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Lücht J, Seiler R, Herre AL, Brankova L, Fritsche-Guenther R, Kirwan J, Huscher D, Münzfeld H, Berger F, Photiadis J, Tong G, Schmitt KRL. Promising results of a clinical feasibility study: CIRBP as a potential biomarker in pediatric cardiac surgery. Front Cardiovasc Med 2024; 11:1247472. [PMID: 38361581 PMCID: PMC10867162 DOI: 10.3389/fcvm.2024.1247472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Objective Cold-inducible RNA binding Protein (CIRBP) has been shown to be a potent inflammatory mediator and could serve as a novel biomarker for inflammation. Systemic inflammatory response syndrome (SIRS) and capillary leak syndrome (CLS) are frequent complications after pediatric cardiac surgery increasing morbidity, therefore early diagnosis and therapy is crucial. As CIRBP serum levels have not been analyzed in a pediatric population, we conducted a clinical feasibility establishing a customized magnetic bead panel analyzing CIRBP in pediatric patients undergoing cardiac surgery. Methods A prospective hypothesis generating observational clinical study was conducted at the German Heart Center Berlin during a period of 9 months starting in May 2020 (DRKS00020885, https://drks.de/search/de/trial/DRKS00020885). Serum samples were obtained before the cardiac operation, upon arrival at the pediatric intensive care unit, 6 and 24 h after the operation in patients up to 18 years of age with congenital heart disease (CHD). Customized multiplex magnetic bead-based immunoassay panels were developed to analyze CIRBP, Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10), Monocyte chemotactic protein 1 (MCP-1), Syndecan-1 (SDC-1), Thrombomodulin (TM), Vascular endothelial growth factor (VEGF-A), Angiopoietin-2 (Ang-2), and Fibroblast growth factor 23 (FGF-23) in 25 µl serum using the Luminex MagPix® system. Results 19 patients representing a broad range of CHD (10 male patients, median age 2 years, 9 female patients, median age 3 years) were included in the feasibility study. CIRBP was detectable in the whole patient cohort. Relative to individual baseline values, CIRBP concentrations increased 6 h after operation and returned to baseline levels over time. IL-6, IL-8, IL-10, and MCP-1 concentrations were significantly increased after operation and except for MCP-1 concentrations stayed upregulated over time. SDC-1, TM, Ang-2, as well as FGF-23 concentrations were also significantly increased, whereas VEGF-A concentration was significantly decreased after surgery. Discussion Using customized magnetic bead panels, we were able to detect CIRBP in a minimal serum volume (25 µl) in all enrolled patients. To our knowledge this is the first clinical study to assess CIRBP serum concentrations in a pediatric population.
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Affiliation(s)
- Jana Lücht
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Raphael Seiler
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Alexa Leona Herre
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Liliya Brankova
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Raphaela Fritsche-Guenther
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna Münzfeld
- Department of Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Giang Tong
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Katharina R. L. Schmitt
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
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Patysheva M, Frolova A, Larionova I, Afanas'ev S, Tarasova A, Cherdyntseva N, Kzhyshkowska J. Monocyte programming by cancer therapy. Front Immunol 2022; 13:994319. [PMID: 36341366 PMCID: PMC9631446 DOI: 10.3389/fimmu.2022.994319] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/27/2022] [Indexed: 08/27/2023] Open
Abstract
Monocytes in peripheral blood circulation are the precursor of essential cells that control tumor progression, that include tumor-associated macrophages (TAMs), dendritic cells (DCs) and myeloid-derive suppressor cells (MDSC). Monocytes-derived cells orchestrate immune reactions in tumor microenvironment that control disease outcome and efficiency of cancer therapy. Four major types of anti-cancer therapy, surgery, radiotherapy, chemotherapy, and most recent immunotherapy, affect tumor-associated macrophage (TAM) polarization and functions. TAMs can also decrease the efficiency of therapy in a tumor-specific way. Monocytes is a major source of TAMs, and are recruited to tumor mass from the blood circulation. However, the mechanisms of monocyte programming in circulation by different therapeutic onsets are only emerging. In our review, we present the state-of-the art about the effects of anti-cancer therapy on monocyte progenitors and their dedifferentiation, on the content of monocyte subpopulations and their transcriptional programs in the circulation, on their recruitment into tumor mass and their potential to give origin for TAMs in tumor-specific microenvironment. We have also summarized very limited available knowledge about genetics that can affect monocyte interaction with cancer therapy, and highlighted the perspectives for the therapeutic targeting of circulating monocytes in cancer patients. We summarized the knowledge about the mediators that affect monocytes fate in all four types of therapies, and we highlighted the perspectives for targeting monocytes to develop combined and minimally invasive anti-cancer therapeutic approaches.
