Ventilation-induced chemokine and cytokine release is associated with activation of nuclear factor-κ B and is blocked by steroids

HD HELD, S BOETTCHER, L HAMANN… - American journal of …, 2001 - atsjournals.org
HD HELD, S BOETTCHER, L HAMANN, S UHLIG
American journal of respiratory and critical care medicine, 2001atsjournals.org
Recent clinical trials have shown that the survival of patients with acute respiratory distress
syndrome (ARDS) is improved by ventilation with reduced volumes. These studies
suggested that overinflation of the lungs causes overactivation of the immune system. The
present study investigated the hypothesis that ventilation with increased tidal volumes
results in early responses similar to those caused by stimulation with one of the major risk
factors for ARDS: bacterial lipopolysaccharide (LPS). We therefore compared the effects of …
Recent clinical trials have shown that the survival of patients with acute respiratory distress syndrome (ARDS) is improved by ventilation with reduced volumes. These studies suggested that overinflation of the lungs causes overactivation of the immune system. The present study investigated the hypothesis that ventilation with increased tidal volumes results in early responses similar to those caused by stimulation with one of the major risk factors for ARDS: bacterial lipopolysaccharide (LPS). We therefore compared the effects of ventilation ( − 10 cm H2O or − 25 cm H2O end-inspiratory pressure) and LPS (50 μ g/ml) on nuclear factor (NF)- κ B activation, chemokine release, and cytokine release in isolated perfused lungs obtained from BALB/C mice. We found that both LPS and ventilation with − 25 cm H2O (overventilation; OV) caused translocation of NF- κ B, which was abolished by pretreatment with the steroid dexamethasone. Furthermore, both treatments resulted in similar increases in perfusate levels of α -chemokines (macrophage inflammatory protein; [MIP]-2; KC), β -chemokines (macrophage chemotactic protein-1; MIP-1 α ), and cytokines (tumor necrosis factor- α , interleukin-6), which were largely prevented by dexamethasone pretreatment. In LPS-resistant C3H/HeJ mice, only OV, and not LPS, caused translocation of NF- κ B and release of MIP-2. We conclude that OV evokes early inflammatory responses similar to those evoked by LPS (i.e., NF- κ B translocation and release of proinflammatory mediators). The NF- κ B translocation elicited by OV appears to be independent of Toll-like receptor 4 and not due to LPS contamination introduced by the ventilator. Our data further suggest that steroids might be considered as a subsidiary treatment during artificial mechanical ventilation.
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