Reactive oxygen species elevations in human immune cell subsets during sepsis are mitigated by norepinephrine and N-acetylcysteine

doi:10.5492/wjccm.v14.i4.108638

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Dec 9, 2025 (publication date) through Dec 9, 2025

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Basic Study

World J Crit Care Med. Dec 9, 2025; 14(4): 108638
Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.108638

Reactive oxygen species elevations in human immune cell subsets during sepsis are mitigated by norepinephrine and N-acetylcysteine

Joby Thoppil, J David Farrar, Drashya Sharma, Shaun Kirby, Angela Mobley, Daniel Mark Courtney

Joby Thoppil, Daniel Mark Courtney, Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States

J David Farrar, Drashya Sharma, Shaun Kirby, Angela Mobley, Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States

Author contributions: Thoppil J contributed to experimental design, performance, analysis and manuscript preparation; Farrar JD contributed to experimental design, analysis and manuscript preparation; Sharma D, Kirby S, and Mobley A all contributed to experimental performance and manuscript preparation; Courtney DM contributed to manuscript preparation; all the authors read and approved the final version of the manuscript to be published.

Supported by Emergency Medicine Foundation; and Zoll Foundation.

Institutional review board statement: This work was approved by the Institutional Review Board at the University of Texas Southwestern Medical Center.

Conflict-of-interest statement: The authors have no conflict of interest statement.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Joby Thoppil, MD, PhD, Assistant Professor, Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E6.110A, Dallas, TX 75390, United States. joby.thoppil@utsouthwestern.edu

Received: April 20, 2025
Revised: May 13, 2025
Accepted: May 29, 2025
Published online: December 9, 2025
Processing time: 223 Days and 18.2 Hours

Core Tip

Core Tip: Sepsis is a life-threatening condition characterized by immune dysregulation, in which peripheral blood mononuclear cells are believed to play a central role. Reactive oxygen species (ROS) are critical to immune cell signaling, but excessive ROS may contribute to immune alterations during sepsis. In this observational study, we demonstrate elevated ROS levels in CD3+ T cells and CD14+ monocytes from septic patients. Using in vitro models, we show that norepinephrine and N-acetylcysteine attenuate ROS accumulation following inflammatory stimulation. These findings suggest that targeting oxidative imbalance may represent a promising direction for future sepsis research.