Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies
The US outbreak of B.anthracis infection in 2001 and subsequent cases in the US and Europe demonstrate that anthrax is a continuing risk for the developed world. While several bacterial components contribute to the pathogenesis of B. anthracis, production of lethal toxin (LT) is strongly associated...
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Language: | English |
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MDPI AG
2015-12-01
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Series: | Toxins |
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Online Access: | http://www.mdpi.com/2072-6651/7/12/4891 |
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author | Dante A. Suffredini Hanish Sampath-Kumar Yan Li Lernik Ohanjanian Kenneth E. Remy Xizhong Cui Peter Q. Eichacker |
author_facet | Dante A. Suffredini Hanish Sampath-Kumar Yan Li Lernik Ohanjanian Kenneth E. Remy Xizhong Cui Peter Q. Eichacker |
author_sort | Dante A. Suffredini |
collection | DOAJ |
description | The US outbreak of B.anthracis infection in 2001 and subsequent cases in the US and Europe demonstrate that anthrax is a continuing risk for the developed world. While several bacterial components contribute to the pathogenesis of B. anthracis, production of lethal toxin (LT) is strongly associated with the development of hypotension and lethality. However, the mechanisms underlying the cardiovascular instability LT produces are unclear. Some evidence suggests that LT causes shock by impairing the peripheral vasculature, effects consistent with the substantial extravasation of fluid in patients dying with B. anthracis. Other data suggests that LT directly depresses myocardial function. However a clinical correlate for this latter possibility is less evident since functional studies and post-mortem examination in patients demonstrate absent or minimal cardiac changes. The purposes of this review were to first present clinical studies of cardiac functional and histologic pathology with B. anthracis infection and to then examine in vivo, in vitro, and ex vivo preclinical studies of LT’s myocardial effects. Together, these data suggest that it is unclear whether that LT directly depresses cardiac function. This question is important for the clinical management and development of new therapies for anthrax and efforts should continue to be made to answer it. |
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format | Article |
id | doaj.art-4f98dfcdfc2f4e67849012b478e24609 |
institution | Directory Open Access Journal |
issn | 2072-6651 |
language | English |
last_indexed | 2024-04-12T19:30:25Z |
publishDate | 2015-12-01 |
publisher | MDPI AG |
record_format | Article |
series | Toxins |
spelling | doaj.art-4f98dfcdfc2f4e67849012b478e246092022-12-22T03:19:21ZengMDPI AGToxins2072-66512015-12-017125417543410.3390/toxins7124891toxins7124891Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical StudiesDante A. Suffredini0Hanish Sampath-Kumar1Yan Li2Lernik Ohanjanian3Kenneth E. Remy4Xizhong Cui5Peter Q. Eichacker6Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USACritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USACritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USACritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USADivision of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USACritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USACritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USAThe US outbreak of B.anthracis infection in 2001 and subsequent cases in the US and Europe demonstrate that anthrax is a continuing risk for the developed world. While several bacterial components contribute to the pathogenesis of B. anthracis, production of lethal toxin (LT) is strongly associated with the development of hypotension and lethality. However, the mechanisms underlying the cardiovascular instability LT produces are unclear. Some evidence suggests that LT causes shock by impairing the peripheral vasculature, effects consistent with the substantial extravasation of fluid in patients dying with B. anthracis. Other data suggests that LT directly depresses myocardial function. However a clinical correlate for this latter possibility is less evident since functional studies and post-mortem examination in patients demonstrate absent or minimal cardiac changes. The purposes of this review were to first present clinical studies of cardiac functional and histologic pathology with B. anthracis infection and to then examine in vivo, in vitro, and ex vivo preclinical studies of LT’s myocardial effects. Together, these data suggest that it is unclear whether that LT directly depresses cardiac function. This question is important for the clinical management and development of new therapies for anthrax and efforts should continue to be made to answer it.http://www.mdpi.com/2072-6651/7/12/4891Bacillus anthracisanthraxlethal and edema toxinscardiovascular dysfunctionshocktreatment |
spellingShingle | Dante A. Suffredini Hanish Sampath-Kumar Yan Li Lernik Ohanjanian Kenneth E. Remy Xizhong Cui Peter Q. Eichacker Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies Toxins Bacillus anthracis anthrax lethal and edema toxins cardiovascular dysfunction shock treatment |
title | Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies |
title_full | Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies |
title_fullStr | Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies |
title_full_unstemmed | Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies |
title_short | Does Bacillus anthracis Lethal Toxin Directly Depress Myocardial Function? A Review of Clinical Cases and Preclinical Studies |
title_sort | does bacillus anthracis lethal toxin directly depress myocardial function a review of clinical cases and preclinical studies |
topic | Bacillus anthracis anthrax lethal and edema toxins cardiovascular dysfunction shock treatment |
url | http://www.mdpi.com/2072-6651/7/12/4891 |
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