Mitochondrial Dysfunction and Lipid Accumulation in the Human Diaphragm during Mechanical Ventilation

作者：Picard Martin; Jung Boris; Liang Feng; Azuelos Ilan; Hussain Sabah; Goldberg Peter; Godin Richard; Danialou Gawiyou; Chaturvedi Rakesh; Rygiel Karolina; Matecki Stefan; Jaber Samir; Des Rosiers Christine; Karpati George; Ferri Lorenzo; Burelle Yan; Turnbull Douglass M; Taivassalo Tanja; Petrof Basil J^*

来源：American Journal of Respiratory and Critical Care Medicine, 2012, 186(11): 1140-1149.

DOI：10.1164/rccm.201206-0982OC

• ventilator-induced diaphragmatic dysfunction
• oxidative stress
• mitochondrial DNA
• metabolic oversupply
• diaphragmatic fatigue

Rationale: Mechanical ventilation (MV) is associated with adverse effects on the diaphragm, but the cellular basis for this phenomenon, referred to as ventilator-induced diaphragmatic dysVIDD), is poorly understood. %26lt;br%26gt;Objectives: To determine whether mitochondrial function and cellular energy status are disrupted in human diaphragms after MV, and the role of mitochondria-derived oxidative stress in the development of VIDD. %26lt;br%26gt;Methods: Diaphragm and biceps specimens obtained from brain-dead organ donors who underwent MV (15-176 h) and age-matched control subjects were compared regarding mitochondrial enzymatic function, mitochondrial DNA integrity, lipid content, and metabolic gene and protein expression. In addition, diaphragmatic force and oxidative stress after exposure to MV for 6 hours were evaluated in mice under different conditions. %26lt;br%26gt;Measurements and Main Results: In human MV diaphragms, mitochondrial biogenesis and content were down-regulated, with a more specific defect of respiratory chain cytochrome-c oxidase. Laser capture microdissection of cytochrome-c oxidase deficient fibers revealed mitochondrial DNA deletions, consistent with damage from oxidative stress. Diaphragmatic lipid accumulation and responses of master cellular metabolic sensors (AMP-activated protein kinase and sirtuins) were consistent with energy substrate excess as a possible stimulus for these changes. In mice, induction of hyper-lipidemia worsened diaphragmatic oxidative stress during MV, whereas transgenic overexpression of a mitochondria-localized antioxidant (peroxiredoxin-3) was protective against VIDD. %26lt;br%26gt;Conclusions: Our data suggest that mitochondrial dysfunction lies at the nexus between oxidative stress and the impaired diaphragmatic contractility that develops during MV. Energy substrate oversupply relative to demand, resulting from diaphragmatic inactivity during MV, could play an important role in this process.

• 出版日期2012-12-1