Leukotriene B4 Generation in Patients With Established Pulmonary Failure

• We investigated the cause of the reduced leukotriene B₄ (LTB₄) production seen in neutrophils from patients with established adult respiratory distress syndrome compared with control neutrophils. Lymphocytes/monocytes from controls were found to synergistically enhance the amount of LTB₄ produced when incubated with neutrophils. This synergistic effect was not seen in cells from patients with adult respiratory distress syndrome. Fatty-acid analysis of neutrophils from patients with adult respiratory distress syndrome and controls showed remarkable similarity in all quantities of fatty acids measured except for arachidonic acid, where there was a 22% reduction in patients' cells compared with controls. Assay of the rate of generation of LTB₄ and its degradation product, 20-hydroxy LTB₄, revealed that reduced LTB₄ generation in patients' neutrophils was not due to increased degradation of LTB₄ by hydroxylase enzymes. When the amount of LTB₄ being generated per milliliter of whole blood was analyzed in the patients with adult respiratory distress syndrome and compared with controls, it was determined that the potential to generate LTB₄ in patients in the intensive care unit was three to five times greater than in controls.

(Arch Surg. 1989;124:1451-1455)