Understanding How Sepsis Causes Kidney Dysfunction
Funder
National Health and Medical Research Council
Funding Amount
$471,770.00
Summary
Acute renal failure is a serious condition that affects up to 20% of patients in Intensive Care Units. Sepsis and septic shock remain the most important causes of acute renal failure in critically ill patients. Despite our ability to support vital organs and resuscitate patients, the incidence and mortality of septic acute renal failure remain unacceptably high at up to 55%. There have been no major advances in our understanding of its pathogenesis and in its prevention or treatment over the las ....Acute renal failure is a serious condition that affects up to 20% of patients in Intensive Care Units. Sepsis and septic shock remain the most important causes of acute renal failure in critically ill patients. Despite our ability to support vital organs and resuscitate patients, the incidence and mortality of septic acute renal failure remain unacceptably high at up to 55%. There have been no major advances in our understanding of its pathogenesis and in its prevention or treatment over the last 50 years. The traditional view is that sepsis-induced renal failure results from reduced perfusion of the kidney secondary to the low blood pressure. In a model of sepsis in sheep with renal failure, we demonstrated, however, that renal blood vessels dilated and blood flow increased. Furthermore, renal function improved following treatment with vasoconstrictor drugs that raised blood pressure and renal blood flow. These findings indicate that renal ischaemia is not the cause of the renal dysfunction in sepsis. We hypothesise that sepsis causes renal vasodilatation, which reduces glomerular filtration rate and renal function, and induces a delayed development of apopotosis. We will study in sepsis 1) the effects of a treatment to increase glomerular filtration rate 2) the development of apoptosis and the effect of an anti-apoptotic drug, and 3) whether there is bioenergetic failure in the kidney in sepsis and the effects of treatments on this. Finally, in septic patients we will measure renal blood flow and determine the effects of our novel treatment on this and renal function. These studies will significantly increase our understanding of the factors causing acute renal failure in sepsis. They are likely to lead to the development of new therapies to improve renal function in sepsis and their effectiveness will be examined in septic animals and patients.Read moreRead less
Protecting Hyposplenic Children And Adults: Identifying Optimal Immunisation Regimens
Funder
National Health and Medical Research Council
Funding Amount
$472,044.00
Summary
Children and adults without normal spleen function are at massively increased risk of overwhelming infection with the pneumococcus bacteria, with 200 times the risk of death from sepsis compared with the normal community. Poor spleen function can be due to an absent spleen (eg after surgery following a car accident) or an underlying medical condition (eg thalassaemia or cancer therapy). Thousands of Australians are affected by this condition and need extra protection from daily antibiotics and a ....Children and adults without normal spleen function are at massively increased risk of overwhelming infection with the pneumococcus bacteria, with 200 times the risk of death from sepsis compared with the normal community. Poor spleen function can be due to an absent spleen (eg after surgery following a car accident) or an underlying medical condition (eg thalassaemia or cancer therapy). Thousands of Australians are affected by this condition and need extra protection from daily antibiotics and additional immunsiations against pneumococcus. A new vaccine against pneumococcus was introduced for Australian infants routinely in 2005 and has prevented many from developing pneumococcal meningitis, sepsis and pneumonia. We wish to see whether this new vaccine, when used with the older existing pneumococcal vaccine, will better protect older children and adults with poor spleen function from the devastating effects of pneumococcus. We will compare different ways of using these vaccines to try to identify the most protective vaccination plan for this vulnerable group of Australians.Read moreRead less
How Does Activated Protein C Create Intact, Non-leaky, Stable Blood Vessels?
Funder
National Health and Medical Research Council
Funding Amount
$564,644.00
Summary
Vascular dysfunction is a common feature of many diseases, including sepsis, diabetes, atherosclerosis, tumours and asthma. These vessels have compromised structural and functional integrity, leading to leakage of blood components and causing inflammation in tissues. Based on our recent findings, this project aims to discover how activated protein C creates normal, healthy non-leaky blood vessels and prevents vascular dysfunction in disease.
