title: AGE-modified albumin containing infusion solutions boosts septicaemia and inflammation in experimental peritonitis.
abstract: HSA preparations for i.v. use are administered in critically ill patients. Although increasing intravascular osmotic pressure seems to be a pathophysiologically orientated treatment, clinical trials do not indicate a benefit for mortality in HSA-treated patients. Instead, there is evidence for inflammatory reactions upon infusion of different HSA batches. A neglected issue concerning the safety and quality of these therapeutics is processing-related post-transcriptional protein modifications, such as AGEs. We therefore tested the hypothesis that commercially available infusion solutions contain AGEs and studied whether these protein modifications influence outcome and inflammation in a murine model of sepsis induced by CLP. Screening of different HSA and Ig preparations in this study revealed an up to approximate tenfold difference in the amount of AGE modifications. Application of clinically relevant concentrations of CML-modified HSA in CLP led to increased inflammation and enhanced mortality in wild-type mice but not in mice lacking the RAGE. Lethality was paralleled by increased activation of the proinflammatory transcription factor NF-kappaB, NF-kappaB-dependent gene expression, and infiltration of inflammatory cells in the peritoneal cavity. This study implies that infusion solutions containing a high load of the AGE-modified protein have the potential to activate RAGE/NF-kappaB-mediated inflammatory reactions, causing increased mortality in experimental peritonitis.
authors.affiliation: Department of Medicine I and Clinical Chemistry, Anesthesiology and Institute of Neuropharmacology, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Per M
authors.initials: PM
authors.lastname: Humpert
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Lukic
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Thorpe
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.forename: Ezzat M
authors.initials: EM
authors.lastname: Awad
authors.forename: Martin
authors.initials: M
authors.lastname: Andrassy
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Deemer
authors.forename: Michael
authors.initials: M
authors.lastname: Kasper
authors.forename: Erwin
authors.initials: E
authors.lastname: Schleicher
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaninger
authors.forename: Markus A
authors.initials: MA
authors.lastname: Weigand
authors.forename: Peter P
authors.initials: PP
authors.lastname: Nawroth
authors.forename: Angelika
authors.initials: A
authors.lastname: Bierhaus
mesh_terms: D000818:Animals; D001011:Aorta / Q000166:cytology; D002417:Cattle; D002478:Cells, Cultured; D004195:Disease Models, Animal; D042783:Endothelial Cells / Q000378:metabolism; D004730:Endothelium, Vascular / Q000166:cytology; D017127:Glycation End Products, Advanced / Q000378:metabolism; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism; D007262:Infusions, Intravenous; D051379:Mice; D008810:Mice, Inbred C57BL; D018345:Mice, Knockout; D010538:Peritonitis / Q000473:pathology*; D018805:Sepsis / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism*; D012996:Solutions; D014162:Transfection
chemical_list: D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D012996:Solutions