O Papel do óxido nítrico na patogênese da leptospirose experimental em hamsters e camundongos / The role of nitric oxide in the pathogenesis of experimental leptospirosis in hamsters and mice

A patogênese da leptospirose é pouco compreendida e os estudos com. enfoque na resposta inflamatória sistêmica ou local são escassos, em especial no que se refere ao papel do óxido nítrico (NO) e da enzima óxido nítrico sintase induzível (iNOS). Dados de ensaios em culturas de células renais sugerem um papel importante da liberação de mediadores inflamatórios, tais como NO, na resposta às leptospiras e consequente nefrite intersticial. A transposição destes achados para o modelo in vivo foi pouco explorada. Por outro lado, estudos em humanos sugerem que a liberação sistêmica de NO correlaciona-se com a gravidade da doença renal e, portanto, pode ser um potencial alvo para terapia adjuvante à antibioticoterapia. O presente trabalho estudou a correlação da iNOS com distúrbios hidroeletrolíticos na patogênese da leptospirose. No modelo experimental de hamsters, avaliamos a associação da inibição dos efeitos do NO, através da terapia combinada de antibioticoterapia padrão e azul de metileno, com distúrbios eletrolíticos, alterações histopatológicas em hamsters e sobrevida. Nenhum benefício da terapia adjuvante com azul de metileno foi demonstrado. No modelo de camundongos transgênicos, investigamos o efeito da ausência do gene da iNOS na nefrite intersticial e na quantidade de bactérias observadas nos tecidos. A ausência do gene iNOS esteve associado a menor frequência de nefrite intersticial grave. Maiores estudos são necessários para investigar a função da inibição da produção de NO na patogenia da doença e da nefrite associada a leptospirose.

The pathogenesis of leptospirosis is poorly understood, and there are few studies fusing on the systemic or local inflammatory responses, especially referring to the role of nitric oxide (NO) and the enzyme inducible nitric oxide synthase (iNOS). Data from in vitro studies suggest an important role of inflammatory mediators, such as NO, in the response to leptospires in the development of interstitial nephritis. The transposition of these findings to an in vivo model was little explored. However, studies in humans suggest that systemic liberation of NO is correlated with severity of renal disease and therefore can be potential target to adjuvant therapy along with antibiotic therapy. The present work evaluated the correlation of iNOS with the pathogenesis of leptospirosis. In the experimental hamster model, we evaluated the effect of inhibiting downstream effects of NO on electrolytic disorders, histopathological changes and survival. No benefit of methylene blue treatment could be observed when compared to antibiotic (ampicillin) therapy only. In the mouse transgenic model, we investigated the effect of the absence of the Inos gene in interstitial nephritis and in the bacterial burden in target tissues. The absence of a functional iNOS gene was associated with lower frequency of severe interstitial nephritis.

Ionic imbalance and lack of effect of adjuvant treatment with methylene blue in the hamster model of leptospirosis

Leptospirosis in humans usually involves hypokalaemia and hypomagnesaemia and the putative mechanism underlying such ionic imbalances may be related to nitric oxide (NO) production. We previously demonstrated the correlation between serum levels of NO and the severity of renal disease in patients with severe leptospirosis. Methylene blue inhibits soluble guanylyl cyclase (downstream of the action of any NO synthase isoforms) and was recently reported to have beneficial effects on clinical and experimental sepsis. We investigated the occurrence of serum ionic changes in experimental leptospirosis at various time points (4, 8, 16 and 28 days) in a hamster model. We also determined the effect of methylene blue treatment when administered as an adjuvant therapy, combined with late initiation of standard antibiotic (ampicillin) treatment. Hypokalaemia was not reproduced in this model: all of the groups developed increased levels of serum potassium (K). Furthermore, hypermagnesaemia, rather than magnesium (Mg) depletion, was observed in this hamster model of acute infection. These findings may be associated with an accelerated progression to acute renal failure. Adjuvant treatment with methylene blue had no effect on survival or serum Mg and K levels during acute-phase leptospirosis in hamsters. .