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Anesth Analg 2008; 106:1150-1160
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e3181683d37
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ANESTHETIC PHARMACOLOGY

Sevoflurane-Mediated Activation of p38-Mitogen-Activated Stresskinase is Independent of Apoptosis in Jurkat T-Cells

Martin Roesslein, MD*, Michael Frick, MD§, Volker Auwaerter, PhD{dagger}, Matjaz Humar, PhD*, Ulrich Goebel, MD*, Christian Schwer, MD*, Klaus K. Geiger, MD*, Heike L. Pahl, PhD*, Benedikt H. J. Pannen, MD{ddagger}, and Torsten Loop, MD*

From the Departments of *Anesthesiology and Critical Care Medicine, {dagger}Forensic Medicine, University Hospital, Freiburg, Germany; {ddagger}Department of Anesthesiology and Critical Care Medicine, University Hospital, Duesseldorf; §Department of Medicine, University Hospital, Wuerzburg, Germany.

Address correspondence and reprint requests to Torsten Loop, MD, Anaesthesiologische Universitätsklinik, Hugstetterstrasse 55, D-79106 Freiburg, Germany. Address e-mail to torsten.loop{at}uniklinik-freiburg.de.


   Abstract
Top
 Abstract
Introduction
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
BACKGROUND: Modulation of the inflammatory stress response by anesthesia may be responsible for an increased susceptibility to infectious complications, such as wound infection or pneumonia. Sevoflurane, a specific inhibitor of activator protein-1, an immediate early transcription factor, induces apoptosis in T-cells. Because p38 can be involved either in pro- or antiapoptotic processes, we examined whether the sevoflurane-induced apoptosis is mediated by p38 activation in Jurkat T-cells.

METHODS: Jurkat T-cells were exposed to different concentrations of sevoflurane, isoflurane, or desflurane in vitro. Phosphorylation of mitogen-activated protein (MAP) kinases, upstream kinases, downstream activating transcription factor 2 ATF-2, and caspase-3 processing were evaluated by Western blot. p38 kinase activity was evaluated after immunoprecipitation and phosphorylation of the substrate ATF-2 using Western blot. Apoptosis was assessed using flow cytometry after staining with green fluorescent protein-annexin V.

RESULTS: While desflurane had no effect, sevoflurane and isoflurane induced p38 phosphorylation with sevoflurane inducing p38 kinase activity. Sevoflurane did not affect the MAP kinases ERK and JNK. Sevoflurane exposure also induced phosphorylation of apoptosis signal-regulating kinase-1 (ASK1), MAP kinase kinases 3 and 6 (MKK3/MKK6), and ATF-2. Pretreatment of cells with the general caspase inhibitor Z-VAD.fmk did not prevent the sevoflurane-induced phosphorylation of p38. Isoflurane- and sevoflurane-mediated caspase-3 processing and apoptosis could not be abolished by pretreatment with the specific p38 inhibitors SB202190 and SB203580.

CONCLUSIONS: Sevoflurane is a specific activator of the apoptosis signal-regulating kinase-1-, MKK3/MKK6-p38 MAP kinase cascade in Jurkat T-cells. Our data suggest that sevoflurane-induced p38 activation is not affected by caspase activation. Furthermore, sevoflurane-induced apoptosis is not dependent on p38 MAP kinase activation.


   Introduction
Top
 Abstract
 Introduction
METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
General anesthesia is able to modulate the inflammatory stress response characterized by peripheral leukocytosis and T-cell lymphopenia.1–6 This may result in an increased susceptibility to infectious complications, such as pneumonia or wound infection, after major surgery with concomitant anesthesia.6 Apoptosis is a genetically controlled and active form of cell death, which occurs both under physiologic as well as pathologic conditions. During apoptosis, a specific class of cysteine proteases, called caspases, are activated in an amplifying proteolytic cascade.7 Apoptosis is the predominant mechanism regulating immunological homeostasis and the termination of surgical injury-induced inflammation.2,3 However, to avoid these side affects and to improve the specificity of anesthetics, the molecular mechanisms responsible for anesthetic-mediated immunomodulation need to be identified.

The mitogen-activated protein (MAP) kinase cascades are multifunctional signaling pathways composed of three distinct subgroups: (1) extracellular signal-regulated kinases (ERKs), (2) c-Jun NH2-terminal (JNK) or stress activated protein kinases, and (3) the p38 group of protein kinases. The three principal MAP kinase pathways mediate changes in cellular gene expression in response to extracellular stimuli. The p38 MAP kinase is an important mediator of apoptosis in T-lymphocytes induced by various drugs.8–13 p38 MAP kinase is activated by an upstream MAP kinase kinase termed MKK3/MKK6. MKK3/MKK6 in turn was reported to be activated by a new MAP kinase kinase kinase, called apoptosis signal-regulating kinase1 (ASK1).14

We have demonstrated that volatile anesthetics, in particular sevoflurane, trigger apoptosis and inhibit the transcription factor activator protein-1 in primary CD3+ T-lymphocytes as well in Jurkat T-cells, which may be exerted by interfering with the p38 MAP kinase cascade.15,16 However, the precise molecular mechanism of the immunosuppressive action remains to be identified. Despite a large number of in vitro studies regarding the function of p38 MAP kinase, the role of p38 in cell death and proliferation remains controversial. Several studies have shown that p38 MAP kinase mediates apoptosis in different cell types.17–20 Other studies have described the antiapoptotic effects of the p38 MAP kinase pathway.21,22

From these and the above mentioned data, three hypotheses can be proposed: (i) sevoflurane-mediated apoptosis leads to activation of p38, (ii) induction of apoptosis is triggered by p38 MAP kinase activation, or (iii) sevoflurane-mediated p38 activation and induction of apoptosis may be unrelated. The aim of this study was to identify the induction of the p38 MAP kinase cascade and the possible association with apoptosis mediated by volatile anesthetics in Jurkat T-cells in vitro.


