PMID- 12907555
OWN - NLM
STAT- MEDLINE
DCOM- 20030904
LR  - 20201208
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 124
IP  - 2
DP  - 2003 Aug
TI  - Deactivation of alveolar macrophages in septic neutropenic ARDS.
PG  - 644-52
AB  - STUDY OBJECTIVES: Neutrophils often have been involved in the pathophysiology of 
      ARDS. However, authentic ARDS has been described in patients with severe 
      neutropenia, suggesting the presence of other potential mechanisms that are 
      responsible of this syndrome. Alveolar macrophages (AMs) could be involved in the 
      development of ARDS, and so we decided to study AM activation in neutropenic 
      patients. PATIENTS: We designed a prospective study and enrolled two subgroups of 
      consecutive patients (group A, 18 patients; group B, 22 patients) with septic 
      ARDS. In the first period, 7 of 18 patients were neutropenic, and in the second 
      period 10 of 22 patients were neutropenic. All neutropenic patients were treated 
      with granulocyte colony-stimulating factor (G-CSF). MEASUREMENTS AND RESULTS: In 
      group A, BAL fluid samples were analyzed for differential and total cell counts, 
      and alveolar activation marker expression (ie, human leukocyte antigen [HLA]-DR 
      locus) was determined. Basal and lipopolysaccharide (LPS)-stimulated production 
      of tumor necrosis factor, interleukin (IL)-1 beta, IL-6, and IL-10 was evaluated 
      in group B. In neutropenic patients, the BAL fluid total cell count and the 
      neutrophil absolute count was significantly lower compared to those in 
      nonneutropenic patients (p = 0.029 and p = 0.046, respectively). HLA-DR 
      expression on AMs was significantly decreased (p = 0.016), and the percentage of 
      AMs expressing HLA-DR was also significantly lower (p = 0.041). In neutropenic 
      patients, the mean percentage of AMs expressing HLA-DR was significantly lower in 
      deceased patients compared to survivors (30 +/- 7 vs 43 +/- 1, respectively; p = 
      0.047). Basal AMs released cytokines was comparable between the two groups; 
      however, LPS stimulation yielded a deactivation of AMs in neutropenic patients. 
      CONCLUSION: These results suggest a deactivation and/or hypoactivation of AMs in 
      septic ARDS patients. This deactivation/hypoactivation could be linked to the use 
      of G-CSF as this molecule has been shown to generate a down-regulation of HLA-DR 
      expression.
FAU - Mokart, Djamel
AU  - Mokart D
AD  - Department of Anesthesiology and Intensive Care Unit, Paoli-Calmette Institute, 
      Marseille, France. mokartd@marseille.fnclcc.fr
FAU - Guery, Benoit P
AU  - Guery BP
FAU - Bouabdallah, Reda
AU  - Bouabdallah R
FAU - Martin, Claude
AU  - Martin C
FAU - Blache, Jean-Louis
AU  - Blache JL
FAU - Arnoulet, Christine
AU  - Arnoulet C
FAU - Mege, Jean-Louis
AU  - Mege JL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Cytokines)
RN  - 0 (HLA-DR Antigens)
RN  - 143011-72-7 (Granulocyte Colony-Stimulating Factor)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cytokines/biosynthesis
MH  - Female
MH  - Granulocyte Colony-Stimulating Factor/therapeutic use
MH  - HLA-DR Antigens/*metabolism
MH  - Humans
MH  - Macrophage Activation
MH  - Macrophages, Alveolar/*metabolism
MH  - Male
MH  - Middle Aged
MH  - *Neutropenia/complications/drug therapy/mortality
MH  - Prognosis
MH  - Prospective Studies
MH  - *Respiratory Distress Syndrome/complications/mortality/physiopathology
EDAT- 2003/08/09 05:00
MHDA- 2003/09/05 05:00
CRDT- 2003/08/09 05:00
PHST- 2003/08/09 05:00 [pubmed]
PHST- 2003/09/05 05:00 [medline]
PHST- 2003/08/09 05:00 [entrez]
AID - S0012-3692(15)33351-1 [pii]
AID - 10.1378/chest.124.2.644 [doi]
PST - ppublish
SO  - Chest. 2003 Aug;124(2):644-52. doi: 10.1378/chest.124.2.644.