RESUMEN
Fine bubbles (FBs) are bubbles with sizes less than 100 µm and are divided into ultrafine bubbles (UFBs, < 1 µm) and microbubbles (MBs, 1-100 µm) depending on their size. Although FB aeration is known as a more efficient way than macrobubble aeration to increase the oxygen level in unoxygenated water, few reports have demonstrated whether dispersed UFBs work as oxygen carriers or not. Furthermore, oxygen supersaturation is one of the attractive characteristics of FB dispersion, but the reason is yet to be revealed. In this study, we evaluated the relationship between the FBs, especially UFB concentration, and oxygen content in several situations to reveal the two questions. The FB concentration and oxygen content were examined using particle analyzers and our developed oxygen measurement method, which can measure the oxygen content in FB dispersion, respectively. First, in the evaluations of the oxygen dispersion from UFBs with respect to the surrounding oxygen level, UFBs did become neither small nor diminish even in degassed water. Second, the changes in UFBs and oxygen content upon storage temperature and the existence of a lid during storage were evaluated, and there was no correlation between them. It means UFBs contribute little to the oxygen content in UFB dispersion. Furthermore, the oxygen content in the UFB dispersion decreased over time identically as that of the oxygen-supersaturated water with little UFBs. Third, we evaluated the relationship between FB concentration and oxygen content during FB generation by measuring them simultaneously. The results showed that dispersed MB and UFB concentrations did not account for the supersaturation of the FB dispersion. From the result, it was revealed that 100-200 nm of UFBs themselves did not work as oxygen carriers, and the oxygen supersaturation in FB dispersions was due to the supersaturated state of dissolved oxygen that was prepared during the FB generation process.
RESUMEN
Fine bubbles (FBs) have attracted significant attention in several research fields. Although some reports have argued that FB dispersion is useful as an oxygen (gas) carrier, only a few reports have examined its properties as an oxygen carrier using experimental data. As one of the reasons for this, there are no standard methods for measuring the oxygen content in FB dispersions. Conventional oxygen measurement methods have certain drawbacks in accuracy or speed; thus, it is difficult to use oxygen content as the primary outcome. In this study, we introduce a Clark-type polarographic oxygen electrode device (OXYG1-PLUS) for oxygen measurement, allowing the dilution of FB dispersion without the influence of ambient air and the adhesion of FBs on the electrode surface due to its special shape. First, the accuracy of our dilution method was evaluated using pure water as a sample, and it was confirmed that our method could measure with an accuracy of ±0.5 mg/L from the results with conventional dissolved oxygen meters. Second, the oxygen content in FB dispersion was evaluated with our method and a chemical titration method (Winkler's method), and it was found that our method could measure the oxygen content in FB dispersions quantitively. This method satisfies the easiness (4 steps) and quickness (within 8 min) for a wide range of oxygen contents (0 to 332 mg/L, theoretical range) with low coefficient variation (< 4.7%) and requires a small sample volume (50-500 µL); thus, it is a useful method for measuring the oxygen in FB dispersions.
Asunto(s)
Aire , Oxígeno/análisis , Oxígeno/química , Agua/química , DifusiónRESUMEN
The 2019 novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global outbreak of infection. In general, children with coronavirus disease-2019 have been reported to show milder respiratory symptoms than adult patients. Here, we have described a case of a SARS-CoV-2-infected infant who presented to our hospital with a severe episode of an apparent life-threatening event (ALTE). An 8-month-old, otherwise healthy female infant presented to our hospital because of a sudden cardiopulmonary arrest. Approximately 1 h before this episode, the patient showed no symptoms, except a worse humor than usual. On arrival at our hospital, the patient had severe acidosis, but there were no clear signs of inflammatory response. Chest computed tomography showed weak consolidations in the upper right lung and atelectasis in the lower left lung. No signs of congenital heart disease or cardiomyopathy were observed on echocardiography, and no significant arrhythmia was observed during the clinical course. However, SARS-CoV-2 RNA was detected by real-time reverse transcription polymerase chain reaction in tracheal aspirate and urine samples. Although the assessment of further similar cases is indispensable, this case suggests that SARS-CoV-2 infection may be an underlying factor in the pathophysiology of ALTE.