   METHODS
Top
 Abstract
 Introduction
 METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Reagents
The following anesthetics were used: sevoflurane, isoflurane (Abbott, Wiesbaden, Germany), and desflurane (Baxter, Unterschleissheim, Germany). The remaining reagents were purchased from Sigma (Deisenhofen, Germany) unless specified otherwise.

Cell Culture
We used a well-established cultured T-cell line the Jurkat T-cells as a model. In order to confirm the similarity between the signaling mechanisms in CD3+ T-lymphocytes and Jurkat T-cells, MAP kinase phosphorylation was evaluated under the same experimental conditions.16 Jurkat T-cells (ACC 282, DSMZ, Braunschweig, Germany) were cultured and grown in RPMI 1640 medium supplemented with 10% fetal calf serum, 1% glutamine and 50 mg/mL penicillin and streptomycin (all from Gibco-BRL, Karlsruhe, Germany) in a humidified atmosphere containing 5% carbon dioxide at 37°C as previously described.16

Exposure to Volatile Anesthetics and Experimental Protocol
Jurkat T-cells were exposed according to the same experimental protocol as previously described.16 Volatile anesthetic concentrations were monitored at the chamber exit port using a ventilation monitor (PM 8050, Dräger, Lübeck, Germany). Concentrations of sevoflurane dissolved in the cell culture medium were determined by headspace gas chromatography-mass spectrometry (Agilent 5973N/6890N, Waldbronn, Germany, equipped with a CTC CombiPal Autosampler, CTC Analytics AG, Zwingen, Switzerland). Data were acquired in selected ion monitoring mode using m/z = 69 as quantifier and nitrogen (N22+, m/z = 14) as internal standard. Good linearity was achieved in the range of 6-300 µg/mL (R2 >0.99, 10-point calibration). Based on this method, a mean concentration of 1170 µmol/L sevoflurane was measured in the culture medium after 24 h of incubation with sevoflurane at a concentration corresponding to 8 Vol.% on the Vapor dial ("8" Vapor Vol.%).

Total Protein Cell Extracts
Total protein cell extracts were prepared using a high-salt detergent buffer "Totex" (20 mM HEPES, pH 7.9, 350 mM NaCl, 20% (v/v) glycerol, 1% (w/v) NP-40, 1 mM MgCl2, 0.5 mM ethylene diamine tetra acetic acid, 0.1 mM EGTA). Inhibitors of proteinases and phosphatases were added at the following concentrations to the extraction and suspension buffer: 10 µg/mL aprotinin, 25 µM leupeptin, 2 mM phenyl-methylsulfonyl-fluoride, 2 mM iodoacetamide, 10 mM sodium fluoride, 0.2 mM sodium orthovanadate, 0.1 mM β-glycerophosphate, and 0.1 mM sodium pyrophosphate. Cells were harvested by centrifugation, washed once in ice-cold phosphate-buffered saline and resuspended in four cell volumes of the detergent buffer. The cell lysate was incubated for 30 min on ice, and then centrifuged for 5 min at 13000g at 4°C. The supernatant containing the cell protein lysate was stored at –80°C.

Sodium-Dodecyl-Sulfate-Polyacrylamide Gel Electrophoresis and Western Blotting
Total cell extracts of Jurkat T-cells (30 µg) were boiled in Laemmli sample buffer and subjected to 10% sodium-dodecyl-sulfate-polyacrylamide gel electrophoresis. Western blotting was performed according to the protocol previously described.15,16 Membranes were incubated in a recommended dilution of specific antibodies (phospho-p38 #9211, p38 #9212, phospho-ERK #9101, ERK #9102, phospho-JNK #9251, JNK #9258, phospho-ASK (Ser83) #3761, phospho-ASK (Ser967) #3764, ASK #3762, phospho-MKK3/MKK6 #9231, MKK3/MKK6 #9232, phospho-activating transcription factor-2 (ATF-2) #9221, ATF-2 #9226, caspase-3 #9662, cleaved caspase-3 #9661, all 1:1000, all Cell Signaling Technology, Danvers) in 20 mM Tris-HCl (pH 7.6) plus 0.1% Tween-20 plus 5% bovine serum albumine overnight at 4°C. After washing 4 times (5 min each), the immunocomplexes were detected using ECL Western blotting reagents (Amersham-Pharmacia, Freiburg, Germany) according to the manufacturers instructions. Exposure to ECL Western blot films (Amersham-Pharmacia, Freiburg, Germany) was performed for 15 s to 1 min.

p38 MAP Kinase and Fluorogenic Caspase Activity Assay
To investigate the activity of p38 MAP kinase, a nonradioactive p38 MAP kinase activity assay kit (Cell Signaling Technology, Danvers) was used and performed according to the manufacturer’s instructions. In brief, immobilized Phosphop38 MAPK (Thr180/Tyr182) antibody was used to immunoprecipitate p38 MAP kinase before performing an in vitro kinase assay using ATF-2 as a substrate. ATF-2 phosphorylation was then detected by Western blotting using Phospho-ATF-2 (Thr71) Antibody.

Fluorogenic caspase activity assay was performed as previously described.15

Flowcytometric Analysis
After exposure to the volatile anesthetics, Jurkat T-cells were washed in phosphate-buffered saline and resuspended in 50 µL binding buffer (10 mM 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid [HEPES], 140 mM NaCl, 2.5 mM CaCl2, pH 7.9) containing 12.27 µg/mL green fluorescent protein (GFP)-annexin-V und 0.5 µg/mL propidiumiodide. Samples were incubated in the dark at room temperature for 15 min. Subsequently, 450 µL binding buffer was added, and the percentage of early apoptotic lymphocytes was measured using a flow cytometer (FACSR-CaliburFCM, Becton Dickinson, Heidelberg, Germany). Jurkat T-cells were gated using forward scatter and side scatter, and fluorescence intensity was measured in 2 x 105 cells. The fluorescence intensity of GFP-annexin-V was measured in the fluorescence 1 (FL1, 515-545 nm) channel, and the fluorescence intensity of propidiumiodide was measured in the fluorescence 2 (FL2, 564-606 nm) channel.

