Alveolar granulocyte colony-stimulating factor and alpha-chemokines in relation to serum levels, pulmonary neutrophilia, and severity of lung injury in ARDS.
OBJECTIVE
To determine granulocyte colony-stimulating factor (G-CSF), epithelial neutrophil-activating peptide (ENA)-78, and interleukin (IL)-8 in BAL fluid (BALF), epithelial lining fluid (ELF), and serum for establishing the concentration gradient of G-CSF, ENA-78, and IL-8 between the blood and the alveolar space in ARDS and acute lung injury (ALI); and to evaluate the relationship of G-CSF, IL-8, and ENA-78 to pulmonary neutrophilia and severity of lung injury.


METHODS
Prospective study.


METHODS
An adult trauma/surgical ICU.


METHODS
Nineteen patients with ARDS and 10 patients with ALI.


METHODS
None.


RESULTS
BAL and blood sampling simultaneously within 12 h and 24 h after onset of ARDS/ALI; G-CSF was detected in BALF in 18 of 19 patients with ARDS, in 7 of 10 patients with ALI, and in all serum samples. G-CSF in BALF and serum was significantly higher in ARDS than in ALI. ENA-78 was detected in BALF in 14 of 19 patients with ARDS, in 8 of 10 patients with ALI, and in serum of all patients. Levels in BALF and serum were not different between ARDS and ALI. IL-8 was detected in all patients; concentrations in BALF in ARDS were significantly higher than in ALI. Concentrations of G-CSF, ENA-78, and IL-8 in ELF were significantly higher than in serum. G-CSF in BALF and serum and IL-8 in BALF correlated positively with pulmonary neutrophilia. G-CSF in serum and IL-8 in BALF correlated negatively with PaO(2)/fraction of inspired oxygen (FIO(2)) ratio. However, ENA-78 did not show a correlation with neutrophil count or with PaO(2)/FIO(2) ratio.


CONCLUSIONS
G-CSF may be pathophysiologically important for accumulation and activation of neutrophils in ARDS. Local G-CSF production is the likely driving force for neutrophils rather than elevation of circulating levels. In comparison to ENA-78, IL-8 seems to be the predominant neutrophil chemoattractant in the early phase of ARDS.
Wiedermann
Franz J
FJ
Departments of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria. franz.wiedermann@uibk.ac.at
Mayr
Andreas J
AJ
Kaneider
Nicole C
NC
Fuchs
Dietmar
D
Mutz
Norbert J
NJ
Schobersberger
Wolfgang
W
D000328:Adult; D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D054365:Chemokine CXCL5; D019743:Chemokines, CXC / Q000032:analysis* / Q000097:blood; D015633:Extravascular Lung Water / Q000737:chemistry; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000032:analysis* / Q000097:blood; D006801:Humans; D016209:Interleukin-8 / Q000031:analogs & derivatives* / Q000032:analysis* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000378:metabolism*; D012128:Respiratory Distress Syndrome / Q000378:metabolism*
C486263:CXCL5 protein, human; D054365:Chemokine CXCL5; D019743:Chemokines, CXC; D016209:Interleukin-8; D016179:Granulocyte Colony-Stimulating Factor