transforming-growth-factor-beta and Shock--Septic

Topics: Animals; Cytokines; Disease Models, Animal; High Mobility Group Proteins; Humans; Inflammation; Interferon-gamma; Interleukins; Macrophage Migration-Inhibitory Factors; Mice; Mice, Knockout; Shock, Septic; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha

The purpose of this study was to examine the pattern of tumor necrosis factor (TNF)-alpha and interleukin (IL)-10 release in endotoxin-stimulated septic monocytes and to determine the role of IL-10 and transforming growth factor (TGF)-beta in monocyte hyporesponsiveness during septic shock.. Monocytes isolated from ten healthy controls and ten patients with septic shock were incubated with endotoxin and cytokine release was assessed. Next, normal monocytes were incubated with either normal or septic serum and stimulated with endotoxin. Finally, normal monocytes were incubated with septic serum either with anti-IL-10 antibodies or anti-TGF-beta antibodies and then stimulated with endotoxin.. TNF-alpha, IL-10, and TGF-beta levels were measured in the serum and in culture supernatants by enzyme-linked immunosorbent assay.. Research laboratory.. IL-10 and TNF-alpha levels were significantly increased in septic serum, whereas TGF-beta levels were not different from controls. Normal monocytes increased TNF-alpha and IL-10 release in response to endotoxin. In contrast, septic monocyte TNF-alpha release was attenuated in response to endotoxin (1.8 +/- 0.5 vs. 1.0 +/- 0.4 ng/mL, stimulated vs. baseline), whereas IL-10 release increased significantly from baseline (173 +/- 91 vs. 8 +/- 4 pg/mL, stimulated vs. baseline). Incubation of normal monocytes with septic serum attenuated TNF-alpha release in response to endotoxin (32% +/- 8% of normal serum; p < .01), whereas IL-10 release was increased (285% +/- 84% of normal serum; p < .05). When normal monocytes were incubated with septic serum combined with anti-IL-10 antibodies, TNF-alpha release increased significantly to 75% +/- 17% of normal serum (p < .05 vs. septic serum alone). Incubation of normal monocytes with anti-TGF-beta antibodies did not significantly affect either TNF-alpha or IL-10 release in response to endotoxin.. Monocytes from patients with septic shock exhibit persistent IL-10 release at a time when TNF-alpha release is downregulated. The continued release of IL-10 may contribute to impairment of monocyte proinflammatory cytokine release and the development of immune dysfunction in septic shock.

Topics: Down-Regulation; Endotoxins; Female; Humans; Immune Tolerance; Interleukin-10; Male; Middle Aged; Monocytes; Regression Analysis; Shock, Septic; Statistics, Nonparametric; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha

Short-chain fatty acids (SCFAs) with the anti-inflammatory capacity are produced by intestinal bacteria; however, their effect on the acute systematical inflammation remains unclear. This study aimed to investigate the effects of SCFAs, acetate, propionate and butyrate, on septic shock and the underlying mechanism. The LPS-induced septic model was used to evaluate the function of SCFAs by survival rate observation. Only butyrate, but not acetate or propionate, significantly decrease the mortality of septic mice. At 2 h and 6 h of LPS administration, the levels of TNF-α, IL-6 and IL-1β in plasma were measured by ELISA to estimate the effects of butyrate pretreatment on excessive inflammation. And the anti-inflammatory mediators including TGF-β, IL-10 and LXT4 in plasma were detected for further mechanism study in septic mice. Moreover, the murine macrophage-like RAW 264.7 cells were stimulated by LPS to further confirm the finding in vivo. Pretreatment with butyrate led to significant attenuation of the LPS-induced elevation of TNF-α, IL-6 and IL-1β levels. However, when detecting the anti-inflammatory factors, a significant increase in IL-10, but not TGF-β or LXT4, was shown in butyrate-pretreated group. Pretreatment of RAW 264.7 cells with butyrate led to downregulation of LPS-induced pro-inflammatory mediators, IL-6 and IL-1β, but did not affect the level of TNF-α, and increased IL-10 (P < 0.01). In conclusion, SCFA butyrate significantly attenuated the inflammation against sepsis through upregulation of anti-inflammatory IL-10.

