Sato Hiroaki, Tanaka Toshiko, Kasai Kentaro, Kita Toshiro, Tanaka Noriyuki
Department of Forensic Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
Shock. 2005 Nov;24(5):488-94. doi: 10.1097/01.shk.0000176594.64626.7f.
Hemorrhagic shock has been reported to induce renal dysfunction as a consequence of different kinds of local inflammatory response. p38 mitogen-activated protein kinase (MAPK) is a key mediator in organ dysfunction relating to the inflammatory states, and acts as an important mediator in the intracellular signal pathway for proliferation, differentiation, and production of proinflammatory cytokines such as TNF-alpha and IL-1beta. The effect of p38 MAPK on the hemorrhagic damage has not been clearly estimated as yet. In this study, our aim was to evaluate the role of p38 MAPK on the renal damage during the first 5 h after a hemorrhage using a specific inhibitor of p38 MAPK activation, FR167653. p38 MAPK activation increased immediately after a hemorrhage and decreased with time. renal mRNA expression of TNF-alpha and IL-1beta increased, renal dysfunction continued to progress, and histological inflammatory injuries were confirmed after hemorrhagic shock. With the pretreatment of FR167653, all of these hemorrhagic changes were attenuated, although the induction of the primary hypotensive state was confirmed. This study demonstrated that renal p38 MAPK is activated in hemorrhagic shock, promotes the expression of proinflammatory cytokines in the kidney, and consequently develops renal dysfunction. We concluded that p38 MAPK activation is essential in causing renal damage and that the inhibition of p38 MAPK activation blocks the development of the renal dysfunction after hemorrhagic shock.
据报道,出血性休克可因各种局部炎症反应而导致肾功能障碍。p38丝裂原活化蛋白激酶(MAPK)是与炎症状态相关的器官功能障碍的关键介质,并且在细胞内信号通路中作为增殖、分化以及促炎细胞因子(如肿瘤坏死因子-α和白细胞介素-1β)产生的重要介质。p38 MAPK对出血性损伤的影响尚未得到明确评估。在本研究中,我们的目的是使用p38 MAPK激活的特异性抑制剂FR167653来评估p38 MAPK在出血后最初5小时内对肾损伤的作用。出血后p38 MAPK激活立即增加,并随时间下降。出血性休克后,肿瘤坏死因子-α和白细胞介素-1β的肾mRNA表达增加,肾功能障碍持续进展,并且组织学炎症损伤得到证实。用FR167653预处理后,所有这些出血性变化均减弱,尽管原发性低血压状态的诱导得到证实。本研究表明,肾p38 MAPK在出血性休克中被激活,促进肾脏中促炎细胞因子的表达,并因此导致肾功能障碍。我们得出结论,p38 MAPK激活在导致肾损伤中至关重要,并且抑制p38 MAPK激活可阻止出血性休克后肾功能障碍的发展。