Genetic Determinants Of Interleukin-10 Response After Infectious Stimuli
Funder
National Health and Medical Research Council
Funding Amount
$276,000.00
Summary
Interleukin-10 is a key protein in the immune defense against infection, being the principal brake for the immune response. An diminished production of interleukin-10 has been implicated as a major cause of a number of devestating medical conditions including septic shock and acute respiratory distress syndrome. An excessive production of interleukin-10 may also be very harmful, and may be the primary cause of the reduction in immune function in many critically ill patients that leads to hospita ....Interleukin-10 is a key protein in the immune defense against infection, being the principal brake for the immune response. An diminished production of interleukin-10 has been implicated as a major cause of a number of devestating medical conditions including septic shock and acute respiratory distress syndrome. An excessive production of interleukin-10 may also be very harmful, and may be the primary cause of the reduction in immune function in many critically ill patients that leads to hospital acquired infections. These potential key roles of interleukin-10 in seriously ill patients makes it an attractive candidate to target for immune therapies. However, past experience with trials of immune-based therapies such as tumor necrosis factor alpha have taught us that we need to be much better at predicting individual immune responses if we are to 'interfere' with the immune system successfully. In the case of interleukin-10 there is substantial individual variation in the amount produced, with studies suggesting up to 70% of this variation is due to genetic differences. This project will establish the basis for this genetic variation by identiying both the genetic markers of high and low interleukin-10 response and the mechanisms by which these genetic markers change interleukin-10 production. This information will not only enable us to better target patients who may need an 'adjustment' of their immune function, but may also lead to novel therapeutic targets or therapeutic agents.Read moreRead less
The Role Of The Microphthalmia Transcription Factor Family In Macrophage Differentiation.
Funder
National Health and Medical Research Council
Funding Amount
$367,193.00
Summary
Macrophages are large white blood cells that are also found in all the tissues of the body. They are a major part of the front line defence against infection and malignancy, but they also cause much of the pathology of many diseases particularly those in which there is chronic inflammation. Macrophages, like all the cells of the blood, are produced from the bone marrow. In the process of macrophage production a suite of genes must be switched on so that the mature macrophage can carry out its fu ....Macrophages are large white blood cells that are also found in all the tissues of the body. They are a major part of the front line defence against infection and malignancy, but they also cause much of the pathology of many diseases particularly those in which there is chronic inflammation. Macrophages, like all the cells of the blood, are produced from the bone marrow. In the process of macrophage production a suite of genes must be switched on so that the mature macrophage can carry out its functions. This project aims to understand the process of selective gene expression in macrophages. It is based upon the identification of four members of a gene family, called the microphthalmia gene family, as candidate master genes that control the overall process of macrophage production. We seek to understand how the products of genes interact.Read moreRead less
Regulation Of Leukocyte Trafficking By Macrophage Migration Inhibitory Factor (MIF).
Funder
National Health and Medical Research Council
Funding Amount
$239,250.00
Summary
The entry of white blood cells in to tissues is a primary event which drives tissue and organ damage in a number of inflammatory and immune mediated conditions. Diseases as diverse as rheumatoid arthritis, lupus or shock due to bacterial infection (septic shock) have many different triggers and manifestations. However almost all autoimmune and inflammatory diseases have one common feature: white blood cells must leave the blood and enter tissue in order to cause tissue inflammation and ultimatel ....The entry of white blood cells in to tissues is a primary event which drives tissue and organ damage in a number of inflammatory and immune mediated conditions. Diseases as diverse as rheumatoid arthritis, lupus or shock due to bacterial infection (septic shock) have many different triggers and manifestations. However almost all autoimmune and inflammatory diseases have one common feature: white blood cells must leave the blood and enter tissue in order to cause tissue inflammation and ultimately tissue damage and loss of function. The mechanism whereby white blood cells leave the blood stream and cross blood vessel walls to get into tissues is a multi-step process often referred to as white blood cell trafficking. Most of the current treatments for immune and inflammatory conditions have the primary aim of keeping white blood cells out of tissue in order to prevent damage. Some of these treatments, like steroids (cortisone), are very effective but cannot be used for prolonged periods because of the risk of problems like bone thinning (osteoporosis), high blood pressure or diabetes. Other treatments and immunosuppressive agents can also be effective but are themselves associated with toxicity and risk of organ damage. Although substantial progress has been made in the management of immune and inflammatory conditions in the last 50 years, the current treatment options are far from ideal. Macrophage migration inhibitory factor (MIF) is an inflammatory substance released by cells which comprise the blood vessel wall as well as by white blood cells themselves. It is known to contribute to the build up of white blood cells in inflamed tissue. The effect of MIF on white blood cell trafficking has never been examined. Understanding how MIF promotes white cell entry in to tissues could be crucial in our understanding of this important process and blocking MIF may prove to be a useful and effective way to prevent it.Read moreRead less
The Molecular Physiology Of Streptococcus Pneumoniae During Sepsis
Funder
National Health and Medical Research Council
Funding Amount
$232,504.00
Summary
The project will determine the way in which pneumococcus changes its properties when it invades the bloodstream of the human host. Since these changes are linked to sepsis then this new understanding will provide information that can be used to manage and control acute pneumococcal infection.