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Alexa AL, Sargarovschi S, Ionescu D. Neutrophils and Anesthetic Drugs: Implications in Onco-Anesthesia. Int J Mol Sci 2024; 25:4033. [PMID: 38612841 PMCID: PMC11012681 DOI: 10.3390/ijms25074033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Apart from being a significant line of defense in the host defense system, neutrophils have many immunological functions. Although there are not many publications that accurately present the functions of neutrophils in relation to oncological pathology, their activity and implications have been studied a lot recently. This review aims to extensively describe neutrophils functions'; their clinical implications, especially in tumor pathology; the value of clinical markers related to neutrophils; and the implications of neutrophils in onco-anesthesia. This review also aims to describe current evidence on the influence of anesthetic drugs on neutrophils' functions and their potential influence on perioperative outcomes.
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Affiliation(s)
- Alexandru Leonard Alexa
- Department of Anesthesia and Intensive Care I, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (S.S.); (D.I.)
- Association for Research in Anesthesia and Intensive Care (ACATI), 400162 Cluj-Napoca, Romania
- Onco-Anaesthesia Research Group, ESAIC, 1000 Brussels, Belgium
| | - Sergiu Sargarovschi
- Department of Anesthesia and Intensive Care I, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (S.S.); (D.I.)
- Association for Research in Anesthesia and Intensive Care (ACATI), 400162 Cluj-Napoca, Romania
| | - Daniela Ionescu
- Department of Anesthesia and Intensive Care I, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (S.S.); (D.I.)
- Association for Research in Anesthesia and Intensive Care (ACATI), 400162 Cluj-Napoca, Romania
- Onco-Anaesthesia Research Group, ESAIC, 1000 Brussels, Belgium
- Outcome Research Consortium, Cleveland, OH 44195, USA
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2
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Butt MN, Shamim N, Faraz A. Anesthetic Challenges for a Pediatric Leukemia Patient Undergoing Total Body Irradiation (TBI): A Case Report. Cureus 2024; 16:e53535. [PMID: 38445113 PMCID: PMC10912886 DOI: 10.7759/cureus.53535] [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] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Radiotherapy of the whole body is called total body irradiation (TBI). It is a well-established component of conditioning regimens before stem cell transplantation in juvenile leukemia. The patient was a three-year-old child with a diagnosis of B-cell acute lymphoblastic leukemia and planned for stem cell transplantation. He was given TBI under anesthesia for three consecutive days prior to the bone marrow transplantation under general anesthesia. The important concerns were related to neutropenia/immune suppression, parental consent for repeated anesthesia, nothing per oral guidelines for the TBI treatment, the possibility of high-grade fever, high chance of respiratory tract infections with repeated anesthesia exposure, etc. Proper preparation, teamwork, and collaborative efforts and the child's parents made this treatment possible with intended success.
