO2 of all patients at baseline was 81.7 ± 11.1%, and did not differ between patients with or without the need for RRT. Patients with RRT showed significantly weaker negative values of the OS (−9.1 ± 3.7 vs. −11.7 ± 4.1%/min, p = 0.01) and lower values for the RS (1.7 ± 0.9 vs. 2.3 ± 1.6%/s, p = 0.02) compared to non-dialysis patients. Consistent with these results, weaker negative values of the OS were found in higher AKI stages (no AKI, −12.7 ± 4.1%/min; AKI stage I, −11.5 ± 3.0%/min; AKI stage II, −11.1 ± 3.3%/min; AKI stage III, −9.1 ± 3.7%/min; p = 0.021). Unprovoked StO2 did not contain prognostic information regarding the AKI stages. Conclusions: The weaker negative values of the VOT parameter OS are associated with an increased risk of developing AKI and RRT, and increased mortality in the early phase of MODS, while unprovoked StO2 does not contain prognostic information in that regard.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Correspondence: ; Tel.: +49-3641-9324-554
| | - Diana Reisberg
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Pädiatrie, Ameos Klinikum Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin, Helios Klinikum Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Sebastian Nuding
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Krankenhaus “St. Elisabeth”, Mauerstr. 5, 06110 Halle (Saale), Germany
| | - P. Christian Schulze
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
| | - Henning Ebelt
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Katholisches Krankenhaus “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Abu Almaaty AH, Elmasry RA, Farrag MS, Althobaiti F, Aldhahrani A, Fayad E, Hussain MA. Impact of Human Umbilical Cord Blood Mononuclear Cells on Gentamicin-Induced Renal Injury and Genotoxicity in Rats. Front Med (Lausanne) 2021; 8:689691. [PMID: 34490290 PMCID: PMC8417307 DOI: 10.3389/fmed.2021.689691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Acute kidney injury (AKI), also known as acute renal failure (ARF), has received considerable critical attention in recent years. Gentamicin (GM) is an antibiotic whose prolonged use results in AKI with a high mortality rate. Methods: Fifty adult female albino rats weighing 150–200 g were used. The animals were divided into five groups: the first group was the normal healthy control one, the second group received only 1 × 106 HUCB mononuclear cells (MNCs)/rat by intravenous (iv) injection, the third diseased group was given GM 100 mg/kg for 10 consecutive days by intraperitoneal injections, the fourth preventive group received 1 × 106 HUCB MNCs/rat by iv injection 24 h before gentamicin treatment, and the fifth treated group received 1 × 106 HUCB MNCs/rat by iv injection 24 h after gentamicin treatment. After 1 week of treatment, blood samples were collected, and kidneys were removed for histopathological examination. Results: Rats treated with HUCB MNCs in the treated group had a significant decrease in renal damage, low levels of biomarkers for nephrotoxicities such as serum creatinine and blood urea nitrogen, and low chromosomal aberrations compared to the diseased third group. The gene expression of KIM-1 and NGAL was decreased in response to HUCB treatment. Conclusions: HUCB MNCs have a curative effect against AKI and gentamicin-induced genotoxicity owing to their regenerative property.