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Evento Inexplicable, Breve y Resuelto/etiología , COVID-19/etiología , Evento Inexplicable, Breve y Resuelto/diagnóstico por imagen , COVID-19/diagnóstico , Prueba de Ácido Nucleico para COVID-19 , Electrocardiografía , Femenino , Paro Cardíaco/etiología , Pruebas Hematológicas , Humanos , Lactante , Tomografía Computarizada por Rayos XRESUMEN
Severe respiratory disorder induced by pulmonary inflammation is one of the causes of acute respiratory distress syndrome, which still has high mortality. It is crucial to remove causative substances and inflammatory mediators early in order to inhibit the progression of pulmonary inflammation. Total alveolar lavage (TAL) may avert the inflammatory response by eliminating causative substances in certain inflammatory lung diseases. We developed an efficient TAL system and examined the efficacy of short-term TAL treatment performed for acute lung injury models of rats. In the first experiment with a severe lung injury model, 15 rats were divided into 3 groups: sham group, mechanical gas ventilation (MGV) treatment group, and TAL treatment group. The treatments were conducted for 5 min, 20 min after the provocation of inflammation. Two days after treatment, the TAL and MGV treatment groups exhibited significant differences in blood oxygen levels, mean arterial pressure, weight-loss ratio, and inflammatory cytokine levels in the lungs. In contrast, almost no differences were observed between the TAL treatment and sham groups. In the second experiment with a lethal lung injury model, the TAL treatment dramatically improved the survival rate of the rats compared to the MGV treatment groups (p = 0.0079). Histopathological analysis confirmed pronounced differences in neutrophil accumulation and thickening of the interstitial membrane between the TAL and MGV treatment groups in both experiments. These results indicate that as little as 5 min of TAL treatment can protect rats from acute lung injury by removing causative substances from the lungs.
Asunto(s)
Lavado Broncoalveolar/métodos , Lipopolisacáridos/efectos adversos , Oxígeno/administración & dosificación , Síndrome de Dificultad Respiratoria/inducido químicamente , Síndrome de Dificultad Respiratoria/terapia , Animales , Citocinas/metabolismo , Modelos Animales de Enfermedad , Mediadores de Inflamación/metabolismo , Pulmón/metabolismo , Pulmón/patología , Masculino , Neutrófilos/inmunología , Neutrófilos/patología , Oximetría , Oxígeno/sangre , Ratas Sprague-Dawley , Síndrome de Dificultad Respiratoria/inmunología , Síndrome de Dificultad Respiratoria/metabolismoRESUMEN
Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. We report the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance due to a convulsion accompanied by unconsciousness. He had never been to any foreign countries. He felt generalized fatigue and fever (day 1). He saw doctors nearby twice (day 2 and 5) and was prescribed Laninamivir and antipyretic agents, His family visited his home and found that he was unconsciousness and lying on the floor in his vomit. He was immediately transported to this hospital by ambulance (day 9). Under emergency transport, he had transient generalized seizures that lasted about a minute. He had obvious neck stiffness. The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. Anti- HSV 1 and varicella-zoster IgM antibodies were not detected in serum samples. A brain MRI showed hyperintensity along the wall of right lateral ventricle and hyperintense signal changes in the right mesial temporal lobe and hippocampus, suggesting the possibility of SARS-CoV-2 meningitis. This case warns the physicians of patients who have CNS symptoms.
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Betacoronavirus , Infecciones por Coronavirus/complicaciones , Encefalitis/virología , Meningitis Viral/virología , Neumonía Viral/complicaciones , COVID-19 , China , Encefalitis/diagnóstico por imagen , Fatiga , Fiebre , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis Viral/diagnóstico por imagen , Pandemias , SARS-CoV-2 , Adulto JovenRESUMEN
In Kawasaki disease (KD), the effect of plasma exchange (PE) on immune cells has not been fully elucidated. Therefore, we examined the changes in the number of CD14+ CD16+ activated monocytes, regulatory T (Treg ), and T-helper type 17 (Th17) cells in KD patients treated with PE. The percentage of total monocytes and subclasses of lymphocytes, including CD4+ and CD8+ T cells, and CD19+ B cells, showed no significant difference before and after PE. However, the percentage of CD14+ CD16+ monocytes in total leukocytes decreased significantly after PE (1.1% ± 1.5% vs. 2.1% ± 2.3%, P < 0.05). Furthermore, while the percentage of Th17 cells in CD4+ T cells did not change, the percentage of Treg cells in CD4+ T cells increased significantly after PE (11.1% ± 5.1% vs. 8.0% ± 4.4%, P < 0.05). Therefore, PE downregulates activated monocytes and upregulates Treg cells toward normal levels and thus attenuates inflammation in KD.
