title: Hyperglycaemia and apoptosis of microglial cells in human septic shock.
abstract: BACKGROUND
  The effect of hyperglycaemia on the brain cells of septic shock patients is unknown. The objective of this study was to evaluate the relationship between hyperglycaemia and apoptosis in the brains of septic shock patients.
  
  
  METHODS
  In a prospective study of 17 patients who died from septic shock, hippocampal tissue was assessed for neuronal ischaemia, neuronal and microglial apoptosis, neuronal Glucose Transporter (GLUT) 4, endothelial inducible Nitric Oxide Synthase (iNOS), microglial GLUT5 expression, microglial and astrocyte activation. Blood glucose (BG) was recorded five times a day from ICU admission to death. Hyperglycaemia was defined as a BG 200 mg/dL g/l and the area under the BG curve (AUBGC) > 2 g/l was assessed.
  
  
  RESULTS
  Median BG over ICU stay was 2.2 g/l. Neuronal apoptosis was correlated with endothelial iNOS expression (rho = 0.68, P = 0.04), while microglial apoptosis was associated with AUBGC > 2 g/l (rho = 0.70; P = 0.002). Neuronal and microglial apoptosis correlated with each other (rho = 0.69, P = 0.006), but neither correlated with the duration of septic shock, nor with GLUT4 and 5 expression. Neuronal apoptosis and ischaemia tended to correlate with duration of hypotension.
  
  
  CONCLUSIONS
  In patients with septic shock, neuronal apoptosis is rather associated with iNOS expression and microglial apoptosis with hyperglycaemia, possibly because GLUT5 is not downregulated. These data provide a mechanistic basis for understanding the neuroprotective effects of glycemic control.
authors: General Intensive Care Medicine, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, 104 boulevard R. Poincaré, Garches, France.
authors: Andrea
authors: A
authors: Polito
authors: Jean-Philippe
authors: JP
authors: Brouland
authors: Raphael
authors: R
authors: Porcher
authors: Romain
authors: R
authors: Sonneville
authors: Shidasp
authors: S
authors: Siami
authors: Robert D
authors: RD
authors: Stevens
authors: Céline
authors: C
authors: Guidoux
authors: Virginie
authors: V
authors: Maxime
authors: Geoffroy Lorin
authors: GL
authors: de la Grandmaison
authors: Fabrice C
authors: FC
authors: Chrétien
authors: Françoise
authors: F
authors: Gray
authors: Djillali
authors: D
authors: Annane
authors: Tarek
authors: T
authors: Sharshar
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