Iba Toshiaki, Hashiguchi Naoyuki, Nagaoka Isao, Tabe Yoko, Kadota Katsuhiko, Sato Koichi
Department of Emergency and Disaster Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Host Defense and Biochemical Research, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
Intensive Care Med Exp. 2015 Dec;3(1):36. doi: 10.1186/s40635-015-0072-z. Epub 2015 Dec 29.
The beneficial effects of heparin in the treatment of severe sepsis, septic shock, and sepsis-associated disseminated intravascular coagulation (DIC) have recently been reported. However, the mechanisms underlying the therapeutic benefits of heparin in these conditions have not yet been clearly elucidated. The purpose of this study was to confirm the effect of heparin of neutralizing histone toxicity.
Rat models of histone H3-induced organ dysfunction were administered in a low or high dose of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or argatroban, and the therapeutic effects of each anticoagulant were examined. In another series, the survival of the histone H3-administered animals was evaluated. Furthermore, the effect of each of the aforementioned anticoagulants on cell death induced by histone H3 was examined in cultured vascular endothelial cells and leukocytes.
Although UFH, LMWH, and argatroban significantly suppressed the histone-induced decrease of the WBC and platelet counts in the animal models of organ dysfunction, only UFH and LMWH attenuated hepatic and renal dysfunction. In addition, the mortality was significantly reduced only by high-dose UFH and LMWH. The in vitro study revealed that both vascular endothelial cell death and leukocyte cell death were significantly attenuated by UFH and LMWH but not by argatroban.
The histone-neutralizing effect of heparin may contribute to the beneficial effects of heparins observed in the animal study. The results of the in vitro study further confirmed the above contention and suggested that heparin binds to histones to attenuate the cytotoxic actions of the latter. Since heparin has been demonstrated to protect animals from the organ damage induced by histones and consequently reduce the mortality, administration of heparin could become a treatment of choice for patients suffering from severe sepsis.
最近有报道称肝素在治疗严重脓毒症、脓毒性休克及脓毒症相关的弥散性血管内凝血(DIC)方面具有有益作用。然而,肝素在这些病症中发挥治疗作用的潜在机制尚未完全阐明。本研究的目的是证实肝素中和组蛋白毒性的作用。
对组蛋白H3诱导的器官功能障碍大鼠模型给予低剂量或高剂量的普通肝素(UFH)、低分子量肝素(LMWH)或阿加曲班,并检测每种抗凝剂的治疗效果。在另一组实验中,评估给予组蛋白H3的动物的存活率。此外,在培养的血管内皮细胞和白细胞中检测上述每种抗凝剂对组蛋白H3诱导的细胞死亡的影响。
虽然UFH、LMWH和阿加曲班在器官功能障碍动物模型中均能显著抑制组蛋白诱导的白细胞和血小板计数下降,但只有UFH和LMWH能减轻肝肾功能障碍。此外,仅高剂量的UFH和LMWH能显著降低死亡率。体外研究表明,UFH和LMWH能显著减轻血管内皮细胞死亡和白细胞死亡,而阿加曲班则不能。
肝素的组蛋白中和作用可能是动物实验中观察到的肝素有益作用的原因。体外研究结果进一步证实了上述观点,并表明肝素与组蛋白结合以减弱后者的细胞毒性作用。由于已证明肝素可保护动物免受组蛋白诱导的器官损伤并因此降低死亡率,肝素给药可能成为严重脓毒症患者的首选治疗方法。