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Monocitos/inmunología , Síndrome Mucocutáneo Linfonodular , Intercambio Plasmático/métodos , Linfocitos T Reguladores/inmunología , Células Th17/inmunología , Antígenos de Diferenciación de Linfocitos T/análisis , Preescolar , Femenino , Humanos , Japón , Subgrupos Linfocitarios , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/inmunología , Síndrome Mucocutáneo Linfonodular/terapia , Resultado del TratamientoRESUMEN
Here, we describe a case of primary graft failure with severe sepsis in a boy who experienced frequent relapses of osteosarcoma. The patient had undergone haploidentical bone marrow transplant after engraftment of unrelated cord blood transplant performed 10 months earlier. Considering his severe condition, we transfused autologous peripheral stem cells along with a single dose of etoposide (50 mg/m2). Granulocyte engraftment was confirmed on human leukocyte antigen-microsatellite analysis of bone marrow on day 14. Although the patient died due to respiratory failure, transfusion of autologous hematopoietic stem cells is a reasonable rescue option for graft failure even in patients whose background hematopoiesis is reconstituted by a first donor.
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Neoplasias Óseas/cirugía , Trasplante de Células Madre Hematopoyéticas , Osteosarcoma/cirugía , Trasplante de Células Madre de Sangre Periférica , Tibia/patología , Neoplasias Óseas/patología , Niño , Resultado Fatal , Hematopoyesis , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Osteosarcoma/secundario , Reoperación , Acondicionamiento Pretrasplante , Trasplante Autólogo , Trasplante Homólogo , Insuficiencia del TratamientoRESUMEN
In original publication of the article, some of the co-author's names were not included. The correct author group is published in this article.
RESUMEN
Recently, intensive care physicians have focused on continuous hemodiafiltration with a cytokine-adsorbing hemofilter in the treatment of sepsis. We aimed to establish extracorporeal circulation in a rat sepsis model to evaluate the cytokine removal properties of mini-modules using two types of membrane materials. Rats were divided into polyester polymer alloy (PEPA) and cellulose triacetate (CTA) groups as membrane materials of mini-modules. One hour after 0.1 mg/kg of lipopolysaccharide administration, continuous hemofiltration (CHF) was started in each group. Plasma interleukin-6 (IL-6), an important mediator of sepsis, was measured over time during hemofiltration. The peak IL-6 concentration in PEPA group was approximately 13,000 pg/mL, in comparison to approximately 31,000 pg/mL in CTA group. IL-6 clearance in PEPA group was much more than CTA group. Since IL-6 was not detected in the filtrate in PEPA group, it was considered that IL-6 was adsorbed to the membrane. In conclusion, our results suggest that CHF with PEPA hemofilter can be suitable for removing IL-6 from the blood stream efficiently.
Asunto(s)
Hemofiltración/instrumentación , Interleucina-6/sangre , Membranas Artificiales , Sepsis/terapia , Adsorción , Aleaciones , Animales , Celulosa/análogos & derivados , Citocinas/sangre , Modelos Animales de Enfermedad , Humanos , Masculino , Poliésteres , Polímeros , Ratas , Ratas Sprague-Dawley , Diálisis RenalRESUMEN
Autoantibodies against cardiac proteins play an important role in the development of dilated cardiomyopathy (DCM). The efficacy and safety of apheresis such as immunoadsorption (IA) or plasma exchange (PE) to remove such antibodies have been reported in adult DCM patients. However, apheresis for pediatric DCM has not been performed because of technical difficulty due to relatively low blood volume and instability of hemodynamics. As we have experiences of preforming apheresis on hemodynamically unstable children, we have preformed ten courses of PE on seven child DCM patients including both patients in chronic and acute phase to assess the safety and efficacy to PE. Under general anesthesia, the patients were administered PE three times during 3 days as 1 course. Simultaneously, continuous hemodiafiltration (CHDF) was performed in series with the PE circuit to stabilize hemodynamic status and to minimize the adverse effects of PE. The changes in LVEF, CTR, mBP, the dosage of furosemide and NYHA were assessed before and after the procedure of PE. There were no severe adverse effects such as systemic bleeding or refractory hypotension due to apheresis. Echocardiography showed that mean baseline LVEF was 24.3 ± 7.8%. Mean LVEF significantly increased 1 week after PE to 30.5 ± 12.5%. CTR significantly decreased after PE. Mean BP significantly increased 1 month after PE (54.5 ± 10.7 to 60.7 ± 9.8 mmHg). NYHA improved after PE significantly (NYHA; 3.4 ± 1.1 to 2.5 ± 1.1). PE is safe and effective in improving both cardiac function and daily activities.
