Ulinastatin reduces urinary sepsis related inflammation by upregulating IL 10 and downregulating TNF α levels

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1 MOLECULAR MEDICINE REPORTS 8: 29-34, 2013 Ulinsttin reduces urinry sepsis relted inflmmtion by upregulting IL 10 nd downregulting TNF α levels XIAN CHEN 1*, YI WANG 1*, HONGMEI LUO 2, ZHIGANG LUO 1, LISHA LIU 1, WUJUN XU 1, TAO ZHANG 1, NING YANG 1, XIANGYANG LONG 1, NENG ZHU 1, HUANG XIE 1 nd JUN LIU 1 1 Deprtment of Urology, The Second Affilited Hospitl of University of South Chin; 2 Deprtment of Histology nd Embryology, University of South Chin, Hengyng, Hunn , P.R. Chin Received December 10, 2012; Accepted April 9, 2013 DOI: /mmr Abstrct. The im of the present study ws to determine the efficcy of ulinsttin (UTI) for the tretment of sepsis nd to investigte the ssocited moleculr mechnisms. Twenty four mle rbbits were rndomly divided into 4 groups, the norml, shm, sepsis model nd UTI groups, ech contining 6 rbbits. Serum levels of interleukin (IL) 10 nd tumor necrosis fctor α (TNF α) were mesured by enzyme linked immunosorbent ssy (ELISA). Liver, kidney nd lung tissues were stined with hemtoxylin nd eosin (H&E) 36 h fter scrifice nd morphologicl chnges were observed under n opticl microscope. The expression levels of IL 10 nd TNF α proteins in rbbit kidney tissue in ech group were determined by immunohistochemicl detection nd western blot nlysis. ELISA results indicted tht, compred with the sepsis model, IL 10 levels were significntly higher in the UTI tretment group (183.91± pg/ml) t 36 h (P=0.000), while serum TNF α concentrtion decresed significntly in the UTI tretment group (31.637±2.770 pg/ml; P=0.000). Results of western blot nlysis were consistent with the immunohistochemistry, indicting tht UTI upregultes IL 10 nd downregultes TNF α levels. In the current study, UTI ws demonstrted to effectively tret urinry sepsis nd llevite the inflmmtory response in tissues. These effects were medited by the upregultion of IL 10 nd downregultion of TNF α levels. Introduction Urosepsis is specific form of urinry trct infection, resulting in serious systemic infection by hemtogenous spred. Specificlly, 20 30% of ptients with sepsis develop the condition s result of Correspondence to: Professor Zhigng Luo, Deprtment of Urology, The Second Affilited Hospitl of University of South Chin, No. 35 Jiefng Rod, Hengyng, Hunn , P.R. Chin E mil: zhigng.luo@yhoo.cn * Contributed eqully Key words: ulinsttin, urinry sepsis, inflmmtion, tumor necrosis fctor α, interleukin 10 urinry trct infection (1), nd urinry trct infection ccounts for 5 7% of severe cses of sepsis (2,3). Cliniclly, cute upper urinry trct obstruction is common nd is likely to cuse septic shock (4). Therefore, erly dignosis nd effective tretment of urinry sepsis is essentil for the prevention of mortlity. Tumor necrosis fctor α (TNF α), interleukin (IL) 6 nd IL 10 re cytokines involved in the inflmmtory response of sepsis. During the inflmmtory response, TNF α is initilly relesed, regulting IL 6 nd IL 8 levels. IL 10 is n importnt nti inflmmtory nd immune inhibitory cytokine secreted by mcrophges, which inhibits TNF α nd increses the IL 1 receptor ntgonist (5). Ulinsttin (UTI) is 143 mino cid, cidic glycoprotein secreted by the liver. UTI inhibits trypsin nd is commonly used in the tretment of pncretitis. In ddition, UTI stbilizes lysosoml membrnes nd inhibits lysosoml enzyme relese nd myocrdil depressnt fctor production. UTI lso inhibits neutrophil ctivtion nd trnsendothelil migrtion, reduces inflmmtory cell infiltrtion nd downregultes inflmmtory cytokines nd is currently used for the tretment of cute circultory filure. Erly dministrtion of UTI hs been demonstrted to inhibit neutrophil protese relese nd excessive inflmmtory responses nd reduce the relese of oxygen free rdicls nd consumption of superoxide dismutse (6,7). UTI effectively reduces body temperture, respirtory rte, white blood cell count (WBC) nd regultes levels of TNF α, plsm IL 6, C rective protein (CRP) nd proclcitonin in ptients with sepsis (8). In our previous study, non cytotoxic ntitumor regent ws demonstrted to downregulte the expression of Survivin, Bcl xl nd Mt 1 in tumor cells (9) nd upregulte expression of Smd 4 (10). In the present study, urinry trct obstruction ws performed in rts nd the urinry trct ws infected with Escherichi coli endotoxin (LPS) to estblish model of sepsis. Successfully estblished models were used to determine whether UTI induces chnges in IL 10 nd TNF α expression. In ddition, the efficcy nd the ssocited moleculr mechnisms of UTI in the tretment of sepsis were investigted. Mterils nd methods Regents. LPS (0111:B4) ws purchsed from Sigm Aldrich (St. Louis, MO, USA). UTI ws purchsed from Techpool

2 30 CHEN et l: ULINASTATIN REDUCES INFLAMMATION Bio-Phrm Co., Ltd. (Gungdong, Chin). TNF α nd IL 10 kits were purchsed from Shnghi Shengke Co. (Shnghi, Chin). TNF α nd IL 10 ntibodies were purchsed from Beijing Biosynthesis Biotechnology Co., Ltd. (Beijing, Chin). Rbbit SP HRP nd DAB color kits were purchsed from Beijing cwbiotech Co., Ltd. (Beijing, Chin). Animl models. Twenty four rbbits (weight, kg) were purchsed from the Deprtment of Animl Experiments, Nnhu University (Hengyng, Chin). The study ws pproved by the ethics committee of the University of South Chin, Hengyng, Hunn, Chin. Rbbits were rndomly divided into 4 groups; the norml, shm, sepsis model nd UTI groups. In the norml, shm nd UTI groups, rbbits were fed normlly. Rbbits were nesthetized with 10% chlorl hydrte (3 ml/kg) fter being weighed, nd were then fixed to the operting tble. The bdominl cvity ws exposed using 3 cm longitudinl incision nd the left psos muscle ws locted. The left ureter ws then seprted. The bdominl cvity ws closed nd the intestines were reset. In the sepsis model nd shm groups, the left ureter ws found nd seprted using the sme surgicl pproch. The lower end of the ureter ws ligted nd 1 ml LPS (800 µg/kg) ws injected. The ureter ws gin ligted bove the injection point. Following locl irrigtion, the bdominl cvity ws closed. In the UTI group, the surgicl pproch ws identicl to tht used in the sepsis model group. Following surgery, 1.5x10 7 units UTI were dissolved in 3 ml sline nd injected into the mrginl er vein. Following surgery, rbbits from ll groups were fed nd wtered normlly. After 24 h, 4 5 ml blood from the mrginl er vein of surviving rbbits in the shm nd sepsis model groups ws extrcted for subsequent nlyses. At 36 h, 2 3 ml blood from the left ilic vein of surviving rbbits ws removed for routine blood testing. Following centrifugtion (1409 x g) of the venous blood smples, 5-8 ml superntnt ws collected nd further detection of IL-10 nd TNF-α ws performed. Rbbits were scrificed following blood smple extrction. The left kidney, the lungs nd the liver were plced in 10% neutrl formlin for 24 h nd embedded in prffin. CRP ws detected using n AU800 utomtic biochemicl nlyzer (Olympus Opticl Co., Ltd., Tokyo, Jpn). Enzyme linked immunosorbent ssy (ELISA). Blood ws cogulted nd centrifuged t room temperture for min. The superntnt ws collected nd stndrds were diluted s the control. Diluted smples (50 µl) were dded to blnk wells nd 50 µl diluted stndrd ws dded to stndrd wells. In the smple wells, 50 µl diluted stndrd nd 10 µl smple ws dded. The smple ws gently mixed nd incubted for 30 min t 37 C. OD vlues t wvelength of 450 nm were determined by ELISA for ech well. Hemtoxylin nd eosin (H&E) stining. Tissues were dried in n incubtor nd dewxed for 10 min using xylene. Next, smples were dewxed gin with fresh xylene for 5 min. Following H&E stining, smples were observed under light microscope nd imges were cptured. Immunohistochemicl method. Rbbit kidney tissue specimens were embedded nd sliced in prffin block Tble I. Comprison of body temperture nd respirtory rte in 4 groups of rbbits t 36 h postopertively (men ± SD, n=6). Body temperture Respirtory rte Group Cses ( C) (bpm) Norml ± ±4.3 Shm ± ±4.2 Sepsis model ±0.7,b 77.5±5.1,b UTI ±0.3 c 72.0±2.8 c P<0.05 vs. norml; b P<0.05 vs. shm; c P<0.05 vs. sepsis model. UTI, ulinsttin. to thickness of 4 mm, ccording to the