PubMed Health⌕ Search

Biomedical subjects

David G Greenhalgh

Publications and source records attributed to David G Greenhalgh.

At least 19 recordsLinked to original sources

CD14-dependent modulation of NF-kappaB alternative splicing in the lung after burn injury.

Nuclear factor kappa-B (NF-kappaB), a key downstream player of the LPS signaling pathway, has been shown to undergo alternative splicing in in vitro studies. In this study, we examined the effect of injury and the role of CD14 on NF-kappaB alternative splicing using a murine burn model. CD14 knockout and respective wild-type mice were sacrificed after 18% total body surface area burn. RT-PCR and subsequent sequencing analysis revealed that injury induced multiple novel splicing variants of relA, relB, and NF-kappaB2 in the lungs of CD14 knockout but not wild-type mice. These novel variants resulted either from exon skipping, alternative usage of splicing signals, or intron retention. All but one variant resulted in a frameshift leading to premature termination of translation. These splicing variants encoded for proteins that lacked the domains essential for NF-kappaB transcription factor functions. Two NF-kappaB2 variants acquired only minor changes in their C-terminus that might affect their post-translational cleavage into active isoforms. These results suggest that alternative splicing may be one of the mechanisms by which NF-kappaB activity in the lungs can be regulated after injury. Furthermore, the CD14-mediated LPS signaling pathway may play a role in the regulation of NF-kappaB alternative splicing in the lungs after injury.

Alternative Splicing↗

Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation.

OBJECTIVE: Albuterol, due to its bronchodilatory and anti-inflammatory effects, is given via continuous nebulization in children with severe asthma. Combined burn and smoke inhalation injury frequently results in acute lung injury due to a combination of airway obstruction and inflammation. We hypothesized that albuterol administered via continuous nebulization would mitigate acute lung injury after smoke inhalation injury and burn. DESIGN: Randomized prospective animal model. SUBJECTS: Twenty adult female sheep (mean weight, 33.1+/-0.9 kg). INTERVENTIONS: Adult ewes were subjected to a 40% body surface area third-degree flame burn and smoke inhalation injury after tracheostomy. Sheep were allocated to a) sham group, b) saline continuous nebulization group, c) 20 mg of albuterol continuous nebulization group, or d) 40 mg of albuterol continuous nebulization group (n=5 animals per group). All groups received intravenous lactated Ringer's solution at 4 mL.kg-1.%burn(-1).24 hrs-1 for resuscitation and were equally mechanically ventilated throughout the 48-hr study period. Pulmonary and cardiac function, lung lymph flow, bronchial obstruction score, and wet/dry lung weights were recorded. RESULTS: Compared with saline and control groups, the albuterol groups had lower pause and peak inspiratory pressures, decreased pulmonary transvascular fluid flux, a significantly higher Pao2/Fio2 ratio, and decreased shunt fraction at 48 hrs postinjury. The wet-to-dry lung weight ratio and bronchial obstruction scores were lower for sheep receiving albuterol. CONCLUSIONS: Continuous nebulization of albuterol improves pulmonary function via improved airway clearance and decreased fluid flux in a combined burn/smoke inhalation injury model.

Administration, Inhalation↗

Effect of blood transfusion on outcome after major burn injury: a multicenter study.

OBJECTIVE: To delineate blood transfusion practices and outcomes in patients with major burn injury. CONTEXT: Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. DESIGN: Multicenter retrospective cohort analysis. SETTING: Regional burn centers throughout the United States and Canada. PATIENT POPULATION: Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area. OUTCOMES MEASURED: Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use. RESULTS: A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001). CONCLUSIONS: The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Adult↗

Norepinephrine modulates the inflammatory and proliferative phases of wound healing.