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Actividades Cotidianas , Cardiomiopatía Dilatada/terapia , Hemodinámica/fisiología , Intercambio Plasmático/métodos , Adolescente , Cardiomiopatía Dilatada/fisiopatología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
Micro/nano-bubbles are practical nanomaterials designed to increase the gas content in liquids. We attempted to use oxygen micro/nano-bubble dispersions as an oxygen-rich liquid as a means for total liquid ventilation. To determine the oxygen content in the bubble dispersion, a new method based on a spectrophotometric change between oxy- and deoxy-hemoglobin was established. The oxygen micro/nano-bubble dispersion was supplied to an experimental total ventilation liquid in anesthetic rats. Though the amount of dissolving oxygen was as low as 6 mg/L in physiological saline, the oxygen content in the oxygen micro/nano-bubble dispersion was increased to 45 mg/L. The positive correlation between the oxygen content and the life-saving time under liquid ventilation clearly indicates that the life-saving time is prolonged by increasing the oxygen content in the oxygen micro/nano-bubble dispersion. This is the first report indicating that the oxygen micro/nano-bubbles containing a sufficient amount of oxygen are useful in producing oxygen-rich liquid for the process of liquid ventilation.
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Ventilación Liquida/instrumentación , Microburbujas , Oxígeno , Cloruro de Sodio , Animales , Diseño de Equipo , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
Healthy bowel function is an important factor when judging the advisability of early enteral nutrition in critically ill patients, but long-term observation and objective evaluation of gastrointestinal motility are difficult. In the study, real-time continuous measurement of gastrointestinal motility was performed in patients with severe sepsis using a developed bowel sound analysis system, and the correlation between bowel sounds and changes over time in blood concentrations of interleukin (IL)-6, which is associated with sepsis severity, was evaluated. The subjects were five adult patients in the acute phase of severe sepsis on a mechanical ventilator, with IL-6 blood concentrations ≥100 pg/mL, who had consented to participate in the study. Gastrointestinal motility was measured for a total of 62,399 min: 31,544 min in 3 subjects in the no-steroids group and 30,855 min in 2 subjects in the steroid treatment group. In the no-steroids group, the bowel sound counts were negatively correlated with IL-6 blood concentration, suggesting that gastrointestinal motility was suppressed as IL-6 blood concentration increased. However, in the steroid treatment group, gastrointestinal motility showed no correlation with IL-6 blood concentration (r = -0.25, p = 0.27). The IL-6 blood concentration appears to have decreased with steroid treatment irrespective of changes in the state of sepsis, whereas bowel sound counts with the monitoring system reflected the changes in the state of sepsis, resulting in no correlation. This monitoring system provides a useful method of continuously, quantitatively, and non-invasively evaluating gastrointestinal motility in patients with severe sepsis. Gastrointestinal motility might be useful as a parameter reflecting disease severity, particularly in patients treated with steroids.
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Motilidad Gastrointestinal/fisiología , Monitoreo Fisiológico/métodos , Sepsis/fisiopatología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios ProspectivosRESUMEN
Variation in protein binding ratio (PBR) of teicoplanin (TEIC) was investigated in continuous hemodiafiltration (CHDF) patients. TEIC is classified as a high PBR drug (â§90%), and it was reported that the PBR of TEIC decreased with an decrease in the serum albumin level in hypoalbuminemia patients. However, few reports can be found about the variation of PBR of TEIC for CHDF patient. An antibiotic activity is directly determined by the level of unbound antibiotics species (Cfree) in the target site, namely, an increase in the Cfree enhances the risks of TEIC as well as the therapeutic effect against Methicillin-resistant Staphylococcus aureus (MRSA). In this study, both the total concentration (Ctotal) and Cfree of TEIC were determined and the PBRs were compared between a patient with normal albumin level, hypoalbuminemia patients and CHDF patients. Similarly to the previous report, the lowering of PBR of TEIC was demonstrated in the hypoalbuminemia patients. On the other hand, the CHDF patients showed lower value of PBR suggesting some change in the protein binding ability, although showed higher values of serum albumin level in comparison with the hypoalbuminemia patients. It was not necessary to measure the Cfree value for the hypoalbuminemia patient routinely, but the monitoring of Cfree as well as Ctotal for the CHDF patients can be important for the proper TEIC use because of the potential specialty of PBR.