mnufcturer's instructions. Tissues were treted with diethylpyrocrbonte (DEPC). The secondry ntibody ws biotin lbeled got nti rbbit secondry ntibody solution. Western blot nlysis. Totl proteins were isolted from tissues, seprted on SDS PAGE gels nd trnsferred to membrnes. Membrnes were incubted with primry ntibodies ginst IL 10 (1:200), TNF α (1:200) nd β ctin (1:1,000; Snt Cruz Biotechnology Inc., Snt Cruz, CA, USA). Next, membrnes were incubted with horserdish peroxidse conjugted secondry ntibodies (sc 2030; Snt Cruz Biotechnology Inc.), visulized using n enhnced chemiluminescence detection kit (Pierce Biotechnology, Inc., Rockford, IL, USA) nd exposed to X ry film. β ctin ws used s loding control. Sttisticl nlysis. Dt were processed using SPSS 13.0 sttisticl softwre. Dt re expressed s the men ± SD. One wy ANOVA ws pplied for comprison between groups. A two smple pired t test nlysis method ws pplied for comprison t 24 nd 36 h following surgery. P<0.05 ws considered to indicte sttisticlly significnt difference. Results Body temperture nd respirtory rte of rbbits following surgery. To estblish the rbbit model, 24 rbbits were rndomly divided into 4 groups, the norml, shm, sepsis model nd UTI groups, ech contining 6 rbbits. As demonstrted in Tble Ⅰ, t 24 nd 36 h postopertively, body temperture ws not found to be significntly different compred with norml rbbits. Respirtory rtes between the shm nd norml groups t 24 nd 36 h following surgery were not identified s significntly different (P=0.731 nd P=0.683). The body temperture of sepsis model rbbits begn to rise 24 h fter estblishment of the model. At 36 h, mrked chnges in body temperture were observed, incresing from 38.6 to 41.0 C (P=0.00), nd the respirtory rte incresed from 46.5 to 77.5 bpm (P=0.00). Body temperture decresed 36 h fter surgery when UTI tretment ws dministered. When compring the UTI nd model groups, the difference ws found to be sttisticlly significnt (P=0.010). Respirtory

3 MOLECULAR MEDICINE REPORTS 8: 29-34, Tble II. Comprison of WBC, PLTs nd CRP in 4 groups of rbbits t 36 h postopertively (men ± SD, n=6). Group Cses WBC (10 9 cells/l) PLT (10 9 cells/l) CRP (mg/l) Norml ± ± ±1.26 Shm ± ± ±3.13 Sepsis model ±1.31,b ± ±7.65,b UTI ±1.22 c ± ±3.19 c P<0.05 vs. norml; b P<0.05 vs. shm; c P<0.05 vs. sepsis model. WBC, white blood cell count; PLTs, pltelets; CRP, C rective protein; UTI, ulinsttin. Figure 1. H&E stining of rbbit kidney tissues nd immunohistochemicl detection of IL 10 nd TNF α in rbbit kidney tissues. (A) H&E stining of rbbit kidney tissues in the norml, shm, sepsis model nd UTI groups. (B) Immunohistochemicl nlysis of levels of IL 10 nd TNF α in rbbit kidney tissues from the 4 groups. Mgnifiction, x400. H&E, hemtoxylin nd eosin; IL, interleukin; TNF α, tumor necrosis fctor α; UTI, ulinsttin. rte ws lso observed to be significntly different between the tretment nd model groups (P=0.034). Peripherl blood cell count nd CRP chnges. As demonstrted in Tble Ⅱ, t 24 nd 36 h postopertively, when compred with norml group, WBC ws slightly elevted in the shm group but ws not identified to be significntly different (P=0.099 nd P=0.062, respectively; P>0.05). WBC ws observed to increse in time dependent mnner. At 24 nd 36 h fter modeling, the WBC in the model group ws 12.66x10 9 nd 15.35x10 9 cells/l, respectively. In the shm group, the WBC 36 h following surgery ws identified to be significntly higher thn the norml group (P=0.00). WBC decresed in the tretment group compred with the sepsis model group (P=0.008). No significnt difference in pltelet count ws identified between the groups (P=0.686 nd P=0.805, respectively). Serum CRP concentrtion 36 h following surgery ws found to be significntly higher in the shm group thn the norml group (P=0.001). CRP levels in the model group were observed to be significntly higher compred with the shm nd norml groups (P=0.000). CRP levels in the tretment nd sepsis model groups were identified to be significntly different, whereby serum CRP concentrtion ws higher in the sepsis model group (P=0.000). Determintion of