title: Role of selectins in development of adult respiratory distress syndrome.
abstract: The acute lung injury of adult respiratory distress syndrome (ARDS) is characterised by inflammatory cell accumulation and activation in the lung. Selectins are a family of adhesion molecules implicated in leucocyte-endothelial adhesion, whose receptors can exist in a cleaved, soluble form. We investigated whether circulating soluble selectin adhesion molecules, obtained from ARDS at-risk patients, were associated with subsequent ARDS development. 82 patients, at risk of ARDS, were enrolled from three well-defined groups (multiple trauma, pancreatitis, perforated bowel). Plasma samples were obtained on hospital presentation and soluble L, E, and P, selectins were quantified with a sandwich enzyme-linked immunosorbent assay (ELISA). 14 patients subsequently developed ARDS. Initial plasma soluble L-selectin (sL-selectin) levels were significantly lower in patients who progressed to ARDS compared to those who did not (p = 0.0001; 95% Cl for mean in ARDS patients as percent of that in non-ARDS patients, 27-61%). Moreover concentrations were lower than in 62 normal volunteers (range 0.37-6.55, median 1.83 micrograms/mL, n = 62), suggesting that a selective reduction of sL-selectin correlates with susceptibility. In addition, a significant correlation was found between low values of sL-selectin and indices of subsequent lung injury including requirement for ventilation (p = 0.0001) and degree of respiratory failure (p = 0.0001). A significant correlation was also found between low values of sL-selectin and patient mortality (p = 0.002). These results elucidate the inflammatory cell endothelial interactions in the early stages of ARDS and may be of prognostic value.
authors.affiliation: Respiratory Medicine Unit, Rayne Laboratory, University of Edinburgh, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Donnelly
authors.forename: C
authors.initials: C
authors.lastname: Haslett
authors.forename: I
authors.initials: I
authors.lastname: Dransfield
authors.forename: C E
authors.initials: CE
authors.lastname: Robertson
authors.forename: D C
authors.initials: DC
authors.lastname: Carter
authors.forename: J A
authors.initials: JA
authors.lastname: Ross
authors.forename: I S
authors.initials: IS
authors.lastname: Grant
authors.forename: T F
authors.initials: TF
authors.lastname: Tedder
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015815:Cell Adhesion Molecules / Q000097:blood / Q000502:physiology*; D019040:E-Selectin; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications; D019041:L-Selectin; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D019007:P-Selectin; D010195:Pancreatitis / Q000150:complications; D010980:Platelet Membrane Glycoproteins / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology*
chemical_list: D015815:Cell Adhesion Molecules; D019040:E-Selectin; D019007:P-Selectin; D010980:Platelet Membrane Glycoproteins; D019041:L-Selectin