The cause of diminished monocyte major histocompatibility complex class II antigen expression after surgery or trauma is unclear. Interleukin-10 (IL-1 0) regulates inflammatory cytokine production and major histocompatibility complex class II (HLA-DR) expression in vitro.
To quantify in vivo IL-10 messenger RNA (mRNA) and protein and monocyte HLA-DR expression after major surgery and to investigate the effects of IL-10 neutralizing blockade on monocyte HLA-DR expression in vitro.
Inception cohort study of 48 surgical patients from preoperative status to postoperative day 7 and 9 healthy volunteers (controls).
Large teaching hospital, Northern England.
Monocyte HLA-DR and cytokine mRNA expression was determined in 32 of 48 consecutive patients undergoing elective major resectional surgery. Mononuclear cells for in vitro studies and serum samples for IL-10 measurement were obtained from the remaining 16 patients.
Main Outcome Measures:
Monocyte HLA-DR expression determined by flow cytometry, IL-10, and tumor necrosis factor mRNA in peripheral blood mononuclear cells assayed by multiplex reverse transcriptase polymerase chain reaction, and serum IL-10 determined by enzyme-linked immunosorbent assay.
Monocyte HLA-DR expression (in mean channel fluorescence units [MCF]) was significantly reduced 24 hours after surgery (MCF [±SEM], 32.6±2.3 vs 16.3±1.2; P<.001) and remained low during the first postoperative week. A relative increase in IL-10 to G3PDH mRNA ratio (mean [±SEM],0.95±0.08 vs 0.59±0.06; P<.01) and serum IL-10 (mean [±SEM], 18.1±4.1 vs 5.4±0.8pg/mL; P<.01) was noted on the first postoperative day. A significant correlation existed between HLA-DR antigen expression and the presence of IL-10 mRNA transcript on the first postoperative day (P<.01). Lipopolysaccharide-induced up-regulation of monocyte HLA-DR expression was significantly impaired on the first postoperative day (mean [±SEM],151%±24.4% vs 60%±10.1%; P<.01), but this was partially reversed by IL-10 neutralizing antibody (mean [±SEM], 60%±10.1% vs 115%±11.6%; P<.01).
Interleukin-10 gene expression correlates with the fall in monocyte HLA-DR antigen expression in patients undergoing major abdominal surgery and may account for the immunosuppression associated with surgical injury.Arch Surg. 1997;132:425-429
Klava A, Windsor ACJ, Farmery SM, Woodhouse LF, Reynolds JV, Ramsden CW, Boylston AW, Guillou PJ. Interleukin-10A Role in the Development of Postoperative Immunosuppression. Arch Surg. 1997;132(4):425-429. doi:10.1001/archsurg.1997.01430280099016