Cross-transfusion of Postshock Mesenteric Lymph Provokes Acute Lung Injury

Wohlauer, Max V.; Fragoso, Miguel; Harr, Jeffrey N.; Silliman, Christopher C.; Banerjee, Anirban; Ee, Moore

doi:10.1016/j.jss.2010.11.131

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…This is demonstrated by prevention of neutrophil priming and accumulation in pulmonary tissues; reduced lung permeability, and histological improvement in lung injury . Furthermore, gut lymph is directly toxic to pulmonary microvascular endothelial cells, and lung injury can be reproduced when donor lymph from a rat subjected to haemorrhagic shock is infused into a naive rat . Clinically, these findings are supported by three non‐randomized studies in AP assessing pulmonary function, one of which observed that arterial oxygenation improved immediately once drainage was instituted …”

Section: Persistent Organ Failurementioning

confidence: 89%

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Windsor

Escott

Brown

et al. 2017

J of Gastro and Hepatol

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Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental redesign of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP.

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Section: Persistent Organ Failurementioning

confidence: 89%

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Windsor

Escott

Brown

et al. 2017

J of Gastro and Hepatol

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“…The “gut-lymph” pathway is therefore important in distant organ injury. However, the factors causing injury remain unknown [6]. Possible factors include Toll-like receptor 4 (TLR4), high-mobility group box 1 protein (HMGB1), endotoxin, as well as bioactive non-microorganism derived proteins and lipoproteins.…”

Section: Introductionmentioning

confidence: 99%

The effect of different treatments of lymph after intestinal ischemia-reperfusion in rats on macrophages in vitro

Zhang

Wang

et al. 2019

PLoS ONE

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BackgroundTo observe the effects of different treatments of lymph after intestinal I/R in rats on macrophages in vitro.MethodsForty-eight healthy SPF SD rats weighing 300 ± 20 g, were randomly divided into two groups: group A, and group B. The rats in group A were drained of lymph fluid for 180 min; the rats in group B were subjected to 60 min ischemia by clamping the SMA, followed by 120 min reperfusion and 180 min of lymph drainage. The lymph fluid collected was divided into 4 sub-groups: 1. no treatment (A1, Ly, and B1, I/R Ly); 2. protein degradation (A2, Ly PD, and B2 I/R PD); 3. endotoxin removal (A3, Ly ER, and B3, I/R ER); 4. protein degradation plus endotoxin removal (A4, Ly PD+ER, and B4, I/R PD+ER), then used to stimulate a monocyte-macrophage cell line.ResultsCompared with group A1, the levels of the inflammatory cytokines, chemokines, HMGB1 concentration, protein and mRNA expression of TLR4, HMGB1 and NF-κBp65 were significantly increased in group B1. There was a significant reduction in proinflammatory cytokines and of the expression of TLR4, NF-κBp65, and chemokines in groups A2, B2, A4, and B4. However, there were no significant decrease of these factors in groups A3 and B3.ConclusionsThe lymph fluid drained after intestinal I/R can cause inflammation in vivo and in vitro. Deproteinization of lymph fluid with proteinase K significantly reduced the concentration of proinflammatory cytokines, chemokines, TLR4 and NF-κBp65 in cell culture supernatant, exerting a protective effect on inflammatory reaction caused by the intestinal I/R. Passage of lymph fluid through an endotoxin removal column did not reduce the levels of active proinflammatory factors produced by macrophages in vitro.

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“…2 It has been also demonstrated that mesenteric lymph (ML) plays an essential role in the delivery of cytokines, coagulation factors, cellular breakdown products, and inflammatory lipid mediators into the circulation from the ischemic gut after HS. 3,4 Inflammatory lipid mediators in the ML are thought to play a significant role in the pathogenesis of MOD after HS, and phospholipase A 2 (PLA 2 ) is related to the generation of these mediators. 5 Free fatty acids generated by PLA 2 have been reported to increase the toxicity of ML in an intestinal ischemia/ reperfusion (I/R) model.…”

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confidence: 99%

Vagus nerve stimulation modulates arachidonic acid production in the mesenteric lymph following intestinal ischemia-reperfusion injury

Nakatsutsumi

Yagi

Doki

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Inflammatory lipid mediators in mesenteric lymph (ML), including arachidonic acid (AA), are considered to play an important role in the pathogenesis of multiple-organ dysfunction after hemorrhagic shock. A previous study suggested that vagus nerve stimulation (VNS) could relieve shock-induced gut injury and abrogate ML toxicity, resulting in the prevention of multiple-organ dysfunction. However, the detailed mechanism of VNS in lymph toxicity remains unclear. The study aimed to investigate the relationship between VNS and inflammatory lipid mediators in ML. METHODS:Male Sprague-Dawley rats underwent laparotomy and superior mesenteric artery obstruction (SMAO) for 60 minutes to induce intestinal ischemia followed by reperfusion and observation. The ML duct was cannulated, and ML samples were obtained both before and after SMAO. The distal ileum was removed at the end of the observation period. In one group of animals, VNS was performed from 10 minutes before 10 minutes after SMAO (5 V, 0.5 Hz). Liquid chromatography-electrospray ionization-tandem mass spectrometry analysis of AA was performed for each ML sample. The biological activity of ML was examined using a monocyte nuclear factor κ-light-chainenhancer of activated B cells activation assay. Western blotting of phospholipase A 2 group IIA (PLA 2 -IIA) was also performed for ML and ileum samples. RESULTS:Vagus nerve stimulation relieved the SMAO-induced histological gut injury. The concentration of AA and level of nuclear factor κ-lightchain-enhancer of activated B cells activation in ML increased significantly after SMAO, whereas VNS prevented these responses. Western blotting showed PLA 2 -IIA expression in the ML and ileum after SMAO; however, the appearance of PLA2-IIA band was remarkably decreased in the samples from VNS-treated animals. CONCLUSION: The results suggested that VNS could relieve gut injury induced by SMAO and decrease the production of AA in ML by altering PLA 2 -IIA expression in the gut and ML.

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Cross-transfusion of Postshock Mesenteric Lymph Provokes Acute Lung Injury

Cited by 3 publications

References 37 publications

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

The effect of different treatments of lymph after intestinal ischemia-reperfusion in rats on macrophages in vitro

Vagus nerve stimulation modulates arachidonic acid production in the mesenteric lymph following intestinal ischemia-reperfusion injury

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