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Affiliation(s)
- Marina Patysheva
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Laboratory of Tumor Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Anastasia Frolova
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Laboratory of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina Larionova
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Laboratory of Tumor Progression Biology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
- Laboratory of Genetic Technologies, Siberian State Medical University, Tomsk, Russia
| | - Sergey Afanas'ev
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Anna Tarasova
- Department of Abdominal Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Nadezhda Cherdyntseva
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Laboratory of Molecular Oncology and Immunology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
- Laboratory of Genetic Technologies, Siberian State Medical University, Tomsk, Russia
| | - Julia Kzhyshkowska
- Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk State University, Tomsk, Russia
- Laboratory of Genetic Technologies, Siberian State Medical University, Tomsk, Russia
- Institute of Transfusion Medicine and Immunology, Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Red Cross Blood Service Baden-Württemberg – Hessen, Mannheim, Germany
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Hakki S, Robinson EJ, Robson MG. Circulating Interleukin-6 and CD16 positive monocytes increase following angioplasty of an arteriovenous fistula. Sci Rep 2022; 12:1427. [PMID: 35082332 PMCID: PMC8792046 DOI: 10.1038/s41598-022-05062-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
Arteriovenous fistulas are the ideal form of vascular access that allows provision of haemodialysis. Stenotic lesions caused by neointimal hyperplasia commonly occur resulting in patients requiring a fistuloplasty. This is effective but there is a high recurrence rate. We sought to investigate the effects of a fistuloplasty on monocyte populations. Blood samples were taken from patients before and after their fistuloplasty procedure. Samples were analysed using flow cytometry, ELISA and Luminex assays. Univariate cox regression was carried out to investigate associations with post fistuloplasty patency. At 1-2 days post fistuloplasty, the proportion of classical (CD14++CD16-) monocytes decreased (p < 0.001), whilst intermediate (CD14++CD16+) and non-classical (CD14+CD16+) monocytes increased (both p < 0.01) in a cohort of 20 patients. A time course study carried out in 5 patients showed that this was due to an increase in absolute numbers of non-classical and intermediate monocytes. Higher levels of non-classical monocytes pre-fistuloplasty were associated with an increased risk for patency loss (p < 0.05). We measured 41 soluble factors in plasma samples taken before a fistuloplasty in 54 patients, with paired post-fistuloplasty samples (1-2 days) available in 30 patients. After correcting for false discovery, the only factor with a significant change in level was IL-6 (P = 0.0003, q = 0.0124). In a further time-course study in 6 patients, peak level of IL-6 occurred 2-3 h post fistuloplasty. This study demonstrates that there is a systemic inflammatory response to the fistuloplasty procedure and that monocyte subsets and IL-6 may be important in the pathophysiology of restenosis.
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Affiliation(s)
- Seran Hakki
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - Emily J Robinson
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael G Robson
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, SE1 9RT, UK.
