Lymphocyte apoptosis is a hallmark of sepsis and contributes to disease mortality. In other acute injuries, such as myocardial and cerebral ischemia/reperfusion, apoptosis plays a significant role in disease-associated morbidity and mortality. We previously showed that constitutive activation of the potent antiapoptotic Akt/protein kinase B signaling pathway in lymphocytes both reduces sepsisinduced lymphocyte apoptosis and confers a significant survival advantage compared to wild-type littermates. Here, we demonstrate a therapeutic approach to acutely augment Akt activity in a wildtype animal. A cell-permeable peptide conjugated to the Akt-binding domain of the endogenous Akt coactivator, Tcl-1, prolongs Akt activity, activates extracellular regulated kinase (ERK) signaling and protects lymphocytes from numerous apoptotic stimuli both in vitro and in vivo. Molecular approaches to activate the antiapoptotic Akt and ERK signaling pathways may provide a novel tool to study these signaling pathways, as well as a new antiapoptotic strategy for the treatment of sepsis and other acute injuries.SEPSIS AFFECTS 750,000 PATIENTS in the United States annually with nearly 30% mortality (1). Despite advances in patient care, the number of cases continues to rise. One difficulty in treating sepsis is that the pathogen causing infection is frequently not identified. As a result, it is difficult to know whether a therapeutic regimen is appropriate, and thus empiric antibiotics are often given.
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NIH-PA Author ManuscriptAlthough a number of approaches are being explored to better diagnose and stage patients with sepsis, none have reached maturity (2).An alternative to current, pathogen-targeted therapies is the development of therapeutic approaches that ameliorate the pathological aspects of the host response (3-6). A common histopathological finding in septic patients at autopsy and in animal models of sepsis is the profound loss of lymphocytes by apoptosis (7). Prevention of sepsis-induced lymphocyte apoptosis confers a significant survival advantage in animal models of disease (8,9). One transgenic mouse that has a significant survival advantage in models of sepsis overexpresses Akt in a T-lymphocyte-restricted manner (10). These mice express a variant of Akt that has an N-terminal myristoylation sequence that results in Akt being constitutively active. Akt is a serine-threonine protein kinase that is activated in response to cell-stimulatory signals, such as growth factors, cytokines, and T cell activation. Akt inactivates a number of proapoptotic molecules, including GSK-3β, Bad, and forkhead transcription factors. As a result, activation of Akt renders a cell transiently refractory to apoptotic stimuli.Endogenous Akt is activated in response to many cell stimuli, however, these stimuli initiate a number of other cellular processes that are independent of Akt. The recent failure of anti-CD28 in phase I safety trials highlights the danger of activating several cell sign...