Journal
JOURNAL OF LEUKOCYTE BIOLOGY
Volume 86, Issue 3, Pages 589-597Publisher
WILEY
DOI: 10.1189/jlb.1008646
Keywords
sepsis; fluid resuscitation; advanced glycation endproducts; RAGE; colloid
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Funding
- Deutsche Forschungsgemeinschaft (DFG/SFB) [405]
- Dietmar Hopp Foundation
- University Tubingen
- National Institutes of Health [DK-19971]
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HSA preparations for i.v. use are administered in critically ill patients. Although increasing intravascular osmotic pressure seems to be a pathophysiologically orientated treatment, clinical trials do not indicate a benefit for mortality in HSA-treated patients. Instead, there is evidence for inflammatory reactions upon infusion of different HSA batches. A neglected issue concerning the safety and quality of these therapeutics is processing-related post-transcriptional protein modifications, such as AGEs. We therefore tested the hypothesis that commercially available infusion solutions contain AGEs and studied whether these protein modifications influence outcome and inflammation in a murine model of sepsis induced by CLP. Screening of different HSA and Ig preparations in this study revealed an up to approximate tenfold difference in the amount of AGE modifications. Application of clinically relevant concentrations of CML-modified HSA in CLP led to increased inflammation and enhanced mortality in wild-type mice but not in mice lacking the RAGE. Lethality was paralleled by increased activation of the proinflammatory transcription factor NF-kappa B, NF-kappa B-dependent gene expression, and infiltration of inflammatory cells in the peritoneal cavity. This study implies that infusion solutions containing a high load of the AGE-modified protein have the potential to activate RAGE/NF-kappa B-mediated inflammatory reactions, causing increased mortality in experimental peritonitis. J. Leukoc. Biol. 86: 589-597; 2009.
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