title: Combined inhibition of complement C5 and CD14 markedly attenuates inflammation, thrombogenicity, and hemodynamic changes in porcine sepsis.
abstract: Complement and the TLR family constitute two important branches of innate immunity. We previously showed attenuating effects on inflammation and thromogenicity by inhibiting the TLR coreceptor CD14 in porcine sepsis. In the present study, we explored the effect of the C5 and leukotriene B4 inhibitor Ornithodoros moubata complement inhibitor (OmCI; also known as coversin) alone and combined with anti-CD14 on the early inflammatory, hemostatic, and hemodynamic responses in porcine Escherichia coli-induced sepsis. Pigs were randomly allocated to negative controls (n = 6), positive controls (n = 8), intervention with OmCI (n = 8), or with OmCI and anti-CD14 (n = 8). OmCI ablated C5 activation and formation of the terminal complement complex and significantly decreased leukotriene B4 levels in septic pigs. Granulocyte tissue factor expression, formation of thrombin-antithrombin complexes (p < 0.001), and formation of TNF-α and IL-6 (p < 0.05) were efficiently inhibited by OmCI alone and abolished or strongly attenuated by the combination of OmCI and anti-CD14 (p < 0.001 for all). Additionally, the combined therapy attenuated the formation of plasminogen activator inhibitor-1 (p < 0.05), IL-1β, and IL-8, increased the formation of IL-10, and abolished the expression of wCD11R3 (CD11b) and the fall in neutrophil cell count (p < 0.001 for all). Finally, OmCI combined with anti-CD14 delayed increases in heart rate by 60 min (p < 0.05) and mean pulmonary artery pressure by 30 min (p < 0.01). Ex vivo studies confirmed the additional effect of combining anti-CD14 with OmCI. In conclusion, upstream inhibition of the key innate immunity molecules, C5 and CD14, is a potential broad-acting treatment regimen in sepsis as it efficiently attenuated inflammation and thrombogenicity and delayed hemodynamic changes.
authors.affiliation: Department of Immunology, Oslo University Hospital, National Hospital, University of Oslo, 0424 Oslo, Norway. andreas.barrattdue@gmail.com
authors.forename: Andreas
authors.initials: A
authors.lastname: Barratt-Due
authors.forename: Ebbe B
authors.initials: EB
authors.lastname: Thorgersen
authors.forename: Kjetil
authors.initials: K
authors.lastname: Egge
authors.forename: Søren
authors.initials: S
authors.lastname: Pischke
authors.forename: Andrey
authors.initials: A
authors.lastname: Sokolov
authors.forename: Bernt C
authors.initials: BC
authors.lastname: Hellerud
authors.forename: Julie K
authors.initials: JK
authors.lastname: Lindstad
authors.forename: Anne
authors.initials: A
authors.lastname: Pharo
authors.forename: Anjan K
authors.initials: AK
authors.lastname: Bongoni
authors.forename: Robert
authors.initials: R
authors.lastname: Rieben
authors.forename: Miles
authors.initials: M
authors.lastname: Nunn
authors.forename: Helge
authors.initials: H
authors.lastname: Scott
authors.forename: Tom E
authors.initials: TE
authors.lastname: Mollnes
mesh_terms: D000818:Animals; D000990:Antithrombin III / Q000096:biosynthesis; D062186:Arterial Pressure / Q000187:drug effects / Q000276:immunology; D060829:Arthropod Proteins / Q000494:pharmacology*; D039481:CD11b Antigen / Q000096:biosynthesis; D002352:Carrier Proteins / Q000494:pharmacology*; D003182:Complement C5 / Q000037:antagonists & inhibitors*; D004926:Escherichia coli / Q000276:immunology; D004927:Escherichia coli Infections / Q000276:immunology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000096:biosynthesis; D006339:Heart Rate / Q000187:drug effects / Q000276:immunology; D006439:Hemodynamics / Q000187:drug effects; D007113:Immunity, Innate; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology; D016753:Interleukin-10 / Q000096:biosynthesis; D053583:Interleukin-1beta / Q000096:biosynthesis; D015850:Interleukin-6 / Q000096:biosynthesis; D016209:Interleukin-8 / Q000096:biosynthesis; D007958:Leukocyte Count; D007975:Leukotriene B4 / Q000037:antagonists & inhibitors*; D018950:Lipopolysaccharide Receptors / Q000276:immunology* / Q000378:metabolism; D009504:Neutrophils / Q000166:cytology; D010447:Peptide Hydrolases / Q000096:biosynthesis; D017395:Plasminogen Activator Inhibitor 1 / Q000096:biosynthesis; D018805:Sepsis / Q000276:immunology*; D034421:Sus scrofa; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
chemical_list: D060829:Arthropod Proteins; D039481:CD11b Antigen; D002352:Carrier Proteins; D003182:Complement C5; D053583:Interleukin-1beta; D015850:Interleukin-6; D016209:Interleukin-8; D018950:Lipopolysaccharide Receptors; C521053:OmCI protein, tick; D017395:Plasminogen Activator Inhibitor 1; D014409:Tumor Necrosis Factor-alpha; C046193:antithrombin III-protease complex; D016753:Interleukin-10; D007975:Leukotriene B4; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D000990:Antithrombin III; D010447:Peptide Hydrolases