Glycyrrhizic Acid Prevents Sepsis-Induced Acute Lung Injury and Mortality in Rats

Glycyrrhizic acid (GA), an active ingredient in licorice, has multiple pharmacological activities. However, the effects of GA on sepsis-induced acute lung injury (ALI) have not been determined. Tthe aim of this study was to investigate the molecular mechanism involved in the effects of GA against sepsis-induced ALI in rats. We found that GA alleviated sepsis-induced ALI through improvements in various pathological changes, as well as decreases in the lung wet/dry weight ratio and total protein content in bronchoalveolar lavage fluid, and a significant increase in the survival rate of treated rats. Additionally, GA markedly inhibited sepsis-induced pulmonary inflammatory responses. Moreover, we found that treatment with GA inhibited oxidative stress damage and apoptosis in lung tissue induced by ALI. Finally, GA treatment significantly inhibited NF-κ B, JNK and P38 MAPK activation. Our data indicate that GA has a protective effect against sepsis-induced ALI by inhibiting the inflammatory response, damage from oxidative stress, and apoptosis via inactivation of NF-κB and MAPK signaling pathways, providing a molecular basis for a new medical treatment for sepsis-induced ALI.     

Sepsis-Induced Acute Lung Injury (ALI) Is Milder in Diabetic Rats and Correlates with Impaired NFkB Activation

Acute lung injury (ALI) develops in response to a direct insult to the lung or secondarily to a systemic inflammatory response, such as sepsis. There is clinical evidence that the incidence and severity of ALI induced by direct insult are lower in diabetics. In the present study we investigated whether the same occurs in ALI secondarily to sepsis and the molecular mechanisms involved. Diabetes was induced in male Wistar rats by alloxan and sepsis by caecal ligation and puncture surgery (CLP). Six hours later, the lungs were examined for oedema and cell infiltration in bronchoalveolar lavage. Alveolar macrophages (AMs) were cultured in vitro for analysis of IκB and p65 subunit of NFκB phosphorylation and MyD88 and SOCS-1 mRNA. Diabetic rats were more susceptible to sepsis than non-diabetics. In non-diabetic rats, the lung presented oedema, leukocyte infiltration and increased COX2 expression. In diabetic rats these inflammatory events were significantly less intense. To understand why diabetic rats despite being more susceptible to sepsis develop milder ALI, we examined the NFκB activation in AMs of animals with sepsis. Whereas in non-diabetic rats the phosphorylation of IκB and p65 subunit occurred after 6 h of sepsis induction, this did not occur in diabetics. Moreover, in AMs from diabetic rats the expression of MyD88 mRNA was lower and that of SOCS-1 mRNA was increased compared with AMs from non-diabetic rats. These results show that ALI secondary to sepsis is milder in diabetic rats and this correlates with impaired activation of NFκB, increased SOCS-1 and decreased MyD88 mRNA.     

L-精氨酸对实验性大鼠急性肺损伤的保护作用

目的 探讨一氧化氮(NO)前体物质L-精氨酸(L-Arg)在内毒素(LPS)致大鼠急性肺损伤中的作用.方法 SD大鼠24只随机分为空白对照组、LPS组和L-Arg(500 mg/kg)组.腹腔注射LPS(100 μg/kg)复制急性肺损伤动物模型.在LPS注射2 h后,取大鼠肺称其湿重与干重,计算肺湿干比,测定肺灌洗液蛋白含量和白细胞数量,并进行肺组织病理学检查.结果 与对照组相比,LPS组肺湿干比、肺灌洗液蛋白含量和白细胞计数显著增高(P<0.01,n=8),病理学切片见急性肺损伤性变化;与LPS组相比,L-Arg组肺湿干比、肺灌洗液蛋白含量和白细胞计数显著降低(P<0.01,n=8),肺组织急性损伤显著减轻.结论 L-Arg具有抗LPS致急性肺损伤的作用.     

