adrenomedullin and Endotoxemia

Adrenomedullin (ADM) is an important regulator of endothelial barrier function and vascular tone, and may represent a novel treatment target in sepsis. The non-neutralizing ADM antibody adrecizumab has shown promising results in preclinical sepsis models. In the present study, we investigated the safety, tolerability and pharmacokinetics (PK)/pharmacodynamics of adrecizumab in a first-in-man study and in a second study during experimental human endotoxaemia.. Forty-eight healthy male volunteers were enrolled in two randomized, double-blind, placebo-controlled phase I studies. In both studies, subjects received placebo or one of three doses of adrecizumab (n = 6 per group). In the second study, a bolus of 1 ng kg. Adrecizumab showed an excellent safety profile in both studies. PK analyses showed proportional increases in the maximum plasma concentration of adrecizumab with increasing doses, a small volume of distribution, a low clearance rate and a terminal half-life of ~14 days. adrecizumab elicited a pronounced increase in plasma ADM levels, whereas levels of mid-regional pro-adrenomedullin remained unchanged, indicating that de novo synthesis of ADM was not influenced. In the second study, no effects of adrecizumab on cytokine clearance were observed, whereas endotoxin-induced flu-like symptoms resolved more rapidly.. Administration of adrecizumab is safe and well tolerated in humans, both in the absence and presence of systemic inflammation. These findings pave the way for further investigation of adrecizumab in sepsis patients.

Topics: Administration, Oral; Adrenomedullin; Adult; Antibodies, Monoclonal, Humanized; Dose-Response Relationship, Drug; Double-Blind Method; Endotoxemia; Escherichia coli; Half-Life; Healthy Volunteers; Human Experimentation; Humans; Lipopolysaccharides; Male; Metabolic Clearance Rate; Treatment Outcome; Young Adult

Adrenomedullin (AM) is a hypotension-causing peptide that was originally isolated from human pheochromocytoma cells, and it has been found to be expressed in various organs, including the liver. As the individual physiological and pathophysiological properties of AM peptide in the liver during endotoxemia in vivo has not yet been examined, we investigated this in experimental endotoxemia using heterozygote AM-deficient (AM(+/-)) mice. The AM concentration of AM(+/-) mice was significantly lesser than that of wild-type (WT) mice in lipopolysaccharide (LPS)-induced endotoxemia. After administering LPS, the survival rate for AM(+/-) mice was significantly lower than that for WT mice. Also, expressions of IL-1β mRNA, and TNF-α mRNA, and NF-κB p65 in the liver were markedly increased and serum ALT greatly elevated in comparison with WT mice. However, supplementation of exogenous AM reversed the deteriorations in mortality and inflammatory responses. Therefore, we conclude that AM plays an important role in regulating systemic inflammation and may be an important intrinsic factor for protecting against liver damage in LPS-induced endotoxemia.

Topics: Adrenomedullin; Alanine Transaminase; Animals; Endotoxemia; Immunohistochemistry; Interleukin-1beta; Liver; Male; Mice; Mice, Inbred C57BL; NF-kappa B; Real-Time Polymerase Chain Reaction; RNA, Messenger; Tumor Necrosis Factor-alpha

Topics: Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; Endotoxemia; Glucocorticoids; Hormones; Humans; Inflammation Mediators; Neurophysins; Prednisolone; Protein Precursors; Shock, Septic; Vasopressins

Sepsis intervention studies need better patient stratification methods, and one way to realize this is the introduction of stable biomarkers. A set of recently developed novel biomarkers, based upon precursor-fragments of short-lived hormones, was previously shown to be increased during sepsis. However, it is not known whether these biomarkers are influenced by sepsis intervention strategies. Therefore we investigated the markers in a model of human endotoxemia intervened by increasing doses of prednisolone.. Prospective, open-label study in a specialized clinical research unit of a university hospital.. Thirty-two healthy male volunteers.. Subjects received prednisolone orally at doses of 0, 3, 10 or 30 mg (n=8 per group) at 2 h before intravenous injection of Escherichia coli lipopolysaccharide (LPS) (4 ng/kg). Blood samples were drawn during 24 h after LPS injection.. LPS injection caused an increase in levels of midregional pro-adrenomedullin (MR-proADM), midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal pro-arginine-vasopressin (CT-proAVP) and procalcitonin (PCT). Prednisolone caused a dose dependent inhibition of MR-proADM, MR-proANP and CT-proAVP levels.. These results show that a set of novel, highly stable sepsis biomarkers was increased during human endotoxemia and was dose-dependently inhibited by corticosteroid pre-treatment.

