title: Transforming growth factor-β, macrophage colony-stimulating factor and C-reactive protein levels correlate with CD14(high)CD16+ monocyte induction and activation in trauma patients.
abstract: Severe injury remains a leading cause of death and morbidity in patients under 40, with the number of annual trauma-related deaths approaching 160,000 in the United States. Patients who survive the initial trauma and post-traumatic resuscitation are at risk for immune dysregulation, which contributes to late mortality and accounts for approximately 20% of deaths after traumatic injury. This post-traumatic immunosuppressed state has been attributed to over-expression of anti-inflammatory mediators in an effort to restore host homeostasis. We measured a panel of monocyte markers and cytokines in 50 severely injured trauma patients for 3 days following admission. We made the novel observation that the subpopulation of monocytes expressing high levels of CD14 and CD16 was expanded in the majority of patients. These cells also expressed CD163 consistent with differentiation into alternatively activated macrophages with potential regulatory or wound-healing activity. We examined factors in trauma plasma that may contribute to the generation and activation of these cells. The percentage of CD14(high)CD16(+) monocytes after trauma correlated strongly with plasma C-reactive protein (CRP) transforming growth factor-β (TGF-β), and macrophage colony-stimulating factor (M-CSF) levels. We demonstrate a role for TGF-β and M-CSF, but not CRP in generating these cells using monocytes from healthy volunteers incubated with plasma from trauma patients. CD16 is a receptor for CRP and IgG, and we showed that monocytes differentiated to the CD14(high)CD16(+) phenotype produced anti-inflammatory cytokines in response to acute phase concentrations of CRP. The role of these cells in immunosuppression following trauma is an area of ongoing investigation.
authors.affiliation: Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA. sowest@salud.unm.edu
authors.forename: Sonlee D
authors.initials: SD
authors.lastname: West
authors.forename: Daniel
authors.initials: D
authors.lastname: Goldberg
authors.forename: Anna
authors.initials: A
authors.lastname: Ziegler
authors.forename: Michael
authors.initials: M
authors.lastname: Krencicki
authors.forename: Terry W
authors.initials: TW
authors.lastname: Du Clos
authors.forename: Carolyn
authors.initials: C
authors.lastname: Mold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D005434:Flow Cytometry; D051547:Heme Oxygenase-1 / Q000378:metabolism; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000378:metabolism*; D016173:Macrophage Colony-Stimulating Factor / Q000097:blood* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects / Q000378:metabolism*; D017452:Receptors, IgG / Q000378:metabolism*; D018709:Statistics, Nonparametric; D016212:Transforming Growth Factor beta / Q000097:blood*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood* / Q000201:enzymology / Q000276:immunology; D055815:Young Adult
chemical_list: D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG; D016212:Transforming Growth Factor beta; D016173:Macrophage Colony-Stimulating Factor; D002097:C-Reactive Protein; D051547:Heme Oxygenase-1