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Therapeutic approaches towards targeting endothelial dysfunction

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Book cover Endothelial Dysfunction and Inflammation

Part of the book series: Progress in Inflammation Research ((PIR))

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Abstract

Endothelial dysfunction is a major cause of organ dysfunction in diseases involving systemic inflammation. The disease with the highest attributable mortality and morbidity due to explosive systemic inflammation is septic shock. In this chapter we use septic shock to illustrate how traditional approaches to therapy have fallen short, and how targeting the microcirculation might be of benefit. Specific therapies are discussed, divided into sections according to their molecular target and mode of action.

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References

  1. Parker MM, Shelhamer JH, Bacharach SL, Green MV, Natanson C, Frederick TM, Damske BA, Parrillo JE (1984) Profound but reversible myocardial depression in patients with septic shock. Ann Intern Med 100: 483–490

    PubMed  CAS  Google Scholar 

  2. Joseph MX, Disney PJ, Da Costa R, Hutchison SJ (2004) Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 126: 1592–1597

    Article  PubMed  Google Scholar 

  3. Khoury AF, Afridi I, Quinones MA, Zoghbi WA (1994) Transesophageal echocardiography in critically ill patients: Feasibility, safety, and impact on management. Am Heart J 127: 1363–1371

    Article  PubMed  CAS  Google Scholar 

  4. Ognibene FP, Parker MM, Natanson C, Shelhamer JH, Parrillo JE (1988) Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 93: 903–910

    Article  PubMed  CAS  Google Scholar 

  5. Jardin F, Fourme T, Page B, Loubieres Y, Vieillard-Baron A, Beauchet A, Bourdarias JP (1999) Persistent preload defect in severe sepsis despite fluid loading: A longitudinal echocardiographic study in patients with septic shock. Chest 116: 1354–1359

    Article  PubMed  CAS  Google Scholar 

  6. Herbertson MJ, Werner HA, Russell JA, Iversen K, Walley KR (1995) Myocardial oxygen extraction ratio is decreased during endotoxemia in pigs. J Appl Physiol 79: 479–486

    PubMed  CAS  Google Scholar 

  7. Anning PB, Finney SJ, Singh S, Winlove CP, Evans TW (2004) Fluids reverse the early lipopolysaccharide-induced albumin leakage in rodent mesenteric venules. Intensive Care Med 30: 1944–1949

    Article  PubMed  Google Scholar 

  8. Anning PB, Sair M, Winlove CP, Evans TW (1999) Abnormal tissue oxygenation and cardiovascular changes in endotoxemia. Am J Respir Crit Care Med 159: 1710–1715

    PubMed  CAS  Google Scholar 

  9. LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28: 2729–2732

    Article  PubMed  CAS  Google Scholar 

  10. Bateman RM, Jagger JE, Sharpe MD, Ellsworth ML, Mehta S, Ellis CG (2001) Erythrocyte deformability is a nitric oxide-mediated factor in decreased capillary density during sepsis. Am J Physiol Heart Circ Physiol 280: H2848–2856

    PubMed  CAS  Google Scholar 

  11. Ellis CG, Bateman RM, Sharpe MD, Sibbald WJ, Gill R (2002) Effect of a maldistribution of microvascular blood flow on capillary O(2) extraction in sepsis. Am J Physiol Heart Circ Physiol 282: H156–164

    PubMed  CAS  Google Scholar 

  12. Goldman D, Bateman RM, Ellis CG (2004) Effect of sepsis on skeletal muscle oxygen consumption and tissue oxygenation: interpreting capillary oxygen transport data using a mathematical model. Am J Physiol Heart Circ Physiol 287: H2535–2544

    Article  PubMed  CAS  Google Scholar 

  13. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R et al (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36: 296–327