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Affiliation(s)
- Mohsin N Butt
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Nazia Shamim
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Asma Faraz
- Department of Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
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3
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Dexmedetomidine does not directly inhibit neutrophil extracellular trap production. Br J Anaesth 2021; 128:e51-e54. [PMID: 34916052 PMCID: PMC8603039 DOI: 10.1016/j.bja.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
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Lesouhaitier M, Gregoire M, Gacouin A, Coirier V, Frerou A, Piau C, Cattoir V, Dumontet E, Revest M, Tattevin P, Roisne A, Verhoye JP, Flecher E, Le Tulzo Y, Tarte K, Tadié JM. Neutrophil function and bactericidal activity against Staphylococcus aureus after cardiac surgery with cardiopulmonary bypass. J Leukoc Biol 2021; 111:867-876. [PMID: 34425029 DOI: 10.1002/jlb.5ab1219-737rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Staphylococcus aureus is the main bacterial pathogen encountered in mediastinitis after cardiac surgical procedures; it remains a devastating complication with a high mortality rate. As neutrophils have a primordial role in the defense against staphylococcus infection and cardiopulmonary bypass (CPB) is known to induce immunosuppression, the aim of this study was to investigate CPB impact on neutrophil functions. Patients without known immunosuppression scheduled for cardiac surgery with CPB were included. Bone marrow and blood samples were harvested before, during, and after surgery. Neutrophil phenotypic maturation and functions (migration, adhesion, neutrophil extracellular trap [NET] release, reactive oxygen species (ROS) production, phagocytosis, and bacteria killing) were investigated. Two types of Staphylococcus aureus strains (one from asymptomatic nasal carriage and another from mediastinitis infected tissues) were used to assess in vitro bacterial direct impact on neutrophils. We found that CPB induced a systemic inflammation with an increase in circulating mature neutrophils after surgery. Bone marrow sample analysis did not reveal any modification of neutrophil maturation during CPB. Neutrophil lifespan was significantly increased and functions such as NET release and ROS production were enhanced after CPB whereas bacteria killing and phagocytosis were not impacted. Results were similar with the two different isolates of Staphylococcus aureus. These data suggest that CPB induces a recruitment of mature neutrophils via a demargination process rather than impacting their maturation in the bone marrow. In addition, neutrophils are fully efficient after CPB and do not contribute to postoperative immunosuppression.
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Affiliation(s)
- Mathieu Lesouhaitier
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
| | - Murielle Gregoire
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Arnaud Gacouin
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Valentin Coirier
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Aurélien Frerou
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Caroline Piau
- Department of Bacteriology, CHU Rennes, Rennes, France
| | | | - Erwan Dumontet
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Matthieu Revest
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Pierre Tattevin
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Antoine Roisne
- Department of Anesthesiology Critical Care Medicine and Perioperative Medicine, CHU Rennes, Rennes, France
| | | | - Erwan Flecher
- Department of thoracic and cardiovascular surgery, CHU Rennes, Rennes, France
| | - Yves Le Tulzo
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
| | - Karin Tarte
- INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France.,Department of Biology, CHU Rennes, Rennes, France
| | - Jean-Marc Tadié
- Department of Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France.,INSERM, EFS Bretagne, UMR U1236, Rennes 1 University, Rennes, France
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Mitsui Y, Hou L, Huang X, Odegard KC, Pereira LM, Yuki K. Volatile Anesthetic Sevoflurane Attenuates Toll-Like Receptor 1/2 Activation. Anesth Analg 2020; 131:631-639. [PMID: 32149756 DOI: 10.1213/ane.0000000000004741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although immunomodulatory effects of anesthetics have been increasingly recognized, their underlying molecular mechanisms are not completely understood. Toll-like receptors (TLRs) are one of the major receptors to recognize invading pathogens and danger signals from damaged host tissues to initiate immune responses. Among the TLR family, TLR2 and TLR4 recognize a wide range of ligands and are considered to be important players in perioperative pathophysiology. Based on our recent finding that volatile anesthetics modulate TLR4 function, we tested our hypothesis that they would also modulate TLR2 function. METHODS The effect of anesthetics isoflurane, sevoflurane, propofol, and dexmedetomidine on TLR2 activation was examined by reporter assays. An anesthetic that affected the activation was subjected to in silico rigid docking simulation on TLR2. To test our prediction that sevoflurane and a TLR1/TLR2 ligand Pam3CSK4 would compete for the same pocket of TLR2, we performed Pam3CSK4 competitive binding assay to TLR2 using HEK cells stably transfected with TLR2 (HEK-TLR2) with or without sevoflurane. We examined the effect of different anesthetics on the functions of human neutrophils stimulated with TLR2 ligands. Kruskal-Wallis test and Mann-Whitney U test were used for statistical analysis. RESULTS We observed that the attenuation of TLR1/TLR2 activation was seen on sevoflurane exposure but not on isoflurane, propofol, or dexmedetomidine exposure. The attenuation of TLR2/TLR6 activation was not seen in any of the anesthetics tested. The rigid docking simulation predicted that sevoflurane and Pam3CSK4 bound to the same pocket of TLR1/TLR2 complex. The binding of Pam3CSK4 to HEK-TLR2 cells was impaired in the presence of sevoflurane, indicating that sevoflurane and Pam3CSK4 competed for the pocket, as predicted in silico. The stimulation of neutrophils with Pam3CSK4 induced L-selection shedding but did not affect phagocytosis and reactive oxygen species production. L-selectin shedding from neutrophils was attenuated only by sevoflurane, consistent with the result of our reporter assays. CONCLUSIONS We found that TLR1/TLR2 activation was attenuated by sevoflurane, but we found no evidence for attenuation by isoflurane, propofol, or dexmedetomidine at clinically relevant concentrations. Our structural analysis and competition assay supported that sevoflurane directly bound to TLR2 at the interphase of the TLR1/TLR2 complex. Sevoflurane attenuated neutrophil L-selectin shedding, an important step for neutrophil migration.