BACKGROUND: Injury results in the massive release of norepinephrine (NE) into the peripheral circulation. Recent investigations have demonstrated functional adrenoreceptors on the cellular mediators of cutaneous wound healing and NE-induced phenotypic alterations in immune cells have been demonstrated in vitro. Despite this, there is little description of how NE might alter the phases of wound healing in vivo. The purpose of this study was to compare cutaneous wound healing in norepinephrine-intact and norepinephrine-depleted mice. METHODS: Norepinephrine-depleted (NED) mice were generated by chemical axotomy with 6-hydroxydopamine and compared with norepinephrine-intact (NEI) animals (n = 6-12 per group, per time point). Using an excisional wound model, neutrophil recruitment was measured by myeloperoxidase assay. Macrophage recruitment and angiogenesis were measured by immunohistochemistry and re-epithelialization was determined histologically. The development of incisional wound disruption strength was determined over time. Finally, macrophage scavenger function was assessed by an in vitro latex bead phagocytosis assay. RESULTS: Wounds from NEI mice demonstrated greater neutrophil infiltration than NED wounds (24, 72 hours; p < 0.05). Wound macrophage recruitment was initially higher in NEI animals (24 hours, p < 0.05), but was eventually surpassed by that of NED animals (120 hours, p < 0.05). Angiogenesis was decreased while re-epithelialization was accelerated in NEI animals (p < 0.05). Wound disruption strength and macrophage scavenger function were unaltered between NED and NEI mice. CONCLUSIONS: Norepinephrine modulates the inflammatory and proliferative phases of wound healing in a temporally defined, cell-specific manner. By increasing recruitment of innate immune cells and expediting wound closure, norepinephrine appears to play a protective role in defense against infection.

Animals↗

CD14-dependent modulation of transcriptional activities of endogenous retroviruses in the lung after injury.

Lipopolysaccharide (LPS) plays a central role in the pathogenesis of distant organs after burn. Recent studies demonstrated the regulation of mouse endogenous retroviruses (MuERVs) in several organs after burn. In this study, the role of CD14, a LPS receptor, in burn-mediated regulation of MuERV expression in the lung was investigated. CD14 knockout (KO) and wild type (WT) mice were subjected to burn followed by RT-PCR analysis of alterations in the MuERV expression in the lung 1 day after injury. Even without injury, CD14 KO mice had a unique profile of MuERV expression compared to WT. Three bands (Lung-1, Lung-2, and Lung-3) in CD14 KO were downregulated after injury. Lung-2 and Lung-3 transcripts were almost identical to 2 previously described defective env transcripts of MuERVs, respectively. The Lung-1-1 transcript was a double spliced message generated by the env and a set of novel splicing signals, whereas the Lung-1-2 transcript was a defective env transcript. Only the Lung-1-1 transcript had a significant ORF capable of encoding a gag-pol fusion polypeptide. Putative proviral sequences of Lung-1-1 and Lung-1-2 transcripts were mapped to chromosomes 4 and 11, respectively. The results from this study suggest that the absence of CD14 expression in CD14 KO mice contributes to the transcriptional regulation of MuERVs in the lung after injury.

Animals↗

Downregulation of NF-kappaB activity associated with alteration in proliferative response in the spleen after burn injury.

Alterations in proliferation status and cellular composition of immune organs are among key events in the modulation of immune function after burn injury. Nuclear factor (NF)-kappaB is a transcription factor that plays a pivotal role in the response to injury as well as immune cell differentiation and proliferation. In this study, we investigated the effects of burn injury on the activity of NF-kappaB and its association with cellular proliferation in the spleen. Western analysis of whole spleen tissues of mice after 18% burn injury revealed a marked reduction in nuclear NF-kappaB rel A protein expression 3 to 21 days after injury when there was an increase in proliferative activity in the red pulp of the spleen after injury as indicated by an increase in proliferating cell nuclear antigen (PCNA). In the splenic B cells, however, the down-regulation of NF-kappaB rel A was associated with decreased PCNA expression as well as IkappaBalpha and phosphorylated IkappaBalpha. In contrast, no significant change in NF-kappaB rel A or PCNA expression was observed for splenic T cells. These data suggest that there is a differential regulation of NF-kappaB and proliferative activity in the splenic cell subsets after burn injury. Furthermore, the regulation of NF-kappaB may be linked to the proliferative changes seen in the spleen after burn injury.

Animals↗

Impact of tight glycemic control in severely burned children.

