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

Alterations of the kallikrein-kinin system consistent with activation and increased consumption have been reported in septic patients and it has been suggested that this activation could contribute to the development of septic shock. The aim of this work was to confirm these alterations in septic patients and to investigate the possible existence of similar changes in subjects developing cardiogenic shock secondary to myocardial infarction as a model of non septic shock. Patients with septic shock, especially in fatal cases, showed a highly significant decrease in levels of factor XII, prekallikrein, high molecular weight kininogen (HMW-kininogen), alpha 2-macroglobulin (alpha 2-M) and antithrombin III (AT-III). C1-esterase inhibitor (C1-INH) activity was increased in uncomplicated sepsis but came back to normal or was slightly decreased in septic shock. Components and inhibitors of the kallikrein-kinin system were within normal limits in patients with cardiogenic shock. Our findings support the idea of a contribution of the kallikrein-kinin system to the development of septic shock though this system does not seem to play a significant role in the pathogenesis of cardiogenic shock or seem to be altered as a consequence of it.
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PMID:Plasma kallikrein-kinin system in patients with uncomplicated sepsis and septic shock--comparison with cardiogenic shock. 367 21

Components of the plasma kallikrein-kinin system were determined in plasma samples from ten healthy subjects and eight patients with septic shock. Five of the patients died. Low levels of Hageman factor, prekallikrein, and high molecular weight kininogen, together with significantly reduced concentrations of alpha 2-macroglobulin, were observed during septic shock both in patients who died and in the survivors. The patients who died also revealed a pronounced reduction of functional kallikrein inhibition determined by a chromogenic peptide substrate assay. In the survivors, however, functional kallikrein inhibition was very well preserved during septic shock, being within the range of values found in normals. Also plasma prekallikrein and C1-esterase inhibitor levels were slightly higher in the survivors than in those who died. Our results confirm that the plasma kallikrein-kinin system becomes activated during septicemia and that consumption of components of this protease system occurs. Because both C1-esterase inhibitor concentrations and functional kallikrein inhibitory activities were higher in patients who survived septic shock than in the fatal cases, our results suggest that functional inhibition of plasma kallikrein appears to play a major role in the outcome of this condition.
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PMID:Studies on components of the plasma kallikrein-kinin system in plasma samples from normal individuals and patients with septic shock. 617 27

Clinical and autopsy studies have shown an association between clotting, microembolism, and inhibition of fibrinolysis and respiratory distress after trauma or sepsis. Prophylaxis and treatment with the aim of decreasing the deposition of fibrin in the lungs were associated with a large decrease in the incidence and death rate of this syndrome. Small fibrin degradation products (peptides) are accumulated in the lungs and are only slowly cleared from this organ, especially during states of inhibition of fibrinolysis. These peptides may contribute to the pulmonary damage in several ways. As well as having a direct effect on the endothelium, they act by interfering with other vasoactive substances as bradykinin, histamine, and products of the arachidonic acid cascade. Products of the cyclooxygenase pathway such as thromboxane A2 play a major role in early microembolism, whereas lipoxygenase products seem to be involved in later stages. Pulmonary microembolism thus seems to be one important, but certainly not the only, pathogenetic factor in acute "idiopathic" respiratory failure. Other factors, such as pulmonary contusion, aspiration of gastric contents or blood, or oxygen toxicity, might well be contributory in some cases. Pulmonary microemboli containing fibrin and leukocytes are probably also involved as contributory agents in some cases in the large group of acute respiratory failures due to "known factors."
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PMID:Clotting, microembolism, and inhibition of fibrinolysis in adult respiratory distress. 619 Feb 36

