Current Understanding of Leukocyte Phenotypic and Functional Modulation During Extracorporeal Membrane Oxygenation: A Narrative Review

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Ki, KK
Millar, JE
Langguth, D
Passmore, MR
McDonald, CI
Shekar, K
Shankar-Hari, M
Cho, HJ
Suen, JY
Fraser, JF
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A plethora of leukocyte modulations have been reported in critically ill patients. Critical illnesses such as acute respiratory distress syndrome and cardiogenic shock, which potentially require extracorporeal membrane oxygenation (ECMO) support, are associated with changes in leukocyte numbers, phenotype, and functions. The changes observed in these illnesses could be compounded by exposure of blood to the non-endothelialized surfaces and non-physiological conditions of ECMO. This can result in further leukocyte activation, increased platelet-leukocyte interplay, pro-inflammatory and pro-coagulant state, alongside features of immunosuppression. However, the effects of ECMO on leukocytes, in particular their phenotypic and functional signatures, remain largely overlooked, including whether these changes have attributable mortality and morbidity. The aim of our narrative review is to highlight the importance of studying leukocyte signatures to better understand the development of complications associated with ECMO. Increased knowledge and appreciation of their probable role in ECMO-related adverse events may assist in guiding the design and establishment of targeted preventative actions.

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Frontiers in Immunology
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© 2021 Ki, Millar, Langguth, Passmore, McDonald, Shekar, Shankar-Hari, Cho, Suen and Fraser. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Medical microbiology
critically ill patients
extracorporeal membrane oxygenation
extracorporeal membrane oxygenation technology
innate and adaptive immunity
leukocyte modulation
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Ki, KK; Millar, JE; Langguth, D; Passmore, MR; McDonald, CI; Shekar, K; Shankar-Hari, M; Cho, HJ; Suen, JY; Fraser, JF, Current Understanding of Leukocyte Phenotypic and Functional Modulation During Extracorporeal Membrane Oxygenation: A Narrative Review, Frontiers in Immunology, 2021, 11, pp. 600684