BACKGROUND: Control of hyperglycemia has been shown to decrease mortality in critically ill adults, but the benefits of strict glucose control have not been established in children. Since January 2002, our pediatric burn center has adopted a policy of 'intensive' insulin therapy to achieve blood glucose levels 90 to 120 mg/dL. The purpose of this study was to examine the impact of this practice on patient outcomes. METHODS: We reviewed the records of children with > or =30% total body surface area (TBSA) burn injury admitted to our regional pediatric burn center from July 1, 2000 to June 31, 2003. Patients were grouped into 'conventional insulin therapy' for the 2000 to 2001 period (n = 31) and into 'intensive insulin therapy' for the 2002 to 2003 period (n = 33). The efficacy of glucose control, infection rates, and patient survival were compared for the two therapies. RESULTS: The demographic characteristics and injury severity were similar between the conventional and intensive insulin therapy groups. Children receiving intensive insulin therapy had glucose levels of 90 to 120 mg/dL more consistently than those in the conventional insulin therapy group. There was a significant decrease in urinary tract infections among intensive insulin therapy patients. TBSA burn, percent full-thickness burn, and Pediatric Risk of Mortality scores were negatively related to survival; intensive insulin therapy was positively associated with survival. CONCLUSION: Intensive insulin therapy to maintain normoglycemia in severely burned children can be safely and effectively implemented in the burn unit. This therapy seems to lower infection rates and improve survival. Intensive insulin therapy should be considered for children with severe burn injuries.

Blood Glucose↗

CD14-dependent alterations in c-Jun expression in the liver after burn injury.

BACKGROUND: Burn injury-triggered activation of lipopolysaccharide signaling via the CD14 pathway alters the expression of a variety of downstream genes contributing to pathogenic changes in distant organs. The regulation of CD14 and its role in the immediate-early response of c-Jun in the liver after burn injury were investigated in this study. MATERIALS AND METHODS: An incidental identification of the differential induction of CD14 mRNA after an approximately 18% TBSA burn injury in mice was confirmed by RT-PCR and immunohistochemical analyses of CD14 expression. Subsequently, CD14's role in the immediate-early regulation of c-Jun expression in the liver after injury was examined by Western blot analysis using CD14 knockout (KO) mice. RESULTS: RT-PCR analysis demonstrated a rapid and transient induction of CD14 mRNA in the liver and lungs of mice after injury. Immunohistochemical analysis revealed a peak induction of CD14 reactivity in cells appearing to be Kupffer cells at day 1 after injury. Furthermore, an augmented and delayed induction of c-Jun mRNA was observed in the liver of CD14 KO mice after injury compared to wild-type controls. The induction of phosphorylated (serine 63 or serine 73) forms of c-Jun after injury was lower in the livers of CD14 KO mice than that in WT controls. CONCLUSIONS: This study provides evidence that injury elicits CD14 induction as well as hyperphosphorylation of the c-Jun N-terminus activation domain and that CD14 is involved in the modulation of c-Jun's transactivation potential via phosphorylation, which may be associated with hepatic pathogenesis after injury.

Animals↗

Sequential induction of Hsp25 and proliferating cell nuclear antigen in the kidney after burn.

Burn injury elicits a wide range of intracellular signaling events leading to alterations in phenotypes of distant organs. Renal dysfunction is one of several serious postburn complications. To better understand the underlying mechanisms of renal dysfunction among burn patients, we investigated alterations in the expression of heat shock proteins (Hsps) and cell cycle-associated proteins in the kidney after burn. Following an approximately 18% total body surface area burn, blood and kidney samples were harvested from mice at several time points. Serum levels of blood urea nitrogen increased significantly at 3 h and returned to basal levels at Day 1 implying a transient dysfunction of glomerular filtration. The expression of Hsp25 was increased at Day 1, whereas no changes in Hsp70 expression were observed. An increase in proliferating cell nuclear antigen (PCNA), a marker of cell proliferation, peaked at Day 3, and its expression was predominantly limited to cells appearing to be tubular epithelial cells in the cortex. In contrast, no significant alterations in the p21 mitosis inhibitor were noted. Furthermore, increases in histones H1 and H2A at Day 3 paralleled the PCNA induction suggesting a burn-mediated alteration in cell cycle activities. The results from this study suggest that a sizeable burn may trigger sequential activation of signaling events involved in the early pathogenesis and subsequent recovery of the kidney after burn.

Animals↗

Involvement of CD14 and toll-like receptor 4 in the acute phase response of serum amyloid A proteins and serum amyloid P component in the liver after burn injury.