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Association of monocyte HLA-DR expression over time with secondary infection in critically ill children: a prospective observational study. Eur J Pediatr 2022; 181:1133-1142. [PMID: 34755207 PMCID: PMC8897323 DOI: 10.1007/s00431-021-04313-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 10/26/2022]
Abstract
An impaired immune response could play a role in the acquisition of secondary infections in critically ill children. Human leukocyte antigen-DR expression on monocytes (mHLA-DR) has been proposed as marker to detect immunosuppression, but its potential to predict secondary infections in critically ill children is unclear. We aimed to assess the association between mHLA-DR expression at several timepoints and the change of mHLA-DR expression over time with the acquisition of secondary infections in critically ill children. In this prospective observational study, children < 18 years with fever and/or suspected infection (community-acquired or hospital-acquired) were included at a paediatric intensive care unit in the Netherlands. mHLA-DR expression was determined by flow cytometry on day 1, day 2-3 and day 4-7. The association between delta-mHLA-DR expression (difference between last and first measurement) and secondary infection was assessed by multivariable regression analysis, adjusted for age and Paediatric Logistic Organ Dysfunction-2 score. We included 104 patients at the PICU (median age 1.2 years [IQR 0.3-4.2]), of whom 28 patients (27%) developed a secondary infection. Compared to 93 healthy controls, mHLA-DR expression of critically ill children was significantly lower at all timepoints. mHLA-DR expression did not differ at any of the time points between patients with and without secondary infection. In addition, delta-mHLA-DR expression was not associated with secondary infection (aOR 1.00 [95% CI 0.96-1.04]).Conclusions: Our results confirm that infectious critically ill children have significantly lower mHLA-DR expression than controls. mHLA-DR expression was not associated with the acquisition of secondary infections. What is Known: • An impaired immune response, estimated by mHLA-DR expression, could play an essential role in the acquisition of secondary infections in critically ill children. • In critically ill children, large studies on the association of mHLA-DR expression with secondary infections are scarce. What is New: • Our study confirms that critically ill children have lower mHLA-DR expression than healthy controls. • mHLA-DR expression and change in mHLA-DR was not associated with the acquisition of secondary infection.
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Chenouard A, Rimbert M, Joram N, Braudeau C, Roquilly A, Bourgoin P, Asehnoune K. Monocytic Human Leukocyte Antigen DR Expression in Young Infants Undergoing Cardiopulmonary Bypass. Ann Thorac Surg 2021; 111:1636-1642. [PMID: 32652073 DOI: 10.1016/j.athoracsur.2020.05.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Monocytic human leukocyte antigen DR (mHLA-DR) expression levels have been reported to be a marker of immunosuppression and a predictor of sepsis and mortality. There are, however, scant data regarding mHLA-DR monitoring in young infants after cardiopulmonary bypass. Our objectives were to investigate the kinetics of mHLA-DR expression and to determine whether mHLA-DR levels are associated with healthcare-associated infection (HAI) after cardiopulmonary bypass in young infants. METHODS mHLA-DR levels were analyzed by flow cytometry using a standardized method in 49 infants (<3 months old) with congenital heart disease before and after cardiopulmonary bypass. Results are expressed as the number of anti-HLA-DR antibodies per cell (AB/c). RESULTS Postoperative mHLA-DR expression was reduced in all infants. Eleven patients (22%) developed HAI, and 4 patients (8%) died during the 30-day follow-up. mHLA-DR expression was significantly lower on postoperative day 4 in the HAI group compared with those who without HAI (3768 AB/c [range, 1938-6144] vs 13,230 AB/c [range, 6152-19,130], P = .014). Although mHLA-DR expression was associated with postoperative severity, mHLA-DR ≤4500 AB/c in the first 72 hours among patients with higher postoperative severity (extracorporeal membrane oxygenation and/or corticoids and/or delayed closure of sternum) was associated with occurrence of HAI in the univariate analysis (odds ratio, 6.3; 95% confidence interval, 1.0-38.7; P = .037). CONCLUSIONS Cardiopulmonary bypass induces a profound decrease in mHLA-DR expression in young infants. Among patients with higher postoperative severity, low level of mHLA-DR in the early postoperative period is associated with the development of HAI.