Quantitative and Statistical Analysis
The fold induction in immunoblot analysis for the phosphorylation status was calculated by performing densitometry of the individual Western blot results using the Chemi-Smart 5000 image acquisition system (Vilber Lourmat, France). The density values of the phosphorylation read-outs were corrected for the density values of the total protein read-outs for each individual intervention to exclude the influence of difference in total amount of protein. The value of the negative control was then set to 1 in order to be able to compare between the different interventions.

Differences in measured variables and densitometric analysis between the experimental conditions were assessed using a one-way analysis of variance on ranks followed by a nonparametric Student-Newman-Keuls test for multiple comparisons. Results were considered statistically significant if P < 0.05. The tests were performed using the Sigma Stat software package (Jandel Scientific, San Rafael, CA).


   RESULTS
Top
 Abstract
 Introduction
 METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Sevoflurane Exposure Induces p38 Phosphorylation and Activity in Jurkat T-Cells
In order to determine whether volatile anesthetics may induce phosphorylation of p38 MAP-kinase, Jurkat T-cells were exposed to different concentrations of sevoflurane (2.5, 5, 8 Vol.%). Phosphorylation was studied by Western blot analysis using a phospho-specific antibody against p38. While exposure of the cells to sevoflurane 2.5 Vol.% had no effect, treatment of the cells with higher concentrations of sevoflurane (5, 8 Vol.%) induced a comparable level of increased phosphorylation of p38 MAP kinase (Fig. 1A, upper panel, lanes 3 and 4). Time kinetic evaluation demonstrated p38 MAP kinase phosphorylation after 12 hours of sevoflurane exposure (Fig. 1B, upper panel, lanes 4–7). p38 MAP kinase activity, measured by phosphorylation of its physiological target ATF-2, was substantially increased after exposure to 8 Vol.% sevoflurane (Fig. 1C, upper panel, lane 2). Sevoflurane-induced ATF-2 phosphorylation was completely inhibited by the specific p38 inhibitor SB 202190 (10 µM; Fig. 1C, upper panel, lane 3). The total amount of p38 MAP kinase was constant throughout each experiment (Fig. 1A, B, and C, lower panels, all lanes).


Figure 119
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  		Figure 1. p38 phosphorylation and activity of Jurkat T-cells after exposure to sevoflurane. Anti-phospho-p38 Western blot analysis and p38 activity assay of Jurkat T-cells after concentration- and time-dependent exposure to sevoflurane (A and B). Phosphorylation was studied by Western blot analysis using a phospho-specific antibody against p38 and densitometric results after Western blot analysis after exposure of the cells to sevoflurane (A and B, upper panel). p38 mitogen-activated protein (MAP) kinase activity was measured by phosphorylation of its physiological target activating transcription factor-2 (ATF-2) (C, upper panel). The total amount of p38 MAP kinase was evaluated by Western blot using a specific antibody against p38 (A, B, and C, lower panels). Data shown are mean and standard deviation. PMA/I denotes phorbol-myristate-acetate and ionomycin. The data shown are representative of six independent experiments. *P < 0.05 vs untreated cells.

 

Isoflurane, but not Desflurane, also Induces p38 Phosphorylation in Jurkat T-Cells
While exposure of the cells to desflurane had no effect on the phosphorylation level of p38 MAP-kinase (Fig. 2B, upper panel, lanes 2-4), treatment of the cells with isoflurane ("2.5" and "5" Vapor Vol.%) induced a comparable level of increased phosphorylation of p38 MAP kinase (Fig. 2A, upper panel, lane 4). Stimulation of cells with phorbol-myristate-acetate (PMA, 15 ng/mL) and ionomycin (I, 700 ng/mL) served as positive controls to validate the negative result.


Figure 219
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  		Figure 2. p38 phosphorylation of Jurkat T-cells after exposure to desflurane and isoflurane. Anti-phospho-p38 Western blot analysis of Jurkat T-cells after concentration-dependent exposure to isoflurane (A) and desflurane (B). Phosphorylation was studied by Western blot analysis using a phospho-specific antibody against p38 and densitometric results after Western blot analysis after exposure of the cells to isoflurane (A, upper panel) or desflurane (B, upper panels) for 24 h. The total amount of p38 mitogen-activated protein (MAP) kinase was evaluated by Western blot using a specific antibody against p38 (A and B, lower panels). Data shown are mean and standard deviation. PMA/I denotes phorbol-myristate-acetate and ionomycin. The data shown are representative of six independent experiments. *P < 0.05 vs untreated cells.

 

Sevoflurane Exposure does not Induce Phosphorylation of c-Jun-NH2-Terminal Kinase (JNK) and p44 (ERK) MAP Kinase in Jurkat T-Cells
In order to assess whether sevoflurane specifically induces p38 phosphorylation or whether other MAP kinases such as ERK and JNK are also activated, we performed additional Western blots using phosphospecific antibodies for ERK and JNK. Treatment of cells with sevoflurane (2.5, 5, 8 Vol.%) did not detectably affect phosphorylation of ERK or JNK kinase (Fig. 3A and B, upper left panels, lanes 2-4). Neither was the phosphorylation of these kinases affected by isoflurane or desflurane (Fig. 3A and B, upper middle and right panels, lanes 2-4). Stimulation of cells with PMA (15 ng/mL) and ionomycin (I, 700 ng/mL) served as positive controls. The total amount of these MAP kinases was constant throughout each experiment (Fig. 3A and B, lower left, middle, and right panels, lanes 1-5).