Acute phase proteins such as serum amyloid A proteins (SAAs) and serum amyloid P component (SAP) are induced in the liver after various insults (e.g., infection, injury). The cellular and molecular mechanisms controlling the expression of these acute phase proteins may be specifically designed for different insults. The roles of two central molecules of the lipopolysaccharide (LPS)-mediated inflammation pathway (CD14 and toll-like receptor 4 [Tlr4]) were investigated for the regulation of SAAs and SAP in the liver of mice after an 18% total body surface area burn injury. RT-PCR analysis revealed a subtype- and time-dependent induction of SAA mRNAs between 3 h and 3 days, while there was a peak induction of SAP mRNA at day 1. Marked elevations of SAA and SAP protein levels at day 1 supported the mRNA data. Furthermore, a differential regulation of SAAs and SAP mRNAs was noted between CD14 knockout (KO) and their control mice after injury. SAA protein was induced to a lesser degree after injury in C3H/HeJ (Tlr4-defective) mice than in their control mice. In addition, in both CD14 KO and C3H/HeJ mice, the induction of SAP protein was significantly reduced compared with respective controls. These data provide evidence that CD14 and Tlr4 participate, at least in part, in a cascade of signaling events that control the immediate-early and differential induction of SAAs and SAP in the liver after injury. They also suggest that LPS may be one of the initial inducing agents associated with these acute phase responses in the liver after injury.

Acute-Phase Reaction↗

Reduced hepatic expression of glutathione s-transferases in burned mice.

BACKGROUND: Glutathione S-transferases (GSTs) contribute to liver homeostasis and are released into plasma after liver injury. This study investigates the hepatic expression of key GST enzyme subtypes after burn injury. METHODS: Mice were subjected to an 18% total body surface area burn. Expression of mGSTalpha3 and mGSTmu1 was analyzed by reverse-transcriptase polymerase chain reaction and Western blots on liver preparations from burned and control mice. GST catalytic activity was measured by conjugation assays. RESULTS: : In burned animals, mGSTalpha3 mRNA was only reduced at 1 day, whereas mGSTmu1 mRNA decreased at 1 day and at 3 days after injury. Total mGSTmu protein levels decreased at the same time points, whereas total mGSTalpha protein levels did not change. Also, by 3 days, total GST conjugation activity was reduced by 25% (p=0.05). CONCLUSION: Reduced expression of specific alpha and mu GST enzymes after burns correlates functionally with reduced GST activity. Altered GST expression may contribute to liver damage after systemic injury.

Animals↗

CD14- and toll-like receptor 4-dependent regulation of c-Fos, c-Jun and c-Jun phosphorylation in the adrenal gland after burn injury.

OBJECTIVES: Although the pathophysiology of the adrenocortical response after injury has been described, alterations in the molecular profile (e.g. transcription factors) of the adrenal gland itself are not well understood. The regulation of c-Fos, c-Jun, and c-Jun phosphorylation in the adrenal gland after burn injury was investigated in this study. In addition, since burn injury is often associated with lipopolysaccharide (LPS)-mediated sepsis, we examined the involvement of the LPS signaling pathway in the regulation of these transcription factors utilizing CD14 knockout and C3H/HeJ (encoding defective toll-like receptor 4) mice. METHODS: Adrenal glands harvested after an 18% total body surface area burn were subjected to RT-PCR and Western blot analyses of c-Jun and c-Fos. RESULTS: There was a rapid induction of c-Jun and c-Fos expression (mRNA and protein), and c-Jun serine phosphorylation. The induction of c-Jun and its phosphorylation after injury was greater in CD14 knockout and C3H/HeJ mice compared to their respective controls. A similar pattern was observed in the c-Fos regulation. CONCLUSIONS: These data suggest that c-Fos and c-Jun are activated in the adrenal gland in response to burn injury. In addition, an LPS-mediated signaling pathway may influence the regulation of these transcription factors after injury.

Adrenal Glands↗

Injury-associated differential regulation of histone expression and modification in the thymus of mice.

