endothelin-1 and Shock--Septic

The endothelial integrity, as mechanical barrier against microorganisms and as natural "anticoagulant", is crucial for physiologic organ function. Systemic activation of the endothelium upon inflammation, sepsis, and septic shock is always ending in blood-tissue barrier disruption. With increasing dysfunction, uncontrolled clotting activation, capillary microthrombi formation, tissue edema, local hypoxia, and ischemia are initiated. This in turn enhances a vicious circle leading to multiple organ failure and death. Therefore, biomarkers reflecting this special compartment may help in the early detection of systemic inflammation and its complications. This review provides an overview of the most important endothelial biomarkers and their possible use in sepsis.

Topics: ADAM Proteins; ADAMTS13 Protein; Angiopoietin-1; Angiopoietin-2; Biomarkers; Child; Endothelin-1; Endothelium, Vascular; Fibrin Fibrinogen Degradation Products; Humans; Infant, Newborn; Inflammation; Multiple Organ Failure; Neoplasm Proteins; Plasminogen Activator Inhibitor 1; Platelet-Derived Growth Factor; Proteoglycans; Selectins; Sepsis; Shock, Septic; Urokinase-Type Plasminogen Activator; Vascular Endothelial Growth Factor A; von Willebrand Factor

Sepsis causes significant alterations in the hepatic macro- and microcirculation. Diverging views exist on global hepatic blood flow during experimental sepsis because of the large variety in animal and sepsis models. Fluid-resuscitated clinical sepsis is characterized by ongoing liver ischemia due to a defective oxygen extraction despite enhanced perfusion. The effects of vasoactive agents on the hepatosplanchnic circulation are variable, mostly anecdotal, and depend on baseline perfusion, time of drug administration, and use of concomitant medication. Microvascular blood flow disturbances are thought to play a pivotal role in the development of sepsis-induced multiorgan failure. Redistribution of intrahepatic blood flow in concert with a complex interplay between sinusoidal endothelial cells, liver macrophages, and passing leukocytes lead to a decreased perfusion and blood flow velocity in the liver sinusoids. Activation and dysfunction of the endothelial cell barrier with subsequent invasion of neutrophils and formation of microthrombi further enhance liver tissue ischemia and damage. Substances that regulate (micro)vascular tone, such as nitric oxide, endothelin-1, and carbon monoxide, are highly active during sepsis. Possible interactions between these mediators are not well understood, and their therapeutic manipulation produces equivocal or disappointing results. Whether and how standard resuscitation therapy influences the hepatic microvascular response to sepsis is unknown. Indirect evidence supports the concept that improving the microcirculation may prevent or ameliorate sepsis-induced organ failure.

Topics: Animals; Carbon Monoxide; Endothelin-1; Humans; Liver; Liver Circulation; Microcirculation; Multiple Organ Failure; Nitric Oxide; Sepsis; Shock, Septic; Splanchnic Circulation

Heart disease is among the leading causes of death in all populations. Cardiac dysfunctions are major complications in patients with advanced viral or bacterial infection, severe trauma and burns accompanied with multiple organ failure - collectively known as systemic inflammatory response syndrome (SIRS). SIRS, which is often subsequent to sepsis, is clinically featured by hypotension, tachypnea, hypo- or hyperthermia, leukocytosis and myocardial dysfunction. The striking association between inflammation and cardiac dysfunction not only prognoses likelihood of survival in patients with SIRS but also prompts the necessity of understanding the pathophysiology of cardiac dysfunction in SIRS, so that effective therapeutic regimen may be identified. Compelling evidence has shown significant and independent link among inflammation, sepsis, insulin resistance and cardiac dysfunction. Several cytokine signaling molecules have been speculated to play important roles in the onset of cardiac dysfunction under SIRS including endothelin-1 and toll-like receptor. Involvement of these pathways in cardiac dysfunction has been convincingly validated with transgenic studies. Nevertheless, the precise mechanism of action underscoring inflammation-induced cardiac contractile dysfunction is far from being clear. Given the substantial impact of inflammation and SIRS on health care, ecosystems and national economy, it is imperative to understand the cellular mechanisms responsible for cardiac contractile dysfunction under inflammation and sepsis so that new and effective therapeutic strategy against such devastating heart problems may be developed.

Topics: Animals; Biopterins; Cytokines; Diabetes Mellitus; Endothelin-1; Heart Diseases; Humans; Inflammation; Insulin Resistance; Myocardium; Nitric Oxide; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome; Toll-Like Receptors

Topics: Animals; Bosentan; Bronchoconstriction; Capillary Permeability; Endothelin A Receptor Antagonists; Endothelin B Receptor Antagonists; Endothelin-1; Humans; Multiple Organ Failure; Peptides, Cyclic; Receptor, Endothelin A; Receptor, Endothelin B; Shock, Septic; Sulfonamides; Vasoconstriction

The view of the endothelium as a passive barrier has gradually changed as a number of endothelium-derived substances have been discovered. Substances like nitric oxide, prostaglandins and endothelins have potent and important properties, involving not only the circulation as such but also the response to stimuli like inflammation and trauma. The endothelin system, discovered in 1988, has not only strong vasoconstrictor properties, but also immunomodulating, endocrinological and neurological effects exerted through at least two types of receptors. Septic shock, a condition with high mortality, is associated with vast cardiovascular changes, organ dysfunction with microcirculatory disturbances and dysoxia. In the experimental setting, endotoxaemia resembles these changes and is, as well as septic shock, accompanied by a pronounced increase in plasma endothelin levels. The pathophysiology in septic and endotoxin shock remains to be fully elucidated, but several studies indicate that endothelial dysfunction is one contributing mechanism. Activation of the endothelin system is associated with several pathological conditions complicating septic shock, such as acute respiratory distress syndrome, cardiac dysfunction, splanchnic hypoperfusion and disseminated intravascular coagulation. Through the development of both selective and nonselective endothelin receptor antagonists, the endothelin system has been the object of a large number of studies during the last decade. This review highlights systematically the findings of previous studies in the area. It provides strong indications that the endothelin system, apart from being a marker of vascular injury, is directly involved in the pathophysiology of septic and endotoxin shock. Interventions with endothelin receptor antagonists during septic and endotoxin shock have so far only been done in animal studies but the results are interesting and promising.

Topics: Animals; Blood Pressure; Endothelin Receptor Antagonists; Endothelin-1; Endothelins; Humans; Intestinal Mucosa; Portal System; Protein Precursors; Receptors, Endothelin; Shock, Septic

To evaluate the effect of continuous blood purification on cardiac function and plasma vasoactive substances in endotoxic shock in piglets.. This was a randomized controlled trial in an animal laboratory in a tertiary care pediatric center.. Twenty-three healthy Shanghai white piglets weighing 8-14 kg were randomly assigned to one of the four groups: control group (n = 5), continuous blood purification without lipopolysaccharide infusion group (continuous blood purification, n = 6), lipopolysaccharide-induced endotoxin shock without continuous blood purification group (lipopolysaccharide, n = 6), and lipopolysaccharide-induced endotoxin shock with continuous blood purification group (continuous blood purification/lipopolysaccharide, n = 6).. The lipopolysaccharide and continuous blood purification/lipopolysaccharide groups were injected intravenously with Escherichia coli endotoxin to induce septic shock. The continuous blood purification and continuous blood purification/lipopolysaccharide groups received continuous venovenous hemodiafiltration right after model establishment. At baseline state (T0), following the injection of lipopolysaccharide (T), 1 hr later (T1), 3 hrs later (T3), and 5 hrs later (T5) after model establishment, clinical systemic inflammatory response syndrome parameters, hemodynamic indexes, and plasma concentration of vasoactive substances were obtained. Plasma concentration of dopamine was measured by enzyme-linked immunosorbent assay (DSL Company) and endothelin-1 by enzyme-linked immunosorbent assay (R&D Company). Nitric oxide synthase activity was measured by chromatometry (Nanjing Jiancheng Bioengineering Institute, China).. In continuous blood purification/lipopolysaccharide group, after treatment with CPB, heart rate decreased significantly (p < .05) and pulse contour cardiac index, systematic vascular resistance index, and stroke volume index increased significantly (p < .05) when compared with lipopolysaccharide and continuous blood purification groups. After treatment with continuous blood purification, dopamine and endothelin-1 level increased and nitric oxide synthase activities decreased in continuous blood purification/lipopolysaccharide group when compared with the lipopolysaccharide group. In the continuous blood purification/lipopolysaccharide group, improvement in hemodynamic indexes was strongly correlated with increases in plasma dopamine and endothelin-1 level and decreases in nitric oxide synthase activity (r > .9, p < .05).. The adverse cardiovascular effects of lipopolysaccharide-induced endotoxin shock can be improved by continuous blood purification. Improvement is correlated with increases in the concentration of plasma vasoactive substances (endothelin and dopamine) and decreases in nitric oxide synthase activity.

