Exposure to Bacterial DNA Before Hemorrhagic Shock Strongly Aggravates Systemic Inflammation and Gut Barrier Loss via an IFN-γ-Dependent Route

Misha Luyer

Wim Buurman

M'hamed Hadfoune

T Wolfs

From the Departments of *Surgery and †Medical Microbiology, Nutrition and Toxicology Research Institute Maastricht, University of Maastricht and University Hospital Maastricht, Maastricht, the Netherlands; and ‡Laboratory for Experimental Internal Medicine, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.

Abstract

Objective:

To investigate the role of bacterial DNA in development of an excessive inflammatory response and loss of gut barrier loss following systemic hypotension.

Summary Background Data:

Bacterial infection may contribute to development of inflammatory complications following major surgery; however, the pathogenesis is not clear. A common denominator of bacterial infection is bacterial DNA characterized by unmethylated CpG motifs. Recently, it has been shown that bacterial DNA or synthetic oligodeoxynucleotides containing unmethylated CpG motifs (CpG-ODN) are immunostimulatory leading to release of inflammatory mediators.

Methods:

Rats were exposed to CpG-ODN prior to a nonlethal hemorrhagic shock. The role of interferon-gamma (IFN-γ) was investigated by administration of anti IFN-γ antibodies.

Results:

Exposure to CpG-ODN prior to hemorrhagic shock significantly augmented shock-induced release of IFN-γ, tumor necrosis factor-alpha (TNF-α) (P < 0.05), interleukin (IL)-6 (P < 0.05), and nitrite levels (P < 0.05), while there was a defective IL-10 response (P < 0.05). Simultaneously, expression of Toll-like receptor (TLR) 4 in the liver was markedly enhanced. Furthermore, intestinal permeability for HRP significantly increased and bacterial translocation was enhanced in hemorrhagic shock rats pretreated with CpG-ODN. Interestingly, inhibition of IFN-γ in CpG-treated animals reduced TNF-α (P < 0.05), IL-6 (P < 0.05), nitrite (P < 0.05), and intestinal permeability following hemorrhagic shock (P < 0.05) and down-regulated expression of TLR4.

Conclusion:

Exposure to bacterial DNA strongly aggravates the inflammatory response, disrupts the intestinal barrier, and up-regulates TLR4 expression in the liver following hemorrhagic shock. These effects are mediated via an IFN-γ-dependent route. In the clinical setting, bacterial DNA may be important in development of inflammatory complications in surgical patients with bacterial infection.

Abstract

Footnotes

Supported by AGIKO-stipendium 920-03-271 (to M.D.L.) and a clinical fellowship grant (NWO 907-00-033, to C.H.D.) from the Netherlands Organisation for Health Research and Development.

Reprints: Misha D. Luyer, MD, PhD, Department of Surgery, University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands. E-mail: ln.saaminu.ha@reyuL.M.

