Investigating the Pathophysiology of Sepsis: Insights from Mechanistic and Animal Studies

Abstract

Sepsis is a life-threatening condition characterized by organ dysfunction due to an uncontrolled response to infection. Despite decades of research, the mortality rate remains high, emphasizing the need for an improved understanding of sepsis pathophysiology and improvements in preclinical animal research. Recently, extracellular histones, major mediators of organ dysfunction and death, have emerged as a potential therapeutic target for sepsis. In this thesis, we reported that the ability of heparin to neutralize the cytotoxic and procoagulant effects of histones is size-dependent but independent of the antithrombin- binding pentasaccharide. In contrast, the ability of heparin to neutralize histone-mediated impairment of activated protein C generation is independent of size and anticoagulant activity. These findings suggest that heparin variants may have differential therapeutic potential in vascular disease states that are associated with elevated levels of histones. Before testing the therapeutic efficacy of the heparin variants in vivo, we aimed to develop and standardize a murine model of sepsis that can be utilized in a multi-center platform. As one of the lead sites for the National Preclinical Sepsis Platform (NPSP), we optimized a 72-hour model of abdominal sepsis using supportive treatments. As sepsis predominately impacts the elderly, we also explored the impact of aging on the host response to sepsis using our fecal induced peritonitis (FIP) model. Aged FIP mice exhibited a higher mortality rate compared to young FIP mice. The worsened organ injury and poor survival in aged mice may be attributed to heightened inflammation in aged mice. We also observed trends in increased bacterial loads, increased coagulation, elevated cell free DNA, and decreased ADAMTS13 activity in aged septic mice. These findings help to improve our understanding of how aging impacts the host response to sepsis, which may be translated into therapeutic strategies that considers advanced age as a risk factor for sepsis.