Changes in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery

Abstract

Expression of class II major histocompatibility complex (MHC) on monocytes is a prerequisite for effective antigen presentation and processing, an important component of the immune response to infection. It has been reported that the level of monocyte class II expression may identify patients who go on to develop infective complications following trauma. In the present study, flow cytometry was used to measure MHC class II (human leucocyte antigen (HLA)-DR) expression on circulating monocytes and T cells in 36 patients undergoing elective major resectional surgery, of whom 12 developed septic complications. The percentage of HLA-DR positive monocytes fell significantly on the first day after operation in both groups (P < 0.001) but was significantly higher in those without than in those with sepsis on days 1, 3 and 5 (P < 0.05). In contrast, the level of T cell HLA-DR expression rose significantly on the first day after operation (P < 0.05) in patients without sepsis to a level higher than in those who developed infection (P < 0.05). These findings have important implications, as predictive biological elements and for biological response modification, in patients at risk of developing sepsis after surgery.

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

“…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.…”

“…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.…”

Primary immune response to keyhole limpet haemocyanin following trauma in relation to low plasma glutamine

“…On admission the mean age of the trauma patients ( n = 31) was 32·8 (range, 18-59), the mean ISS was 32·0 (17-59), APACHE II score of 13·5 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) and mean GCS of 8·7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). There were 25 men and six women.…”

“…1 day after the traumatic event, was evaluated by assessment of HLA-DR expression on monocytes, a parameter known to correlate with clinical outcome in diverse populations [7][8][9][10][11][12]. In addition, the proliferative capacity of T cells and cytokine production profile upon mitogenic stimulation were evaluated, because T cells are essential for a primary immune response and were reported to be functionally compromised in traumatized patients [13,14].…”

Monitoring Immune Dysfunctions in the Septic Patient: A New Skin for the Old Ceremony

“…Up to now, the decrease of mHLA-DR expression has mainly been assessed as a predictor of septic complications after trauma, surgery, or pancreatitis (28,(92)(93)(94)(95)(96)(97)(98). In these studies, low levels of mHLA-DR (<40% of positive monocytes, normal >90%) were observed in patients who subsequently developed nosocomial infections.…”