Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma
Background. Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and an...
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| Veröffentlicht in: | Surgery 1996-03, Vol.119 (3), p.316-325 |
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| creator | Decker, Dorothee Schöndorf, Martin Bidlingmaier, Frank Hirner, Andreas von Ruecker, Alexander A. |
| description | Background. Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and antibody-mediated immunity as illustrated by the type 1/type 2 T-helper (Th1/Th2) cell balance. The sensitivity of this approach was evaluated by comparing laparoscopic and conventional cholecystectomy (LCE, CCE).
Methods. In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n=25) or CCE (n=18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.
Results. Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (FœRII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p |
| doi_str_mv | 10.1016/S0039-6060(96)80118-8 |
| format | Article |
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Methods. In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n=25) or CCE (n=18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.
Results. Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (FœRII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p<0.05). Also the expression of CD23 on B cells was higher after CCE than LCE (+146% versus +63%; p<0.01). CD30, a membrane molecule that belongs to the tumor necrosis factor receptor superfamily and probably is an important indicator of Th2 activity, was more elevated on T cells from patients who underwent CCE. The Th1 response, characterized by phytohemagglutinin-induced IFN-γ secretion in peripheral blood mononuclear cells and up-regulation of human leukocyte antigen-DR expression on monocytes, was lower after CCE than after LCE.
Conclusions. This study shows that surgical stress induces a shift in the Th1/Th2 balance toward Th2, suggesting that cell-mediated immunity is down-regulated and antibody-mediated immunity is up-regulated after surgery. The evaluation of this shift may be clinically meaningful and help quantify even less invasive surgical procedures. When comparing CCE and LCE in this not strictly randomized study, we found LCE to be the less stressful procedure.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/S0039-6060(96)80118-8</identifier><identifier>PMID: 8619187</identifier><identifier>CODEN: SURGAZ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>AIDS/HIV ; Biological and medical sciences ; Down-Regulation ; Female ; HLA-DR Antigens - analysis ; Humans ; Immunity ; Interferon-gamma - biosynthesis ; Interleukin-4 - biosynthesis ; Ki-1 Antigen - analysis ; Lymphocyte Count ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Receptors, IgE - analysis ; Stress, Physiological - immunology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgical Procedures, Operative ; Th1 Cells - immunology ; Th2 Cells - immunology ; Up-Regulation</subject><ispartof>Surgery, 1996-03, Vol.119 (3), p.316-325</ispartof><rights>1996 Mosby-Year Book, Inc.</rights><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-5ec5b3aca1a6c0c982615236038ae11e73e1de587ff9fc5e75f7bf77f5462f013</citedby><cites>FETCH-LOGICAL-c415t-5ec5b3aca1a6c0c982615236038ae11e73e1de587ff9fc5e75f7bf77f5462f013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0039-6060(96)80118-8$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3028275$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8619187$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Decker, Dorothee</creatorcontrib><creatorcontrib>Schöndorf, Martin</creatorcontrib><creatorcontrib>Bidlingmaier, Frank</creatorcontrib><creatorcontrib>Hirner, Andreas</creatorcontrib><creatorcontrib>von Ruecker, Alexander A.</creatorcontrib><title>Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background. Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and antibody-mediated immunity as illustrated by the type 1/type 2 T-helper (Th1/Th2) cell balance. The sensitivity of this approach was evaluated by comparing laparoscopic and conventional cholecystectomy (LCE, CCE).
Methods. In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n=25) or CCE (n=18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.
Results. Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (FœRII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p<0.05). Also the expression of CD23 on B cells was higher after CCE than LCE (+146% versus +63%; p<0.01). CD30, a membrane molecule that belongs to the tumor necrosis factor receptor superfamily and probably is an important indicator of Th2 activity, was more elevated on T cells from patients who underwent CCE. The Th1 response, characterized by phytohemagglutinin-induced IFN-γ secretion in peripheral blood mononuclear cells and up-regulation of human leukocyte antigen-DR expression on monocytes, was lower after CCE than after LCE.