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Affiliation(s)
| | - Marie Rimbert
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Nicolas Joram
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Cécile Braudeau
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France; Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Antoine Roquilly
- CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
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Rosenthal LM, Tong G, Wowro S, Walker C, Pfitzer C, Böttcher W, Miera O, Berger F, Schmitt KRL. A Prospective Clinical Trial Measuring the Effects of Cardiopulmonary Bypass Under Mild Hypothermia on the Inflammatory Response and Regulation of Cold-Shock Protein RNA-Binding Motif 3. Ther Hypothermia Temp Manag 2020; 10:60-70. [DOI: 10.1089/ther.2018.0038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Lisa-Maria Rosenthal
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Giang Tong
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sylvia Wowro
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Christoph Walker
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Constanze Pfitzer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DHZK), Partner Site Berlin, Berlin, Germany
| | - Wolfgang Böttcher
- Department for Cardiovascular Perfusion, German Heart Institute Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DHZK), Partner Site Berlin, Berlin, Germany
- Department of Pediatric Cardiology, Charité–Universitaetsmedizin Berlin, Berlin, Germany
| | - Katharina Rose Luise Schmitt
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DHZK), Partner Site Berlin, Berlin, Germany
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7
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Daix T, Guérin E, Tavernier E, Marsaud J, Hacan A, Gauthier F, Piccardo A, Vignon P, Feuillard J, François B. Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:887-894. [DOI: 10.1002/cyto.b.21739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/06/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Daix
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
| | - Estelle Guérin
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Elsa Tavernier
- Inserm CIC1415, Tours Teaching HospitalFrançois Rabelais University Tours France
| | | | - Adélaïde Hacan
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
| | | | - Alessandro Piccardo
- Cardiothoracic and Vascular Surgery UnitDupuytren Teaching Hospital Limoges France
| | - Philippe Vignon
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
| | - Jean Feuillard
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Bruno François
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
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Abstract
BACKGROUND To longitudinally study blood monocyte subset distribution and human leukocyte antigen-DR (HLA-DR) expression on monocyte subsets in children with sepsis, post-surgery and trauma in relation to nosocomial infections and mortality. METHODS In 37 healthy children and 37 critically ill children (12 sepsis, 11 post-surgery, 10 trauma and 4 admitted for other reasons)-participating in a randomized controlled trial on early versus late initiation of parenteral nutrition-monocyte subset distribution and HLA-DR expression on monocyte subsets were measured by flow cytometry upon admission and on days 2, 3 and 4 of pediatric intensive care unit (PICU) stay. RESULTS Upon PICU admission, critically ill children had a higher proportion of classical monocytes (CD14++CD16-) than healthy children [PICU 95% (interquartile range [IQR] 88%-98%); controls, 87% (IQR 85%-90%), P < 0.001]. HLA-DR expression was significantly decreased within all monocyte subsets and at all time points, being most manifest on classical monocytes and in patients with sepsis. Percentage of HLA-DR expressing classical monocytes [upon PICU admission 67% (IQR 44%-88%); controls 95% (IQR 92%-98%), P < 0.001], as well as the HLA-DR mean fluorescence intensity [upon PICU admission 3219 (IQR 2650-4211); controls 6545 (IQR 5558-7647), P < 0.001], decreased during PICU stay. Patients who developed nosocomial infections (n = 13) or who died (n = 6) had lower HLA-DR expression on classical monocytes at day 2 (P = 0.002) and day 3 (P = 0.04), respectively. CONCLUSIONS Monocytic HLA-DR expression decreased during PICU stay and was lower compared with controls on all examined time points, especially on classical monocytes and in children admitted for sepsis. Low HLA-DR expression on classical monocytes was associated with nosocomial infections and death.
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9
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Abstract
Background While the process of sepsis-induced immunosuppression is now well described in adults, very little information is available on immune functions in pediatric sepsis. The current study investigated this in children with septic shock by performing immunomonitoring, including both innate (monocyte human leukocyte antigen-DR, mHLA-DR, expression) and adaptive immunity (lymphocyte subsets count), as well as cytokine concentrations (IL-6, IL-8, IL-10, IL-1Ra, TNF-α, IFN-γ). Subsequent objectives were to assess the associations between inflammatory response, potential immunosuppression and secondary acquired infection occurrence. Methods Single-center prospective observational study, including children aged between 1 month and 18 years admitted to pediatric intensive care unit (PICU) for septic shock. Age-matched controls were children hospitalized for elective surgery without any infectious criteria. Blood was sampled at day 1–2, 3–5, and 7–9 after sepsis onset. mHLA-DR and lymphocyte subsets count were measured by flow cytometry and cytokine concentrations by Luminex technology. Results A total of 26 children and 30 controls were included. Patients had lymphopenia, and mHLA-DR levels were significantly lower than controls at each time point (p < 0.0001). All cytokines peaked at day 1–2. Children with secondary acquired infection had lower day 3–5 mHLA-DR and higher pro-inflammatory cytokine concentrations (IL-6, IL-8 and TNF-α) at day 1–2 compared to children without secondary acquired infection. Conclusions The higher initial inflammatory cytokine production was, the more innate immunity was altered, while evaluated by low mHLA-DR expression. Children with decreased mHLA-DR expression developed more secondary acquired infections. Upon confirmation in multicenter cohorts, these results pave the way for immunostimulation for the most immunosuppressed children in order to prevent nosocomial infections in PICU. Trial registration PedIRIS study NCT02848144. Retrospectively registered 28 July 2016 Electronic supplementary material The online version of this article (10.1186/s13613-018-0382-x) contains supplementary material, which is available to authorized users.
