Antithrombin-III exerts antiinflammatory effects via ligation of heparan sulfate proteoglycans. Here we show in vitro that recombinant human antithrombin-III attenuates CDllb/CD18 expression ofaetivated neutrophils and monocytes in whole blood ex vivo. As leukocyte integrin expression is triggered by extracorporeal circulation, this observation may be of relevance for pharmacological treatment during cardiopulmonary bypass.Cardiac surgery involving cardiopulmonary bypass leads to fulminant activation of the hemostatic-inflammatory system (1). Transgenic recombinant human antithrombin III (rhAT-III) is in phase III clinical trials in the US and Europe as an anticoagulant and antiinflammatory agent in patients undergoing elective cardiac surgery with cardiopulmonary bypass (2).AT-III supplementation to maintain normal physiologic concentrations during cardiopulmonary bypass does not alter significantly thrombin generation, fibrinolytic activity, or blood loss in adults undergoing cardiac surgery (3). However, treatment with AT-III concentrate of heparin resistance, which is frequently associated with cardiopulmonary bypass due to aquired AT-III deficiency, is more effective and faster for obtaining adequate anticoagulation than using additional heparin (4, 5). Effects of AT-III supplementation on the inflammatory response during cardiac surgery are less well investigated.Cardiopulmonary bypass is associated with extensive granulocyte and monocyte activation including the release of pro-and antiinflammatory cytokines and up-regulation ofadhesion molecules including CD 11blCD 18 which is responsible for firm leukocyte adhesion to platelets and fibrinogen (6-7). Blood contact with artificial surfaces decreases the ability of platelets, leukocytes and their aggregates to pass through organ capillaries, and neutrophil sequestration has been implicated in the inflammatory response associated with cardiopulmonary bypass (8). In the presence of plasma and platelets, aggregation of normal white blood cells after stimulation with lectin is inhibited by AT-III (9). Here we show that rhAT-III reduces CD 11blCD 18 expression of neutrophils and monocytes.
MATERIALS AND METHODSVenous blood from healthy adult donors was collected intosterile bloodcollection tubesanticoagulated with EDTA. Blood samples were incubated with 1 UI mL of rhAT-III (Genzyme Transgenics, Boston, MA) or vehicle at 37°C for 20 min. After the end of the incubation period, blood cells were washed and resuspendedin phosphate-bufferedsaline. All samples wereimmediately processed forstimulationandstaining procedures.