Conclusions. This study shows that surgical stress induces a shift in the Th1/Th2 balance toward Th2, suggesting that cell-mediated immunity is down-regulated and antibody-mediated immunity is up-regulated after surgery. The evaluation of this shift may be clinically meaningful and help quantify even less invasive surgical procedures. When comparing CCE and LCE in this not strictly randomized study, we found LCE to be the less stressful procedure.</description><subject>AIDS/HIV</subject><subject>Biological and medical sciences</subject><subject>Down-Regulation</subject><subject>Female</subject><subject>HLA-DR Antigens - analysis</subject><subject>Humans</subject><subject>Immunity</subject><subject>Interferon-gamma - biosynthesis</subject><subject>Interleukin-4 - biosynthesis</subject><subject>Ki-1 Antigen - analysis</subject><subject>Lymphocyte Count</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Receptors, IgE - analysis</subject><subject>Stress, Physiological - immunology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgical Procedures, Operative</subject><subject>Th1 Cells - immunology</subject><subject>Th2 Cells - immunology</subject><subject>Up-Regulation</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUuLFDEQgIMo67j6ExZyEFEwbtI9efRpkcUXLHjY9RzS6UpPpDs95qHM3_OXmXkwghdPRVJfJVX1IXTF6DtGmbi-p7TtiKCCvu7EG0UZU0Q9QivG24bIVrDHaHVGnqJnKX2nlHZrpi7QhRKsY0qu0O_7EkdvzYRTjpAS9mEoFhI2OG28y_WM8wZw3m2BsOtDaPAD2cC0hYgtTBPuzWSChbc4lXGElH0Y8bD8CiTCWCaT_RLw4g4smWHwJsOATRhw2f6DmJB9vwy7v5if5xJ83mG7zDOEVGK9xnk5NhVNmc1z9MSZKcGLU7xE3z5-eLj9TO6-fvpy-_6O2DXjmXCwvG-NNcwIS22nGsF40wraKgOMgWyBDcCVdK5zloPkTvZOSsfXonGUtZfo1fHdbVx-lDqnnn3aD2UCLCVpWR1QJboK8iNo45JSBKe30c8m7jSjeu9OH9zpvRjdCX1wp1Wtuzp9UPq6gHPVSVbNvzzlTarGXKxb9-mMtbRRjeQVuzliUJfx00PUyXqoggYfwWY9LP4_jfwB6Wq6IQ</recordid><startdate>19960301</startdate><enddate>19960301</enddate><creator>Decker, Dorothee</creator><creator>Schöndorf, Martin</creator><creator>Bidlingmaier, Frank</creator><creator>Hirner, Andreas</creator><creator>von Ruecker, Alexander A.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19960301</creationdate><title>Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma</title><author>Decker, Dorothee ; Schöndorf, Martin ; Bidlingmaier, Frank ; Hirner, Andreas ; von Ruecker, Alexander A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-5ec5b3aca1a6c0c982615236038ae11e73e1de587ff9fc5e75f7bf77f5462f013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>AIDS/HIV</topic><topic>Biological and medical sciences</topic><topic>Down-Regulation</topic><topic>Female</topic><topic>HLA-DR Antigens - analysis</topic><topic>Humans</topic><topic>Immunity</topic><topic>Interferon-gamma - biosynthesis</topic><topic>Interleukin-4 - biosynthesis</topic><topic>Ki-1 Antigen - analysis</topic><topic>Lymphocyte Count</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Receptors, IgE - analysis</topic><topic>Stress, Physiological - immunology</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgical Procedures, Operative</topic><topic>Th1 Cells - immunology</topic><topic>Th2 Cells - immunology</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Decker, Dorothee</creatorcontrib><creatorcontrib>Schöndorf, Martin</creatorcontrib><creatorcontrib>Bidlingmaier, Frank</creatorcontrib><creatorcontrib>Hirner, Andreas</creatorcontrib><creatorcontrib>von Ruecker, Alexander A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Decker, Dorothee</au><au>Schöndorf, Martin</au><au>Bidlingmaier, Frank</au><au>Hirner, Andreas</au><au>von Ruecker, Alexander A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>1996-03-01</date><risdate>1996</risdate><volume>119</volume><issue>3</issue><spage>316</spage><epage>325</epage><pages>316-325</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background. Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and antibody-mediated immunity as illustrated by the type 1/type 2 T-helper (Th1/Th2) cell balance. The sensitivity of this approach was evaluated by comparing laparoscopic and conventional cholecystectomy (LCE, CCE).
Methods. In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n=25) or CCE (n=18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.
Results. Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (FœRII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p<0.05). Also the expression of CD23 on B cells was higher after CCE than LCE (+146% versus +63%; p<0.01). CD30, a membrane molecule that belongs to the tumor necrosis factor receptor superfamily and probably is an important indicator of Th2 activity, was more elevated on T cells from patients who underwent CCE. The Th1 response, characterized by phytohemagglutinin-induced IFN-γ secretion in peripheral blood mononuclear cells and up-regulation of human leukocyte antigen-DR expression on monocytes, was lower after CCE than after LCE.
Conclusions. This study shows that surgical stress induces a shift in the Th1/Th2 balance toward Th2, suggesting that cell-mediated immunity is down-regulated and antibody-mediated immunity is up-regulated after surgery. The evaluation of this shift may be clinically meaningful and help quantify even less invasive surgical procedures. When comparing CCE and LCE in this not strictly randomized study, we found LCE to be the less stressful procedure.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>8619187</pmid><doi>10.1016/S0039-6060(96)80118-8</doi><tpages>10</tpages></addata></record> |
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| ispartof | Surgery, 1996-03, Vol.119 (3), p.316-325 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | AIDS/HIV Biological and medical sciences Down-Regulation Female HLA-DR Antigens - analysis Humans Immunity Interferon-gamma - biosynthesis Interleukin-4 - biosynthesis Ki-1 Antigen - analysis Lymphocyte Count Male Medical sciences Middle Aged Miscellaneous Receptors, IgE - analysis Stress, Physiological - immunology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgical Procedures, Operative Th1 Cells - immunology Th2 Cells - immunology Up-Regulation |
| title | Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma |
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