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10
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Chenouard A, Braudeau C, Cottron N, Bourgoin P, Salabert N, Roquilly A, Josien R, Joram N, Asehnoune K. HLA-DR expression in neonates after cardiac surgery under cardiopulmonary bypass: a pilot study. Intensive Care Med Exp 2018; 6:1. [PMID: 29327145 PMCID: PMC5764905 DOI: 10.1186/s40635-017-0166-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/14/2017] [Indexed: 08/30/2023] Open
Abstract
Monocyte HLA-DR expression has been reported as a marker of immunosuppression and a predictor of sepsis development. However, to date, there is no report on monocyte HLA-DR monitoring exclusively in neonates (< 28 days of life) who underwent cardiac surgery under cardiopulmonary bypass (CPB), which have a high risk of nosocomial infection. In this pilot study, we studied nine neonates with a diagnosis of congenital heart disease requiring surgery under CPB. There was a significant reduction in monocyte HLA-DR expression for the first two postoperative days, as compared to preoperatively (p = 0.004). Moreover, neonates who displayed an episode of NI had a dramatically lower HLA-DR expression at day 4, as compared to neonates without NI (4257 AB/c [2220–5895] vs 14,947 AB/c [9858–16,960]; p = 0.04). Our preliminary results could indicate that HLA-DR expression may be a useful biomarker of immunosuppression-induced secondary infection after CPB in neonates.
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Affiliation(s)
| | - Cécile Braudeau
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | - Nicolas Cottron
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Nina Salabert
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Antoine Roquilly
- CHU Nantes, Pôle anesthésie réanimations, Service d'anesthésie réanimation chirurgicale, Hôtel Dieu, Nantes, France
| | - Régis Josien
- CHU Nantes, Laboratoire d'Immunologie, CIMNA, Nantes, France.,Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Nicolas Joram
- CHU Nantes, Service de Réanimation Pédiatrique, Nantes, France
| | - Karim Asehnoune
- CHU Nantes, Pôle anesthésie réanimations, Service d'anesthésie réanimation chirurgicale, Hôtel Dieu, Nantes, France
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Kim OY, Monsel A, Bertrand M, Coriat P, Cavaillon JM, Adib-Conquy M. Differential down-regulation of HLA-DR on monocyte subpopulations during systemic inflammation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R61. [PMID: 20385017 PMCID: PMC2887183 DOI: 10.1186/cc8959] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 02/17/2010] [Accepted: 04/13/2010] [Indexed: 01/09/2023]
Abstract
Introduction Decreased expression of human leukocyte antigen class II (HLA-DR) on monocytes is a hallmark of altered immune status in patients with a systemic inflammatory response syndrome (SIRS). So far, the analyses were mainly performed without taking into account monocytes subpopulations. Methods We studied this modification on CD14HIGH and CD14LOW monocytes of 20 SIRS patients undergoing abdominal aortic surgery (AAS), 20 patients undergoing carotid artery surgery (CAS), and 9 healthy controls, and we investigated mediators and intracellular molecules that may be involved in this process. Results HLA-DR on CD14HIGH monocytes started to decrease during surgery, after blood reperfusion, and was further reduced post-surgery. In contrast, HLA-DR expression on CD14LOW cells only decreased after surgery, and to a lesser extent than on CD14HIGH monocytes. Negative correlations were found between the reduction of HLA-DR expression and the change in cortisol levels for both subpopulations, whereas a negative correlation between interleukin-10 (IL-10) levels and HLA-DR modulation was only observed for CD14HIGH cells. In accordance with these ex vivo results, HLA-DR on CD14HIGH and CD14LOW monocytes of healthy donors was reduced following incubation with hydrocortisone, whereas IL-10 only acted on CD14HIGH subpopulation. Furthermore, flow cytometry revealed that the expression of IL-10 receptor was higher on CD14HIGH versus CD14LOW monocytes. In addition, hydrocortisone, and to a lesser extent IL-10, reversed the up-regulation of HLA-DR induced by bacterial products. Finally, membrane-associated RING-CH-1 protein (MARCH1) mRNA, a negative regulator of MHC class II, was up-regulated in monocytes of AAS patients on Day 1 post-surgery, and in those of healthy subjects exposed to hydrocortisone. Conclusions This study reveals that HLA-DR expression is modulated differently on CD14HIGH (classical) versus CD14LOW (inflammatory) monocytes after systemic inflammation.