Footnotes

REFERENCES

References

1. Cohen JThe immunopathogenesis of sepsis. Nature. 2002;420:885–891. [[PubMed]
2. Fan J, Kapus A, Marsden PA, et alRegulation of Toll-like receptor 4 expression in the lung following hemorrhagic shock and lipopolysaccharide. J Immunol. 2002;168:5252–5259. [[PubMed]
3. Turnbull RG, Talbot JA, Hamilton SMHemodynamic changes and gut barrier function in sequential hemorrhagic and endotoxic shock. J Trauma. 1995;38:705–712. [[PubMed]
4. Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA. 1995;274:968–974. [[PubMed]
5. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132; quiz 133–134; discussion 96. [[PubMed]
6. Krieg AM, Yi AK, Matson S, et alCpG motifs in bacterial DNA trigger direct B-cell activation. Nature. 1995;374:546–549. [[PubMed]
7. Hacker G, Redecke V, Hacker HActivation of the immune system by bacterial CpG-DNA. Immunology. 2002;105:245–251.
8. Hemmi H, Takeuchi O, Kawai T, et alA Toll-like receptor recognizes bacterial DNA. Nature. 2000;408:740–745. [[PubMed]
9. Krieg AMCpG motifs in bacterial DNA and their immune effects. Annu Rev Immunol. 2002;20:709–760. [[PubMed]
10. Rhee EG, Mendez S, Shah JA, et alVaccination with heat-killed leishmania antigen or recombinant leishmanial protein and CpG oligodeoxynucleotides induces long-term memory CD4+ and CD8+ T cell responses and protection against leishmania major infection. J Exp Med. 2002;195:1565–1573.
11. Wang XS, Sheng Z, Ruan YB, et alCpG oligodeoxynucleotides inhibit tumor growth and reverse the immunosuppression caused by the therapy with 5-fluorouracil in murine hepatoma. World J Gastroenterol. 2005;11:1220–1224.
12. Sparwasser T, Miethke T, Lipford G, et alBacterial DNA causes septic shock. Nature. 1997;386:336–337. [[PubMed]
13. Clark E, Hoare C, Tanianis-Hughes J, et alInterferon gamma induces translocation of commensal Escherichia coli across gut epithelial cells via a lipid raft-mediated process. Gastroenterology. 2005;128:1258–1267. [[PubMed]
14. Bruewer M, Luegering A, Kucharzik T, et alProinflammatory cytokines disrupt epithelial barrier function by apoptosis-independent mechanisms. J Immunol. 2003;171:6164–6172. [[PubMed]
15. Ferrier L, Mazelin L, Cenac N, et alStress-induced disruption of colonic epithelial barrier: role of interferon-gamma and myosin light chain kinase in mice. Gastroenterology. 2003;125:795–804. [[PubMed]
16. Carpentier AF, Xie J, Mokhtari K, et alSuccessful treatment of intracranial gliomas in rat by oligodeoxynucleotides containing CpG motifs. Clin Cancer Res. 2000;6:2469–2473. [[PubMed]
17. van der Meide PH, Dubbeld M, Vijverberg K, et alThe purification and characterization of rat gamma interferon by use of two monoclonal antibodies. J Gen Virol. 1986;67:1059–1071. [[PubMed]
18. van der Meide PH, Borman AH, Beljaars HG, et alIsolation and characterization of monoclonal antibodies directed to rat interferon-gamma. Lymphokine Res. 1989;8:439–449. [[PubMed]
19. Engelberts I, Moller A, Schoen GJ, et alEvaluation of measurement of human TNF in plasma by ELISA. Lymphokine Cytokine Res. 1991;10:69–76. [[PubMed]
20. Luyer MD, Jacobs J, Vreugdenhil AC, et alEnteral administration of high-fat nutrition before and directly after hemorrhagic shock reduces endotoxemia and bacterial translocation. Ann Surg. 2004;239:257–264.
21. Luyer MD, Buurman WA, Hadfoune M, et alPretreatment with high-fat enteral nutrition reduces endotoxin and TNF-α and preserves gut barrier function early after hemorrhagic shock. Shock. 2004;21:65–71. [[PubMed]
22. Jiang J, Bahrami S, Leichtfried G, et alKinetics of endotoxin and tumor necrosis factor appearance in portal and systemic circulation after hemorrhagic shock in rats. Ann Surg. 1995;221:100–106.
23. Crabtree TD, Jin L, Raymond DP, et alPreexposure of murine macrophages to CpG oligonucleotide results in a biphasic tumor necrosis factor alpha response to subsequent lipopolysaccharide challenge. Infect Immun. 2001;69:2123–2129.
24. Bahrami S, Yao YM, Leichtfried G, et alMonoclonal antibody to endotoxin attenuates hemorrhage-induced lung injury and mortality in rats. Crit Care Med. 1997;25:1030–1036. [[PubMed]