Kinins, which are vasodilatory, permeability-increasing, pain-producing polypeptides, are formed from inactive precursors: kininogens. Their actions make kinins a particularly powerful potential pro-inflammatory factor. However the absence of specific antagonists has so far made it impossible to ascribe them a definite role in inflammation. Two studies of experimental endotoxemia in burns patients, septicemia and septic shock have demonstrated the following facts: activation occurs of specific ( pKK ) and non-specific (plasminogen-plasmin system) kininogenases , K-HMW and K-LMW levels are significantly decreased. Kininogen consumption corresponds to increased BDK production. This would therefore appear to be one of the humoral factors responsible for haemodynamic changes. Though measurement of kininogen levels is still a painstaking process, the development of chromogenic substrates has made pKK and KK measurement simple and fast. Once they have been validated physico-pathologically in a large number of patients, such assays should take their place among the diagnostic weapons of clinical biology at the disposal of clinicians.
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PMID:[Role of the kallikrein-kininogen-kinin system in the inflammatory reaction and septic shock]. 623 19

Angiotensin-converting enzyme (ACE) is localized to the luminal surface of pulmonary endothelial cells, where it converts angiotensin I and activates bradykinin. Sepsis may result in endothelial cell dysfunction. We have previously reported that the marked decrease in serum ACE in patients with the Adult Respiratory Distress Syndrome (ARDS) is present only in septic patients. Serum was evaluated in seven baboons made septic by the infusion of live E coli. There was a significant decline in serum ACE from a control value of 41.5 +/- 4.2 to 25.8 +/- 2.2 at 8 h (P less than 0.05), which correlated with the 65 +/- 11 torr decline in mean arterial pressure. There was no change in PaO2. We conclude that sepsis results in marked depletion of serum ACE activity, which corresponds to the decrease in mean arterial pressure, and may reflect reduced bradykinin inactivation.
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PMID:Angiotensin-converting enzyme (ACE) in sepsis. 631 57

These studies have indicated some quantitative aspects of the kallikrein kinin system in sepsis. While other investigators have noted the fall in plasma kininogen in patients with sepsis, e.g. Erdos and colleagues (23), this study has indicated that it is the fall in the LMWK that is significant in these patients. LMWK comprises of three-quarters of the total plasma kininogen and its consumption can lead to the production of 2.24 million picograms bradykinin/ml plasma. In health bradykinin concentration is of the order of 100-400 picograms/ml. It is not unreasonable to suggest therefore, that bradykinin levels are increased in acute disease and other investigators have shown this by direct assay of the peptide in such patients. The present study has shown that once bradykinin is generated in the circulation in terms of ng/ml, even with passage through the lung, systemic effects occur, namely reduction in TPR and a fall in CO and BP. Thus, bradykinin could be the humoral factor responsible for the hyperdynamic state and systemic hypotension in severe sepsis. It is apparent that metabolism of bradykinin involves more than simply clearance of the peptide. It appears that bradykinin can stimulate the production of other vasoactive mediators by the lung. The consumption of LMWK in sepsis indicates that it is not plasma kallikrein activity but rather non-specific kininogenase activity that is critical. This may be important not only from the viewpoint of kinin generation, but also because of the consumption of plasma protease inhibitors. A mechanism to control or inhibit such protease activity offers a possible therapeutic approach to circulatory failure in these patients.
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PMID:The kallikrein-kinin system in the acutely-ill: (A) changes in plasma kininogen in acutely-ill patients. (B) the efficacy of pulmonary clearance of bradykinin. 655 53

Clinical and autopsy studies have shown an association between pulmonary microembolism and acute respiratory failure after trauma or sepsis. Prophylaxis and treatment with the aim of decreasing the fibrin deposition in the lungs were associated with a decrease in the incidence and death rate of this syndrome. Small fibrin degradation products (peptides) are accumulated in the lungs and are only slowly cleared from this organ, especially during states of fibrinolysis inhibition. These peptides may contribute to the pulmonary damage in several ways. They act by interfering with other vasoactive substances as bradykinin, histamine and products of the arachidonic acid cascade. Products of the cyclooxygenase pathways as thromboxane A2 play a major role in early microembolism whereas lipoxygenase products seem to be involved in delayed microembolism. Pulmonary microembolism thus seems to be one important, but certainly not the only pathogenetic factor in acute "idiopathic" respiratory failure. Other factors such as pulmonary contusion, aspiration of gastric contents or blood, or oxygen toxicity, might well be contributory in some cases. Pulmonary microemboli containing fibrin and leukocytes are probably also involved as contributory agents in some cases in the large group of acute respiratory failure due to "known factors".
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PMID:Pulmonary microembolism as a cause of acute respiratory failure. 696 76

