Effect of isoflurane on monocyte adhesion molecule expression in human whole blood

Sevoflurane depletes macrophages from the melanoma microenvironment

BACKGROUND

With more than 18 million annual new cases, cancer belongs to the major challenges of modern healthcare. Surgical resection of solid tumours under general anaesthesia is the prime therapy. Different aspects of anaesthesia are under discussion to independently influence the long-term outcome of cancer patients. Most recently, the commonly used volatile anaesthetics like sevoflurane have entered the spotlight, as retrospective studies suggest a detrimental outcome in certain cancer aetiologies with sparse mechanistic understanding. Our objective was to investigate this concept in a murine melanoma model, herein comparing the consequence of inhalative and injection anesthesia on tumour composition and growth.

METHODS

We used a murine model of malignant melanoma in male, adult C57BL/6 mice (n = 92), induced by the subcutaneous injection of B16-F10 cells. We either exposed the melanoma cells to sevoflurane before implantation or subjected the animals to single or double anaesthesia with either volatile or injection drugs. After a maximum follow-up of 4 weeks, leucocytes within the tumour microenvironment (TME) were comprehensively analysed by flow cytometry with focus on tumor-associated macrophages (TAM).

RESULTS

We found that exposure of melanoma cells to sevoflurane before implantation induced long-lasting transcriptome changes and aggravated tumour growth, without extensive changes of the TME. Contrastingly, both a single and double anaesthesia with sevoflurane led to a significant reduction of TAMs (injection vs. sevoflurane: 2,0 vs. 0.3% and 1.2 vs. 0.6%, respectively), whilst increasing PD-L1 expression on the remaining cells (mean fluorescent intensity injection vs. sevoflurane: 3,804 vs. 7,143 and 9,090 vs. 32,228, respectively). No changes in tumour growth were observed in these groups.

CONCLUSION

In sharp contrast to the detrimental impact of sevoflurane on patients' outcome reported in retrospective clinical studies, we propose here that sevoflurane might actually exert a beneficial effect by decreasing TAMs within the TME, rendering the tumour again susceptible for cytotoxic T cells and immunotherapies. Further research is warranted to delineate, how these results translate into the clinic.

Cellular adhesion molecule expression, nocturnal sleep, and partial night sleep deprivation

Sleep is hypothesized to have a role in the regulation of the immune system. This study evaluated the nocturnal expression of cellular adhesion molecules, Mac-1 and L-selectin on monocytes and lymphocytes during a full nights sleep and following a partial night of sleep deprivation (PSD). Healthy male subjects (n=16) had an increase in the percentage of Mac-1 positive lymphocytes across the baseline night. Whereas, the percentage of Mac-1 positive lymphocytes was reduced and L-selectin positive lymphocytes and monocytes were greater during the PSD night as compared to the baseline night. These data indicate that acute sleep disruption is associated with alterations in cellular adhesion molecule expression, with implications for the regulation of immune cell trafficking.