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The Orchestra of Mediators in the Pathogenesis of Septic Shock: A Review

  • Conference paper
Update 1991

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 14))

Abstract

Sepsis is a clinical syndrome that in most cases is induced by severe bacterial infections. Its manifestations may vary and include fever, leukocytosis, thrombocytopenia, tachycardia and tachypnea. Frequently, sepsis is complicated by the development of shock and multiple organ failure. Septic shock still continues to be a challenge for clinical investigators. In spite of advances in intensive care medicine and the availability of a large number of antibiotics, the mortality rate of this condition is still high, in some studies being 50–70%.

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References

  1. Morrison DC, Ulevitch RJ (1978) The effects of bacterial endotoxins on host mediation systems. Am J Pathol 93:527–617

    Google Scholar 

  2. Tracey KJ, Beutler B, Lowry SF, et al. (1986) Shock and tissue injury induced by human recombinant cachectin. Science 234:470–474

    Article  PubMed  CAS  Google Scholar 

  3. Tracey KJ, Lowry SF, Fahey TJ III, et al. (1987) Cachectin tumor necrosis factor induces lethal shock and stress hormone responses in the dog. Surg Gynecol Obstet 164:415–422

    PubMed  CAS  Google Scholar 

  4. Okusawa S, Gelfland JA, Ikejima T, Connolly RJ, Dinarello CA (1988) Interleukin 1 induces a shock-like state in rabbits. J Clin Invest 81:1162–1172

    Article  PubMed  CAS  Google Scholar 

  5. Ognibene FP, Rosenberg SA, Lotze M, et al. (1988) Interleukin-2 administration causes reversible hemodynamic changes and left ventricular dysfunction similar to those seen in septic shock. Chest 94:750–754

    Article  PubMed  CAS  Google Scholar 

  6. Beutler B, Milsark IW, Cerami A (1985) Passive immunization against cachectin/tumor necrosis factor protects mice from lethal effect of endotoxin. Science 229:869–871

    Article  PubMed  CAS  Google Scholar 

  7. Tracey KJ, Fong Y, Hesse DG, et al. (1987) Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. Nature 330:662–664

    Article  PubMed  CAS  Google Scholar 

  8. Marks JD, Marks CB, Luce JM, et al. (1990) Plasma tumor necrosis factor in patients with septic shock: Mortality rate, incidence of adult respiratory distress syndrome, and effects of methylprednisolone administration. Am Rev Respir Dis 141:94–97

    PubMed  CAS  Google Scholar 

  9. Michie HR, Manogue KR, Spriggs DR, et al. (1988) Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318:1481–1486

    Article  PubMed  CAS  Google Scholar 

  10. Hesse DG, Tracey KJ, Fong Y, et al. (1988) Cytokine appearance in human endotoxemia and primate bacteremia. Surg Gynecol Obstet 166:147–153

    PubMed  CAS  Google Scholar 

  11. Hack CE, De Groot ER, Felt-Bersma RJF, et al. (1989) Increased plasma levels of interleu-kin-6 in sepsis. Blood 74:1704–1710

    PubMed  CAS  Google Scholar 

  12. Van Deventer SJH, Büller HR, Ten Cate JW, Aarden LA, Hack CE, Sturk A (1991) Experimental endotoxaemia in humans: effect on cytokines, coagulation, and complement. Blood (in press)

    Google Scholar 

  13. Remick DG, Strieter RM, Eskandari MK, et al. (1990) Role of tumor necrosis factor-alpha in lipopolysaccharide-induced pathologic alterations. Am J Pathol 136:49–60

    PubMed  CAS  Google Scholar 

  14. de Groote MA, Martin MA, Densen P, Pfaller MA, Wenzel RP (1989) Plasma tumor necrosis factor levels in patients with presumed sepsis. JAMA 262:249–251

    Article  PubMed  Google Scholar 

  15. Creasey AA, Stevens P, Kenney J, et al. (1991) Endotoxin and cytokine profile in plasma of baboons challenged with lethal and sublethal E. coli. Circ Shock (in press)