急性肺损伤的生物标记物

急性呼吸窘迫综合征(ARDS)和急性肺损伤(ALI)多由低氧性呼吸衰竭引起,导致高通透性肺水肿,临床上有较高的发病率与死亡率。近十年来,针对血浆和支气管肺泡灌洗液中相关生物标记物的研究为探索急性肺损伤的病理生理机制指明了新的方向。个别生物标记物已在一些大型、多中心ARDS试验中得到证实。但迄今仍没有一个或一组生物标记物常规应用于临床。随着人类对ALI发病机制理解的进一步深入,或许不久的将来,生物标记物会真正应用于评估疾病的严重程度和预后。本文将概述近年来ALI相关生物标记物的研究进展。     

抗炎多肽AF-2对LPS诱导的小鼠急性肺损伤的保护

目的研究抗炎多肽AF-2（antiflammin-2）对内毒素（LPS）诱导的小鼠急性肺损伤的保护作用。方法Balb/c雄性小鼠37只,随机分为3组,对照组（n=10）、急性肺损伤（ALI）模型组（n=14）和AF-2治疗组（n=13）,模型组和治疗组腹腔注射大肠杆菌内毒素复制小鼠肺损伤模型,治疗组同时注射抗炎多肽AF-2,对照组和模型组注射等量的生理盐水。在0h、6h和12h记录动物的呼吸频率,12h处死动物,肺组织切片观察肺病理变化,ELISA法检测血清细胞因子。结果6h和12hAF-2治疗组动物呼吸频率均低于模型组。肺组织病理显示AF-2对LPS诱导的小鼠ALI肺组织的渗出、炎细胞浸润有一定的抑制作用。AF-2治疗组与ALI模型组比较血清IL-6水平明显下降。结论AF-2对内毒素诱导的小鼠急性肺损伤有一定的保护作用。     

氨溴索注射液对急性肺损伤患者保护作用的研究

目的 探讨氨溴索对急性肺损伤患者预后的影响,对进一步发展至急性呼吸窘迫综合征（ARDS）的作用.方法 选择77例病情程度基本相同的急性肺损伤患者作为研究对象,随机分为氨溴索治疗组38例,常规治疗组39例.比较治疗7天后两组患者动脉血气的差异;比较两组患者的预后,包括ARDS发生率、病死率、存活患者的住院时间、SIRS评分及肺损伤评分.结果 治疗7天后两组患者动脉血气分析指标均有明显改善（P〈0.01）,氨溴索治疗组比常规治疗组改善更明显（P〈0.01）;氨溴索治疗组患者ARDS发生率（28.95%）低于常规治疗组（53.85%）（P〈0.05）,氨溴索治疗组存活患者的SIRS评分（1.71±1.61）低于常规治疗组（2.73±1.41）（P〈0.05）;肺损伤评分（0.24±0.16）明显低于常规治疗组（0.79±0.21）,住院时间（14.01±7.16）天,明显短于常规治疗组（19.14±6.25）天（均P〈0.01）.结论氨溴索对急性肺损伤有保护作用,可降低急性肺损伤患者ARDS的发生率,缩短患者住院时间,改善预后.     

原儿茶酸对脂多糖诱导的急性肺损伤小鼠的保护作用

目的:探索原儿茶酸(protocatechuicacid,PCA)对脂多糖(lipopolysaccharide,LPS)诱导的急性肺损伤(acute lung injury,ALI)小鼠的保护作用,探讨其保护机制。方法:将40只昆明小鼠按随机数字表法均分为空白对照组(NC组)、LPS模型组、原儿茶酸预处理组(PCA+LPS组)、地塞米松阳性对照组(Dex+LPS组),每组10只,模型组以5mg·kg-1脂多糖腹腔内注射诱导急性肺损伤。6h后处死小鼠,HE染色观察肺组织病理学变化;BCA法检测肺泡灌洗液中总蛋白浓度;ELISA检测肺泡灌洗液炎症因子TNF-α、IL-1β含量;Western Blot检测肺组织中p38MAPK、p-p38MAPK、p-ATF2蛋白的表达水平。结果:与对照组相比,模型组小鼠肺损伤明显,肺泡内出血、水肿、炎细胞浸润,肺泡灌洗液中TNF-α、IL-1β的含量及总蛋白浓度增加,肺组织中p38MAPK/p-p38MAPK、p-ATF2表达均明显增加(均P0.01)。与模型组相比,原儿茶酸预处理组、地塞米松阳性对照组肺组织病理损伤程度明显减轻,肺泡灌洗液中TNF-α、IL-1β的含量及总蛋白浓度、肺组织中p38MAPK/p-p38MAPK、p-ATF2表达均明显降低(均P0.01)。结论:PCA对LPS诱导的急性肺损伤有保护作用,其作用机制可能与其抑制p38MAPK-p-ATF2信号通路的活化、降低肺组织炎症反应有关。     

