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López-Alonso I, López-Martínez C, Martín-Vicente P, Amado-Rodríguez L, González-López A, Mayordomo-Colunga J, Del Busto C, Bernal M, Crespo I, Astudillo A, Arias-Guillén M, Fueyo A, Almendros I, Otero J, Sanz-Fraile H, Farré R, Albaiceta GM. Mechanical ventilation promotes lung tumor spread by modulation of cholesterol cell content. Eur Respir J 2021; 60:13993003.01470-2021. [PMID: 34887328 DOI: 10.1183/13993003.01470-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/22/2021] [Indexed: 11/05/2022]
Abstract
Mechanical stretch of cancer cells can alter their invasiveness. During mechanical ventilation, lungs may be exposed to an increased amount of stretch, but the consequences on lung tumors have not been explored. To characterize the influence of mechanical ventilation on the behavior of lung tumors, invasiveness assays and transcriptomic analyses were performed in cancer cell lines cultured in static conditions or under cyclic stretch. Mice harbouring lung melanoma implants were submitted to mechanical ventilation and metastatic spread was assessed. Additional in vivo experiments were performed to determine the mechano-dependent specificity of the response. Incidence of metastases was studied in a cohort of lung cancer patients that received mechanical ventilation compared with a matched group of non-ventilated patients. Stretch increases invasiveness in melanoma B16F10luc2 and lung adenocarcinoma A549 cells. We identified a mechanosensitive upregulation of pathways involved in cholesterol processing in vitro, leading to an increase in PCSK9 and LDLR expression, a decrease in intracellular cholesterol and preservation of cell stiffness. A course of mechanical ventilation in mice harboring melanoma implants increased brain and kidney metastases two weeks later. Blockade of PCSK9 using a monoclonal antibody increased cell cholesterol and stiffness and decreased cell invasiveness in vitro and metastasis in vivo In patients, mechanical ventilation increased PCSK9 abundance in lung tumors and the incidence of metastasis, thus decreasing survival. Our results suggest that mechanical stretch promote invasiveness of cancer cells, which may have clinically relevant consequences. Pharmacological manipulation of cholesterol endocytosis could be a novel therapeutic target in this setting.
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Affiliation(s)
- Inés López-Alonso
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain .,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,These authors contributed equally
| | - Cecilia López-Martínez
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,These authors contributed equally
| | - Paula Martín-Vicente
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Laura Amado-Rodríguez
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,Unidad de Cuidados Intensivos Cardiológicos. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Adrián González-López
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Germany
| | - Juan Mayordomo-Colunga
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cecilia Del Busto
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Unidad de Cuidados Intensivos Polivalente. Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marina Bernal
- Servicio de Medicina Interna. Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Crespo
- Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
| | - Aurora Astudillo
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Miguel Arias-Guillén
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Servicio de Neumología. Hospital Unviersitario Central de Asturias. Oviedo, Spain
| | - Antonio Fueyo
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain.,Centro de Investigación Biomédica en Red-Oncología, Madrid, Spain
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Unitat Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Jorge Otero
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Unitat Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Héctor Sanz-Fraile
- Unitat Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Farré
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Unitat Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Guillermo M Albaiceta
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.,Unidad de Cuidados Intensivos Cardiológicos. Hospital Universitario Central de Asturias, Oviedo, Spain.,Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
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Amado-Rodríguez L, Del Busto C, López-Alonso I, Parra D, Mayordomo-Colunga J, Arias-Guillén M, Albillos-Almaraz R, Martín-Vicente P, López-Martínez C, Huidobro C, Camporota L, Slutsky AS, Albaiceta GM. Biotrauma during ultra-low tidal volume ventilation and venoarterial extracorporeal membrane oxygenation in cardiogenic shock: a randomized crossover clinical trial. Ann Intensive Care 2021; 11:132. [PMID: 34453620 PMCID: PMC8397875 DOI: 10.1186/s13613-021-00919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiogenic pulmonary oedema (CPE) may contribute to ventilator-associated lung injury (VALI) in patients with cardiogenic shock. The appropriate ventilatory strategy remains unclear. We aimed to evaluate the impact of ultra-low tidal volume ventilation with tidal volume of 3 ml/kg predicted body weight (PBW) in patients with CPE and veno–arterial extracorporeal membrane oxygenation (V–A ECMO) on lung inflammation compared to conventional ventilation. Methods A single-centre randomized crossover trial was performed in the Cardiac Intensive Care Unit (ICU) at a tertiary university hospital. Seventeen adults requiring V–A ECMO and mechanical ventilation due to cardiogenic shock were included from February 2017 to December 2018. Patients were ventilated for two consecutive periods of 24 h with tidal volumes of 6 and 3 ml/kg of PBW, respectively, applied in random order. Primary outcome was the change in proinflammatory mediators in bronchoalveolar lavage fluid (BALF) between both ventilatory strategies. Results Ventilation with 3 ml/kg PBW yielded lower driving pressures and end-expiratory lung volumes. Overall, there were no differences in BALF cytokines. Post hoc analyses revealed that patients with high baseline levels of IL-6 showed statistically significant lower levels of IL-6 and IL-8 during ultra-low tidal volume ventilation. This reduction was significantly proportional to the decrease in driving pressure. In contrast, those with lower IL-6 baseline levels showed a significant increase in these biomarkers. Conclusions Ultra-low tidal volume ventilation in patients with CPE and V–A ECMO may attenuate inflammation in selected cases. VALI may be driven by an interaction between the individual proinflammatory profile and the mechanical load overimposed by the ventilator. Trial registration The trial was registered in ClinicalTrials.gov (identifier NCT03041428, Registration date: 2nd February 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00919-0.