    Google Scholar 

  16. Heremans H, Van Damme J, Dillen C, Dijkmans R, Billiau A (1990) Interferon gamma, a mediator of lethal lipopolysaccharide-induced Shwartzman-like shock reactions in mice. J Exp Med 171:1853–1869

    Article  PubMed  CAS  Google Scholar 

  17. Natanson C, Eichenholz PW, Danner RL, et al. (1989) Endotoxin and tumor necrosis factor challenges in dogs simulate the cardiovascular profile of human septic shock. J Exp Med 169:823–832

    Article  PubMed  CAS  Google Scholar 

  18. Butler LD, Layman NK, Cain RL, et al. (1989) Interleukin 1-induced pathophysiology: induction of cytokines, development of histopathologic changes, and immunopharmaco- logic intervention. Clin Immunol Immunopathol 53:400–421

    Article  PubMed  CAS  Google Scholar 

  19. Martin S, Maruta K, Burkart V, Gillis S, Kolb H (1988) IL-1 and IFN-gamma increase vascular permeability. Immunology 64:301–305

    PubMed  CAS  Google Scholar 

  20. Kilbourn RG, Gross SS, Jubran A, et al. (1990) N G-MethyI-L-arginine inhibits tumor necrosis factor-induced hypotension: Implications for the involvement of nitric oxide. Proc Natl Acad Sci USA 87:3629–3632

    Article  PubMed  CAS  Google Scholar 

  21. Mantovani A, Dejana E (1989) Cytokines as communication signals between leukocytes and endothelial cells. Immunol Today 10:370–375

    Article  PubMed  CAS  Google Scholar 

  22. Smedly LA, Tonnesen MG, Sandhaus RA, et al. (1986) Neutrophil-mediated injury to endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase. J Clin Invest 77:1233–1243

    Article  PubMed  CAS  Google Scholar 

  23. Waage A, Brandtzaeg P, Halstensen A, Kierulf P, Espevik T (1989) The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med 169:333–338

    Article  PubMed  CAS  Google Scholar 

  24. Girardin E, Grau GE, Dayer J-M, Roux-Lambard P, the J5 Study Group, Lambert P-H (1988) Tumor necrosis factor and interleukin-1 in the serum of children with severe infectious purpura. N Engl J Med 319:397–400

    Article  PubMed  CAS  Google Scholar 

  25. Gauldie J, Richards C, Harnish D, Lansdorp PM, Baumann H (1987) Interferon B2/B-cell stimulatory factor type 2 shares identity with monocyte-derived hepatocyte-stimulating factor and regulates the major acute phase protein response in liver cells. Proc Natl Acad Sci USA 84:7251–7255

    Article  PubMed  CAS  Google Scholar 

  26. Fong Y, Tracey KJ, Moldawer LL, et al. (1989) Antibodies to cachectin/tumor necrosis factor reduce interleukin 1β and interleukin 6 appearance during lethal bacteremia. J Exp Med 170:1627–1633

    Article  PubMed  CAS  Google Scholar 

  27. Helle M, Brakenhoff JPJ, De Groot ER, Aarden LA (1988) Interleukin 6 is involved in interleukin-1-induced activities. Eur J Immunol 18:957–959

    Article  PubMed  CAS  Google Scholar 

  28. Nijsten MWN, De Groot ER, ten Duis HJ, Klasen HJ, Hack CE, Aarden LA (1987) Serum levels of interleukin-6 and acute phase responses. Lancet 2:921–921

    Article  PubMed  CAS  Google Scholar 

  29. Morrison DC, Kline LF (1977) Activation of the classical and properdin pathways of complement by bacterial lipopolysaccharides (LPS). J Immunol 118:362–368

    PubMed  CAS  Google Scholar 

  30. Vogt W. (1986) Anaphylatoxins: possible roles in disease. Complement 3:177–188

    PubMed  CAS  Google Scholar 

  31. Bjork J, Hugh TE, Smedegard G (1985) Microvascular effects of anaphylatoxins C3a and C5a. J Immunol 134:1115–1119

    PubMed  CAS  Google Scholar 

  32. Lundberg C, Marcheau F, Hugli TE (1987) C5a-induced hemodynamic and hematologic changes in the rabbit. Am J Pathol 128:471–483