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Antibacterianos/metabolismo , Hemodiafiltración , Hipoalbuminemia/metabolismo , Teicoplanina/metabolismo , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/sangre , Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Femenino , Humanos , Hipoalbuminemia/sangre , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Persona de Mediana Edad , Unión Proteica , Albúmina Sérica/metabolismo , Teicoplanina/administración & dosificación , Teicoplanina/sangre , Teicoplanina/farmacologíaRESUMEN
CONTEXT: A functional thyroid-stimulating autoantibodies (TSAb) assay using a thyroid-stimulating hormone receptor chimera (Mc4) appears to be clinically more useful than the commonly used assay, a binding assay that measures all the antibodies binding to the thyroid-stimulating hormone receptor without functional discrimination, in diagnosing patient with Graves' disease (GD). OBJECTIVE: The objective of the study was to investigate whether an Mc4 assay can predict relapse/remission of hyperthyroidism after antithyroid drug (ATD) treatment in patients with GD. DESIGN: An Mc4 assay was used to prospectively track TSAb activity in GD patients treated with ATD over a 5-yr period. SETTING AND PATIENTS: GD patients from the Chieti University participated in this study. INTERVENTIONS: Interventions included the assessment of patients' sera using the Mc4 assay, the Mc4-derivative assay (Thyretain), and a human monoclonal thyroid-stimulating hormone receptor antibody, M22 assay. MAIN OUTCOME MEASURES: The Mc4 assay, a sensitive index of remission and recurrence, was used in this study. RESULTS: The TSAb levels significantly decreased only in the remitting group as evidenced by Mc4 assay values at the end of ATD (0.96 ± 1.47, 10.9 ± 26.6. and 24.7 ± 37.5 arbitrary units for the remitting, relapsing, and unsuspended therapy groups, respectively). Additional prognostic help was obtained by thyroid volume measurements at the end of treatment. Although not statistically significant, the Mc4 assay has a trend toward improved positive predictive value (95.4 vs. 84.2 or 87.5%), specificity (96.4 vs. 86.4 and 90.9%), and accuracy (87.3 vs. 83.3 and 80.9%) comparing the Mc4, Thyretain, and M22 assays, respectively. Thyretain has a trend toward improved negative predictive value (82.6 vs. 81.8 and 76.9%) and sensitivity (80 vs. 77.8 and 70%) comparing Thyretain, Mc4, and M22 assays, respectively. CONCLUSION: The Mc4 assay is a clinically useful index of remission and relapse in patients with GD. Larger studies are required to confirm these findings.
Asunto(s)
Enfermedad de Graves/diagnóstico , Inmunoglobulinas Estimulantes de la Tiroides/análisis , Receptores de HL/análisis , Receptores de Tirotropina/análisis , Proteínas Recombinantes de Fusión , Adulto , Animales , Antitiroideos/uso terapéutico , Autoanticuerpos/análisis , Autoanticuerpos/sangre , Células CHO , Ensayos Clínicos como Asunto/métodos , Cricetinae , Cricetulus , Femenino , Estudios de Seguimiento , Enfermedad de Graves/sangre , Enfermedad de Graves/tratamiento farmacológico , Enfermedad de Graves/inmunología , Células HEK293 , Humanos , Inmunoglobulinas Estimulantes de la Tiroides/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Receptores de HL/química , Receptores de HL/fisiología , Receptores de Tirotropina/química , Receptores de Tirotropina/fisiología , Proteínas Recombinantes de Fusión/farmacología , Recurrencia , Inducción de Remisión , Pruebas de Función de la Tiroides/métodos , Adulto JovenRESUMEN
CONTEXT: Stimulating thyrotropin receptor (TSHr) autoantibodies (TSAb) are the cause of hyperthyroidism in Graves' disease. In a patient's serum, TSAb can coexist with antagonist TSHr autoantibodies that block TSAb stimulatory activity (TSBAb); both can vary in amount and time. OBJECTIVE: The objective of the study was to create a functional assay that detects only TSAb, thus having an increased accuracy for diagnosing Graves' disease. DESIGN: A TSHr chimera (Mc4) that retains an agonist-sensitive TSAb epitope but replaces a TSBAb epitope was stably transfected in cells to establish the Mc4 assay. SETTING: The study was conducted at the Chieti University (Outpatient Endocrine Clinic) and the University of Pisa (the Department of Endocrinology). PATIENTS: The assay was validated using sera from 170 individuals with Graves' disease, Hashimoto's thyroiditis, and nonautoimmune hyperthyroidism and normal subjects from Chieti University. A second blinded study evaluated sera from 175 patients with autoimmune thyroid disease (mainly Graves' disease) from the University of Pisa. INTERVENTIONS: Interventions included the assessment of patients' sera using human wild-type TSHr (WT-TSHr), Mc4 chimera, and binding (TRAb) assays. MAIN OUTCOME MEASURES: The Mc4 assay has the best accuracy for diagnosing Graves' disease. RESULTS: The Mc4 assay has a better diagnostic accuracy than WT-TSHr and second-generation TRAb assays. Indeed, the sensitivity of the WT-TSHr, TRAb, and Mc4 assays was 97.3, 86.5, and 100%, respectively, whereas the specificity was 93.1, 97, and 98.5%, respectively. CONCLUSION: The Mc4 assay is a functional assay with improved sensitivity and specificity for the detection of TSAb and is clinically useful in diagnosing Graves' disease.