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Affiliation(s)
- Ali H Abu Almaaty
- Department of Zoology, Faculty of Science, Port Said University, Port Said, Egypt
| | - Reham A Elmasry
- Department of Zoology, Faculty of Science, Port Said University, Port Said, Egypt
| | - Mayada S Farrag
- Department of Pathology, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Fayez Althobaiti
- Department of Biotechnology, Faculty of Sciences, Taif University, Taif, Saudi Arabia
| | - Adil Aldhahrani
- Clinical Laboratory Sciences Department, Turabah University Faculty, Taif University, Taif, Saudi Arabia
| | - Eman Fayad
- Department of Biotechnology, Faculty of Sciences, Taif University, Taif, Saudi Arabia
| | - Mona A Hussain
- Department of Physiology, Faculty of Medicine, Port Said University, Port Said, Egypt
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Yang N, Wang H, Zhang R, Niu Z, Zheng S, Zhang Z. C/EBP β Mediates the Aberrant Inflammatory Response and Cell Cycle Arrest in Lps-stimulated Human Renal Tubular Epithelial Cells by Regulating NF-κB Pathway. Arch Med Res 2021; 52:603-610. [PMID: 33947580 DOI: 10.1016/j.arcmed.2021.03.008] [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: 05/16/2020] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The main cause of sepsis-induced Acute kidney injury (AKI) is acute infection after surgery and subsequent progression. However, the mechanism by which AKI is caused and developed from sepsis are not completely known. Herein, we determined the role of CCAAT/enhancer-binding protein β (C/EBP β) in sepsis-induced AKI METHODS: C/EBP β expression was up or down-regulated in LPS-stimulated human renal tubular epithelial cells in vitro by recombinant adenoviruses or siRNA. Subsequent analyses included the test of TNF-α and IL-6 levels by ELISA, cell cycle assay by flow cytometry. RESULTS C/EBP β was aberrantly expressed in renal tubular epithelial HK-2 cells exposed to LPS. C/EBP β overexpression significantly enhanced, but C/EBP β silencing obviously decreased the production and secretion of inflammatory cytokines TNF-α and IL-6 induced by LPS stimulus in HK-2 cells. And the cell cycle arrest of HK-2 cells induced by LPS was also enhanced after C/EBP β overexpression while attenuated after C/EBP β silencing. Consistent pattern of changes in Cyclin D1 and p21 expression were observed in LPS-stimulated HK-2 cells after C/EBP β silencing and C/EBP β overexpression. Additionally, the increased p-NF-κB levels induced by LPS were found to be obviously decreased after C/EBP β silencing in HK-2 cells. And the enhanced TNF-α and IL-6 secretion as well as cell cycle arrest by C/EBP β overexpression were blocked by BAY11-7082 inhibitor of NF-κB pathway. CONCLUSIONS C/EBP β could mediate the LPS-induced aberrant inflammatory response and cell cycle arrest in tubular epithelial cells by NF-κB pathway.
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Affiliation(s)
- Ni Yang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China
| | - Hai Wang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China
| | - Rui Zhang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China
| | - Zequn Niu
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China
| | - Shaowei Zheng
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China
| | - Zhengliang Zhang
- Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xibei Hospital, Xi'an, China.
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Dave M, Barry S, Coulthard P, Daniels R, Greenwood M, Seoudi N, Walton G, Patel N. An evaluation of sepsis in dentistry. Br Dent J 2021; 230:351-357. [PMID: 33772188 DOI: 10.1038/s41415-021-2724-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major health concern and causes substantial morbidity and mortality. It is imperative that the signs of sepsis are identified early in both adult and paediatric patients and appropriately escalated to initiate early treatment and improve prognosis. This paper aims to discuss the change in classification from the previous systemic inflammatory response syndrome (SIRS) criteria to the current definition in adults and also the unchanged definition in children. The hallmark signs of sepsis (both red and amber flags) are discussed in relation to their underlying cellular mechanisms to provide a comprehensive overview for clinicians in primary care, hospital and community settings. The rise of antimicrobial resistance is also an increasing global health concern with resistant bacteria from common infections likely to result in greater patient morbidity and worse outcomes.A literature search identified reported sepsis cases in dentistry through searches in Ovid Medline and Embase from January 1990 to December 2019. Only primary studies were included with no restrictions on languages. Four articles were identified which reported sepsis associated with tooth extractions, dental abscess and submental/submandibular cellulitis. It is well known that locoregional infections of dental origin have the potential to cause sepsis. Therefore, dental healthcare professionals need to be vigilant and understand the specific signs and escalation protocols to ensure patient safety.
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Affiliation(s)
- Manas Dave
- Academic Clinical Fellow in Oral and Maxillofacial Pathology, University of Manchester, UK.
