Alteration of Monocyte Function Following Major Injury

Faist, Eugen; Mewes, A.; Strasser, Theodor; Walz, Alfred; Alkan, Şefik Ş.; Baker, Christopher C.; Ertel, Wolfgang; Heberer, G.

doi:10.1001/archsurg.1988.01400270021002

Cited by 238 publications

(89 citation statements)

References 21 publications

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“…Total numbers of T lymphocytes fall in proportion to injury severity during the first week after injury (194,362) and there is a decrease in T-celldependent immune functions (75,227,402,405,462). Diminished T-cell proliferation in response to mitogens (210,364,462) is associated with, and may be the result of, decreased production of IL-2 and IFN-␥ by monocytes (133,463). The production of immunoglobulin G (IgG) in response to Tcell-dependent antigens is also impaired after serious injury; however, no impairment of antibody formation to T-cellindependent antigens has been observed (325).…”

Section: Adaptive Immune System In Response To Burn Injurymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,600

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Section: Adaptive Immune System In Response To Burn Injurymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,600

1,345

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“…Decreased production of IL-1and IL-2 and increased monocyte prostaglandin E 2 production after trauma have been suggested as two of the major monocyte dysfunctions that contribute to alterations in immune system responsiveness (16,17,44). Following injury or major surgery, elevated levels of prostaglandin E 2 in monocytes have been shown to suppress monocyte antigen-presenting capacity and T-cell expression of IL-2 (16)(17)(18), along with a loss of cell surface HLA-DR molecules (74).…”

mentioning

confidence: 99%

Bacterial Clearance and Cytokine Profiles in a Murine Model of Postsurgical Nosocomial Pneumonia

Manderscheid

Bodkin

Davidson

et al. 2004

Clin Vaccine Immunol

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The development of a nosocomial pneumonia is facilitated by alterations in host innate pulmonary antibacterial defenses following surgical trauma, which can result in decreased pulmonary bacterial clearance and increased morbidity and mortality. In a murine model of postoperative nosocomial infection, surgical stress (laparotomy) decreased Escherichia coli clearance from the lungs of animals that underwent surgery. Consistent with previous studies, (i) pulmonary levels of tumor necrosis factor alpha at 6 h and of interleukin-1␤ (IL-1␤), IL-6, and gamma interferon (IFN-␥) at 24 h post-bacterial infection (PBI) were decreased in animals that underwent laparotomy 24 h prior to E. coli infection (LAP/E. coli) compared to animals that received E. coli only; (ii) KC and macrophage inhibitory protein 2 were elevated at 6 h PBI in LAP/E. coli animals compared to E. coli-only animals; however, at 24 h PBI, levels were higher in the E. coli-only group; (iii) at 24 h PBI, monocyte chemoattractant protein 1 was lower in the LAP/E. coli group compared to the E. coli-only group; (iv) IL-10 levels were unaffected at all time points evaluated; and (v) the total number of neutrophils present in the lungs of LAP/E. coli animals at 6 h PBI was decreased in comparison to that in E. coli-only animals, resulting in decreased bacterial clearance and increased mortality in LAP/E. coli animals by 24 h PBI. Similar changes in cytokine profiles, pulmonary bacterial clearance, and mortality were consistent with reported findings in patients following surgical trauma. This model, therefore, provides a clinically relevant system in which the molecular and cellular mechanisms that lead to the development of nosocomial pneumonia can be further explored.

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“…Monocytes present antigens to lymphocytes in the context of major histocompatibility (MHC) restriction via class II human leukocyte antigen (HLA) molecules such as HLA-DR. Decreases in the percentage of circulating monocytes that express HLA-DR are associated with a worse short-term outcome after major elective surgery and trauma [18][19][20]. Kloosterman et al reported a significant decline in the expression of HLA-DR 1 day after open cholecystectomy whereas laparoscopic removal was not associated with a change from baseline [9].…”

Section: Monocytes and Neutrophilsmentioning

confidence: 99%

Immunologic Consequences and Considerations of the Laparoscopic Approach

Feingold¹,

Carter²,

Whelan³

2006

The Sages Manual

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The introduction of advanced laparoscopic operations in the early 1990s led to a close examination of the immunologic consequences of both open and closed surgical methods. This scrutiny has significantly increased our understanding of the impact of surgery on the body and will, it is hoped, lead to new perioperative pharmacologic therapies that will lessen the deleterious immunologic effects of all types of surgery. Before the laparoscopic era, it had been well established that major open surgery is associated with the temporary suppression of a variety of cells that are involved with both innate and specific immunity, including lymphocytes, neutrophils, monocytes, and macrophages. Interactions between cells, chemotaxis, expression of surface antigens, the ability to produce cytokines, and other functions of these immune system cells are negatively influenced by open surgical trauma. Further, the ability to mount a positive response to a delayed-type hypersensitivity (DTH) recall antigen challenge is suppressed after surgery [1][2][3][4][5].The relative contribution of each part of an abdominal procedure (abdominal wall access incision versus intraabdominal dissection and resection) to postsurgical immunosuppression had not been assessed before the advent of advanced laparoscopic methods. The results of recent studies suggest that the method of entry into the abdomen is the most important determinant of postoperative immune function. Minimally invasive methods, for a variety of immune parameters, have been shown to be associated with significantly better preserved function when compared to the equivalent open procedure. Of note, in many cases the differences are small and short lived, on the order of a day, and sometimes less for several variables. For a number of parameters no differences have been noted.It should be realized that the clinical significance, if any exists, of the immune function differences that have been found has not been determined. Better preserved postoperative cell-mediated immune function, in theory, may have an impact on the rate of infections and, possibly, tumor recurrence rates and survival.This chapter reviews the available literature in this area and also speculates on how our improved understanding of surgery's impact on the immune system may lead to novel perioperative treatments in the future.

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Alteration of Monocyte Function Following Major Injury

Cited by 238 publications

References 21 publications

Burn Wound Infections

Burn Wound Infections

Bacterial Clearance and Cytokine Profiles in a Murine Model of Postsurgical Nosocomial Pneumonia

Immunologic Consequences and Considerations of the Laparoscopic Approach

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