Figure 319
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  		Figure 3. ERK (A) and JNK (B) phosphorylation after exposure of Jurkat T-cells to sevoflurane. Anti-phospho-ERK (A) and -JNK (B) Western blot analysis of cytosols of Jurkat T-cells exposed to sevoflurane (2.5, 5, and 8 Vol.%, upper panels) for 24 h. The total amount of ERK and JNK was evaluated by Western blot using a specific antibody (A and B, lower panels). PMA/I denotes phorbol-myristate-acetate and ionomycin. The data shown are representative of six independent experiments.

 

Sevoflurane Exposure Induces Phosphorylation of ASK1, MAP Kinase Kinase 3 and 6 (MKK3/MKK6), and ATF-2 in Jurkat T-Cells
In order to determine whether other members of the p38 MAP kinase signaling pathway are also affected by sevoflurane, we analyzed the phosphorylation of the upstream kinases ASK1 and MKK3/MKK6, as well as ATF-2, a target substrate of p38, in Jurkat T-cells after treatment with sevoflurane. Sevoflurane (8 Vol.%) induced phosphorylation of ASK1 at Serine residues 83 and 967 (Fig. 4A, upper and third panel, lane 2). Furthermore, phosphorylation of MKK3/MKK6, which is activated by ASK1, was also induced by sevoflurane (8 Vol.%; Fig. 4B, upper panel, lane 2). In addition, phosphorylation of ATF-2, a substrate of p38, was also induced by sevoflurane (8 Vol.%; Fig. 4C, upper panel, lane 3). Preincubation of cells with SB202190 before sevoflurane exposure reduced sevoflurane-mediated ATF-2 phosphorylation (Fig. 4C, upper panel, lane 4). (Note that this effect, which is seen in whole cell extracts, is weaker than in the in vitro kinase assay using ATF-2 in excess as a substrate.) Stimulation of cells with PMA (15 ng/mL) and ionomycin (700 ng/mL) served as a positive control (Fig. 4A, B, upper panels, lane 3, and C, upper panel, lane 5). The total amount of ASK, MKK3/MKK6, and ATF-2 was constant throughout each experiment (Fig. 4A, second and lower panel, lanes 1-3, B, lower panel, lanes 1-3, and C, lower panel, lanes 1-5).


Figure 419
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  		Figure 4. Effects of sevoflurane on p38 signal transduction pathway. Western blot analyses of cytosols of Jurkat T-cells exposed to sevoflurane for 24 hours: (A) Anti-phospho-ASK1 (Serine residues 83 and 967, upper and third panel), (B) Anti-phospho-MKK3/MKK6 (upper panel), and (C) Anti-phosho-ATF-2. The total amount of the respective protein was evaluated by Western blot using a specific antibody (A, ASK1, second and fourth panel), MKK3/MKK6 (B, lower panel), and ATF-2 (C, lower panel). PMA/I denotes phorbol-myristate-acetate and ionomycin. The data shown are representative of six independent experiments.

 

Sevoflurane-Induced p38 Phosphorylation is Caspase-Independent
Based on the above findings, we evaluated whether sevoflurane-induced p38 phosphorylation was dependent on caspases, or could also be executed in a caspase-independent manner. For that purpose, we performed Western blots using a p38 phosphospecific antibody in the presence (pretreatment 1 h before start of sevoflurane exposure) or absence of the pan-caspase inhibitor N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (Z-VAD.fmk). Z-VAD.fmk did not prevent the phosphorylation of p38 induced by sevoflurane (Fig. 5, upper panel, lane 4 vs 3). Z-VAD.fmk alone had no effect on the phosphorylation of p38 (Fig. 5, upper panel lane 2). The total amount of p38 MAP kinase was constant throughout the experiment (Fig. 5, lower panel, lanes 1-4).


Figure 519
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  		Figure 5. The effect of the general caspase inhibitor Z-VAD.fmk on sevoflurane-induced p38 phosphorylation in Jurkat T-cells. Anti-phospho-p38 Western blot analysis and densitometric results after Western blot analysis of cytosols of Jurkat T-cells exposed to sevoflurane (8 Vol.%, 24 h, upper panel) in the absence or presence of Z-VAD.fmk (20 µM; pretreatment 1 h before start of sevoflurane exposure). The total amount of p38 was evaluated by Western blot using a specific antibody (lower panels). Z-VAD.fmk denotes Z-Val-Ala-Asp (OMe)-fluoro-methyl-ketone. Data shown are mean and standard deviation. The data shown are representative of six independent experiments.

 

Sevoflurane-Induced Apoptosis is not p38 MAP-Kinase-Dependent
To determine whether primary CD3+, as well as Jurkat T-cells, caspase-3 processing of sevoflurane15 is a result of the activation of p38 MAP kinase, we exposed Jurkat T-cells to sevoflurane (8 Vol.%, Fig. 6A) in the presence or absence of specific p38 inhibitors (SB2020190 or SB203580), and studied the processing of p32 procaspase-3 to its active p19/17 forms by immunoblotting. These experiments demonstrated that sevoflurane-induced caspase-3 processing could not be (completely) abolished by pretreatment with the specific p38 inhibitors (Fig. 6A). To confirm and quantify caspase-3 activation, we performed a caspase-3 activity assay of the cytosols of these T-cells by using a specific fluorogenic caspase-3 substrate (DEVD-AMC). Jurkat T-cells exposed to sevoflurane showed a significant increase in caspase-3 activity (Fig. 6B; P < 0.05 vs untreated cells, n = 12 each), while induced caspase-3 processing could not be abolished by pretreatment with the specific p38 inhibitors (Fig. 6B). In addition, GFP-annexin-V/PI staining, an indicator of apoptosis, was not reduced by SB203580 (Fig. 6C, plot 3 vs 2). Statistical analysis of the apoptotic cells of independent experiments revealed no statistically significant effect of pretreatment using SB203580 (Fig. 6D, table: comparison sevoflurane-treated versus sevoflurane plus inhibitor, n = 7; *P < 0.05). The p38 inhibitor SB203580 (5 µM) alone had no influence on the GFP-annexin-V/PI staining (data not shown).


