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Granulocyte colony-stimulating factor therapy and systemic inflammation in critically ill patients
A Takala1, V Pettilä, O Takkunen
1The Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. annika.takala@helsinki.fi
Objective And Design:
The effect of the granulocyte colony-stimulating factor filgrastim on systemic inflammation was investigated in a prospective, randomized, placebo-controlled, double-blind study in critically ill patients.
Subjects:
59 critically ill patients were recruited within 48 h of intubation due to ventilatory insufficiency.
Treatment:
Subcutaneous dosage of placebo or 300 microg filgrastim once daily.
Methods:
Serum samples were collected at study entry, and 1 and 3 days after the start (Day1 and Day3, respectively). Levels of soluble E-selectin (sE-selectin) and interleukin (IL)-10 were determined by ELISA, and those of IL-6, and soluble IL-2 receptor (sIL-2R) by Immulite chemiluminescence immunoassay.
Results:
The median sE-selectin level decreased by day 3 significantly in the control group but not in the filgrastim group. The difference in the change between the study groups was significant (p = 0.049). IL-10 levels decreased significantly in the filgrastim group, tended to decrease in controls (p = 0.052), and the difference in the change tended to be significant (p = 0.058). IL-6 levels decreased in both groups comparably. sIL-2R levels were elevated and stable.
Conclusions:
Filgrastim prolongs endothelial activation and possibly inhibits development of immune suppression mediated by IL-10.
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