Group Title: Critical Care
Title: Respiratory burst activity of PMN is increased in most patients during septic shock
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 Material Information
Title: Respiratory burst activity of PMN is increased in most patients during septic shock
Series Title: Critical Care
Physical Description: Archival
Creator: Barth,E.
Fischer,G.
Börner,F.
Moldawer,L. L.
Schneider,E. M.
Georgieff,M.
Weiss,M.
Publication Date: 2000
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General Note: Start pageP54
General Note: M3: 10.1186/cc774
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Bibliographic ID: UF00100068
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: Open Access: http://www.biomedcentral.com/info/about/openaccess/
Resource Identifier: issn - 1364-8535

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Critical Care Vol 4 Suppl 1 20th International Symposium on Intensive Care and Emergency Medicine


P53 In contrast to CD64 expression, CD14 expression is persistently downregulated on
polymorphonuclear cells (PMN) but not on monocytes of patients with septic shock

E Barth, J Wollmeyer, G Fischer, T Weckmann, M Appel, EM Schneider, LL Moldawer*, M Georgieff and M Weiss
Department of Anesthesiology, University of Ulm, Steinhoevelstr. 9, 89070 Ulm, Germany; *Department of Surgery, University of
Florida, Gainesville, USA


Objectives: To investigate the time course of surface
CD14 and CD64 on PMN and on monocytes, in postoper-
ative/post-traumatic patients with septic shock, from the
first day of septic shock onwards.

Methods: Over a six month period, in 22 patients admit-
ted to the intensive care unit, a daily analysis of CD14 and
CD64 surface expression on PMN and monocytes was
performed by flow cytometry (Becton Dickinson, USA). All
patients suffered from septic shock for three days at least.
Box plots of the mean intensity (Mnl) values of surface
CD14 and CD64 are given for days 1-14. Statistical
analysis was performed by Wilcoxon rank sum test
(P<0.05; significant intragroup differences between the
day indicated by a star [*] and the following days denoted
by a line over the respective days [I-I]). In addition, normal
range of controls [C] is presented by a box plot.


Figure


PMN


D I D3 D5 D7 D9 Dl11 D13 C
D2 D4 D6 D8 D10 D 12 D14
PMN







D 1 D3 D5 D7 1D9 D1 1 D13 C
D2 D4 D6 D8 DI1G D 12 D14


Results: CD64 is significantly upregulated on PMN and
monocytes compared to healthy volunteers, whereas
CD14 expression is significantly decreased on all days.
Regarding the time course, a significant decrease in
CD14 and CD64 expression on PMN occurred within the
first three days. In monocytes, compared with the first two
days, CD64 expression was diminished from day 3
onwards, however, CD14 expression on day 4, only.

Conclusions: Upregulation of CD64 expression on PMN
and monocytes indicates leukocyte activation in patients
with septic shock. In contrast to CD64, surface CD14 on
PMN decreased and is continuously downregulated over
time, whereas no decrease in surface CD14 on mono-
cytes is observed. This may be due to different membrane
anchors and/or different LPS-CD14 signaling in PMN and
monocytes in patients during septic shock.




Monocytes

4000 T



1000 -T


500
400
300
CD 200
100


D1 D3 D5 D7 D9 D11 D13 C
D2 D4 D6 D8 D10 D12 D14
Monocytes







D1 D3 D5 D7 D9 D11 D13 C
D2 D4 D6 D8 D10 D12 D14


P54 Respiratory burst activity of PMN is increased in most patients during septic shock

E Barth, G Fischer, F Borner, LL Moldawer*, EM Schneider, M Georgieff and M Weiss
Department of Anesthesiology, University of Ulm, Steinhoevelstr. 9, 89070 Ulm, Germany; *Department of Surgery, University of
Florida, Gainesville, USA


Objectives: To investigate whether burst activity of poly-
morphonuclear cells (PMN) of postoperative/post-trau-
matic patients during septic shock is predominantly
increased, unchanged or decreased compared to that of
healthy volunteers.


Methods: Over a period of six months, 12 patients (four
survivors and eight nonsurvivors) with septic shock for at
least three days duration were studied during their period
of septic shock on the intensive care unit. E. coli induced
burst activity of granulocytes was determined by flow








http://ccforum.com/supplements/4/S1


cytometry (BursttestTM, Orpegen, Heidelberg, Germany).
The PMN burst activity of 12 healthy volunteers served as
normal range.

Results: PMN burst activity in healthy volunteers ranged
from 5-18 Mnl (median 9.2). Compared to this normal
range, burst activity of patients with septic shock was pre-
dominantly (i.e. on more than 50% of days in septic shock)
greater than that of healthy volunteers, in all patients, sur-
vivors and non-survivors.

Conclusions: PMN burst activity is predominantly
increased in most patients with septic shock compared to
healthy volunteers, indicating an activation of PMN during
septic shock. Moreover, burst activity of granulocytes


Number of patients with more than 50% of days during septic
shock within a distinct range of PMN burst activity compared
to the normal range

below within above
Mnl <5 5-18 >18

Survivors 0/4 2/4 2/4
Non-survivors 0/8 2/8 6/8
All patients 0/12 4/12 8/12


during septic shock does not discriminate survivors from
non-survivors.


P55 Differences in phagocytosis by polymorphonuclear leucocytes (PMNs) and monocytes (Mos) in
endotoxemia and endotoxin (ET) tolerance

K-H Staubach, J Nolde, L Song, H Brade* and H-P Bruch
Department of Surgery, Medical University of Libeck, Ratzeburger Allee 160, 23538 Libeck, *Research Center Borstel, Medical
University of Libeck


Flow cytometry offers a rapid method to quantitate phago-
cytosis by PMNS and Mos. Since the PMN is a major
defense beside the Mos against bacterial infection we
compared both systems in a porcine endotoxin shock
model in control animals (C) and endotoxin-tolerant
animals (T). A commercial test kit (phagotest, Orpegen,
Heidelberg, Germany) was used for demonstrating inges-
tion of opsonized fluorescent E. coli (Fl) and phagocytos-
ing cells (PC). Seven pigs were pretreated over five days
with increasing doses of atoxic endotoxin from
Rhodopseudomonas sphaeroides (T) before induction of


an ET shock with ET from Salmonella friedenau at a dose
of 250 ng/kg BW/h, like the controls who were not pre-
treated.

Results of both groups were expressed in fluorescence
intensity (Fl) and summarized in the Table.

The functional assessment of Mos and PMNS in our shock
model revealed an enhancement of phagocytic activity in
endotoxin-tolerant animals both in Mos and PMNS with
the highest increase in the latter.


Mos T
PMNS C
PMNS T
PC

Mos C
Mos T
PMNS C
PMNS T


Days (immunization period)

I II III IV V

679 715 631 670 -
532 639 529 438 -
996 886 1007 940 -


1165 1096 984


1082


I II III IV V

15.0 15.0 15.0 15.0 -
10.6 16.7 14.9 5.9 -
8.2 8.2 8.2 8.2 -
4.9 8.4 8.2 2.6 -


Hours (ET shock)

1 3 6 9 12

459 723 554 210
294 683 617 743 703
1316 1810 1375 501
555 1426 1343 1964 2146
1 3 6 9 12

19.2 15.6 9.7 2.9
20.8 23.6 19.3 15.3 14.0
5.7 6.8 6.7 8.9
14.6 14.0 7.5 9.1 11.0




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