Post-operative immune suppression is mediated via reversible, Interleukin-10 dependent pathways in circulating monocytes following major abdominal surgery

Torrance, Hew D.T.; Longbottom, E. Rebecca; Vivian, Mark; Lalabekyan, Bagrat; Abbott, Tom; Ackland, Gareth L.; Hinds, C. J.; Pearse, Rupert M; O’Dwyer, Michael J.

doi:10.1371/journal.pone.0203795

Cited by 24 publications

(33 citation statements)

References 50 publications

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“…These findings have been confirmed in multiple subsequent studies, which have suggested that both a more robust initial inflammatory reaction along with the inability to recover HLA-DR expression predispose and prognosticate trauma patients to subsequent development of sepsis [40, 41]. In addition, reduced HLA-DR expression has been observed within 24 h after surgery and can be restored through the application of granulocyte-macrophage colony stimulating factor (GM-CSF) and interferon-gamma (IFN-γ) [42]. Continued suppression of monocyte HLA-DR expression has also been correlated with a worse outcome in patients with sepsis [43].…”

Section: Mechanisms Of Post-injury Immune Dysfunctionmentioning

confidence: 97%

Late immune consequences of combat trauma: a review of trauma-related immune dysfunction and potential therapies

2019

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With improvements in personnel and vehicular body armor, robust casualty evacuation capabilities, and damage control resuscitation strategies, more combat casualties are surviving to reach higher levels of care throughout the casualty evacuation system. As such, medical centers are becoming more accustomed to managing the deleterious late consequences of combat trauma related to the dysregulation of the immune system. In this review, we aim to highlight these late consequences and identify areas for future research and therapeutic strategies. Trauma leads to the dysregulation of both the innate and adaptive immune responses, which places the injured at risk for several late consequences, including delayed wound healing, late onset sepsis and infection, multi-organ dysfunction syndrome, and acute respiratory distress syndrome, which are significant for their association with the increased morbidity and mortality of wounded personnel. The mechanisms by which these consequences develop are complex but include an imbalance of the immune system leading to robust inflammatory responses, triggered by the presence of damage-associated molecules and other immune-modifying agents following trauma. Treatment strategies to improve outcomes have been difficult to develop as the immunophenotype of injured personnel following trauma is variable, fluid and difficult to determine. As more information regarding the triggers that lead to immune dysfunction following trauma is elucidated, it may be possible to identify the immunophenotype of injured personnel and provide targeted treatments to reduce the late consequences of trauma, which are known to lead to significant morbidity and mortality.

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Section: Mechanisms Of Post-injury Immune Dysfunctionmentioning

confidence: 97%

Late immune consequences of combat trauma: a review of trauma-related immune dysfunction and potential therapies

2019

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“…Since every major surgical intervention results in stress for the patient's body and immune suppression during the postoperative recovery may occur, a patient undergoing elective surgery should to be as well prepared as possible, especially during the descend of the pandemic curve [101,102].…”

Section: Considerations On Perioperative Pharmacologic Prophylaxismentioning

confidence: 99%

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Kaye¹,

Paprottka²,

Escudero³

et al. 2020

Aesth Plast Surg

101

145

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Background The worldwide spread of a novel coronavirus disease has led to a near total stop of nonurgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the selfimposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/ procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. Methods We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of crosscontamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. Conclusion The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a riskminimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare

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“…Because perioperative inflammation always consists of a balance between a proand anti-inflammatory response, we measured IL-10 as an immunosuppressant cytokine and also detected a postoperative increase. Postoperative elevation of IL-10 has been well-described (24). The surgical impact also was associated with an increase in postoperative PTX3 and CRP after both surgeries.…”

Section: Discussionmentioning

confidence: 81%

“…As Tregs produce IL-10 (39) one could expect to see differences in the IL-10 response to the 2nd surgical procedure. However, Tregs are not necessarily the origin of postoperative systemically secreted IL-10, as it has been recently shown that a postoperative increase of IL-10 mRNA in patients' blood was not accompanied with FOXP3 mRNA increase but in fact a decrease (24).…”

Section: Discussionmentioning

confidence: 98%

Sequential Surgical Procedures in Vascular Surgery Patients Are Associated With Perioperative Adverse Cardiac Events

Janssen

Felgner

Kummer

et al. 2020

Front. Cardiovasc. Med.

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Patients at elevated cardiovascular risk are prone to perioperative cardiovascular complications, like myocardial injury after non-cardiac surgery (MINS). We have demonstrated in a mouse model of atherosclerosis that perioperative stress leads to an increase in plaque volume and higher plaque vulnerability. Regulatory T cells (Tregs) play a pivotal role in development and destabilization of atherosclerotic plaques. For this exploratory post-hoc analysis we identified 40 patients recruited into a prospective perioperative biomarker study, who within the inclusion period underwent sequential open vascular surgery. On the basis of protein markers measured in the biomarker study, we evaluated the perioperative inflammatory response in patients' plasma before and after index surgery as well as before and after a second surgical procedure. We also analyzed available immunohistochemistry samples to describe plaque vulnerability in patients who underwent bilateral carotid endarterectomy (CEA) in two subsequent surgical procedures. Finally, we assessed if MINS was associated with sequential surgery. The inflammatory response of both surgeries was characterized by postoperative increases of interleukin-6,−10, Pentraxin 3 and C-reactive protein with no clear-cut difference between the two time points of surgery. Plaques from CEA extracted during the second surgery contained less Tregs, as measured by Foxp3 staining, than plaques from the first intervention. The 2nd surgical procedure was associated with MINS. In conclusion, we provide descriptive evidence that sequential surgical procedures involve repeat inflammation, and we hypothesize that elevated rates of cardiovascular complications after the second procedure could be related to reduced levels of intraplaque Tregs, a finding that deserves confirmatory testing and mechanistic exploration in future populations.

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Post-operative immune suppression is mediated via reversible, Interleukin-10 dependent pathways in circulating monocytes following major abdominal surgery

Cited by 24 publications

References 50 publications

Late immune consequences of combat trauma: a review of trauma-related immune dysfunction and potential therapies

Late immune consequences of combat trauma: a review of trauma-related immune dysfunction and potential therapies

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Sequential Surgical Procedures in Vascular Surgery Patients Are Associated With Perioperative Adverse Cardiac Events

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