rbbit serum IL 10 nd TNF α concentrtions. As is reveled in Tble Ⅲ, there ws no significnt difference in serum IL 10 levels between the shm (34.543±2.820 pg/ml) nd norml groups (28.751±3.608 pg/ml) t ech time-point (P=0.301 nd 0.234) ccording to ELISA results. In the sepsis model group, serum IL 10 levels ( ±7.840 pg/ml) were significntly higher thn the norml nd shm groups (P=0.000). Compred with the sepsis model group, IL 10 ws significntly higher in the UTI tretment group (183.91± pg/ml) 36 h following surgery (P=0.000). TNF α levels were slightly higher in the shm (18.711±1.493 ng/l) thn norml group (15.074±1.413 ng/l), but were not found to be significntly different (P=0.466 nd P=0.134). Serum TNF α levels in the sepsis model group (88.769±6.358 ng/l) were significntly higher thn in the norml nd shm groups (P=0.000). However, compred with the sepsis model group, serum TNF α concentrtion ws

4 32 CHEN et l: ULINASTATIN REDUCES INFLAMMATION Tble III. Comprison of IL 10 nd TNF α in 4 groups of rbbits t 36 h postopertively (men ± SD, n=6), s mesured by ELISA. Group Cses IL 10 (pg/ml) TNF α (ng/l) Norml ± ±1.413 Shm ± ±1.493 Sepsis model ±7.840,b ±6.358,b UTI ± c ±2.770 c P<0.05 vs. norml; b P<0.05 vs. shm; c P<0.05 vs. sepsis model. IL 10, interleukin 10; TNF α, tumor necrosis fctor α; UTI, ulinsttin; ELISA, enzyme linked immunosorbent ssy. Tble Ⅳ. Comprison of IL 10 nd TNF α expression in the kidneys of 4 groups of rbbits t 36 h postopertively (OD, men ± SD, n=6). Group Cses IL 10 TNF α Norml ± ±0.022 Shm ± ±0.021 Sepsis model ±0.019,b 0.264±0.025,b UTI ±0.018 c 0.222±0.023 c P<0.05 vs. norml; b P<0.05 vs. shm; c P<0.05 vs. sepsis model. IL 10, interleukin 10; TNF α, tumor necrosis fctor α; UTI, ulinsttin. Figure 2. Western blot nlysis of IL 10 protein expression in rbbit kidney tissues. IL 10 nd β ctin primry ntibodies were used. β ctin ws used s loding control. A representtive blot is presented in the upper pnel. Bnds were scnned nd the OD rtios of IL 10 reltive to tht of β ctin were quntified in the lower pnel. IL, interleukin; UTI, ulinsttin. ** P<0.01, vs. the control group; ## P<0.01 vs. the sepsis group. observed to decrese significntly in the UTI tretment group (31.637±2.770 ng/l; P=0.000). These results indicte tht UTI Figure 3. Western blot nlysis of TNF α protein expression in rbbit kidney tissues. TNF α nd β ctin primry ntibodies were used. β ctin ws used s loding control. A representtive blot is presented in the upper pnel. Bnds were scnned nd OD rtios of TNF α reltive to tht of β ctin were quntified in the lower pnel. TNF α, tumor necrosis fctor α; UTI, ulinsttin. ** P<0.01, vs. the control group; ## P<0.01 vs. the sepsis group. tretment incresed levels of IL 10, but decesed levels of TNF α. H&E stining of rbbit kidney, liver nd lung tissues. To exmine the effect of UTI tretment on rbbit tissue, H&E stining ws performed in ll 4 groups. As demonstrted in Fig. 1A, kidney tissues obtined from norml nd shm groups exhibited norml morphologies. In the sepsis model group, glomerulus deformities nd tubulr lumen enlrgement were observed. The renl interstitil spce ws congested with edem nd infiltrted with inflmmtory cells. There ws slight swelling of liver cells nd scttered inflmmtory cell infiltrtion in liver biopsies. In lung biopsies, we observed diffuse thickening of the lveolr sept nd inflmmtory cell infiltrtion. Pthologicl deformities were ttenuted in the UTI tretment group compred with the sepsis model group. Similr results were lso observed in the liver nd lung tissues (dt not shown). Immunohistochemicl detection of IL 10 nd TNF α in kidney tissues of ech group. To detect whether UTI induces ltertions in levels of IL 10 nd TNF α, immunohistochemicl nlysis of rbbit kidney tissues ws performed. Imges re presented in Fig. 1B. Levels were clculted bsed on immunohistochemistry detection. As demonstrted in Tble Ⅳ, differences in the expression of IL 10 nd TNF α between the norml nd shm groups were not significnt. IL 10 protein levels in the UTI tretment group were higher thn in the sepsis model group. However, levels of TNF α in the UTI tretment group were lower thn those in the sepsis model group. Western blot nlysis of IL 10 nd TNF α in kidney tissue of ech group. To further determine whether UTI induces ltertions in the levels of IL 10 nd TNF α, totl proteins were extrcted from rbbit kidney tissues in every group nd western blot nlysis ws performed. As demonstrted in Fig. 2, IL 10