Topics: Animals; Disease Models, Animal; Dopamine; Endothelin-1; Endotoxins; Escherichia coli; Heart Rate; Hemofiltration; Lipopolysaccharides; Nitric Oxide Synthase; Shock, Septic; Statistics, Nonparametric; Stroke Volume; Swine; Vascular Resistance

Hemorrhagic shock-induced changes in vascular reactivity appear organ-specific. In the present study, we examined the hypothesis that vascular reactivity induced by septic shock similarly displays organ-specific differences and is regulated by inducible nitric oxide synthase (iNOS) and endothelin-1 (ET-1).. Endotoxic shock was induced in rabbits by administration of lipopolysaccharide (LPS) (1 mg/kg), and organ specificity of vascular reactivity of superior mesenteric artery (SMA), celiac artery (CA), and left renal artery (LRA) as well as the potential involvement of iNOS and ET-1 examined.. Vascular reactivity of SMA, CA, and LRA was increased at the early stages and decreased at the late stages after LPS administration. Superior mesenteric artery showed the greatest decrease in vascular reactivity in response to norepinephrine (NE) (34.9%) and acetylcholine (Ach; 32.3%), followed by LRA (NE, 33.7%; Ach, 30.5%) and CA (NE, 16.2%), whereas the relaxation reactivity of CA in response to Ach was increased to 159%. The mRNA and protein levels of iNOS and ET-1 in SMA, CA, and LRA were not affected at the early stages of endotoxic shock after LPS administration but significantly increased at the late stages. Expression levels were higher in SMA than CA and LRA and negatively correlated with the decrease in vascular reactivity. The iNOS and ET-1 inhibitors, aminoguanidine (20 mg/kg) and PD-142893 (0.02 mg/kg), respectively, induced significant improvements in vascular reactivity and organ perfusion and stabilized the hemodynamic parameters in rabbits subjected to endotoxic shock.. Changes in vascular reactivity during endotoxic shock are organ-specific. Differential expression patterns of iNOS and ET-1 in different blood vessels contribute to the organ specificity of vascular reactivity.. Therapeutic study, level II.

Topics: Acetylcholine; Animals; Celiac Artery; Disease Models, Animal; Endothelin A Receptor Antagonists; Endothelin-1; Enzyme Inhibitors; Female; Guanidines; Lactic Acid; Lipopolysaccharides; Male; Mesenteric Artery, Superior; Nitric Oxide Synthase Type II; Norepinephrine; Oligopeptides; Rabbits; Renal Artery; RNA, Messenger; Shock, Septic; Vasoconstriction; Vasoconstrictor Agents; Vasodilation; Vasodilator Agents

To investigate the relationship between the degree of liver dysfunction, quantified by maximal liver function capacity (LiMAx test) and endothelin-1, TNF-α and IL-6 in septic surgical patients.. 28 septic patients (8 female, 20 male, age range 35-80y) were prospectively investigated on a surgical intensive care unit. Liver function, defined by LiMAx test, and measurements of plasma levels of endothelin-1, TNF-α and IL-6 were carried out within the first 24 hours after onset of septic symptoms, followed by day 2, 5 and 10. Patients were divided into 2 groups (group A: LiMAx ≥100 μg/kg/h, moderate liver dysfunction; group B: LiMAx <100 μg/kg/h, severe liver dysfunction) for analysis and investigated regarding the correlation between endothelin-1 and the severity of liver failure, quantified by LiMAx test.. Group B showed significant higher results for endothelin-1 than patients in group A (P = 0.01, d5; 0.02, d10). For TNF-α, group B revealed higher results than group A, with a significant difference on day 10 (P = 0.005). IL-6 showed a non-significant trend to higher results in group B. The Spearman's rank correlation coefficient revealed a significant correlation between LiMAx and endothelin-1 (-0.434; P <0.001), TNF-α (-0.515; P <0.001) and IL-6 (-0.590; P <0.001).. Sepsis-related hepatic dysfunction is associated with elevated plasma levels of endothelin-1, TNF-α and IL-6. Low LiMAx results combined with increased endothelin-1 and TNF-α and a favourable correlation between LiMAx and cytokine values support the findings of a crucial role of Endothelin-1 and TNF-α in development of septic liver failure.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Disease Progression; Endothelin-1; Female; Humans; Intensive Care Units; Interleukin-6; Liver Failure; Liver Function Tests; Male; Middle Aged; Prospective Studies; Severity of Illness Index; Shock, Septic; Tumor Necrosis Factor-alpha

Effective management of hypotension refractory to vasoconstrictors in severe sepsis is limited. A new strategy to ameliorate endotoxemic hypotension by inducing endothelium-dependent constriction of large arteries was assessed.. Endotoxemia in rats was induced by injection of LPS (10 mg·kg(-1), i.v.). Haemodynamics were measured in vivo, reactivity of isolated mesenteric arteries by myography and expression of proteins and enzyme activities by immunohistochemistry, biochemistry and molecular biology.. Six hours after LPS, the hypotension was promptly reversed following injection (i.v. or i.p.) of oroxylin-A (OroA) . In isolated LPS-treated but not normal mesenteric arteries, OroA (1-10 μM) induced endothelium-dependent, sustained constriction, blocked by endothelin-1 (ET-1) receptor antagonists. OroA further enhanced LPS-induced expression of endothelin-converting enzyme, ET-1 mRNA and proteins and ET-1 release, OroA also enhanced phosphorylation of Rho-associated protein kinase (ROCK) and reversed LPS-induced suppression of RhoA activities in smooth muscle of arteries with endothelium. Activated- phosphorylation of smooth muscle ROCK was blocked by ET-1-receptor antagonists and ROCK inhibitors. Moreover, OroA post-treatment suppressed, via inhibiting NF-κB activation, inducible NOS expression and circulating NO.. Reversal of endotoxemic hypotensive by OroA was due to release of endothelial ET-1, upregulated by LPS, from mesenteric arteries, inducing prompt and sustained vasoconstriction via activation of vascular smooth muscle RhoA/ROCK-pathway. In late endotoxemia, OroA-induced vasoconstriction was partly due to decreased circulating NO. Activation of endothelium-dependent constriction in large resistance arteries and suppression of systemic inflammation offer new strategies for acute management of endotoxemic hypotensive shock.

Topics: Animals; Endothelin A Receptor Antagonists; Endothelin-1; Endothelium, Vascular; Endotoxemia; Flavonoids; Hypotension; Lipopolysaccharides; Male; Mesenteric Arteries; Nitric Oxide; Nitric Oxide Synthase Type II; Phosphorylation; Rats, Sprague-Dawley; rho-Associated Kinases; rhoA GTP-Binding Protein; Shock, Septic; Vasoconstriction

Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality.. A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated.. Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold.. MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.

Topics: Adrenomedullin; Aged; Aged, 80 and over; Biomarkers; Cardiomyopathies; Cohort Studies; Endothelin-1; Female; Humans; Intensive Care Units; Male; Middle Aged; Prognosis; Shock, Septic; Survival Analysis; Sweden

The aim of this study was to evaluate echocardiography-based indices of myocardial function and markers of vascular inflammation and endothelial dysfunction in the early phases of severe sepsis.. Forty-five adult patients (67% women; age 51 ± 18 years; Acute Physiology and Chronic Health Disease Classification System II score, 23 ± 7) admitted to the intensive care unit up to 24 hours after fulfilling criteria for severe sepsis or septic shock were studied. Clinical, laboratorial (endothelin 1 [ET1], vascular cellular adhesion molecule 1), and echocardiographic data were collected within the first 24 hours and again 72 hours and 7 days after admission.. Intrahospital mortality was 33% (15 deaths). Left ventricular (LV) dysfunction (LV ejection fraction <55%) was identified in 15 (33%) patients, whereas right ventricular (RV) dysfunction (RV tissue Doppler peak systolic velocity [RV-Sm] <12 cm/s) was present in 14 (30%) patients. LogET1 was increased in patients with LV dysfunction (2.3 ± 0.6 vs 1.8 ± 0.4 pg/mL; P = .01) and RV dysfunction (2.5 ± 0.5 vs 1.8 ± 0.4 pg/mL; P < .001) and had negative correlations with LV ejection fraction (r = -0.50; P = .002) and RV-Sm (r = -0.67; P < .001). Left ventricular end-diastolic diameter, RV-Sm, and diastolic dysfunction were able to discriminate survivors from nonsurvivors, and the combination of these parameters identified groups of very low and high risk.. Both LV and RV systolic dysfunctions are prevalent in severe sepsis, being directly associated with markers of endothelial dysfunction. Left ventricular nondilation, RV dysfunction, and diastolic dysfunction seem related to poor prognosis in this scenario.

