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Do all β-blockers attenuate the excess hematopoietic progenitor cell mobilization from the bone marrow following trauma/hemorrhagic shock?

Pasupuleti, Latha V. MD; Cook, Kristin M. MD; Sifri, Ziad C. MD; Alzate, Walter D. MS; Livingston, David H. MD; Mohr, Alicia M. MD

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 970–975
doi: 10.1097/TA.0000000000000181
EAST 2013 Plenary Paper

BACKGROUND Severe injury results in increased mobilization of hematopoietic progenitor cells (HPC) from the bone marrow (BM) to sites of injury, which may contribute to persistent BM dysfunction after trauma. Norepinephrine is a known inducer of HPC mobilization, and nonselective β-blockade with propranolol has been shown to decrease mobilization after trauma and hemorrhagic shock (HS). This study will determine the role of selective β-adrenergic receptor blockade in HPC mobilization in a combined model of lung contusion (LC) and HS.

METHODS Male Sprague-Dawley rats were subjected to LC, followed by 45 minutes of HS. Animals were then randomized to receive atenolol (LCHS + β1B), butoxamine (LCHS + β2B), or SR59230A (LCHS + β3B) immediately after resuscitation and daily for 6 days. Control groups were composed of naive animals. BM cellularity, %HPCs in peripheral blood, and plasma granulocyte-colony stimulating factor levels were assessed at 3 hours and 7 days. Systemic plasma-mediated effects were evaluated in vitro by assessment of BM HPC growth. Injured lung tissue was graded histologically by a blinded reader.

RESULTS The use of β2B or β3B following LCHS restored BM cellularity and significantly decreased HPC mobilization. In contrast, β1B had no effect on HPC mobilization. Only β3B significantly reduced plasma G-CSF levels. When evaluating the plasma systemic effects, both β2B and β3B significantly improved BM HPC growth as compared with LCHS alone. The use of β2 and β3 blockade did not affect lung injury scores.

CONCLUSION Both β2 and β3 blockade can prevent excess HPC mobilization and BM dysfunction when given after trauma and HS, and the effects seem to be mediated systemically, without adverse effects on subsequent healing. Only treatment with β3 blockade reduced plasma G-CSF levels, suggesting different mechanisms for adrenergic-induced G-CSF release and mobilization of HPCs. This study adds to the evidence that therapeutic strategies that reduce the exaggerated sympathetic stimulation after severe injury are beneficial and reduce BM dysfunction.

From the Division of Trauma, Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey.

Submitted: December 4, 2012, Revised: September 23, 2013, Accepted: December 23, 2013.

This study was part of the oral presentation at the 26th annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2013, in Scottsdale, Arizona.

Address for reprints: Alicia M. Mohr, MD, University of Florida, Department of Surgery, Division of Acute Care Surgery,1600 SW Archer Road PO Box 100108, Gainesville, FL 32610; email:

© 2014 Lippincott Williams & Wilkins, Inc.