Histologic, Immunohistochemical, and Ultrastructural Findings in Human Blast Lung Injury

Tsokos, Michael; Paulsen, Friedrich; Petri, Susan; Madea, Burkhard; Püschel, Klaus; Türk, Elisabeth E.

doi:10.1164/rccm.200304-528oc

Cited by 111 publications

(53 citation statements)

References 26 publications

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“…In PBLI, studies have shown neutrophil infiltration histologically or by assaying activation markers such as MPO in BALF or lung homogenates [9][10][11][12]14,18,19,34 . Our histological data showed marked cellular infiltration and free erythrocytes due to alveolar haemorrhage consistent with previous human and rodent reports 11,35 . Furthermore and in line with previous studies 18, 36 , we observed increased BALF levels of CXCL-1, IL-6, TNF-α and albumin -an indicator of endothelial and epithelial barrier damage.…”

Section: Modelsupporting

confidence: 92%

CD43Lo classical monocytes participate in the cellular immune response to isolated primary blast lung injury

Barnett-Vanes

Sharrock

Eftaxiopoulou

et al. 2016

Journal of Trauma and Acute Care Surgery

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BackgroundExplosive blast trauma occurs by four mechanisms: primary injuries are due to the isolated effect of the blast wave on the human body, secondary injuries are due to damage from fragments energised from the explosion, tertiary injuries result from acceleration of the body against an object or through the explosion energising hard materials in a solid form (not fragments) and encroaching upon the person, and quaternary injuries describe other physical insults, including burns and smoke inhalation 1 .Gas-containing organs such as the lungs are particularly susceptible to barotrauma, and 'Primary Blast Lung Injury' (PBLI) is a commonly reported injury amongst blast casualties. A review of terrorist bombings worldwide found the incidence of PBLI in immediate fatalities to be as high as 47% 2 ; whilst in a review of military blast casualties that survived to emergency admission, PBLI was found in 11.2% of 648 blast casualties. In this series, 16.2% of mounted and 17.1% of dismounted injuries developed PBLI, which was significantly associated with increased mortality 3,4 .Laboratory investigations of PBLI have sought to recapitulate the injury under experimental conditions. Studies investigating the subsequent immune response have been reported most commonly in rats 5-10 , mice [11][12][13][14][15] and swine 16,17 . These studies have offered overwhelming evidence of the neutrophil response to PBLI in animal models, with increases in circulating and broncho-alveolar lavage fluid (BALF) neutrophils, increases in Myeloperoxidase (MPO) activity in the lung, and neutrophil staining by histology [9][10][11][12]14,18,19 . However, the immune response to tissue damage differs depending on the type of organ injured and their local physiology; it remains unclear what specific contribution blast injuries to different parts of the body make to the inflammatory response that ensues. Whilst most clinically blast injured patients are polytraumatised, discerning these interacting immune responses experimentally is necessary for translational studies seeking to better understand, monitor or attenuate the immune response in blast trauma.Further, knowledge of the role played by other immune cells to PBLI is limited -no study has characterised the full repertoire of immune cells in PBLI; specifically, the involvement of monocytes in PBLI remains unclear. These cells are frequently recruited to sites of inflammation; in humans they are characterised by differential CD14 and CD16 expression 20 , in mice by CCR2, CX3CR1 and Ly6C 21,22 and in rats by CD43 alone or in conjunction with His48 23 . In rats, CD43 Hi and Lo monocytes are considered to be analogous to the Ly6C Lo (Non-classical) and Ly6C Hi (Classical) murine monocytes respectively. Classical Ly6C Hi monocytes are recruited to tissues in sterile 24 and infectious 25 models of inflammation. There, they can differentiate into inflammatory macrophages and dendritic cells, amplifying or resolving inflammation. In rats, circulating monocyte subsets are activated by inflammator...

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Section: Modelsupporting

confidence: 92%

CD43Lo classical monocytes participate in the cellular immune response to isolated primary blast lung injury

Barnett-Vanes

Sharrock

Eftaxiopoulou

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…The explosives used in a suicide attack are capable of an abrupt expansion of gas creating a pressure wave on detonation, known as the ''blast wave'' [11]. The blast wave consists of a shock wave of high pressure, followed by a blast wind.…”

Section: Discussionmentioning

confidence: 99%

Injury pattern of suicide bomb attacks in Pakistan

Yasin

Nasreen

Malik

2011

Eur J Trauma Emerg Surg

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“…It is the leading cause of respiratory deterioration in blast victims who survive [13]. As no evidence of myeloid tissue was found in lung sections from blunt trauma victims, it is believed that soft tissue is the source of FE in these cases [14].…”

Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

159

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Histologic, Immunohistochemical, and Ultrastructural Findings in Human Blast Lung Injury

Cited by 111 publications

References 26 publications

CD43Lo classical monocytes participate in the cellular immune response to isolated primary blast lung injury

CD43Lo classical monocytes participate in the cellular immune response to isolated primary blast lung injury

Injury pattern of suicide bomb attacks in Pakistan

Nonthrombotic pulmonary embolism

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