Topics: Biomarkers; Brazil; Cardiomyopathy, Dilated; Echocardiography; Endothelin-1; Endothelium, Vascular; Female; Humans; Intercellular Adhesion Molecule-1; Male; Middle Aged; Prognosis; Sepsis; Shock, Septic; Survival Rate; Ventricular Dysfunction

Risk stratification could represent a major improvement in critically ill patients' management. The objective of this study is to evaluate the association between concentrations of four circulating prohormones (C-terminal-provasopressin, midregional-proadrenomedullin (MR-proADM), midregional-proatrial natriuretic peptide, and C-terminal- proendothelin-1) and the occurrence of nosocomial infections (NIs) in septic shock patients.. We performed an observational, clinical study with septic shock patients (n = 98) recruited from adult intensive care units in a university hospital. Prohormone concentrations were assessed three times within the first week after the onset of septic shock using an immunoluminometric assay.. Significantly elevated plasmatic MR-proADM concentrations were measured in patients who went on to develop NIs in comparison with patients who remain infection free (p = 0.043). No differences were observed for the other three prohormone concentrations.. Elevated plasmatic MR-proADM concentration is associated with the development of secondary NIs after septic shock. This information, if confirmed in a larger group of patients, could represent a major advance in the monitoring of intensive care unit patient infectious risk.

Topics: Adrenomedullin; Aged; Atrial Natriuretic Factor; Cohort Studies; Cross Infection; Endothelin-1; Female; Glycopeptides; Humans; Male; Middle Aged; Peptide Fragments; Protein Precursors; Risk Factors; Severity of Illness Index; Shock, Septic

Septic shock is a major health care problem that affects a heterogeneous population of patients. To improve sepsis management, a key point is to decrease this heterogeneity by stratifying patients according to specific criteria, such as appropriate biomarkers. As the early phase of septic shock is characterized by cardiovascular dysfunction, precursors of vasoactive hormones represent interesting candidates. The objective of the present study was to concomitantly assess the predictive value of C-terminal proendothelin-1 and midregional proatrial natriuretic peptide (CT-proET-1 and MR-proANP, respectively vasoconstrictor and vasodilator) on 28-day mortality following septic shock.. In this observational study which included 99 patients, concentrations of MR-proANP and CT-proET-1 were measured using an immunoluminometric assay three times within the first week after the onset of septic shock.. While MR-proANP concentrations were significantly increased in non-survivors in comparison with survivors, no differences were noted for CT-proET-1. Increased MR-proANP concentrations were significantly associated with mortality after both univariate and multivariate analyses, adjusted for usual clinical confounders [SAPS II (simplified acute physiology score II), SOFA (sepsis-related organ failure assessment) scores and number of co-morbidities].. In septic shock patients, MR-proANP appears to be a good predictor of 28-day mortality, whereas CT-proET-1 does not present any predictive value during monitoring.

Topics: Atrial Natriuretic Factor; Biomarkers; Endothelin-1; Humans; Immunoassay; Mortality; Observation; Predictive Value of Tests; Prognosis; Protein Precursors; Shock, Septic; Survivors

To investigate the effects of endothelin-1 (ET-1) and nitric oxide (NO) on lipopolysaccharide(LPS)-induced myocardial dysfunction, and explore the related underlying mechanisms.. Experimental septic model was established by intraperitoneal injection of LPS (10 mg x kg(-1)). The study was carried out on the isolated rat hearts to determine the roles of ET-1 and NO in the effect of LPS on the cardiac contractility and on the isolated rat ventricular myocytes model to observe the [Ca2+]i homeostasis in cardiac myocytes.. (1) The levels of serum NO2-/NO3- and plasma ET-1 were markedly increased by LPS treatment for 4 hours. (2) LPS induced the decrease in rate-pressure product (RPP), and increase in left ventricular end-diastolic pressure (LVEDP) in the isolated perfused rat hearts. Pretreatment with either aminoguanidine (AMG) (100 mg x kg(-1), i.p.) or BQ-123 (1 mg x kg(-1), i.p.) partially attenuated LPS-induced myocardial depression. When these two drugs were simultaneously given, myocardial depression elicited by LPS was almost abolished. (3) LPS significantly decreased the amplitude of caffeine induced [Ca2+]i transients compared to the control cells. The activity of SR Ca22+ -ATPase was significantly decreased in the cardiac myocytes from LPS-treated rats. Single pretreatment with either AMG or BQ-123 did not attenuate the impairment of SR Ca2+ -ATPase induced by LPS.. ET-1 and NO mediate myocardial dysfunction in hearts isolated and decrease [Ca2+]i transients in cardiac myocytes from LPS-treated rats. But neither ET-1 nor NO participates in the impairment of SR Ca2+ -ATPase induced by LPS.

Topics: Animals; Depression, Chemical; Endothelin-1; Lipopolysaccharides; Male; Myocardial Contraction; Nitric Oxide; Rats; Rats, Sprague-Dawley; Shock, Septic

To find out if the extravascular lung water index (EVLWI) and the derived permeability indexes determined by the single transpulmonary thermodilution technique are associated with markers of acute lung injury in human septic shock.. Prospective, observational study.. Mixed intensive care unit of a 900-bed university hospital.. Thirty-eight consecutive adult patients with septic shock and acute lung injury.. None.. The variables were assessed over a 72-hr period and included hemodynamics, EVLWI, and pulmonary vascular permeability indexes determined with the single indicator transpulmonary thermodilution technique, lung compliance, oxygenation ratio (Pao2/Fio2), lung injury score, cell counts, and the plasma concentration of endothelin-1. At day 1, EVLWI was elevated (>or=7 mL/kg) in 28 (74%) patients and correlated with lung compliance (r=-.48, p=.002), Pao2/Fio2 (r=-.50, p=.001), lung injury score (r=.46, p=.004), roentgenogram quadrants (r=.39, p=.02), and platelet count (r=-.43, p=.007). At day 3, EVLWI correlated with compliance (r=-.51, p=.002), Pao2/Fio2 (r=-.49, p = .006), and lung injury score (r=.53, p=.003). At day 3, EVLWI and pulmonary vascular permeability indexes were higher in nonsurvivors (p<.05). The plasma concentration of endothelin-1 (mean+/-sd) was significantly higher in patients with elevated EVLWI (>or=7 mL/kg) (3.85+/-1.40 vs. 2.07+/-0.38 pg/mL, respectively). Twenty-two (59%) patients died before day 28.. In human septic shock, EVLWI demonstrated moderate correlation with markers of acute lung injury, such as lung compliance, oxygenation ratio, roentgenogram quadrants, and lung injury score. In nonsurvivors, EVLWI and permeability indexes were significantly increased at day 3. Thus, EVLWI might be of value as an indicator of prognosis and severity of sepsis-induced acute lung injury.

Topics: Biomarkers; Endothelin-1; Extravascular Lung Water; Female; Follow-Up Studies; Humans; Lung Compliance; Male; Middle Aged; Prognosis; Prospective Studies; Respiratory Distress Syndrome; Severity of Illness Index; Shock, Septic; Thermodilution

To examine whether a novel endothelin receptor antagonist, CPU0213, is effective in relieving the acute renal failure (ARF) of septic shock by suppressing the activated endothelin-reactive oxygen species (ET-ROS) pathway and nuclear factor kappa B (NF-kappaB).. The cecum was ligated and punctured in rats under anesthesia. CPU0213 (30 mg .kg(-1).d(-1), bid, sc X 3 d) was administered 8 h after surgical operation.. In the untreated septic shock group, the mean arterial pressure and survival rate were markedly decreased (P<0.01), and heart rate, weight index of kidney, serum creatinine and blood urea nitrogen, 24 h urinary protein and creatinine were significantly increased (P<0.01). The levels of ET-1, total NO synthetase (tNOS), indusible nitric oxide synthetase (iNOS), nitric oxide (NO), and ROS in serum and the renal cortex were markedly increased (P<0.01). The upregulation of the mRNA levels of preproET-1, endothelin converting enzyme, ET(A), ET(B), iNOS, and tumor necrosis factor-alpha in the renal cortex was significant (P<0.01). The protein amount of activated NF-kappaB was significantly increased (P<0.01) in comparison with the sham operation group. All of these changes were significantly reversed after CPU0213 administration.. Upregulation of the ET signaling pathway and NF-kappaB play an important role in the ARF of septic shock. Amelioration of renal lesions was achieved by suppressing the ET(A) and ET(B) receptors in the renal cortex following CPU0213 medication.

Topics: Acute Kidney Injury; Animals; Endothelin Receptor Antagonists; Endothelin-1; Kidney Cortex; Male; NF-kappa B; Nitric Oxide; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Pyrazoles; Rats; Rats, Wistar; Reactive Oxygen Species; RNA, Messenger; Shock, Septic; Tumor Necrosis Factor-alpha

Endothelin-1 (ET-1) is a potent vasoconstrictor, which has been implicated in diseases involving dysfunctions of the cardiovascular system. For the biogenesis of ET-1, a larger precursor peptide (proET-1) is cleaved at two sites to give rise to bigET-1, which is subsequently cleaved to generate mature ET-1. In the present study, we investigated, which other peptides are derived from proET-1 in vivo. Six sandwich immunoassays covering various regions of proET-1 were developed and used to detect circulating proET-1 immunoreactivities in plasma of healthy subjects and septic patients. With this approach we could (a) demonstrate that, in addition to bigET-1/ET-1, three stable proET-1 fragments are generated, (b) exclude two previously discussed regions as sites for prohormone conversion and (c) show that the proteolytic processing pattern of proET-1 is unchanged under pathological conditions, which are associated with elevated levels of proET-1 fragments. The high stability and similarity in concentration of the proET-1 fragments suggest that these might be non-functional in the circulation. Stable proET-1 fragments maybe used in the future as reliable diagnostic targets to indirectly assess the release of ET-1, which might help to more selectively direct therapeutic measures.

