A large-bolus injection, but not a continuous infusion of sodium selenite improves outcome in peritonitis. Shock32:140-146, 2009. To the Editor: We read with interest the article by Wang et al. (1) reporting beneficial effects of a large bolus of sodium selenite in a sheep model of septic shock. Administration of 2 mg sodium selenite as a bolus, but not a continuous infusion, delayed hypotension and lactic acidosis, alleviated microvascular alterations, lowered plasma IL-6, and prolonged survival in septic sheep. These findings are intriguing, being obtained at a dose of selenite known to promote pro-oxidant effects (1). Selenium exerts its biological activity through its incorporation into selenoproteins, including glutathione peroxidases and thioredoxin reductases, which function as antioxidant enzymes (2). Conversely, when present in excess for the needs of selenoprotein synthesis, selenium (mainly as selenite) becomes pro-oxidant via catalytic redox cycling (3, 4). Redox cycling agents accept one electron from various reductants, notably glutathione, and, in the presence of oxygen, are oxidized back to the original parent by donating this electron to oxygen, producing superoxide (·O2−). Repetition of the cycle builds up progressive oxidative stress by depleting reducing equivalents and by generating free radicals (5). Since oxidative stress represents a critical pathophysiological mechanism in septic shock (6), the benefits of a pro-oxidant dose of selenium appear paradoxical. It is here important to point out that oxidants and free radicals, beyond their direct cytotoxic potential, also exert multiple indirect effects by modulating redox-sensitive signal transduction pathways (7). A prototypical example is the transcription factor nuclear factor κB (NF-κB), a master regulator of inflammation, crucial for the coordinated transactivation of inflammatory mediators in sepsis (8). Nuclear factor κB is normally retained in the cytoplasm of resting cells, bound to an inhibitory IκB protein. Upon stimulation by cytokines or microbial components, NF-κB dissociates from IκB after IκB phosphorylation by a protein kinase complex termed IκB kinase (IKK), allowing NF-κB to translocate into the nucleus and activate target genes (9). Redox regulation of NF-κB is a complex and controversial issue. Although NF-κB can be activated in some cell types by oxidants through yet incompletely understood mechanisms, evidence is accumulating that redox stress can rather abrogate NF-κB activation by cytokines (9). As mentioned by Wang et al. (1), NF-κB-DNA binding can be disrupted through oxidation of essential thiols within NF-κB. We propose an alternate molecular mechanism, relying in the inactivation of IKK, the upstream kinase in the NF-κB pathway. Phosphorylation of serines 177/181 is required for IKK activation by cytokines, a mechanism that can be inhibited by redox modifications of interjacent cysteine 179: sulfhydryl oxidation or S-nitrosylation of cysteine 179 blocks IKK serine phosphorylation and activity (10). We (9) and others (11, 12) have thus shown that reactive oxygen and nitrogen species abrogated IKK activation and downstream signaling in response to cytokines. Such peculiar redox sensitivity of IKK may provide the molecular basis for the decreased inflammation elicited by the pro-oxidant doses of selenium in the study by Wang et al. (1). Future studies should be designed to precisely monitor the process of IKK-dependent NF-κB activation and its modulation by oxidants in sepsis, which might open the way to innovative anti-inflammatory strategies in this setting. Noureddine Loukili Lucas Liaudet University Hospital Lausanne, Switzerland
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