Asunto(s)
Enfermedad de Graves/diagnóstico , Inmunoglobulinas Estimulantes de la Tiroides/análisis , Receptores de HL/análisis , Receptores de Tirotropina/análisis , Proteínas Recombinantes de Fusión , Adulto , Anciano , Animales , Autoanticuerpos/análisis , Autoanticuerpos/sangre , Células CHO , Estudios de Casos y Controles , Células Cultivadas , Cricetinae , Femenino , Enfermedad de Graves/sangre , Enfermedad de Graves/inmunología , Células HEK293 , Humanos , Inmunoglobulinas Estimulantes de la Tiroides/sangre , Masculino , Persona de Mediana Edad , Visón , Receptores de HL/química , Receptores de HL/fisiología , Receptores de Tirotropina/química , Receptores de Tirotropina/fisiología , Proteínas Recombinantes de Fusión/análisis , Pruebas de Función de la Tiroides/métodosRESUMEN
BACKGROUND: One form of sepsis, or endotoxic shock, is a hyperactivated systemic response caused by excessive expression of proinflammatory mediators, which results from Gram-negative bacterial lipopolysaccharide-stimulated Toll-like receptor-4 signaling. This lipopolysaccharide signaling is known to consist of a MyD88-dependent nuclear factor-κB-mediated pathway that results in production of proinflammatory mediators (tumor necrosis factor-α, interleukin-6, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, inducible nitric oxide synthase, cyclooxygenase-2) and a MyD88-independent interferon regulatory factor-mediated pathway that regulates production of Type 1 interferon-inducible proteins (interferon γ-induced protein-10, monocyte chemotactic protein-1). In prior studies, phenylmethimazole markedly decreased virally induced Toll-like receptor-3 expression and signaling and significantly suppressed murine colitis in an experimental model wherein lipopolysaccharide is known to play an important role. OBJECTIVE: In this study, we probed the hypothesis that phenylmethimazole inhibits lipopolysaccharide-mediated Toll-like receptor-4 signaling and is efficacious in attenuating inflammatory changes and improving survival in an in vivo murine model of endotoxic shock. DESIGN: Experimental animal model. SETTING: University laboratory. SUBJECTS: Male C57BL/6J mice weighing 18-22 g. INTERVENTIONS: Phenylmethimazole (1 mg/kg) was administered intraperitoneally to mice before a lethal lipopolysaccharide challenge (25 mg/kg). RAW264.7 mouse macrophage cells were pretreated with phenylmethimazole followed by lipopolysaccharide stimulation. MEASUREMENTS AND MAIN RESULTS: : Macroscopic observations revealed that phenylmethimazole was significantly protective in controlling clinical manifestations of endotoxic shock and death under conditions wherein flunixin of meglumine and prednisolone were marginally effective. A combination of enzyme-linked immunosorbent assay, Northern blot, reverse transcriptase-polymerase chain reaction, immunohistochemistry, and Western blot analyses showed that phenylmethimazole attenuated lipopolysaccharide-induced increases in production of proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, interferon-γ), endothelial cell adhesion molecules (intercellular adhesion molecule-1, vascular cell adhesion molecule-1), inducible nitric oxide synthase and cyclooxygenase-2, interferon regulatory factor-1, interferon-inducible proteins (interferon γ-induced protein-10, monocyte chemotactic protein-1), and signal transducer and activator of transcription-1 phosphorylation in multiple tissues in mice. Consistent with these observations, electrophoretic mobility shift assay demonstrated that phenylmethimazole inhibited in vitro lipopolysaccharide-induced nuclear factor-κB and interferon regulatory factor-1 activation in RAW 264.7 mouse macrophages. CONCLUSIONS: Collectively, these results provide direct evidence that phenylmethimazole diminishes lipopolysaccharide-induced MyD88-dependent as well as MyD88-independent signaling pathways and is protective in an experimental model of endotoxic shock.