| | - Siobhan Barry
- Professor and Honorary Consultant in Paediatric Dentistry, University of Manchester, UK
| | - Paul Coulthard
- Dean for Dentistry and Institute Director, Professor of Oral and Maxillofacial Surgery, Queen Mary University London, UK
| | - Ron Daniels
- , Consultant in Critical Care, Executive Director UK Sepsis Trust and Chief Executive of the Global Sepsis Alliance; University Hospitals Birmingham NHS Foundation Trust, UK
| | - Mark Greenwood
- Consultant in Oral and Maxillofacial Surgery and Honorary Professor of Medical Education in Dentistry, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, UK
| | - Noha Seoudi
- Senior Clinical Lecturer in Oral Microbiology, Queen Mary University London, UK
| | - Graham Walton
- Consultant in Special Care Dentistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Patel
- Senior Lecturer in Oral Surgery, University of Manchester, UK
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Emoto C, Johnson TN, Yamada T, Yamazaki H, Fukuda T. Teicoplanin physiologically based pharmacokinetic modeling offers a quantitative assessment of a theoretical influence of serum albumin and renal function on its disposition. Eur J Clin Pharmacol 2021; 77:1157-1168. [PMID: 33527208 DOI: 10.1007/s00228-021-03098-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Variability in teicoplanin pharmacokinetics has been explained by multiple factors such as body weight, renal function, and serum albumin level. To improve mechanistic understanding of the causes of variability, a physiologically based pharmacokinetic (PBPK) model can be used as a systematic platform. In this study, a PBPK model of teicoplanin was developed to quantitatively assess the effects of physiological changes due to disease status using virtual populations. METHODS Predictive performance of the models was evaluated by comparing simulated and observed concentration-time profiles of teicoplanin. Subsequently, sensitivity analyses were conducted to identify potential factors contributing to individual differences in teicoplanin PK. RESULTS The developed PBPK model generated concentration-time profiles that were comparable to clinical observations in healthy adults, including Caucasians and Japanese, and after single-dose and multiple-dose administration. The predicted PK parameters (i.e., Cmax, AUC, clearance) were within a two-fold range of the observed data in patients with renal impairments as well as healthy adults. Changes in total and unbound teicoplanin concentrations at 72 h, after various dosing regimens (tested 4-14 mg/kg q12h for three doses as a loading dose and then 4-14 mg/kg daily as a maintenance dose), were sensitive to renal function and serum albumin concentrations. CONCLUSION The PBPK model of teicoplanin provides mechanistic insight into the factors altering its disposition and allows assessments of the theoretical and quantitative impact of individual changes in physiological parameters on its PK even when an actual assessment with adequate sample sizes of patients is challenging.
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Affiliation(s)
- Chie Emoto
- Laboratory of Drug Metabolism and Pharmacokinetics, Showa Pharmaceutical University, 3-3165, Machida, Tokyo, 194-8543, Japan.
| | | | - Takaaki Yamada
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Yamazaki
- Laboratory of Drug Metabolism and Pharmacokinetics, Showa Pharmaceutical University, 3-3165, Machida, Tokyo, 194-8543, Japan
| | - Tsuyoshi Fukuda
- Laboratory of Drug Metabolism and Pharmacokinetics, Showa Pharmaceutical University, 3-3165, Machida, Tokyo, 194-8543, Japan.,National Center for Child Health and Development, Tokyo, Japan
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Maehara T, Higashitarumi F, Kondo R, Fujimori K. Prostaglandin F 2α receptor antagonist attenuates LPS-induced systemic inflammatory response in mice. FASEB J 2020; 34:15197-15207. [PMID: 32985737 DOI: 10.1096/fj.202001481r] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022]
Abstract
Although it is known that prostaglandin (PG) F2α level is elevated in the plasma of patients with sepsis, the roles of PGF2α is still unknown. We aimed to clarify the roles of PGF2α in the regulation of lipopolysaccharide (LPS)-induced systemic inflammation. At 24 hours after LPS administration, neutrophil infiltration in peritoneal cavity, the mRNA expression of pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and macrophage inflammatory protein-2, and tissue damages in lung, liver, and kidney were all increased. Inhibition of FP receptors significantly decreased LPS-induced neutrophil infiltration and lowered the mRNA expression of the pro-inflammatory cytokines. At 6 hour after LPS administration, the level of anti-inflammatory cytokine, IL-10 in peritoneal lavage fluid was higher than that in naïve mice. Inhibition of FP receptors in these mice increased IL-10 level further. Stimulation of isolated peritoneal neutrophils by LPS increased the gene expression of IL-10, which was further increased by AL8810 treatment. Administration of an anti-IL-10 antibody antagonized the AL8810-decreased mRNA expression of pro-inflammatory cytokines and tissue damages. These results indicate that inhibition of FP receptors by AL8810 attenuated LPS-induced systemic inflammation in mice via enhanced IL-10 production.
