Influence of Vaccination and Surgery on HLA-DR Expression in Patients with Upper Aerodigestive Tract Cancer

Spies, Claudia; Kip, Miriam; Lau, Alexandra; Sander, Michael; Breuer, J; Meyerhoefer, J; Paschen, Christian; Schumacher, Guido; Volk, Hans‐Dieter; Wernecke, Klaus‐Dieter; Dossow, Vera von

doi:10.1177/147323000803600212

Cited by 11 publications

(5 citation statements)

References 25 publications

(38 reference statements)

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“…Haining et al demonstrated increased mHLA-DR expression after influenza vaccination in children after hematopoietic stem cell transplantation [ 20 ]. We showed similar effects in patients with upper aerodigestive tract cancer [ 23 ]. In contrast, in the same study influenza vaccination failed to significantly prevent downregulation of mHLA-DR expression when the vaccine was administered pre-operatively [ 23 ].…”

Section: Discussionmentioning

confidence: 61%

“…We showed similar effects in patients with upper aerodigestive tract cancer [ 23 ]. In contrast, in the same study influenza vaccination failed to significantly prevent downregulation of mHLA-DR expression when the vaccine was administered pre-operatively [ 23 ]. Thus, in conjunction with the current study demonstrating no beneficial effect of post-operative influenza vaccination in immunosuppressed surgical patients, vaccination at least with influenza vaccine did not appear to be an effective immunostimulatory treatment approach either to prevent or to reverse surgery-induced immunosuppression.…”

Section: Discussionmentioning

confidence: 61%

“…Several studies have demonstrated that suppressed mHLA-DR could be restored by administration of vaccination or Granulocyte-Macrophage Colony-stimulating factor (GM-CSF) [ 20 – 27 ]. Our research group found an increase in mHLA-DR after influenza vaccination in patients with untreated cancer of the upper aero-digestive tract [ 23 ] and after preoperative vaccination [ 28 ]. Others found the normalization of the immunoregulatory index and the stimulation of the phagocytic function in the absence of essential influence on the level of HLA-DR+ expression [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

et al. 2015

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PurposeSurgical patients are at high risk for developing infectious complications and postoperative delirium. Prolonged infections and delirium result in worse outcome. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and influenza vaccination are known to increase HLA-DR on monocytes and improve immune reactivity. This study aimed to investigate whether GM-CSF or vaccination reverses monocyte deactivation. Secondary aims were whether it decreases infection and delirium days after esophageal or pancreatic resection over time.MethodsIn this prospective, randomized, placebo-controlled, double-blind, double dummy trial setting on an interdisciplinary ICU of a university hospital 61 patients with immunosuppression (monocytic HLA-DR [mHLA-DR] <10,000 monoclonal antibodies [mAb] per cell) on the first day after esophageal or pancreatic resection were treated with either GM-CSF (250 μg/m2/d), influenza vaccination (Mutagrip 0.5 ml/d) or placebo for a maximum of 3 consecutive days if mHLA-DR remained below 10,000 mAb per cell. HLA-DR on monocytes was measured daily until day 5 after surgery. Infections and delirium were followed up for 9 days after surgery. Primary outcome was HLA-DR on monocytes, and secondary outcomes were duration of infection and delirium.ResultsmHLA-DR was significantly increased compared to placebo (p < 0.001) and influenza vaccination (p < 0.001) on the second postoperative day. Compared with placebo, GM-CSF-treated patients revealed shorter duration of infection (p < 0.001); the duration of delirium was increased after vaccination (p = 0.003).ConclusionTreatment with GM-CSF in patients with postoperative immune suppression was safe and effective in restoring monocytic immune competence. Furthermore, therapy with GM-CSF reduced duration of infection in immune compromised patients. However, influenza vaccination increased duration of delirium after major surgery.Trial Registration www.controlled-trials.com ISRCTN27114642

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

et al. 2015

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“…Previous studies suggested that monocytes upregulate MHC II cell surface receptor HLA-DR in AAV patients [ 14 ]. Moreover, increased HLA-DR + monocytes have already been described in response to influenza vaccination and might be a potential trigger for AAV onset [ 46 ]. This is supported by our observation that HLA-DR is present on the surface of most monocytes in this case of AAV in temporal association with SARS-CoV-2 booster vaccination.…”

Section: Discussionmentioning

confidence: 99%

Dual-Positive MPO- and PR3-ANCA-Associated Vasculitis Following SARS-CoV-2 mRNA Booster Vaccination: A Case Report and Systematic Review

et al. 2022

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As the coronavirus disease 2019 (COVID-19) pandemic is ongoing, and new variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are emerging, vaccines are needed to protect individuals at high risk of complications and to potentially control disease outbreaks by herd immunity. After SARS-CoV-2 vaccination, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) presenting with a pulmonary hemorrhage has been described. Previous studies suggested that monocytes upregulate major histocompatibility complex (MHC) II cell surface receptor human leukocyte antigen receptor (HLA-DR) molecules in granulomatosis with polyangiitis (GPA) patients with proteinase 3 (PR3)- and myeloperoxidase (MPO)-ANCA seropositivity. Here, we present a case of new-onset AAV after booster vaccination with the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. Moreover, we provide evidence that the majority of monocytes express HLA-DR in AAV after SARS-CoV-2 booster vaccination. It is possible that the enhanced immune response after booster vaccination and presence of HLA-DR+ monocytes could be responsible for triggering the production of the observed MPO- and PR3-ANCA autoantibodies. Additionally, we conducted a systematic review of de novo AAV after SARS-CoV-2 vaccination describing their clinical manifestations in temporal association with SARS-CoV-2 vaccination, ANCA subtype, and treatment regimens. In light of a hundred million individuals being booster vaccinated for SARS-CoV-2 worldwide, a potential causal association with AAV may result in a considerable subset of cases with potential severe complications.

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“…Surgery has long been known to suppress immune function [1][2][3][4][5][6]. 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].…”

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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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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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Influence of Vaccination and Surgery on HLA-DR Expression in Patients with Upper Aerodigestive Tract Cancer

Cited by 11 publications

References 25 publications

Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

Dual-Positive MPO- and PR3-ANCA-Associated Vasculitis Following SARS-CoV-2 mRNA Booster Vaccination: A Case Report and Systematic Review

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

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