Comparison of the clinical application of reactive oxygen species and inflammatory markers in patients with endocarditis

Modulation of Reactive Oxygen Species Homeostasis as a Pleiotropic Effect of Commonly Used Drugs

Age-associated diseases represent a growing burden for global health systems in our aging society. Consequently, we urgently need innovative strategies to counteract these pathological disturbances. Overwhelming generation of reactive oxygen species (ROS) is associated with age-related damage, leading to cellular dysfunction and, ultimately, diseases. However, low-dose ROS act as crucial signaling molecules and inducers of a vaccination-like response to boost antioxidant defense mechanisms, known as mitohormesis. Consequently, modulation of ROS homeostasis by nutrition, exercise, or pharmacological interventions is critical in aging. Numerous nutrients and approved drugs exhibit pleiotropic effects on ROS homeostasis. In the current review, we provide an overview of drugs affecting ROS generation and ROS detoxification and evaluate the potential of these effects to counteract the development and progression of age-related diseases. In case of inflammation-related dysfunctions, cardiovascular- and neurodegenerative diseases, it might be essential to strengthen antioxidant defense mechanisms in advance by low ROS level rises to boost the individual ROS defense mechanisms. In contrast, induction of overwhelming ROS production might be helpful to fight pathogens and kill cancer cells. While we outline the potential of ROS manipulation to counteract age-related dysfunction and diseases, we also raise the question about the proper intervention time and dosage.

Lipoteichoic acid reduces antioxidant enzymes in H9c2 cells

Infective endocarditis (IE) is an illness where the heart is invaded by bacteria, like Streptococcal and Staphylococcal species that contain lipoteichoic acid (LTA) related to an essential role in this disease. This study is the first in evaluating antioxidant enzyme levels in embryonic cardiomyocyte cell line (H9c2) induced by LTA from Streptococcus sanguinis. LTA increased reactive oxygen species (ROS) and reduced the levels of the antioxidant enzymes glutathione peroxidase, superoxide dismutase (SOD)-1 and catalase (CAT) but did not affect glutathione content. At the highest LTA concentration (15 μg/ml), SOD-1 and CAT levels did not change, and this effect was related to the induction of mRNA levels of Nrf2 induced by LTA. These results suggest that low antioxidant enzyme levels and ROS production could be related to IE.

Baseline C-reactive protein levels and prognosis in patients with infective endocarditis: A prospective cohort study

Background

Early diagnosis and risk-stratification among infective endocarditis (IE) patients are limited by poor microbiological yield and inadequate characterization of vegetations. A simple tool that can predict adverse outcomes in the early phase of management is required.

Aim

To study the prognostic value of C-reactive protein (CRP) levels at admission and its role in predicting various clinical outcomes.

Methods

In a prospective study of consecutive IE patients diagnosed by modified Duke’s criteria, we measured the peak levels of CRP and erythrocyte sedimentation rate (ESR) in the first 3 days of admission and correlated it with in-hospital mortality, six-month mortality, embolic phenomena and the need for urgent surgery. Predefined laboratory-microbiological sampling protocols and antibiotic-initiation protocols were followed. Receiver-operating-characteristics curves were generated to identify a reliable cut-off for CRP in predicting various outcomes.

Results

Out of 101 patients who were treated, 85 patients had ‘definite’ IE. Blood cultures were positive in 55% (n = 39); and Staphylococcus species was the most common organism. Major complications occurred in 74.1% (n = 63) and in-hospital mortality was 32.9% (n = 28). Mean ESR and CRP levels were 102 ± 31 mm/h and 51 ± 20 mg/l, respectively. In multivariable analysis, high CRP levels were independently predictive of mortality, major complications, embolic events and need for urgent surgery. A CRP >40 mg/l predicted adverse outcomes with a sensitivity of 73% and specificity of 99%.

Conclusion

The study shows that baseline CRP level in the first 3 days of admission is a strong predictor of short term adverse outcomes in IE patients, and a useful marker for early risk stratification.

Neutrophil elastase stimulates MUC5AC expression in human biliary epithelial cells: a possible pathway of PKC/Nox/ROS

INTRODUCTION

Bacterial infection and bile flow retardation form a vicious cycle which promotes stone formation and recurrence, and it seems that mucin overexpression plays an important role in this process. However, the mechanism of increased mucus secretion in the biliary tract by bacterial infection and its treatment remain unclear.

MATERIAL AND METHODS

Human biliary epithelial cells were induced by neutrophil elastase (NE), and H₂O₂ production in the cell supernatants was detected by a specific kit, and then cells were pretreated with a H₂O₂ inhibitor, and expression of MUC5AC was detected by real-time polymerase chain reaction (PCR), Western blot, and immunohistochemistry. Moreover, selective PKC and Nox inhibitors, apocynin and bisindolylmaleimide I, were used to pretreat cells and detect H₂O₂, MUC5AC mRNA and protein expression. Then, we pretreated cells with selective inhibitors or NE, and detected transforming growth factor α (TGF-α) using an ELISA kit.

RESULTS

H₂O₂ production increased in an NE dose-dependent manner (p < 0.001), and NE upregulated MUC5AC expression at both mRNA and protein levels, while DMTU, could reduce this high expression (p < 0.01 at mRNA level, p < 0.001 at grey analysis for western blot and p < 0.01 at mean density for immunohistochemical staining at protein level). Moreover, apocynin and bisindolylmaleimide I could reduce the H₂O₂ production stimulated by NE (p < 0.05), and reduce MUC5AC high expression (p < 0.01 at mRNA level, p < 0.001 at both grey analysis for western blot and mean density for immunohistochemical staining at protein level). In addition, NE induced TGF-α production, and any of the three selective inhibitors could reduce it (p < 0.05).

