研究动态
Articles below are published ahead of final publication in an issue. Please cite articles in the following format: authors, (year), title, journal, DOI.

应激诱导的嗜酸性粒细胞活化导致肺切除术后的发病率和死亡率。

Stress-induced eosinophil activation contributes to postoperative morbidity and mortality after lung resection.

发表日期:2024 Aug 21
作者: Zhongcheng Mei, May A Khalil, Yizhan Guo, Dongge Li, Anirban Banerjee, Mojtaba Taheri, Christina M Kratzmeier, Kelly Chen, Christine L Lau, Irina G Luzina, Sergei P Atamas, Sivaveera Kandasamy, Daniel Kreisel, Andrew E Gelman, Elizabeth A Jacobsen, Alexander Sasha Krupnick
来源: Science Translational Medicine

摘要:

胸部手术后比腹部手术后更容易发生呼吸衰竭。尽管这种并发症的病因通常归因于接受胸外科手术的患者存在潜在的肺部疾病,但这种观点通常是没有根据的,因为许多术前肺功能正常的患者即使在最小限度切除肺组织后也经常需要长时间补充氧气。使用肺切除的小鼠模型和接受肺或腹部器官切除的患者的外周血样本,我们证明肺部手术启动促炎症循环,导致剩余肺组织损伤、非心源性肺水肿、缺氧,甚至死亡。具体来说,我们证明切除小鼠肺组织会增加稳态细胞因子白细胞介素7的浓度,从而导致2型先天淋巴细胞的局部和全身激活。这一过程激活了肺内的嗜酸性粒细胞,并以粒细胞-巨噬细胞集落刺激因子依赖性方式促进了骨髓中应激诱导的嗜酸性粒细胞成熟,导致小鼠和人类出现全身性嗜酸性粒细胞增多。肺内嗜酸性粒细胞中诱导型一氧化氮合酶的上调导致组织亚硝基化、肺水肿、缺氧,有时甚至导致死亡。在任何阶段破坏这种激活级联都可以改善小鼠模型肺切除后的有害结果并提高生存率。我们的数据表明,重新利用美国食品和药物管理局批准的嗜酸性粒细胞靶向策略可能会提供一种治疗干预措施,以改善因良性或恶性病因而需要肺切除术的患者的预后。
Respiratory failure occurs more frequently after thoracic surgery than abdominal surgery. Although the etiology for this complication is frequently attributed to underlying lung disease present in patients undergoing thoracic surgery, this notion is often unfounded because many patients with normal preoperative pulmonary function often require prolonged oxygen supplementation even after minimal resection of lung tissue. Using a murine model of pulmonary resection and peripheral blood samples from patients undergoing resection of the lung or abdominal organs, we demonstrated that lung surgery initiates a proinflammatory loop that results in damage to the remaining lung tissue, noncardiogenic pulmonary edema, hypoxia, and even death. Specifically, we demonstrated that resection of murine lung tissue increased concentrations of the homeostatic cytokine interleukin-7, which led to local and systemic activation of type 2 innate lymphoid cells. This process activated lung-resident eosinophils and facilitated stress-induced eosinophil maturation in the bone marrow in a granulocyte-macrophage colony-stimulating factor-dependent manner, resulting in systemic eosinophilia in both mice and humans. Up-regulation of inducible nitric oxide synthase in lung-resident eosinophils led to tissue nitrosylation, pulmonary edema, hypoxia, and, at times, death. Disrupting this activation cascade at any stage ameliorated deleterious outcomes and improved survival after lung resection in the mouse model. Our data suggest that repurposing US Food and Drug Administration-approved eosinophil-targeting strategies may potentially offer a therapeutic intervention to improve outcomes for patients who require lung resection for benign or malignant etiology.