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Anergy, Immunosuppressive Serum, and Impaired Lymphocyte Blastogenesis in Burn Patients

Anergy, Immunosuppressive Serum, and Impaired Lymphocyte Blastogenesis in Burn Patients Abstract • Skin testing with four recall antigens was performed serially in 21 patients after a major thermal burn. We looked for a correlation between the occurrence of anergy, the presence of immunosuppressive serum, and the impairment of the lymphocyte-proliferative response to phytohemagglutinin (PHA). Serum cortisol, endotoxin, and prostaglandin E2 (PGE2) levels were also measured in the serum or plasma. When anergy developed, it became apparent early in the course of the illness. It did not correlate closely with the severity of the burn, but was associated with mortality. There was a good correlation between anergy and coexisting serum suppression of lymphocyte activation in vitro. This serum immunosuppressive activity was not related to serum cortisol, PGE2, or plasma endotoxin levels. Anergy also correlated with coexistent impairment of patient peripheral blood lymphocyte activation by PHA. These results suggest that both immunosuppressive serum and an impaired lymphocyte response to mitogens are associated with anergy in burn patients and confirm that the development of anergy is an index of poor prognosis. (Arch Surg 1982;117:1266-1271) References 1. Pietsch JB, Meakins JL, MacLean LD: The delayed hypersensitivity response: Application to clinical surgery . Surgery 1977;82:349-355. 2. Christou NW, Meakins JL: Delayed hypersensitivity in surgical patients: A mechanism for anergy . Surgery 1979;86:78-85. 3. Constantian MB: Association of sepsis with an immunosuppressive polypeptide in the serum of burn patients . Ann Surg 1978;188:209-215.Crossref 4. Hiebert JM, McGough M, Rodeheaver G, et al: Influence of catabolism on immunocompetence in burned patients . Surgery 1979;86:242-246. 5. McLoughlin GA, Wu AVO, Saporoschetz I, et al: Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma . Ann Surg 1979;190:297-304.Crossref 6. Kurland JI, Bockman R: Prostaglandin E production by human blood monocytes and mouse peritoneal macrophages . J Exp Med 1978; 147:952-957.Crossref 7. Rogers TJ, Nowowiejski I, Webb OR: Partial characterization of a prostaglandin induced suppressor factor . Cell Immunol 1980;50:82-83.Crossref 8. Fauci AS, Murakami T, Brandon DD, et al: Mechanisms of corticosteroid action on lymphocyte subpopulation . Cell Immunol 1980;49:43-50.Crossref 9. Ellner JJ, Spagnuolo PJ: Suppression of antigen and mitogen induced human T lymphocyte DNA synthesis by bacterial lipopolysaccharide . J Immunol 1979;123:2689-2695. 10. Oppenheim JJ, Perry S: Effect of endotoxin on cultured leukocytes . Proc Soc Exp Biol Med 1965;11:104-107. 11. Rickles FR, Levin J, Hardin JA, et al: Tissue factor generation of human mononuclear cells: Effect of endotoxin and dissociation of tissue factor generation from mitogenic response . J Lab Clin Med 1977;89:792-803. 12. Meakins JL, Pietsch JB, Bubenick O, et al: Delayed hypersensitivity: Indicators of acquired failure of host defense in sepsis and trauma . Ann Surg 1977;186:241-250.Crossref 13. Baker CC, Miller CL, Trunkey DD: Predicting fatal sepsis in burn patients . J Trauma 1979;19:641-648.Crossref 14. Wolfe JHN, O'Connor NE, Young AE, et al: The relative clinical importance of serum suppressor factor and cellular suppression in burns . Surg Forum 1980;31:58-61. 15. Levine L, Allan I, Langone J: The use of immobilized ligans and 125I protein A for immunoassays of thromboxane B2, prostaglandin D2, 13,14-dihydro-prostaglandin E2, 5-6 dihydro-prostaglandin I2, 6-keto prostaglandin F, 15-hydroxy-9,11 epoxymethano-prostaglandin-5,13-dionic acid and 15-hydroxy-11,19 epoxymethano-prostaglandin-5,13-dionic acid . Prostaglandins Med 1979;2:177-183.Crossref 16. Mandran R, Brown DR: An improved in vitro pyrogenic test to detect picograms of endotoxin contamination in intravenous fluid using limulus amoebocyte lysate . J Lab Clin Med 1977;89:910-918. 