    PubMed  CAS  Google Scholar 

  33. Hammerschmidt DE, Hudson LD, Weaver LJ, Craddock PR, Jacob HS (1980) Association of complement activation and elevated plasma-C5a with adult respiratory distress syndrome: pathophysiological relevance and possible prognostic value. Lancet 1:947–949

    Article  PubMed  CAS  Google Scholar 

  34. Stevens, JH, O’Hanley P, Shapiro JM, et al. (1986) Effects of anti-C5a antibodies on the adult respiratory distress syndrome in septic primates. J Clin Invest 77:1812–1816

    Article  Google Scholar 

  35. Smedegard G, Cui L, Hugli TE (1989) Endotoxin-induced shock in the rat. Am J Pathol 135:489–497

    PubMed  CAS  Google Scholar 

  36. Okusawa S, Yancey KB, Van der Meer JWM, et al. (1988) C5a stimulates secretion of tumor necrosis factor from human mononuclear cells in vitro. Comparison with secretion of interleukin 1β and interleukin 1α. J Exp Med 168:443–448

    Article  PubMed  CAS  Google Scholar 

  37. Osterud B, Olsen JO, Benjaminsen AW (1984) The role of complement in the induction ofthromboplasmin synthesis. Haemostasis 14:386–392

    PubMed  CAS  Google Scholar 

  38. Hamilton KK, Hattori R, Esmon CT, Sims PJ (1990) Complement proteins C5b-9 induce vesiculation of the endothelial plasma membrane and expose catalytic surface of assembly of the prothrombinase enzyme complex. J Biol Chem 265:3809–3814

    PubMed  CAS  Google Scholar 

  39. McCabe WR (1973) Serum complement levels in bacteremia due to gram-negative organisms. N Engl J Med 288:21–23

    Article  PubMed  CAS  Google Scholar 

  40. Fearon DT, Ruddy S, Schur PH, McCabe WR (1975) Activation of the properdin pathway of complement in patients with gram-negative bacteremia. N Engl J Med 292:937–940

    Article  PubMed  CAS  Google Scholar 

  41. Heidemann M, Hugli TE (1984) Anaphylatoxin generation in multisystem organ failure. J Trauma 24:1038–1043

    Article  Google Scholar 

  42. Slotman GJ, Burchard KW, Williams JJ, D’Arezzo A, Yellin SA (1986) Interaction of prostaglandins, activated complement, and granulocytes in clinical sepsis and hypotension. Surgery 99:744–751

    PubMed  CAS  Google Scholar 

  43. Langlois PF, Gawryl MS (1988) Accentuated formation of the terminal C5b-9 complement complex in patient plasma precedes development of the adult respiratory distress syndrome. Am Rev Respir Dis 138:368–375

    PubMed  CAS  Google Scholar 

  44. Hack CE, Nuijens JH, Felt-Bersma RJF, et al. (1989) Elevated plasma levels of the anaphy-latoxins C3a and C4a are associated with a fatal outcome in sepsis. Am J Med 86:20–26

    Article  PubMed  CAS  Google Scholar 

  45. Carrell RW, Christey PB, Boswell DR (1987) Serpins: antithrombin and other inhibitors of coagulation and fibrinolysis. Evidence from amino acid sequences. In: Verstraete M, Vermylen J, Lijnen R, Arnout J (eds) Thrombosis and haemostasis. Leuven University Press, Leuven, pp 1–15

    Google Scholar 

  46. Nuijens JH, Eerenberg Belmer AJM, Huijbregts CCM, et al. (1989) Proteolytic inactivation of plasma C1-Inhibitor in spesis. J Clin Invest 84:443–450

    Article  PubMed  CAS  Google Scholar 

  47. Thijs LG, Hack CE, Strack van Schijndel RJM, et al. (1990) Activation of the complement system during immunotherapy with recombinant interleukin-2 : Relation to the development of side effects. J Immunol 144:2419–2424

    PubMed  CAS  Google Scholar 

  48. Thijs LG, Hack CE, Strack van Schijndel RJM, et al. (1989) Complement activation and high-dose of interleukin-2. Lancet 2:395–395