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Affiliation(s)
- Toko Maehara
- Department of Pathobiochemistry, Osaka University of Pharmaceutical Sciences
| | | | - Risa Kondo
- Department of Pathobiochemistry, Osaka University of Pharmaceutical Sciences
| | - Ko Fujimori
- Department of Pathobiochemistry, Osaka University of Pharmaceutical Sciences
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11
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Immunomodulatory and Therapeutic Effects of Mesenchymal Stem Cells on Organ Dysfunction in Sepsis. Shock 2020; 55:423-440. [PMID: 32826813 DOI: 10.1097/shk.0000000000001644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Sepsis is a life-threatening disorder that is caused by a dysregulated inflammatory response during an infection. The disease mostly affects pregnant women, newborns, and patients in intensive care units. Sepsis treatment is a significant part of a country's health budgets. Delay in the therapy causes irreversible failure of various organs due to the lack of blood supply and reduction of oxygen in the tissues and eventually increased mortality. The involvement of four or five organs by sepsis has been attributed to an increased risk of death to over 90%. Although antibiotics are at the first line of sepsis treatment, they do not possess enough potency to control the disease and prevent subsequent organ failure. The immunomodulatory, anti-inflammatory, anti-apoptotic, and anti-microbial properties of mesenchymal stem cells (MSCs) have been reported in various studies. Therefore, the application of MSCs has been considered a potentially promising therapeutic strategy. In preclinical studies, the administration of MSCs has been associated with reduced bacterial load and decreased levels of pro-inflammatory factors as well as the improved function of the different vital organs, including heart, kidney, liver, and lungs. The current study provides a brief review of sepsis and its pathophysiology, and then highlights recent findings in the therapeutic effects of MSCs and MSC-derived secretome in improving sepsis-induced organ dysfunction. Besides, eligible sepsis candidates for MSC-therapy and the latest clinical findings in these areas have been reviewed.
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12
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Raza A, Estepa A, Chan V, Jafar MS. Acute Renal Failure in Critically Ill COVID-19 Patients With a Focus on the Role of Renal Replacement Therapy: A Review of What We Know So Far. Cureus 2020; 12:e8429. [PMID: 32642345 PMCID: PMC7336623 DOI: 10.7759/cureus.8429] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Acute renal failure remains a significant concern in all patients with the coronavirus disease 2019 (COVID-19) infection. Management is particularly challenging in critically ill patients requiring intensive care unit (ICU) level of care. Supportive care in the form of accurate volume correction and avoiding nephrotoxic agents are the chief cornerstone of the management of these patients. The pathophysiology of acute renal failure in COVID-19 is multifactorial, with significant contributions from excessive cytokine release. Gaining a better insight into the pathophysiology of renal failure will hopefully help develop more directed treatment options. A considerable number of these patients deteriorate despite adequate supportive care owing to the complexity of the disease and multi-organ involvement. Renal replacement therapy is used for a long time in critically ill septic patients who develop progressive renal failure despite adequate conservative support. Timing and choice of renal replacement therapy in critically ill COVID-19 patients remains an area of future research that may help decrease mortality in this patient population.
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Affiliation(s)
- Ahmad Raza
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Adrian Estepa
- Internal Medicine, Abington Hospital, Jefferson Health, Abington, USA
| | - Vincent Chan
- Internal Medicine, Abington Hospital, Jefferson Health, Abington, USA
| | - Munnam S Jafar
- Internal Medicine, Abington Hospital, Jefferson Health, Abington, USA
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13
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Stonoga ETS, Bueno RZ, Nagano TA, Martins V, Rocha SL. EFFECTS OF INTRAPERITONEAL GLUTAMINE IN THE TREATMENT OF EXPERIMENTAL SEPSIS. ACTA ACUST UNITED AC 2019; 32:e1431. [PMID: 31038556 PMCID: PMC6488273 DOI: 10.1590/0102-672020190001e1431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/16/2019] [Indexed: 11/22/2022]
Abstract
Background: Sepsis is an important public health issue and is associated with high treatment costs and high mortality rates. Glutamine supplementation has proven to be beneficial to the functions of the immune system, acting beneficially in the evolution of patients in severe catabolic states. Aim: To evaluate the effect of glutamine supplementation via intraperitoneal in rats, induced sepsis, considering the following organs: intestines, liver, kidneys and lungs. Methods: Male Wistar rats subjected to sepsis by ligature and cecal puncture were divided into two groups: control C (n=6) and glutamine G (n=11), in which were administered dipeptiven 20% at a dose of 2 ml/kg/day (equivalent to 0.4g N(2)-L-alanyl-L-glutamine/kg) intraperitoneally 48 h prior to sepsis induction. After 48 h they were euthanized and intestine, liver, lung and kidney were removed for histological analysis. Results: Intestinal epithelial desquamation of the control group was more intense compared to the glutamine group (p=0.008). In the kidneys, degenerative tubular epithelial changes were less severe in the animals that received glutamine (p=0.029). Regarding to the liver, glutamine group showed lower levels of cell swelling than the control group (p=0.034). In the lung there were no results with statistical significance. Conclusion: Prior intraperitoneal supplementation with glutamine in experimental animals is able to reduce the damage to the intestinal mucosa, to the kidneys and liver’s histoarchitecture.