大鼠胰腺炎相关性急性肺损伤模型的探讨

目的研究5%牛磺胆酸钠(TAC)逆行胆胰管注射诱发急性胰腺炎相关肺损伤的大鼠模型。方法采用改进的胆胰管逆行注射TAC造成大鼠急性出血坏死型胰腺炎(AHNP)模型,将大鼠随机分为3组:AHNP组、假手术组、地塞米松(DXM)治疗组。造模成功后,立即静脉注射大剂量DXM(5 mg/kg)。术后于3、6、12 h处死,留取外周血测定血清淀粉酶、脂肪酶,取右肺中叶测定肺湿干比值及作病理切片,计算等级评分评价肺损伤;行支气管肺泡灌洗,以灌洗液白蛋白与血清白蛋白含量比值计算肺指数。结果AHNP组36、、12 h肺通透性指数、湿干比值及病理学评分逐渐增加,经单因素方差分析,61、2 h组高于3 h组(P<0.05),前两者于6、12 h组组内比较差异不显著(P>0.05)。DXM组于术后61、2 h,各项肺损伤指标均低于AHNP组(P<0.05)。结论TAC胆胰管逆行注射造成AHNP模型大鼠于术后6 h即出现明显的肺损伤表现,符合PALI病理改变,与临床AHNP合并急性肺损伤(ALI)的病理过程相似,可于此时相点作为研究AHNP合并肺损伤的模型。     

Sonic Hedgehog Signaling: Evidence for Its Protective Role in Endotoxin Induced Acute Lung Injury in Mouse Model

Objective

To investigate the protective role of the sonic hedgehog (SHH) signaling associated with a lipopolysaccharide (LPS)-induced acute lung injury (ALI) in a mouse model.

Methods

Male BALB/c mice were randomly divided into four groups: control, LPS, LPS-cyclopamine group and cyclopamine group. ALI was induced by LPS ip injection (5 mg/kg). The sonic hedgehog inhibitor cyclopamine (50 mg/kg) was given to the LPS-cyclopamine group at 30 min after LPS injection as well as normal mice as control. Lung injury was observed histologically in hematoxylin and eosin (HE) stained tissue sections, semi-quantified by lung tissue injury score, and the lung tissue mass alteration was measured by wet to dry weight ratio (W/D). mRNA expression levels of TNF-α, SHH, Patched (PTC) and GLI1 in lung tissue were studied with real time quantitative PCR (RT-PCR), while the protein expression of SHH and GLI1 was determined by western blot analysis.

Results

Lung tissue injury score, thickness of alveolar septa, W/D, and TNF-α mRNA expression levels were significantly higher in the ALI mice than the normal mice (P<0.05). The mRNA expression levels of SHH, PTC, and GLI1 in the ALI mice were significantly higher at 12h and 24h after LPS injection, but not at the 6h time point. Protein production of SHH and GLI1 at 6h, 12h, and 24h in the lungs of ALI mice significantly increased, in a time-dependent manner, compared with that in normal mice. Cyclopamine alone has no effect on pathological changes in normal mice. Intervention with cyclopamine in ALI mice led to a reduction in mRNA levels of SHH, PTC, and GLI1 as well as SHH and GLI1 protein levels; meanwhile, the pathological injury scores of lung tissues, thickness of alveolar septa, W/D, and mRNA expression levels of TNF-α increased compared with mice receiving LPS only.

Conclusion

The SHH signaling pathway was activated in response to LPS-induced ALI, and up-regulation of SHH expression could alleviate lung injury and be involved in the repair of injured lung tissue.     