    Article  PubMed  CAS  Google Scholar 

  49. Kozin F, Cochrane CG (1988) The contact activation systems of plasma: Biochemistry and pathophysiology. In: Gallin JI, Goldstein IM, Snyderman R (eds) Inflammation: Basic principles and clinical correlates. Raven Press, New York, pp 101–120

    Google Scholar 

  50. Morrison DC, Cochrane CG (1974) Direct evidence for Hageman factor (factor XII) activation by bacterial lipopolysaccharides (endotoxins). J Exp Med 140:797–811

    Article  PubMed  CAS  Google Scholar 

  51. Colman RW, Edelman R, Scott CF, Gilman RM (1978) Plasma kallikrein activation and inhibition during typhoid fever. J Clin Invest 61:287–296

    Article  PubMed  CAS  Google Scholar 

  52. Mason JM, Kleeberg V, Dolan P, Colman RW (1970) Plasma kallikrein and Hageman factor in gram-negative bacteremia. Ann Intern Med 73:545–551

    PubMed  CAS  Google Scholar 

  53. Nuijens JH, Huijbregts CC, Eerenberg-Belmer AJ, et al. (1988) Quantification of plasma factor XIIa-C1-inhibitor and kallikrein-C1-inhibitor complexes in sepsis. Blood 72:1814–1848

    Google Scholar 

  54. Hack CE, Nuijens JH, Strack van Schijndel RJM, Abbink JJ, Eerenberg AJM, Thijs LG (1991) Interplay of cytokines, neutrophils, and of the complement and contact system in sepsis : a study in 48 patients. Intensive Care Med (in press)

    Google Scholar 

  55. Cadena de la RA, Suffredini AF, Kaufman N, Parrillo JE, Colman RW (1990) Activation of kallikreinkinin system after endotoxin administration to normal human volunteers. Clin Res 38:346a

    Google Scholar 

  56. Pixley RA, Cadena de la RA, Wijshock E, et al. (1990) Role of the contact system in lethal hypotensive septicemia in baboons. Clin Res 38:345a

    Google Scholar 

  57. Egbring R, Schmidt W, Fuchs G, Havermann K (1977) Demonstration of granulocytic proteases in plasma of patients with acute leukemia and septicemia with coagulation defects. Blood 49:219–231

    PubMed  CAS  Google Scholar 

  58. Duswald KH, Jochum M, Schramm W, Fritz H (1985) Released granulocytic elastase: an indicator of pathobiochemical alterations in septicemia after abdominal surgery. Surgery 98:892–898

    PubMed  CAS  Google Scholar 

  59. Seitz R, Wolf M, Egbring R, et al. (1987) Participation and interactions of neutrophil elastase in haemostatic disorders of patients with severe infections. Eur J Haematol 38:231–240

    Article  PubMed  CAS  Google Scholar 

  60. Abbink JJ, Nuijens JH, Eerenberg AJM, et al. (1991) Quantification of functional and inactivated α2-macroglobulin in sepsis. Thromb Haemost (in press)

    Google Scholar 

  61. Van Hinsbergh VWM, Kooistra T, van den Berg EA, Princen HMG, Fiers W, Emeis JJ (1988) Tumor necrosis factor increases the production of plasminogen activator inhibitor in human endothelial cells in vitro and rats in vivo. Blood 72:1467–1473

    PubMed  Google Scholar 

  62. Bevilacqua MP, Pober JS, Majeau GR, Cotran RS, Gimbrone Jr MA (1984) Interleukin 1 (IL-1) induces biosynthesis and cell surface expression of procoagulant activity in human endothelial cells. J Exp Med 160:618–623

    Article  PubMed  CAS  Google Scholar 

  63. Bevilacqua MP, Pober JS, Majeau GR, Fiers W, Cotran RS, Gimbrone MA Jr (1986) Recombinant tumor necrosis factor induces procoagulant activity in cultured human vascular endothelium: characterization and comparison with the actions of interleukin 1. Proc Natl Acad Sci USA 83:4533–4537

    Article  PubMed  CAS  Google Scholar 

  64. van der Poll T, Büller HR, ten Cate H, et al. (1990) Activation of coagulation after administration of tumor necrosis factor to normal subjects. N Engl J Med 322:1622–1626