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Affiliation(s)
- Laura Amado-Rodríguez
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain. .,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Cecilia Del Busto
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Inés López-Alonso
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Diego Parra
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Juan Mayordomo-Colunga
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Arias-Guillén
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rodrigo Albillos-Almaraz
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Paula Martín-Vicente
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Universidad de Oviedo, Oviedo, Spain
| | - Cecilia López-Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Covadonga Huidobro
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, King's College, London, UK
| | - Arthur S Slutsky
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Guillermo M Albaiceta
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Avda de Roma s/n, 33011, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Universidad de Oviedo, Oviedo, Spain
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Arias Guillen M, De Francisco R, Riestra-Menéndez S, Muñiz-Albaiceta G, González-Budiño MT, García-Clemente MM, Del Busto C, Santibáñez-Margüello M, Castaño-García A, Martínez-González S, Huidobro C, Pérez-González LA, Ruiz-Alvarez I, Herrero-Huertas J, Ugarriza P, Jiménez-Beltrán V, Flórez-Díez P, Rodríguez N, Bailón C, Gómez-Mañas S, Losada-Dieguez A, Escalante P. TB status in a dynamic cohort of patients with Inflammatory Bowel Disease receiving immunosuppression treatment, with up to 8 years of follow-up. Tuberculosis (Edinb) 2019. [DOI: 10.1183/13993003.congress-2019.oa3818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND Intensive care unit (ICU) environment disrupts the circadian rhythms due to environmental and other nonphotic synchronizers. The main purpose of this article is to establish whether critically patients have desynchronization at the molecular level after 1 week of stay in the ICU. METHODS The rhythm of Clock, Bmal1, Cry1, and Per2 genes in neuro-ICU patients (n = 11) on the first day after admission in the unit (1 day) and 1 week later (1 week) was studied, 4 time points throughout the day, at 6, 12, 18, and 24 hours. Human whole blood samples were obtained from neuro-ICU patients. The total RNA was isolated and each sample was reverse transcribed to complementary DNA and quantitative polymerase chain reaction (PCRq) was performed. The possible rhythm was studied using Fourier Series. RESULTS After 1 week, the clock gene rhythmicity completely disappeared. Messenger RNA (mRNA) expression for the 4 clock genes was shown rhythmicity at the first day after admission in the ICU. Circadian rhythmicity for none of them was observed but rather, ultradian rhythmicity was found. The expression of Clock, Bmal1, and Per2 mRNA after 1 week was similar in the 4-time point studies without significant fluctuation among the 4 time points analyzed. DISCUSSION Rhythmic mRNA expression is present at the first day after admission in the ICU. However, ICU stay during 1 week affects the molecular machinery of the biological clock generating chronodisruption. Circadian disruption is associated with the risk of several pathologies, thus, it seems to be clear that ICU stay in constant conditions could adversely affect patient evolution and probably, circadian resynchronization restoring clock gene expression could lead to a better clinical evolution of the patient. CONCLUSIONS Clock genes disruption is observed in neuro-ICU patients. Light therapy as well as melatonin treatment could reduce the impact of ICU stay period in biological clock, thereby improving patients' recovery.
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Affiliation(s)
- Elena Diaz
- Area of Physiology, Department of Functional Biology, 90195University of Oviedo, Oviedo, Spain
| | - Irene Diaz
- Area of Computation Science and Artificial Intelligence, Department of Computer Science, 16763University of Oviedo, Oviedo, Spain
| | - Cecilia Del Busto
- Cardiological Intensive Care Unit. 16474Heart Area-Central University Hospital of AsturiasHeart Area-Central University Hospital of Asturias. Network Biomedical Research Center (CIBERES), Madrid, Spain
| | - Dolores Escudero
- Intensive Care Unit, 16474Central University Hospital of Asturias, Oviedo, Spain
| | - Silvia Pérez
- Unit of Cell Therapy and Regenerative Medicine, 16474Central University Hospital of Asturias, Oviedo, Spain
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