Citation

Monneret G, Venet F, Cour M, Argaud L. J. Thorac. Dis. 2016; 8(6): 1060-1061.

Affiliation

1 Immunology Department, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 2 Université de Lyon, Claude Bernard University, EA PI3 "Pathology of Injury-induced Immunosuppression", Lyon, France ; 3 Department of Medical Intensive Care Unit, Hospices Civils de Lyon, Lyon University Hospital, Edouard Herriot Hospital, Lyon, France ; 4 INSERM UMR 1060, CarMeN, Team 5 "Cardioprotection", Lyon, France.

Copyright

(Copyright © 2016, Pioneer Bioscience)

DOI

10.21037/jtd.2016.04.30

PMID

27293819

Abstract

We read with great interest the study by Timmermans et al. entitled “Plasma levels of danger associated molecular patterns are associated with immune suppression in trauma patients” which was recently published in Intensive Care Medicine (1). This very interesting work shed light on immune functions after trauma as the authors investigated various aspects of host response in these severely injured patients. In particular, the concentrations of several plasma danger associated molecular patterns (DAMPs, i.e., mitochondrial DNA, nuclear DNA, heat shock protein-70) and plasma cytokines (IL-6, IL-8, IL-10) were evaluated in parallel with mRNA expression of HLA-DR and innate immune functionality through whole blood cytokine release upon LPS challenge. One major result is the first time report of the swiftness of immunosuppression development in those patients. Indeed, by collecting blood at the trauma scene and emergency room, the authors were able to show that, in parallel with expected increased DAMPs levels, usual markers indicative of immunosuppression were already measurable: reduced HLA-DR mRNA expression, increased IL-10 and IL-6 plasma levels (while those of TNF were unchanged). Most importantly, innate immune cells response to LPS stimulation was readily altered as a decreased release of IL-6 and TNF was observed whereas IL-10 production was significantly enhanced even at early sampling times. This shows that, at the systemic level, immunosuppression is occurring immediately at the onset of injury. Another interesting finding of the present study is to observe that the magnitude of HLA-DR fall inversely correlated with elevated DAMPs concentrations. In addition, both HLA-DR mRNA ratio <1 (between measurements at day 3 and at emergency room samples) and circulating nuclear DNA values were associated with increased rate of secondary infections. This confirms results obtained by flow cytometry.

1. Timmermans K, Kox M, Vaneker M, et al. Plasma levels of danger-associated molecular patterns are associated with immune suppression in trauma patients. Intensive Care Med 2016;42:551-61.

Language: en