Lung T Lymphocyte Trafficking and Activation during Ischemic Acute Kidney Injury

Despite advances in renal replacement therapy, the mortality rate for acute kidney injury (AKI) remains unacceptably high, likely owing to extrarenal organ dysfunction. Kidney ischemia-reperfusion injury (IRI) activates cellular and soluble mediators that facilitate organ crosstalk and induce caspase-dependent lung apoptosis and injury through a TNFR1-dependent pathway. Given that T lymphocytes mediate local IRI in the kidney and are known to drive TNFR1-mediated apoptosis, we hypothesized that T lymphocytes activated during kidney IRI would traffic to the lung and mediate pulmonary apoptosis during AKI. In an established murine model of kidney IRI, we identified trafficking of CD3(+) T lymphocytes to the lung during kidney IRI by flow cytometry and immunohistochemistry. T lymphocytes were primarily of the CD3(+)CD8(+) phenotype; however, both CD3(+)CD4(+) and CD3(+)CD8(+) T lymphocytes expressed CD69 and CD25 activation markers during ischemic AKI. The activated lung T lymphocytes did not demonstrate an increased expression of intracellular TNF-α or surface TNFR1. Kidney IRI induced pulmonary apoptosis measured by caspase-3 activation in wild-type controls, but not in T cell-deficient (T(nu/nu)) mice. Adoptive transfer of murine wild-type T lymphocytes into T(nu/nu) mice restored the injury phenotype with increased cellular apoptosis and lung microvascular barrier dysfunction, suggesting that ischemic AKI-induced pulmonary apoptosis is T cell dependent. Kidney-lung crosstalk during AKI represents a complex biological process, and although T lymphocytes appear to serve a prominent role in the interorgan effects of AKI, further experiments are necessary to elucidate the specific role of activated T cells in modulating pulmonary apoptosis.     

人参皂苷Rg5对脓毒血症大鼠急性肺损伤的保护作用

目的:观察人参皂苷Rg5对脓毒血症大鼠引起急性肺损伤(ALI)的作用.方法:30只大鼠建立盲肠结扎穿孔法(CLP)脓毒症模型,随机均分为以下3组(n=10):阴性对照组(Sham组)、CLP组及CLP+Rg5组.各组分别于手术后24 h时检测大鼠血清TNF-、IL-6、高迁移率族蛋白1(HMGB1)及IL-10含量;手术24 h后检测肺组织干湿重比(W/D)、髓过氧化物酶活性(MPO)及NF-кB活性;HE法进行肺组织学评分.结果:CLP+Rg5组血浆及肺组织HMGB1和TNF-水平明显低于CLP组(P＜0.05).CLP+Rg5组肺组织W/D、MPO活性、NF-кB活性及肺组织损伤评分均明显低于CLP组(P＜0.05).IL-10水平24h时在各组动物比较结果差异无统计学意义(P＞0.05).结论:人参皂苷Rg5可以改善脓毒血症引起ALI时炎症反应从而发挥肺保护作用.     

NDRG2在大鼠肺缺血再灌注损伤中的表达

目的:通过建立大鼠肺缺血再灌注损伤(Lung ischemia-reperfusion injury,LIRI)模型,观察肺缺血再灌注损伤后,肺组织中N-myc下游调节基因2(N-myc downstream regulated gene,NDRG2)表达水平的变化.方法:将70只健康成年雄性SD大鼠随机分成对照组(C)、缺血组(I)、缺血再灌注组(I/R)(后两组各含3个亚组),每组10只.麻醉固定大鼠,颈部切口行气管插管.右侧开胸,肺缺血组依次分别选择游离夹闭右肺门(即右主支气管,右肺动、静脉)缺血30 min、60 min、120 min后,麻醉处死大鼠获取肺组织.肺缺血再灌注组同样选择游离夹闭右肺门,于夹闭右肺门60 min后松开,分别取再灌注30 min、60 min、120m in后麻醉处死大鼠获取肺组织样本.采用免疫组化对肺组织NDRG2进行蛋白定位检测、RT-PCR对肺组织NDRG2 mRNA含量进行检测、Western-blot对肺组织NDRG2蛋白含量进行检测.结果:肺缺血组与对照组比较,肺组织NDRG2的表达无明显变化(P＞0.05);肺缺血再灌注组与对照组比较,NDRG2蛋白含量和mRNA表达量逐渐下降,在60 min时达最低,之后又有所回升,但仍低于对照组(P＜0.05).结论:肺缺血再灌注损伤可下调肺组织中NDR G2的表达含量,NDRG2可能是肺缺血再灌注损伤的靶向调控位点.     

