title: Hypertonic saline, mannitol and hydroxyethyl starch preconditioning of platelets obtained from septic patients attenuates CD40 ligand expression in vitro.
abstract: BACKGROUND
  Because platelet CD40 ligand (CD40L) expression plays an important role in inflammatory conditions, reduction of CD40L expression may be beneficial for patients with sepsis. Although hypertonic saline, mannitol, and hydroxyethyl starch (HES) solutions have been shown to modulate inflammatory responses, their effects on platelet CD40L expression are unclear. We assessed the effects of hypertonic saline, mannitol, and HES solutions on platelet CD40L expression.
  
  
  METHODS
  Platelet-rich plasma samples were obtained from septic patients and diluted to 1%, 2.5%, 5%, or 7.5% (vol/vol) with 7.5% saline, 3% saline, 0.9% saline, 20% mannitol, 10% HES (200/0.5), or Ringer's solution. Twenty-five samples were used per dilution. To determine platelet CD40L expression, platelet samples were stimulated with thrombin (0.1 U/mL), incubated with fluorochrome-conjugated platelet antibodies, and analyzed using flow cytometry.
  
  
  RESULTS
  Preconditioning of platelet-rich plasma with hypertonic saline, mannitol, and HES attenuated CD40L expression at dilution ratios of 5%, 1%, and 1%, respectively. The decreases were concentration dependent. The effects of mannitol and HES on CD40L expression were almost identical and were superior to those of 3% saline. In contrast, 0.9% saline and Ringer's solution had no effect on CD40L expression.
  
  
  CONCLUSIONS
  Our data show that resuscitation fluids, such as hypertonic saline, mannitol, and HES, inhibit agonist-induced CD40L expression on platelets. These resuscitation fluids may have an anti-inflammatory action when administered to septic patients.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Go-Shine
authors.initials: GS
authors.lastname: Huang
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Wu
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Hu
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
authors.forename: Wen-Jinn
authors.initials: WJ
authors.lastname: Liaw
authors.forename: Shun-Ming
authors.initials: SM
authors.lastname: Chan
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Li
mesh_terms: D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism*; D023201:CD40 Ligand / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005434:Flow Cytometry; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008353:Mannitol / Q000494:pharmacology*; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D018805:Sepsis / Q000378:metabolism*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D012462:Saline Solution, Hypertonic; D023201:CD40 Ligand; D008353:Mannitol