Topics: Acetates; Animals; Anti-Inflammatory Agents; Butyrates; Cell Line; Enzyme-Linked Immunosorbent Assay; Inflammation; Interleukin-10; Interleukin-1beta; Interleukin-6; Lipopolysaccharides; Male; Mice; Mice, Inbred ICR; Propionates; RAW 264.7 Cells; Shock, Septic; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha

Sepsis is one of the highest causes of mortality in hospitalized people and a common complication in both surgical and clinical patients admitted to hospital for non-infectious reasons. Sepsis is especially common in older people and its incidence is likely to increase substantially as a population ages. Despite its increased prevalence and mortality in older people, immune responses in the elderly during septic shock appear similar to that in younger patients. The purpose of this study was to conduct a genome-wide gene expression analysis of circulating neutrophils from old and young septic patients to better understand how aged individuals respond to severe infectious insult. We detected several genes whose expression could be used to differentiate immune responses of the elderly from those of young people, including genes related to oxidative phosphorylation, mitochondrial dysfunction and TGF-β signaling, among others. Our results identify major molecular pathways that are particularly affected in the elderly during sepsis, which might have a pivotal role in worsening clinical outcomes compared with young people with sepsis.

Topics: Adult; Aged; Aged, 80 and over; Female; Gene Expression Profiling; Gene Expression Regulation; Humans; Male; Middle Aged; Neutrophils; Oligonucleotide Array Sequence Analysis; Oxidative Phosphorylation; Prevalence; Real-Time Polymerase Chain Reaction; RNA; Shock, Septic; Signal Transduction; Transforming Growth Factor beta

Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock.. We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 μg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy.. Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normalization of pH (P = .046) and P(aCO2) (P = .008); reduction of lactate (P = .001); and an increase in P(aO2) (P = .03), arterial oxygen saturation (P = .02), and P(aO2)/F(IO2) (P = .034), 15 min after it was applied.. The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters.

Topics: Aged; Blood Pressure; Carbon Dioxide; Female; Heart Rate; Humans; Hydrogen-Ion Concentration; Lactic Acid; Male; Middle Aged; Nitric Oxide; Oxygen; Partial Pressure; Physical Therapy Modalities; Respiratory Rate; Shock, Septic; Suction; Thiobarbituric Acid Reactive Substances; Thorax; Time Factors; Transforming Growth Factor beta; Vibration

Acute lung injury is a common disorder with a high mortality rate, but previous efforts to develop drugs to treat this disorder have been unsuccessful. In an effort to develop more effective treatments, we have been studying the molecular pathways that regulate the dysfunction of alveolar epithelial cells and endothelial cells that serve as a final common pathway leading to alveolar flooding. Using integrin subunit knockout mice and antibodies we developed by immunizing these mice, we have found important and distinct roles for the αvβ6 integrin on epithelial cells and the αvβ5 integrin on endothelial cells in mediating increases in alveolar permeability in multiple models of acute lung injury. We have also found therapeutic effects of αvβ5 inhibition in two models of septic shock even when the antibody was administered to animals that were obviously ill. These results identify αvβ6 and αvβ5 as promising therapeutic targets for the treatment of acute lung injury and septic shock.

