Mechanisms of neutropenia involving myeloid maturation arrest in burn sepsis.
OBJECTIVE
To determine the mechanisms that lead to the decrease in bone marrow production of neutrophils during burn sepsis.


BACKGROUND
Impaired bone marrow granulopoiesis during burn sepsis often results in neutropenia despite elevated circulating levels of granulocyte colony-stimulating factor (G-CSF). To date, neither the specific stages of neutrophil maturation involved in the bone marrow suppression nor the mechanisms for the impairment have been determined.


METHODS
Peripheral blood absolute neutrophil count and G-CSF levels were determined in mice 3 days after randomization to control, burn alone, or burn plus a topical inoculation of Pseudomonas aeruginosa (1000 colony-forming units). Bone marrow aspirates were analyzed for their neutrophil differentiation patterns by Gr-1 antigen expression and their G-CSF receptor status. Histologic analysis of liver, lung, spleen, and wound site was performed.


RESULTS
In burn sepsis, absolute neutrophil count was reduced whereas plasma G-CSF levels were elevated, and myeloid differentiation was significantly shifted toward the immature mitotic myeloid cells. Bone marrow G-CSF receptor mRNA levels and G-CSF-stimulated proliferation were substantially decreased in burn sepsis. Histologic analysis revealed no significant neutrophil infiltration into the tissues.


CONCLUSIONS
In thermal injury with superimposed sepsis, neutropenia and myeloid maturation arrest, despite the elevated levels of G-CSF, correlate with the reduction in bone marrow G-CSF receptor expression. These observations may provide a potential mechanism for neutropenia in sepsis.
Department of Pathology, Burn and Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA.
M
M
Shoup
J M
JM
Weisenberger
J L
JL
Wang
J M
JM
Pyle
R L
RL
Gamelli
R
R
Shankar
D000818:Animals; D000954:Antigens, Surface / Q000378:metabolism; D001853:Bone Marrow / Q000503:physiopathology*; D002056:Burns / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D005069:Evaluation Studies as Topic; D005434:Flow Cytometry; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood; D007958:Leukocyte Count; D008168:Lung / Q000473:pathology; D008297:Male; D051379:Mice; D008815:Mice, Inbred Strains; D009503:Neutropenia; D009195:Peroxidase / Q000378:metabolism; D012333:RNA, Messenger / Q000032:analysis; D011897:Random Allocation; D016188:Receptors, Granulocyte Colony-Stimulating Factor / Q000378:metabolism; D018805:Sepsis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*
D000954:Antigens, Surface; D012333:RNA, Messenger; D016188:Receptors, Granulocyte Colony-Stimulating Factor; D016179:Granulocyte Colony-Stimulating Factor; D009195:Peroxidase