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Affiliation(s)
- Yusuke Mitsui
- From the Department of Anesthesia, Harvard Medical School.,Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesiology and Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Lifei Hou
- From the Department of Anesthesia, Harvard Medical School.,Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Xiayi Huang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kirsten C Odegard
- From the Department of Anesthesia, Harvard Medical School.,Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Luis M Pereira
- From the Department of Anesthesia, Harvard Medical School.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Koichi Yuki
- From the Department of Anesthesia, Harvard Medical School.,Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Agung Senapathi T, Gede Widnyana IM, Utara Hartawan IGAG, Ryalino C, Kusuma O. Differences in the suppression of immune response between general anesthesia and spinal anesthesia in femoral bone surgery. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_10_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meier A, Chien J, Hobohm L, Patras KA, Nizet V, Corriden R. Inhibition of Human Neutrophil Extracellular Trap (NET) Production by Propofol and Lipid Emulsion. Front Pharmacol 2019; 10:323. [PMID: 31024300 PMCID: PMC6460395 DOI: 10.3389/fphar.2019.00323] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Uncontrolled bacteremia is a common and life threatening condition that can lead to sepsis and septic shock with significant morbidity and mortality. Neutrophil granulocytes, the most abundant phagocytic leukocyte of the innate immune system, play an essential role in capturing and killing invading pathogens. Their antimicrobial repertoire includes the formation of Neutrophil Extracellular Traps (NETs), chromatin-based, web-like structures of DNA that facilitate the capture and killing of bacteria. In sepsis, however, it has been suggested that the uncontrolled release of NETs worsens disseminated coagulation and promotes venous thrombosis. Here, we describe how clinically relevant concentrations of the commonly used sedative propofol as well as a lipid composition similar to the propofol carrier impair NET production by human neutrophils. Drugs commonly administered in the Intensive Care Unit (ICU) may impact the inflammatory response to either worsen or improve clinical outcomes and may therefore be considered for additional therapeutic effects if clinical studies confirm such findings.
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Affiliation(s)
- Angela Meier
- Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, University of California, San Diego, La Jolla, CA, United States
| | - Jason Chien
- Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, University of California, San Diego, La Jolla, CA, United States
| | - Laura Hobohm
- Institut für Physiologische Chemie, Stiftung Tierärztliche Hochschule Hannover, Hanover, Germany
| | - Kathryn Ann Patras
- Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, University of California, San Diego, La Jolla, CA, United States
| | - Victor Nizet
- Department of Pediatrics, Division of Host-Microbe Systems and Therapeutics, University of California, San Diego, La Jolla, CA, United States
| | - Ross Corriden
- Department of Pharmacology, University of California, San Diego, La Jolla, CA, United States
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Nathan N. Impact on the Frontlines. Anesth Analg 2019; 128:389. [DOI: 10.1213/ane.0000000000004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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