Abstract
Purpose
The underlying mechanisms for cerebral blood flow (CBF) abnormalities in acute bacterial meningitis (ABM) are largely unknown. Putative mediators include vasoactive peptides, e.g. calcitonin-gene related peptide (CGRP), vasoactive intestinal peptide (VIP), and endothelin-1 (ET-1), all of which may be affected by therapeutic interventions used in the intensive care unit. We measured arterial levels as well as the net cerebral flux of these peptides in patients with ABM, and in healthy volunteers undergoing interventions relevant to intensive care.
Methods
Seven patients with severe ABM and sepsis and fifteen healthy volunteers were included after informed consent. The net cerebral fluxes of vasoactive peptides were measured by the Kety-Schmidt technique in ABM patients (baseline study only), as well as in volunteers at baseline, during voluntary hyperventilation, after an intravenous injection of lipopolysaccharide (LPS), and during norepinephrine infusion.
Results
The arterial levels of CGRP, but not of VIP or ET-1, were elevated in patients with ABM, but no net cerebral flux was present. CGRP levels decreased during hyperventilation and after LPS injection. No net cerebral flux of VIP occurred in any group at any time. A cerebral efflux of ET-1, which occurred in volunteers at baseline, was neither present in volunteers after LPS injection nor in patients with ABM.
Conclusion
The arterial concentration of the vasodilatory peptide, CGRP, but of neither VIP nor the vasoconstrictor ET-1, is elevated in patients with ABM and sepsis. A constitutive cerebral output of ET-1 appears to be present in healthy humans, but is abolished after LPS injection.
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Acknowledgments
Supported by grants from The Foundation in Commemoration of Holger and Ruth Hesse, The Foundation for Clinical Research in Copenhagen Hospital Corporation, The AP Møller Foundation, The Larsen Foundation, The Skovgaard Foundation, The Hørslev Foundation, The University of Copenhagen, The Danish National Health Research Council, The Laerdal Foundation, The Maigaard Foundation, The Novo Nordisk Foundation, The P. Carl Pedersen Foundation, and The Gangsted Foundation. The Centre of Inflammation and Metabolism is supported by grants from the Danish National Research Foundation (DG 02-512-555) and the Commission of the European Communities (contract no. LSHM-CT-2004-005272 EXGENESIS).
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Berg, R.M.G., Strauss, G.I., Tofteng, F. et al. Circulating levels of vasoactive peptides in patients with acute bacterial meningitis. Intensive Care Med 35, 1604–1608 (2009). https://doi.org/10.1007/s00134-009-1515-3
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DOI: https://doi.org/10.1007/s00134-009-1515-3