Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pathologic oxygen supply dependency (PO2SD) may be etiologic in multisystem organ failure (MSOF) and has been related to mortality in sepsis. Although elevated lactate levels are generally assumed to be a marker of anaerobiosis in these patients, endotoxin may increase serum lactate by inactivation of pyruvate dehydrogenase (PDH), unrelated to tissue PO2. We hypothesized that regional lactate flux may correlate poorly with local oxygen delivery in sepsis. This study examined both the whole-body (WB) and regional (isolated hind limb L and gut G) responses to endotoxin infusion in terms of oxygen delivery, oxygen uptake, and lactate flux in 12 pentobarbital-anesthetized dogs. To separate hypoxia-induced lactate production from that related to inactivation of PDH by endotoxin, half the dogs received dichloroacetate (DCA), a PDH activator. After endotoxin and volume resuscitation, each animal had low systemic vascular resistance with normal to high cardiac output. Despite adequate oxygen delivery to WB, L, and G, arterial lactate levels rose significantly. A 30-min hypoxic challenge (12% FIO2) did not increase lactate levels but did increase WB O2 uptake. DCA normalized lactate levels without influencing oxygen delivery and uptake relations. These data show that lactate levels in endotoxic states may be a poor marker of tissue hypoxia and may be more related to PDH activity.
 ...
PMID:Regional and systemic oxygen delivery/uptake relations and lactate flux in hyperdynamic, endotoxin-treated dogs. 129 May 54

The effect of sterile inflammation and sepsis on the proportion of active pyruvate dehydrogenase complex (PDH) in mitochondria isolated from skeletal muscle has been investigated. The proportion of active PDH in mitochondria isolated from septic animals was significantly reduced compared with control under all incubation conditions examined, even in the presence of inhibitors of the PDH kinase. There was no significant difference between control and sterile inflammation in any of the incubations examined. The rate constant for ATP-dependent inactivation of the PDH complex in mitochondrial extracts from control animals was -0.42 min-1 (r = 0.993; P less than 0.001) and was not altered in mitochondrial extracts from sterile inflammatory animals (-0.43 min-1; r = 0.999; P less than 0.001). However, rate constants for inactivation in septic animals was significantly increased over twofold to -1.08 min-1 (r = 0.987; P less than 0.001) (P less than 0.001 vs. control or sterile inflammation). In the presence of inhibitors of the PDH kinase reaction (2.5 mM pyruvate or 1 mM dichloroacetate), inactivation of PDH after addition of ATP was significantly greater in mitochondrial extracts from septic than either control or sterile inflammatory animals. These results suggest that sepsis, but not sterile inflammation, induces a stable factor in skeletal muscle mitochondria that increased PDH kinase activity.
 ...
PMID:Increased pyruvate dehydrogenase kinase activity in response to sepsis. 203 22

The effect of sterile inflammation and sepsis on the release of lactate and amino acids by peripheral tissues was investigated by removing the splanchnic organs (liver and small intestines) from the circulation and monitoring changes in plasma substrates for 30 min. Functional hepatectomy was performed in rats 5-7 days following the intraperitoneal introduction of a fecal-agar pellet (1.5 ml) [sterile vs. Bacteriodes fragilis (10(8) CFU) + E. coli (10(3) CFU)]. Following functional hepatectomy, dichloroacetate, an activator of the pyruvate dehydrogenase complex, significantly inhibited both lactate and alanine release. L-cycloserine, an inhibitor of alanine aminotransferase, significantly (P less than .05) reduced alanine following hepatectomy. Methionine sulfoximine, an inhibitor of glutamine synthetase, significantly (P less than .005) decreased glutamine accumulation following functional hepatectomy in each of the conditions examined. Treatment with each of these drugs abolished the differences between control and sepsis following hepatectomy. These results demonstrate that alterations in the amino acid profiles during sepsis may be modulated in peripheral organs pharmacologically by utilizing known inhibitors of critical regulatory enzymes.
 ...
PMID:Pharmacologic modulation of increased release of gluconeogenic precursors from extra-splanchnic organs in sepsis. 257 28

