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2017 ; 12
(6
): e0179468
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Survival, bacterial clearance and thrombocytopenia are improved in polymicrobial
sepsis by targeting nuclear transport shuttles
#MMPMID28628637
Veach RA
; Liu Y
; Zienkiewicz J
; Wylezinski LS
; Boyd KL
; Wynn JL
; Hawiger J
PLoS One
2017[]; 12
(6
): e0179468
PMID28628637
show ga
The rising tide of sepsis, a leading cause of death in the US and globally, is
not adequately controlled by current antimicrobial therapies and supportive
measures, thereby requiring new adjunctive treatments. Severe microvascular
injury and multiple organ failure in sepsis are attributed to a "genomic storm"
resulting from changes in microbial and host genomes encoding virulence factors
and endogenous inflammatory mediators, respectively. This storm is mediated by
stress-responsive transcription factors that are ferried to the nucleus by
nuclear transport shuttles importins/karyopherins. We studied the impact of
simultaneously targeting two of these shuttles, importin alpha 5 (Imp ?5) and
importin beta 1 (Imp ?1), with a cell-penetrating Nuclear Transport Modifier
(NTM) in a mouse model of polymicrobial sepsis. NTM reduced nuclear import of
stress-responsive transcription factors nuclear factor kappa B, signal transducer
and activator of transcription 1 alpha, and activator protein 1 in liver, which
was also protected from sepsis-associated metabolic changes. Strikingly, NTM
without antimicrobial therapy improved bacterial clearance in blood, spleen, and
lungs, wherein a 700-fold reduction in bacterial burden was achieved while
production of proinflammatory cytokines and chemokines in blood plasma was
suppressed. Furthermore, NTM significantly improved thrombocytopenia, a prominent
sign of microvascular injury in sepsis, inhibited neutrophil infiltration in the
liver, decreased L-selectin, and normalized plasma levels of E-selectin and
P-selectin, indicating reduced microvascular injury. Importantly, NTM combined
with antimicrobial therapy extended the median time to death from 42 to 83 hours
and increased survival from 30% to 55% (p = 0.022) as compared to antimicrobial
therapy alone. This study documents the fundamental role of nuclear signaling
mediated by Imp ?5 and Imp ?1 in the mechanism of polymicrobial sepsis and
highlights the potential for targeting nuclear transport as an adjunctive therapy
in sepsis management.