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The Annals of Thoracic Surgery, Vol 56, 1503-1508, Copyright © 1993 by The Society of Thoracic Surgeons
MJ Elliott and AH Finn
The endothelial permeability associated with cardiopulmonary bypass in
children is due, at least in part, to an inflammatory response. Neutrophils
and their relationship with endothelium are fundamental to the production
of capillary leak. This review discusses current concepts of the mechanisms
involved in adhesion between neutrophils and the endothelium and its
control. Evidence for modulation of these changes during bypass in children
is reviewed. We have shown that cardiopulmonary bypass in children is
associated with down-regulation (or shedding) of L-selectin and
up-regulation of expression of CD11b/CD18. There may be a role for the
cytokine interleukin-8 in the modulation of this process. We have
demonstrated in vitro that certain of the procedures associated with bypass
are associated with up- regulation of circulating neutrophil adhesion
molecules and with the release of interleukin-8. These factors include
changes in temperature and circulation. More research is required to tease
out the most important components of the mechanisms of adhesion, and
clinical correlations must be defined.
ARTICLES
Interaction between neutrophils and endothelium
Hospital for Sick Children, London, England.
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