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Arnold D. K. Hill, FRCSI; Hassan Naama, FRCSI; Jian Shou, MD; Steve E. Calvano, PhD; John M. Daly, MD

Arch Surg. 1995;130(12):1273-1278.

Abstract
Objectives
To evaluate, in a murine model of protein-energy malnutrition, whether granulocyte-macrophage colony-stimulating factor (GM-CSF) improves the host response to a septic challenge and to determine the potential mechanisms involved.

Design
Nonblinded study of GM-CSF in mice with protein-energy malnutrition.

Setting
A university-based surgical laboratory and animal facility.

Intervention
In study 1, malnourished mice were randomized to receive either GM-CSF (120 µg/kg subcutaneously from day 4 to 7 of the protein-free diet) or saline vehicle as a control. On day 7, all mice were given Candida albicans (5x10⁵ organisms intravenously). In study 2, malnourished mice received the same dose of GM-CSF or saline vehicle for 7 days of the protein-free diet.

Main Outcome Measures
In study 1 mice were followed up for survival. In study 2, after 7 days of diets, splenic macrophages were harvested and were assayed for interleukin-6, superoxide anion, and nitric oxide production. Splenocytes were stimulated with concanavalin A (5 µg/mL) for interleukin-4, interleukin-10, and interferon- production.

Results
Treatment with GM-CSF significantly enhanced survival in malnourished mice infected with C albicans. Treatment with GM-CSF was associated with increased production from splenic macrophages of interleukin-6, superoxide anion, and nitric oxide as well as decreased interleukin-4 production from splenocytes.

Conclusions
This study suggests a beneficial role for GM-CSF in the malnourished host predisposed to infection. The antimicrobial properties of GM-CSF may function through enhanced production of nitric oxide and superoxide anion.

(Arch Surg. 1995;130:1273-1278)

Author Affiliations
From the Department of Surgery, New York (NY) Hospital–Cornell Medical Center.

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