Acute Lung Injury. Stefanie Nickl. Lab Meeting 14/11/2011
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1 Acute Lung Injury Stefanie Nickl Lab Meeting 14/11/2011
2 N Engl J Med May 4;342(18): Crit Care Med Jan;28(1): Definition of ALI/ARDS
3 N Engl J Med May 4;342(18): Crit Care Med Jan;28(1): Definition of ALI/ARDS
4 Some Facts Epidemiology Risk Factors 190,000 cases / year in the US 74,500 deaths In-hospital mortality ALI 38.5% ARDS 41.1% Outcome (survivors) restriction/obstruction gas-exchange abnormalities reduced health-related QOL fibrosis N Engl J Med May 4;342(18): Inter Med 2009;48: J Aerosol Med Pulm Drug Deliv Aug;23(4):
5 Pathophysiology damage of alveolar-capillary barrier increased vascular and epithelial permeability influx of protein-rich fluid into interstitial and alveolar compartments impaired gas exchange cell infiltration formation of hyaline membranes reduced surfactant production (damaged alveolar type II cells) atelectasis N Engl J Med May 4;342(18): Crit Care Med Jan;28(1):232-5.
6 Pathophysiology II Proteins / Cytokines ALI induces production and release of cytokines and pro-inflammatory mediators Amplification of inflammatory response in ALI CXCR2 critically involved N Engl J Med May 4;342(18): APMIS Jul-Aug;112(7-8): Front Biosci Jan 1;14:150-8.
7 Animal Models for ALI Number of papers indexed in PubMed using animal models of acute lung injury in the English literature from Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
8 Animal Models for ALI Species differences in Toll-like receptors the mononuclear phagocyte system nitric oxide chemokines and chemokine receptors Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
9 Animal Models for ALI LPS Initial mechanisms LPS i.v. apoptosis of (capillary) endothelial cells initial phase of leukopenia cardiac output and arterial pressure pulmonary arterial pressure due to resistance of postcapillary veins Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
10 Animal Models for ALI LPS after the initial phase 4 6 hours slow improvement in leucocyte counts and hemodynamic profile 2 4 hours changes in the lung - hypoxemia - alveolar-arterial oxygen difference - changes in PMN deformability and entrapment of PMN in pulmonary capillaries Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
11 Animal Models for ALI LPS A, B: normal mouse lungs; thin alveolar walls, majority of alveoli contain no cells C, D: 18h after intratracheal instillation of 5ng/g LPS; patchy nature of the injury, presence of Am J Physiol Lung Cell Mol Physiol Sep;295(3):L inflammatory infiltrates and vascular congestion
12 Animal Models for ALI LPS Pros Easy administration (intraperitoneal, intratracheal, i.v.) Potent activator of the innate immune responses via TLR4 and little direct toxicity to cells in vitro Reproducible results Cons Variable species responses to LPS Differences in LPS responses between different strains of same species (e.g. BALB/c vs. C57BL/6) LPS-preparations may contain contaminants Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
13 cecum ligation 3 5 x punction with a needle Animal Models for ALI Cecal Ligation and Puncture (CLP) Technique - severity of injury depends on no. of holes and size of the needle Mechanisms effects develop over days less abrupt onset h: leukpenia, pulmonary hypertension h: lung injury (hypoxemia, neutrophilic inflammation, interstitial and alveolar edema) Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
14 Am J Physiol Lung Cell Mol Physiol Sep;295(3):L Animal Models for ALI Cecal Ligation and Puncture (CLP)
15 Animal Models for ALI Cecal Ligation and Puncture (CLP) Pros Single best animal model of sepsis and organ injury Lung injury very similar to ALI/ARDS Cons Major surgery required High mortality Evtl. differences in colonic flora among animals Am J Physiol Lung Cell Mol Physiol Sep;295(3):L
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