title: Hypertonic saline enhances host defense to bacterial challenge by augmenting Toll-like receptors.
abstract: OBJECTIVE
  To determine whether hypertonic saline infusion modulates thermal injury-induced bacterial translocation and host response to bacterial challenge through the augmentation of Toll-like receptors (TLRs).
  
  
  METHODS
  Prospective, experimental study.
  
  
  METHODS
  Research laboratory at a university hospital.
  
  
  METHODS
  Thermal injury models in the mice.
  
  
  METHODS
  In experiment 1, mice underwent burn were given with 10 mL/kg hypertonic saline (7.5% NaCl), 10 mg/kg saline (N/S1), or 80 mL/kg saline (N/S2) at 4 or 8 hrs after burn. At 24 hrs after burn, mesenteric lymph nodes were harvested for bacterial translocation assay. In experiment 2, mice receiving hypertonic saline or saline after thermal injury received peritoneal challenge with Escherichia coli, and bacterial clearance was measured. In experiment 3, peritoneal cells from mice receiving hypertonic saline or saline after thermal injury were incubated with E. coli, and bacterial count, TLR2, TLR4, MIP2, CXCR2, pp38, and ERK expression were evaluated. In experiment 4, reactive oxygen species production, CXCR2, MIP2, TLR2, and TLR4 expression of bone marrow neutrophil from mice receiving hypertonic saline or saline treatment after thermal injury were evaluated. In experiment 5, neutrophil were cultured with hypertonic saline or N/S and incubated with E. coli. TLR2 and TLR4 expression and bacterial count were evaluated. In experiment 6, mice were fed with oral antibiotics with or without lipopolysaccharide, a TLR ligand, supplements. At 24 hrs after burn, mesenteric lymph nodes were harvested for bacterial translocation assay, and neutrophils were harvested for TLR2 and TLR4 protein assay.
  
  
  RESULTS
  Hypertonic saline decreased thermal injury-induced bacterial translocation. Hypertonic saline increased bacterial clearance, phagocytic activity, and TLR2, TLR4, CXCR2, pp38, and p44/42 expression of peritoneal cells. Hypertonic saline treatment at 4 or 8 hrs after thermal injury decreased reactive oxygen species production of neutrophil. Hypertonic saline injection increased TLR2, TLR4, and pp38 expression of neutrophil. In vitro treatment of neutrophil with hypertonic saline increased phagocytic activity and TLR2 and TLR4 expression. Commensal depletion with oral antibiotics decreased TLR2 and TLR4 expression of neutrophil; lipopolysaccharide increased TLR4 expression of neutrophil and decreased thermal injury-induced bacterial translocation.
  
  
  CONCLUSIONS
  Restoration of extracellular fluid in burn shock with hypertonic saline decreased thermal injury-induced bacterial translocation. Hypertonic saline increased the phagocytic activity and TLR2, TLR4, CXCR2, pp38, and P44/42 expression of peritoneal cells. Hypertonic saline decreased reactive oxygen species but increased TLR2, TLR4, and pp38 expression and phagocytic activity of bone marrow neutrophil. Stimulation of the TLRs with lipopolysaccharide in commensal depleted mice increased TLRs expression of neutrophil and decreased thermal injury-induced bacterial translocation. Taken together with the fact that stimulation of TLRs with hypertonic saline increases phagocytic activity of systemic inflammatory cells, we conclude that TLRs play a critical role in the innate immunity by recognizing bacteria and that hypertonic saline enhances host response to bacterial challenge by increasing TLRs of inflammatory cells.
authors.affiliation: Department of Surgery, Kaohsiung Veterans General Hospital, National Yang-Ming Medical University, Taipei (L-WC, I-TL), R.O.C.
authors.forename: Lee-Wei
authors.initials: LW
authors.lastname: Chen
authors.forename: Hau-Lun
authors.initials: HL
authors.lastname: Huang
authors.forename: I-Te
authors.initials: IT
authors.lastname: Lee
authors.forename: Ching-Mei
authors.initials: CM
authors.lastname: Hsu
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Lu
mesh_terms: D000818:Animals; D018988:Bacterial Translocation / Q000187:drug effects*; D015153:Blotting, Western; D001854:Bone Marrow Cells / Q000187:drug effects / Q000378:metabolism; D002056:Burns / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D004195:Disease Models, Animal; D004926:Escherichia coli / Q000502:physiology*; D066298:In Vitro Techniques; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009504:Neutrophils / Q000378:metabolism; D010537:Peritoneum / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D010538:Peritonitis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D010587:Phagocytosis / Q000187:drug effects; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012313:RNA / Q000235:genetics; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D051193:Toll-Like Receptors / Q000187:drug effects / Q000235:genetics / Q000378:metabolism*
chemical_list: D012462:Saline Solution, Hypertonic; D051193:Toll-Like Receptors; D012313:RNA