title: Cardiopulmonary bypass tubes and prime solutions stimulate neutrophil adhesion molecules.
abstract: OBJECTIVE
  To evaluate effects of the material of the cardiopulmonary bypass (CPB) tubes (polyvinyl chloride, PVC) and prime solutions on expression of neutrophil adhesion molecule CD11b and L-selectin.
  
  
  METHODS
  We carried out a series of experiments using donor blood from 30 healthy adult human volunteers. In all experiments, neutrophil cell surface expressions of CD11b and L-selectin were assayed immediately and serially up to 2 hours, using immune-fluorescence techniques and flow cytometry. Study 1: Effects of PVC were compared with glass and polystyrene (n = 5). Study 2: Blood was mixed with Plasma-lyte (Pl) (prime solution), Hartman solutions, albumin or not altered (control), n = 5. Study 3: The effects of changing pH of the Pl (control, neutralised and acidic solution, n = 5) were examined. Study 4: Haemodilution (undiluted, 1:1, 1:2, and 1:3, vol/vol, prime to blood, n = 5) was carried out using Pl and the subsequent changes in expressions of the adhesion molecules were analysed. Study 5: The combined effect of PVC and Pl was assessed (n = 5). Study 6: We evaluated the effect of increasing plasma water by adding sterile water to whole blood and compared it with control (n = 5).
  
  
  RESULTS
  Study 1: PVC, similar to glass, caused more up-regulation of CD11b and down-regulation of L-selectin than polystyrene (238 and 162% vs. 68 increase of CD11b, P < 0.001; 89 and 95% vs. 16% decrease of L-selectin, P < 0.001). Study 2: Pl and Hartman solutions caused more up-regulation of CD11b and down-regulation of L-selectin compared to albumin and control (166 and 188% vs. 26 and 44% increase of CD11b, P < 0.01; 19 and 26% vs. 10 and 6% decrease of L-selectin, P < 0.01, respectively). Study 3: Haemodilution had no effect on these molecules. Study 4: The mean of the difference between the acidic and neutral solution was 208% increase of CD11b and 30% decrease of L-selectin, P < 0.05. Study 5: The combined effect of mixing blood with Pl and exposure to PVC caused marked up-regulation of CD11b (336% increase, P < 0.01) and down-regulation of L-selectin (78% decrease, P < 0.05). Study 6: Water for injection caused marked up-regulation of CD1 1b and down-regulation of L-selectin.
  
  
  CONCLUSIONS
  Mixing blood with acidic prime solution and/or exposing it to PVC tubes causes up-regulation of neutrophil adhesion molecule CD11b and down-regulation of L-selectin. Neutralisation of the prime solution reduces the extent of neutrophil activation, whereas haemodilution has no effect. Increasing plasma water is stimulating to the neutrophil. Modulation of prime solutions and the material of CPB tubes may reduce neutrophil activation which may reduce patient morbidity.
authors.affiliation: Postgraduate Medical Education and Cardiothoracic Unit, Institute of Child Health, London, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: el Habbal
authors.forename: L J
authors.initials: LJ
authors.lastname: Smith
authors.forename: M J
authors.initials: MJ
authors.lastname: Elliott
authors.forename: S
authors.initials: S
authors.lastname: Strobel
mesh_terms: D000328:Adult; D018845:CD11 Antigens / Q000032:analysis; D002314:Cardioplegic Solutions / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D005942:Gluconates / Q000009:adverse effects; D006801:Humans; D019041:L-Selectin / Q000032:analysis; D015636:Magnesium Chloride / Q000009:adverse effects; D018375:Neutrophil Activation; D009504:Neutrophils / Q000276:immunology; D011137:Polystyrenes / Q000009:adverse effects; D011143:Polyvinyl Chloride / Q000009:adverse effects*; D011189:Potassium Chloride / Q000009:adverse effects; D019346:Sodium Acetate / Q000009:adverse effects; D012965:Sodium Chloride / Q000009:adverse effects
chemical_list: D018845:CD11 Antigens; D002314:Cardioplegic Solutions; D005942:Gluconates; C012499:Plasma-lyte 148; D011137:Polystyrenes; D015636:Magnesium Chloride; D019041:L-Selectin; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride; D011143:Polyvinyl Chloride