HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis.
BACKGROUND
HMG-CoA reductase inhibitors, such as simvastatin, have been shown to exhibit pronounced immunomodulatory effects independent of lipid lowering but to date have not been used to treat severe inflammatory disease such as sepsis. We thus approached the question of whether treatment with simvastatin might improve cardiovascular function and survival in sepsis.


RESULTS
Mice treated with simvastatin and rendered septic by cecal ligation and perforation (CLP) show a mean survival time close to 4 times the value found in untreated mice. This dramatic improvement is based on a complete preservation of cardiac function and hemodynamic status, which are severely impaired in untreated CLP mice [eg, 20 hours after CLP, cardiac output declined from 1.24+/-0.09 to 0.87+/-0.11 mL x min(-1) x g(-1) in untreated mice (P<0.005; n=12), while remaining unaltered (1.21+/-0.08 mL x min(-1) x g(-1) at baseline and 1.15+/-0.1 mL x min(-1) x g(-1) 20 hours after CLP, P=NS, n=12) in CLP mice treated with simvastatin]. Untreated CLP mice remained refractory to beta-stimulation, whereas the responsiveness to dobutamine was restored by treatment with simvastatin. Susceptibility of coronary flow to endothelial nitric oxide synthase (eNOS) stimulation by bradykinin was close to 3 times as pronounced in untreated CLP mice as in untreated sham-operated mice, indicating a high level of eNOS activation secondary to sepsis. In addition, treatment with simvastatin reversed inflammatory alterations in CLP mice, namely, increased monocyte adhesion to endothelium.


CONCLUSIONS
Simvastatin, which is well established in the treatment of lipid disorders and coronary artery disease, might have the additional potential of being an effective agent in sepsis treatment.
Merx
Marc W
MW
Medizinische Klinik I, RWTH Aachen, Germany. mmerx@ukaachen.de
Liehn
Elisa A
EA
Janssens
Uwe
U
Lütticken
Rudolf
R
Schrader
Jürgen
J
Hanrath
Peter
P
Weber
Christian
C
D000818:Animals; D001011:Aorta / Q000000981:diagnostic imaging; D001920:Bradykinin / Q000494:pharmacology; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents; D002429:Cecal Diseases / Q000150:complications; D002448:Cell Adhesion / Q000187:drug effects; D002478:Cells, Cultured / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D004280:Dobutamine; D004353:Drug Evaluation, Preclinical; D004730:Endothelium, Vascular / Q000473:pathology; D006439:Hemodynamics / Q000187:drug effects; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D007416:Intestinal Perforation / Q000150:complications; D007962:Leukocytes / Q000473:pathology; D008026:Ligation; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009200:Myocardial Contraction / Q000187:drug effects; D019001:Nitric Oxide Synthase / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II; D052250:Nitric Oxide Synthase Type III; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D019821:Simvastatin / Q000494:pharmacology / Q000627:therapeutic use*; D014463:Ultrasonography
D002316:Cardiotonic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D004280:Dobutamine; D019821:Simvastatin; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II; D052250:Nitric Oxide Synthase Type III; C496315:Nos3 protein, mouse; D001920:Bradykinin