TY - JOUR

T1 - Circulating levels of vasoactive peptides in patients with acute bacterial meningitis

AU - Berg, Ronan Martin Griffen

AU - Strauss, Gitte Irene

AU - Tofteng, Flemming

AU - Qvist, Tavs

AU - Edvinsson, Lars

AU - Fahrenkrug, Jan

AU - Qvist, Jesper

AU - Fonsmark, Lise

AU - Skinhøj, Peter

AU - Møller, Kirsten

N1 - Keywords: Acute Disease; Adult; Aged; Brain; Calcitonin Gene-Related Peptide; Endothelin-1; Female; Humans; Intensive Care; Lipopolysaccharides; Male; Meningitis, Bacterial; Middle Aged; Vasoactive Intestinal Peptide Times Cited: 1ArticleEnglishBerg, R. M. GUniv Hosp Rigshosp, Dept Infect Dis, Ctr Inflammat & Metab, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkCited References Count: 15498VCSPRINGER233 SPRING ST, NEW YORK, NY 10013 USANEW YORK

PY - 2009/9/1

Y1 - 2009/9/1

N2 - 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.

AB - 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.

U2 - 10.1007/s00134-009-1515-3

DO - 10.1007/s00134-009-1515-3

M3 - Journal article

C2 - 19513693

VL - 35

SP - 1604

EP - 1608

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

SN - 0935-1701

IS - 9

ER -