    Article  PubMed  Google Scholar 

  65. Teitel JM, Rosenberg RD (1983) Protection of factor Xa from neutralization by the heparin-anti-thrombin complex. J Clin Invest 71:1383–1391

    Article  PubMed  CAS  Google Scholar 

  66. Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J (1990) Clot-bound thrombin is protected from inhibition by heparin — antithrombin III but is suspectible to inactivation by antithrombin III-independent inhibitors. J Clin Invest 86:385–391

    Article  PubMed  CAS  Google Scholar 

  67. Taylor FB Jr, Emerson TE Jr, Jordan R, Chang AK, Blick KE (1988) Antithrombin-III prevents the lethal effects of Escherichia coli infusion in baboons. Circ Shock 26:227–235

    PubMed  CAS  Google Scholar 

  68. Suffredini AF, Harpel PC, Parillo JE (1989) Promotion and subsequent inhibition of plasminogen activator after administration of intravenous endotoxin to normal subjects. N Engl J Med 18:1165–1171

    Article  Google Scholar 

  69. Hesselvik JF, Blomback M, Brodin B, Maller R (1989) Coagulation, fibrinolysis, and kalli-krein systems in sepsis: relation to outcome. Crit Care Med 17:724–733

    Article  PubMed  CAS  Google Scholar 

  70. Moalli R, Doyle JM, Tahhan HR, Hasan FM, Braman SS, Saldeen T (1989) Fibrinolysis in critically ill patients. Am Rev Respir Dis 140:287–293

    Article  PubMed  CAS  Google Scholar 

  71. Pralong G, Calandra T, Glauser MP, et al. (1989) Plasminogen activator inhibitor 1: A new prognostic marker in septic shock. Thromb Haemost 61:459–462

    PubMed  CAS  Google Scholar 

  72. Warr TA, Rao LV, Rapaport SI (1990) Disseminated intravascular coagulation in rabbits induced by administration of endotoxin or tissue factor: effect of anti — tissue factor antibodies and measurement of plasma extrinsic pathway inhibitor activity. Blood 75:1481–1489

    PubMed  CAS  Google Scholar 

  73. Taylor FB Jr, Chang A, Esmon CT, D’Angelo A, Vigano-D’Angelo S, Blick KE (1987) Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest 79:918–925

    Article  PubMed  CAS  Google Scholar 

  74. Hoffmann H, Siebeck M, Spannagl M, et al. (1990) Effect of recombinant hirudin, a specific inhibitor of thrombin, on endotoxin-induced intravascular coagulation and acute lung injury in pigs. Am Rev Respir Dis 142:782–788

    PubMed  CAS  Google Scholar 

  75. Varani J, Ginsburg I, Schuger L, et al. (1989) Endothelial cell killing by neutrophils. Synergistic interaction of oxygen products and proteases. Am J Pathol 135:435–438

    PubMed  CAS  Google Scholar 

  76. Weiss SJ (1989) Tissue destruction by neutrophils. N Engl J Med 320:365–376

    Article  PubMed  CAS  Google Scholar 

  77. Beatty K, Bieth B, Travis J (1980) Kinetics of association of serine proteinases with native and oxidized α1proteinase inhibitor and α1-antichymotrypsin. J Biol Chem 255:3931–3934

    PubMed  CAS  Google Scholar 

  78. Reddy VY, Pizzo SV, Weiss SJ (1989) Functional inactivation and structural disruption of human α2-macroglobulin by neutrophils and eosinophils. J Biol Chem 264:13801–13809

    PubMed  CAS  Google Scholar 

  79. Goetzl EJ, Goldstein IM (1985) Cellular components of inflammation: granulocytes. In: Kelley WN, Harris ED, Ruddy S, Sledge CB (eds) Textbook of rheumatology. Saunders, New York, pp 115–144

    Google Scholar 

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© 1991 Springer-Verlag Berlin, Heidelberg

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Hack, C.E., Thijs, L.G. (1991). The Orchestra of Mediators in the Pathogenesis of Septic Shock: A Review. In: Vincent, J.L. (eds) Update 1991. Update in Intensive Care and Emergency Medicine, vol 14. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84423-2_27

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