Emergency Medicine Department, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, Room 3189, LIM51, 01246-903, São Paulo, SP, Brazil.
Inflammation. 2014 Aug;37(4):1231-9. doi: 10.1007/s10753-014-9850-0.
Severe acute pancreatitis (AP) induces a systemic inflammatory disease that is responsible for high mortality rates, particularly when it is complicated by infection. Therefore, differentiating sepsis from the systemic inflammation caused by AP is a serious clinical challenge. Considering the high metabolic rates of leukocytes in response to stress induced by infection, we hypothesized that the transcription coactivator peroxisome proliferator-activated receptor gamma coactivator 1 (PGC-1α), a master regulator of mitochondrial biogenesis and function, would be distinctly expressed during inflammation or infection and, therefore, could constitute a useful marker to differentiate between these two conditions. Rats were subjected to injection of taurocholate into the main pancreatic duct, which caused a severe AP with high amylase levels and white blood cell counts. In these animals, a marked increase in PGC-1α mRNA levels in circulating leukocytes was observed 48 h after the surgical procedure, a time when bacteremia is present. Antibiotic treatment abolished PGC-1α up-regulation. Moreover, PGC-1α expression was higher in peritoneal macrophages from animals subjected to a bacterial insult (cecal ligation and puncture) than in animals with AP. In isolated macrophages, we also observed that PGC-1α expression is more prominent in the presence of a phagocytic stimulus (zymosan) when compared to lipopolysaccharide-induced aseptic inflammation. Moreover, abolishing PGC-1α expression with antisense oligos impaired zymosan phagocytosis. Together, these findings suggest that PGC-1α is differentially expressed during aseptic inflammation and infection and that it is necessary for adequate phagocytosis. These results could be useful in developing new tests for differentiating infection from inflammation for clinical purposes in patients with AP.
严重的急性胰腺炎(AP)会引发全身性炎症疾病,这是导致高死亡率的主要原因,尤其是当它合并感染时。因此,区分败血症和 AP 引起的全身性炎症是一项严峻的临床挑战。考虑到白细胞对感染引起的应激的高代谢率,我们假设过氧化物酶体增殖物激活受体 γ 共激活因子 1(PGC-1α)作为线粒体生物发生和功能的主要调节因子,在炎症或感染期间会有明显的表达,因此可以作为区分这两种情况的有用标志物。大鼠被注射牛磺胆酸钠到主胰管,导致严重的 AP,淀粉酶水平和白细胞计数升高。在这些动物中,手术后 48 小时观察到循环白细胞中 PGC-1α mRNA 水平显著增加,此时存在菌血症。抗生素治疗消除了 PGC-1α 的上调。此外,在接受细菌刺激(盲肠结扎和穿孔)的动物的腹膜巨噬细胞中,PGC-1α 的表达高于 AP 动物。在分离的巨噬细胞中,我们还观察到与脂多糖诱导的无菌性炎症相比,在吞噬刺激(酵母聚糖)存在的情况下,PGC-1α 的表达更为明显。此外,用反义寡核苷酸消除 PGC-1α 的表达会损害酵母聚糖吞噬作用。总之,这些发现表明 PGC-1α 在无菌性炎症和感染期间有差异表达,并且它是适当吞噬作用所必需的。这些结果可能有助于开发新的测试方法,以便在 AP 患者中为临床目的区分感染和炎症。