Patients with kidney replacement exhibit disrupted circadian rhythms. Most studies measuring blood pressure use the dipper/non-dipper classification, which does not consider analysis of transitional stages between low and high blood pressure, confidence intervals nor shifts in the time of peak, while assuming subjective onsets of night and day phases. In order to better understand the nature of daily variation of blood pressure in these patients, we analyzed 24 h recordings from 41 renal transplant recipients using the non-symmetrical double-logistic fitting assessment which does not assume abruptness nor symmetry in ascending and descending stages of the blood pressure profile, and a cosine best-fitting regression method (Cosinor). Compared with matched controls, double-logistic fitting showed that the times for most transitional stages (ascending systolic and descending systolic, diastolic, and mean arterial pressure) had a wider distribution along the 24-h. The proportion of individuals without daily blood pressure rhythm in the transplanted group was larger only for systolic arterial pressure, and the amplitude showed no significant difference. Furthermore, the transplant recipient group had a less pronounced slope in descending systolic and ascending mean blood pressure. Cosinor analysis confirmed this phase-related changes, showing a wider distribution of times of peak (acrophases). We conclude that daily disruptions in renal transplant recipients can be explained not necessarily by an absence in diurnal variation, but also by changes in waveform-related parameters of the rhythm, and that alterations in the phase of the rhythm are the most consistent finding in these patients.

Objective: To describe circadian disruptions in septic patients and their relation to clinical outcome. Methods: In this work we performed an individual analysis of hemodynamic variables (cardiac frequency and mean blood pressure) in three groups of patients: severe sepsis, septic shock and individuals housed in the same intensive care unit by causes other than inflammation or infection, as controls, during the first and the last 24 hours of their permanency in the critical care unit. Results: Although the cosinor analysis showed no difference in the proportion of patients that expressed a statistically significant circadian rhythm, during the first 24 hours, the phase of the variations were disrupted in both septic groups, being almost in anti-phase as compared to control individuals. During the last 24 hours, this variation was present only for mean blood pressure. No association of these changes could be related to outcome (surveillance). Conclusion: We conclude that disruptions in circadian rhythms in patients during severe stages of sepsis are related to phase better than presence/absence of variation, which could be crucial to time scheduled therapies.

Many immune parameters exhibit daily and circadian oscillations, including the number of circulating cells and levels of cytokines in the blood. Mice also have a differential susceptibility to lipopolysaccharide (LPS or endotoxin)-induced endotoxic shock, depending on the administration time in the 24 h light-dark (LD) cycle. We replicated these results in LD, but we did not find temporal differences in LPS-induced mortality in constant darkness (DD). Animals challenged with LPS showed only transient effects on their wheel locomotor activity rhythm without modification of circadian period and phase. Levels of several key factors involved in the pathology of sepsis and septic shock were tested in LD. We found that LPS-induced levels of interleukin (IL)-1β, IL-6, JE (MCP-1), and MIP1α were significantly higher at zeitgeber time (ZT) 11 (time of increased mortality) than at ZT19 (ZT12 = time of lights-off in the animal quarters for the 12L:12D condition). Our results indicate that the differences found in mortality that are dependent on the time of LPS-challenge are not directly related to an endogenous circadian clock, and that some relevant immune factors in the development of sepsis are highly induced at ZT11, the time of higher LPS-induced mortality, compared to ZT19. (Author correspondence: dgolombek@unq.edu.ar)

PP2B is a Ca2+/calmodulin-dependent protein phosphatase that is ubiquitously expressed in mammals. Among other actions, it is an effector mechanism in NMDA-mediated glutamate neurotransmission as well as a regulator of GSK3beta and MAPK signaling cascades. Because all of these mechanisms have demonstrable roles in the control of circadian rhythyms, we hypothesized that PP2B would be a key regulator of rhythm generation and entrainment, and that through inhibition of its phosphatase activity, the circadian system would be affected by immunosuppressant drug therapy. We report here that immunosuppressant drugs (cyclosporin A, FK506) (1) block the circadian responses to light that underlie photic entrainment; (2) produce circadian phase shifts with a characteristic nonphotic profile; and (3) disrupt circadian rhythm expression when applied chronically. These results indicate a role for PP2B in circadian rhythm generation and entrainment. In addition, because rhythm disturbance has been implicated in impairment of both physical and mental health, we suggest that the use of immunosuppressants would be safer and more efficacious if their impacts on circadian rhythmicity were taken into account.