Cardiorenal Syndrome Type 5 (CRS Type 5) is characterized by concomitant cardiac and renal dysfunction in the setting of different systemic disorders, such as sepsis. In this study, we investigated the possible relationship between endotoxin levels, renal cell death and inflammation in patients with CRS Type 5.
We enrolled 11 patients with CRS type 5 and 16 healthy controls (CTR). Serum endotoxin activity was measured by the EAAtm. Plasma from patients and CTR was incubated with renal tubular cells (RTCs) and cell death levels were evaluated. Plasma cytokines levels were measured as well.
Accordingly to EAA levels, patients were divided into two groups: 36.3% of patients had low endotoxin activity level (negative EAA), while 63.6% of patients showed high endotoxin activity level (positive EAA). Renal cell death, pro- and anti-inflammatory cytokines were all significantly elevated in the CRS Type 5 patients. In particular, RTCs incubated with plasma from EAA positive patients showed significantly higher apoptosis levels and higher caspase-3 activation compared to cells incubated with plasma from EAA negative patients. Moreover, a significant positive correlation was observed between EAA levels and RTC apoptosis levels. Furthermore, IL-6 and IFN-γ levels were significantly higher in CRS Type 5 patients with positive EAA.
In conclusion, this study confirms the high immune deregulation and the strong inflammation in CRS type 5 patients, especially in those with high endotoxin activity. Our data demonstrate, indeed, a strong relationship between endotoxin levels, renal apoptosis and inflammatory markers levels in patients with CRS Type 5.