Topics: Endothelin-1; Endothelins; Humans; Plasma; Protein Precursors; Protein Processing, Post-Translational; Shock, Septic

Endothelin (ET)-1 is a potent vasoconstrictive peptide and it is involved in the pathogenesis of septic shock. Blockade of ET-1 receptors abolishes the LPS-induced pulmonary hypertension and worsens the LPS-dependent systemic hypotension, but the role of ET-1 in sepsis remains uncertain. To determine the role of ET-1 in cardiovascular and respiratory derangement in a porcine model of endotoxemic shock we evaluated ET-1 plasma levels and ET-1 mRNA and protein levels in lung, liver, and heart as well as Endothelin Converting Enzyme-1, ET(A) and ET(B) receptors mRNA in the same tissues. Twelve piglets were randomised to sham operated or to LPS-treated (40 microg/kg/h for 4 h) groups. During the experiment, respiratory and circulatory parameters have been recorded and blood samples collected. At the end of the experiment the animals were sacrificed and tissue samples collected for real-time quantitative PCR and ELISA test. LPS infusion evokes a large increase in ET-1 plasma concentration, and in tissues mRNA levels, associated with an increase in pulmonary arterial pressure, as well as in pulmonary and systemic vascular resistances, and a decrease in stroke volume. LPS infusion caused also a derangement of respiratory mechanics, evidenced by an increase in resistance and a decrease in compliance of the respiratory system. ET(A) and ET(B) receptor mRNA levels were markedly decreased in liver and lung and slightly increased in heart, evidencing that ET receptor subtypes were differentially regulated in the major organs of endotoxin treated pigs. In conclusion our data show the presence of a continuative and differentially regulated stimulating mechanism of ET-1 expression during pig endotoxaemia as well as a fundamental role of ET-1 system in the cardiovascular and respiratory derangement.

Topics: Animals; Aspartic Acid Endopeptidases; Disease Models, Animal; Endothelin-1; Endothelin-Converting Enzymes; Female; Hemodynamics; Male; Metalloendopeptidases; Random Allocation; Receptor, Endothelin A; Respiration; Shock, Septic; Swine; Tissue Distribution

Role of endoteline-1 (ET-1) in pathogenesis of septic shock (SS) was studied in 22 patients in the age from 34 to 58 years. There was shown, that ET-1 content in plasma depends on functional level of the adaptation-compensation reaction of organism as an answer on occurrence of SS in patients with abdominal sepsis. This is demonstrated by more high concentration of the index studied in the patients survived and also presence of correlative connection between ET-1 level in plasma of blood, indexes of middle arterial pressure and general peripheral resistance of vessels. There were received preliminary data, witnessing, that circulating cytokines, in particular, interleukin-8, stimulate the heightened production of ET-1 by endothelial cells, what probably in early terms the SS course constitutes the compensatory reaction, directed on elimination of pathogenic microorganisms, securing of reparative processes and maintenance of homeostasis.

Topics: Abdominal Abscess; Adult; Endothelin-1; Humans; Hydrocortisone; Middle Aged; Shock, Septic

To evaluate the effects of endothelin receptor antagonism on cardiac performance in endotoxin shock.. Prospective, experimental study.. A university-affiliated research institution.. Domestic anesthetized landrace pigs.. Thirty-seven pigs were anesthetized and subjected to echocardiography, coronary sinus catheterization, and monitoring of central and regional hemodynamics in order to assess cardiac performance. All animals received endotoxin for 5 hrs. Twenty pigs served as endotoxin controls. Tezosentan, a dual endothelin-A and -B receptor antagonist, was administered during established endotoxemic shock. Seven pigs received an infusion of tezosentan of 1 mg x kg(-1) x hr(-1) (tezo1), and an additional ten pigs received a higher dose of 10 mg x kg(-1) x hr(-1) (tezo10).. Endotoxemia evoked a state of shock with pulmonary hypertension and metabolic acidosis. A decrease in stroke volume and coronary perfusion pressure as well as an increase in troponin I was also noted. Tezosentan administration resulted in a significant increase in cardiac index, stroke volume index, left ventricular stroke work index, and left ventricular end-diastolic area index. Decreases in systemic and pulmonary vascular resistance indexes were also evident after intervention. This was achieved without changes in heart rate or systemic arterial or pulmonary artery occlusion pressures in tezo, animals compared with controls. In addition, metabolic variables were improved by tezosentan. These effects were sustained only in the tezo, group. In the higher dosage, tezosentan resulted in a deterioration of cardiac performance and 50% mortality rate. The endotoxin-induced increase in troponin I was attenuated in the tezo, group compared with controls.. In this porcine model of volume-resuscitated, endotoxemic shock, endothelin-receptor blockade with tezosentan improved cardiac performance. However, the effect was not sustained with higher doses of tezosentan, possibly due to reduced coronary perfusion pressure. These findings show differentiated, dose-dependent effects by dual endothelin receptor blockade on endotoxin-induced cardiovascular dysfunction.

Topics: Animals; Cardiac Catheterization; Cardiovascular System; Coronary Circulation; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Drug Monitoring; Echocardiography; Endothelin Receptor Antagonists; Endothelin-1; Endothelin-2; Infusions, Intravenous; Pyridines; Resuscitation; Shock, Septic; Stroke Volume; Swine; Tetrazoles; Troponin I; Vascular Resistance; Vasodilator Agents; Ventricular Function, Left

Topics: Animals; Blood Pressure; Endothelin-1; Female; Lipopolysaccharides; Male; Pulmonary Artery; Respiratory Tract Diseases; Shock, Septic; Swine; Swine Diseases

Levels of the endothelium-derived vasoconstrictor endothelin (ET)-1 and the vasodilator nitric oxide (NO) are markedly increased in endotoxic shock, although the pathophysiological role of ET-1 and its relation to NO under septic conditions remains obscure. To delineate the roles of ET-1 and the ET receptors, and the NO/inducible NO synthase (iNOS) system in endotoxic shock, we examined the gene expression of ET-1, ET receptors A and B (ETA and ETB) and iNOS in the heart and the liver of a rat endotoxic shock model, and we studied the effects of ET receptor antagonists on haemodynamics, survival rate and expression of ET-1, ET receptors and iNOS. Administration of bacterial lipopolysaccharide (LPS) into rats caused a profound hypotension with resultant death. However, these effects were blocked by a non-selective ETA/ETB receptor antagonist (TAK044), but not by an ETA-selective antagonist (BQ123). Injection of LPS caused a marked elevation in the plasma levels of both ET-1 and NO, which were not affected by treatment with either ET receptor antagonist. Administration of LPS caused increases in levels of ET-1, ETB and iNOS mRNA in the heart and the liver, whereas ETA mRNA expression was markedly downregulated in these organs. These results suggest that ET receptor subtype genes are differentially regulated in major organs from endotoxic shock rats, and that non-selective ET receptor antagonists ameliorate endotoxin-induced hypotension and death irrespective of iNOS-derived NO.

Topics: Animals; Endothelin Receptor Antagonists; Endothelin-1; Gene Expression; Liver; Male; Models, Animal; Myocardium; Nitric Oxide; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Peptides, Cyclic; Rats; Rats, Wistar; Receptor, Endothelin A; Receptor, Endothelin B; Receptors, Endothelin; RNA, Messenger; Shock, Septic

We evaluated the endothelin-1 (ET-1) and thrombin involvement in cardiovascular and respiratory dysfunction during endotoxic shock in 18 anaesthetized, mechanically ventilated pigs, divided into three groups. Group 1 was pre-treated only with lipopolysaccharide (LPS), group 2 was treated with lepirudin, a thrombin inhibitor, group 3 was pre-treated with bosentan, a dual inhibitor of ET-1 receptors. Results show that LPS caused systemic hypotension, pulmonary biphasic hypertension, increase in lung resistances (R(L)) and decrease in compliance (C(L)). Lepirudin partially reduced the LPS-dependent pulmonary hypertension, without affecting the changes in C(L) and R(L). On the contrary, bosentan completely abolished the pulmonary hypertension and the changes inC(L) and R(L), and worsened the LPS-dependent systemic hypotension. Our results show that ET-1 is largely responsible for pulmonary derangement due to endotoxic shock; at bronchial level, the ET-1 release seems due only to LPS, while, at pulmonary vascular level, it results also from LPS-dependent thrombin activation.

