Major upper gastrointestinal surgery is associated with an antigen-dependent proinflammatory T cell response

• Published in: British journal of surgery Vol. 92; no. 8; pp. 989 - 995
• Main Authors: Sweeney, K. J., Kell, M. R., Ravi, N., Reynolds, J. V.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-08-2005; Wiley
• Subjects: Adult; Aged; Antigens, CD - metabolism; Antigens, Differentiation, T-Lymphocyte - metabolism; Biological and medical sciences; Enterotoxins - pharmacology; Esophageal Neoplasms - immunology; Esophageal Neoplasms - surgery; Esophagectomy; fas Receptor; Female; General aspects; Humans; Interferon-gamma - metabolism; Interleukins - metabolism; Lectins, C-Type; Leukocytes, Mononuclear - immunology; Lymphocyte Activation; Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - immunology; Pancreatic Neoplasms - surgery; Postoperative Complications - immunology; Receptors, Interleukin-2 - metabolism; Receptors, Tumor Necrosis Factor - metabolism; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; T-Lymphocytes - immunology; Antigen; Medicine; Inflammation; Association; Immune response
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4844

Background:
T cells play a central role in the immune response to injury. Oesophageal and pancreatic resections are associated with significant risk of systemic inflammatory response syndrome and sepsis. This study involved a detailed analysis of T cell function in a consecutive cohort of patients undergoing such surgery.
Methods:
Twenty‐five patients undergoing major oncological upper gastrointestinal surgery were investigated for T cell expression of Fas and the activation markers CD69 and CD25, as well as interleukin (IL) 2, IL‐10 and interferon (IFN) γ responses to stimulation with staphylococcal enterotoxin B (SEB). T cell activation in healthy volunteer peripheral blood mononuclear cells was studied in co‐culture with patients' serum, either alone or with cytotoxic T lymphocyte‐associated antigen (CTLA) 4, an inhibitor of antigen presentation.
Results:
T cells expressed significantly raised levels of CD69 and CD25 after surgery, but no change in Fas expression was evident. There was a significant increase in the production of IL‐2 after surgery without a concomitant increase in IFN‐γ or IL‐10 in response to SEB. Postoperative serum activated healthy volunteer T cells, a response that was inhibited (P = 0·053) by co‐incubation with CTLA‐4.
Conclusion:
Major surgery results in pan‐T cell activation via a serum‐mediated antigenic mechanism that is independent of Fas expression. Postoperative T cells are primed for an augmented proinflammatory response to superantigen, sustained for at least 1 week, implicating the adaptive immune system in the development of the postoperative systemic immunoinflammatory state. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
How the immune system is primed after major surgery