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Affiliation(s)
| | - Roberta Zawadzki Bueno
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Thais Ayumi Nagano
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Vanessa Martins
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Sérgio Luiz Rocha
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
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Mansuri U, Patel AA, Dave M, Chauhan K, Shah AS, Banala R, Ali D, Kamal S, Verma P, Ahmed S, Maiyani P, Pathak AC, Rahman S, Savani S, Pandya S, Nadkarni G. Impact of Dialysis Requirement in Community-acquired Pneumonia Hospitalizations. Cureus 2018; 10:e3164. [PMID: 30357013 PMCID: PMC6197503 DOI: 10.7759/cureus.3164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is a common cause of hospitalization. While there are single-center studies on acute kidney injury requiring dialysis (AKI-D) and CAP, data on national trends and outcomes regarding AKI-D in CAP hospitalizations is lacking. Methods We utilized the Nationwide Inpatient Sample to analyze trends overall and within subgroups. We also utilized multivariate regression to adjust for potential confounders of annual trends and to generate adjusted odds ratios (aOR) for predictors and outcomes, including mortality and adverse discharge. Results There were 11,500,456 pneumonia hospitalizations between 2002 and 2013, of which 3675 (0.3%) were complicated by AKI-D. The AKI-D rate increased from 2.7/1000 hospitalizations in 2002 to 4.3/1000 hospitalizations in 2013. The rate of increase was higher in males and African Americans. Although temporal changes in demographics and comorbidities explained a substantial proportion, they could not explain the entire trend. The predictor with the highest odds of AKI-D required mechanical ventilation during hospitalization (aOR 12.47; 95% CI 11.66-13.34). Other significant predictors included sepsis (aOR 4.37; 95% CI 4.09-4.66), heart failure (aOR 2.40; 95% CI 2.25-2.55), and chronic kidney disease (CKD) (aOR 2.00; 95% CI 1.86-2.16). AKI-D was associated with increased in-hospital mortality (aOR 3.08; 95% CI 2.88-3.30) and adverse discharge (aOR 2.09; 95% CI 1.92-2.26). Although adjusted mortality decreased per year, attributable mortality remained stable. Conclusion Pneumonia hospitalizations complicated by AKI-D have increased with a differential increase by demographic groups. AKI-D is associated with significant morbidity and mortality. In the absence of effective AKI-D therapies, the focus should be on early risk stratification and prevention to avoid this devastating complication.
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Affiliation(s)
- Uvesh Mansuri
- Internal Medicine, Medstar Union Memorial Hospital, Baltimore, USA
| | - Achint A Patel
- Nephrology, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mihir Dave
- Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kinsuk Chauhan
- Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Aakashi S Shah
- Cardiology, Icahn School of Medicine at Mount Sinai, New Rochelle, USA
| | - Ramyasree Banala
- Public Health, Rutgers School of Public Health, Piscataway , USA
| | - David Ali
- Miscellaneous, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Saad Kamal
- Miscellaneous, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Pooja Verma
- Internal Medicine, Kings Brook Jewish Medical Center, New York, USA
| | - Shamim Ahmed
- Miscellaneous, St. George's University School of Medicine, St. George, GRD
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | | | | | | | | | - Girish Nadkarni
- Nephrology, Icahn School of Medicine at Mount Sinai, New York, USA
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15
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Knowlin LT, Purcell L, Cairns BA, Charles AG. Burn injury mortality in patients with preexisting and new onset renal disease. Am J Surg 2018. [PMID: 29526247 DOI: 10.1016/j.amjsurg.2018.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION We sought to examine the impact of preexisting and new onset renal disease on burn injury mortality. METHODS Retrospective analysis of patients admitted to a regional burn center from 2002-2012 was performed. Variables analyzed included demographics, burn mechanism, inhalation injury status, and % TBSA. Poisson regression was performed to estimate risk of in-hospital burn mortality. RESULTS There were a total of 7640 patients over the study period. The adjusted 60-day risk of in-hospital mortality in patients with preexisting renal disease (PRD was 3 times higher compared to patients with no preexisting renal disease (IRR = 3.22, 95% CI = 1.26-8.25). The adjusted 60-day risk of mortality is 2 times higher for patients with new onset renal disease compared to those without (IRR = 2.11, 95% CI = 1.55-2.87). CONCLUSION Preexisting and new onset renal disease results in a significantly higher risk of mortality following burn injury compared to patients without renal disease. Prevention of new onset renal injury and careful management of patients with preexisting renal disease to prevent exacerbation should be pursued.