Topics: Animals; Antihypertensive Agents; Bosentan; Cardiovascular System; Endothelin-1; Female; Fibrinolytic Agents; Hemodynamics; Hirudins; Lipopolysaccharides; Lung; Male; Recombinant Proteins; Respiratory System; Shock, Septic; Sulfonamides; Swine; Thrombin; Time Factors

The purpose of this article is to elucidate the effect of L-canavanine, a selective inhibitor of inducible NO synthase (iNOS), on hemodynamics, blood gas parameters, and plasma concentrations of lactate and endothelin-1 (ET-1) during endotoxic shock.. Eleven mongrel dogs under pentobarbital anesthesia were divided into two groups: (1) bacterial lipopolysaccharide (LPS) plus vehicle group (n = 5) receiving infusion of LPS (3 mg/kg/h for 1 h) followed by vehicle (2 mL/h for 5 hours); (2) LPS plus L-canavanine group (n = 6) receiving infusion of LPS (3 mg/kg/h for 1 hour) followed by L-canavanine (10 mg/kg/h for 5 hours).. LPS caused a significant (P < .05) decrease in mean arterial pressure (MAP) at 1 hour, but there was no significant difference in MAP during 6-hour period between the two groups. LPS alone did not cause significant changes in other hemodynamics, whereas L-canavanine caused a significant (P < .05) increase in pulmonary vascular resistance index (PVRI) and a decrease in oxygen delivery at 6 hours. The LPS-induced lactic acidosis and hypersecretion of ET-1 were aggravated after L-canavanine infusion. Plasma ET-1 showed positive correlations to lactate levels and PVRI, and negative correlations to cardiac output and oxygen delivery only in the LPS plus L-canavanine group, but not in the LPS plus vehicle group.. This study suggests that L-canavanine induces tissue hypoperfusion and ischemia with concomitant hypersecretion of ET-1 in dogs with endotoxic shock.

Topics: Animals; Blood Gas Analysis; Canavanine; Disease Models, Animal; Dogs; Endothelin-1; Enzyme Inhibitors; Hemodynamics; Lactic Acid; Male; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Shock, Septic

Endothelin (ET)-1, a potent vasoconstrictor peptide derived from the endothelium, is markedly increased in endotoxic shock, although the pathophysiological role of ET-1 under septic conditions remains obscure. To delineate the role of ET-1 and its receptor subtype in endotoxic shock, we here attempted to determine the changes of circulating levels of ET-1 and its biosynthetic intermediate big ET-1 in endotoxic shock rats, to evaluate the gene expression of ET-1 as well as the ET-1 receptor subtypes (ETA and ETB) in the heart, lung and liver, and to study the effects of ET receptor antagonists on systemic arterial blood pressure, heart rate and survival rate. Administration of bacterial lipopolysaccharide (LPS) caused profound hypotension, increased heart rate and death, and these effects were blocked by a nonselective ETA/ETB receptor antagonist (TAK044), but not by an ETA selective antagonist (BQ123). Administration of exogenous ET-1 caused a profound pressor response in control rats, but not in the LPS-pretreated rats. Injection of LPS caused marked elevation of plasma levels of both ET-1 and big ET-1, which were not affected by treatment with either ET receptor antagonist. Administration of LPS caused up-regulation of ET-1 and ETB receptor mRNA in the heart, whereas ETA receptor mRNA was markedly down-regulated in the heart, lung and liver. These data suggest differential gene regulation of ET-1 and its receptor subtypes in various organs from endotoxic shock rats, and that nonselective ETA/ETB receptor antagonist, but not ETA receptor antagonist, ameliorates endotoxin-induced hypotension and death.

Topics: Animals; Antihypertensive Agents; Blood Pressure; Endothelin-1; Endothelins; Gene Expression; Heart Rate; Lipopolysaccharides; Male; Peptides, Cyclic; Protein Precursors; Rats; Rats, Wistar; Receptor, Endothelin A; Receptor, Endothelin B; Receptors, Endothelin; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Shock, Septic; Survival Rate

To elucidate the possible roles of nitric oxide (NO), endothelin-1 (ET-1), and reactive oxygen species (ROS) in the pathophysiology of serogroup A streptococcal (GAS) peritoneal sepsis, we investigated the effects of aminoethylisothiourea (AE-ITU), an inducible NO synthase (iNOS) inhibitor, and a ROS scavenger, and the ET-1 receptor antagonist bosentan. In rats, live GAS inocula, 3 x 10(8) and 1 x 10(9) cfu/kg, entailed a 24-h mortality of 10% and 90%, respectively. GAS caused increases in tissue iNOS activity (9 h), in serum nitrite/nitrate (9-24 h), and in intracellular leukocyte ROS levels (3-6 h). These changes were all prevented by the pre-treatment with AE-ITU. A novel finding was that AE-ITU also prevented the GAS-induced marked increase in plasma ET-1 at 6 h. Short-term (7-h) survival was improved by both AE-ITU and by bosentan. The mechanism(s) for the beneficial effects of AE-ITU may possibly be a combined mode of action; iNOS inhibition, ROS scavenging, and inhibition of the increase in plasma ET-1 caused by GAS.

Topics: Animals; Antihypertensive Agents; Blood Pressure; Bosentan; Endothelin Receptor Antagonists; Endothelin-1; Enzyme Inhibitors; Male; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Rats; Rats, Sprague-Dawley; Receptor, Endothelin A; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Sulfonamides; Survival Rate; Thiourea; Time Factors

Cardiac dysfunction during septic shock is well described but the underlying mechanisms still remain to be resolved. This study was conducted to elucidate the involvement of endothelin in cardiac function during endotoxin shock by the use of endothelin receptor antagonism.. Anaesthetised and haemodynamically stable landrace pigs received the nonpeptide mixed endothelin receptor antagonist bosentan, two hours after onset of endotoxaemia (n=7). Cardiopulmonary vascular changes, including cardiac index, stroke work index, coronary artery blood flow, rate of change of left ventricular pressure (dp/dt), and arterial and coronary sinus plasma levels of endothelin-1-like immunoreactivity were compared to a control group only receiving endotoxin (n=7).. Plasma endothelin-1-like immunoreactivity increased threefold in the control group. Bosentan effectively counteracted the endotoxin induced decrease in cardiac index. This was accompanied by a significant reduction of both right and left ventricular afterload. In addition, coronary artery blood flow increased and coronary vascular resistance decreased compared to controls. Dp/dt remained unaffected by endothelin receptor antagonism. A further increase in plasma endothelin-1-like immunoreactivity was seen in response to bosentan.. These results indicate that the increased endothelin production during endotoxaemia contributes to a depressed cardiac performance and that endothelin receptor antagonism may counteract this development. Possible mechanisms for the improved cardiac performance include both a reduction of afterload and enhanced coronary blood flow.

Topics: Animals; Bosentan; Cardiac Output; Coronary Circulation; Endothelin Receptor Antagonists; Endothelin-1; Hemodynamics; Pulmonary Circulation; Shock, Septic; Stroke Volume; Sulfonamides; Swine; Ventricular Function, Left

Excessive nitric oxide (NO) production in septic shock is thought to contribute to the associated profound hypotension. Here we show that despite induction of NO synthase (NOS) in the hearts of endotoxin-treated rats, coronary vascular responses to the contractile peptide endothelin-1, were not modified. This was not due to any change in the expression of endothelin receptors. However, when the substrate for NOS, L-arginine, was added to the perfusate, increases in coronary perfusion pressure stimulated by endothelin were reduced in hearts from endotoxin-treated animals compared to those from controls. In addition, L-glutamine, which blocks the generation of L-arginine from intracellular stores, enhanced the increase in perfusion pressure stimulated by endothelin-1. These data suggest that L-arginine becomes rate limiting for the production of NO in the coronary vessels during septic shock. Moreover, it suggests that vascular reactivity may be modulated positively or negatively by supplementation with the relevant amino acids.

Topics: Animals; Arginine; Coronary Vessels; Endothelin-1; Endotoxins; Enzyme Induction; Glutamine; Male; Myocardium; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Rats; Rats, Wistar; RNA, Messenger; Shock, Septic

To explore the role of endogenous endothelin (ET) in the regulation of vascular functions, we studied the effects endothelin receptor blockade on blood pressure, plasma volume and albumin escape during endotoxin shock in conscious, chronically catheterized rats. Red blood cell volume and plasma volume were determined by using chromium-51-tagged erythrocytes and iodine-125-labelled albumin, respectively. Intravenous injection of lipopolysaccharide (LPS, 10 mg kg(-1)) resulted in hypotension, haemoconcentration, and increased total-body albumin escape, which is reflected by a 30% reduction in plasma volume. Plasma ET-1 concentrations increased 2.1 fold and 5.4 fold at 30 and 120 min post-LPS, respectively. LPS-induced losses in plasma volume and albumin escape were significantly attenuated by pretreatment of animals with the dual ET(A)/ET(B) receptor antagonist bosentan (17.4 micromol kg(-1), i.v. 15 min prior to LPS) or the ET(A) receptor antagonist FR 139317 (3.8 micromol kg(-1), i.v.) during both the immediate and delayed phases of endotoxin shock. The inhibitory actions of bosentan and FR 139317 were similar. Both antagonists augmented the hypotensive action of LPS. Administration of bosentan or FR 139317 70 min after injection of LPS also attenuated further losses in plasma volume and increases in total body and organ albumin escape rates with the exception of the lung and kidney. These results indicate a role for endogenous endothelin in mediating losses in plasma volume and albumin escape elicited by LPS predominantly through activation of ET(A) receptors, and suggest that by attenuating these events, ET(A) or dual ET(A)/ET(B) receptor blockers may be useful agents in the therapy of septic shock.

