Antithrombin attenuates vascular leakage via inhibiting neutrophil activation in acute lung injury

Sebastian Rehberg, Yusuke Yamamoto, Linda Sousse, Collette Jonkam, Yong Zhu, Lillian D. Traber, Robert Cox, Donald S. Prough, Daniel L. Traber, Perenlei Enkhbaatar

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


OBJECTIVE:: To test the hypothesis that restoration of antithrombin plasma concentrations attenuates vascular leakage by inhibiting neutrophil activation through syndecan-4 receptor inhibition in an established ovine model of acute lung injury. DESIGN:: Randomized controlled laboratory experiment. SETTING:: University animal research facility. SUBJECTS:: Eighteen chronically instrumented sheep. INTERVENTIONS:: Following combined burn and smoke inhalation injury (40% of total body surface area, third-degree flame burn; 4 × 12 breaths of cold cotton smoke), chronically instrumented sheep were randomly assigned to receive an IV infusion of 6 IU/kg/hr recombinant human antithrombin III or normal saline (n = 6 each) during the 48-hour study period. In addition, six sham animals (not injured, continuous infusion of vehicle) were used to obtain reference values for histological and immunohistochemical analyses. MEASUREMENTS AND MAIN RESULTS:: Compared to control animals, recombinant human antithrombin III reduced the number of neutrophils per hour in the pulmonary lymph (p < 0.01 at 24 and 48 hr), alveolar neutrophil infiltration (p = 0.04), and pulmonary myeloperoxidase activity (p = 0.026). Flow cytometric analysis revealed a significant reduction of syndecan-4-positive neutrophils (p = 0.002 vs control at 24 hr). Treatment with recombinant human antithrombin III resulted in a reduction of pulmonary nitrosative stress (p = 0.002), airway obstruction (bronchi: p = 0.001, bronchioli: p = 0.013), parenchymal edema (p = 0.044), and lung bloodless wet-to-dry-weight ratio (p = 0.015). Clinically, recombinant human antithrombin III attenuated the increased pulmonary transvascular fluid flux (12-48 hr: p ≤ 0.001 vs control each) and the deteriorated pulmonary gas exchange (12-48 hr: p < 0.05 vs control each) without increasing the risk of bleeding. CONCLUSIONS:: The present study provides evidence for the interaction between antithrombin and neutrophils in vivo, its pathophysiological role in vascular leakage, and the therapeutic potential of recombinant human antithrombin III in a large animal model of acute lung injury.

Original languageEnglish (US)
Pages (from-to)e439-e446
JournalCritical care medicine
Issue number12
StatePublished - Dec 2013


  • Acute respiratory distress syndrome
  • Burn and smoke inhalation injury
  • Neutrophil migration
  • Syndecan-4 receptor

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Antithrombin attenuates vascular leakage via inhibiting neutrophil activation in acute lung injury'. Together they form a unique fingerprint.

Cite this