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Affiliation(s)
- Laquanda T Knowlin
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, USA
| | - Laura Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, USA
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, USA
| | - Anthony G Charles
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center, USA.
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16
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Hashad DI, Elsayed ET, Helmy TA, Elawady SM. Study of the role of tumor necrosis factor-α (-308 G/A) and interleukin-10 (-1082 G/A) polymorphisms as potential risk factors to acute kidney injury in patients with severe sepsis using high-resolution melting curve analysis. Ren Fail 2017; 39:77-82. [PMID: 27788614 PMCID: PMC6014343 DOI: 10.1080/0886022x.2016.1244081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/25/2016] [Accepted: 09/16/2016] [Indexed: 01/16/2023] Open
Abstract
RATIONAL Septic acute kidney injury (AKI) is a prevalent complication in intensive care units with an increased incidence of complications. OBJECTIVE The aim of the present study was to assess the use of high-resolution melting curve (HRM) analysis in investigating whether the genetic polymorphisms; -308 G/A of tumor necrosis factor-α (TNF-α), and -1082 G /A of Interleukin-10 (IL-10) genes may predispose patients diagnosed with severe sepsis to the development of AKI. METHODS One hundred and fifty patients with severe sepsis participated in the present study; only sixty-six developed AKI. Both polymorphisms were studied using HRM analysis. MAIN FINDINGS The low producer genotype of both studied polymorphism of TNF-α and IL-10 genes was associated with AKI. Using logistic regression analysis, the low producer genotypes remained an independent risk factor for AKI. A statistically significant difference was detected between both studied groups as regards the low producer genotype in both TNF-α (-308 G/A) and interleukin-10 (IL-10) (-1082 G/A) polymorphisms being prevalent in patients developing AKI. Principle conclusions: The low producer genotypes of both TNF-α (-308 G/A) and IL-10 (-1082 G/A) polymorphisms could be considered a risk factor for the development of AKI in critically ill patients with severe sepsis, thus management technique implemented for this category should be modulated rescuing this sector of patients from the grave deterioration to acute kidney injury. Using HRM for genotyping proved to be a highly efficient, simple, cost-effective genotyping technique that is most appropriate for the routine study of large-scale samples.
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Affiliation(s)
- Doaa I. Hashad
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman T. Elsayed
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer A. Helmy
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samier M. Elawady
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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17
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Trends and outcomes of sepsis hospitalizations complicated by acute kidney injury requiring hemodialysis. J Crit Care 2016; 38:353-355. [PMID: 27986342 DOI: 10.1016/j.jcrc.2016.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022]
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18
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Abstract
Sepsis-associated acute kidney injury (SA-AKI) is an independent predictor of increased mortality and morbidity. It is essential that further advances in the treatment of sepsis should prioritize targeted therapies in SA-AKI in order to improve these bleak outcomes. As yet, a unique therapy that effectively reduces the impact of acute kidney injury has not been demonstrated. However, the emergence of novel targeted therapies, perhaps in combination, has the possibility of significantly reducing the long-term sequelae of an episode of SA-AKI. In this review, we will focus on the shared etiology of these conditions and how this is managed with targeted therapy and finally the emerging novel therapies that may play an additional role to current treatment strategies.
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Affiliation(s)
- James F Doyle
- Department of Intensive Care, Medicine and Surrey Peri-Operative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital NHS Foundation Trust
| | - Lui G Forni
- Department of Intensive Care, Medicine and Surrey Peri-Operative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital NHS Foundation Trust
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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19
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Jung SY, Kim H, Park S, Jhee JH, Yun HR, Kim H, Kee YK, Yoon CY, Oh HJ, Chang TI, Park JT, Yoo TH, Kang SW, Lee H, Kim DK, Han SH. Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy. Medicine (Baltimore) 2016; 95:e4542. [PMID: 27603344 PMCID: PMC5023866 DOI: 10.1097/md.0000000000004542] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT.
