Impaired alveolar macrophage 11β-hydroxysteroid dehydrogenase type 1 reductase activity contributes to increased pulmonary inflammation and mortality in sepsis-related ARDS
Copyright © 2023 Mahida, Lax, Bassford, Scott, Parekh, Hardy, Naidu, Matthay, Stewart, Cooper, Perkins and Thickett..
Background: Acute Respiratory Distress Syndrome (ARDS) is a devastating pulmonary inflammatory disorder, commonly precipitated by sepsis. Glucocorticoids are immunomodulatory steroids that can suppress inflammation. Their anti-inflammatory properties within tissues are influenced by their pre-receptor metabolism and amplification from inactive precursors by 11β-hydroxysteroid dehydrogenase type-1 (HSD-1). We hypothesised that in sepsis-related ARDS, alveolar macrophage (AM) HSD-1 activity and glucocorticoid activation are impaired, and associated with greater inflammatory injury and worse outcomes.
Methods: We analysed broncho-alveolar lavage (BAL) and circulating glucocorticoid levels, AM HSD-1 reductase activity and Receptor for Advanced Glycation End-products (RAGE) levels in two cohorts of critically ill sepsis patients, with and without ARDS. AM HSD-1 reductase activity was also measured in lobectomy patients. We assessed inflammatory injury parameters in models of lung injury and sepsis in HSD-1 knockout (KO) and wild type (WT) mice.
Results: No difference in serum and BAL cortisol: cortisone ratios are shown between sepsis patients with and without ARDS. Across all sepsis patients, there is no association between BAL cortisol: cortisone ratio and 30-day mortality. However, AM HSD-1 reductase activity is impaired in patients with sepsis-related ARDS, compared to sepsis patients without ARDS and lobectomy patients (0.075 v 0.882 v 0.967 pM/hr/106 AMs, p=0.004). Across all sepsis patients (with and without ARDS), impaired AM HSD-1 reductase activity is associated with defective efferocytosis (r=0.804, p=0.008) and increased 30-day mortality. AM HSD-1 reductase activity negatively correlates with BAL RAGE in sepsis patients with ARDS (r=-0.427, p=0.017). Following intra-tracheal lipopolysaccharide (IT-LPS) injury, HSD-1 KO mice demonstrate increased alveolar neutrophil infiltration, apoptotic neutrophil accumulation, alveolar protein permeability and BAL RAGE concentrations compared to WT mice. Caecal Ligation and Puncture (CLP) injury in HSD-1 KO mice results in greater peritoneal apoptotic neutrophil accumulation compared to WT mice.
Conclusions: AM HSD-1 reductase activity does not shape total BAL and serum cortisol: cortisone ratios, however impaired HSD-1 autocrine signalling renders AMs insensitive to the anti-inflammatory effects of local glucocorticoids. This contributes to the decreased efferocytosis, increased BAL RAGE concentrations and mortality seen in sepsis-related ARDS. Upregulation of alveolar HSD-1 activity could restore AM function and improve clinical outcomes in these patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
Frontiers in immunology - 14(2023) vom: 01., Seite 1159831 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mahida, Rahul Y [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.05.2023 Date Revised 13.03.2024 published: Electronic-eCollection Citation Status MEDLINE |
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| doi: |
10.3389/fimmu.2023.1159831 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Mahida, Rahul Y |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Impaired alveolar macrophage 11β-hydroxysteroid dehydrogenase type 1 reductase activity contributes to increased pulmonary inflammation and mortality in sepsis-related ARDS |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 16.05.2023 | ||
| 500 | |a Date Revised 13.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Mahida, Lax, Bassford, Scott, Parekh, Hardy, Naidu, Matthay, Stewart, Cooper, Perkins and Thickett. | ||