Activation of the kallikrein-kinin system in sepsis has long been recognized, but its role, beneficial or pathologic, has not been defined. Recently, however, specific bradykinin (BK) antagonists have become available and this study investigated the effects of a BK antagonist, NPC17731 (Scios-Nova) on systemic and pulmonary hemodynamics in a model of gram-negative sepsis. Anesthetized swine were studied for 5 h receiving a 1-h infusion of saline (controls, group 1, N = 8) or live Pseudomonas aeruginosa (septic, group 2, N = 8). Group 3 (treatment, N = 6) received NPC17731 (5 mg/kg initial bolus followed by 1 mg/kg hourly) just prior to the onset of sepsis. Group 2 animals showed a rapid decrease in systemic arterial pressure (SAP) from 30 min onward, and sustained significant hypotension from 2 h onward. In group 3, SAP fell similarly until 2 h then progressively rose, returning to baseline levels by 5 h. In contrast, cardiac index fell progressively from 3 h onward in groups 2 and 3. Systemic vascular resistance index (SVRI) fell significantly by 2 h in group 2 animals, recovering to baseline by 5 h. Group 3 showed a similar initial fall followed by a rebound increase in SVRI, which, at 5 h was significantly raised above the other groups. Group 2 developed significant, persistent pulmonary artery hypertension which was not reduced by NPC17731. The data imply a significant role for bradykinin in the pathogenesis of hypotension in septic shock in this model. Septic shock was reversed by a BK antagonist which increased peripheral resistance without affecting cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic effects of bradykinin antagonism in porcine gram-negative sepsis. 761 81

Local variations in endothelial permeability, hypothesized to play a role in the development of multiple-organ injury, were measured by 125I-labeled human serum albumin flux and leakage index in rats with a variety of challenges. The albumin flux significantly increased in the peritoneum, pancreas, stomach, and liver in acute pancreatitis; in the peritoneum and liver in abdominal sepsis; in the spleen, proximal small intestine, colon, liver, lungs, heart, and muscle in bacteremia; in the kidneys, liver, lungs, heart, brain, and muscle in endotoxemia; and in the peritoneum, proximal small intestine, colon, kidneys, liver, and heart after bradykinin administration. A redistribution of the tissue blood content, measured by 51Cr-labeled red blood cells, was noted. An increased albumin leakage index, assaying endothelial permeability considering local hemodynamic alterations, was noted in various organs in the different experimental groups. Thus septic and nonseptic challenges induce endothelial barrier injury. The endothelial resistance appears to be organ and/or tissue dependent and associated with a redistribution of blood.
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PMID:Endothelial barrier resistance in multiple organs after septic and nonseptic challenges in the rat. 766 99

The linear nonapeptide hormone bradykinin (Arg1-Pro2-Pro3-Gly4-Phe5-Ser6-Pro7-Phe8-Arg9) is involved, either directly or indirectly, in a wide variety of physiological processes, particularly pain and hyperanalgesia. Additional evidence suggests that bradykinin also plays a major role in inflammatory response, asthma, sepsis, and symptoms associated with the rhinoviral infection. It has long been speculated that a beta-turn at the C-terminus of bradykinin plays a major role in the biological activity of the neuropeptide. The beta-turn forming potential of bradykinin in three vastly different local chemical environments, DMSO, 9:1 dioxane/water, and in the presence of 7.4 mM lyso phosphatidylcholine micelles, was investigated using two-dimensional homonuclear nmr experiments coupled with simulated annealing calculations. The results of these investigations show that in all three systems residues 6-9 of the C-terminus adopt very similar beta-turn like structures. These results suggest that the beta-turn at the C-terminus of bradykinin is an important secondary structural feature for receptor recognition and binding.
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PMID:Nmr and molecular modeling investigations of the neuropeptide bradykinin in three different solvent systems: DMSO, 9:1 dioxane/water, and in the presence of 7.4 mM lyso phosphatidylcholine micelles. 800 21


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