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In vivo leukocyte-mediated brain microcirculatory inflammation: a comparison of osmotherapies and progesterone in severe traumatic brain injury.

Authors
  • Kumasaka, Kenichiro1
  • Marks, Joshua A1
  • Eisenstadt, Rachel1
  • Murcy, Mohammad A1
  • Samadi, Davoud1
  • Li, Shengjie1
  • Johnson, Victoria2
  • Browne, Kevin D2
  • Smith, Douglas H2
  • Schwab, C William1
  • Pascual, Jose L3
  • 1 Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • 2 Department of Neurosurgery, Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • 3 Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: [email protected]
Type
Published Article
Journal
American journal of surgery
Publication Date
Dec 01, 2014
Volume
208
Issue
6
Identifiers
DOI: 10.1016/j.amjsurg.2014.08.004
PMID: 25305798
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Mannitol, hypertonic saline, and progesterone may blunt leukocyte recruitment after traumatic brain injury (TBI). We hypothesized that progesterone reduces pericontusional recruitment of leukocytes to a greater extent than either osmotherapy a day after TBI. CD1 mice underwent controlled cortical impact and were treated with osmotherapy (mannitol and hypertonic saline) or progesterone. Thirty-two hours after TBI, live pial microscopy was used to evaluate leukocyte-endothelial interactions and immunohistochemistry was used for the detection of pericontusional tissue polymorphonuclear neutrophils. Neurologic recovery was assessed before sacrifice. Mannitol resulted in the lowest in vivo leukocyte recruitment compared with progesterone (795 ± 282 vs 1,636 ± 434 LEU/100 μm/minutes, P < .05). Mannitol also displayed lower tissue accumulation of leukocytes as compared with progesterone (5.7 ± 1.7 vs 15.2 ± .1 LEU/mm(2), P = .03). However, progesterone resulted in better neurologic recovery than either osmotherapy. Leukocyte recruitment to injured brain is lowest with mannitol administration. How different agents alter progression of secondary brain injury will require further evaluation in humans. Copyright © 2014 Elsevier Inc. All rights reserved.

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