Perspectives of leukocyte activation in the microcirculation

Recent evidence for a role of granulocytes in ischemic organ injury and in hemorrhagic shock is provided. Compared to red cell, granulocytes are large cells and have a stiff cytoplasm, making them prone to entrapment in the microcirculation. After activation, granulocytes become adhesive, they can elaborate superoxide radicals and release proteolytic enzymes. In the circulation a subgroup of granulocytes are in a spontaneously activated state. If during shock such cells become trapped in the microcirculation they impose a risk for organ injury. In a short term shock protocol, the group of surviving and non-surviving animals can be sharply distinguished by the number of activated granulocytes before shock. Experimental forms of granulocyte activation in the coronary circulation cause temporary trapping of cells, an increase in vascular resistance, and a transient reduction of muscle contraction even in the presence of a normal perfusion pressure. Detection of spontaneous granulocyte activation requires the development of new tests which can be carried out on fresh unseparated blood samples. We provide here also a critical evaluation of experimental neutropenia as a test for granulocyte related hypotheses.