Topics: Acute Lung Injury; Animals; Antigens, Neoplasm; Capillary Permeability; Endothelial Cells; Epithelial Cells; Integrin alphaVbeta3; Integrins; Mice; Pulmonary Alveoli; Receptors, Vitronectin; Shock, Septic; Transforming Growth Factor beta

Smooth muscle alpha-actin (SMA) is a cytoskeletal protein characteristic to vascular smooth muscle cells (VSMC), and it serves to facilitate cell contraction and migration. Bacterial lipopolysaccharide (LPS), a major mediator of septic shock secondary to infection, is known to directly affect VSMC. The objective of this study was to investigate the effect of LPS on the expression levels of SMA in VSMC.. This study was performed on cultured VSMC derived from human aorta, human coronary artery, or rat aorta.. We show that SMA expression in VSMC, induced by endothelin-1 (ET1) or transforming growth factor-beta (TGF-beta), is potently inhibited by a LPS. This parallels a decreased migration of VSMC after LPS treatment. Downregulation of SMA by LPS is not a result of altered signaling of ET1 or TGF-beta receptors, and it is not mediated by canonical (for LPS) mechanisms, such as production of prostaglandins or nitric oxide, or secretion of other endocrine factors. On a molecular level, downregulation of SMA expression by LPS occurs at the level of transcription, as both SMA mRNA levels and SMA promoter activity are inhibited by LPS. The SMA promoter is controlled largely by two major regulatory elements-CArG boxes activated by serum response factor (SRF), and TGF-beta control elements (TCE). LPS does not affect the activity of SRF, but it potently inhibits both basal and inducible TCE activation.. We show for the first time that LPS attenuates SMA transcription and protein expression in VSMC likely through inhibition of a TCE element on the SMA promoter.

Topics: Actins; Animals; Aorta; Cell Movement; Cells, Cultured; Coronary Vessels; Down-Regulation; Gene Expression; Humans; Lipopolysaccharides; Myocytes, Smooth Muscle; Rats; Rats, Inbred WKY; Shock, Septic; Transcription, Genetic; Transforming Growth Factor beta

Direct hemoperfusion (DHP) with polymixin B-immobilized fiber (PMX) has been reported to be effective for patients with septic shock. The aim of this study was to clarify the mechanism of PMX-DHP effect on septic shock.. The following parameters were measured in septic shock patients who were treated with PMX-DHP: survival rate, sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE-II) score, and plasma concentrations of cannabinoids [anandamide (ANA) and 2-arachidonyl glyceride (2-AG)], cytokines [interleukin (IL)-6, IL-8, IL-10], transforming growth factor beta (TGF-beta), and calcitonin gene-related peptide (CGRP)]. The primary end point was mortality from all causes at day 28 after intensive care unit (ICU) admission or discharge.. The survival rate of all patients at 28 days after ICU admission was 37.5% (9/24). The survival group showed significantly lower SOFA and APACHE-II scores than the nonsurvival group after PMX-DHP treatment (P = 0.008 and 0.028, respectively). The improved SOFA score group showed a better survival rate than the nonimproved SOFA score group (71.4% versus 23.5%, P = 0.028). Plasma ANA level significantly decreased after PMX-DHP treatment both in the improved SOFA score group and in the survival group. The level of 2-AG, however, showed no significant change in either group.. ANA, an intrinsic cannabinoid that induces hypotension in septic shock, is inferred to be the main mechanism of the PMX-DHP effect. Removal of ANA by PMX-DHP could be key to successful septic shock treatment.

Topics: Adult; Aged; APACHE; Arachidonic Acids; Calcitonin Gene-Related Peptide; Endocannabinoids; Female; Hemoperfusion; Humans; Male; Middle Aged; Multiple Organ Failure; Polymyxin B; Polyunsaturated Alkamides; Prognosis; Prospective Studies; Shock, Septic; Survival Rate; Transforming Growth Factor beta