One of the key events in the regulation of gene expression is chromatin remodeling involving histone regulation. We investigated the effects of burns on the expression of histone that might be associated with altered molecular and pathological profiles in the thymus. A markedly decreased expression of histone variant H2A.1 mRNA was identified in the thymus after burn during a differential display experiment. Subsequently, we examined the histone expression (mRNA and protein) and posttranslational modification in the thymus after burn. Also, changes in proliferating cell nuclear antigen (PCNA), a central molecule in chromatin assembly, was examined. Reverse-transcription polymerase chain reaction analysis revealed a transient decrease in the expression of several histone variants (H2A.1, H1(r1), H3-B, H3-1, and H4-D) mRNAs in the thymus at 1 day after burn. A decrease in histone subtypes H2A, H2B, H3, and H4, but not H1, was demonstrated 1 and 3 days after burn according to the results of Western blot. Furthermore, there were different levels of decreases in acetylated and dimethylated forms of histone H3 1 and 3 days after burn. In addition, decreased levels of PCNA were evident in the thymus 1 day after burn. Changes in the expression of histones and PCNA may reflect mere decrease in proliferating cells and/or a reorganization of the chromatin structure associated with altered transcriptional activities, eventually contributing to the phenotypic changes in the thymus after burn.

Animals↗

Expression of transforming growth factor beta1 in patients with and without previous abdominal surgery.

HYPOTHESIS: Transforming growth factor beta1 (TGF-beta1) plays an important role in the formation of adhesions after abdominal operations. DESIGN: Prospective, observational study. SETTING: University-based, tertiary referral center. PATIENTS: Patients undergoing elective open abdominal operations were recruited and divided into 2 groups. Twenty-two patients with a history of abdominal surgery were designated as study patients, and 10 patients with no history of abdominal surgery served as controls. INTERVENTIONS: Samples of normal peritoneum, peritoneal scar tissues, and serum were obtained from all patients at the time of surgery. MAIN OUTCOME MEASURES: Samples were assayed for total TGF-beta1 expression using an enzyme-linked immunosorbent assay. RESULTS: Scar tissues expressed significantly greater amounts of TGF-beta1 (0.47 pg/ micro L) compared with normal peritoneal tissue from both study patients (0.29 pg/ micro L; P =.03) and controls (0.17 pg/ micro L; P =.002). Serum TGF-beta1 levels were also higher in study patients (1.71 pg/ micro L) compared with controls (1.22 pg/ micro L; P =.02). Neither adhesion nor serum TGF-beta1 expression correlated with time since last operation, total number of previous operations, or severity of intra-abdominal adhesions. CONCLUSION: These results suggest that TGF-beta1 may play an important role in human peritoneal adhesion formation.

Abdominal Cavity↗

Split thickness skin grafting for recreation of the scrotum following Fournier's gangrene.

Fournier's gangrene is an infection of the genitals and perineum that is treated with extensive soft tissue debridement, often leading to loss of scrotal skin. Multiple options for reconstruction of the scrotum are available. Four cases of recreation of the scrotum with meshed split thickness skin grafts (STSG) are presented. The discussion includes a comparison of STSG with other treatment options. We conclude that STSG are a safe, technically easy treatment option with satisfactory cosmetic and functional results.

Aged↗

CD14-dependent regulation of Grp78 in the liver and lungs of mice after burn injury.

Recent reports have suggested that interactions between the lipopolysaccharide receptor CD14 and heat shock proteins (Hsps) play roles in proinflammatory responses. The involvement of glucose-regulated protein 78 (Grp78), a member of Hsp70 family, and CD14 in signaling events activated in the liver and lungs of mice after burn injury was investigated. Differential induction of Grp78 in the liver of CD14 knockout (KO) mice after 18% total body surface area burn was associated with a transient down-regulation of serum glucose level at day 1 after injury. Subsequent studies revealed that the liver of both CD14 KO and wild-type control mice had a significant induction of Grp78 mRNA at day 1 after injury, while the level of induction was greater in CD14 KO mice. In contrast, in the lungs, there was an up-regulation of Grp78 mRNA only in CD14 KO mice at day 1 after injury. Interestingly, both the liver and the lungs had no apparent changes in Grp78 protein expression after injury. These data demonstrate CD14-dependent and tissue-specific regulation of the Grp78 expression after burn injury. They also suggest potential activation of a CD14-independent signaling pathway involving Grp78 in distant organs after injury.

Animals↗