HLA-DR antigen expression on peripheral blood monocytes correlates with surgical infection

Cheadle, William G.; Hershman, M. J.; Wellhausen, Samuel R.; Polk, Hiram C.

doi:10.1016/0002-9610(91)91247-g

Cited by 187 publications

(106 citation statements)

References 30 publications

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“…While decreased monocyte HLA-DR expression can be associated with increased infection rates or poor outcome in major surgery or trauma [9][10][11][12][13], we observed a substantial degree of HLA-DR reduction in our patients, whose risk of developing postoperative complications was lower than the complex major surgery previously studied. Delayed recovery of HLA-DR depression (i.e.…”

Section: Discussioncontrasting

confidence: 54%

“…Human Leukocyte Antigen-DR (HLA-DR), one of the Major Histocompatibility Complex class-II proteins expressed on monocytes, macrophages and dendritic cells, is a crucial molecule for the presentation of antigen to lymphocytes and the initiation of adaptive immune responses [7,8]. Reduced levels of HLA-DR expression on blood monocytes following surgery is proposed as a potential biomarker for surgeryinduced immunosuppression and the development of postoperative infections [7,[9][10][11][12][13]. However, previous studies have focused on high risk surgery, trauma or sepsis.…”

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confidence: 99%

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HLA‐DR expression and differential trafficking of monocyte subsets following low to intermediate risk surgery*

et al. 2009

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SummaryReduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14 high and CD14 low CD16+ monocyte subsets. The numbers of CD14high monocytes increased at 24 h (mean (SD), 5.0 (2.2) vs 7.6 (3.9) · 10 5 cells.ml )1 ; p < 0.01) while CD14 low CD16+ monocytes decreased (0.68 (0.36) vs 0.44 (0.36) · 10 5 cells.ml; p < 0.01). HLA-DR expression was significantly reduced in both subsets by 24 h (mean (SD) fluorescent intensity 440 (310) vs 160 (130) for CD14 high and 1000 (410) vs 560 (380) for CD14 low CD16+ subsets; p < 0.01). This reduction of monocyte HLA-DR expression 24 h following lower risk surgery raises questions about the purported clinical utility of this biomarker as an early predictor of postoperative complications. Our results also suggest that surgery induces significant trafficking (i.e. mobilisation, margination and extravasation) of monocyte subsets, and that monocyte HLA-DR depression is the result of a down-regulatory phenomenon (decreased protein expression on each cell) rather than the differential trafficking of monocyte subsets.

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Section: Discussioncontrasting

confidence: 54%

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confidence: 99%

HLA‐DR expression and differential trafficking of monocyte subsets following low to intermediate risk surgery*

et al. 2009

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“…At the cellular level, increasing temperatures have been shown to enhance monocyte antigen presentation via HLA-DR receptor surface expression, attenuate proinflammatory cytokine production, enhance cellular phagocytosis rates, and promote the formation of reactive oxygen species available for intracellular killing in both monocytes and polymorphonuclear leukocytes. These cellular parameters have repeatedly been shown to provide prognostic significance in their levels of expression [19][20][21][22][23][24]. As a result of these findings, significant changes have been made within the intraoperative environment to ensure adequate monitoring of patient body temperature, in efforts to prevent hypothermia.…”

Section: Temperaturementioning

confidence: 99%

Controversies in host defense against surgical site infection

Qadan¹,

Cheadle²

2009

Expert Review of Anti-infective Therapy

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“…prerequisite for effective antigen presentation and processing) is diminished in trauma patients and can assist in identifying those who go on to develop infective complications (Hershman et al 1990;Cheadle et al 1991). Defects in neutrophil chemotaxis, phagocytosis, lysosome activity and superoxide production have been identified postoperatively (Utoh et al 1988), in addition to increased prostaglandin E2, defective monocyte interleukin (1L)-1 secretion, and diminished IFN-y production (Faist et al 1988).…”

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confidence: 99%