The Impact of Chronic Alcohol Abuse on the Pathophysiology of Sepsis

长期酗酒对脓毒症病理生理学的影响

• 批准号: 10091965
• 负责人: Craig M Coopersmith
• 金额: $ 35.1万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091965
• 关键词: Adaptive Immune System; Affect; Alcohol abuse; Alcohol consumption; Alcohols; Animals; CD4 Positive T Lymphocytes; CD8-Positive T-Lymphocytes; CTLA4 blockade; CTLA4 gene; Caliber; Cell physiology; Cessation of life; Charge; Chronic; Data; Diagnosis; Disease; Epidermal Growth Factor; Exhibits; FOXP3 gene; Financial Hardship; Frequencies; Functional disorder; Funding; Genetic; Goals; Healthcare Systems; Histology; Homing; Hour; Immune System Diseases; Immune response; Immune system; Intensive Care Units; Interleukin-12; Intestinal permeability; JAM protein; Modeling; Mus; Organ; Outcome; Pathway interactions; Patients; Permeability; Proteins; Pseudomonas aeruginosa pneumonia; Recording of previous events; Regulatory T-Lymphocyte; Role; Sepsis; Septic Shock; Severities; Surface; T cell regulation; T-Lymphocyte; Testing; Therapeutic; Tight Junctions; Time; United States; Up-Regulation; Vulnerable Populations; Water; adaptive immune response; alcohol abuse therapy; alcohol exposure; alcohol use disorder; cecal ligation puncture; cell type; chronic alcohol ingestion; comorbidity; cost; effector T cell; improved outcome; in vivo; mortality; mortality risk; mouse model; occludin; problem drinker; receptor; septic; septic patients; targeted treatment

Between 100,000 and 250,000 patients with alcohol use disorder develop sepsis annually. Septic patients with chronic alcohol abuse have increased mortality and severity of multiple organ dysfunction compared to septic patients without a history of alcohol abuse. This proposal aims to understand why chronic alcohol abuse worsens outcomes in sepsis, as this common -- and deadly -- scenario is responsible for thousands of deaths per year and poses a huge financial burden on the U.S. healthcare system. In the previous cycle of finding, we characterized murine models that replicate the increased mortality seen in alcoholic septic patients compared to patients who develop sepsis without a history of alcohol abuse. Importantly, while the majority of organs have similar function and histology between alcohol/septic and water/septic mice, both gut integrity and the immune system are severely dysregulated in alcohol/septic mice. This is manifested in two complementary ways. First, abnormalities in gut integrity and the immune response are exacerbated in alcohol/septic mice compared to water/septic mice. Second, there are a number of differences identified only in alcohol/septic mice that are not present with either alcohol in isolation or sepsis in isolation. Notably, intestinal permeability is worsened in alcohol/sepsis, and this is associated with changes in the gut tight junction that are specific to the combination of alcohol and sepsis. Blockade of the co-inhibitory receptor CTLA-4 is also significantly more efficacious in alcohol/sepsis than water/sepsis, associated with differences in regulatory T cells and effector CD4+ cells. Finally, CD43 (which is implicated in T cell homing and activation) expression is delayed in alcohol/sepsis and survival is altered in septic CD43-/- mice. The proposal seeks to understand the mechanisms underlying these specific differences in gut permeability and the adaptive immune response in alcohol/septic mice. Since septic hosts with alcohol use disorders appear to respond differently to a septic insult than those without a history of alcohol abuse, this may require a different therapeutic approach than would be needed in a “typical” septic host. As such, this proposal will elucidate mechanisms underlying gut and immune dysfunction during alcohol/sepsis with the ultimate goal of improving outcomes in this common and very vulnerable population.

每年有 100,000 至 250,000 名酒精使用障碍患者患上败血症。 与脓毒症相比，长期酗酒会增加死亡率和多器官功能障碍的严重程度 没有酗酒史的患者该提案旨在了解为什么长期酗酒。 败血症的结果恶化，因为这种常见且致命的情况导致数千人死亡 每年，给美国医疗保健系统带来巨大的财务负担。 表征的小鼠模型复制了酒精性脓毒症患者死亡率增加的情况 重要的是，对于没有酗酒史的败血症患者来说，大多数器官。 酒精/脓毒症小鼠和水/脓毒症小鼠之间具有相似的功能和组织学，包括肠道完整性和 酒精/败血症小鼠的免疫系统严重失调，这在两种互补的小鼠中得到了体现。 首先，酒精/败血症小鼠的肠道完整性和免疫反应异常加剧。 其次，仅在酒精/败血症小鼠中发现了许多差异。 值得注意的是，肠道通透性与单独的酒精或脓毒症无关。 酒精/脓毒症时会加剧，这与肠道紧密连接的变化有关，而肠道紧密连接是特定于 酒精和脓毒症的结合对共抑制受体 CTLA-4 的阻断也显着更多。 对酒精/脓毒症比水/脓毒症更有效，这与调节性 T 细胞和效应器的差异有关 最后，CD43（与 T 细胞归巢和激活有关）表达延迟。 酒精/脓毒症和脓毒症 CD43-/- 小鼠的存活率发生改变。 肠道通透性和适应性免疫反应的这些特定差异背后的机制 酒精/脓毒症小鼠由于患有酒精使用障碍的脓毒症宿主似乎对脓毒症有不同的反应。 侮辱那些没有虐待史的人，这可能需要与其他人不同的治疗方法 因此，该提案将阐明肠道和脓毒症的潜在机制。 酒精/败血症期间的免疫功能障碍，最终目标是改善这一常见和败血症的结果 非常脆弱的人群。