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Citocinas/biosíntesis , Citocinas/efectos de los fármacos , Metimazol/análogos & derivados , Choque Séptico/inmunología , Choque Séptico/prevención & control , Tionas/uso terapéutico , Animales , Modelos Animales de Enfermedad , Inflamación/inmunología , Masculino , Metimazol/uso terapéutico , Ratones , Ratones Endogámicos C57BL , Choque Séptico/metabolismoRESUMEN
The aim of this study was to investigate whether continuous hemodiafiltration (CHDF) with a high-performance membrane dialyzer made of polymethylmethacrylate (PMMA-CHDF) in the treatment of septic shock patients with acute renal failure (ARF) is clinically relevant. 30 patients were treated with PMMA-CHDF. 13 patients treated with CHDF used a hemofilter made of polyacrylonitrile membrane (PAN-CHDF). Systolic blood pressure significantly increased in the PMMA-CHDF group following 24 h of treatment (p < 0.01), whereas it did not improve in the PAN-CHDF group. Urine volume significantly increased in the PMMA-CHDF group following 24 h of treatment which was more than in the PAN-CHDF group (p < 0.05). 28-day survival was 83.3% in the PMMA-CHDF group and 30.8% in the PAN-CHDF group, respectively (p < 0.01). We can assume that PMMA-CHDF in the treatment of septic shock patients with ARF is clinically relevant.
Asunto(s)
Resinas Acrílicas , Lesión Renal Aguda/terapia , Hemodiafiltración/métodos , Hemofiltración/métodos , Membranas Artificiales , Polimetil Metacrilato , Choque Séptico/complicaciones , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/etiología , Adsorción , Anciano , Agua Corporal/metabolismo , Terapia Combinada , Diuréticos/uso terapéutico , Femenino , Fluidoterapia , Furosemida/uso terapéutico , Hemodiafiltración/instrumentación , Hemofiltración/instrumentación , Humanos , Hipotensión/etiología , Hipotensión/terapia , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Choque Séptico/terapia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Ulcerative colitis is an autoimmune-inflammatory disease characterized by abnormally increased expression of Toll-like receptor-4 (TLR4) in colonic epithelial cells, increased production of pro-inflammatory cytokines (e.g., TNF-alpha, IL-1beta, IL-6, IL-12), chemokines (e.g., IP-10), and endothelial cell adhesion molecules (e.g., VCAM-1), plus enhanced leukocyte infiltration into colonic interstitium. Previously, we have shown that phenyl methimazole (C10) markedly decreases virally-induced TLR-3 expression and signaling and potently inhibits both TNF-alpha-induced VCAM-1 expression and the resultant leukocyte-endothelial cell adhesion. In this study we probed the hypothesis that C10 is efficacious in a TLR-4- and VCAM-1-associated murine model [the dextran sulfate sodium (DSS) model] of human colitis. C10 was administered intraperitoneally coincident with or after DSS treatment was initiated. Macroscopic colon observations revealed that C10 significantly reversed DSS-induced shortening of the colon (P<0.05) and reduced the presence of blood in the colon. Histological analyses of colonic tissues revealed that C10 distinctly attenuated both DSS-induced edema as well as leukocyte infiltration in the colonic mucosa and resulted in pronounced protection against DSS-induced crypt damage (P<0.001). Northern blot analyses and immunohistochemistry of colonic tissue revealed that C10 markedly diminished DSS-induced expression of pertinent inflammatory mediators: TNF-alpha, IL-1beta, IL-6, IL-12, IP-10, TLR-4 and VCAM-1. Most importantly, C10 significantly improved survival and protected mice against DSS-induced colitic-death: 75% by comparison to 12.5% with identical treatment with DMSO-control (log rank test: P=0.005). These results provide direct evidence that C10 suppresses DSS-induced colitis by inhibiting expression of key inflammatory mediators and leukocyte infiltration, and is a potentially attractive therapeutic for colitis.