Figure 619
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  		Figure 6. The effects of the p38 inhibitors SB202190 and SB203580 on sevoflurane-induced caspase-3 processing (A), caspase-like activity (B) and phosphatidylserine externalization and plasma membrane integrity (C, D) as markers for apoptosis in Jurkat T-cells. (A) Anti-Caspase-3 Western blot analysis of the cytosols of Jurkat T-cells exposed to the indicated anesthetics for 24 h. p32: inactive caspase-3 proform, p19/p17: processed, active caspase-3 fragments. The data shown are representative of six independent experiments. (B) Fluorogenic caspase-3 assay (DEVDase assay) of the above cytosols. The results are given in arbitrary fluorescent units (RFU). Data represent the mean and standard deviation of six independent experiments. *P < 0.05 vs untreated cells. (C) Representative flowcytometric analysis of Jurkat T-cells stained with GFP-annexin-V and propidiumiodide after exposure to sevoflurane (8 Vol.%, 24 h) in the presence (III) or absence (II) of pretreatment with SB203580. Insets: percentage of cells of each quadrant. (D) Statistical analysis of the flowcytometric data. Data represent the mean and standard deviation of seven independent experiments. *P < 0.05 vs untreated cells.

 


   DISCUSSION
Top
 Abstract
 Introduction
 METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Volatile anesthetics are widely used for the maintenance of anesthesia during major surgery. In addition to their anesthetic effects, volatile anesthetics have been shown to modulate the inflammatory stress response.1,6 This is of particular importance because anesthetics are exclusively administered to patients undergoing surgical procedures, already exposing them to a particular risk of developing infections. A compromised immune status could affect the postoperative infection rate, healing reactions, and the rate and size of tumor metastases disseminated during surgery.6,23–25 Numerous immunomodulatory and immunosuppressive effects of volatile anesthetics on leukocyte and lymphocyte function have been described in vitro.26–29

Here, we present evidence that sevoflurane and isoflurane induce the activation of p38 MAP kinase in Jurkat T-cells. This effect appears to be selective and specific, since (i) sevoflurane and isoflurane act in the same dose-dependent manner, whereas desflurane did not exert an effect, (ii) sevoflurane did not affect the phosphorylation of other MAP kinases such as ERK and JNK. The induction of p38 kinase activity could be completely abolished by the specific p38 inhibitor SB 202190. From our results we conclude that sevoflurane-mediated p38 activation and induction of apoptosis may be unrelated, because blocking of caspase processing by the general caspase inhibitor Z-VAD.fmk was not able to prevent phosphorylation of p38 by sevoflurane. Neither did inhibition of sevoflurane-mediated p38 phosphorylation by specific inhibitors attenuate caspase-3 processing and apoptosis in Jurkat T-cells.

The activation of the p38-MAP kinase pathway mediated by sevoflurane was associated with an activation of the upstream kinases ASK1 and MKK3/MKK6 and accompanied by the phosphorylation of a p38 target, the transcription factor ATF-2. Recent data provide evidence that the ATF/CREB family of transcription factors plays a functional role in ischemia and reperfusion injury. Very few physiologic activators of ATF-2 have been identified. These include reperfusion of ischemic organs and viral infection.30–33

While many stimulants may induce several MAP kinase pathways simultaneously, oxidative stress has been shown to selectively activate p38.34,35 Compared with propofol, volatile anesthetics augment both systemic and local (i.e., pulmonary) oxidative stress.36–39 Thus, it would be possible, and in agreement with our findings, that sevoflurane may activate the p38 MAP kinase pathway by inducing oxidative stress.

The MAP kinase p38 is involved in the molecular mechanisms of adaptive cellular functions after tissue injury due to ischemia and reperfusion.40 For example, activation of p38 MAP kinase by isoflurane before ischemia induces neuroprotection. This effect can be blocked using a p38 inhibitor (SB203580). Zheng et al.41 used a rat model wherein p38 MAP kinase was induced by isoflurane in the cerebral neocortex for at least 24 h. Subsequently, brain ischemic tolerance was measured. Animals, pretreated with isoflurane showed significantly smaller infarct sizes with less necrosis and apoptosis.41 Isoflurane similarly has a preconditioning effect against renal ischemia/reperfusion injury when administered before ischemia. In addition to p38 activation, an inhibition of JNK and ERK might be involved in this mechanism.42

However, little is known about the role of the MAP kinase cascade in apoptosis induced by volatile anesthetics. In the past, the role of p38 MAPK in the context of cell death was mostly considered to be sensitizing to or enhancing apoptosis. For example, it was shown that apoptosis induced in human fibroblasts by the nonsteroidal anti-inflammatory drug sodium salicylate was suppressed by a p38 MAP kinase inhibitor.18 Likewise, p38 MAP kinase inhibition protected PC12 cells from apoptosis after nerve growth factor withdrawal.43 Previous data in our model demonstrated that sevoflurane and isoflurane induce apoptosis in CD3+ T as well as in Jurkat T-cells via increased mitochondrial membrane permeability and caspase-3 activation, but independent of death receptor signaling.15 By contrast, desflurane did not exert any proapoptotic effects.15 Here we demonstrate that sevoflurane mediates the phosphorylation of ASK1 in Jurkat T-cells. ASK1 is a ubiquitously expressed MAP3-kinase, which is able to activate the JNK- and p38-MAP kinase signaling cascades. ASK1 appears to act as a proapoptotic intermediate and multifunctional stress-sensing kinase through mitochondria-dependent caspase activation and is required for apoptosis induced by oxidative stress, tumor necrosis factor, and endoplasmic reticulum stress.44–49