CONCLUSIONS

NE-induced reactive oxygen species participated in the upregulation of MUC5AC production. Moreover, protein kinase C and NADPH oxidase (Nox) regulate MUC5AC production in NE-challenged human biliary epithelial cells.

Different effects of H2O2 treatment on cervical squamous carcinoma cells and adenocarcinoma cells

INTRODUCTION

This study aims to compare the antioxidant abilities of cervical squamous carcinoma cells and cervical adenocarcinoma cells and to study the related mechanisms.

MATERIAL AND METHODS

Cervical squamous carcinoma and adenocarcinoma cells were treated with H2O2. Cell proliferation was determined with the MTT assay. The reactive oxygen species (ROS) level was detected by the 2',7'-dichlorofluorescein-diacetate (DCFH-DA) method. The 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) method was performed to measure intracellular concentrations of reduced glutathione (GSH) and oxidized glutathione (GSSG). The nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method were used to determine activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), respectively.

RESULTS

Compared with untreated control cells, cell proliferation of cervical squamous carcinoma cells and cervical adenocarcinoma cells was significantly inhibited by H2O2 treatment (p < 0.05). Reactive oxygen species levels and GSSG levels were significantly increased (p < 0.01), whereas GSH levels were significantly decreased (p < 0.05 or 0.01) in both cells after H2O2 treatment. Thus the ratio of GSH/GSSG was significantly decreased by H2O2 treatment in both cells (p < 0.01). In addition, H2O2 treatment significantly increased activities of SOD, CAT, and GPx in both cells (p < 0.05 or 0.01). Furthermore, the above-mentioned changes induced by H2O2 treatment were more dramatic in cervical squamous carcinoma cells.

CONCLUSIONS

The antioxidant ability of cervical squamous carcinoma cells is lower than that of cervical adenocarcinoma cells, which may be related to the increased ROS levels in cervical squamous carcinoma cells induced by H2O2 treatments.

The effect of electromagnetic radiation emitted by display screens on cell oxygen metabolism - in vitro studies

INTRODUCTION

Research studies carried out for decades have not solved the problem of the effect of electromagnetic radiation of various frequency and strength on the human organism. Due to this fact, we decided to investigate the changes taking place in human blood platelets under the effect of electromagnetic radiation (EMR) emitted by LCD monitors.

MATERIAL AND METHODS

The changes of selected parameters of oxygen metabolism were measured, i.e. reactive oxygen species concentration, enzymatic activity of antioxidant defence proteins - superoxide dismutase (SOD-1) and catalase (CAT) - and malondialdehyde concentration (MDA). A suspension of human blood platelets was exposed to electromagnetic radiation of 1 kHz frequency and 150 V/m and 220 V/m intensity for 30 and 60 min. The level of changes of the selected parameters of oxidative stress was determined after the exposure and compared to the control samples (not exposed).

RESULTS

The measurements revealed an increase of the concentration of reactive oxygen species. The largest increase of ROS concentration vs. the control sample was observed after exposure to EMF of 220 V/m intensity for 60 min (from x = 54.64 to x = 72.92). The measurement of MDA concentration demonstrated a statistically significant increase after 30-min exposure to an EMF of 220 V/m intensity in relation to the initial values (from x = 3.18 to x = 4.41). The enzymatic activity of SOD-1 decreased after exposure (the most prominent change was observed after 60-min and 220 V/m intensity from x = 3556.41 to x = 1084.83). The most significant change in activity of catalase was observed after 60 min and 220 v/m exposure (from x = 6.28 to x = 4.15).

CONCLUSIONS

The findings indicate that exposure to electromagnetic radiation of 1 kHz frequency and 150 V/m and 220 V/m intensity may cause adverse effects within blood platelets' oxygen metabolism and thus may lead to physiological dysfunction of the organism.

Inflammatory parameters and prediction of prognosis in infective endocarditis

Background

Procalcitonin (PCT) is widely used in critically ill patients to diagnose clinically significant infection and sepsis. Aim of this study was to evaluate the prognostic value of PCT in comparison to white blood cell count (WBC) and C-reactive protein (CRP) for clinical outcome and its correlation with microbiological etiology in patients with infective endocarditis (IE).

Methods

A retrospective single-center analysis was performed from 2007 till 2009. All patients were diagnosed having IE according to Duke standard criteria. Before starting antibiotic therapy, WBC, CRP and PCT were measured and blood cultures were taken for microbiological diagnosis of the etiological pathogen. Patients were followed up during in-hospital stay for poor outcome, defined as death or serious complications due to IE.

Results

During the study period 50 patients (57 ± 17 years, 72% male) fulfilling Duke criteria for IE were identified. In all patients PCT measurements before start of antibiotic therapy were available. In ROC analysis, a cut-off for PCT > 0.5 ng/mL was most accurate for the prediction of poor outcome with a sensitivity of 73% and specificity of 79%, a positive predictive value of 79% and a negative predictive value of 73%. Patients with a PCT > 0.5 ng/mL had an odds ratio of 12.8 (95% CI 2.5 – 66.2) for finding Staphylococcus aureus in blood cultures.

Conclusions

For the first time, this study shows that in IE, an initial value of PCT > 0.5 ng/mL is a useful predictor of poor outcome, i.e. death or serious infectious complications. PCT > 0.5 ng/mL should raise the suspicion of Staphylococcus aureus as the etiological pathogen, whereas PCT levels < 0.5 ng/mL make staphylococcal infection unlikely.