A Comparison of Monocyte Counts and Ex Vivo and In Vitro Monocyte Cytokine Production After Major Surgical Trauma

Franke, Axel; Lante, Wolfgang; Kollig, E.; Markewitz, Andreas

doi:10.1016/j.jss.2008.06.003

Cited by 9 publications

(5 citation statements)

References 40 publications

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“…This indicates that immunoparalysis does not play an important role in the pathogenesis of delirium and presumably not in the development of secondary infections that are more frequently observed in patients suffering from delirium. In addition, our data confirms previous studies [ 14 , 20 – 23 ] that the ex vivo-stimulated production of both pro-inflammatory (IL-6, IL-8 and TNF-α) and anti-inflammatory (IL-10) cytokines are severely suppressed following on-pump cardiothoracic surgery.…”

Section: Discussionsupporting

confidence: 91%

“…Third, in the current study all patients were treated with dexamethasone per-operatively, while dexamethasone inhibits LPS-stimulated production of TNF-α, IL-6, IL-8 and IL-10 [ 27 – 29 ]. However, previous research demonstrated that immunoparalysis occurs after cardiothoracic surgery irrespective of corticosteroids use [ 14 , 20 – 23 ]. Finally, the incidence of secondary infections after cardiac surgery is low [ 30 , 31 ], and the power of this cohort was insufficient to analyze associations between delirium, secondary infections and immunoparalysis.…”

Section: Discussionmentioning

confidence: 99%

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Case–control study on the interplay between immunoparalysis and delirium after cardiac surgery

CheheiliSobbi

Ton

Wesselink

et al. 2021

J Cardiothorac Surg

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Background Delirium occurs frequently following cardiothoracic surgery, and infectious disease is an important risk factor for delirium. Surgery and cardiopulmonary bypass induce suppression of the immune response known as immunoparalysis. We aimed to investigate whether delirious patients had more pronounced immunoparalysis following cardiothoracic surgery than patients without delirium, to explain this delirium-infection association. Methods A prospective matched case–control study was performed in two university hospitals. Cytokine production (tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10) of ex vivo lipopolysaccharide (LPS)-stimulated whole blood was analyzed in on-pump cardiothoracic surgery patients preoperatively, and at 5 timepoints up to 3 days after cardiothoracic surgery. Delirium was assessed by trained staff using two validated delirium scales and chart review. Results A total of 89 patients were screened of whom 14 delirious and 52 non-delirious patients were included. Ex vivo-stimulated production of TNF-α, IL-6, IL-8, and IL-10 was severely suppressed following cardiothoracic surgery compared to pre-surgery. Postoperative release of cytokines in non-delirious patients was attenuated by 84% [IQR: 13–93] for TNF-α, 95% [IQR: 78–98] for IL-6, and 69% [IQR: 55–81] for IL-10. The attenuation in ex vivo-stimulated production of these cytokines was not significantly different in patients with delirium compared to non-delirious patients (p > 0.10 for all cytokines). Conclusions The post-operative attenuation of ex vivo-stimulated production of pro- and anti-inflammatory cytokines was comparable between patients that developed delirium and those who remained delirium-free after on-pump cardiothoracic surgery. This finding suggests that immunoparalysis is not more common in cardiothoracic surgery patients with delirium compared to those without.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Case–control study on the interplay between immunoparalysis and delirium after cardiac surgery

CheheiliSobbi

Ton

Wesselink

et al. 2021

J Cardiothorac Surg

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“…Immature neutrophils were shown to have even higher antibacterial capacity in vitro and exhibit efficient migration, which led to the hypothesis that immature neutrophils are not released as bystanders but rather as cells more efficient in pathogen killing, in line with the observed increased immune cell activity in our study. Other previous studies reported an increase of immune cell activation for monocytes and neutrophils after surgery, by evaluating the expression of immune cell specific activation markers and the cytokine profile [37][38][39] . However, they do not provide a quantitative change of the immune cell functionality during the response to different pathogens serving as stimuli.…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Immune Profiling in Patient Blood Enables Quantification of Innate Immune Effector Functions

Lehnert

Leonhardt

Timme

et al. 2021

Preprint

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Assessment of a patient’s immune function is critical in many clinical situations. One prominent example is sepsis, which results from a loss of immune homeostasis due to microbial infection and is characterized by a plethora of pro- and anti-inflammatory stimuli that may occur consecutively or simultaneously. Thus, any immunomodulatory therapy would require in depth knowledge of an individual patient’s immune status at a given time. Whereas lab-test based immune profiling often relies solely on quantification of cell numbers, we have used an ex vivo whole-blood infection model in combination with biomathematical modeling to quantify functional parameters of innate immune cells in blood from patients undergoing cardiac surgery. These patients experience a well characterized inflammatory insult, which results in mitigation of pathogen-specific response patterns towards Staphylococcus aureus and Candida albicans that are characteristic for healthy people and baseline results in our patients. This does not only interfere with pathogen elimination from blood but also selectively augments the escape of C. albicans from phagocytosis. In summary, our model gives insight into immune functionality and might serve as a functional immune assay to record and evaluate innate response patterns towards infection.

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“…Previous studies have shown that monocyte counts immediately increase in the acute phase of stroke (190,191). Furthermore, it was recently found that CD14+ monocyte counts increased after surgical trauma and reach a peak in the first week (192). Zhiqi et al reported a significant correlation between monocyte counts and 6 month outcomes in patients with moderate-to-severe traumatic brain injuries (193).…”

Section: Monocytesmentioning

confidence: 99%

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

et al. 2022

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Although cellular and molecular mediators of the immune system have the potential to be prognostic indicators of disease outcomes, temporal interference between diseases might affect the immune mediators, and make them difficult to predict disease complications. Today one of the most important challenges is predicting the prognosis of COVID-19 in the context of other inflammatory diseases such as traumatic injuries. Many diseases with inflammatory properties are usually polyphasic and the kinetics of inflammatory mediators in various inflammatory diseases might be different. To find the most appropriate evaluation time of immune mediators to accurately predict COVID-19 prognosis in the trauma environment, researchers must investigate and compare cellular and molecular alterations based on their kinetics after the start of COVID-19 symptoms and traumatic injuries. The current review aimed to investigate the similarities and differences of common inflammatory mediators (C-reactive protein, procalcitonin, ferritin, and serum amyloid A), cytokine/chemokine levels (IFNs, IL-1, IL-6, TNF-α, IL-10, and IL-4), and immune cell subtypes (neutrophil, monocyte, Th1, Th2, Th17, Treg and CTL) based on the kinetics between patients with COVID-19 and trauma. The mediators may help us to accurately predict the severity of COVID-19 complications and follow up subsequent clinical interventions. These findings could potentially help in a better understanding of COVID-19 and trauma pathogenesis.

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A Comparison of Monocyte Counts and Ex Vivo and In Vitro Monocyte Cytokine Production After Major Surgical Trauma

Cited by 9 publications

References 40 publications

Case–control study on the interplay between immunoparalysis and delirium after cardiac surgery

Case–control study on the interplay between immunoparalysis and delirium after cardiac surgery

Ex Vivo Immune Profiling in Patient Blood Enables Quantification of Innate Immune Effector Functions

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

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