The phosphorylation and induction of p38 activity mediated by sevoflurane was observed in a dose-dependent manner and was also observed at in vitro concentrations, which are higher than those attained in the plasma of patients during administration of sevoflurane for general anesthesia, allowing for only careful conclusions regarding clinical practice.50,51 In addition, conclusions due to the use of Jurkat T-cells instead of primary CD3+ T-cells could be of limited value. However, Jurkat T-cells originate from a T-leukemia cell line and are widely used as a well established T-cell model.52 Besides, sevoflurane-mediated phosphorylation of p38 MAP kinase has been shown for primary CD3+ T-cells.16

We had originally developed three alternative hypotheses regarding the role of p38 in sevoflurane-induced apoptosis. We therefore conclude that the third hypothesis, stating that sevoflurane-mediated p38 activation and induction of apoptosis may be unrelated to one another is the most plausible. Induction of apoptosis leading to activation of p38, our first hypothesis, seems to be less likely, because inactivation of caspase-3 did not inhibit induction of p38 phosphorylation by sevoflurane. Neither could our second hypothesis be confirmed, stating a direct role for p38 in mediating apoptosis by sevoflurane, because treatment of cells with p38 inhibitors before sevoflurane exposure could not attenuate caspase-3 processing and apoptosis in Jurkat T-cells. In contrast, ERK and JNK have been shown to become activated by caspases.53

In summary, our data suggest that sevoflurane (and isoflurane) are specific inducers of the ASK1-, MKK3/MKK6-p38 MAP kinase cascade in Jurkat T-cells as illustrated in Figure 7. We further conclude that sevoflurane-induced p38 activation and sevoflurane-mediated apoptosis are two uncorrelated phenomena.


Figure 719
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  		Figure 7. p38 mitogen-activated protein kinase (MAPK) signal transduction pathway (simplified) and the role of sevoflurane. p38 is activated via a sequential activation cascade in response to different stimuli and leads to the activation of different gene transcription factors providing a biological response. MAPKK: MAPK kinase; MAPKKK: MAPK kinase kinase; HSP27: heat shock protein 27; ATF-2: activating transcription factor 2; CHOP: C/EBP homologous protein; Stat1: Signal transducer and activator of transcription 1; Dotted lines: Effects mediated by sevoflurane.

 


   Footnotes
 
Accepted for publication December 18, 2007.

This work was conducted at the Department of Anesthesiology and Critical Care Medicine, University Hospital, Freiburg, Germany, and supported by departmental funding.


