Changes in T Lymphocyte Subsets Following Injury

Abstract

The increased susceptibility of severely injured patients to infection and death from sepsis has been attributed to abnormalities in cell-mediated immunity. The authors therefore assessed the relative number of peripheral blood T helper cells and T suppressor/cytotoxic cells and total T lymphocytes identified by the monoclonal antibodies (McA) OKT4, OKT8, and OKT3, respectively, in 25 patients with burns from 5 to 85% total body surface area (TBSA) (mean: 40%) and 21 patients with nonthermal injuries (mean Injury Severity Score (ISS): 21.4). Patients were compared to 21 healthy controls. Cells reacting with the McA were detected by flow cytometry, which enabled the examination of a population of cells the size of T lymphocytes, excluding larger contaminating cells that might bind the McA. Patients with burns of 30% TBSA or greater had a significant reduction (p less than or equal to 0.05) in OKT3+ cells up to 50 days post-burn. Both septic and nonseptic burn patients had reduced numbers of OKT3+ cells, as did patients after nonthermal injury, suggesting that this reduction was due to the injury itself. Patients with smaller burns (less than 30% TBSA) as a group did not have reduced OKT4+ cells, whereas those with larger burns showed significant reductions in OKT4+ cells (P less than or equal to 0.05) at 0 to 5, 6 to 10, 11 to 20, 21 to 30, and 41 to 50 days post-burn. Seven burn patients who became septic 10 days post-burn or later had significantly lower OKT4+ cells within 10 days of injury (mean: 33.75% +/- 7.4 SEM) than 10 patients who remained free of sepsis (mean: 42.2% +/- 5.4, p = 0.004). Patients with uncomplicated nonthermal injuries failed to show any significant reduction in OKT4+ cells. Following thermal injury, a reduction in OKT8+ cells was observed up to 10 days in patients with burns less than 30% TBSA, and up to 20 days in patients with larger burns. In both groups, at no time were increased OKT8+ cells found to correlate with clinical events. In patients with nonthermal injury, OKT8+ cells generally remained near the normal range.

Impairment of Helper T-Cell Function Following Severe Head Injury

“…The importance of this finding is underscored by the importance of the helper/inducer (CD4+/CDw29+) T-cell subset in activating monocytes and other cells responsible for the destruction of Staphylococcus aureus and other common pathogens seen following severe head injury (McLean et al, 1975;O'Mahony et al, 1985;Abo et al, 1986;Morgan et al, 1984;Damle et al, 1986;Nencioni et al, 1983;Klimpel et al, 1988). Specifically, the helper/inducer (CD4+/CDw29 + ) T-cell subset is believed to be the human analog of the murine TH, cell, which has been characterized in animal models as the T cell producing IL-2, INF-G, and other cytokines responsible for the upregulation of cellular immunity.…”

“…Although cellular immunity has classically been cited in immune surveilance against intracellular bacterial, viral, and fungal infections, several studies have demonstrated the importance of cellular immunity in defending against pyogenic bacterial and nonintracellular bacterial infections (McLean et al, 1975;O'Mahony et al, 1985;Abo et al, 1986;Morgan et al, 1984;Damleetal., 1986;Nencioni et al, 1983;Klimpel et al, 1988). Recent studies of alveolar macrophages in humans have shown that intact cellular immune function involving T-cell activity is required for clearing of Staphylococcus aureus following ingestion by polymorphonuclear cells and alveolar macrophages (McLean et al, 1975;O'Mahony et al, 1985;Abo et al, 1986). This pathogen accounts for the majority of infections seen in the acute phase following severe head injury, underscoring the clinical relevance of alterations in cellular immunity that occur after head injury (Helling et al, 1988;Quattrocchi et al, 1990Quattrocchi et al, , 1991aMilleret al, 1991;Hoyt et al, 1990).…”

Changes in T cell subsets, interleukin-6 and C-reactive protein after laparoscopic and open colorectal resection for malignancy

“…T lymphocyte subpopulations, studied as a marker of trauma-induced stress in burn and postoperative models, have been found to correlate with degree of insult [11,27]. Interleukin-6 (Il-6) and C-reactive protein (CRP) levels, studied extensively as markers of operative stress in open surgery, have been used to compare the stress response in laparoscopic and open surgery with somewhat conflicting results [ [9,10,13,26,[28][29][30]32].…”

Cachectin/TNF Production in Experimental Burns and Pseudomonas Infection

“…We sought to determine the relationship between body composition changes and in vivo hepatic levels of pretranslational message for cachectin (messenger RNA) in a burn and infection rodent model. Adult Wistar rats were grouped as follows: (1) (1) scald burn only (n = 10), (2) scald burn and infection (n = 10), (3) freely fed controls (n = 14) anesthetized and submerged in thermoneutral water, (4) (Fig 1).…”