title: The role of neutrophils in severe sepsis.
abstract: Neutrophils are key effectors of the innate immune response. Reduction of neutrophil migration to infection sites is associated with a poor outcome in sepsis. We have demonstrated a failure of neutrophil migration in lethal sepsis. Together with this failure, we observed more bacteria in both peritoneal exudates and blood, followed by a reduction in survival rate. Furthermore, neutrophils obtained from severe septic patients displayed a marked reduction in chemotactic response compared with neutrophils from healthy subjects. The mechanisms of neutrophil migration failure are not completely understood. However, it is known that they involve systemic Toll-like receptor activation by bacteria and/or their products and result in excessive levels of circulating cytokines/chemokines. These mediators acting together with LPS stimulate expression of iNOS that produces high amounts of NO, which in turn mediates the failure of neutrophil migration. NO reduced expression of CXCR2 on neutrophils and the levels of adhesion molecules on both endothelial cells and neutrophils. These events culminate in decreased endothelium-leukocyte interactions, diminished neutrophil chemotactic response, and neutrophil migration failure. Additionally, the NO effect, at least in part, is mediated by peroxynitrite. In this review, we summarize what is known regarding the mechanisms of neutrophil migration impairment in severe sepsis.
authors.forename: José C
authors.initials: JC
authors.lastname: Alves-Filho
authors.forename: Andressa
authors.initials: A
authors.lastname: de Freitas
authors.forename: Fernando
authors.initials: F
authors.lastname: Spiller
authors.forename: Fabrício O
authors.initials: FO
authors.lastname: Souto
authors.forename: Fernando Q
authors.initials: FQ
authors.lastname: Cunha
mesh_terms: D000818:Animals; D002465:Cell Movement; D018925:Chemokines / Q000378:metabolism; D002633:Chemotaxis; D016207:Cytokines / Q000378:metabolism; D004727:Endothelium / Q000378:metabolism; D006801:Humans; D007107:Immune System; D018375:Neutrophil Activation / Q000276:immunology; D020556:Neutrophil Infiltration / Q000276:immunology; D009504:Neutrophils / Q000166:cytology* / Q000378:metabolism / Q000502:physiology*; D009569:Nitric Oxide / Q000378:metabolism; D030421:Peroxynitrous Acid / Q000378:metabolism; D018805:Sepsis / Q000097:blood* / Q000276:immunology* / Q000382:microbiology; D051193:Toll-Like Receptors / Q000378:metabolism
chemical_list: D018925:Chemokines; D016207:Cytokines; D051193:Toll-Like Receptors; D030421:Peroxynitrous Acid; D009569:Nitric Oxide