Abstract

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis 3.0) recommended defining sepsis as a life-threatening organ dysfunction caused by the host's uncontrolled response to infection. The bromodomain and extra-terminal (BET) protein family (such as BRD2, BRD3, and BRD4), an epigenetic regulator of gene transcription, has recently been recognized as a significant septic regulator of inflammation and immune response, including cytokine and chemokine production. Mechanistically, the two N-terminal conserved tandem bromodomains (namely the first bromodomain [BD1] and the second bromodomain [BD2]) favor the binding of BETs to acetylated histones or transcription factors, thereby initiating gene transcription machinery after CycT1 and CDK9 (also known as P-TEFb) are recruited to gene promoters to phosphorylate RNA pol II. Notably, BD1 and BD2 are not functionally redundant because they have different target genes in innate immune cells. Small-molecule BET inhibitors (BETis) for different BDs, such as I-BET, JQ1, I-BET151, apabetalone, RVX-297, and dBET1 have shown promising therapeutic effects in experimental sepsis models. This mini-review summarizes the emerging roles of BETs and the applications of BETis in sepsis, discusses the existing shortcomings of BETis, and introduces possible future research directions in this area.

Highlights

  • Sepsis is a medical condition driven by an unrestricted host response to infection and subsequent multiple organ dysfunction or failure (Singer et al, 2016)

  • Once patients develop septic shock with multiple organ dysfunction syndrome (MODS), the mortality rate can reach as high as 70% (Rudd et al, 2020)

  • Since the production of inflammation and immune response genes involved in sepsis is strictly controlled at the transcriptional, posttranscriptional, translational, and posttranslational levels, targeting these regulatory pathways may reasonably provide potential treatment strategies for sepsis (Carson et al, 2011; Vachharajani and McCall, 2019)

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Summary

Pharmacological Modulation of BET Family in Sepsis

The bromodomain and extra-terminal (BET) protein family (such as BRD2, BRD3, and BRD4), an epigenetic regulator of gene transcription, has recently been recognized as a significant septic regulator of inflammation and immune response, including cytokine and chemokine production. BD1 and BD2 are not functionally redundant because they have different target genes in innate immune cells. Small-molecule BET inhibitors (BETis) for different BDs, such as I-BET, JQ1, I-BET151, apabetalone, RVX-297, and dBET1 have shown promising therapeutic effects in experimental sepsis models. This mini-review summarizes the emerging roles of BETs and the applications of BETis in sepsis, discusses the existing shortcomings of BETis, and introduces possible future research directions in this area

INTRODUCTION
BETs and Sepsis
Expression of BETs
Structure of BETs
Target molecule and main action
Function of BETs
Application of BETis in Sepsis and Septic Shock
CONCLUSION AND OUTLOOK
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