    Article  PubMed  Google Scholar 

  14. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166: 98–104

    Article  PubMed  Google Scholar 

  15. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32: 1825–1831

    Article  PubMed  Google Scholar 

  16. Trzeciak S, McCoy JV, Phillip Dellinger R, Arnold RC, Rizzuto M, Abate NL, Shapiro NI, Parrillo JE, Hollenberg SM (2008) Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med 34: 2210–2217

    Article  PubMed  Google Scholar 

  17. Alejandria MM, Lansang MA, Dans LF, Mantaring JB (2002) Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst Rev CD001090

    Google Scholar 

  18. Werdan K, Pilz G, Bujdoso O, Fraunberger P, Neeser G, Schmieder RE, Viell B, Marget W, Seewald M, Walger P et al (2007) Score-based immunoglobulin G therapy of patients with sepsis: the SBITS study. Crit Care Med 35: 2693–2701

    Article  PubMed  CAS  Google Scholar 

  19. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274: 968–974

    Article  PubMed  CAS  Google Scholar 

  20. Wang HE, Shapiro NI, Angus DC, Yealy DM (2007) National estimates of severe sepsis in United States emergency departments. Crit Care Med 35: 1928–1936

    Article  PubMed  Google Scholar 

  21. Ziegler EJ, McCutchan JA, Fierer J, Glauser MP, Sadoff JC, Douglas H, Braude AI (1982) Treatment of gram-negative bacteremia and shock with human antiserum to a mutant Escherichia coli. N Engl J Med 307: 1225–1230

    Article  PubMed  CAS  Google Scholar 

  22. McCloskey RV, Straube RC, Sanders C, Smith SM, Smith CR (1994) Treatment of septic shock with human monoclonal antibody HA-1A. A randomized, double-blind, placebocontrolled trial. CHESS Trial Study Group. Ann Intern Med 121: 1–5

    PubMed  CAS  Google Scholar 

  23. Angus DC, Birmingham MC, Balk RA, Scannon PJ, Collins D, Kruse JA, Graham DR, Dedhia HV, Homann S, MacIntyre N (2000) E5 murine monoclonal antiendotoxin antibody in gram-negative sepsis: A randomized controlled trial. E5 Study Investigators. JAMA 283: 1723–1730

    Article  PubMed  CAS  Google Scholar 

  24. Albertson TE, Panacek EA, MacArthur RD, Johnson SB, Benjamin E, Matuschak GM, Zaloga G, Maki D, Silverstein J, Tobias JK et al (2003) Multicenter evaluation of a human monoclonal antibody to Enterobacteriaceae common antigen in patients with Gram-negative sepsis. Crit Care Med 31: 419–427

    Article  PubMed  Google Scholar 

  25. Abraham E, Glauser MP, Butler T, Garbino J, Gelmont D, Laterre PF, Kudsk K, Bruining HA, Otto C, Tobin E et al (1997) p55 Tumor necrosis factor receptor fusion protein in the treatment of patients with severe sepsis and septic shock. A randomized controlled multicenter trial. Ro 45–2081 Study Group. JAMA 277: 1531–1538

    Article  PubMed  CAS  Google Scholar 

  26. Abraham E, Laterre PF, Garbino J, Pingleton S, Butler T, Dugernier T, Margolis B, Kudsk K, Zimmerli W, Anderson P et al (2001) Lenercept (p55 tumor necrosis factor receptor fusion protein) in severe sepsis and early septic shock: A randomized, doubleblind, placebo-controlled, multicenter phase III trial with 1342 patients. Crit Care Med 29: 503–510

    Article  PubMed  CAS  Google Scholar 

  27. Abraham E, Wunderink R, Silverman H, Perl TM, Nasraway S, Levy H, Bone R, Wenzel RP, Balk R, Allred R et al (1995) Efficacy and safety of monoclonal antibody to human tumor necrosis factor alpha in patients with sepsis syndrome. A randomized, controlled, double-blind, multicenter clinical trial. TNF-alpha MAb Sepsis Study Group. JAMA 273: 934–941

