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Craig M. Coopersmith, MD; Paul E. Stromberg, BS; W. Michael Dunne, PhD; Christopher G. Davis; Daniel M. Amiot II; Timothy G. Buchman, MD,PhD; Irene E. Karl, PhD; Richard S. Hotchkiss, MD

JAMA. 2002;287:1716-1721.

Context  Increased intestinal epithelial apoptosis is present in both human autopsy studies and animal models of sepsis. Whether altering gut apoptosis decreases mortality in sepsis induced by pathogenic bacteria outside the gut is unknown.

Objective  To determine if decreasing levels of intestinal cell death improves survival in a murine model of Pseudomonas aeruginosa pneumonia–induced sepsis.

Design and Materials  Prospective study in which transgenic mice that overexpress the antiapoptotic protein Bcl-2 in their intestinal epithelium (n = 25) and control littermates (n = 26) were subjected to intratracheal injection of P aeruginosa.

Main Outcome Measures  Survival at 7 postoperative days, compared between the 2 groups. Secondary outcomes included quantification of gut epithelial apoptosis.

Results  Survival in transgenic mice that overexpress Bcl-2 in the intestinal epithelium was 40% (10/25) compared with 4% (1/26) in control littermates 7 days after intratracheal injection of P aeruginosa (P = .001), with differences in survival noted within 24 hours of surgery. Overexpression of Bcl-2 was associated with a decrease in gut epithelial apoptosis demonstrated by active caspase 3 staining, the terminal deoxynucleotidyltransferase-mediated dUTP nick end-labeling assay, and hematoxylin-eosin staining.

Conclusions  In this murine model, inhibiting gut epithelial apoptosis by overexpression of Bcl-2 was associated with a survival advantage in P aeruginosa pneumonia–induced sepsis. These results suggest that intestinal epithelial apoptosis may play a role in sepsis-related mortality.

Author Affiliations: Departments of Surgery (Drs Coopersmith and Buchman, Mssrs Stromberg and Amiot), Anesthesiology (Mr Davis and Dr Hotchkiss), Pathology (Dr Dunne), and Medicine (Dr Karl), Washington University School of Medicine, St Louis, Mo.

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