Neutrophil FFA2/GPR43 Receptor Expression in Patients With the Diagnosis of Sepsis

Sepsis Clinical Trial

— GPR43Sepsis  

Official title:

Neutrophil FFA2/GPR43 Receptor Expression in Patients With the Diagnosis of Sepsis

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02699905
• Other study ID #: STUDY00004607
• Status: Withdrawn
• Phase: N/A
• First received: March 1, 2016
• Last updated: January 11, 2017
• Start date: August 2016
• Est. completion date: November 2017

Study information

• Verified date: January 2017
• Source: Milton S. Hershey Medical Center
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Observational

Clinical Trial Summary

This study seeks to elucidate the quantitative expression of G - protein receptor 43/free fatty acid (GPR43/FFA2) receptors in patients with the diagnosis of sepsis and specifically, its expression as it relates to the severity of sepsis. The investigators hypothesize that patients with more severe sepsis, as defined by a higher SOFA (Sequential Organ Failure Assessment Score), will have decreased expression of the GPR43/FFA2 as compared to patients with lower SOFA scores, consistent with a less exuberant immune response to infection.

Patients admitted to Penn State Hershey Medical Center with a diagnosis of sepsis of any cause will undergo blood testing of leukocytes to determine the expressed quantity of GP43 during standardized time points of their illness and recovery. No interventions will be made in the standard clinical management of the patient. Additionally, healthy volunteers will be recruited to exam baseline GPR43 receptor expression between sepsis and control groups.

Description:

Despite advancements in recognition and treatment, sepsis continues to be a frequently fatal condition comprising 750,000 cases in the US with an estimated death rate of 28-38%. Bacterial sepsis complications are the result of a cascade of inflammatory mediators secondary to the immune system's recognition and response to invading bacteria, intracellular constituents and metabolites. Bacterial recognition results in the widespread activation of biological mediators essential to the immune response such as cytokines, chemokines, prostaglandins and reactive oxygen species. These compounds result in the activation and up-regulation of neutrophils, monocytes at the cellular level as well as the physiological changes of sepsis such as hyperpyrexia, vasodilation, and tachycardia. Despite this generally coordinated response, it is likely that marked complications are related to the sequela of the uncontrolled immune response leading to significant injury to the lungs (Acute Respiratory Distress Syndrome), and other organs (acute renal failure, shock liver). In addition, there is question that impairment of the gut mucosal barrier may result in translocation of bacteria and perpetuate the multiple organ failure.

G protein-coupled receptors (GPCRs) comprise one of the largest collections of transmembrane proteins in the mammalian genome. Recently, a subfamily of G protein coupled receptors have been identified that utilize short chain free fatty acids as ligands, FFA1 (GPR40), FFA2 (GPR43) and FFA3 (GPR41). Research has intimated that these receptors are involved in essential biological crosstalk between colonic bacteria, host and immune defenses. Although highly conserved in structure, members of this sub family demonstrate differences in fatty acid specificity, intracellular signaling mechanisms and tissue localization. Specifically, FFA2 (GPR43)4 expression has been shown to be expressed in higher magnitudes within immune cells, has been hypothesized to be involved in the modulation of pro- and anti-inflammatory mediators, such as prostaglandin E2 and is involved in neutrophil chemotaxis in mice. GPR43 is involved in the process of differentiation of progenitor immune cells into monocytes and macrophages, a key component of host defense. In addition, highly selective expression of GPR43 in polymorphonuclear cells point to strong role in chemotaxis and recruitment of immune cells to foci of bacterial infection. Short chain fatty acids also activate GPR43 receptors on intestinal epithelial cells with rapid production of secondary chemokine and cytokines after being challenged with inflammation and infection, and likely aid in the coordinated immune response. GP43 is likely an essential component of the phagocytic chemotaxis that maintains normal intestinal immune defense. In a model of acute colitis, GPR43 knockout mice demonstrated increased mortality. The authors concluded that GPR43 deficiency likely suppressed the role of immune cells within the gut immune milieu leading to death from sepsis related complications. Conversely, in a chronic colitis model, GPR43 deficient knockout mice demonstrated reduced colonic inflammation, without overwhelming infection, the authors concluded that GPR43 has an unfavorable role in the manifestation of chronic inflammatory conditions. These findings were confirmed with at least one later study. In humans, fetal membrane expression of GPR43 was higher in parturients in preterm labor with signs of infection.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: November 2017
• Est. primary completion date: August 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Diagnosis of sepsis or septic shock

• Age greater than eighteen years old.

• Ability to give informed consent (as determined by the attending physician) or presence of designated healthcare proxy that can give informed consent.

Exclusion Criteria:

• Patients or designated healthcare proxy with the inability to give informed consent.