Altered glucose metabolism and lactic acidemia are features of Gram-negative polymicrobial abscesses, but the relationship between carbohydrate metabolism and the aerobic or anaerobic organisms is unclear. Since reductions in the % active pyruvate dehydrogenase complex (PDHa) limits glucose oxidation in sepsis, the effect of a 7-day monoclonal (E. coli or B. fragilis) vs. biclonal (E. coli + B. fragilis) intra-abdominal abscess (IA) on PDHa and lactate concentrations in skeletal muscle (SM) and plasma was studied in rats. A chronic IA was created by the intraperitoneal introduction of a sterile rat fecal-agar pellet (1.5 ml) inoculated with a known bacterial flora [sterile (S); E. coli 10(6) CFU/ml (EC); B. fragilis 10(8) CFU/ml (BF); E. coli 10(3) CFU/ml + B. fragilis 10(4) CFU/ml (ECLBF); E. coli 10(3) CFU/ml + B. fragilis 10(8) CFU/ml (ECHBF)]. Neither SM PDHa nor SM nor plasma lactate were altered from control in animals with either sterile (S) or E. coli (EC) monoclonal IA, but SM PDHa was significantly (p less than 0.001) reduced and SM lactate increased (p less than 0.05) in rats with B. fragilis 10(8)/ml (BF) monoclonal IA. In biclonal IA, the effect of sepsis on SM PDHa depended on the concentration of B. fragilis in the IA fluid (ECLBF = 10(4) CFU/ml vs. ECHBF = 10(8) CFU/ml) since the E. coli were constant (10(3) CFU/ml). At the lower B. fragilis IA concentration (ECLBF), the SM PDHa was not different from control. However, when the IA B. fragilis concentration was increased to 10(8) CFU/ml (ECHBF), the SM PDHa was significantly (p less than 0.001) decreased relative to control. A decreased muscle PDHa was always associated with elevated SM and plasma lactate concentrations. These results suggest that IA which permit a threshold of relatively nonlethal (BF = 0% mortality) anaerobic B. fragilis (greater than or equal to 10(8) CFU/ml) to enter the circulation are more important in altering metabolic control of skeletal muscle glucose oxidation and in producing lactic acidemia than are IA with only aerobic E. coli. However, in biclonal intra-abdominal abscesses, B. fragilis potentiated the early mortality from E. coli (EC = 6% vs. ECHBF = 37% mortality), suggesting that the metabolic effect of the B. fragilis-induced lactic acidemia is synergistic with the direct toxic effects of the E. coli.
 ...
PMID:Role of anaerobic bacteria in intra-abdominal septic abscesses in mediating septic control of skeletal muscle glucose oxidation and lactic acidemia. 266

We have investigated the responsiveness of protein kinetics to insulin and the role of glucose oxidation rate as a mediator of the protein catabolic response to burn injury and sepsis by assessing the response of leucine and urea kinetics to a 5-h hyperinsulinemic euglycemic clamp with and without the simultaneous administration of dichloroacetate (DCA) (to further increase glucose oxidation via stimulation of pyruvate dehydrogenase activity) in eight severely burned and eight septic patients. Leucine and urea kinetics were measured by the primed-constant infusions of [1(-13)C]leucine and [15N2]urea. Compared with controls, basal leucine kinetics (flux and oxidation) were significantly elevated (P less than 0.01) in both groups of patients. Hyperinsulinemia elicited significant (P less than 0.05) decreases in leucine kinetics in both groups of patients. Consistent with this observation, hyperinsulinemia caused urea production to decrease significantly (P less than 0.05) in both patient groups. The administration of DCA to patients during hyperinsulinemia elicited a significant increase in glucose oxidation rate compared with the clamp rate (P less than 0.05), and the percent of glucose uptake oxidized increased from 45.5 +/- 5.5 to 53.5 +/- 4.8%; yet the response of leucine and urea kinetics to the clamp plus DCA was not different from the response to the clamp alone. These results suggest that the maximal effectiveness of insulin to suppress protein breakdown is not impaired and that a deficit in glucose oxidation or energy supply is probably not playing a major role in mediating the protein catabolic response to severe burn injury and sepsis.
 ...
PMID:Role of insulin and glucose oxidation in mediating the protein catabolism of burns and sepsis. 267 28