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Affiliation(s)
- Su-Young Jung
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyunwook Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Seohyun Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyoungnae Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Youn Kyung Kee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Chang-Yun Yoon
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Tae Ik Chang
- Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
- Correspondence: Seung Hyeok Han, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, Republic of South Korea (e-mail: )
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20
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Manne NDPK, Arvapalli R, Nepal N, Shokuhfar T, Rice KM, Asano S, Blough ER. Cerium oxide nanoparticles attenuate acute kidney injury induced by intra-abdominal infection in Sprague-Dawley rats. J Nanobiotechnology 2015; 13:75. [PMID: 26498824 PMCID: PMC4619421 DOI: 10.1186/s12951-015-0135-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/13/2015] [Indexed: 12/30/2022] Open
Abstract
Background Intra-abdominal infection or peritonitis is a cause for great concern due to high mortality rates. The prognosis of severe intra-abdominal infection is significantly diminished in the presence of acute kidney injury (AKI) which is often characterized by renal tubular cell death that can lead to renal failure. The purpose of the current study is to examine the therapeutic efficacy of cerium oxide (CeO2) nanoparticles for the treatment of peritonitis-induced AKI by polymicrobial insult. Results A one-time administration of CeO2 nanoparticles (0.5 mg/kg) in the absence of antibiotics or other supportive care, attenuated peritonitis-induced tubular dilatation and the loss of brush border in male Sprague–Dawley rats. These improvements in renal structure were accompanied by decreases in serum cystatin-C levels, reduced renal oxidative stress, diminished Stat-3 phosphorylation and an attenuation of caspase-3 cleavage suggesting that the nanoparticle treatment improved renal glomerular filtration rate, diminished renal inflammation and reduced renal apoptosis. Consistent with these data, further analysis demonstrated that the CeO2 nanoparticle treatment diminished peritonitis-induced increases in serum kidney injury molecule-1 (KIM-1), osteopontin, β-2 microglobulin and vascular endothelial growth factor-A (VEGF-A) levels. In addition, the nanoparticle attenuated peritonitis-induced hyperglycemia along with increases in blood urea nitrogen (BUN), serum potassium and sodium. Conclusion CeO2 nanoparticles scavenge reactive oxygen species and attenuate polymicrobial insult induced increase in inflammatory mediators and subsequent AKI. Taken together, the data indicate that CeO2 nanoparticles may be useful as an alternative therapeutic agent or in conjunction with standard medical care for the treatment of peritonitis induced acute kidney injury.
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Affiliation(s)
- Nandini D P K Manne
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA. .,Department of Public Health, Marshall University, Huntington, WV, USA. .,Department of Pharmaceutical Sciences and Research, Marshall University, Huntington, WV, USA.
| | - Ravikumar Arvapalli
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA.
| | - Niraj Nepal
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA. .,Department of Pharmacology, Physiology and Toxicology, Marshall University, Huntington, WV, USA.
| | - Tolou Shokuhfar
- Department of Mechanical Engineering and Engineering Mechanics, Michigan Technological University, Houghton, MI, USA.
| | - Kevin M Rice
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA.
| | - Shinichi Asano
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA.
| | - Eric R Blough
- Center for Diagnostic Nanosystems, Marshall University, Huntington, WV, USA. .,Department of Pharmaceutical Sciences and Research, Marshall University, Huntington, WV, USA. .,Department of Pharmacology, Physiology and Toxicology, Marshall University, Huntington, WV, USA.