Topics: Administration, Oral; Adrenomedullin; Adult; Arginine Vasopressin; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Dose-Response Relationship, Drug; Endotoxemia; Humans; Inflammation Mediators; Injections, Intravenous; Lipopolysaccharides; Male; Peptide Hormones; Prednisolone; Prospective Studies; Protein Precursors; Sepsis; Severity of Illness Index

Sepsis is a critical inflammatory condition from which numerous patients die due to multiple organ failure and septic shock. The vasoactive hormone adrenomedullin (AM) and its binding protein (AMBP-1) are beneficial in sepsis by abrogating the progression to irreversible shock and decreasing proinflammatory cytokine release. To investigate the anti-inflammatory mechanism, we studied to determine the effect of the AM/AMBP-1 complex on peroxisome proliferator-activated receptor-gamma (PPAR-gamma) expression and activation by using RAW264.7 cells and a rat endotoxemia model. LPS treatment significantly decreased PPAR-gamma expression in vivo and in vitro and was associated with increased TNF-alpha production. Treatment with AM/AMBP-1 for 4 h completely restored PPAR-gamma levels in both models, resulting in TNF-alpha suppression. In a knockdown model using small interfering RNA in RAW264.7 macrophages, AM/AMBP-1 failed to suppress TNF-alpha production in the absence of PPAR-gamma. LPS caused the suppression of intracellular cyclic AMP (cAMP), which was prevented by simultaneous AM/AMBP-1 treatment. Although incubation with dibutyryl cAMP significantly decreased LPS-induced TauNuF-alpha release, it did not alter PPAR-gamma expression. Through inhibition studies using genistein and PD98059 we found that the Pyk-2 tyrosine kinase-ERK1/2 pathway is in part responsible for the AM/AMBP-1-mediated induction of PPAR-gamma and the anti-inflammatory effect. We conclude that AM/AMBP-1 is protective in sepsis due to its vasoactive properties and direct anti-inflammatory effects mediated through both the cAMP-dependent pathway and Pyk-2-ERK1/2-dependent induction of PPAR-gamma.

Topics: Adrenomedullin; Animals; Cell Line; Complement Factor H; Cyclic AMP; Endotoxemia; Focal Adhesion Kinase 2; Inflammation; Lipopolysaccharides; Male; MAP Kinase Signaling System; Mice; Mitogen-Activated Protein Kinase 1; Mitogen-Activated Protein Kinase 3; PPAR gamma; Rats; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha; Up-Regulation

Hypodynamic septic shock is associated with a poor prognosis. The present randomized-controlled laboratory experiment was designed to test the hypothesis that the vasodilatory peptide hormone adrenomedullin (ADM) is a useful agent to prevent and reverse the development of hypodynamic circulation in ovine endotoxaemia.. Twenty-four healthy ewes were chronically instrumented for haemodynamic monitoring and randomly allocated to either the control, treatment, or prophylaxis group (n = 8 each). After a baseline (BL) measurement in the healthy state, all sheep were subjected to a continuous endotoxin infusion started at 10 ng kg(-1) min(-1) and doubled every hour six times. After 4 h of endotoxin challenge, the treatment group received ADM (50 ng kg(-1) min(-1)) for the remaining 3 h of the experiment. The prophylaxis group received a simultaneous infusion of endotoxin and ADM (50 ng kg(-1) min(-1)) from the beginning to the end of the 7 h intervention period.. In the control and treatment groups, the ewes exhibited a hypodynamic circulation at 4 h (>20% reduction in cardiac index, both P < 0.01 vs BL). Endotoxin also increased mean pulmonary arterial pressure (MPAP) and arterial lactate concentrations. Prophylactic infusion of ADM prevented the occurrence of pulmonary hypertension and hypodynamic circulation and thereby blunted the increase in arterial lactate concentrations. In the treatment group, ADM administration increased CI (P < 0.001) and reduced both MPAP (P = 0.023) and arterial lactate concentrations (P < 0.001 each at 7 h) when compared with the control group.. This study demonstrates that exogenous ADM prevents and reverses hypodynamic circulation, attenuates pulmonary hypertension, and limits lactic acidosis in ovine endotoxaemia.

