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(Circulation. 2004;109:2560-2565.)
© 2004 American Heart Association, Inc.

Basic Science Reports

HMG-CoA Reductase Inhibitor Simvastatin Profoundly Improves Survival in a Murine Model of Sepsis

Marc W. Merx, MD; Elisa A. Liehn, MD; Uwe Janssens, MD; Rudolf Lütticken, MD; Jürgen Schrader, MD; Peter Hanrath, MD; Christian Weber, MD

From the Medizinische Klinik I (M.W.M., U.J., P.H., C.W.), Kardiovaskuläre Molekularbiologie (E.A.L., C.W.), and Institut für Mikrobiologie (R.L.), RWTH Aachen, and Institut für Herz- und Kreislaufphysiologie, Heinrich-Heine-Universität (J.S.), Düsseldorf, Germany.

Correspondence to Marc W. Merx, MD, Medizinische Klinik I, Universitätsklinikum Aachen, Pauwelsstraße 30, 52057 Aachen, Germany. E-mail mmerx{at}ukaachen.de

Received October 7, 2003; revision received February 13, 2004; accepted February 17, 2004.

Background— HMG-CoA reductase inhibitors, such as simvastatin, have been shown to exhibit pronounced immunomodulatory effects independent of lipid lowering but to date have not been used to treat severe inflammatory disease such as sepsis. We thus approached the question of whether treatment with simvastatin might improve cardiovascular function and survival in sepsis.

Methods and Results— Mice treated with simvastatin and rendered septic by cecal ligation and perforation (CLP) show a mean survival time close to 4 times the value found in untreated mice. This dramatic improvement is based on a complete preservation of cardiac function and hemodynamic status, which are severely impaired in untreated CLP mice [eg, 20 hours after CLP, cardiac output declined from 1.24±0.09 to 0.87±0.11 mL · min^–1 · g^–1 in untreated mice (P<0.005; n=12), while remaining unaltered (1.21±0.08 mL · min^–1 · g^–1 at baseline and 1.15±0.1 mL · min^–1 · g^–1 20 hours after CLP, P=NS, n=12) in CLP mice treated with simvastatin]. Untreated CLP mice remained refractory to ß-stimulation, whereas the responsiveness to dobutamine was restored by treatment with simvastatin. Susceptibility of coronary flow to endothelial nitric oxide synthase (eNOS) stimulation by bradykinin was close to 3 times as pronounced in untreated CLP mice as in untreated sham-operated mice, indicating a high level of eNOS activation secondary to sepsis. In addition, treatment with simvastatin reversed inflammatory alterations in CLP mice, namely, increased monocyte adhesion to endothelium.

Conclusions— Simvastatin, which is well established in the treatment of lipid disorders and coronary artery disease, might have the additional potential of being an effective agent in sepsis treatment.

Key Words: sepsis • inflammation • hemodynamics • leukocytes • statins

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