   REFERENCES
Top
 Abstract
 Introduction
 METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Rem J, Brandt MR, Kehlet H. Prevention of postoperative lymphopenia and granulocytosis by epidural analgesia. Lancet 1980;1:283–4[Web of Science][Medline]
  2. Oka M, Hirazawa K, Yamamoto K, Iizuka N, Hazama S, Suzuki T, Kobayashi N. Induction of Fas-mediated apoptosis on circulating lymphocytes by surgical stress. Ann Surg 1996;223:434–40[Web of Science][Medline]
  3. Sasajima K, Inokuchi K, Onda M, Miyashita M, Okawa KI, Matsutani T, Takubo K. Detection of T cell apoptosis after major operations. Eur J Surg 1999;165:1020–3[Web of Science][Medline]
  4. Kono K, Takahashi A, Iizuka H, Fujii H, Sekikawa T, Matsumoto Y. Effect of oesophagectomy on monocyte-induced apoptosis of peripheral blood T lymphocytes. Br J Surg 2001;88:1110–6[Web of Science][Medline]
  5. Faist E, Schinkel C, Zimmer S. Update on the mechanisms of immune suppression of injury and immune modulation. World J Surg 1996;20:454–9[Web of Science][Medline]
  6. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1–12[Abstract/Free Full Text]
  7. Nicholson DW. Caspase structure, proteolytic substrates, and function during apoptotic cell death. Cell Death Differ 1999; 6:1028–42[Web of Science][Medline]
  8. Xia Z, Dickens M, Raingeaud J, Davis RJ, Greenberg ME. Opposing effects of ERK and JNK-p38 MAP kinases on apoptosis. Science 1995;270:1326–31[Abstract/Free Full Text]
  9. Boudreau RT, Conrad DM, Hoskin DW. Apoptosis induced by protein phosphatase 2A (PP2A) inhibition in T leukemia cells is negatively regulated by PP2A-associated p38 mitogen-activated protein kinase. Cell Signal 2007;19:139–51[Web of Science][Medline]
  10. Kutuk O, Pedrech A, Harrison P, Basaga H. Pramanicin induces apoptosis in Jurkat leukemia cells: a role for JNK, p38 and caspase activation. Apoptosis 2005;10:597–609[Web of Science][Medline]
  11. Herrera B, Carracedo A, Diez-Zaera M, Guzman M, Velasco G. p38 MAPK is involved in CB2 receptor-induced apoptosis of human leukaemia cells. FEBS Lett 2005;579:5084–8[Web of Science][Medline]
  12. Park MT, Choi JA, Kim MJ, Um HD, Bae S, Kang CM, Cho CK, Kang S, Chung HY, Lee YS, Lee SJ. Suppression of extracellular signal-related kinase and activation of p38 MAPK are two critical events leading to caspase-8- and mitochondria-mediated cell death in phytosphingosine-treated human cancer cells. J Biol Chem 2003;278:50624–34[Abstract/Free Full Text]
  13. Kim BS, Yoon KH, Oh HM, Choi EY, Kim SW, Han WC, Kim EA, Choi SC, Kim TH, Yun KJ, Kim EC, Lyou JH, Nah YH, Chung HT, Cha YN, Jun CD. Involvement of p38 MAP kinase during iron chelator-mediated apoptotic cell death. Cell Immunol 2002;220:96–106[Web of Science][Medline]
  14. Kyriakis JM, Avruch J. Mammalian mitogen-activated protein kinase signal transduction pathways activated by stress and inflammation. Physiol Rev 2001;81:807–69[Abstract/Free Full Text]
  15. Loop T, Dovi-Akue D, Frick M, Roesslein M, Egger L, Humar M, Hoetzel A, Schmidt R, Borner C, Pahl HL, Geiger KK, Pannen BH. Volatile anesthetics induce caspase-dependent, mitochondria-mediated apoptosis in human T lymphocytes in vitro. Anesthesiology 2005;102:1147–57[Web of Science][Medline]
  16. Loop T, Scheiermann P, Doviakue D, Musshoff F, Humar M, Roesslein M, Hoetzel A, Schmidt R, Madea B, Geiger KK, Pahl HL, Pannen BH. Sevoflurane inhibits phorbol-myristate-acetate-induced activator protein-1 activation in human T lymphocytes in vitro: potential role of the p38-stress kinase pathway. Anesthesiology 2004;101:710–21[Web of Science][Medline]
  17. Heidenreich KA, Kummer JL. Inhibition of p38 mitogen-activated protein kinase by insulin in cultured fetal neurons. J Biol Chem 1996;271:9891–4[Abstract/Free Full Text]
  18. Schwenger P, Bellosta P, Vietor I, Basilico C, Skolnik EY, Vilcek J. Sodium salicylate induces apoptosis via p38 mitogen-activated protein kinase but inhibits tumor necrosis factor-induced c-Jun N-terminal kinase/stress-activated protein kinase activation. Proc Natl Acad Sci U S A 1997;94:2869–73[Abstract/Free Full Text]
  19. Mackay K, Mochly-Rosen D. An inhibitor of p38 mitogen-activated protein kinase protects neonatal cardiac myocytes from ischemia. J Biol Chem 1999;274:6272–9[Abstract/Free Full Text]
  20. Yue TL, Ni J, Romanic AM, Gu JL, Keller P, Wang C, Kumar S, Yu GL, Hart TK, Wang X, Xia Z, DeWolf WE Jr, Feuerstein GZ. TL1, a novel tumor necrosis factor-like cytokine, induces apoptosis in endothelial cells. Involvement of activation of stress protein kinases (stress-activated protein kinase and p38 mitogen-activated protein kinase) and caspase-3-like protease. J Biol Chem 1999;274:1479–86[Abstract/Free Full Text]
  21. Zechner D, Craig R, Hanford DS, McDonough PM, Sabbadini RA, Glembotski CC. MKK6 activates myocardial cell NF-{kappa}B and inhibits apoptosis in a p38 mitogen-activated protein kinase-dependent manner. J Biol Chem 1998;273:8232–9[Abstract/Free Full Text]
  22. Takeda K, Hatai T, Hamazaki TS, Nishitoh H, Saitoh M, Ichijo H. Apoptosis signal-regulating kinase 1 (ASK1) induces neuronal differentiation and survival of PC12 cells. J Biol Chem 2000;275:9805–13[Abstract/Free Full Text]
  23. Salo M. Effects of anaesthesia and surgery on the immune response. Acta Anaesthesiol Scand 1992;36:201–20[Web of Science][Medline]
  24. Morisaki H, Aoyama Y, Shimada M, Ochiai R, Takeda J. Leucocyte distribution during sevoflurane anaesthesia. Br J Anaesth 1998;80:502–3[Abstract/Free Full Text]
  25. Moudgil GC, Singal DP. Halothane and isoflurane enhance melanoma tumour metastasis in mice. Can J Anaesth 1997;44:90–4[Web of Science][Medline]
  26. Frohlich D, Rothe G, Schwall B, Schmid P, Schmitz G, Taeger K, Hobbhahn J. Effects of volatile anaesthetics on human neutrophil oxidative response to the bacterial peptide FMLP. Br J Anaesth 1997;78:718–23[Free Full Text]
  27. Frohlich D, Rothe G, Schmitz G, Hansen E. Volatile anaesthetics induce changes in the expression of P-selectin and glycoprotein Ib on the surface of platelets in vitro. Eur J Anaesthesiol 1998;15:641–8[Web of Science][Medline]
