Monocytic HLA-DR expression in intensive care patients: Interest for prognosis and secondary infection prediction*

Abstract

For a given severity, mHLA-DR proved not to a predictive marker of outcome, but a weak trend of mHLA-DR recovery was associated with an increased risk of secondary infection. Monitoring immune functions through mHLA-DR in intensive care unit patients therefore could be useful to identify a high risk of secondary infection.

Mechanisms of sepsis‐induced immunosuppression and immunological modification therapies for sepsis

“…Recently, we reported that there exists a significant positive correlation between serum IL‐10 levels and the percentage of Treg cells in the CD4 + T‐cell population in patients with postoperative infections, and that septic injury induced by cecal ligation and puncture increases the percentage of Treg cells among CD4 + T cells in the spleen, and there was a significant positive correlation between the percentage of Treg cells and serum IL‐10 or TGF‐β levels. Neutralization of IL‐10 or TGF‐β decreased the percentage of Treg cells among CD4 + T cells, restored the percentage of CD4 + T cells among spleen mononuclear cells, and improved survival rates in septic mice 25. We also found that PMX therapy directly reduces the number of Treg cells and improves the number of CD4 + T cells, which are key lymphocytes involved in maintaining immune responses under septic conditions (Figure 4).…”

“…Low levels of monocyte human leukocyte antigen (HLA)‐DR expression function as a surrogate marker of monocyte unresponsiveness 25. We previously reported that expression of the human leukocyte antigen HLA‐DR by peripheral blood monocytes was decreased in septic patients, particularly in patients with septic shock or severe sepsis 26.…”

Measurement of monocytic HLA-DR (mHLA-DR) expression in patients with severe sepsis and septic shock: assessment of immune organ failure

“…less than 48 h after establishing of the diagnosis). Alternatively, the recovery slope of a diminished mHLA-DR expression seems interesting to investigate [16]. Second, specific (pre)analytical requirements for flow cytometric mHLA-DR analysis apply [17,18].…”

Mucosal associated invariant T (MAIT) cell: a novel cellular mechanism participating in post-aggressive immunodepression

“…This has been substantiated by clinical results [3][4][5][6]. Early immunodepression involves both innate and adaptive immunity [7] with a reduction in monocyte human leukocyte antigens (HLA)-DR expression [4,6], ''exhaustion'' of T cells with induced apoptosis and reduced functional activity of almost all T-lymphocyte subsets [2], with the exception of CD25(?)Fox(-)P3(?) T lymphocytes [8].…”

“…The described decrease in MAIT cells in patients during secondary infection can be a cause or consequence, a concept that needs further investigation. By analogy with monocytic expression of HLA-DR, it is more likely that the non-recovery of MAIT cell number-rather than the amplitude of cell number reduction-which could be the factor favoring the occurrence of secondary infection in septic patients [6]. However, it has been shown that even if the HLA-DR expression has a positive slope to recover, the occurrence of a secondary infection once again induces a drop in HLA-DR expression.…”