Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 41, Issue 5, Pages 1091-1102Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X20948612
Keywords
Cardiac arrest; resuscitation; immune response; immunosuppression; HPA
Categories
Funding
- American Heart Association [16GRNT30270003, 18CSA34080277]
- National Institutes of Health [R56HL126891]
- Department of Anesthesiology (Duke University Medical Center)
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In patients who are successfully resuscitated after initial cardiac arrest, post-CA outcomes are affected by neuroinflammation in the brain and activation of the hypothalamic-pituitary-adrenal axis, leading to severe immunosuppression characterized by lymphoid organ atrophy and reduced immune function. Targeting the HPA axis could be a potential therapeutic approach to preserve immune homeostasis and improve prognosis in post-resuscitation CA patients.
In patients who are successfully resuscitated after initial cardiac arrest (CA), mortality and morbidity rates are high, due to ischemia/reperfusion injury to the whole body including the nervous and immune systems. How the interactions between these two critical systems contribute to post-CA outcome remains largely unknown. Using a mouse model of CA and cardiopulmonary resuscitation (CA/CPR), we demonstrate that CA/CPR induced neuroinflammation in the brain, in particular, a marked increase in pro-inflammatory cytokines, which subsequently activated the hypothalamic-pituitary-adrenal (HPA) axis. Importantly, this activation was associated with a severe immunosuppression phenotype after CA. The phenotype was characterized by a striking reduction in size of lymphoid organs accompanied by a massive loss of immune cells and reduced immune function of splenic lymphocytes. The mechanistic link between post-CA immunosuppression and the HPA axis was substantiated, as we discovered that glucocorticoid treatment, which mimics effects of the activated HPA axis, exacerbated post-CA immunosuppression, while RU486 treatment, which suppresses its effects, significantly mitigated lymphopenia and lymphoid organ atrophy and improved CA outcome. Taken together, targeting the HPA axis could be a viable immunomodulatory therapeutic to preserve immune homeostasis after CA/CPR and thus improve prognosis of post-resuscitation CA patients.
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