• Patients under the age of eighteen

Study Design

Observational Model: Cohort, Time Perspective: Prospective

Related Conditions & MeSH terms

• Intra-abdominal Sepsis
• Multiple Organ Dysfunction
• Sepsis
• Septic Shock
• Shock, Septic
• Toxemia

Intervention

Other:
• phlebotomy
phlebotomy

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Milton S. Hershey Medical Center

References & Publications (13)

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul;29(7):1303-10. — View Citation

Bindels LB, Dewulf EM, Delzenne NM. GPR43/FFA2: physiopathological relevance and therapeutic prospects. Trends Pharmacol Sci. 2013 Apr;34(4):226-32. doi: 10.1016/j.tips.2013.02.002. Review. — View Citation

Brown AJ, Goldsworthy SM, Barnes AA, Eilert MM, Tcheang L, Daniels D, Muir AI, Wigglesworth MJ, Kinghorn I, Fraser NJ, Pike NB, Strum JC, Steplewski KM, Murdock PR, Holder JC, Marshall FH, Szekeres PG, Wilson S, Ignar DM, Foord SM, Wise A, Dowell SJ. The Orphan G protein-coupled receptors GPR41 and GPR43 are activated by propionate and other short chain carboxylic acids. J Biol Chem. 2003 Mar 28;278(13):11312-9. — View Citation

Covington DK, Briscoe CA, Brown AJ, Jayawickreme CK. The G-protein-coupled receptor 40 family (GPR40-GPR43) and its role in nutrient sensing. Biochem Soc Trans. 2006 Nov;34(Pt 5):770-3. — View Citation

Cox MA, Jackson J, Stanton M, Rojas-Triana A, Bober L, Laverty M, Yang X, Zhu F, Liu J, Wang S, Monsma F, Vassileva G, Maguire M, Gustafson E, Bayne M, Chou CC, Lundell D, Jenh CH. Short-chain fatty acids act as antiinflammatory mediators by regulating prostaglandin E(2) and cytokines. World J Gastroenterol. 2009 Nov 28;15(44):5549-57. — View Citation

Kim MH, Kang SG, Park JH, Yanagisawa M, Kim CH. Short-chain fatty acids activate GPR41 and GPR43 on intestinal epithelial cells to promote inflammatory responses in mice. Gastroenterology. 2013 Aug;145(2):396-406.e1-10. doi: 10.1053/j.gastro.2013.04.056. — View Citation

Le Poul E, Loison C, Struyf S, Springael JY, Lannoy V, Decobecq ME, Brezillon S, Dupriez V, Vassart G, Van Damme J, Parmentier M, Detheux M. Functional characterization of human receptors for short chain fatty acids and their role in polymorphonuclear cell activation. J Biol Chem. 2003 Jul 11;278(28):25481-9. — View Citation

Masui R, Sasaki M, Funaki Y, Ogasawara N, Mizuno M, Iida A, Izawa S, Kondo Y, Ito Y, Tamura Y, Yanamoto K, Noda H, Tanabe A, Okaniwa N, Yamaguchi Y, Iwamoto T, Kasugai K. G protein-coupled receptor 43 moderates gut inflammation through cytokine regulation from mononuclear cells. Inflamm Bowel Dis. 2013 Dec;19(13):2848-56. doi: 10.1097/01.MIB.0000435444.14860.ea. — View Citation

Senga T, Iwamoto S, Yoshida T, Yokota T, Adachi K, Azuma E, Hamaguchi M, Iwamoto T. LSSIG is a novel murine leukocyte-specific GPCR that is induced by the activation of STAT3. Blood. 2003 Feb 1;101(3):1185-7. — View Citation

Sina C, Gavrilova O, Förster M, Till A, Derer S, Hildebrand F, Raabe B, Chalaris A, Scheller J, Rehmann A, Franke A, Ott S, Häsler R, Nikolaus S, Fölsch UR, Rose-John S, Jiang HP, Li J, Schreiber S, Rosenstiel P. G protein-coupled receptor 43 is essential for neutrophil recruitment during intestinal inflammation. J Immunol. 2009 Dec 1;183(11):7514-22. doi: 10.4049/jimmunol.0900063. — View Citation

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10. — View Citation

Vinolo MA, Ferguson GJ, Kulkarni S, Damoulakis G, Anderson K, Bohlooly-Y M, Stephens L, Hawkins PT, Curi R. SCFAs induce mouse neutrophil chemotaxis through the GPR43 receptor. PLoS One. 2011;6(6):e21205. doi: 10.1371/journal.pone.0021205. — View Citation

Yao YM, Redl H, Bahrami S, Schlag G. The inflammatory basis of trauma/shock-associated multiple organ failure. Inflamm Res. 1998 May;47(5):201-10. Review. — View Citation

* Note: There are 13 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Quantitative FFA2/GPR43 receptor expression as a function of SOFA score	Quantitative expression of FFA2/GPR43 will be measured at specific time intervals and compared to SOFA score.	Time of diagnosis, 24, 72, 168 hour intervals	No