Zhao, Ting2; Li, Yongqing3; Liu, Baoling4; Wu, Erxi5; Sillesen, Martin6; Velmahos, George C7; Halaweish, Ihab8; Alam, Hasan B9
1 Anæstesi- og operationsklinikken HOC, HovedOrtoCentret Rigshospitalet, Rigshospitalet, The Capital Region of Denmark2 Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA.3 Department of Surgery, University of Michigan, Ann Arbor, MI.4 Department of Surgery, University of Michigan, Ann Arbor, MI.5 Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND.6 Department of Anaesthesiology, Amager and Hvidovre Hospital, The Capital Region of Denmark7 Department of Surgery, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA.8 Department of Surgery, University of Michigan, Ann Arbor, MI.9 Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: firstname.lastname@example.org.
BACKGROUND: Sepsis has a profound impact on the inflammatory and hemostatic systems. In addition to systemic inflammation, it can produce disseminated intravascular coagulation, microvascular thrombosis, consumptive coagulopathy, and multiple organ failure. We have shown that treatment with suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor (HDACI), improves survival in a lethal model of cecal ligation and puncture (CLP) in mice, but its effect on coagulation remains unknown. The goal of this study was to quantify the impact of SAHA treatment on coagulopathy in sepsis. METHODS: C57BL/6J mice were subjected to CLP, and 1 hour later given intraperitoneally either SAHA dissolved in dimethyl sulfoxide (DMSO) or DMSO only. Sham-operated animals were handled in similar manner without CLP. Blood samples were collected by cardiac puncture and evaluated using the TEG 5000 Thrombelastograph Hemostasis Analyzer System. RESULTS: Compared with the sham group, all animals in DMSO vehicle group died within 72 hours, and developed coagulopathy that manifested as prolonged initial fibrin formation and fibrin cross-linkage time, and decreased clot formation speed, platelet function, and clot rigidity. SAHA treatment significantly improved survival and was associated with improvement in fibrin cross-linkage and clot formation, as well as platelet function and clot rigidity, without a significant impact on the clot initiation parameters. CONCLUSION: SAHA treatment enhances survival and attenuates sepsis-associated coagulopathy by improving fibrin cross-linkage, rate of clot formation, platelet function, and clot strength. HDACI may represent a novel therapeutic strategy for correcting sepsis-associated coagulopathy.