Patient-specific Immune States before Surgery Are Strong Correlates of Surgical Recovery
| Autor: | Nima Aghaeepour, Edward A. Ganio, Garry P. Nolan, Martin S. Angst, Gabriela K. Fragiadakis, Brice Gaudilliere, Martha Tingle |
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| Rok vydání: | 2015 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Perioperative management business.industry Patient specific Preoperative care Article Surgery 03 medical and health sciences Hip arthroplasty 030104 developmental biology 0302 clinical medicine Anesthesiology and Pain Medicine Immune system Surgical recovery Immune correlates 030220 oncology & carcinogenesis Anesthesia Medicine In patient Mass cytometry business |
| Zdroj: | Anesthesiology. 123:1241-1255 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/aln.0000000000000887 |
| Popis: | Background Recovery after surgery is highly variable. Risk-stratifying patients based on their predicted recovery profile will afford individualized perioperative management strategies. Recently, application of mass cytometry in patients undergoing hip arthroplasty revealed strong immune correlates of surgical recovery in blood samples collected shortly after surgery. However, the ability to interrogate a patient’s immune state before surgery and predict recovery is highly desirable in perioperative medicine. Methods To evaluate a patient’s presurgical immune state, cell-type–specific intracellular signaling responses to ex vivo ligands (lipopolysaccharide, interleukin [IL]-6, IL-10, and IL-2/granulocyte macrophage colony-stimulating factor) were quantified by mass cytometry in presurgical blood samples. Selected ligands modulate signaling processes perturbed by surgery. Twenty-three cell surface and 11 intracellular markers were used for the phenotypic and functional characterization of major immune cell subsets. Evoked immune responses were regressed against patient-centered outcomes, contributing to protracted recovery including functional impairment, postoperative pain, and fatigue. Results Evoked signaling responses varied significantly and defined patient-specific presurgical immune states. Eighteen signaling responses correlated significantly with surgical recovery parameters (|R| = 0.37 to 0.70; false discovery rate < 0.01). Signaling responses downstream of the toll-like receptor 4 in cluster of differentiation (CD) 14+ monocytes were particularly strong correlates, accounting for 50% of observed variance. Immune correlates identified in presurgical blood samples mirrored correlates identified in postsurgical blood samples. Conclusions Convergent findings in pre- and postsurgical analyses provide validation of reported immune correlates and suggest a critical role of the toll-like receptor 4 signaling pathway in monocytes for the clinical recovery process. The comprehensive assessment of patients’ preoperative immune state is promising for predicting important recovery parameters and may lead to clinical tests using standard flow cytometry. |
| Databáze: | OpenAIRE |
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