Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center (MDACC), Houston, Texas, USA.
Department of Surgery, Fundeni Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Clin Invest. 2023 Jul 17;133(14):e158348. doi: 10.1172/JCI158348.
Sepsis remains a leading cause of death for humans and currently has no pathogenesis-specific therapy. Hampered progress is partly due to a lack of insight into deep mechanistic processes. In the past decade, deciphering the functions of small noncoding miRNAs in sepsis pathogenesis became a dynamic research topic. To screen for new miRNA targets for sepsis therapeutics, we used samples for miRNA array analysis of PBMCs from patients with sepsis and control individuals, blood samples from 2 cohorts of patients with sepsis, and multiple animal models: mouse cecum ligation puncture-induced (CLP-induced) sepsis, mouse viral miRNA challenge, and baboon Gram+ and Gram- sepsis models. miR-93-5p met the criteria for a therapeutic target, as it was overexpressed in baboons that died early after induction of sepsis, was downregulated in patients who survived after sepsis, and correlated with negative clinical prognosticators for sepsis. Therapeutically, inhibition of miR-93-5p prolonged the overall survival of mice with CLP-induced sepsis, with a stronger effect in older mice. Mechanistically, anti-miR-93-5p therapy reduced inflammatory monocytes and increased circulating effector memory T cells, especially the CD4+ subset. AGO2 IP in miR-93-KO T cells identified important regulatory receptors, such as CD28, as direct miR-93-5p target genes. In conclusion, miR-93-5p is a potential therapeutic target in sepsis through the regulation of both innate and adaptive immunity, with possibly a greater benefit for elderly patients than for young patients.
脓毒症仍然是人类死亡的主要原因,目前尚无针对其发病机制的特定治疗方法。进展受阻部分归因于对深层机制过程缺乏深入了解。在过去的十年中,解析小非编码 miRNA 在脓毒症发病机制中的功能已成为一个活跃的研究课题。为了筛选脓毒症治疗的新 miRNA 靶点,我们使用了脓毒症患者和对照个体的 PBMCs、脓毒症患者的两批血液样本以及多种动物模型(小鼠盲肠结扎穿孔诱导(CLP 诱导)脓毒症、小鼠病毒 miRNA 挑战和狒狒革兰氏阳性和革兰氏阴性脓毒症模型)的 miRNA 数组分析样本。miR-93-5p 符合治疗靶点的标准,因为它在诱导脓毒症后早期死亡的狒狒中表达上调,在脓毒症后存活的患者中下调,并且与脓毒症的负面临床预后标志物相关。治疗上,抑制 miR-93-5p 延长了 CLP 诱导的脓毒症小鼠的总生存期,对老年小鼠的效果更强。在机制上,抗 miR-93-5p 治疗减少了炎症性单核细胞并增加了循环效应记忆 T 细胞,尤其是 CD4+亚群。miR-93-KO T 细胞中的 AGO2 IP 确定了重要的调节受体,如 CD28,作为直接的 miR-93-5p 靶基因。总之,miR-93-5p 通过调节固有免疫和适应性免疫,是脓毒症的潜在治疗靶点,对老年患者的益处可能大于对年轻患者的益处。