17. Slade MS, Simmons RL, Yunis E, et al: Immunodepression after major surgery in normal patients . Surgery 1975;78:363-372. 18. Constantian MB, Menzoian JO, Nimberg RB, et al: Association of circulating immunosuppressive polypeptide with operative and accidental trauma . Ann Surg 1977;186:73-79.Crossref 19. Munster AM, Leary AG: Cell mediated response to Pseudomonas aeruginosa . Am J Surg 1977;133:710-712.Crossref 20. Sorensen RU, Stern RC, Chase P, et al: Defective cellular immunity to gram negative bacteria in cystic fibrosis patients . Infect Immun 1979; 23:398-402. 21. Reynolds HY, Thompson RE, Devlin HB: Development of cellular and humoral immunity in the respiratory tract of rabbits to Pseudomonas lipopolysaccharide . J Clin Invest 1974;53:1351-1358.Crossref 22. Tormey DC, Fundenberg HH, Komin RM: Effect of prednisolone on synthesis of DNA and RNA by human lymphocytes in vitro . Nature 1967;213:281-283.Crossref 23. Slocat SJ, Miller CA, Snyder P: Evaluation of cellular immunity and adrenocortisol activity in surgical patients . J Surg Res 1979;26:332-340.Crossref 24. Eurenius K, Mortensen RF: The phytohemagglutinin (PHA) response in the thermally injured rat . Int Arch Allergy 1971;40:707-718.Crossref 25. Miller RA, Gartner S, Kaplan HS: Stimulation of mitogenic responses in human peripheral blood lymphocytes by lipopolysaccharide . J Immunol 1978;121:2160-2165. 26. Goodwin JS, Webb DR: Regulation of the immune response by prostaglandins . Cell Immunol Immunopathol 1980;15:106-122.Crossref 27. Arturson G: Prostaglandins in human burn wound secretion . Burns 1977;3:112-118.Crossref 28. Miller CL, Baker CC: Change of lymphocyte activity after thermal injury . J Clin Invest 1979;63:202-210.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Anergy, Immunosuppressive Serum, and Impaired Lymphocyte Blastogenesis in Burn Patients

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380340002002
Publisher site
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Abstract

Abstract • Skin testing with four recall antigens was performed serially in 21 patients after a major thermal burn. We looked for a correlation between the occurrence of anergy, the presence of immunosuppressive serum, and the impairment of the lymphocyte-proliferative response to phytohemagglutinin (PHA). Serum cortisol, endotoxin, and prostaglandin E2 (PGE2) levels were also measured in the serum or plasma. When anergy developed, it became apparent early in the course of the illness. It did not correlate closely with the severity of the burn, but was associated with mortality. There was a good correlation between anergy and coexisting serum suppression of lymphocyte activation in vitro. This serum immunosuppressive activity was not related to serum cortisol, PGE2, or plasma endotoxin levels. Anergy also correlated with coexistent impairment of patient peripheral blood lymphocyte activation by PHA. These results suggest that both immunosuppressive serum and an impaired lymphocyte response to mitogens are associated with anergy in burn patients and confirm that the development of anergy is an index of poor prognosis. (Arch Surg 1982;117:1266-1271) References 1. Pietsch JB, Meakins JL, MacLean LD: The delayed hypersensitivity response: Application to clinical surgery . Surgery 1977;82:349-355. 2. Christou NW, Meakins JL: Delayed hypersensitivity in surgical patients: A mechanism for anergy . Surgery 1979;86:78-85. 3. Constantian MB: Association of sepsis with an immunosuppressive polypeptide in the serum of burn patients . Ann Surg 1978;188:209-215.Crossref 4. Hiebert JM, McGough M, Rodeheaver G, et al: Influence of catabolism on immunocompetence in burned patients . Surgery 1979;86:242-246. 