Neutrophil priming for elastase release in adult blunt trauma patients.
BACKGROUND
Elevated plasma elastase levels have been reported following major trauma and isolated femoral fracture. Reamed femoral nailing has been shown to further increase plasma elastase levels. The aim of this study was to investigate polymorphonuclear neutrophil (PMN) priming for degranulation following major trauma and isolated long-bone/pelvis fracture by assessing the ability of PMN to release elastase in vitro in response to a stimulus.


METHODS
We further analyzed PMN surface expression of the integrins CD11b and CD18 as markers of PMN activation. Ten major trauma (Injury Severity Score>or=18) patients and 12 patients with isolated long-bone/pelvis fracture were included in the study. Patients in the isolated fracture group were further stratified into reamed nail and external-fixation groups following surgery.


RESULTS
A significant increase in the capacity of PMN to release elastase was seen following major trauma, but not in isolated fracture patients. Surgery did not further alter PMN elastase release. CD11b and CD18 expression was essentially unaltered in all groups.


CONCLUSIONS
PMN is primed for increased degranulation following major trauma but not following isolated long-bone/pelvis fracture. Accumulation of primed, hyperactive PMN into tissues can lead to severe tissue damage and thus multiple organ failure.
Department of Trauma and Orthopaedics, University Hospital for Wales, Cardiff, United Kingdom.
Raj
R
Bhatia
Colin
C
Dent
Nicholas
N
Topley
Ian
I
Pallister
D000293:Adolescent; D000328:Adult; D039481:CD11b Antigen / Q000097:blood; D018821:CD18 Antigens / Q000097:blood; D005260:Female; D005264:Femoral Fractures / Q000276:immunology; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D066298:In Vitro Techniques; D015601:Injury Severity Score; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D009104:Multiple Trauma / Q000276:immunology*; D018375:Neutrophil Activation / Q000276:immunology*; D009504:Neutrophils / Q000276:immunology*; D010384:Pelvic Bones / Q000293:injuries; D011183:Postoperative Complications / Q000276:immunology; D012016:Reference Values; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology*; D013978:Tibial Fractures / Q000276:immunology; D014949:Wounds, Nonpenetrating / Q000276:immunology*
D039481:CD11b Antigen; D018821:CD18 Antigens; D019272:Leukocyte Elastase