Moore Thomas A, Lau Helen Y, Cogen Anna L, Standiford Theodore J
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0642, USA.
Clin Infect Dis. 2005 Aug 1;41 Suppl 3:S213-7. doi: 10.1086/430126.
Klebsiella pneumoniae is a leading cause of pneumonia due to gram-negative bacteria. A significant clinical complication of pulmonary infection with K. pneumoniae is peripheral blood dissemination, which results in a systemic infection coincident with the localized pulmonary infection. This study describes the critical importance of tumor necrosis factor (TNF) receptor 1 (TNFR1)-mediated signaling during K. pneumoniae bacteremia. TNFR1-deficient mice displayed a significantly increased mortality rate after intravenous inoculation. Unexpectedly, this increased mortality occurred in the absence of either increased bacterial burden or increased liver injury. However, excessive production of proinflammatory cytokines, including TNF-alpha , was observed in TNFR1-deficient mice, compared with that observed in infected C57BL/6 mice, which suggests that production was dysregulated in the absence of TNFR1 signaling. In contrast, other experiments examined the effect of immunotherapy with anti-TNF-alpha during K. pneumoniae bacteremia. Administration of a neutralizing anti-TNF-alpha antibody completely ablated K. pneumoniae-induced liver injury. This reduction in liver injury failed to translate into an improved survival rate, because mice died of the infection as late as 10 days after infection. Bacterial clearance after neutralization of TNF-alpha was significantly impaired at later time points during infection. Diminished production of liver-associated cytokines and chemokines correlated with impaired bacterial clearance, which suggests that antibacterial immune responses were dampened. These data indicate that the antibacterial host response is dysregulated in mice lacking TNFR1 or TNF-alpha bioactivity.
肺炎克雷伯菌是革兰氏阴性菌所致肺炎的主要病因。肺炎克雷伯菌肺部感染的一个重要临床并发症是外周血播散,这会导致与局部肺部感染同时发生的全身感染。本研究描述了肿瘤坏死因子(TNF)受体1(TNFR1)介导的信号传导在肺炎克雷伯菌菌血症期间的关键重要性。TNFR1缺陷小鼠静脉接种后死亡率显著增加。出乎意料的是,这种死亡率增加发生在细菌负荷未增加或肝损伤未加重的情况下。然而,与感染的C57BL/6小鼠相比,在TNFR1缺陷小鼠中观察到促炎细胞因子(包括TNF-α)的过度产生,这表明在缺乏TNFR1信号传导的情况下产生失调。相比之下,其他实验研究了抗TNF-α免疫疗法在肺炎克雷伯菌菌血症期间的作用。给予中和性抗TNF-α抗体可完全消除肺炎克雷伯菌诱导的肝损伤。肝损伤的减轻并未转化为存活率的提高,因为小鼠在感染后长达10天死于感染。在感染后期,TNF-α中和后细菌清除显著受损。肝脏相关细胞因子和趋化因子的产生减少与细菌清除受损相关,这表明抗菌免疫反应受到抑制。这些数据表明,在缺乏TNFR1或TNF-α生物活性的小鼠中,抗菌宿主反应失调。