A considerable amount of research has focused on elucidating the mechanisms by which cytokines synthesized by cells of the innate immune system participate in the life-threatening multiple-organ failure of endotoxic shock. We show here that alphabeta T cells, which are archetypes of the adaptive cellular immune response, suppress the proinflammatory cascade triggered during the early stages of lipopolysaccharide (LPS)-induced endotoxemia. The absence of alphabeta T cells led to the fulminant death of LPS-challenged mice, coinciding with a massive release of the proinflammatory cytokines tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma and a marked reduction in the synthesis of the immunosuppressive cytokine transforming growth factor (TGF)-beta. Cytotoxic T lymphocyte antigen (CTLA)-positive alphabeta T cells emerging shortly after LPS challenge appear to control TGF-beta synthesis. The neutralization of either TGF-beta or CTLA4 resulted in similar increases in IFN-gamma and TNF-alpha serum concentrations in LPS-challenged mice. These observations suggest that suppressor alphabeta T lymphocytes protect against the proinflammatory cascade unleashed during the innate stages of endotoxemia.

Topics: Animals; Disease Models, Animal; Endotoxemia; Immunity, Innate; Lipopolysaccharides; Mice; Mice, Inbred C57BL; Receptors, Antigen, T-Cell, alpha-beta; Shock, Septic; Survival Analysis; T-Lymphocytes, Regulatory; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha

The structural component of Gram- bacteria, endotoxin (ET), induces the release of endogenous mediators of sepsis. Attempts to remove these downstream molecules in vivo, have not improved survival. However, extracorporeal strategies such as continuous renal replacement therapy or therapeutic plasmapheresis have shown benefit. We are presenting an affinity-based extracorporeal technology for the removal of ET from whole blood. The small-scale device contains an adsorbent that removed 75% of ET present in whole blood. This affinity resin displayed good hemocompatibility regarding the coagulation pathway. Minimal platelet, neutrophil and complement activation were observed. There was also no evidence of consumption of coagulation factors or cell loss. In as much as ET participates in both the inflammatory and coagulation abnormalities in sepsis, this method represents an efficient and hemocompatible way to remove ET from whole blood, which, in an extracorporeal setting, may improve the outcome of sepsis.

Topics: Adsorption; Anti-Infective Agents; Blood Coagulation Factors; Cell Count; Chromatography, Affinity; Complement C3a; Endotoxins; Fibrinogen; Gram-Negative Bacterial Infections; Hemostasis; Humans; Leukocyte Elastase; Ligands; Monocytes; Ofloxacin; Sepharose; Shock, Septic; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha

To observe the influence of Niupo Zhibao pellet (NZP) on transforming growth factor-beta1 (TGF-beta1) and its receptor's expression.. Endotoxic shock model was established by intravenous injection of lipopolysaccharide (LPS) 1.5 mg/kg and intraperitoneal injection of D-galactosamine 100 mg/kg, and intervened by NZP, TGF-beta1 and its receptor's expression in lung tissue were detected by immunohistochemical method.. NZP could enhance the TGF-beta1 and its receptor's expression in endotoxic shock lung tissue, and reduce the injury of lung.. The mechanism of NZP in reducing endotoxic shock lung injury is possibly related with its effect in enhancing the TGF-beta1 and its receptor's expression in lung tissue.

Topics: Animals; Drugs, Chinese Herbal; Female; Galactosamine; Lipopolysaccharides; Male; Rats; Rats, Sprague-Dawley; Receptors, Transforming Growth Factor beta; Respiratory Distress Syndrome; Shock, Septic; Transforming Growth Factor beta; Transforming Growth Factor beta1