  28. Moudgil GC, Gordon J, Forrest JB. Comparative effects of volatile anaesthetic agents and nitrous oxide on human leucocyte chemotaxis in vitro. Can Anaesth Soc J 1984;31:631–7[Web of Science][Medline]
  29. Mitsuhata H, Shimizu R, Yokoyama MM. Suppressive effects of volatile anesthetics on cytokine release in human peripheral blood mononuclear cells. Int J Immunopharmacol 1995;17:529–34[Web of Science][Medline]
  30. Ferrer I, Friguls B, Dalfo E, Planas AM. Early modifications in the expression of mitogen-activated protein kinase (MAPK/ERK), stress-activated kinases SAPK/JNK and p38, and their phosphorylated substrates following focal cerebral ischemia. Acta Neuropathol 2003;105:425–37[Medline]
  31. Schulz R, Belosjorow S, Gres P, Jansen J, Michel MC, Heusch G. p38 MAP kinase is a mediator of ischemic preconditioning in pigs. Cardiovasc Res 2002;55:690–700[Abstract/Free Full Text]
  32. Shackelford DA, Yeh RY. Differential effects of ischemia and reperfusion on c-Jun N-terminal kinase isoform protein and activity. Brain Res Mol Brain Res 2001;94:178–92[Medline]
  33. Faccio L, Chen A, Fusco C, Martinotti S, Bonventre JV, Zervos AS. Mxi2, a splice variant of p38 stress-activated kinase, is a distal nephron protein regulated with kidney ischemia. Am J Physiol Cell Physiol 2000;278:C781–C790[Abstract/Free Full Text]
  34. Wang X, Martindale JL, Liu Y, Holbrook NJ. The cellular response to oxidative stress: influences of mitogen-activated protein kinase signalling pathways on cell survival. Biochem J 1998;333:291–300[Web of Science][Medline]
  35. Floyd RA. Antioxidants, oxidative stress, and degenerative neurological disorders. Proc Soc Exp Biol Med 1999;222:236–45[Abstract/Free Full Text]
  36. Allaouchiche B, Debon R, Goudable J, Chassard D, Duflo F. Oxidative stress status during exposure to propofol, sevoflurane and desflurane. Anesth Analg 2001;93:981–5[Abstract/Free Full Text]
  37. Nielsen VG, Baird MS, McAdams ML, Freeman BA. Desflurane increases pulmonary alveolar-capillary membrane permeability after aortic occlusion-reperfusion in rabbits: evidence of oxidant-mediated lung injury. Anesthesiology 1998;88:1524–34[Web of Science][Medline]
  38. Koksal GM, Sayilgan C, Aydin S, Uzun H, Oz H. The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Eur J Anaesthesiol 2004;21:217–20[Web of Science][Medline]
  39. Takala RS, Soukka HR, Salo MS, Kirvela OA, Kaapa PO, Rajamaki AA, Riutta A, Aantaa RE. Pulmonary inflammatory mediators after sevoflurane and thiopentone anaesthesia in pigs. Acta Anaesthesiol Scand 2004;48:40–5[Web of Science][Medline]
  40. Lai EW, Toledo-Pereyra LH, Walsh J, Lopez-Neblina F, Anaya-Prado R. The role of MAP kinases in trauma and ischemia-reperfusion. J Invest Surg 2004;17:45–53[Web of Science][Medline]
  41. Zheng S, Zuo Z. Isoflurane preconditioning induces neuroprotection against ischemia via activation of P38 mitogen-activated protein kinases. Mol Pharmacol 2004;65:1172–80[Abstract/Free Full Text]
  42. Hashiguchi H, Morooka H, Miyoshi H, Matsumoto M, Koji T, Sumikawa K. Isoflurane protects renal function against ischemia and reperfusion through inhibition of protein kinases, JNK and ERK. Anesth Analg 2005;101:1584–9[Abstract/Free Full Text]
  43. Kummer JL, Rao PK, Heidenreich KA. Apoptosis induced by withdrawal of trophic factors is mediated by p38 mitogen-activated protein kinase. J Biol Chem 1997;272:20490–4[Abstract/Free Full Text]
  44. Hofmann TG, Moller A, Hehner SP, Welsch D, Droge W, Schmitz ML. CD95-induced JNK activation signals are transmitted by the death-inducing signaling complex (DISC), but not by Daxx. Int J Cancer 2001;93:185–91[Web of Science][Medline]
  45. Yamamoto K, Ichijo H, Korsmeyer SJ. BCL-2 is phosphorylated and inactivated by an ASK1/Jun N-terminal protein kinase pathway normally activated at G(2)/M. Mol Cell Biol 1999;19:8469–78[Abstract/Free Full Text]
  46. Kanamoto T, Mota M, Takeda K, Rubin LL, Miyazono K, Ichijo H, Bazenet CE. Role of apoptosis signal-regulating kinase in regulation of the c-Jun N-terminal kinase pathway and apoptosis in sympathetic neurons. Mol Cell Biol 2000;20:196–204[Abstract/Free Full Text]
  47. Hatai T, Matsuzawa A, Inoshita S, Mochida Y, Kuroda T, Sakamaki K, Kuida K, Yonehara S, Ichijo H, Takeda K. Execution of apoptosis signal-regulating kinase 1 (ASK1)-induced apoptosis by the mitochondria-dependent caspase activation. J Biol Chem 2000;275:26576–81[Abstract/Free Full Text]
  48. Tobiume K, Matsuzawa A, Takahashi T, Nishitoh H, Morita K, Takeda K, Minowa O, Miyazono K, Noda T, Ichijo H. ASK1 is required for sustained activations of JNK/p38 MAP kinases and apoptosis. EMBO Rep 2001;2:222–8[Web of Science][Medline]
  49. Nishitoh H, Matsuzawa A, Tobiume K, Saegusa K, Takeda K, Inoue K, Hori S, Kakizuka A, Ichijo H. ASK1 is essential for endoplasmic reticulum stress-induced neuronal cell death triggered by expanded polyglutamine repeats. Genes Dev 2002;16:1345–55[Abstract/Free Full Text]
  50. Eckenhoff RG, Johansson JS. What are relevant concentrations? Anesthesiology 2001;95:1537–9[Web of Science][Medline]
  51. Eckenhoff RG, Johansson JS, Wei H, Carnini A, Kang B, Wei W, Pidikiti R, Keller JM, Eckenhoff MF. Inhaled anesthetic enhancement of amyloid-β oligomerization and cytotoxicity. Anesthesiology 2004;101:703–9[Web of Science][Medline]
  52. Abraham RT, Weiss A. Jurkat T cells and development of the T-cell receptor signalling paradigm. Nat Rev Immunol 2004;4:301–8[Web of Science][Medline]
  53. Schlesinger TK, Bonvin C, Jarpe MB, Fanger GR, Cardinaux JR, Johnson GL, Widmann C. Apoptosis stimulated by the 91-kDa caspase cleavage MEKK1 fragment requires translocation to soluble cellular compartments. J Biol Chem 2002;277:10283–91[Abstract/Free Full Text]



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Y. Dong, G. Zhang, B. Zhang, R. D. Moir, W. Xia, E. R. Marcantonio, D. J. Culley, G. Crosby, R. E. Tanzi, and Z. Xie
The Common Inhalational Anesthetic Sevoflurane Induces Apoptosis and Increases {beta}-Amyloid Protein Levels
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