Alterations in cell signaling in sepsis.
Multiple intracellular signaling pathways involving kinases, transcriptional factors, and the expression of immunoregulatory mediators are altered in sepsis. Recent data have shown stable patterns of activation among peripheral blood mononuclear cells and neutrophils in healthy human subjects. Although polymorphisms in Toll-like receptors play a contributory role in determining cellular activation, other factors are involved as well. Increased activation of the mitogen-activated protein kinase protein 38, Akt, and nuclear factor (NF)-kappa B in neutrophils and other cell populations obtained at early time points in the clinical course of sepsis-induced acute lung injury or after accidental trauma is associated with a more-severe clinical course, suggesting that a proinflammatory cellular phenotype contributes to organ system dysfunction in such settings. Identification of patients with cellular phenotypes characterized by increased activation of NF-kappa B, Akt, and protein 38, as well as discrete patterns of gene activation, may permit identification of patients with sepsis who are likely to have a worse clinical outcome, thereby permitting early institution of therapies that modulate deleterious signaling pathways before organ system dysfunction develops, reducing morbidity and improving survival.
Abraham
Edward
E
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA. edward.abraham@uchsc.edu
D000818:Animals; D002467:Cell Nucleus / Q000276:immunology; D005786:Gene Expression Regulation; D006801:Humans; D018836:Inflammation Mediators / Q000276:immunology / Q000378:metabolism*; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000378:metabolism*; D008070:Lipopolysaccharides; D009102:Multiple Organ Failure / Q000209:etiology; D016328:NF-kappa B / Q000096:biosynthesis; D009504:Neutrophils / Q000276:immunology / Q000378:metabolism; D051057:Proto-Oncogene Proteins c-akt / Q000096:biosynthesis; D012128:Respiratory Distress Syndrome / Q000209:etiology; D018805:Sepsis / Q000276:immunology / Q000378:metabolism* / Q000401:mortality; D015398:Signal Transduction; D015533:Transcriptional Activation; D048051:p38 Mitogen-Activated Protein Kinases / Q000096:biosynthesis
D018836:Inflammation Mediators; D008070:Lipopolysaccharides; D016328:NF-kappa B; D051057:Proto-Oncogene Proteins c-akt; D048051:p38 Mitogen-Activated Protein Kinases