title: Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction.
abstract: OBJECTIVE
  The purpose of this study was to determine whether apoptosis is a major mechanism of cell death in patients with sepsis. The activities of caspase-3 and the antiapoptotic protein, BCL-2, were investigated also.
  
  
  METHODS
  A prospective study of 20 patients who died of sepsis and multiple organ dysfunction was performed. The control group of 16 patients consisted of critically ill, nonseptic patients who were evaluated either prospectively (7) or retrospectively (9). In addition, normal colon sections from seven patients who had bowel resections were included. Apoptosis was evaluated in hematoxylin and eosin-stained specimens by deoxyuridine triphosphate nick end-labeling (TUNEL) and by DNA gel electrophoresis.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  Critically ill patients.
  
  
  RESULTS
  In septic patients, apoptosis was detected in diverse organs by all three methods with a predominance in lymphocytes and intestinal epithelial cells. Hematoxylin and eosin-stained specimens from septic patients demonstrated at least focal apoptosis in 56.3% of spleens, 47.1% of colons, and 27.7% of ileums. Indirect evidence of lymphocyte apoptosis in septic patients included extensive depletion of lymphocytes in white pulp and a marked lymphocytopenia in 15 of 19 patients. Hematoxylin and eosin from nonseptic patients' tissues revealed a low level of apoptosis in one patient only. The TUNEL method increased in positivity with a delay in tissue fixation and was highly positive in many tissues from both septic and nonseptic patients. Immunohistochemical staining for active caspase-3 showed a marked increase in septic vs. nonseptic patients (p < .01), with >25% to 50% of cells being positive focally in the splenic white pulp of six septic but in no nonseptic patients.
  
  
  CONCLUSIONS
  We conclude that caspase-3-mediated apoptosis causes extensive lymphocyte apoptosis in sepsis and may contribute to the impaired immune response that characterizes the disorder.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA. hotch@morpheus.wustl.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Hotchkiss
authors.forename: P E
authors.initials: PE
authors.lastname: Swanson
authors.forename: B D
authors.initials: BD
authors.lastname: Freeman
authors.forename: K W
authors.initials: KW
authors.lastname: Tinsley
authors.forename: J P
authors.initials: JP
authors.lastname: Cobb
authors.forename: G M
authors.initials: GM
authors.lastname: Matuschak
authors.forename: T G
authors.initials: TG
authors.lastname: Buchman
authors.forename: I E
authors.initials: IE
authors.lastname: Karl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis / Q000502:physiology*; D001344:Autopsy; D015415:Biomarkers; D016022:Case-Control Studies; D053148:Caspase 3; D020169:Caspases / Q000378:metabolism; D004792:Enzyme Precursors / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007422:Intestines / Q000473:pathology; D008214:Lymphocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000473:pathology*; D011446:Prospective Studies; D018805:Sepsis / Q000473:pathology*; D012772:Shock, Septic / Q000473:pathology; D013154:Spleen / Q000473:pathology
chemical_list: D015415:Biomarkers; D004792:Enzyme Precursors; C505407:CASP3 protein, human; D053148:Caspase 3; D020169:Caspases