A new experimental drug, pirfenidone (5-methyl-1-phenyl-1H-pyridine-one; S-7701), has been reported to have beneficial effects for the treatment of certain fibrotic diseases. We investigated the anti-inflammatory properties in murine endotoxic shock to determine the pharmacological characteristics. The present study describes the prophylactic effect, cytokine regulatory profiles and therapeutic effect of pirfenidone in murine endotoxic shock, which was induced in mice using an intraperitoneal (i.p.) injection of lipopolysaccharide and D-galactosamine. First, we examined the prophylactic effect and cytokine regulatory profiles. A single oral administration of pirfenidone prior to lipopolysaccharide/D-galactosamine challenge inhibited the production of circulating tumor necrosis factor-alpha (TNF-alpha), interleukin-12 and interferon-gamma, markedly enhanced that of interleukin-10, and offered protection from subsequent lethal symptoms in a dose-dependent manner. Second, we examined the therapeutic effect. A single oral administration of pirfenidone 1, 2, 3, 4 and 5 h post lipopolysaccharide/D-galactosamine challenge provided protection against lethal shock in a time-dependent manner. At the histopathological level, apoptotic positive cells were found to be suppressed in the liver. The transforming growth factor (TGF)-beta1 level was markedly elevated in the liver of lipopolysaccharide/D-galactosamine-challenged mice, suppressed in pirfenidone-treated mice. These findings may offer an alternative for both protective and therapeutical treatment of several human acute or chronic inflammatory diseases by pirfenidone.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Apoptosis; Galactosamine; Interferon-gamma; Interleukin-10; Interleukin-12; Lipopolysaccharides; Liver; Liver Failure; Mice; Mice, Inbred C57BL; Necrosis; Pyridones; Shock, Septic; Transforming Growth Factor beta; Transforming Growth Factor beta1; Tumor Necrosis Factor-alpha

Major surgery, multiple injury, and severe sepsis lead to an impaired immune response. The suppressed status of the immune system is reflected by a reduced TNFalpha production of whole blood after stimulation with endotoxin in vitro and by a decreased HLA-DR expression on monocytes. In the present study, the effect of the immunostimulating hematopoetic growth factor GM-CSF on whole blood cultures of multiple injury, cardiac surgery, and severe sepsis patients was investigated. Endotoxin-induced TNFalpha production and HLA-DR expression was reduced in blood cultures of these patients compared to healthy donors. Preincubation with GM-CSF in vitro increased cytokine production in volunteers' and all patients' blood specimens in a dose-dependent manner. The elevation of cytokine response in cardiopulmonary bypass patients' blood, caused by in vitro preincubation with GM-CSF, equaled that of normal patients, whereas GM-CSF caused a lower rise of TNFalpha-producing capacity in blood of multiple-injury and sepsis patients. Further, GM-CSF treatment in vitro increased the down-regulated HLA-DR expression on monocytes prepared after cardiac surgery to a degree comparable to preoperative levels. Finally, GM-CSF incubation in vitro elevated TNFalpha synthesis in normal monocytes and in cells treated with a combination of the anti-inflammatory mediators IL-10, TGFbeta, and PGE2. These experiments show that hyporesponsiveness of whole blood induced by trauma, sepsis, or cardiac surgery is not irreversible but can be, at least in vitro, overridden by the immunostimulating compound GM-CSF.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Cells; Cardiopulmonary Bypass; Cells, Cultured; Dinoprostone; Endotoxins; Female; Granulocyte-Macrophage Colony-Stimulating Factor; HLA-DR Antigens; Humans; Interleukin-10; Male; Middle Aged; Shock, Septic; Transforming Growth Factor beta; Tumor Necrosis Factor-alpha; Wounds and Injuries

Heme oxygenase (HO)-1 generates CO, a gas with vasodilatory properties, during heme metabolism. HO-1 is expressed highly in vascular tissue after endotoxin stimulation, and generation of CO through the HO-1 pathway contributes to the hemodynamic compromise of endotoxic shock. Shock related to endotoxemia is an immune-mediated process that involves the generation of proinflammatory cytokines such as interleukin (IL)-1beta. Because transforming growth factor (TGF)-beta1 is a modulator of immune-mediated inflammatory responses and it blocks the hypotension of endotoxic shock, we determined whether TGF-beta1 could be used to reduce expression of HO-1 in vascular tissue and smooth muscle cells. In a rat model of endotoxic shock, lipopolysaccharide-induced HO-1 mRNA and protein expression was reduced by TGF-beta1 in highly vascularized tissue, such as heart and lung, by Northern and Western analysis. Furthermore, TGF-beta1 downregulated HO-1 mRNA after its induction by IL-1beta in vascular smooth muscle cells in culture. TGF-beta1 also decreased HO-1 but not HO-2 protein expression in these cells. TGF-beta1 decreased HO enzyme activity induced in IL-1beta treated vascular smooth muscle cells to a level not different from that in vehicle-treated cells. These studies suggest that this downregulation of HO-1 mRNA and protein expression and decrease in IL-1beta-induced HO enzyme activity may contribute to the beneficial effect of TGF-beta1 on endotoxic shock.