Topics: Acidosis, Lactic; Adrenomedullin; Animals; Cardiac Output; Drug Evaluation, Preclinical; Endotoxemia; Female; Hypertension, Pulmonary; Lactic Acid; Sheep, Domestic; Shock, Septic; Vasodilator Agents

Urocortin 1 (UCN) and adrenomedullin (AM) are two neuropeptides that have emerged as potential endogenous anti-inflammatory factors based on their production by and binding to immune cells. Because human septic shock involves excessive inflammatory cytokine production, we investigated the effect of UCN and AM in the production of inflammatory mediators and their therapeutic actions in two models of septic shock. Both peptides down-regulated the production of inflammatory mediators by endotoxin-activated macrophages. The administration of UCN or AM protected against lethality after cecal ligation and puncture or after injection of bacterial endotoxin and prevented septic shock-associated histopathology, such as infiltration of inflammatory cells and intravascularly disseminated coagulation in various target organs. The therapeutic effect of UCN and AM was mediated by decreasing the local and systemic levels of a wide spectrum of inflammatory mediators, including cytokines, chemokines, and the acute phase protein serum amyloid A. Importantly, UCN or AM treatment was therapeutically effective in established endotoxemia. In conclusion, UCN and AM could represent two multistep therapeutic agents for human septic shock to be used in combination with other immunomodulatory agents or complementary as anti-inflammatory factors to other therapies.

Topics: Adrenomedullin; Amyloid; Animals; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Corticotropin-Releasing Hormone; Down-Regulation; Endotoxemia; Inflammation; Macrophages; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Nitric Oxide; Peptides; Peroxidase; Shock, Septic; Urocortins

Adrenomedullin (AM) is a peptide involved in cardiovascular homeostasis and in inflammation. We examined its expression in a rat model of endotoxaemia. Male Sprague-Dawley rats received intraperitoneal injection of 5 or 10 mg/kg lipopolysaccharide (LPS), or saline as control. Rats were killed at 1, 3, 6, 12 and 24 h after injection. LPS at 5 mg/kg, but not saline, increased plasma AM significantly at 3 h. At 10 mg/kg, plasma AM was raised at 3, 6 and 12 h. Immunoreactive AM concentration in lung increased after 5 or 10 mg/kg LPS, but not saline. PreproAM mRNA level in lung was significantly increased at 3 and 6 h. In conclusion, endotoxin stimulates the expression of AM in the lungs and increases its circulatory concentration. AM may be involved in the systemic response to sepsis.

Topics: Adrenomedullin; Animals; Endotoxemia; Injections, Intraperitoneal; Lipopolysaccharides; Lung; Male; Models, Animal; Peptides; Protein Precursors; Rats; Rats, Sprague-Dawley; RNA, Messenger; Time Factors

Adrenomedullin (AM) is a vasodilatory peptide hormone, playing a key role in the regulation of cardiovascular homeostasis. In view of the circulatory failure in sepsis, it is still debated as to whether the occurrence of vascular hyporeactivity against AM plays a causative or protective role. This study was designed as a prospective, controlled trial to elucidate the hemodynamic response following a titrating infusion of human AM in healthy and endotoxemic sheep. ANOVA demonstrated that AM infusion produced hypotension and tachycardia, and increased cardiac index in a dose-dependent manner, both in healthy and endotoxemic sheep. In addition, AM application reduced pulmonary vascular resistance index in ovine endotoxemia (P=0.02). These findings confirm that AM produces a hyperdynamic circulation, in the presence and absence of systemic inflammation. Further, exogenous AM could possibly be a useful adjunct in the common setting of sepsis-associated pulmonary hypertension.

Topics: Adrenomedullin; Animals; Endotoxemia; Hemodynamics; Infusions, Intravenous; Peptides; Prospective Studies; Sheep