Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen. Aachen, Germany.
Shock. 2023 Feb 1;59(2):161-172. doi: 10.1097/SHK.0000000000002010. Epub 2022 Nov 3.
Sepsis is a life-threatening organ dysfunction, caused by dysregulation of the host response to infection. To understand the underlying mechanisms of sepsis, the vast spectrum of extracellular vesicles (EVs) is gaining importance in this research field. A connection between EVs and sepsis was shown in 1998 in an endotoxemia pig model. Since then, the number of studies describing EVs as markers and mediators of sepsis increased steadily. Extracellular vesicles in sepsis could be friends and foes at the same time depending on their origin and cargo. On the one hand, transfer of EVs or outer membrane vesicles can induce sepsis or systemic inflammatory response syndrome with comparable efficiency as well-established methods, such as cecal ligation puncture or lipopolysaccharide injection. On the other hand, EVs could provide certain therapeutic effects, mediated via reduction of reactive oxygen species, inflammatory cytokines and chemokines, influence on macrophage polarization and apoptosis, as well as increase of anti-inflammatory cytokines. Moreover, EVs could be helpful in the diagnosis of sepsis. Extracellular vesicles of different cellular origin, such as leucocytes, macrophages, platelets, and granulocytes, have been suggested as potential sepsis biomarkers. They ensure the diagnosis of sepsis earlier than classical clinical inflammation markers, such as C-reactive protein, leucocytes, or IL-6. This review summarizes the three roles of EVs in sepsis-mediator/inducer, biomarker, and therapeutic tool.
脓毒症是一种危及生命的器官功能障碍，由宿主对感染的反应失调引起。为了了解脓毒症的潜在机制，细胞外囊泡（EVs）的广泛谱在这个研究领域变得越来越重要。1998 年，在一个内毒素血症猪模型中首次显示 EVs 与脓毒症之间存在联系。从那时起，描述 EVs 作为脓毒症标志物和介质的研究数量稳步增加。根据其来源和 cargo，脓毒症中的细胞外囊泡既可以是朋友，也可以是敌人。一方面，EVs 或外膜囊泡的转移可以诱导脓毒症或全身炎症反应综合征，其效率与经典方法（如盲肠结扎穿刺或脂多糖注射）相当。另一方面，EVs 可以通过减少活性氧、炎症细胞因子和趋化因子、影响巨噬细胞极化和细胞凋亡以及增加抗炎细胞因子来提供一定的治疗效果。此外，EVs 可能有助于脓毒症的诊断。不同细胞来源的 EVs，如白细胞、巨噬细胞、血小板和粒细胞，已被提议作为潜在的脓毒症生物标志物。它们比经典的临床炎症标志物（如 C 反应蛋白、白细胞或 IL-6）更早地诊断脓毒症。这篇综述总结了 EVs 在脓毒症中的三种作用——介质/诱导物、生物标志物和治疗工具。