Topics: Animals; Down-Regulation; Endotoxemia; Enzyme Induction; Heme Oxygenase (Decyclizing); Male; Muscle, Smooth, Vascular; Rats; Rats, Sprague-Dawley; Salmonella typhi; Shock, Septic; Transforming Growth Factor beta; Vasodilation

Endotoxin induced suppression of cellular immune function is thought to contribute to septic complications in trauma patients. A rabbit model of endotoxemia was used to determine the relative roles of the anti-inflammatory factors interleukin-4 (IL-4), interleukin-10 (IL-10), transforming growth factor beta1 (TGFbeta1), and prostaglandin E2 (PGE2) in addition to other factors, in inducing immunosuppression.. T-cell suppressive factors (TSF) in serum ultrafiltrates were separated and tested for the presence of the known suppressive factors PGE2, IL-4, IL-10, and TGFbeta1.. New Zealand rabbits were injected with 50 microg/kg of purified Escherichia coli lipopolysaccharide. Animals were exsanguinated after 48 hours and serum was separated by ultrafiltration (cutoff 50 kd), TSK HW-40 size exclusion chromatography, and Q-Sepharose anion exchange chromatography. TSF activities of chromatographic fractions and serum samples were measured with a mitogen induced in vitro T-cell proliferation assay. Levels of PGE2, IL-4, IL-10, and TGFbeta1 were measured with enzyme immunoassays.. Serum TSF activity, and levels of PGE2, IL-4, IL-10, and TGFbeta1 were increased after endotoxemia. Size exclusion chromatography revealed three major fractions (TSF1-3) with up to 600 times more TSF activity compared with controls. IL-4 and IL-10 were found in TSF1 and TSF3. Further separation of TSF1 by anion exchange chromatography revealed a total of eight different T-cell suppressive factors. TGFbeta1 probably remained in the retentate after ultrafiltration, while PGE2 eluted at a higher retention time. The known anti-inflammatory factors TGFbeta1, IL-10, IL-4, and PGE2 only accounted for 13% of the total serum TSF activity of 614 U/mL.. Lipopolysaccharide shock results in the release of multiple T-cell suppressive factors in addition to known immunosuppressive factors, all of which contribute to the anti-inflammatory response.

Topics: Animals; Chromatography, Gel; Chromatography, Ion Exchange; Dinoprostone; Disease Models, Animal; Escherichia coli Infections; Immune Tolerance; Interleukin-10; Interleukin-4; Male; Rabbits; Shock, Septic; Suppressor Factors, Immunologic; Transforming Growth Factor beta

