PMID- 14530752
OWN - NLM
STAT- MEDLINE
DCOM- 20031105
LR  - 20220311
IS  - 0090-3493 (Print)
IS  - 0090-3493 (Linking)
VI  - 31
IP  - 10
DP  - 2003 Oct
TI  - Effect of granulocyte-macrophage colony-stimulating factor on the immune response 
      of circulating monocytes after severe trauma.
PG  - 2462-9
AB  - OBJECTIVE: Severe injury compromises functions of the antigen-presenting immune 
      cells, resulting in an increased vulnerability toward bacterial sepsis. Support 
      of the immune capabilities contributes a desirable therapeutic option in 
      high-risk patients. Factors possessing immunostimulating properties such as 
      granulocyte-macrophage colony-stimulating factor (GM-CSF) may serve as potential 
      tools to compensate immunosuppression caused by severe trauma. In the present 
      study, therefore, GM-CSF was examined with regard to its capacity to overcome 
      trauma-induced down-regulation of immune functions. DESIGN: Prospective clinical 
      experimental study. SETTING: University hospital intensive care unit and research 
      facility. PATIENTS: Severely injured patients with >25 points on the Injury 
      Severity Score. INTERVENTIONS: Blood samples of severely injured patients were 
      incubated in vitro with 10 ng/mL GM-CSF for 6 hrs. MEASUREMENTS: Human leukocyte 
      antigen (HLA)-DR expression on monocytes was analyzed by flow cytometry, 
      lipopolysaccharide-induced tumor necrosis factor (TNF)alpha and interleukin-10 
      production of blood samples was measured by means of enzyme-linked 
      immunoabsorbent assay. MAIN RESULTS: Compared with blood specimens of healthy 
      donors, ex vivo endotoxin-induced TNF alpha production and HLA-DR expression on 
      monocytes were significantly reduced in blood of trauma patients. Ex vivo 
      treatment of blood specimens with GM-CSF increased HLA-DR expression and TNF 
      alpha production stimulated by lipopolysaccharides in both healthy volunteers and 
      patients on day 1 after trauma. Blood samples of patients with an uneventful 
      recovery showed nearly normal TNF alpha synthesis and HLA-DR expression after 2-3 
      wks, whereas TNF alpha production and HLA-DR expression of patients with sepsis 
      and multiple organ failure remained at low levels. In the sepsis/multiple organ 
      failure group, GM-CSF also enhanced HLA-DR expression and TNF alpha production, 
      although the levels of the volunteers' blood were not reached. CONCLUSIONS: The 
      presented data show that trauma- and sepsis-induced depression of monocyte 
      functions can be counteracted by GM-CSF in vitro, suggesting that this substance 
      may serve as support of immune functions in severely injured patients.
FAU - Flohe, Sascha
AU  - Flohe S
AD  - Department of Trauma Surgery, University Hospital of Essen, Germany.
FAU - Lendemans, Sven
AU  - Lendemans S
FAU - Selbach, Christian
AU  - Selbach C
FAU - Waydhas, Christian
AU  - Waydhas C
FAU - Ackermann, Marcus
AU  - Ackermann M
FAU - Schade, F Ulrich
AU  - Schade FU
FAU - Kreuzfelder, Ernst
AU  - Kreuzfelder E
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Crit Care Med
JT  - Critical care medicine
JID - 0355501
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 83869-56-1 (Granulocyte-Macrophage Colony-Stimulating Factor)
SB  - IM
MH  - Adult
MH  - Female
MH  - Granulocyte-Macrophage Colony-Stimulating Factor/*therapeutic use
MH  - HLA-DR Antigens/blood/*immunology
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Tumor Necrosis Factor-alpha/*biosynthesis
MH  - *Wounds and Injuries/drug therapy/immunology/metabolism
EDAT- 2003/10/08 05:00
MHDA- 2003/11/06 05:00
CRDT- 2003/10/08 05:00
PHST- 2003/10/08 05:00 [pubmed]
PHST- 2003/11/06 05:00 [medline]
PHST- 2003/10/08 05:00 [entrez]
AID - 10.1097/01.CCM.0000089640.17523.57 [doi]
PST - ppublish
SO  - Crit Care Med. 2003 Oct;31(10):2462-9. doi: 10.1097/01.CCM.0000089640.17523.57.