Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Anesthesiology. 2011 Sep;115(3):555-67. doi: 10.1097/ALN.0b013e31822a22f7.
Toll-like receptors (TLRs) such as TLR2, TLR4, and TLR9 contribute to the pathogenesis of polymicrobial sepsis. These TLRs signal via the common myeloid differentiation factor 88 (MyD88)-dependent pathways. TLR4 also signals through MyD88-independent but TIR domain-containing adaptor inducing interferon-β-mediated transcription factor (Trif)-dependent pathway. The role of the two signaling pathways in cardiac dysfunction during polymicrobial sepsis and endotoxin shock is unknown.
Sepsis was generated by cecum ligation and puncture. Mice were divided into sham and cecum ligation and puncture groups or subjected to saline or endotoxin. Left ventricular function was assessed in a Langendorff apparatus or by echocardiography. Cytokines were examined using a multiplex immunoassay. Neutrophil migratory and phagocytic functions were assessed using flow cytometry.
In comparison with wild-type mice, MyD88(-/-) but not Trif(-/-) mice had markedly improved cardiac function and survival after cecum ligation and puncture. In comparison, both MyD88(-/-) and Trif(-/-) mice were protected from cardiac depression and mortality during endotoxin shock. Septic MyD88(-/-) but not Trif(-/-) mice had diminished cytokine production in serum and in peritoneal space in comparison with wild-type mice after cecum ligation and puncture. In contrast, both MyD88(-/-) and Trif(-/-) mice had attenuated serum cytokines in comparison with wild-type mice after endotoxin challenge. Neither MyD88(-/-) nor Trif(-/-) signaling had any effect on neutrophil phagocytic function or bacterial clearance at 24 h of polymicrobial sepsis.
These studies establish that MyD88 but not Trif signaling plays a critical role in mediating cardiac dysfunction, systemic inflammation, and mortality during polymicrobial sepsis. Both MyD88 and Trif are essential for cardiac depression and mortality during endotoxin shock.
Toll 样受体(TLR),如 TLR2、TLR4 和 TLR9,有助于多微生物脓毒症的发病机制。这些 TLR 通过共同的髓样分化因子 88(MyD88)依赖性途径发出信号。TLR4 还通过 MyD88 非依赖性但 TIR 结构域包含衔接子诱导干扰素-β介导的转录因子(Trif)依赖性途径发出信号。这两种信号通路在多微生物脓毒症和内毒素休克期间心脏功能障碍中的作用尚不清楚。
通过盲肠结扎和穿刺产生脓毒症。将小鼠分为假手术和盲肠结扎和穿刺组,或接受生理盐水或内毒素。在 Langendorff 仪器或超声心动图上评估左心室功能。使用多重免疫测定法检查细胞因子。使用流式细胞术评估中性粒细胞迁移和吞噬功能。
与野生型小鼠相比,MyD88(-/-)而非 Trif(-/-)小鼠在盲肠结扎和穿刺后心脏功能和存活率明显改善。相比之下,MyD88(-/-)和 Trif(-/-)小鼠在内毒素休克期间均免受心脏抑制和死亡率的影响。与野生型小鼠相比,盲肠结扎和穿刺后,感染性 MyD88(-/-)但不是 Trif(-/-)小鼠的血清和腹腔空间中的细胞因子产生减少。相比之下,内毒素挑战后,MyD88(-/-)和 Trif(-/-)小鼠的血清细胞因子均较野生型小鼠减弱。在多微生物脓毒症 24 小时内,MyD88(-/-)和 Trif(-/-)信号均对中性粒细胞吞噬功能或细菌清除无任何影响。
这些研究表明,MyD88 而不是 Trif 信号在介导多微生物脓毒症期间的心脏功能障碍、全身炎症和死亡率中发挥关键作用。MyD88 和 Trif 对于内毒素休克期间的心脏抑制和死亡率都是必不可少的。