Topics: Animals; Azepines; Bacterial Toxins; Blood Pressure; Bosentan; Endothelin Receptor Antagonists; Endothelin-1; Endothelins; Enterotoxins; Erythrocyte Volume; Escherichia coli Proteins; Indoles; Lipopolysaccharides; Male; Plasma Volume; Rats; Rats, Wistar; Receptor, Endothelin A; Receptor, Endothelin B; Regional Blood Flow; Serum Albumin; Serum Albumin, Radio-Iodinated; Shock, Septic; Sulfonamides

Despite the fact that gram-positive infections constitute around 50% of all cases leading to septic shock, little is yet known about the mechanisms involved. This study was carried out to find out more about the effects of cell wall components peptidoglycan (PepG) and lipoteichoic acid (LTA) of the gram-positive bacterium Streptococcus pyogenes in the pig. Specific pathogen-free pigs (20 kg bodyweight) were pretreated with metyrapone (a cortisol-synthesis inhibitor) and then were given 2-h infusions of 160 microg/kg of PepG (n = 5), 160 microg/kg LTA (n=5), or a combination of both (LTA + PepG, 160 microg/kg each, n = 5). Four hours after start of the infusions, the PepG, LTA, and LTA + PepG groups showed decreases in mean arterial pressure (change of -11%, -25%, and -47% from baseline, respectively), dynamic lung compliance (-18%, -24%, and -38%), arterial oxygen tension (-10%, -16%, and -37%), changes in blood leukocyte numbers (+11%, -27%, and -67%), and increases in pulmonary vascular resistance index (+7%, +106%, and +307% from baseline) and metabolic acidosis (base excess values decreased with 1.8, 2.3 and 8.1 units). The differences between the PepG and LTA + PepG groups were statistically significant (P < 0.05, Kruskal-Wallis tests), but not between LTA and LTA + PepG groups. However, no changes in systemic nitric oxide (NO) production could be detected, which is much in contrast to studies on lower order animals. Moreover, comparison of the results obtained using this model with those obtained in a model of endotoxin-induced septic shock showed distinct difference in the mechanisms by which gram-positive and gram-negative bacterial components exert their actions. For example, a marked fall in systemic blood pressure and dynamic lung compliance is seen in both models, but in the present gram-positive sepsis model, much less interleukin-8 and tumor necrosis factor-alpha are produced. In conclusion, this study showed that PepG and LTA act synergistically to cause respiratory failure and septic shock in the pig. The infusion of the combination of PepG and LTA in the pig could serve as a new, well-controlled model for studies of gram-positive sepsis.

Topics: Animals; Drug Synergism; Endothelin-1; Endotoxins; Female; Hydrocortisone; Interleukin-8; Leukocyte Count; Lipopolysaccharides; Lung Compliance; Male; Metyrapone; Nitric Oxide; Oxygen; Peptidoglycan; Pulmonary Circulation; Sepsis; Shock, Septic; Specific Pathogen-Free Organisms; Streptococcus pyogenes; Swine; Teichoic Acids; Tumor Necrosis Factor-alpha; Vascular Resistance

To determine the predictive value of early determination of tumor necrosis factor (TNF)-alpha, TNF-alpha 1 and 2 soluble receptors (sTNFR1 and sTNFR2) and endothelin-1 (ET-1) for mortality in patients with septic shock.. Prospective study.. Intensive care unit of a university hospital.. Twenty-one patients with septic shock.. None.. Patients with septic shock had a pulmonary artery catheter inserted and blood samples drawn at time zero, 6, 12 and 24 h, simultaneously with hemodynamic assessments. Plasma levels of all markers were measured by ELISA. All patients were followed up to hospital discharge or death. Age and APACHE II scores were significantly higher in nonsurvivors (n = 11) than in survivors (n = 10). Hemodynamic assessments did not aid in the discrimination between the two groups of patients (P > 0.05). Levels of TNF-alpha were higher in nonsurvivors than in survivors at all time-points. sTNFR1 and sTNFR2 were also significantly elevated in nonsurvivors, but not in all measurements. Endothelin-1, however, was significantly higher in nonsurvivors than in survivors only at 6 h (P = 0.02). When both TNF-alpha and ET-1 were increased at early time-points, the best predictive values for mortality were obtained [positive and negative predictive values of 72 and 100% at 6 h, odds ratio 3.0, 95% CI (1.2-7.6)].. Increased levels of TNF-alpha were consistently higher at all time-points in nonsurvivors with septic shock. ET-1 levels, however, appeared also to be an early and sensitive predictor of mortality. Very early determination of TNF-alpha and ET-1 in septic shock may help to identify patients at higher risk for adverse outcome.

Topics: Adult; Aged; Aged, 80 and over; Antigens, CD; APACHE; Critical Illness; Endothelin-1; Enzyme-Linked Immunosorbent Assay; Female; Hemodynamics; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Receptors, Tumor Necrosis Factor; Receptors, Tumor Necrosis Factor, Type I; Receptors, Tumor Necrosis Factor, Type II; Shock, Septic; Tumor Necrosis Factor-alpha

Topics: Animals; Endothelin-1; Gram-Positive Bacterial Infections; Humans; Nitric Oxide; Nitric Oxide Synthase; Sepsis; Shock, Septic

The systemic hypotension during human sepsis has been ascribed to increased production of nitric oxide (NO). Therefore, inhibitors of NO synthesis have been used in the treatment of hypotension in patients with septic shock. In addition, NO production may inhibit the synthesis and vasoconstrictor effects of endothelin-1 (ET-1). In this study, we tested whether ET-1 contributed to the vasopressor action of the NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) in patients with severe septic shock.. Compared with healthy volunteers, patients with septic shock had increased plasma levels of nitrite/nitrate (37+/-5 [SEM] versus 12+/-5 mmol/L, P<0.01), the stable end products of NO metabolism, and ET-1 (45+/-7 versus 3+/-2 pg/mL, P<0.001). Plasma ET-1 concentration was not related to plasma nitrite/nitrate concentration or blood pressure. Continuous infusion of L-NAME (1 mg. kg-1. h-1 IV) for 12 hours increased mean arterial pressure by 43+/-5% and systemic vascular resistance by 64+/-10% (both P<0.01). The increase in blood pressure and systemic vascular resistance correlated positively with the level of ET-1 (both P<0. 005) but not with plasma nitrite/nitrate level. L-NAME infusion did not result in significant changes in the plasma concentrations of ET-1 or nitrite/nitrate.. NO and ET-1 may both play a role in the cardiovascular derangements of human sepsis. Although L-NAME does not increase ET-1 concentration in patients with septic shock, the vasopressor response induced by L-NAME depends on the plasma level of ET-1. These findings may indicate that inhibitors of NO synthesis unmask a tonic pressor response of ET-1 in human septic shock.

Topics: Blood Pressure; Endothelin-1; Female; Humans; Male; Middle Aged; NG-Nitroarginine Methyl Ester; Nitrates; Nitric Oxide; Nitrites; Shock, Septic; Vascular Resistance

The renin angiotensin system is highly activated in shock states and has been suggested to be involved in the pathophysiology of the markedly deteriorated splanchnic circulation seen in septic shock. The purpose of the present study was to elucidate the capability of losartan, a nonpeptide angiotensin II type 1 (AT1) receptor antagonist, to attenuate splanchnic blood flow disturbances and counteract intestinal mucosal acidosis in endotoxin shock. A total of 20 pigs were anesthetized and catheterized. Central and regional hemodynamics were monitored. A tonometer in the ileum was used for measurement of mucosal pH. Onset of endotoxin challenge was followed by losartan administration (n = 10) 2 h later. Ten animals receiving endotoxin only served as controls. The experiments were terminated 5 h after onset of endotoxin challenge. Endotoxin infusion induced an hypodynamic shock with a reduction in cardiac index and systemic oxygen delivery. Losartan reduced both systemic vascular resistance and pulmonary capillary wedge pressure while stroke volume was improved. Pulmonary hypertension induced by endotoxin was significantly reduced by losartan without further changes in gas exchange. The profound reduction in gut oxygen delivery in response to endotoxin was counteracted by losartan administration. However, losartan failed to improve the markedly deteriorated intestinal mucosal pH and mucosal-arterial PCO2gap (i.e., difference in intestinal mucosal PCO2 and arterial PCO2). Also the mucosal-portal venous PCO2gap, used as a monitor of the mucosa in relation to the gut as a whole (including the spleen and pancreas), was greatly increased by endotoxemia but unaffected by losartan administration. In summary, although the angiotensin II type 1 receptor antagonist losartan improved gut oxygen delivery and reduced pulmonary hypertension during established endotoxin shock, it had no effect on intestinal mucosal acidosis. These findings suggest contribution of the angiotensin II type 1 receptor to perfusion disturbances, but not to deterioration of intestinal mucosal homeostasis seen during endotoxemia.

