Brain tight junction protein expression in sepsis in an autopsy series
Abstract Background Neuroinflammation often develops in sepsis along with increasing permeability of the blood-brain barrier (BBB), which leads to septic encephalopathy. The barrier is formed by tight junction structures between the cerebral endothelial cells. We investigated the expression of tight...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-020-03101-3 |
| _version_ | 1819043662664826880 |
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| author | Kristo Erikson Hannu Tuominen Merja Vakkala Janne Henrik Liisanantti Tuomo Karttunen Hannu Syrjälä Tero Ilmari Ala-Kokko |
| author_facet | Kristo Erikson Hannu Tuominen Merja Vakkala Janne Henrik Liisanantti Tuomo Karttunen Hannu Syrjälä Tero Ilmari Ala-Kokko |
| author_sort | Kristo Erikson |
| collection | DOAJ |
| description | Abstract Background Neuroinflammation often develops in sepsis along with increasing permeability of the blood-brain barrier (BBB), which leads to septic encephalopathy. The barrier is formed by tight junction structures between the cerebral endothelial cells. We investigated the expression of tight junction proteins related to endothelial permeability in brain autopsy specimens in critically ill patients deceased with sepsis and analyzed the relationship of BBB damage with measures of systemic inflammation and systemic organ dysfunction. Methods The case series included all (385) adult patients deceased due to sepsis in the years 2007–2015 with available brain specimens taken at autopsy. Specimens were categorized according to anatomical location (cerebrum, cerebellum). The immunohistochemical stainings were performed for occludin, ZO-1, and claudin. Patients were categorized as having BBB damage if there was no expression of occludin in the endothelium of cerebral microvessels. Results Brain tissue samples were available in 47 autopsies, of which 38% (18/47) had no expression of occludin in the endothelium of cerebral microvessels, 34% (16/47) developed multiple organ failure before death, and 74.5% (35/47) had septic shock. The deceased with BBB damage had higher maximum SOFA scores (16 vs. 14, p = 0.04) and more often had procalcitonin levels above 10 μg/L (56% vs. 28%, p = 0.045) during their ICU stay. BBB damage in the cerebellum was more common in cases with C-reactive protein (CRP) above 100 mg/L as compared with CRP less than 100 (69% vs. 25%, p = 0.025). Conclusions In fatal sepsis, damaged BBB defined as a loss of cerebral endothelial expression of occludin is related with severe organ dysfunction and systemic inflammation. |
| first_indexed | 2024-12-21T10:00:21Z |
| format | Article |
| id | doaj.art-d1bf4421da8547d3b9449ce9baa287a2 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T10:00:21Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-d1bf4421da8547d3b9449ce9baa287a22022-12-21T19:07:57ZengBMCCritical Care1364-85352020-06-012411710.1186/s13054-020-03101-3Brain tight junction protein expression in sepsis in an autopsy seriesKristo Erikson0Hannu Tuominen1Merja Vakkala2Janne Henrik Liisanantti3Tuomo Karttunen4Hannu Syrjälä5Tero Ilmari Ala-Kokko6Division of Intensive Care Medicine, Department of Anesthesiology, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, University of OuluDepartment of Anesthesiology, Intensive Care Center, North Estonia Medical CentreDivision of Intensive Care Medicine, Department of Anesthesiology, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, University of OuluDivision of Intensive Care Medicine, Department of Anesthesiology, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, University of OuluDepartment of Anesthesiology, Intensive Care Center, North Estonia Medical CentreDepartment of Pathology and Department of Infection Control, Oulu University Hospital, Medical Research Center Oulu, University of OuluDivision of Intensive Care Medicine, Department of Anesthesiology, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu, University of OuluAbstract Background Neuroinflammation often develops in sepsis along with increasing permeability of the blood-brain barrier (BBB), which leads to septic encephalopathy. The barrier is formed by tight junction structures between the cerebral endothelial cells. We investigated the expression of tight junction proteins related to endothelial permeability in brain autopsy specimens in critically ill patients deceased with sepsis and analyzed the relationship of BBB damage with measures of systemic inflammation and systemic organ dysfunction. Methods The case series included all (385) adult patients deceased due to sepsis in the years 2007–2015 with available brain specimens taken at autopsy. Specimens were categorized according to anatomical location (cerebrum, cerebellum). The immunohistochemical stainings were performed for occludin, ZO-1, and claudin. Patients were categorized as having BBB damage if there was no expression of occludin in the endothelium of cerebral microvessels. Results Brain tissue samples were available in 47 autopsies, of which 38% (18/47) had no expression of occludin in the endothelium of cerebral microvessels, 34% (16/47) developed multiple organ failure before death, and 74.5% (35/47) had septic shock. The deceased with BBB damage had higher maximum SOFA scores (16 vs. 14, p = 0.04) and more often had procalcitonin levels above 10 μg/L (56% vs. 28%, p = 0.045) during their ICU stay. BBB damage in the cerebellum was more common in cases with C-reactive protein (CRP) above 100 mg/L as compared with CRP less than 100 (69% vs. 25%, p = 0.025). Conclusions In fatal sepsis, damaged BBB defined as a loss of cerebral endothelial expression of occludin is related with severe organ dysfunction and systemic inflammation.http://link.springer.com/article/10.1186/s13054-020-03101-3SepsisTight junction protein expressionBBB damage |
| spellingShingle | Kristo Erikson Hannu Tuominen Merja Vakkala Janne Henrik Liisanantti Tuomo Karttunen Hannu Syrjälä Tero Ilmari Ala-Kokko Brain tight junction protein expression in sepsis in an autopsy series Critical Care Sepsis Tight junction protein expression BBB damage |
| title | Brain tight junction protein expression in sepsis in an autopsy series |
| title_full | Brain tight junction protein expression in sepsis in an autopsy series |
| title_fullStr | Brain tight junction protein expression in sepsis in an autopsy series |
| title_full_unstemmed | Brain tight junction protein expression in sepsis in an autopsy series |
| title_short | Brain tight junction protein expression in sepsis in an autopsy series |
| title_sort | brain tight junction protein expression in sepsis in an autopsy series |
| topic | Sepsis Tight junction protein expression BBB damage |
| url | http://link.springer.com/article/10.1186/s13054-020-03101-3 |
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