A study of the combined effects of intravenous infusion of the recombinant cytokines beta-interleukin 1 (IL-1) and alpha-tumor necrosis factor (TNF) on energy substrate metabolism in awake, conditioned, adult rabbits was performed. After a 2-h basal or control period, 48-h fasted rabbits were administered TNF and IL-1 as a bolus (5 micrograms/kg) followed by a continuous intravenous infusion (25 ng.kg-1.min-1) for 3 h. Significant increases in plasma lactate (P less than 0.01), glucose (P less than 0.01), and triglycerides (P less than 0.05) occurred during the combined infusion of IL-1 and TNF, whereas neither cytokine alone had no effect. There was a 33% increase in the rate of glucose appearance (P less than 0.05), but glucose clearance was not altered compared with the control period. Glucose oxidation increased during the combined cytokine infusion period and glucose recycling increased by 600% (P less than 0.002). Lactic acidosis and decreased oxygen consumption, as a result of the cytokine infusions, indicated development of anaerobic glycolytic metabolism. A reduction in the activity state of hepatic mitochondrial pyruvate dehydrogenase (65 vs. 82% in control animals, P less than 0.05) was consistent with the observed increase in anaerobic glycolysis. Thus the combined infusion of IL-1 and TNF in rabbits produces metabolic manifestations seen in severe injury and sepsis in human patients and, as such, may account for the profound alterations of energy metabolism seen in these conditions.
 ...
PMID:Role of interleukin 1 and tumor necrosis factor on energy metabolism in rabbits. 314 80

Decreased pyruvate dehydrogenase (PDH) activity in skeletal muscle has been observed during sepsis and may contribute to the altered glucose kinetics seen in this condition. The purpose of the present study was to determine if dichloroacetate (DCA), a known stimulator of PDH activity, could reverse the sepsis-induced increase in glucose metabolism. Hypermetabolic sepsis was produced in chronically catheterized rats by repeated subcutaneous injections of live Escherichia coli. Whole body glucose kinetics, assessed by a constant iv infusion of [6-3H and U-14C]-glucose, were determined in fasted septic and nonseptic rats before and for 4 hr after an injection of DCA (30 mg/100 g BW, iv). Sepsis produced hyperthermia (+1.6 degrees C) and increased the rates of glucose appearance (Ra; 95%), recycling (318%), metabolic clearance (MCR; 114%), and elevated plasma lactate levels (295%) compared to nonseptic controls. After injection of DCA into septic rats, glucose levels gradually fell, and the sepsis-induced hyperlactacidemia was completely reversed. Treatment of septic rats with DCA reversed the elevated glucose Ra; recycling, although reduced, was still elevated by 50% compared to control animals. DCA did not alter the hyperglucagonemia seen in septic animals, but it did reduce the plasma insulin levels by 60%. Hepatic and muscle PDH activities were not different in saline-treated septic and nonseptic animals. DCA elevated PDH activity in muscle from septic rats, but the increase was smaller than that seen in control animals. This may explain the smaller decline in glucose recycling and plasma lactate in septic animals. These results are consistent with DCA reducing the elevated glucose Ra in sepsis by partial activation of PDH, which reduces the elevated precursor (lactate) supply for gluconeogenesis. However, alterations in PDH activity did not appear to contribute to the underlying increase in glucose Ra and recycling observed in sepsis.
 ...
PMID:Glucose kinetics and pyruvate dehydrogenase activity in septic rats treated with dichloroacetate. 331 89