Topics: Acidosis; Angiotensin Receptor Antagonists; Animals; Antihypertensive Agents; Dose-Response Relationship, Drug; Endothelin-1; Endotoxins; Female; Hemodynamics; Hemoglobins; Intestinal Mucosa; Losartan; Lung; Male; Oxygen; Pulmonary Gas Exchange; Receptor, Angiotensin, Type 1; Receptor, Angiotensin, Type 2; Renin; Shock, Septic; Splanchnic Circulation; Swine; Urination

The endothelin system is highly activated during endotoxin and septic shock. To investigate this matter the selective non-peptide endothelin ET(B) receptor antagonist A-192621 ([2R-(2alpha,3beta, 4alpha)]-4-(1,3-benzodioxol-5-yl)-1-[2-[2, 6-diethylphenyl)amino]-2-oxoethyl]-2-(4-propoxy-phenyl)-3-py rrolidine carboxylic acid) was administered alone and in combination with the selective non-peptide endothelin ET(A) receptor antagonist PD 155080 (sodium 2-benzo[1, 3]dioxol-5-yl-3-benzyl-4-(4-methoxy-phenyl)-4-oxobut-2-enoat e) during established porcine endotoxin shock. Cardiopulmonary vascular function, metabolic parameters and plasma endothelin-1-like immunoreactivity levels were compared to a control group only receiving endotoxin. Administration of A-192621 alone resulted in cardiovascular collapse and death whereas combining A-192621 with PD 155080 abolished endotoxin induced pulmonary hypertension, enhanced cardiac performance and improved systemic oxygen delivery and acid-base balance. The beneficial effects of mixed endothelin ET(A)/ET(B) receptor antagonisms on the pulmonary and cardiovascular systems may result from blockage of constrictive endothelin receptors in and pulmonary circulation, reduced afterload and a direct inotropic effect. Possible mechanisms for the devastating effects by selective endothelin ET(B) receptor antagonism include increased endothelin ET(A) receptor-mediated vasoconstriction due to lack of endothelin ET(B) receptormediated vasodilation and decreased endothelin clearance from endothelin ET(B) receptor blockade. In conclusion, selective endothelin ET(B) receptor antagonism is deleterious whereas combined endothelin ET(A) and ET(B) receptor antagonism has favourable effects on haemodynamics, suggesting participation of the endothelin system in cardiopulmonary dysfunction during endotoxin shock.

Topics: Animals; Dioxoles; Endothelin Receptor Antagonists; Endothelin-1; Endotoxins; Female; Hemodynamics; Hemoglobins; Hydrogen-Ion Concentration; Male; Pulmonary Circulation; Pyrrolidines; Receptor, Endothelin A; Receptor, Endothelin B; Receptors, Endothelin; Shock, Septic; Swine

Recently much attention has been paid to the circulatory disturbance and peripheral vascular damage in patients with sepsis and septic shock. We intended to elucidate the interaction between nitric oxide (NO) and endothelin (ET)-1 under various pathological conditions by measuring the concentrations of NO3-, the principal metabolite of NO and immunoreactive ET-1. In cases with good prognosis after the septic shock, ET-1 was significantly higher as compared with these in sepsis without shock. In lethal cases with septic shock, these parameters were abnormally high as compared with the survived case. These levels elevated as the degree of severity progressed. When patients recovered from the septic shock, plasma ET-1 levels rapidly decreased. These results may mean that the level of the concentration of ET-1 plays a key role for prevention of the multiple organ failure even after the recovery from septic shock. The elevated level of NO3- during the initial several days in septic shock will mean that NO is acting to prevent platelet aggregation and to keep blood flow by dilating the arteries during septic shock. On the contrary, it may also be suggested that the elevated level of NO3- and ET-1 leads to the dysfunction of vascular endothelial cells and the apoptosis.

Topics: Adult; Biomarkers; Endothelin-1; Female; Humans; Male; Middle Aged; Multiple Organ Failure; Nitric Oxide; Prognosis; Sepsis; Severity of Illness Index; Shock, Septic

To elucidate the pathologic role of endothelin-1 (ET-1) in septic shock, we measured plasma ET-1 concentrations after bacterial lipopolysaccharide (LPS) administration in dogs and determined systemic, pulmonary, and renal hemodynamics and blood gas parameters with or without the nonselective ET receptor antagonist TAK-044. Plasma ET-1 concentrations increased significantly after LPS administration, which correlated positively with mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and central venous pressure. LPS infusion induced hypotension, metabolic acidosis, hypoxemia, and renal dysfunction. TAK-044 prevented LPS-induced metabolic acidosis, hypoxemia, and renal dysfunction, but not hypotension. These findings suggest that increased circulating ET-1 plays a compensatory role in the reversal of systemic vasodilatation in septic shock, but exerts deleterious effects on renal and pulmonary circulation.

Topics: Animals; Blood Gas Analysis; Blood Pressure; Dogs; Endothelin-1; Endotoxins; Escherichia coli; Hemodynamics; Lipopolysaccharides; Pulmonary Circulation; Pulmonary Wedge Pressure; Renal Circulation; Shock, Septic

Septic shock is a life-threatening disorder caused by lipopolysaccharide (LPS) and other bacterial products. Accumulating evidence indicates a role for vasoactive substances and cytokines in this disease process. In this study we examined the effect of LPS on the gene expression of endothelin-1 (ET-1) and adrenomedullin (AM), two major vasoactive peptides predominantly produced by vascular endothelial cells, to investigate their role in the pathophysiology of septic shock. LPS induced ET-1 and AM gene expression in the heart, lung, kidney, liver, and aorta within 6 h. In the liver, whereas basal ET-1 and AM mRNA were hardly detectable, ET-1 and AM gene expression and peptide production were markedly increased by LPS. This LPS-induced upregulation of ET-1 and AM expression is greatly potentiated by D-galactosamine (D-GalN), although D-GalN alone could not induce ET-1 and AM gene expression. These results, together with the previous findings that liver injury induced by LPS and D-GalN is mainly mediated by tumor necrosis factor-alpha (TNF-alpha), suggest that the LPS-cytokine pathway may cause upregulation of ET-1 and AM production, leading to dysregulation of systemic and regional vascular tone.

Topics: Adrenomedullin; Animals; Blotting, Northern; Endothelin-1; Endotoxins; Enzyme-Linked Immunosorbent Assay; Galactosamine; Lipopolysaccharides; Liver; Male; Mice; Mice, Inbred C57BL; Peptides; RNA; Shock, Septic; Up-Regulation

Topics: Antihypertensive Agents; Bosentan; Cytokines; Endothelin Receptor Antagonists; Endothelin-1; Endotoxins; Humans; Intestinal Mucosa; Intestines; Ischemia; Shock, Septic; Sulfonamides; Time Factors

Circulating endothelin-1 (ET-1) concentration increases significantly in animal models of sepsis. The main mechanism responsible for this rise in ET-1 levels is believed to be upregulation of ET-1 synthesis in various organs, such as the lungs and heart. In this study we investigated whether ET-1 is synthesized in the ventilatory muscles and whether this synthesis is regulated in septic shock. Conscious rats were injected with Escherichia coli endotoxin (lipopolysaccharide [LPS]) and killed 6, 12, and 24 h later. A fourth group of rats was injected with normal saline and served as a control. The diaphragm was excised at the end of the experiment and quickly frozen. Diaphragmatic ET-1 level was measured with radioimmunoassay, and messenger RNA (mRNA) expression of ET-1 precursor prohormone (preproET-1), preproET-3, and endothelin-converting enzyme was measured with reverse transcription-polymerase chain reaction. LPS injection elicited an early (within 6 h) and prolonged rise in diaphragmatic ET-1 concentration. In addition, mRNA levels of preproET-1 and preproET-3 rose by about 4- and 3-fold within 6 to 12 h of LPS injection, whereas mRNA of endothelin-converting enzyme increased by more than 10-fold and peaked within 24 h of LPS injection. Immunostaining with anti-ET-1 antibody revealed positive ET-1 staining in the endothelium and somatic muscle fibers of septic diaphragms. These results indicate that diaphragmatic muscle fibers synthesize significant amounts of ET-1 in septic shock and that the rise in ET-1 production is due to upregulation of ET precursors and the converting enzyme.

