Endotoxin, a constituent of Gram-negative bacteria, stimulates macrophages to release large quantities of tumor necrosis factor (TNF) and interleukin-1 (IL-1), which can precipitate tissue injury and lethal shock (endotoxemia). Antagonists of TNF and IL-1 have shown limited efficacy in clinical trials, possibly because these cytokines are early mediators in pathogenesis. Here a potential late mediator of lethality is identified and characterized in a mouse model. High mobility group-1 (HMG-1) protein was found to be released by cultured macrophages more than 8 hours after stimulation with endotoxin, TNF, or IL-1. Mice showed increased serum levels of HMG-1 from 8 to 32 hours after endotoxin exposure. Delayed administration of antibodies to HMG-1 attenuated endotoxin lethality in mice, and administration of HMG-1 itself was lethal. Septic patients who succumbed to infection had increased serum HMG-1 levels, suggesting that this protein warrants investigation as a therapeutic target.
This document reflects a process whereby a group of experts and opinion leaders revisited the 1992 sepsis guidelines and found that apart from expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience, no evidence exists to support a change to the definitions. This lack of evidence serves to underscore the challenge still present in diagnosing sepsis in 2003 for clinicians and researchers and also provides the basis for introducing PIRO as a hypothesis-generating model for future research.
1. Current concepts of sepsis, severe sepsis and septic shock remain useful to clinicians and researchers. 2. These definitions do not allow precise staging or prognostication of the host response to infection. 3. While SIRS remains a useful concept, the diagnostic criteria for SIRS published in 1992 are overly sensitive and non-specific. 4. An expanded list of signs and symptoms of sepsis may better reflect the clinical response to infection. 6. PIRO, a hypothetical model for staging sepsis is presented, which, in the future, may better characterize the syndrome on the basis of predisposing factors and premorbid conditions, the nature of the underlying infection, the characteristics of the host response, and the extent of the resultant organ dysfunction.
High mobility group box 1 (HMGB1) protein, originally described as a DNA-binding protein that stabilizes nucleosomes and facilitates transcription, can also be released extracellularly during acute inflammatory responses. Exposure of neutrophils, monocytes, or macrophages to HMGB1 results in increased nuclear translocation of NF-B and enhanced expression of proinflammatory cytokines. Although the receptor for advanced glycation end products (RAGE) has been shown to interact with HMGB1, other putative HMGB1 receptors are known to exist but have not been characterized. In the present experiments, we explored the role of RAGE, Tolllike receptor ( HMGB11 (formerly HMG1) was originally described as a non-histone, chromatin-associated nuclear protein (1-4).HMGB1 has a highly conserved sequence among species, with murine HMGB1 differing from the human form by only two amino acids. HMGB1-deficient mice die within a few hours of birth, demonstrating the crucial role of this protein in cellular function. HMGB1 consists of two tandem L-shaped domains, HMGB boxes A and B, each ϳ75 amino acids in length, and a highly acidic carboxyl terminus of 30 amino acids in length.HMGB1 appears to have two distinct functions in cellular systems. First, it has been shown to be an intracellular regulator of transcription, and, second, HMGB1 can occupy an extracellular role in which it promotes tumor metastasis and inflammation (2-9). Extracellular HMGB1 has been demonstrated to participate in inflammatory processes, including delayed endotoxin lethality and acute lung injury (10, 11). Monocytes and macrophages stimulated by lipopolysaccharide (LPS), tumor necrosis factor (TNF)-␣, or interleukin-1 (IL-1) secrete HMGB1 (5, 11). Culture of monocytes with HMGB1 results in the release of TNF-␣, IL-1␣, IL-1, IL-1Ra, IL-6, IL-8, macrophage inflammatory protein-1␣, macrophage inflammatory protein-1, but not IL-10 or IL-12 (5, 11). Production of proinflammatory cytokines after exposure to HMGB1 occurs with delayed kinetics as compared with LPS-induced stimulation. For example, culture of macrophages with LPS results in increases in TNF-␣ that are apparent within less than 1 h, whereas TNF-␣ synthesis following HMGB1 exposure only begins to occur after 2 h and then persists for as long as 8 h (8, 11). The signaling mechanisms responsible for the delayed expression of proinflammatory cytokines by HMGB1-stimulated cells remain incompletely explained but appear to involve the p38, ERK, JNK, and Akt kinases and to lead to enhanced nuclear translocation of .In recent studies (13), we found that the magnitude and kinetics of cytokine expression and nuclear translocation of NF-B after culture of neutrophils with HMGB1 or LPS were similar, suggesting that overlapping mechanisms of cellular activation might be involved. Comparison of gene expression arrays also demonstrated substantial but not complete homology in response to HMGB1 and LPS. Signaling via the TLR 4 receptor is responsible for LPS-induced activation of the IKK kinase complex, including IKK...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.