Does liraglutide alleviate inflammation in brain-dead donors? A randomized clinical trial

Abstract

Brain death triggers an inflammatory cascade that damages organs before procurement, adversely affecting the quality of grafts. This randomized clinical trial aimed to compare the efficacy of liraglutide compared to placebo in attenuating brain death-induced inflammation, endoplasmic reticulum stress, and oxidative stress. We conducted a double-blinded, placebo-controlled, randomized clinical trial with brain-dead donors. Fifty brain-dead donors were randomized to receive subcutaneous liraglutide or placebo. The primary outcome was the reduction in IL-6 plasma levels. Secondary outcomes were changes in other plasma pro-inflammatory (IL-1β, interferon-γ, TNF) and anti-inflammatory cytokines (IL-10), expression of antiapoptotic (BCL2), endoplasmic reticulum stress markers (DDIT3/CHOP, HSPA5/BIP), and antioxidant (superoxide dismutase 2, uncoupling protein 2) genes, and expression TNF, DDIT3, and superoxide dismutase 2 proteins in liver biopsies. The liraglutide group showed lower cytokine levels compared to the placebo group during follow-up: Δ IL-6 (−28 [−182, 135] vs. 32 [−10.6, 70.7] pg/mL; p = 0.041) and Δ IL-10 (−0.01 [−2.2, 1.5] vs. 1.9 [−0.2, 6.1] pg/mL; p = 0.042), respectively. The administration of liraglutide did not significantly alter the expression of inflammatory, antiapoptotic, endoplasmic reticulum stress, or antioxidant genes in the liver tissue. Similar to gene expression, expressions of proteins in the liver were not affected by the administration of liraglutide. Treatment with liraglutide did not increase the organ recovery rate [OR = 1.2 (95% CI: 0.2–8.6), p = 0.82]. Liraglutide administration reduced IL-6 and prevented the increase of IL-10 plasma levels in brain-dead donors without affecting the expression of genes and proteins related to inflammation, apoptosis, endoplasmic reticulum stress, or oxidative stress.

Transplantation’s next frontier: The promise of deceased donor studies

“…Building on this, Custódio et al 5 work to gather some clinical insights, at the same time prompting a wider discussion on the importance and the implications of deceased donor intervention research (DDIR)—an area whose potential and challenges are yet to be fully realized. Central to their investigation is glucagon-like peptide 1 (GLP-1), a gut-derived hormone synthesized by L-cells primarily localized within terminal ileal and colonic mucosa and secreted as a neuroendocrine response to eating 6 .…”