We have developed a functional assay to study the inflammatory capacity of plasma collected from patients with severe gram-negative septic shock. In this assay, elutriation-purified, cryo-preserved human monocytes from one healthy donor are combined with plasma from patients with severe persistent septic shock for 5 h. Subsequently, the plasma is removed, medium added, and procoagulant activity (PCA) and secretion of tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6) measured after 18-h incubation. Plasma from 10 patients (6 died) infected with Neisseria meningitidis previously shown to contain high levels of native lipopolysaccharide (LPS) (median 2,700 pg/ml), TNF-alpha, IL-6, IL-8, and complement activation products, had a low net spontaneous inflammatory capacity on the monocytes. The median levels of PCA, TNF-alpha, and IL-6 were 5, 0, and 4%, respectively, of the monocyte activities induced by normal plasma boosted with purified N. meningitidis (Nm)-LPS (2,500 pg/ml; net LPS-boosted capacity, 100%). The levels of PCA, TNF-alpha, and IL-6 obtained with plasma from shock patients were not different from those induced by plasma from 10 meningococcal patients without shock or with plasma from healthy persons. Boosting shock plasma with 2,500 pg/ml Nm-LPS had little effect on the monocyte activities since the median values of PCA, TNF-alpha, and IL-6 revealed a minimal increase from 5, 0, and 4% to 9, 2, and 6%, respectively. The shock plasmas revealed a strong LPS-inhibitory capacity that was largely absent in plasmas from 10 meningococcal patients without shock since the median levels of PCA, TNF-alpha, and IL-6 increased from 5, 0, and 0% to 135, 51, and 73%, respectively, after boosting with 2,500 pg/ml Nm-LPS. The LPS-inhibitory capacity was closely associated with the levels of IL-10. The median levels of IL-10 were 19,000 pg/ml in nine shock patients vs. 22 pg/ml in nine nonshock patients with systemic meningococcal disease. Removal of native IL-10 by immunoprecipitation restored the capacity of plasmas to induce monocyte activation either by native LPS or by boosting with Nm-LPS. IL-4 and TGF-beta were not detected in shock plasmas. In 24 patients with detectable meningococcal LPS ( > 10 pg/ml, 0.1 endotoxin units/ml), the levels of IL-10 were correlated to the levels of LPS (r = 0.79, P < 0.001). IL-10 declined from initiation of antibiotic therapy and paralleled the levels of native LPS. Decreasing levels of IL-10 in serially coll

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Inflammation; Interleukin-10; Interleukin-4; Lipopolysaccharides; Male; Meningococcal Infections; Monocytes; Neisseria meningitidis; Shock, Septic; Time Factors; Transforming Growth Factor beta

Septic shock is a cytokine-mediated process typically caused by a severe underlying infection. Toxins generated by the infecting organism trigger a cascade of events leading to hypotension, to multiple organ system failure, and frequently to death. Beyond supportive care, no effective therapy is available for the treatment of septic shock. Nitric oxide (NO) is a potent vasodilator generated late in the sepsis pathway leading to hypotension; therefore, NO represents a potential target for therapy. We have previously demonstrated that transforming growth factor (TGF) beta1 inhibits inducible NO synthase (iNOS) mRNA and NO production in vascular smooth muscle cells after its induction by cytokines critical in the sepsis cascade. Thus, we hypothesized that TGF-beta1 may inhibit iNOS gene expression in vivo and be beneficial in the treatment of septic shock. In a conscious rat model of septic shock produced by Salmonella typhosa lipopolysaccharide (LPS), TGF-beta1 markedly reduced iNOS mRNA and protein levels in several organs. In contrast, TGF-beta1 did not decrease endothelium-derived constitutive NOS mRNA in organs of rats receiving LPS. We also performed studies in anesthetized rats to evaluate the effect of TGF-beta1 on the hemodynamic compromise of septic shock; after an initial 25% decrease in mean arterial pressure, TGF-beta1 arrested LPS-induced hypotension and decreased mortality. A decrease in iNOS mRNA and protein levels in vascular smooth muscle cells was demonstrated by in situ hybridization and NADPH diaphorase staining in rats treated with TGF-beta1. Thus these studies suggest that TGF-beta1 inhibits iNOS in vivo and that TGF-beta1 may be of future benefit in the therapy of septic shock.

Topics: Animals; Base Sequence; Enzyme Induction; Gene Expression; Hypotension; Kidney; Lipopolysaccharides; Lung; Male; Muscle, Smooth; Nitric Oxide Synthase; Rats; Rats, Sprague-Dawley; RNA, Messenger; Shock, Septic; Spleen; Transforming Growth Factor beta