Erica Martin

Phosphoinositide 3-kinase p110beta activity : key role in metabolism and mammary gland cancer but not development

The phosphoinositide 3-kinase p110β subunit has noncatalytic functions; its catalytic activity is pertinent to both diabetes and cancer. Unveiling p110β Phosphatidylinositide 3-kinase (PI3K) signaling has been implicated in the response to insulin and various growth factors. However, the specific role of the β isoform of the PI3K catalytic subunit (p110β) has been unclear. Analysis of mouse mutants carrying a catalytically inactive form of p110β reveals that it possesses noncatalytic as well as catalytic functions. Moreover, its catalytic activity is involved in sustaining the response to insulin signaling and in mediating forms of breast cancer associated with oncogenic epidermal growth factor signaling. The phosphoinositide 3-kinase (PI3K) pathway crucially controls metabolism and cell growth. Although different PI3K catalytic subunits are known to play distinct roles, the specific in vivo function of p110β (the product of the PIK3CB gene) is not clear. Here, we show that mouse mutants expressing a catalytically inactive PIK3CBK805R mutant survived to adulthood but showed growth retardation and developed mild insulin resistance with age. Pharmacological and genetic analyses of p110β function revealed that p110β catalytic activity is required for PI3K signaling downstream of heterotrimeric guanine nucleotide–binding protein (G protein)–coupled receptors as well as to sustain long-term insulin signaling. In addition, PIK3CBK805R mice were protected in a model of ERBB2-driven tumor development. These findings indicate an unexpected role for p110β catalytic activity in diabetes and cancer, opening potential avenues for therapeutic intervention.

Polymyxin-B hemoperfusion inactivates circulating proapoptotic factors

ObjectiveTo test the hypothesis that extracorporeal therapy with polymyxin B (PMX-B) may prevent Gram-negative sepsis-induced acute renal failure (ARF) by reducing the activity of proapoptotic circulating factors.SettingMedical-Surgical Intensive Care Units.Patients and interventionsSixteen patients with Gram-negative sepsis were randomized to receive standard care (Surviving Sepsis Campaign guidelines) or standard care plus extracorporeal therapy with PMX-B.Measurements and resultsCell viability, apoptosis, polarity, morphogenesis, and epithelial integrity were evaluated in cultured tubular cells and glomerular podocytes incubated with plasma from patients of both groups. Renal function was evaluated as SOFA and RIFLE scores, proteinuria, and tubular enzymes. A significant decrease of plasma-induced proapoptotic activity was observed after PMX-B treatment on cultured renal cells. SOFA and RIFLE scores, proteinuria, and urine tubular enzymes were all significantly reduced after PMX-B treatment. Loss of plasma-induced polarity and permeability of cell cultures was abrogated with the plasma of patients treated with PMX-B. These results were associated to a preserved expression of molecules crucial for tubular and glomerular functional integrity.ConclusionsExtracorporeal therapy with PMX-B reduces the proapoptotic activity of the plasma of septic patients on cultured renal cells. These data confirm the role of apoptosis in the development of sepsis-related ARF.

Tracheostomy in Mechanical Ventilation

Airway access for mechanical ventilation (MV) can be provided either by orotracheal intubation (OTI) or tracheostomy tube. During episodes of acute respiratory failure, patients are commonly ventilated through an orotracheal tube that represents an easy and rapid initial placement of the airway device. OTI avoids acute surgical complications such as bleeding, nerve and posterior tracheal wall injury, and late complications such as wound infection and tracheal lumen stenosis that may emerge due to tracheostomy tube placement. Tracheostomy is often considered when MV is expected to be applied for prolonged periods or for the improvement of respiratory status, as this approach provides airway protection, facilitates access for secretion removal, improves patient comfort, and promotes progression of care in and outside the intensive care unit (ICU). The aim of this review is to assess the frequency and performance of different surgical or percutaneous dilational tracheostomy and timing and safety procedures associated with the use of fiberoptic bronchoscopy and ultrasounds. Moreover, we analyzed the performance based on National European surveys to assess the current tracheostomy practice in ICUs.

Phosphorylation mechanisms in intensive care medicine

IntroductionThe phosphorylation states of proteins, lipids, carbohydrates, amino acids, and nucleotides control the mechanisms behind nearly all cellular functions. Therefore, not surprisingly, recent findings have shown that alterations in these phosphorylation pathways play a central role in the development and progression of many disease states. This review provides a brief summary of the function and activity of various phosphorylation mechanisms, outlines some of the major phosphorylation signaling cascades, and describes the role of these phosphorylation mechanisms in intensive care medicine.MethodsThis article will comprise a comprehensive review of the literature in the context of intensive care medicine. Specifically, we will discuss the involvement of phosphorylation in the pathogenesis, diagnosis, and treatment of heart failure, myocardial infarction, stroke, respiratory failure, ventilation-induced lung injury, traumatic brain injury, acute organ failure, systemic sepsis, and shock.ConclusionPhosphorylation mechanisms clearly play an important role in many pathologies and treatment strategies of intensive care and therefore further understanding of these mechanisms may lead to the development of novel therapies and improved patient care.

Lipopolysaccharide is required for leukocyte adhesion to Toraymyxin ® filters used in the treatment of sepsis

Extracorporeal hemoperfusion with polymyxin B is a novel septic treatment, shown to improve hemodynamics, organ dysfunction, and mortality through the removal of circulating lipopolysaccharide (LPS). This therapy can also remove activated leukocytes, which likely contributes to reduced inflammation and improved patient outcome; however, the mechanistic role of LPS in the removal of leukocytes remains unclear.