Asunto(s)
Colitis Ulcerosa/prevención & control , Metimazol/análogos & derivados , Tionas/uso terapéutico , Receptor Toll-Like 4/antagonistas & inhibidores , Molécula 1 de Adhesión Celular Vascular/inmunología , Animales , Northern Blotting , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/metabolismo , Colitis Ulcerosa/patología , Citocinas/biosíntesis , Citocinas/inmunología , Sulfato de Dextran , Modelos Animales de Enfermedad , Inmunohistoquímica , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/inmunología , Mucosa Intestinal/patología , Masculino , Metimazol/farmacología , Metimazol/uso terapéutico , Ratones , Ratones Endogámicos C57BL , Tionas/farmacología , Receptor Toll-Like 4/biosíntesis , Molécula 1 de Adhesión Celular Vascular/biosíntesisRESUMEN
Thyroglobulin (Tg), a major product of the thyroid gland, serves as a macromolecular precursor of thyroid hormone biosynthesis. In addition, Tg stored in the thyroid follicles is a potent regulator of thyroid-specific gene expression. In conjunction with thyroid stimulating hormone (TSH) and iodide, Tg regulates thyroid follicle function, which is the minimal functional unit of the thyroid gland. In the present study, we show that Tg stimulates growth of FRTL-5 thyroid cells in the absence of TSH, insulin and serum. Unlike TSH, Tg did not increase cellular cyclic AMP (cAMP) levels; rather, the TSH signal counteracted Tg-induced cell growth. A specific inhibitor of A-kinase, H-89, did not modulate the effect of Tg. Tg increased kinase activity of Akt to the same level as TSH, insulin and 5% serum, while LY294002 abolished Tg-induced growth. Interestingly, low Tg concentrations maximized growth-promotion activity and induction of the apical iodide transporter (PDS; SLC26A4), whereas high Tg concentrations suppressed both cell growth and the expression of thyroid-specific genes. These results suggest that a low levels of Tg in the follicular lumen might stimulates cell growth and iodide transport to accelerate the iodide organification process; however, elevated Tg levels in the follicle might then shut down all of these functions.
Asunto(s)
Proliferación Celular , AMP Cíclico/metabolismo , Tiroglobulina/metabolismo , Glándula Tiroides/fisiología , Tirotropina/metabolismo , Animales , Línea Celular , AMP Cíclico/farmacología , Proteínas Quinasas Dependientes de AMP Cíclico/metabolismo , Expresión Génica/efectos de los fármacos , Ratas , Timidina/metabolismo , Tiroglobulina/farmacología , Glándula Tiroides/citología , Glándula Tiroides/efectos de los fármacos , Tirotropina/farmacologíaRESUMEN
PURPOSE: To evaluate whether (a) Wnt5a expression in pancreatic cancer and malignant melanoma cells might be associated with constitutive levels of Toll-like receptor 3 (TLR3) and/or TLR3 signaling; (b) phenylmethimazole (C10), a novel TLR signaling inhibitor, could decrease constitutive Wnt5a and TLR3 levels together with cell growth and migration; and (c) the efficacy of C10 as a potential inhibitor of pancreatic cancer and malignant melanoma cell growth in vivo. EXPERIMENTAL DESIGN: We used a variety of molecular biology techniques including but not limited to PCR, Western blotting, and ELISA to evaluate the presence of constitutively activated TLR3/Wnt5a expression and signaling. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide-based technology and scratch assays were used to evaluate inhibition of cell growth and migration, respectively. TLR3 regulation of cell growth was confirmed using small interfering RNA technology. Nude and severe combined immunodeficient mice were implanted with human pancreatic cancer and/or melanoma cells and the effects of C10 on tumor growth were evaluated. RESULTS: We show that constitutive TLR3 expression is associated with constitutive Wnt5a in human pancreatic cancer and malignant melanoma cell lines, that C10 can decrease constitutive TLR3/Wnt5a expression and signaling, suggesting that they are interrelated signal systems, and that C10 inhibits growth and migration in both of these cancer cell lines. We also report that C10 is effective at inhibiting human pancreatic cancer and malignant melanoma tumor growth in vivo in nude or severe combined immunodeficient mice and associate this with inhibition of signal transducers and activators of transcription 3 activation. CONCLUSIONS: C10 may have potential therapeutic applicability in pancreatic cancer and malignant melanoma.