Burns 29 (2003) 307–314 Effects of rolling inhibition on smoke inhalation injury  Cengiz Çetin a , Mahmut Özyilmaz a , Cengiz Bayçu b , A. Aydan Köse a,∗ , Yakup Karaba˘ gli a a Department of Plastic and Reconstructive Surgery, Medical School, Osmangazi University, 26480 Me¸ s elik Eski¸ s ehir, Turkey b Department of Histology, Medical School, Osmangazi University, 26480 Me¸ s elik Eski¸ s ehir, Turkey Accepted 11 December 2002 Abstract Inhalation of chemical and particulate products of smoke is one of the principal determinant of mortality following burn injury. Inflamma- tory responses have been implicated in the pathogenesis of lung injury after smoke inhalation. In the current study, we tested the inhibitory effect of Fucoidin on the neutrophil rolling stage of inflammatory response and determined the degree of pulmonary injury. Fifteen rats were divided into three groups: sham group (n: 5) of rats inhaled room air; control group (n: 5) inhaled smoke, and experimental group inhaled smoke and received Fucoidin. All the rats were sacrificed 24 h after smoke inhalation. The trachea and lungs were removed totally; samples for histopathological and biochemical (myeloperoxidase (MPO)) analysis were taken from each lung and trachea. Morphologic studies using light and electron microscopes showed a decrease in lung parenchymal and tracheoepithelial injury in the experiment group of rats. Also, biochemical analysis of tissue MPO was significantly lower in test group than in control group. These results suggest that the inhibition of neutrophil rolling leads to a reduction of neutrophil invasion to pulmonary parenchyma and trachea, which may be beneficial for attenuating neutrophil mediated inhalation injury. © 2003 Elsevier Science Ltd and ISBI. All rights reserved. Keywords: Smoke inhalation injury; Fucoidin 1. Introduction Smoke inhalation injury is a major contributor to morbid- ity and mortality in severely burned fire victims. Lethal res- piratory failure risk for patients who have severe inhalation injury is greater than 50% [1]. The mechanism of inhalation injury is attributed to a com- bination of thermal, hypoxaemic and chemical effects of smoke [2,3]. Thermal injury to the respiratory tract is usually limited to above the vocal cords. Low heat carrying capacity of dry air and reflex adduction of vocal cords protect the lower airways from thermal injury [3,4]. Carbon monoxide is a very common product of combus- tion and responsible for hypoxaemic effects of smoke [4]. The chemical property of smoke induces an inflammatory response, increased vascular permeability and pulmonary edema. These physiopathological changes are thought to be mediated by activated polymorphonuclear leukocytes [5–7].  This report was presented at the XXIIIrd Annual Congress of Turkish Plastic and Reconstructive Surgeons. ∗ Corresponding author. Fax: +90-222-229-01-10. E-mail address: aakose@ogu.edu.tr (A.A. Köse). Pulmonary injury after smoke inhalation can be con- firmed by the presence of tracheitis, bronchitis, peri- bronchial vascular congestion, peribronchial edema, at- electasis, intra-alveolar hemorrhage, pulmonary edema and intra-alveolar polymorphonuclear leukocyte (PMNL) infil- tration under light and electron microscopy [8–12]. PMNL, particularly neutrophils are the primary media- tors of acute inflammatory process. Rolling and adhesion are consecutive steps before tissue invasion by neutrophils [13]. Medical interventions that prevent either of these steps have been shown to exert beneficial effects on outcome. Leuko- cyte depletion, rolling inhibition or adhesion blockage have been reported to attenuate the PMNL mediated inflamma- tory injury [14–18]. Accordingly, the present study was undertaken to inves- tigate the effects of inhibition of rolling—the first step of inflammatory injury—on smoke inhalation injury. The polysaccharide Fucoidin is known to inhibit leuko- cyte rolling specifically blocking the selectins in a dose de- pendent manner [19–22]. Kubes et al. reported that 25 mg/kg Fucoidin can inhibit leukocyte rolling over 90% in rats [23]. In the present study, the histopathological and biochem- ical alterations after cooled smoke from burning cotton ex- posure were compared with those treated or not treated with Fucoidin. 0305-4179/03/$30.00 © 2003 Elsevier Science Ltd and ISBI. All rights reserved. doi:10.1016/S0305-4179(03)00005-6