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AND
[13]
T. G. BUCHMAN
[9]
Agents that provoke oxidative injury include products of oxidative metabolism (especially from the
mitochondria) and those released from activated
phagocytes. Collectively, they are called reactive
oxygen species (ROS), and include superoxide, hydrogen peroxide, hydroxyl radical (the generation of
which depends on availability of ferrous ion and
superoxide) and nitric oxide. Iron, which is essential
for DNA synthesis and oxidative metabolism, also
catalyses the Fenton and Haber-Weiss reactions,
converting superoxide to molecular oxygen and
hydrogen peroxide to the hydroxyl radical. Under
normal conditions, free iron is compartmentalized
by the protein ferritin, which protects the cell by
keeping iron in a non-reactive crystallized core as
ferric ion (Fe3;). The results of the oxidative
reactions of ROS include de-energization of mitochondria and loss of energy stores, peroxidation and
disruption of lipid membranes, and direct DNA
damage.
The adaptive response of the cell to oxidative
stress includes both enzymatic and non-enzymatic
capacities and induction of oxidative stress response
proteins [9]. Superoxide dismutase reduces superoxide to molecular oxygen and hydrogen peroxide;
catalase catalyses the conversion of this hydrogen
peroxide to oxygen and water. Reduced glutathione
(which reacts with hydrogen peroxide in the presence
of glutathione peroxidase to form water and oxidized
glutathione), vitamin C and vitamin E constitute the
[10, 20]
[26]
TERMINOLOGY
Figure 1 Electron micrographs of murine thymocytes from normal (A, sham laparotomy) and septic (B, caecal ligation and puncture) mice. Note the differences in the pattern and
distribution of chromatin. Compared with controls (A), thymocytes from septic animals (B) demonstrate nuclear condensation and cell shrinkage, consistent with apoptosis.
Figure 2 Micrographs (360 magnification) of murine thymocytes from normal (A, sham laparotomy) and septic
(B, caecal ligation and puncture) mice photographed using the fluorescent TUNEL (terminal deoxynucleotidyl
transferase-mediated dUTP nick end-labelling) technique. Cells are permeabilized and treated with fluorescein
labelled dUTP and terminal deoxynucleotide transferase. Note that in the control mice, all nuclei appear dark (A).
In contrast, nuclei of septic mice (B) are fluorescent, consistent with DNA strand breaks and apoptosis.
Figure 3 Normal cultured porcine aortic endothelial cells (A, 360 magnification) stained with nuclear binding
dye Hoechst 33342. The nuclei are smooth and ovoid. Nuclei from cells challenged with endotoxin followed by
arsenite are compact and fragmented (apoptotic bodies, B, 360 magnification).
Apoptosisdeath by shrinkage
8
contrast, neighbouring hepatic endothelial cells in
this model did not stain for heat shock gene
expression (in situ hybridization), suggesting that
there are cell-specific differences in the genetic
response to similar injury. A subsequent investigation conducted in vitro under more controlled
conditions explored the time-course and interaction
of these cellular stress responses. Human hepatoblastoma (HepG2) cell lines were treated with
inducers of the acute phase response (IL-1 and
TNF) and heat shock responses separately and in
combination. The results indicated that shockinduced expression of these responses were distinct,
exclusive and prioritized [6]. Specifically, the heat
shock stress response, the most primitive and highly
conserved of stress gene responses, was capable of
extinguishing expression of other genetic programmes [5, 28]. These data suggest that hepatocyte
injury of sufficient severity to trigger the heat shock
response can prevent production of system-stabilizing acute phase proteins and other adaptive
responses. The livers response to such a systemic
injury, from the hosts perspective, would appear to
be inadequate and indicative of failure. Hepatic
dysfunction in this model of MODS, thus, would
result from execution of primitive, protective genetic
responses that give individual cells priority over the
organism.
The sequence of stress gene programme activation
also appears to be important. In one in vitro model,
the endothelial cell response to arsenite, an inducer
of the heat shock response, and to endotoxin, an
inducer of the acute phase response, were studied.
The results indicated that induction of the heat
shock response could protect against endotoxininduced cytotoxicity, but reversing the order
endotoxin challenge followed by induction of the
heat shock responseincreased cell death by apoptosis [5]. The effect of the heat shock response was
not the result of a detrimental effect of the heat shock
proteins themselves, but rather to the heat shockinduced inhibition of further protein synthesis [5].
An important hypothesis drawn from these data is
that two independent programmes of stress gene
expression can interact, depending on the sequence,
to either protect the cell or trigger cell death by
suicide (apoptosis). This may explain the absence of
endothelial cells expressing heat shock proteins after
shock in vivo ([7], discussed above), as endothelial
cell apoptosis may have resulted in their subsequent
removal by phagocytes before in situ staining. Thus,
endothelial cell dysfunction and death in this model
result from the adverse interaction of two usually
beneficial patterns of stress responses. The mechanism responsible may involve alterations in the
cellular redox potential and changes in nuclear
transcription factor activity [unpublished observations]. For example, in the cultured endothelial cell
model, reducing agents such as N-acetyl-L-cysteine
and dithiothreitol block induction of endotoxin/
arsenite-induced endothelial cell apoptosis, implicating ROS in the induction of apoptotic cell death
[1, 2]. This raises the possibility that the adaptive
response produced by oxidative stress could modulate the interaction of the acute phase and heat shock
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