大潮气量致急性肺损伤犬呼吸机相关性肺损伤模型的构建

目的建立大潮气量致急性肺损伤（ALI）犬呼吸机相关性肺损伤（VILI）模型。方法健康雄性杂种犬12只用油酸静脉注射法制备犬ALI模型,造模成功后进行支持通气15min过渡,然后随机分为VILI组及对照组行机械通气6 h,每组6只。VILI组潮气量（Vt）=20 mL/kg,对照组Vt=6 mL/kg,两组呼气末正压（PEEP）均为10 cmH2O。动态观察各组血气交换指标变化。通气6 h后取支气管肺泡灌洗液（BALF）作白蛋白浓度检查,取肺组织作病理切片肺损伤评分。结果各组在油酸静脉注射后（2.50±0.80）h达到ALI标准。VILI组在犬机械通气6 h后PaO2、SaO2及氧合指数（OI）较对照组略下降（P〈0.05）,而PaCO2波动不大,且心率、血压波动也较对照组小（P〈0.05）。VILI组BALF中蛋白浓度和肺组织损伤评分均较对照组显著升高（分别P〈0.05,P〈0.01）。结论本实验成功建立了大潮气量致ALI犬VILI模型。     

Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome

ObjectiveIt has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS), but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.MethodsEighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAP_SB) and abdominal muscle paralysis group (BIPAP_AP). All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH₂O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO₂ of 35–60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV) and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL)-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.ResultsFor the comparable ventilator setting, as compared with BIPAP_SB group, the BIPAP_AP group presented higher EELV (427±47 vs. 366±38 ml) and oxygenation index (293±36 vs. 226±31 mmHg), lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml) and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml) in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7) and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9) in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAP_AP group (22.5±2.0 vs. 25.2±2.1).ConclusionAbdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.     

Protective Ventilation of Preterm Lambs Exposed to Acute Chorioamnionitis Does Not Reduce Ventilation-Induced Lung or Brain Injury

Background

The onset of mechanical ventilation is a critical time for the initiation of cerebral white matter (WM) injury in preterm neonates, particularly if they are inadvertently exposed to high tidal volumes (V_T) in the delivery room. Protective ventilation strategies at birth reduce ventilation-induced lung and brain inflammation and injury, however its efficacy in a compromised newborn is not known. Chorioamnionitis is a common antecedent of preterm birth, and increases the risk and severity of WM injury. We investigated the effects of high V_T ventilation, after chorioamnionitis, on preterm lung and WM inflammation and injury, and whether a protective ventilation strategy could mitigate the response.

Methods

Pregnant ewes (n = 18) received intra-amniotic lipopolysaccharide (LPS) 2 days before delivery, instrumentation and ventilation at 127±1 days gestation. Lambs were either immediately euthanased and used as unventilated controls (LPS_UVC; n = 6), or were ventilated using an injurious high V_T strategy (LPS_INJ; n = 5) or a protective ventilation strategy (LPS_PROT; n = 7) for a total of 90 min. Mean arterial pressure, heart rate and cerebral haemodynamics and oxygenation were measured continuously. Lungs and brains underwent molecular and histological assessment of inflammation and injury.

Results

LPS_INJ lambs had poorer oxygenation than LPS_PROT lambs. Ventilation requirements and cardiopulmonary and systemic haemodynamics were not different between ventilation strategies. Compared to unventilated lambs, LPS_INJ and LPS_PROT lambs had increases in pro-inflammatory cytokine expression within the lungs and brain, and increased astrogliosis (p<0.02) and cell death (p<0.05) in the WM, which were equivalent in magnitude between groups.

Conclusions

Ventilation after acute chorioamnionitis, irrespective of strategy used, increases haemodynamic instability and lung and cerebral inflammation and injury. Mechanical ventilation is a potential contributor to WM injury in infants exposed to chorioamnionitis.     

NMDA Receptor Antagonist Attenuates Bleomycin-Induced Acute Lung Injury

Background

Glutamate is a major neurotransmitter in the central nervous system (CNS). Large amount of glutamate can overstimulate N-methyl-D-aspartate receptor (NMDAR), causing neuronal injury and death. Recently, NMDAR has been reported to be found in the lungs. The aim of this study is to examine the effects of memantine, a NMDAR channel blocker, on bleomycin-induced lung injury mice.

Methods

C57BL/6 mice were intratracheally injected with bleomycin (BLM) to induce lung injury. Mice were randomized to receive saline, memantine (Me), BLM, BLM plus Me. Lungs and BALF were harvested on day 3 or 7 for further evaluation.

Results

BLM caused leukocyte infiltration, pulmonary edema and increase in cytokines, and imposed significant oxidative stress (MDA as a marker) in lungs. Memantine significantly mitigated the oxidative stress, lung inflammatory response and acute lung injury caused by BLM. Moreover, activation of NMDAR enhances CD11b expression on neutrophils.

Conclusions

Memantine mitigates oxidative stress, lung inflammatory response and acute lung injury in BLM challenged mice.