25. Wolfs TG, Buurman WA, van Schadewijk A, et alIn vivo expression of Toll-like receptor 2 and 4 by renal epithelial cells: IFN-gamma and TNF-alpha mediated up-regulation during inflammation. J Immunol. 2002;168:1286–1293. [[PubMed]
26. Beutler BInferences, questions and possibilities in Toll-like receptor signalling. Nature. 2004;430:257–263. [[PubMed]
27. Latz E, Schoenemeyer A, Visintin A, et alTLR9 signals after translocating from the ER to CpG DNA in the lysosome. Nat Immunol. 2004;5:190–198. [[PubMed]
28. Li Y, Ishii K, Hisaeda H, et alIL-18 gene therapy develops Th1-type immune responses in Leishmania major-infected BALB/c mice: is the effect mediated by the CpG signaling TLR9? Gene Ther. 2004. [[PubMed]
29. Meldrum DR, Ayala A, Perrin MM, et alDiltiazem restores IL-2, IL-3, IL-6, and IFN-gamma synthesis and decreases host susceptibility to sepsis following hemorrhage. J Surg Res. 1991;51:158–164. [[PubMed]
30. Ertel W, Morrison MH, Ayala A, et alInterferon-gamma attenuates hemorrhage-induced suppression of macrophage and splenocyte functions and decreases susceptibility to sepsis. Surgery. 1992;111:177–187. [[PubMed]
31. Han X, Fink MP, Delude RLProinflammatory cytokines cause NO*-dependent and -independent changes in expression and localization of tight junction proteins in intestinal epithelial cells. Shock. 2003;19:229–237. [[PubMed]
32. Chakravortty D, Kumar KSModulation of barrier function of small intestinal epithelial cells by lamina propria fibroblasts in response to lipopolysaccharide: possible role in TNFalpha in inducing barrier dysfunction. Microbiol Immunol. 1999;43:527–533. [[PubMed]
33. Fan J, Marshall JC, Jimenez M, et alHemorrhagic shock primes for increased expression of cytokine-induced neutrophil chemoattractant in the lung: role in pulmonary inflammation following lipopolysaccharide. J Immunol. 1998;161:440–447. [[PubMed]
34. Krieg AMCpG DNA: trigger of sepsis, mediator of protection, or both? Scand J Infect Dis. 2003;35:653–659. [[PubMed]
35. Slotta JE, Scheuer C, Menger MD, et alImmunostimulatory CpG-oligodeoxynucleotides (CpG-ODN) induce early hepatic injury, but provide a late window for protection against endotoxin-mediated liver damage. J Hepatol. 2006;44:576–855. [[PubMed]
36. Luyer MD, Buurman WA, Hadfoune M, et alStrain-specific effects of probiotics on gut barrier integrity following hemorrhagic shock. Infect Immun. 2005;73:3686–3692.
37. Gao JJ, Xue Q, Papasian CJ, et alBacterial DNA and lipopolysaccharide induce synergistic production of TNF-alpha through a post-transcriptional mechanism. J Immunol. 2001;166:6855–6860. [[PubMed]
38. Jin L, Raymond DP, Crabtree TD, et alPreexposure of murine macrophages to CpG-containing oligonucleotides results in nuclear factor kappaB p50 homodimer-associated hyporesponsiveness. Surgery. 2002;132:245–251. [[PubMed]
39. Dalpke AH, Opper S, Zimmermann S, et alSuppressors of cytokine signaling (SOCS)-1 and SOCS-3 are induced by CpG-DNA and modulate cytokine responses in APCs. J Immunol. 2001;166:7082–7089. [[PubMed]
40. Rachmilewitz D, Katakura K, Karmeli F, et alToll-like receptor 9 signaling mediates the anti-inflammatory effects of probiotics in murine experimental colitis. Gastroenterology. 2004;126:520–528. [[PubMed]
41. Bosisio D, Polentarutti N, Sironi M, et alStimulation of toll-like receptor 4 expression in human mononuclear phagocytes by interferon-gamma: a molecular basis for priming and synergism with bacterial lipopolysaccharide. Blood. 2002;99:3427–3431. [[PubMed]
42. Suzuki M, Hisamatsu T, Podolsky DKGamma interferon augments the intracellular pathway for lipopolysaccharide (LPS) recognition in human intestinal epithelial cells through coordinated up-regulation of LPS uptake and expression of the intracellular Toll-like receptor 4-MD-2 complex. Infect Immun. 2003;71:3503–3511.
43. Donnelly RP, Freeman SL, Hayes MPInhibition of IL-10 expression by IFN-gamma up-regulates transcription of TNF-alpha in human monocytes. J Immunol. 1995;155:1420–1427. [[PubMed]
44. Moore KW, de Waal Malefyt R, Coffman RL, et alInterleukin-10 and the interleukin-10 receptor. Annu Rev Immunol. 2001;19:683–765. [[PubMed]