1. A Thrombomodulin Mutation that Impairs Active Protein C Generation Is Detrimental in Severe Pneumonia-Derived Gram-Negative Sepsis (Melioidosis)
- Author
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W. Joost Wiersinga, Joris J. T. H. Roelofs, Cornelis van 't Veer, Tom van der Poll, Onno J. de Boer, Liesbeth M. Kager, Hartmut Weiler, Amsterdam institute for Infection and Immunity, Gastroenterology and Hepatology, Infectious diseases, Amsterdam Cardiovascular Sciences, Pathology, and Center of Experimental and Molecular Medicine
- Subjects
Male ,lcsh:Arctic medicine. Tropical medicine ,Burkholderia pseudomallei ,Melioidosis ,lcsh:RC955-962 ,Thrombomodulin ,Immunology ,Inflammation ,Pathogenesis ,Biology ,Pathology and Laboratory Medicine ,Microbiology ,Sepsis ,Mice ,Immune system ,Pneumonia, Bacterial ,Medicine and Health Sciences ,medicine ,Animals ,Point Mutation ,Gram Negative ,Immune Response ,Microbial Pathogens ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,lcsh:RA1-1270 ,Bacteriology ,medicine.disease ,biology.organism_classification ,Survival Analysis ,Bacterial Pathogens ,Mice, Inbred C57BL ,Infectious Diseases ,Burkholderia ,Medical Microbiology ,Host-Pathogen Interactions ,Mutant Proteins ,medicine.symptom ,Protein C ,Research Article ,medicine.drug - Abstract
Background During severe (pneumo)sepsis inflammatory and coagulation pathways become activated as part of the host immune response. Thrombomodulin (TM) is involved in a range of host defense mechanisms during infection and plays a pivotal role in activation of protein C (PC) into active protein C (APC). APC has both anticoagulant and anti-inflammatory properties. In this study we investigated the effects of impaired TM-mediated APC generation during melioidosis, a common form of community-acquired Gram-negative (pneumo)sepsis in South-East Asia caused by Burkholderia (B.) pseudomallei. Methodology/Principal Findings (WT) mice and mice with an impaired capacity to activate protein C due to a point mutation in their Thbd gene (TMpro/pro mice) were intranasally infected with B. pseudomallei and sacrificed after 24, 48 or 72 hours for analyses. Additionally, survival studies were performed. When compared to WT mice, TMpro/pro mice displayed a worse survival upon infection with B. pseudomallei, accompanied by increased coagulation activation, enhanced lung neutrophil influx and bronchoalveolar inflammation at late time points, together with increased hepatocellular injury. The TMpro/pro mutation had limited if any impact on bacterial growth and dissemination. Conclusion/Significance TM-mediated protein C activation contributes to protective immunity after infection with B. pseudomallei. These results add to a better understanding of the regulation of the inflammatory and procoagulant response during severe Gram-negative (pneumo)sepsis., Author Summary Pneumonia and sepsis are conditions in which a procoagulant state is observed, with activation of coagulation and downregulation of anticoagulant pathways, both closely interrelated with inflammation. The protein C (PC) system is an important anticoagulant pathway implicated in the pathogenesis of sepsis. After binding to thrombomodulin (TM), PC is converted into active protein C (APC), mediated via high-affinity binding of thrombin to thrombomodulin (TM) and further augmented via association of the endothelial protein C receptor (EPCR) to the TM-thrombin complex. We studied the role of TM-associated PC-activation during the host response during pneumonia-derived sepsis caused by Burkholderia (B.) pseudomallei, the causative agent of melioidosis, a common form of community-acquired Gram-negative (pneumo)sepsis in South-East Asia and a serious potential bioterrorism threat agent. Mice with an impaired capacity to activate protein C displayed a worse survival upon infection with B. pseudomallei, accompanied by increased coagulation activation, enhanced lung neutrophil influx and bronchoalveolar inflammation at late time points, together with increased hepatocellular injury. These data further expand the knowledge about the role of the protein C system during melioidosis and may be of value in the development of therapeutic strategies against this dangerous pathogen.
- Published
- 2014
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