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Histone deacetylase III as a potential therapeutic target for the treatment of lethal sepsis

Zhao, Ting MD; Li, Yongqing MD, PhD; Liu, Baoling MD; Bronson, Roderick T. DVM; Halaweish, Ihab MD; Alam, Hasan B. MD

Journal of Trauma and Acute Care Surgery: December 2014 - Volume 77 - Issue 6 - p 913–919
doi: 10.1097/TA.0000000000000347
WTA 2014 Plenary Papers

BACKGROUND: We have recently demonstrated that inhibition of histone deacetylase (HDAC) Class I, II, and IV with nonspecific HDAC inhibitors improves survival in a mouse model of lethal cecal ligation and puncture (CLP). However, the consequence of HDAC Class III inhibition is unknown in this model. The aims of the present study were to explore the effect of EX-527, a selective Sirtuin 1 (SIRT1) inhibitor, on survival in the lethal model of CLP-sepsis and to assess the impact of the treatment on inflammatory cytokine production, coagulopathy, and bone marrow atrophy during severe sepsis.

METHODS: For Experiment I, C57BL/6J mice were subjected to CLP and, 1 hour later, intraperitoneally injected with either EX-527 dissolved in dimethyl sulfoxide (DMSO) or DMSO only. Survival was monitored for 10 days. For Experiment II, 1 hour after CLP animals were randomly treated with (1) DMSO vehicle and (2) EX-527. Peritoneal fluid and blood samples were collected for measurement of cytokines, and blood was also used to evaluate coagulation status using thrombelastography. In addition, long bones (femurs and tibias) were examined to determine morphologic changes in the marrow by hematoxylin and eosin staining. For Experiment III, normal primary splenocytes were cultured and treated with lipopolysaccharide in the presence or absence of EX-527 to assess cytokine production.

RESULTS: EX-527 significantly improved survival (50% vs. 0% survival as compared to vehicle, p = 0.0007) and attenuated levels of cytokines tumor necrosis factor α and interleukin 6 in the blood and the peritoneal fluid compared with the vehicle control. It also decreased tumor necrosis factor α and interleukin 6 production by splenocytes in vitro. Selective inhibition of SIRT1 was associated with significant improvements in fibrin cross-linkage, platelet function, and clot rigidity but had no significant impact on the clot initiation parameters. Moreover, inhibition of SIRT1 was associated with a significant decrease in bone marrow atrophy.

CONCLUSION: Selective inhibition of Class III HDAC SIRT1 significantly improves survival, attenuates cytokine levels and sepsis-associated coagulopathy, and decreases bone marrow atrophy in a lethal mouse septic model.

From the Department of Surgery (T.Z.), Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Department of Surgery (Y.L., B.L., I.H., H.B.A.), University of Michigan Hospital, Ann Arbor, Michigan; and Department of Microbiology and Immunobiology (R.T.B.), Harvard Medical School, Boston, Massachusetts.

Submitted: January 28, 2014, Revised: March 21, 2014, Accepted: March 31, 2014, Published online: July 21, 2014.

This study was presented at the 44th Annual Meeting of the Western Trauma Association, March 2–7, 2014, in Steamboat Springs, Colorado.

Address for reprints: Hasan B. Alam, MD, Department of Surgery, 2920 Taubman Center/5331, University of Michigan Hospital, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5331; email:

© 2014 Lippincott Williams & Wilkins, Inc.