Intravenous immunoglobulins prevent the breakdown of the blood-brain barrier in experimentally induced sepsis.
METHODS
The effects of immunoglobulin G and immunoglobulins enriched with immunoglobulin A and immunoglobulin M on blood-brain barrier integrity and survival rates in septic rats were comparatively investigated.


METHODS
Sepsis was induced by cecal ligation and perforation in Sprague-Dawley rats. The animals were divided into the following groups: Sham, cecal ligation and perforation, cecal ligation and perforation plus immunoglobulin G (250 mg/kg, intravenous), and cecal ligation and perforation plus immunoglobulins enriched with immunoglobulin A and immunoglobulin M (250 mg/kg, intravenous). Immunoglobulins were administered 5 mins before cecal ligation and perforation and the animals were observed for behavioral changes for 24 hrs following cecal ligation and perforation. Blood-brain barrier permeability was functionally and structurally evaluated by determining the extravasation of Evans Blue and horseradish peroxidase tracers, respectively. Immunohistochemistry and Western blotting for occludin were performed.


RESULTS
The high mortality rate (34%) noted in the septic rats was decreased to 15% and 3% by immunoglobulin G and immunoglobulins enriched with immunoglobulin A and immunoglobulin M, respectively (p < .01). Both immunoglobulin G and immunoglobulins enriched with immunoglobulin A and immunoglobulin M alleviated the symptoms of sickness behavior in the septic rats, with the animals becoming healthy and active. Increased extravasation of Evans Blue into the brain tissue of the septic rats was markedly decreased with the administration of both immunoglobulin G and immunoglobulins enriched with immunoglobulin A and immunoglobulin M (p < .01). Occludin expression remained essentially unchanged in all groups, including the cecal ligation and perforation group. In the cecal ligation and perforation group, increased luminal and abluminal vesicles containing electron-dense horseradish peroxidase-reaction product were noted in the cytoplasm of endothelial cells located in the hippocampus and the cerebral cortex. Tight junction was ultrastructurally intact, suggesting that the transcellular pathway is responsible for the blood-brain barrier breakdown in sepsis. Following immunoglobulin G or immunoglobulins enriched with immunoglobulin A and immunoglobulin M treatment, no ultrastructural evidence of leaky capillaries in the brain was observed in the septic rats, indicating the blockade of the transcellular pathway by immunoglobulins administration.


CONCLUSIONS
Our study suggests that immunoglobulin G and immunoglobulins enriched with immunoglobulin A and immunoglobulin M improve the integrity of the blood-brain barrier and inhibits cecal ligation and perforation-induced symptoms of sickness behavior in rats.
Department of Anesthesiology, Istanbul University, Istanbul, Turkey.
Figen
F
Esen
Evren
E
Senturk
Perihan E
PE
Ozcan
Bulent
B
Ahishali
Nadir
N
Arican
Nurcan
N
Orhan
Oguzhan
O
Ekizoglu
Mutlu
M
Kucuk
Mehmet
M
Kaya
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000503:physiopathology* / Q000648:ultrastructure; D015153:Blotting, Western; D001831:Body Temperature / Q000502:physiology; D005260:Female; D006624:Hippocampus / Q000737:chemistry; D007070:Immunoglobulin A / Q000008:administration & dosage / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000627:therapeutic use; D007075:Immunoglobulin M / Q000008:administration & dosage / Q000627:therapeutic use; D007136:Immunoglobulins / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D053582:Interleukin-1alpha / Q000032:analysis; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007136:Immunoglobulins; D053582:Interleukin-1alpha; D014409:Tumor Necrosis Factor-alpha