Dual blockade of P-selectin and β2-integrin in the liver inflammatory response after uncontrolled hemorrhagic shock

Roberto Anaya-Prado, Luis H. Toledo-Pereyra, J. T. Collins, R. Smejkal, J. McClaren, Larry D. Crouch, Peter A. Ward

Research output: Contribution to journalArticle

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Abstract

Background: Neutrophil infiltration is a characteristic feature of the hepatic injury associated with prolonged hypotension. Previous work has already stressed the important contribution of neutrophil-endothelial cell interactions in the organ injury seen after hemorrhagic shock. Single- blockade strategies using monoclonal antibodies (MAbs) against either selectin or integrin receptors have been demonstrated to be effective in limiting the tissue inflammatory response observed in this clinical disorder. One unexplored topic is the additive effect(s) and the potential antiinflammatory properties of the combined blocking of P-selectin plus β2- integrin in the liver inflammatory response after uncontrolled hemorrhagic shock in rats. Study Design: Sprague-Dawley rats (n = 64) weighing 250-300 g were included in a three-phase model of uncontrolled hemorrhagic shock. A prehospital phase consisted of 90 minutes of fluid resuscitation with lactated Ringers solution to reach a mean arterial pressure (MAP) of 40 mmHg; a hospital phase consisted of 60 minutes of hemostasis and fluid resuscitation with lactated Ringer's solution to reach a MAP of 80 mmHg; and the third phase was 3 days of observation. All rats had 3 mL/100 g of blood volume shed during the initial 15 minutes. At 30 minutes, 75% tail amputation produced uncontrolled hemorrhagic shock. Four groups were randomized (n = 16 per group), and treatment at the beginning of resuscitation included normal saline (group 1); anti-P-selectin MAb, RMP-1 (group 2); anti-β2-integrin MAb, WT.3 (group 3); or anti-Pselectin plus anti-β2-integrin MAbs (group 4). The following indices were evaluated: fluid requirements for resuscitation, liver injury tests, liver tissue myeloperoxidase, and liver histology. Results: Dual blockade of P-selectin and β2-integrin significantly reduced fluid requirements for resuscitation (p < 0.05). We also observed a statistically significant improvement (p < 0.05) in tests demonstrating hepatic injury, myeloperoxidase in hepatic tissue, and histology studies. Survival was increased from 40% in controls to 60% with the dual-blockade treatment. Conclusions: These results indicate that dual- blockade strategies aimed at P-selectin and β2-integrin provided a protective effect in the liver inflammatory response after uncontrolled hemorrhagic shock in rats. Although dual blockade was more effective than either individual blockade alone, questions remain about the possible redundancy in the inflammatory adhesion pathways after this clinical condition.

Original languageEnglish (US)
Pages (from-to)22-31
Number of pages10
JournalJournal of the American College of Surgeons
Volume187
Issue number1
DOIs
StatePublished - Jul 14 1998

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P-Selectin
Hemorrhagic Shock
Integrins
Resuscitation
Liver
Wounds and Injuries
Peroxidase
Histology
Arterial Pressure
Monoclonal Antibodies
Selectins
Critical Pathways
Neutrophil Infiltration
Blood Volume
Hemostasis
Amputation
Cell Communication
Hypotension
Sprague Dawley Rats
Tail

ASJC Scopus subject areas

  • Surgery

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Dual blockade of P-selectin and β2-integrin in the liver inflammatory response after uncontrolled hemorrhagic shock. / Anaya-Prado, Roberto; Toledo-Pereyra, Luis H.; Collins, J. T.; Smejkal, R.; McClaren, J.; Crouch, Larry D.; Ward, Peter A.

In: Journal of the American College of Surgeons, Vol. 187, No. 1, 14.07.1998, p. 22-31.

Research output: Contribution to journalArticle

Anaya-Prado, Roberto ; Toledo-Pereyra, Luis H. ; Collins, J. T. ; Smejkal, R. ; McClaren, J. ; Crouch, Larry D. ; Ward, Peter A. / Dual blockade of P-selectin and β2-integrin in the liver inflammatory response after uncontrolled hemorrhagic shock. In: Journal of the American College of Surgeons. 1998 ; Vol. 187, No. 1. pp. 22-31.
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AU - McClaren, J.

AU - Crouch, Larry D.

AU - Ward, Peter A.

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N2 - Background: Neutrophil infiltration is a characteristic feature of the hepatic injury associated with prolonged hypotension. Previous work has already stressed the important contribution of neutrophil-endothelial cell interactions in the organ injury seen after hemorrhagic shock. Single- blockade strategies using monoclonal antibodies (MAbs) against either selectin or integrin receptors have been demonstrated to be effective in limiting the tissue inflammatory response observed in this clinical disorder. One unexplored topic is the additive effect(s) and the potential antiinflammatory properties of the combined blocking of P-selectin plus β2- integrin in the liver inflammatory response after uncontrolled hemorrhagic shock in rats. Study Design: Sprague-Dawley rats (n = 64) weighing 250-300 g were included in a three-phase model of uncontrolled hemorrhagic shock. A prehospital phase consisted of 90 minutes of fluid resuscitation with lactated Ringers solution to reach a mean arterial pressure (MAP) of 40 mmHg; a hospital phase consisted of 60 minutes of hemostasis and fluid resuscitation with lactated Ringer's solution to reach a MAP of 80 mmHg; and the third phase was 3 days of observation. All rats had 3 mL/100 g of blood volume shed during the initial 15 minutes. At 30 minutes, 75% tail amputation produced uncontrolled hemorrhagic shock. Four groups were randomized (n = 16 per group), and treatment at the beginning of resuscitation included normal saline (group 1); anti-P-selectin MAb, RMP-1 (group 2); anti-β2-integrin MAb, WT.3 (group 3); or anti-Pselectin plus anti-β2-integrin MAbs (group 4). The following indices were evaluated: fluid requirements for resuscitation, liver injury tests, liver tissue myeloperoxidase, and liver histology. Results: Dual blockade of P-selectin and β2-integrin significantly reduced fluid requirements for resuscitation (p < 0.05). We also observed a statistically significant improvement (p < 0.05) in tests demonstrating hepatic injury, myeloperoxidase in hepatic tissue, and histology studies. Survival was increased from 40% in controls to 60% with the dual-blockade treatment. Conclusions: These results indicate that dual- blockade strategies aimed at P-selectin and β2-integrin provided a protective effect in the liver inflammatory response after uncontrolled hemorrhagic shock in rats. Although dual blockade was more effective than either individual blockade alone, questions remain about the possible redundancy in the inflammatory adhesion pathways after this clinical condition.

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