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Liu L, Song Y, Zhao M, Yi Z, Zeng Q. Protective effects of edaravone, a free radical scavenger, on lipopolysaccharide-induced acute kidney injury in a rat model of sepsis. Int Urol Nephrol 2015; 47:1745-52. [DOI: 10.1007/s11255-015-1070-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/24/2015] [Indexed: 02/06/2023]
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22
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Gupta KK, Donahue DL, Sandoval-Cooper MJ, Castellino FJ, Ploplis VA. Abrogation of plasminogen activator inhibitor-1-vitronectin interaction ameliorates acute kidney injury in murine endotoxemia. PLoS One 2015; 10:e0120728. [PMID: 25799354 PMCID: PMC4370643 DOI: 10.1371/journal.pone.0120728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/06/2015] [Indexed: 01/20/2023] Open
Abstract
Sepsis-induced acute kidney injury (AKI) contributes to the high mortality and morbidity in patients. Although the pathogenesis of AKI during sepsis is poorly understood, it is well accepted that plasminogen activator inhibitor-1 (PAI-1) and vitronectin (Vn) are involved in AKI. However, the functional cooperation between PAI-1 and Vn in septic AKI has not been completely elucidated. To address this issue, mice were utilized lacking either PAI-1 (PAI-1−/−) or expressing a PAI-1-mutant (PAI-1R101A/Q123K) in which the interaction between PAI-1 and Vn is abrogated, while other functions of PAI-1 are retained. It was found that both PAI-1−/− and PAI-1R101A/Q123K mice are associated with decreased renal dysfunction, apoptosis, inflammation, and ERK activation as compared to wild-type (WT) mice after LPS challenge. Also, PAI-1−/− mice showed attenuated fibrin deposition in the kidneys. Furthermore, a lack of PAI-1 or PAI-1-Vn interaction was found to be associated with an increase in activated Protein C (aPC) in plasma. These results demonstrate that PAI-1, through its interaction with Vn, exerts multiple deleterious mechanisms to induce AKI. Therefore, targeting of the PAI-1-Vn interaction in kidney represents an appealing therapeutic strategy for the treatment of septic AKI by not only altering the fibrinolytic capacity but also regulating PC activity.
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Affiliation(s)
- Kamlesh K Gupta
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Deborah L Donahue
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Mayra J Sandoval-Cooper
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Francis J Castellino
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, United States of America; Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Victoria A Ploplis
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, United States of America; Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana, United States of America
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23
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Sharma K, Kumar M, Batra UB. Anesthetic management for patients with perforation peritonitis. J Anaesthesiol Clin Pharmacol 2014; 29:445-53. [PMID: 24249978 PMCID: PMC3819835 DOI: 10.4103/0970-9185.119128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential.
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Affiliation(s)
- Kiran Sharma
- Department of Anaesthesiology and Critical Care, Kalpana Chawla Medical College Karnal, New Delhi, India
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Adembri C, Selmi V, Vitali L, Nosi D, Tani A, Thyrion GDZ, Santoro G, Bonaccini L, Avveduto G, Caldini AL, Sgambati E. Expression and characterization of anionic components in the tubulointerstitial compartment of rat kidney during polymicrobial sepsis. Acta Histochem 2014; 116:94-105. [PMID: 23810033 DOI: 10.1016/j.acthis.2013.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 12/18/2022]
Abstract
The aim of the study was to evaluate sialic acids and hyaluronan expression, anionic components important for the structure and function of the renal tubulointerstitial compartment, in the early stages of sepsis. Two groups of rats were used: (1) sham-operated controls; (2) cecal ligation and puncture (CLP) (polymicrobial sepsis model). A search for microbial growth was made in the peritoneal fluid to document infection. Tubular function was evaluated by means of urinary protein loss, urinary Na(+) and urea excretion. Kidney samples were processed to analyze histology, sialic acids (lectin histochemistry) and hyaluronan (immunohistochemistry) expression. Results showed increased urinary protein loss and fractional excretion of Na(+) and urea reduction in the CLP group. Histological changes, particularly in the cortex and in proximal tubules of the CLP group, were observed. In septic rats, compared to controls, sialic acids decreased in amount and their acetylation increased in the tubules, although to a lesser extent in the proximal portion. Hyaluronan was expressed in the medullary interstitium and in a few areas of cortex in controls. In septic rats it increased in the cortical interstitium and appeared in proximal tubules. These results suggest correlation between expression changes of anionic components and tubulointerstitium morphofunctional alterations during sepsis. A role of these molecules in protection/defense and repair processes may be suggested.
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Gurjar M, Baronia AK, Azim A, Prasad N, Jain S, Singh RK, Poddar B, Bhadauria D. Septic acute kidney injury in critically ill Indian patients. Indian J Crit Care Med 2013; 17:49-52. [PMID: 23833478 PMCID: PMC3701399 DOI: 10.4103/0972-5229.112147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute kidney injury (AKI) is an independent variable for poor outcome in critically ill patients. The pathophysiology of septic AKI is distinct from that of non-septic AKI. We studied the clinical profile and outcome of septic AKI since such data is sparse in Indian patients. In this single-center retrospective, observational, cohort study, septic AKI has been found with high incidence (31%) and overall mortality was 52%. Age, number of non-renal organ failure, and APACHE II score were found as significant predictors of outcome in this population.
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Affiliation(s)
- Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
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