While through efforts like the Surviving Sepsis Campaign and others, supportive therapies have improved survival of the critically ill septic patient, nonetheless, a substantial number still develop this morbid syndrome and die. Unfortunately, there presently exists no true medicinal/ molecular therapeutic agent that can be applied to treat sepsis or diagnosis/ prognosis (beyond Pro-calcitonin) the trajectory of the critically ill patient. Thus, the need remains to further clarify the complex pathobiology of the septic process. In this respect, our laboratory has had sustained interest in understanding how sepsis, as produced by cecal ligation and puncture (CLP), differentially effects the immune response observed in divergent tissue sites. Importantly, we have observed that CLP induces marked changes in the functional responsiveness of monocyte/ macrophages, as well as in key regulatory T-cell populations, i.e., invariant natural killer T (iNKT)-cells and CD4+CD25+ native T- regulatory (T-reg)-cells (within the spleen, liver and intestine), which we have found to either have the ability to induce marked immune suppression or have an effect on the animal's capacity to ward off septic morbidity/ mortality. Most significantly, we have recently shown that a novel family of co-inhibitory molecules/ receptors as well as their cell-associated ligands, belonging to the Programmed Cell Death Receptor family, appear to be playing a unique and very proximal role in both immune cell/ organ morbidity and mortality seen not only in experimental septic mice, but their increased expression is associated with poor outcome in critically ill patients. With this in mind, we propose the following hypothesis that classic adaptive/ lymphoid co- inhibitory receptors, such as programmed cell death receptor (PD)-1 and B &T lymphocyte attenuator (BTLA) and/or their ligands (PD-L1 or PD-L2 for PD-1 &HVEM for BTLA), contribute to the development of septic morbidity via their novel myeloid cell and/or select regulatory lymphoid subset interactions with other immune/ non-immune (endothelial and/or epithelial) cells present in a given tissue.
In AIM 1 : We will establish the extent to, which macrophages, neutrophils and regulatory lymphoid cell's expression of PD-1 and/or BTLA contributes to the development of immune cell dysfunction in sepsis.
AIM 2 : We will determine how and what non-immune cells express the ligands for PD-1 or BTLA, i.e., PD-L1, PD-L2 and/or HVEM, respectively, following the onset of sepsis;how this contributes to the development of organ dysfunction and/or subsequent survival of sepsis;and what the significance of this expression is to liver or intestinal endothelial and/or epithelial cell dysfunction seen in sepsis. We firmly believe the results of these studies will provide information that not only allows us to better understand the pathobiology of sepsis both experimentally in mice and critically ill patients, but also point to agents that can be used to possibly diagnose, prognosticate and/or therapeutically inhibit the progression of sepsis.

Public Health Relevance

Despite the use of specific antibiotics, aggressive operative intervention, nutritional support and recently, antibodies against endotoxin, activated protein C and anti-cytokine therapies in septic patients, multiple organ failure continues to be a major cause of morbidity/ mortality in the surgical intensive care unit. Thus, it is essential to determie in depth the mechanism(s) underlying the patho-physiology of sepsis so that more appropriate therapeutic interventions can be designed. We propose to determine the impact of a novel family of cell-associated co-inhibitor molecules/ ligands, on the development of immune/ organ dysfunction/injury and death resulting from sepsis. The contribution of these molecules to the development of both septic morbidity and mortality will be examined in the setting of experimental sepsis using genetically altered mice as well as drug interventions directed at genes or mediators thought to be involved in the regulation of these cells. We believe that these studies will provide new and useful mechanistic information concerning the patho-biology of sepsis.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Research Project (R01)
Project #
2R01GM046354-19A1
Application #
8629191
Study Section
Surgery, Anesthesiology and Trauma Study Section (SAT)
Program Officer
Dunsmore, Sarah
Project Start
1991-09-30
Project End
2017-11-30
Budget Start
2014-01-01
Budget End
2014-11-30
Support Year
19
Fiscal Year
2014
Total Cost
$341,850
Indirect Cost
$126,850
Name
Rhode Island Hospital
Department
Type
DUNS #
075710996
City
Providence
State
RI
Country
United States
Zip Code
02903
Hutchins, Noelle A; Unsinger, Jacqueline; Hotchkiss, Richard S et al. (2014) The new normal: immunomodulatory agents against sepsis immune suppression. Trends Mol Med 20:224-33
Ayala, Alfred; Elphick, Gwendolyn F; Kim, Ye Sul et al. (2014) Sepsis-induced potentiation of peritoneal macrophage migration is mitigated by programmed cell death receptor-1 gene deficiency. J Innate Immun 6:325-38
Huang, Xin; Chen, Yaping; Chung, Chun-Shiang et al. (2014) Identification of B7-H1 as a novel mediator of the innate immune/proinflammatory response as well as a possible myeloid cell prognostic biomarker in sepsis. J Immunol 192:1091-9
Hu, Caroline K; Venet, Fabienne; Heffernan, David S et al. (2009) The role of hepatic invariant NKT cells in systemic/local inflammation and mortality during polymicrobial septic shock. J Immunol 182:2467-75
Venet, Fabienne; Chung, Chun-Shiang; Kherouf, Hakim et al. (2009) Increased circulating regulatory T cells (CD4(+)CD25 (+)CD127 (-)) contribute to lymphocyte anergy in septic shock patients. Intensive Care Med 35:678-86
Elphick, Gwendolyn F; Sarangi, Pranita P; Hyun, Young-Min et al. (2009) Recombinant human activated protein C inhibits integrin-mediated neutrophil migration. Blood 113:4078-85
Ward, Nicholas S; Casserly, Brian; Ayala, Alfred (2008) The compensatory anti-inflammatory response syndrome (CARS) in critically ill patients. Clin Chest Med 29:617-25, viii
Venet, Fabienne; Chung, Chun-Shiang; Monneret, Guillaume et al. (2008) Regulatory T cell populations in sepsis and trauma. J Leukoc Biol 83:523-35
Wisnoski, Nicholas; Chung, Chun-Shiang; Chen, Yaping et al. (2007) The contribution of CD4+ CD25+ T-regulatory-cells to immune suppression in sepsis. Shock 27:251-7
Chung, Chun-Shiang; Chen, Yaping; Grutkoski, Patricia S et al. (2007) SOCS-1 is a central mediator of steroid-increased thymocyte apoptosis and decreased survival following sepsis. Apoptosis 12:1143-53

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