453 ALI = acute lung injury; ARDS = acute respiratory distress syndrome; BAL = bronchoalveolar lavage; CXCL = CXC chemokine ligand; CXCR = CXC chemokine receptor; ENA = epithelial neutrophil-activating peptide; fMLP = N-formylmethionyl-leucyl-phenylalanine; GAG = glycosaminoglycan; ICAM = intercellular adhesion molecule; IL = interleukin; KC = keratinocyte-derived chemokine; LPS = lipopolysaccharide; MIP = macrophage inflammatory protein; PECAM = platelet endothelial cell adhesion molecule; PMN = polymorphonuclear leukocyte; TF = tissue factor; TFPI = tissue factor pathway inhibitor; TNF = tumor necrosis factor; VCAM = vascular cell adhesion molecule.Available online http://ccforum.com/content/8/6/453
IntroductionAcute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by increased permeability of the alveolar-capillary barrier, resulting in influx of proteinrich edema fluid and consequently impairment in arterial oxygenation. Although mortality has decreased over recent decades, it remains high (30-40%), and pulmonary and nonpulmonary morbidity in ARDS survivors is significant [1]. Although ALI has been described in neutropenic patients, activation and transmigration of circulating neutrophils (polymorphonuclear leukocytes [PMNs]) are thought to play a major role in the early development of ALI [2]. In most animal models, elimination of PMNs markedly decreases the severity of ALI [3]. In addition, recovery from neutropenia in some patients with lung injury is associated with a deterioration in pulmonary function [4].Various animal models have been developed to study the molecular basis of PMN trafficking in the lung (Table 1), but each mimics only some aspects of the clinical situation. Preexisting pulmonary or nonpulmonary diseases, fluid resuscitation, and mechanical ventilation significantly influence the course of ALI but are not considered in most animal models. In addition, experimental methods with which to study PMN recruitment are limited; for example, intravital
AbstractAcute lung injury and its more severe form, acute respiratory distress syndrome, are major challenges in critically ill patients. Activation of circulating neutrophils and transmigration into the alveolar airspace are associated with development of acute lung injury, and inhibitors of neutrophil recruitment attenuate lung damage in many experimental models. The molecular mechanisms of neutrophil recruitment in the lung differ fundamentally from those in other tissues. Distinct signals appear to regulate neutrophil passage from the intravascular into the interstitial and alveolar compartments. Entry into the alveolar compartment is under the control of CXC chemokine receptor (CXCR)2 and its ligands (CXC chemokine ligand [CXCL]1-8). The mechanisms that govern neutrophil sequestration into the vascular compartment of the lung involve changes in the actin cytoskeleton and adhesion molecules, including selectins, β 2 integrins and intercellular adhesion molecule-1. The mechanisms of neutrophil entry into the...