5. McLoughlin GA, Wu AVO, Saporoschetz I, et al: Correlation between anergy and a circulating immunosuppressive factor following major surgical trauma . Ann Surg 1979;190:297-304.Crossref 6. Kurland JI, Bockman R: Prostaglandin E production by human blood monocytes and mouse peritoneal macrophages . J Exp Med 1978; 147:952-957.Crossref 7. Rogers TJ, Nowowiejski I, Webb OR: Partial characterization of a prostaglandin induced suppressor factor . Cell Immunol 1980;50:82-83.Crossref 8. Fauci AS, Murakami T, Brandon DD, et al: Mechanisms of corticosteroid action on lymphocyte subpopulation . Cell Immunol 1980;49:43-50.Crossref 9. Ellner JJ, Spagnuolo PJ: Suppression of antigen and mitogen induced human T lymphocyte DNA synthesis by bacterial lipopolysaccharide . J Immunol 1979;123:2689-2695. 10. Oppenheim JJ, Perry S: Effect of endotoxin on cultured leukocytes . Proc Soc Exp Biol Med 1965;11:104-107. 11. Rickles FR, Levin J, Hardin JA, et al: Tissue factor generation of human mononuclear cells: Effect of endotoxin and dissociation of tissue factor generation from mitogenic response . J Lab Clin Med 1977;89:792-803. 12. Meakins JL, Pietsch JB, Bubenick O, et al: Delayed hypersensitivity: Indicators of acquired failure of host defense in sepsis and trauma . Ann Surg 1977;186:241-250.Crossref 13. Baker CC, Miller CL, Trunkey DD: Predicting fatal sepsis in burn patients . J Trauma 1979;19:641-648.Crossref 14. Wolfe JHN, O'Connor NE, Young AE, et al: The relative clinical importance of serum suppressor factor and cellular suppression in burns . Surg Forum 1980;31:58-61. 15. Levine L, Allan I, Langone J: The use of immobilized ligans and 125I protein A for immunoassays of thromboxane B2, prostaglandin D2, 13,14-dihydro-prostaglandin E2, 5-6 dihydro-prostaglandin I2, 6-keto prostaglandin F, 15-hydroxy-9,11 epoxymethano-prostaglandin-5,13-dionic acid and 15-hydroxy-11,19 epoxymethano-prostaglandin-5,13-dionic acid . Prostaglandins Med 1979;2:177-183.Crossref 16. Mandran R, Brown DR: An improved in vitro pyrogenic test to detect picograms of endotoxin contamination in intravenous fluid using limulus amoebocyte lysate . J Lab Clin Med 1977;89:910-918. 17. Slade MS, Simmons RL, Yunis E, et al: Immunodepression after major surgery in normal patients . Surgery 1975;78:363-372. 18. Constantian MB, Menzoian JO, Nimberg RB, et al: Association of circulating immunosuppressive polypeptide with operative and accidental trauma . Ann Surg 1977;186:73-79.Crossref 19. Munster AM, Leary AG: Cell mediated response to Pseudomonas aeruginosa . Am J Surg 1977;133:710-712.Crossref 20. Sorensen RU, Stern RC, Chase P, et al: Defective cellular immunity to gram negative bacteria in cystic fibrosis patients . Infect Immun 1979; 23:398-402. 21. Reynolds HY, Thompson RE, Devlin HB: Development of cellular and humoral immunity in the respiratory tract of rabbits to Pseudomonas lipopolysaccharide . J Clin Invest 1974;53:1351-1358.Crossref 22. Tormey DC, Fundenberg HH, Komin RM: Effect of prednisolone on synthesis of DNA and RNA by human lymphocytes in vitro . Nature 1967;213:281-283.Crossref 23. Slocat SJ, Miller CA, Snyder P: Evaluation of cellular immunity and adrenocortisol activity in surgical patients . J Surg Res 1979;26:332-340.Crossref 24. Eurenius K, Mortensen RF: The phytohemagglutinin (PHA) response in the thermally injured rat . Int Arch Allergy 1971;40:707-718.Crossref 25. Miller RA, Gartner S, Kaplan HS: Stimulation of mitogenic responses in human peripheral blood lymphocytes by lipopolysaccharide . J Immunol 1978;121:2160-2165. 26. Goodwin JS, Webb DR: Regulation of the immune response by prostaglandins . Cell Immunol Immunopathol 1980;15:106-122.Crossref 27. Arturson G: Prostaglandins in human burn wound secretion . Burns 1977;3:112-118.Crossref 28. Miller CL, Baker CC: Change of lymphocyte activity after thermal injury . J Clin Invest 1979;63:202-210.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Oct 1, 1982

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