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2016 ; 38
(5
): 1054-65
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Purinergic Signaling and the Immune Response in Sepsis: A Review
#MMPMID27156007
Ledderose C
; Bao Y
; Kondo Y
; Fakhari M
; Slubowski C
; Zhang J
; Junger WG
Clin Ther
2016[May]; 38
(5
): 1054-65
PMID27156007
show ga
PURPOSE: Sepsis remains an unresolved clinical problem with high in-hospital
mortality. Despite intensive research over decades, no treatments for sepsis have
become available. Here we explore the role of ATP in the pathophysiology of
sepsis. ATP is not only a universal energy carrier but it also acts as an
extracellular signaling molecule that regulates immune function. ATP stimulates a
large family of purinergic receptors found on the cell surface of virtually all
mammalian cells. In severe sepsis and septic shock, ATP is released in large
amounts into the extracellular space where it acts as a "danger" signal. In this
review, we focus on the roles of ATP as a key regulator of immune cell function
and as a disruptive signal that contributes to immune dysfunction in sepsis.
METHODS: We summarized the current understanding of the pathophysiology of
sepsis, with special emphasis on the emerging role of systemic ATP as a
disruptive force that promotes morbidity and mortality in sepsis. FINDINGS: Over
the past two decades, the discovery that regulated ATP release and purinergic
signaling represent a novel regulatory mechanism in immune cell physiology has
opened up new possibilities in the treatment of sepsis. Immune cells respond to
stimulation with the release of cellular ATP, which regulates cell functions in
autocrine and paracrine fashions. In sepsis, large amounts of systemic ATP
produced by tissue damage and inflammation disrupt these regulatory purinergic
signaling mechanisms, leading to immune dysfunction that promotes the
pathophysiologic processes involved in sepsis. IMPLICATIONS: The knowledge of
these ATP-dependent signaling processes is likely to reveal exciting new avenues
in the treatment of the unresolved clinical problem of sepsis.