Seeger W, Schneider U, Kreusler B, von Witzleben E, Walmrath D, Grimminger F, Neppert J
Department of Internal Medicine, Justus-Liebig-University, Giessen, FRG.
Blood. 1990 Oct 1;76(7):1438-44.
Leukoagglutinins are implicated in transfusion-related acute lung injury (TRALI). In the present study, severe lung vascular leakage was reproduced by application of a leukoagglutinating antibody of anti-5b specificity in an ex vivo lung model. The antibody originated from a multiparous donor-plasma, observed to cause noncardiogenic edema during transfusion therapy. Heated full plasma (anti-5b-titer 1/128) or purified immunoglobulin G fraction was used for the studies. Ex vivo isolated rabbit lungs were perfused with albumin buffer, and human granulocytes (PMN) were admixed to the recirculating perfusate. In presence of anti-5b antibody plus 5b-positive PMN plus rabbit plasma as complement-source, severe lung edema occurred after a latent period of 3 to 6 hours. Pulmonary artery pressure was only transiently and moderately increased, and the leakage reaction could be traced back to a several-fold increase in lung vascular permeability. In contrast, no vascular leakage was noted in lungs perfused in the absence of anti-5b antibody, PMN, or rabbit plasma. Moreover, no permeability increase occurred on use of 5b-negative PMN. This reproduction of TRALI in an ex vivo lung model corroborates the role of leukoagglutinating antibodies in initiating PMN-dependent respiratory distress and suggests a contribution of concomitant complement activation.
白细胞凝集素与输血相关的急性肺损伤（TRALI）有关。在本研究中，通过在离体肺模型中应用抗5b特异性的白细胞凝集抗体再现了严重的肺血管渗漏。该抗体源自一位经产妇的供体血浆，在输血治疗期间观察到可导致非心源性肺水肿。加热的全血浆（抗5b滴度1/128）或纯化的免疫球蛋白G组分用于研究。将离体分离的兔肺用白蛋白缓冲液灌注，并将人粒细胞（PMN）混入再循环灌注液中。在存在抗5b抗体加5b阳性PMN加兔血浆作为补体来源的情况下，经过3至6小时的潜伏期后发生了严重的肺水肿。肺动脉压仅短暂且适度升高，渗漏反应可追溯到肺血管通透性增加数倍。相比之下，在没有抗5b抗体、PMN或兔血浆的情况下灌注的肺中未观察到血管渗漏。此外，使用5b阴性PMN时未发生通透性增加。在离体肺模型中再现TRALI证实了白细胞凝集抗体在引发PMN依赖性呼吸窘迫中的作用，并提示伴随补体激活的作用。
