Innate immunity recovers earlier than acquired immunity during severe postoperative immunosuppression

Abstract

Background: Postoperative immune suppression, particularly a loss of cell-mediated immunity, is commonly seen after surgery and is associated with worse outcome, i.e. delayed wound healing, infections, sepsis, multiple-organ failure and cancer recurrence. However, the recovery of immune cells focusing on differences between innate and acquired immunity during severe postoperative immunosuppression is not investigated. Methods: In this retrospective randomized controlled trial (RCT) subgroup analysis, 10 postoperatively immune suppressed patients after esophageal or pancreatic resection were analyzed. Innate and acquired immune cells, the expression of human leukocyte antigen-D related on monocytes (mHLA-DR), lipopolysaccharide (LPS)-induced monocytic TNF-α and IL-10 secretion ex vivo, Concanavalin A (Con A)-induced IFN-γ, TNF-α, IL-2, IL-4, IL-5 and IL-10 release were measured preoperatively (od) until day 5 after surgery (pod5). Recovery of immune cells was defined by a significant decrease respectively increase after a significant postoperative alteration. Statistical analyses were performed using nonparametric statistical procedures. Results: Postoperative alterations of innate immune cells recovered on pod2 (eosinophils), pod3 (neutrophils) and pod5 (mHLA-DR, monocytic TNF-α and IL-10 secretion), whereas alterations of acquired immune cells (lymphocytes, T cells, T helper cells, and cytotoxic T cells) did not recover until pod5. Peripheral blood T cells showed an impaired production of the T helper (Th) 1 cytokine IFN-γ upon Con A stimulation on pod1, while Th2 specific cytokine release did not change until pod5. Conclusions: Innate immunity recovered earlier than acquired immunity during severe postoperative immunosuppression. Furthermore, we found a more anti- than pro-inflammatory T cell function on the first day after surgery, while T cell counts decreased.

Dynamic changes in routine blood parameters of a severe COVID-19 case

“…A retrospective study of 10 patients with postoperative immunosuppression revealed that among innate immune cells, eosinophils recovered on the second day, neutrophils on the third day, and monocytes on the fifth day but that acquired immune cells such as lymphocytes did not recover until the fifth day [4], which supported the results of our study. Therefore, we believe that eosinophils have important value for the clinical prognosis of COVID-19 patients.…”

Premetastatic niches, exosomes and circulating tumor cells: Early mechanisms of tumor dissemination and the relation to surgery

“…After the acute inflammatory reaction comes a longer period of immunosuppression and overall, the local and systemic changes that follow the surgical intervention, fuel the growth and migration of residual cancer cells, as well as the formation of metastases in distant organs …”

Correlation study between blood cytokines and lymphocytes in early postoperative critical patients with compromised immune function

“…Previous study found that during severe postoperative immunosuppression, postoperative alterations of innate immune cells could recover on day 2 to 5 after surgery; however, the alterations of acquired immune cells (lymphocytes, T cells, Th cells, and cytotoxic T cells) recover later than innate immunity. [ 39 ] We speculate that the inadequate compensatory response of increase in IL-2, IL-4, and GM-CSF in the early postoperative period may contribute to the sustained immunosuppression. Elevation of IL-2, IL-4, and GM-CSF by their respective recombinant proteins in the early postoperative period may be a good therapeutic strategy for the treatment of sustained immunosuppression.…”