flavin-adenine-dinucleotide and Sepsis

Diminished availability of oxygen at the cellular level might account for organ dysfunction in sepsis. Although the classical forms of tissue hypoxia due to hypoxemia, anemia, or inadequate perfusion all might be important under some conditions, it seems increasingly likely that a fourth mechanism, namely cytopathic hypoxia, might play a role as well. The term cytopathic hypoxia is used to denote diminished production of adenosine triphosphate (ATP) despite normal (or even supranormal) PO2 values in the vicinity of mitochondria within cells. At least in theory, cytopathic hypoxia could be a consequence of several different (but mutually compatible) pathogenic mechanisms, including diminished delivery of a key substrate (e.g., pyruvate) into the mitochondrial tricarboxylic acid (TCA) cycle, inhibition of key mitochondrial enzymes involved in either the TCA cycle or the electron transport chain, activation of the enzyme, poly-(ADP)-ribosylpolymerase (PARP), or collapse of the protonic gradient across the inner mitochondrial membrane leading to uncoupling of oxidation (of NADH and FADH) from phosphorylation of ADP to form ATP. Tantalizing, but limited, data support the view that cytopathic hypoxia occurs in both animals and patients with sepsis or endotoxemia.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Anemia; Animals; Cell Hypoxia; Citric Acid Cycle; Electron Transport; Endotoxemia; Enzyme Activation; Enzyme Inhibitors; Flavin-Adenine Dinucleotide; Humans; Hypoxia; Mitochondria; NAD; Oxidation-Reduction; Oxygen; Oxygen Consumption; Phosphorylation; Poly(ADP-ribose) Polymerases; Pyruvates; Sepsis

Although blood neutrophils with toxic granulation provide an excellent means of evaluating acute bacterial infections, the methods are labor-intensive and their reproducibilities depend on the staining technique and the observer's judgment. We measured the flavin adenine dinucleotide (FAD) content of normal neutrophils and neutrophils with toxic granulation by flow cytometry after incubating them with bis(Zn(2+)-dipicolylamine) complex. A total of 122 blood samples (78 with neutrophils with toxic granulation, 44 with normal neutrophils without toxic granulation) were analyzed. The mean autofluorescence levels of neutrophils in the toxic granulation (+) group and toxic granulation (-) group were both 1.9 x 10(3) MESF (mean equivalent soluble fluorochrome) values. However, after incubating neutrophils with bis(Zn(2+)-dipicolylamine) complex for 15 min, the mean fluorescence intensities of neutrophils in the toxic granulation (+) and toxic granulation (-) groups were significantly enhanced by 71- and 19-fold to 138+/-78 x 10(3) MESF and 37+/-37 x 10(3) MESF, respectively (p <0.001). An MESF cutoff value of 79 x 10(3) showed a sensitivity of 93.2% and a specificity of 81.8% for neutrophils with toxic granulation. Similarly, the MESF level ratio, defined as the ratio of the MESF value after incubation with bis(Zn(2+)-dipicolylamine) complex to the autofluorescence MESF value, at a cutoff value of 41, showed a sensitivity of 92.3% and a specificity of 81.8% for the detection of neutrophils with toxic granulation. The MESF values of neutrophils after incubation with bis(Zn(2+)-dipicolylamine) complex did not correlate with the leukocyte (p >0.05) or neutrophil counts (p >0.05). In conclusion, measurement of FAD fluorescence intensity in neutrophils by flow cytometry after incubation with bis(Zn(2+)-dipicolylamine) complex is an easy, objective, and reliable method of detecting neutrophils with toxic granulation.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amines; Bacterial Infections; Child; Female; Flavin-Adenine Dinucleotide; Granuloma; Hematopoietic Stem Cell Transplantation; Humans; Indicators and Reagents; Leukemia; Leukocyte Count; Male; Middle Aged; Neutrophils; Picolinic Acids; Sepsis; Young Adult

It is increasingly apparent that organ dysfunction in sepsis is caused, at least in part, by an acquired intrinsic derangement in cellular oxidative adenosine triphosphate (ATP) production. We have termed this phenomenon "cytopathic hypoxia". Although several different but mutually compatible mechanisms might account for the development of cytopathic hypoxia in sepsis, recent data from our laboratory point to activation of the nuclear enzyme, poly-ADP-ribosyl polymerase (PARP), as being the most important.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Aerobiosis; Animals; Cell Hypoxia; Enzyme Activation; Flavin-Adenine Dinucleotide; Humans; Mitochondria; NAD; Phosphorylation; Poly(ADP-ribose) Polymerases; Sepsis