Topics: Animals; Aspartic Acid Endopeptidases; Diaphragm; Endothelin-1; Endothelin-Converting Enzymes; Endothelins; Immunohistochemistry; Lipopolysaccharides; Male; Metalloendopeptidases; Polymerase Chain Reaction; Protein Precursors; Rats; Rats, Sprague-Dawley; RNA, Messenger; Shock, Septic; Up-Regulation

To examine the relationship between the profound hypotension in endotoxic shock and the dynamic changes of nitric oxide (NO) and endothelin-1 (ET-1), so as to figure out which of the NO or ET-1 was more involved in the pathogenesis of endotoxic shock. And to investigate whether an offset of their opposite vasoactive effects would occur during endotoxic shock.. 24 rabbits were anesthetized and instrumented for recording hemodynamics. Endotoxin (E. coli 026: B6, 600 micrograms/kg) was bolus injected intravenously and the animals were randomly divided into four groups. Group I was control without any more intervention, and Group II, III, IV received bolus injections of L-NMA (10 mg/kg), phosphoramidon (2 mg/kg) or dexamethasone (2 mg/kg) respectively at 30 min post-endotoxin. Plasma NO3-, ET-1 and hemodynamics were measured at regular intervals. Their relationships were compared and analysed.. Plasma ET-1 achieved its peak level at 60 min post-endotoxin, and then waned. Plasma NO3- started rising at 120 min post-endotoxin, then progressive increase continued till the last measurement at 180 min post-endotoxin. The decrease of blood pressure was significant at about 120 min post-endotoxin and further went down until death. The changes of hemodynamics and NO showed a quite close temporal correspondence between the increase of NO and the decrease of blood pressure. L-NMA and phosphoramidon obviously reduced the plasma levels of NO and ET-1 to below their respective baseline levels, and showed transient effect of increase on blood pressure. Soon afterwards, however, the status of hemodynamics was aggravated. Dexamethasone just inhibited the excessive increase of NO and ET-1 during endotoxic shock without interfering their baseline levels and showed most beneficial effects on hemodynamics.. Both NO and ET-1 increase during endotoxic shock, but only the increase of NO has a close temporal correspondence with the decrease of blood pressure. It suggests a more important role of NO in pathogenesis of endotoxic shock. The increase of NO and ET-1 is different in time-process, which indicates that an offset of their opposite vasoactive effects would not occur. Intreference against the increase of NO and ET-1 during endotoxic shock is most beneficial when their baseline levels are maintained.

Topics: Animals; Blood Pressure; Dexamethasone; Endothelin-1; Glycopeptides; Hemodynamics; Male; Nitric Oxide; omega-N-Methylarginine; Rabbits; Random Allocation; Shock, Septic

A porcine model of endotoxemic shock was used to test the hypothesis that endothelins (ET) mediate the sustained increases in portal and pulmonary vascular resistances. Anesthetized pigs (n = 18) were instrumented and pretreated with 1) saline as a control; 2) indomethacin (Idm), a cyclooxygenase (Cox) inhibitor; or 3) Idm + bosentan (Bos), a mixed ET-receptor antagonist, and then were treated with endotoxin to produce shock and followed for 240 min. Global and regional hemodynamic parameters and plasma levels of ET-1 and thromboxane B2 were measured. The results show that 1) ET is independently responsible for the sustained increase in pulmonary vascular resistance; 2) ET and Cox products combine to increase portal venous resistance; 3) ET independently reduces cardiac output and attenuates or negates global systemic arterial vasodilation (presumptively mediated by nitric oxide) and exhibits regional differences, having little if any influence on the gut arterial bed. When considered with our prior study of nitric oxide regulation of the same beds in endotoxemic shock (N. Brienza, T. Ayuse, J. P. Revelly, C. P. O'Donnell, and J. L. Robotham, J. Appl. Physiol. 78: 784-792, 1995), the similarities between the portal venous and pulmonary arterial beds suggest that these two beds reflect phenomena occurring in microvascular and/or venous beds in multiple organs. The overall results suggest that a dynamic balance exists between NO and ET regulating arterial and microvascular and/or venous vasomotor activity during the evolution of endotoxemic shock.

Topics: Analysis of Variance; Animals; Bosentan; Cyclooxygenase Inhibitors; Endothelin Receptor Antagonists; Endothelin-1; Endothelins; Endotoxemia; Hemodynamics; Hypertension, Portal; Hypertension, Pulmonary; Indomethacin; Liver Circulation; Portal System; Pulmonary Artery; Pulmonary Circulation; Regional Blood Flow; Shock, Septic; Sulfonamides; Swine; Thromboxane B2; Vascular Resistance

In a porcine endotoxin shock model, the mixed nonpeptide endothelin receptor antagonist bosentan was administered 2 h after onset of endotoxemia (n = 8). Cardiopulmonary vascular changes, oxygen-related variables, and plasma levels of endothelin-1-like immunoreactivity were compared with a control group that received only endotoxin (n = 8). Bosentan abolished the progressive increase in mean pulmonary artery pressure and pulmonary vascular resistance seen in controls. Possible mechanisms include blockade of vasoconstrictive endothelin receptors, and a lesser degree of edema and inflammation indicated by less alveolar protein and a lower inflammatory cell count observed in bronchoalveolar lavage. Further, bosentan restored cardiac index to the pre-endotoxin level by an increase in stroke volume index, improved systemic oxygen delivery, and acid base balance. Because mean arterial blood pressure was unaffected, bosentan reduced systemic vascular resistance. Endotoxemia resulted in an increase in tumor necrosis factor-alpha and endothelin-1-like immunoreactivity plasma levels, the latter being further increased by bosentan. In conclusion, in porcine endotoxemia, treatment with the endothelin receptor antagonist bosentan, administered during fulminate shock, abolished pulmonary hypertension and restored cardiac index. These findings suggest that bosentan could be an effective treatment for reversing a deteriorated cardiopulmonary state during septic shock.

Topics: Acid-Base Imbalance; Animals; Bosentan; Cardiovascular Diseases; Endothelin Receptor Antagonists; Endothelin-1; Female; Hemoglobins; Hypertension, Pulmonary; Lactic Acid; Male; Oxygen Consumption; Shock, Septic; Sulfonamides; Swine; Treatment Outcome; Tumor Necrosis Factor-alpha

To evaluate the effects of removing circulatory tumor necrosis factor (TNF) by immunoadsorption on endotoxin shock animals.. Sixty New Zealand white rabbits were injected intravenously with lethal dose of endotoxin (10 Billion cfu/kg E. Coli endotoxin) and randomly divided into 3 groups: perfusion group, hemoperfusion started at 1 hour after injecting endotoxin through immunoadsorbent columns against TNF; pseudoperfusion group, hemoperfusion through blank columns; and control group, injected with endotoxin only. The arterial pressure, microcirculation of the mesentery, plasma levels of TNF, IL-1, IL-6, IL-8, nitrite, endothelin-1 (ET-1), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine were measured and analyzed and finally the survival rate was observed.. Plasma levels of TNF were sharply reduced after immunoadsorption. Moreover, release of IL-1, IL-6, IL-8, NO and ET-1 were also attenuated. Hemodynamic abnormalities could be improved and survival rate ameliorated significantly.. Specific immunoadsorption of circulating TNF might be a new and effective therapy for endotoxin shock.

Topics: Animals; Endothelin-1; Immunosorbent Techniques; Interleukin-1; Interleukin-6; Interleukin-8; Rabbits; Random Allocation; Shock, Septic; Tumor Necrosis Factor-alpha

1. To evaluate the possible contribution of endothelin-1 (ET-1) to the pathophysiology of porcine septic shock, the non-peptide, mixed ET-receptor antagonist, bosentan (RO 47-0203) was administered (5 mg kg-1, i.v.) 30 min before infusion of lipopolysaccharide (LPS) (E. coli., serotype 0111:B4) (15 micrograms kg-1 h-1) and at 3.5 h of endotoxaemia in six anaesthetized and mechanically ventilated pigs. Six other pigs served as controls and received only LPS infusion. Pulmonary and systemic haemodynamics as well as splenic, renal and intestinal blood flows were measured continuously. Release and synthesis of ET-1 and Big ET-1 were also measured. 2. Only three of the six pigs in the control group survived 3 h of LPS infusion while in the bosentantreated group all six pigs were alive at that time. A biphasic increase in mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR) was seen in control pigs. Pretreatment with bosentan did not influence the first peak but markedly attenuated the second, more prolonged increase in MPAP and PVR. The second dose of bosentan completely restored these parameters to pre-LPS levels. The LPS-induced changes in mean arterial blood pressure, heart rate and systemic vascular resistance were similar in both groups, while cardiac output (CO) was significantly higher in the bosentan-treated group. The second bosentan dose increased CO and splenic and intestinal blood flow without further lowering of blood pressure. 3. Bosentan caused an increase of the basal arterial plasma levels of ET-1-like immunoreactivity (LI), from 16.8 +/- 1.3 pM to 49.6 +/- 10.0 pM (n = 6, P < 0.01). However, the rate of the increase of ET-1 levels during the LPS infusion was not affected by bosentan. Repeated administration of bosentan during LPS infusion caused an additional increase of ET-1-LI levels. Neither the basal levels of Big ET-LI nor the LPS induced 8 fold increase in Big ET-LI were changed by bosentan. The level of preproET-1 mRNA in the lung was increased about 3 fold after 4.5 h of LPS treatment. This elevation was not influenced by bosentan. 4. From these studies using bosentan, a non-peptide, selective and mixed ET-receptor antagonist, we conclude that during LPS-induced shock bosentan can abolish the late phase pulmonary hypertension and improve cardiac output as well as increase blood flow to the splenic and intestinal vascular beds without causing a further decrease in mean arterial blood pressure. Further investi

Topics: Animals; Blood Pressure; Bosentan; Dose-Response Relationship, Drug; Endothelin-1; Female; Heart Rate; Lipopolysaccharides; Male; Pulmonary Circulation; Shock, Septic; Sulfonamides; Swine; Time Factors; Vascular Resistance