Acute tubular injury in sepsis is associated with proximal tubular epithelial cell (PTEC) detachment into the lumen leading to back-leakage of glomerular ultrafiltrate and tubule obstruction. Inflammatory cytokines, such as IL-1alpha, IFNgamma and TNFalpha, are important mediators in sepsis-induced acute renal failure, although their precise role is unclear. We used primary cultures of human PTEC to investigate the hypothesis that inflammatory cytokines exert cytotoxic effects and cause detachment of cells from adherent monolayers, possibly through the intermediate nitric oxide (NO). At 5 days post-confluence, PTEC monolayers were stimulated for 24 hours with IL-1alpha (10 ng/ml), IFNgamma (200 u/ml) and TNFalpha (10 ng/ml). Monolayer viability was assessed by a live/dead dual fluorescence labeling technique. Apoptosis within monolayers was determined by morphological examination and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). PTEC in supernatants were counted and then analyzed by flow cytometry, using propidium iodide to assess cell viability and annexin V labeling to determine apoptosis. Results (mean +/- SEM; monolayers, n = 4; cell counts, n = 3; flow cytometry, n = 2) are shown below (at test, p < 0.05). Monolayers Supernatants Viable necrotic% of cells apoptotic countsx104/ml viable necrotic% of cells apoptotic Unstimulated 99.0+/-0.5 1.0+/-0.5 0 8.0+/-0.6a 64.6+/-2.5a 26.7+/-1.9a 6.2+/-0.6a Stimulated 92.4+/-3.2 7.6+/-3.2 0 14.7+/-0.6a 37.9+/-0.05a 48.0+/-0.3a 14.1+/-0.35a Following cytokine stimulation, there were significantly increased numbers of shed cells in supernatants. This cell population demonstrated significant loss of viability with increased numbers of both necrotic and apoptotic cells, as compared to unstimulated PTEC supernatants. Cytokine-stimulated monolayers maintained viability with no significant cell necrosis and no evidence of apoptosis. Preliminary experiments with the NO synthase inhibitor L-NMMA show that it reduces the number of cytokine-induced shed cells to the levels found in unstimulated cells (8.0 +/- 1.0 x 104/ml), although the percentages of necrotic and apoptotic cells are unchanged from cytokine-stimulated PTEC (44% and 15%, respectively). In conclusion, inflammatory cytokines induce necrotic and apoptotic cell shedding from PTEC monolayers with maintenance of monolayer viability. Preliminary data suggest that NO plays a cytotoxic role in this process.