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Affiliation(s)
- Oh Yoen Kim
- Unit Cytokines & Inflammation, Institut Pasteur, 28 rue Dr, Roux, Paris, France.
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Heying R, van Oeveren W, Wilhelm S, Schumacher K, Grabitz RG, Messmer BJ, Seghaye MC. Children undergoing cardiac surgery for complex cardiac defects show imbalance between pro- and anti-thrombotic activity. Crit Care 2007; 10:R165. [PMID: 17125503 PMCID: PMC1794476 DOI: 10.1186/cc5108] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 11/05/2006] [Accepted: 11/24/2006] [Indexed: 11/10/2022] Open
Abstract
Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is associated with the activation of inflammatory mediators that possess prothrombotic activity and could cause postoperative haemostatic disorders. This study was conducted to investigate the effect of cardiac surgery on prothrombotic activity in children undergoing cardiac surgery for complex cardiac defects. Methods Eighteen children (ages 3 to 163 months) undergoing univentricular palliation with total cavopulmonary connection (TCPC) (n = 10) or a biventricular repair (n = 8) for complex cardiac defects were studied. Prothrombotic activity was evaluated by measuring plasma levels of prothrombin fragment 1+2 (F1+2), thromboxane B2 (TxB2), and monocyte chemoattractant protein-1 (MCP-1). Anti-thrombotic activity was evaluated by measuring levels of tissue factor pathway inhibitor (TFPI) before, during, and after cardiac surgery. Results In all patients, cardiac surgery was associated with a significant but transient increase of F1+2, TxB2, TFPI, and MCP-1. Maximal values of F1+2, TxB2, and MCP-1 were found at the end of CPB. In contrast, maximal levels of TFPI were observed at the beginning of CPB. Concentrations of F1+2 at the end of CPB correlated negatively with the minimal oesophageal temperature during CPB. Markers of prothrombotic activity returned to preoperative values from the first postoperative day on. Early postoperative TFPI levels were significantly lower and TxB2 levels significantly higher in patients with TCPC than in those with biventricular repair. Thromboembolic events were not observed. Conclusion Our data suggest that children with complex cardiac defects undergoing cardiac surgery show profound but transient imbalance between pro- and anti-thrombotic activity, which could lead to thromboembolic complications. These alterations are more important after TCPC than after biventricular repair but seem to be determined mainly by low antithrombin III.
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Affiliation(s)
- Ruth Heying
- Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Wim van Oeveren
- Department of BioMedical Engineering, University of Groningen, A. Deusinglaan1, 9713 AV Groningen, The Netherlands
| | - Stefanie Wilhelm
- Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Katharina Schumacher
- Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Ralph G Grabitz
- Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Bruno J Messmer
- Department of Cardiothoracic and Vascular Surgery, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Marie-Christine Seghaye
- Department of Pediatric Cardiology, University Hospital, RWTH-Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Abstract
PURPOSE This review briefly summarizes recent advances in the understanding of the pathophysiology of the inflammatory response to cardiac surgery and its ties to clinical outcomes. Links between specific inflammatory mediators and vulnerable organs will be emphasized, along with genetic risk factors that render specific patients susceptible to these complications. RECENT FINDINGS Circulation of blood on the cardiopulmonary bypass circuit and the operative procedure itself provoke activation of circulating hematopoietic cells and vascular endothelial cells. These activated cells subsequently secrete mediators that amplify this inflammatory response and activated phagocytes undergo changes that facilitate their exit from the circulation into tissue, where they exacerbate organ complications of the procedure. Cardiac, renal and pulmonary dysfunction are among the most common complications of cardiac surgery and progress has been made in recent years demonstrating how the cellular inflammatory response is related to adverse outcomes in these organs. Accordingly, this review will focus on these three systems and the pathophysiology of their cardiac surgical complications. SUMMARY Advances in our understanding of the pathways by which inflammatory mediators contribute to host injury offers the promise of interventions that are tailored to specific risks and the possibility of preoperatively identifying those patients most likely to benefit.
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Affiliation(s)
- Christine Rinder
- Department of Anesthesiology, Yale University, New Haven, Connecticut 06520, USA.
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