    Article  PubMed  CAS  Google Scholar 

  28. Cohen J, Carlet J (1996) INTERSEPT: an international, multicenter, placebo-controlled trial of monoclonal antibody to human tumor necrosis factor-alpha in patients with sepsis. International Sepsis Trial Study Group. Crit Care Med 24: 1431–1440

    Article  PubMed  CAS  Google Scholar 

  29. Panacek EA, Marshall JC, Albertson TE, Johnson DH, Johnson S, MacArthur RD, Miller M, Barchuk WT, Fischkoff S, Kaul M et al (2004) Efficacy and safety of the monoclonal anti-tumor necrosis factor antibody F(ab’)2 fragment afelimomab in patients with severe sepsis and elevated interleukin-6 levels. Crit Care Med 32: 2173–2182

    PubMed  CAS  Google Scholar 

  30. Calandra T, Echtenacher B, Roy DL, Pugin J, Metz CN, Hultner L, Heumann D, Mannel D, Bucala R, Glauser MP (2000) Protection from septic shock by neutralization of macrophage migration inhibitory factor. Nat Med 6: 164–170

    Article  PubMed  CAS  Google Scholar 

  31. Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR (2000) Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 28: 3581–3587

    Article  PubMed  CAS  Google Scholar 

  32. Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM et al (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359: 7–20

    Article  PubMed  CAS  Google Scholar 

  33. Warren BL, Eid A, Singer P, Pillay SS, Carl P, Novak I, Chalupa P, Atherstone A, Penzes I, Kubler A et al (2001) Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: A randomized controlled trial. JAMA 286: 1869–1878

    Article  PubMed  CAS  Google Scholar 

  34. Abraham E, Reinhart K, Opal S, Demeyer I, Doig C, Rodriguez AL, Beale R, Svoboda P, Laterre PF, Simon S et al (2003) Efficacy and safety of tifacogin (recombinant tissue factor pathway inhibitor) in severe sepsis: A randomized controlled trial. JAMA 290: 238–247

    Article  PubMed  CAS  Google Scholar 

  35. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699–709

    Article  PubMed  CAS  Google Scholar 

  36. Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D et al (2004) Multiple-center, randomized, placebocontrolled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med 32: 21–30

    Article  PubMed  CAS  Google Scholar 

  37. Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson WJ, Wright PE, Christman BW, Dupont WD et al (1997) The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med 336: 912–918

    Article  PubMed  CAS  Google Scholar 

  38. Sprung CL, Caralis PV, Marcial EH, Pierce M, Gelbard MA, Long WM, Duncan RC, Tendler MD, Karpf M (1984) The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med 311: 1137–1143

    Article  PubMed  CAS  Google Scholar 

  39. 1987) Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. The Veterans Administration Systemic Sepsis Cooperative Study Group. N Engl J Med 317: 659–665

    Article  PubMed  Google Scholar 

  40. Bone RC, Fisher CJ, Jr., Clemmer TP, Slotman GJ, Metz CA, Balk RA (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: 653–658

    Article  PubMed  CAS  Google Scholar 

  41. Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G et al (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288: 862–871

    Article  PubMed  CAS  Google Scholar 

  42. Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H et al (2008) Hydrocortisone therapy for patients with septic shock. N Engl J Med 358: 111–124

    Article  PubMed  CAS  Google Scholar 

  43. Bateman RM, Walley KR (2005) Microvascular resuscitation as a therapeutic goal in severe sepsis. Crit Care 9 (Suppl 4): S27–32

    Article  PubMed  Google Scholar 

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Boyd, J.H., Walley, K.R. (2010). Therapeutic approaches towards targeting endothelial dysfunction. In: Dauphinee, S., Karsan, A. (eds) Endothelial Dysfunction and Inflammation. Progress in Inflammation Research. Springer, Basel. https://doi.org/10.1007/978-3-0346-0168-9_13

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  • DOI: https://doi.org/10.1007/978-3-0346-0168-9_13

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