| 520 | |a Background: Acute Respiratory Distress Syndrome (ARDS) is a devastating pulmonary inflammatory disorder, commonly precipitated by sepsis. Glucocorticoids are immunomodulatory steroids that can suppress inflammation. Their anti-inflammatory properties within tissues are influenced by their pre-receptor metabolism and amplification from inactive precursors by 11β-hydroxysteroid dehydrogenase type-1 (HSD-1). We hypothesised that in sepsis-related ARDS, alveolar macrophage (AM) HSD-1 activity and glucocorticoid activation are impaired, and associated with greater inflammatory injury and worse outcomes | ||
| 520 | |a Methods: We analysed broncho-alveolar lavage (BAL) and circulating glucocorticoid levels, AM HSD-1 reductase activity and Receptor for Advanced Glycation End-products (RAGE) levels in two cohorts of critically ill sepsis patients, with and without ARDS. AM HSD-1 reductase activity was also measured in lobectomy patients. We assessed inflammatory injury parameters in models of lung injury and sepsis in HSD-1 knockout (KO) and wild type (WT) mice | ||
| 520 | |a Results: No difference in serum and BAL cortisol: cortisone ratios are shown between sepsis patients with and without ARDS. Across all sepsis patients, there is no association between BAL cortisol: cortisone ratio and 30-day mortality. However, AM HSD-1 reductase activity is impaired in patients with sepsis-related ARDS, compared to sepsis patients without ARDS and lobectomy patients (0.075 v 0.882 v 0.967 pM/hr/106 AMs, p=0.004). Across all sepsis patients (with and without ARDS), impaired AM HSD-1 reductase activity is associated with defective efferocytosis (r=0.804, p=0.008) and increased 30-day mortality. AM HSD-1 reductase activity negatively correlates with BAL RAGE in sepsis patients with ARDS (r=-0.427, p=0.017). Following intra-tracheal lipopolysaccharide (IT-LPS) injury, HSD-1 KO mice demonstrate increased alveolar neutrophil infiltration, apoptotic neutrophil accumulation, alveolar protein permeability and BAL RAGE concentrations compared to WT mice. Caecal Ligation and Puncture (CLP) injury in HSD-1 KO mice results in greater peritoneal apoptotic neutrophil accumulation compared to WT mice | ||
| 520 | |a Conclusions: AM HSD-1 reductase activity does not shape total BAL and serum cortisol: cortisone ratios, however impaired HSD-1 autocrine signalling renders AMs insensitive to the anti-inflammatory effects of local glucocorticoids. This contributes to the decreased efferocytosis, increased BAL RAGE concentrations and mortality seen in sepsis-related ARDS. Upregulation of alveolar HSD-1 activity could restore AM function and improve clinical outcomes in these patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a 11b-hydroxysteroid dehydrogenase type-1 | |
| 650 | 4 | |a ARDS (acute respiratory disease syndrome) | |
| 650 | 4 | |a alveolar macrophage (AM) | |
| 650 | 4 | |a autocrine action | |
| 650 | 4 | |a sepsis | |
| 650 | 7 | |a 11-beta-Hydroxysteroid Dehydrogenase Type 1 |2 NLM | |
| 650 | 7 | |a EC 1.1.1.146 |2 NLM | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 650 | 7 | |a Hydrocortisone |2 NLM | |
| 650 | 7 | |a WI4X0X7BPJ |2 NLM | |
| 650 | 7 | |a Cortisone |2 NLM | |
| 650 | 7 | |a V27W9254FZ |2 NLM | |
| 650 | 7 | |a Receptor for Advanced Glycation End Products |2 NLM | |
| 650 | 7 | |a Hydroxysteroid Dehydrogenases |2 NLM | |
| 650 | 7 | |a EC 1.1.- |2 NLM | |
| 650 | 7 | |a Anti-Inflammatory Agents |2 NLM | |
| 700 | 1 | |a Lax, Siân |e verfasserin |4 aut | |
| 700 | 1 | |a Bassford, Christopher R |e verfasserin |4 aut | |
| 700 | 1 | |a Scott, Aaron |e verfasserin |4 aut | |
| 700 | 1 | |a Parekh, Dhruv |e verfasserin |4 aut | |
| 700 | 1 | |a Hardy, Rowan S |e verfasserin |4 aut | |
| 700 | 1 | |a Naidu, Babu |e verfasserin |4 aut | |
| 700 | 1 | |a Matthay, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Stewart, Paul M |e verfasserin |4 aut | |
| 700 | 1 | |a Cooper, Mark C |e verfasserin |4 aut | |
| 700 | 1 | |a Perkins, Gavin D |e verfasserin |4 aut | |
| 700 | 1 | |a Thickett, David R |e verfasserin |4 aut | |
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