The metabolic effects of dichloroacetate on carbohydrate metabolism were investigated in normal fed, sterile inflammatory, and chronic septic animals. Chronic sepsis, but not sterile inflammation, was associated with elevated plasma, liver, and skeletal muscle lactate concentrations. Sodium dichloroacetate significantly reduced both plasma and intracellular pyruvate and lactate concentrations in all conditions examined, while plasma glucose concentrations remained unchanged. Decreased tissue metabolite concentrations were associated with a significantly increased active pyruvate dehydrogenase complex in liver and skeletal muscle in each of the conditions examined. In liver, dichloroacetate fully activated (greater than 85%) the pyruvate dehydrogenase complex under all conditions. In skeletal muscle from chronic septic animals, the dichloroacetate-induced increases in active pyruvate dehydrogenase were significantly less than those observed in non-septic animals. The data suggest that although dichloroacetate can partially reverse the sepsis-induced effects on skeletal muscle pyruvate dehydrogenase activity, there may be additional regulatory factors in skeletal muscle from septic animals. The dichloroacetate stimulation of the pyruvate dehydrogenase activity may provide a pharmacological method for reducing the elevated lactate concentrations observed in chronic severe sepsis.
 ...
PMID:Metabolic effects of partial reversal of pyruvate dehydrogenase activity by dichloroacetate in sepsis. 334 93

Sepsis has been shown to decrease skeletal muscle glucose oxidation by inhibiting the pyruvate dehydrogenase activity (PDHa) and to increase proteolysis and use of branched-chain amino acids (BCAA). The effects of dichloroacetate (DCA), which reverses PDHa inhibition, were studied in skeletal muscle from a septic (S) rat model of intra-abdominal abscess (E. coli + B. fragilis) and compared to control (C) and sterile inflammatory abscess (I) animals. In one set of S, I, and C animals, DCA (1 mmol/kg) was injected intraperitoneally at 0, 30, and 60 min. Septic, but not I, rats had a twofold increase in skeletal muscle lactate concentrations over C, but no changes in pyruvate. After DCA, both lactate and pyruvate were reduced (p less than 0.001) to same level in S, I, and C. Skeletal muscle alanine was increased in S compared to I or C, but after DCA was reduced threefold in C, S, and I (p less than 0.001) suggesting that alanine synthesis may be impaired due to decreased pyruvate availability. Like alanine, skeletal muscle BCAA were increased in S compared to C, but not altered in I. Following DCA, BCAA levels in muscle from S were reduced (p less than 0.001) to values seen in C or I. Muscle phenylalanine content was significantly elevated in S (p less than 0.05) compared to C or I, but was reduced (p less than 0.05) after DCA in S but not in C or I. Decreased muscle phenylalanine associated with lowered BCAA suggests DCA may decrease septic muscle protein catabolism and/or enhance protein synthesis. Coupled with an increased PDHa and reduced lactate levels, this suggests that DCA may reverse the excess muscle catabolism and BCAA dependence of sepsis by increasing glucose and lactate oxidation and may be a useful therapeutic modality.
 ...
PMID:Pharmacological reversal of abnormal glucose regulation, BCAA utilization, and muscle catabolism in sepsis by dichloroacetate. 341 55

The effect of chronic sepsis on the concentration of active pyruvate dehydrogenase complex has been investigated in liver and skeletal muscle of normal, sterile inflammatory, and chronic septic (small and large abscess) animals. Hyperdynamic sepsis was induced by the intraperitoneal introduction of a rat fecal-agar pellet of known size and bacterial composition (Escherichia coli + Bacteroides fragilis). Total pyruvate dehydrogenase complex activity was not altered in either liver or skeletal muscle in any of the conditions studied. In hepatic tissue, sterile inflammation increased the proportion of active complex 2.5-fold compared with control. The same increase in the concentration of active complex was observed in animals with a small abscess. When the abscess size was increased (large abscess), the concentration of active complex was decreased relative to sterile inflammatory or small abscess septic animals. In contrast to liver, sterile inflammation did not alter the proportion of active complex in skeletal muscle. Sepsis (either small or large septic abscess) resulted in threefold decrease in the concentration of active complex relative to control or sterile inflammatory animals. Changes in the concentration of active complex did not appear to be dependent on the ATP/ADP concentration ratio or tissue pyruvate levels but were consistent with changes in the acetyl-coenzyme A-to-coenzyme A concentration ratio. The mechanism responsible for altered concentration of active complex may be mediated through changes in the activity of the pyruvate dehydrogenase kinase, secondary to alterations in the effector concentration ratios.
 ...
PMID:Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. 352 10


1 2 3 4 Next >>