5 MOLECULAR MEDICINE REPORTS 8: 29-34, levels in the norml nd shm groups were similr. In the sepsis group, IL 10 levels were incresed. However, IL 10 levels in the UTI tretment group were found to be significntly incresed compred with the sepsis group. As reveled in Fig. 3, TNF α levels in the norml nd shm groups were similr. In the sepsis group, TNF α levels were incresed compred with the control group. However, TNF α levels in the UTI tretment group were significntly decresed compred with the sepsis group. Results of western blot nlysis were consistent with the immunohistochemistry results, indicting tht UTI upregultes IL 10 levels nd downregultes TNF α levels. Discussion Animl models provide bsis for pthogenesis studies of the mechnisms of sepsis nd re essentil for the development, prevention nd control of this condition. Models of sepsis simulte the etiology, pthogenesis, development nd clinicl chrcteristics of sepsis to provide insight into methods for its prevention nd tretment. Severl sepsis models hve been estblished nd re ech ssocited with specific chrcteristics (5). In the present study, model of urinry trct infection nd cute upper urinry trct obstruction ws estblished by injection of LPS nd ligtion of the ureter to induce cute obstruction nd model of urinry sepsis. In this study, no significnt differences in rbbit rectl tempertures, respirtory rtes, peripherl blood leukocytes nd serum TNF α nd IL 10 levels were identified in the shm nd norml groups t ech time-point. These observtions indicte tht the surgery itself did not ffect orgn function. In the sepsis model group, body temperture begn to rise t 24 h, respirtory rte ccelerted in time dependent mnner, TNF α nd IL 10 levels were observed to be significntly incresed, rectl temperture incresed from 38.6 to 41.0 C nd peripherl blood leukocytes (15.35x10 9 /l) nd CRP (31.03±8.06 mg/l) incresed significntly compred with the control group. In ddition, liver, kidney nd lung morphologies were ltered, indicting tht the urinry sepsis model ws estblished successfully. Inflmmtory cytokines, including TNF α, IL 6 nd IL 10, were previously reveled to cuse sepsis relted multiple orgn dysfunction syndrome (MODS) (11 14). TNF α is lrgely generted by ctivted monocytes/mcrophges nd endothelil cells, which induce systemic inflmmtory response syndrome/mods. IL 6 is mjor cytokine tht is ctivted by monocytes, mcrophges nd endothelil cells in the cute response phse nd is induced by IL 1β nd TNF α. IL 6 is heptocyte-stimulting fctor tht induces liver cells to produce cute CRP nd enhnces the destructive inflmmtory response of the host. Continully incresing IL 6 levels indicte poor prognosis (15). IL 10 is n importnt cytokine produced by T cells, mcrophges nd monocytes. It inhibits mrna trnscription for vriety of immune ctive cytokines nd the ctivtion of monocytes nd mcrophges to secrete other cytokines, including TNF α nd IL 1, which regultes dmge by the excessive inflmmtory response triggered by proinflmmtory cytokines (16). IL 10 is protective nd nti inflmmtory cytokine in sepsis nd MODS tht reduces the systemic inflmmtory response nd orgn dmge (17). CRP is n extremely sensitive nd nonspecific indictor of sepsis dignosis, which is n ctive protein in the cute phse of n infectious disese nd is significntly elevted in inflmmtion nd tissue dmge. Incresing levels of CRP re closely ssocited with the severity of tissue dmge. Molor Erdene et l (18) demonstrted tht UTI inhibited TNF α induced by LPS nd significntly reduced TNF α expression in dose dependent mnner in rt lung tissue. UTI reduces TNF α nd IL 6 nd improves IL 10 levels to prevent further MODS (19). 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