Leukocyte L-selectin is up-regulated after mechanical trauma in adults

Abstract

Background: Infection and multiple organ failure remain the principal causes of late mortality after trauma despite advances in the resuscitation of injured patients. Because a better understanding of postinjury leukocyte trafficking is essential to the development of possible therapeutic measures aimed at preventing these complications, we have performed a study of one factor in the early posttrauma endothelial adhesion behavior of monocytes, lymphocytes, and neutrophils: their cell surface expression of L-selectin (CD62L). We have also studied the plasma levels of soluble L-selectin in these patients. Methods: Two venous blood samples were taken from each of 41 trauma patients at median times of 1 and 20 hours after injury. The study group included 16 patients with major (Injury Severity Score (ISS) ≤ 16), 17 with moderate (ISS = 9-15), and 8 with minor (ISS < 9) trauma. Cell surface L-selectin was measured on leukocyte subsets by staining with specific fluorescent-labeled monoclonal antibodies to CD62L and using flow cytometry. Both the percentage of cells expressing the molecule and the mean channel fluorescence were measured. Levels of soluble L-selectin were measured in the plasma, sampled concurrently, by enzyme-linked immunosorbent assay. Results: Monocytes, lymphocytes, and neutrophils all showed an early increase in cell surface L-selectin expression as measured by mean channel fluorescence (p < 0.0001, p < 0.001, and p < 0.0001, respectively), and this persisted in later samples taken at a median 20 hours after injury (p < 0.0001, p < 0.0001, and p < 0.01). Only monocytes showed an increased percentage of cells expressing the molecule in the early phase (p < 0.02), and this remained in the later phase (p < 0.001). Monocytes also showed a further significant increase in mean channel fluorescence (p < 0.02) between the two periods. No significant changes in levels of plasma soluble L-selectin were found at either stage. Conclusion: An increase in the expression of L-selectin on each of three leukocyte populations has been demonstrated in the early phase after trauma. This would tend to promote rolling behavior of leukocytes and increase their contact with the vascular endothelium. There were marked differences in the later responses of the three populations, which may represent differential control of their behavior.