Modulation of granulocyte LAM-1 and MAC-1 during dialysis--a prospective, randomized controlled trial.
Modulation of granulocyte LAM-1 and MAC-1 during dialysis--a prospective, randomized controlled trial.
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透析过程中粒细胞 LAM-1 和 MAC-1 的调节——一项前瞻性、随机对照试验。
DOI：
10.1038/ki.1992.54
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发表时间：
1992
影响因子：
19.6
通讯作者：
Hakim,R
中科院分区：
文献类型：
--
作者：
Himmelfarb,J;Zaoui,P;Hakim,R
透析过程中粒细胞LAM-1和MAC-1的调节：一项前瞻性随机对照试验。首次使用纤维透析膜的血液透析导致补体和严重的中性粒细胞减少的替代途径的激活，随后是反跳性白细胞增加。中性粒细胞减少与黏附受体表达增加和粒细胞肺隔离有关。然而，粒细胞回归的机制尚未阐明。在一项随机交叉研究中，我们同时测定了使用补体激活膜和非补体激活膜透析过程中粒细胞黏附受体MAC-1(CD11b-CD18)和选择素LAM-1受体的变化。随着纤维素膜透析的开始，MAC-1受体的表达迅速而显著增加。在粒细胞计数的最低点，在补体激活膜开始透析15分钟后，MAC-1受体的表达增加了4倍。同时，LAM-1的表达减少了一倍。另外两种已知在粒细胞激活过程中不受调节的粒细胞受体CD11a和CD15的表达没有变化。在透析过程中采集的高MAC-1和低LAM-1表达的粒细胞与内皮细胞单层的粘附率显著降低。相同患者使用非补体激活膜透析后，粒细胞上这些受体的表达或与内皮细胞的粘附性没有明显变化。这些结果为新纤维素膜透析中周期性粒细胞减少和反跳粒细胞减少的机制提供了新的线索。
Modulation of granulocyte LAM-1 and MAC-1 during dialysis—A prospective, randomized controlled trial. Hemodialysis with first-use cellulosic dialysis membranes results in activation of the alternative pathway of complement and profound neutropenia followed by rebound leukocytosis. The neutropenia has been shown to be associated with increased expression of adhesion receptors and pulmonary sequestration of granulocytes. However, the mechanism underlying the return of the granulocytes has not been elucidated. We determined simultaneously the changes in the granulocyte adhesion receptor MAC-1 (CD11b-CD18) and the selectin LAM-1 receptor during dialysis using a complement activating and a non-complement activating membrane, in a randomized, cross-over study. With initiation of dialysis with cellulosic membranes, there was a rapid and prominent increase in the expression of MAC-1 receptors. At the nadir of granulocyte count, 15 minutes after initiation of dialysis with the complement activating membrane, there was a four-fold increase in the MAC-1 receptor expression. At the same time, there was a two-fold decrease in LAM-1 expression. There were no changes in the expression of two other granulocyte receptors CD 11a and CD 15 which are known not to be modulated during granulocyte activation. Granulocytes harvested during dialysis and which had high MAC-1 and low LAM-1 expression had a significantly decreased adherence to endothelial cell monolayers. Dialysis of the same patients with non-complement activating membranes resulted in no significant change in the expression of these receptors on granulocytes nor in their adherence to endothelial cells. These results shed new light on the mechanism of the cyclical granulocytopenia and rebound granulocytosis during dialysis with new cellulosic membranes.