Perioperative recombinant human granulocyte colony-stimulating factor (Filgrastim) treatment prevents immunoinflammatory dysfunction associated with major surgery.
OBJECTIVE
To examine the effects of perioperative rhG-CSF administration on immune function in patients subjected to major surgery.


BACKGROUND
Severe trauma, such as major surgery, initiates acute immunodysfunction which predisposes the patient towards infectious complications.


METHODS
Sixty patients undergoing elective surgery received either recombinant human granulocyte colony-stimulating factor/rh G-CSF (Filgrastim) or a placebo perioperatively. At several time points before and after the surgical intervention immunofunctional parameters were assessed. RESULTS Leukocyte counts and serum levels of anti-inflammatory mediators (IL-1ra and TNF-R) were increased in Filgrastim-treated patients, while the post-operative acute phase response was attenuated. Monocyte deactivation (reduced TNF-alpha release and HLA-DR expression) and lymphocyte anergy (impaired mitogenic proliferation and reduced TH1 lymphokine release) were blunted and the incidence and severity of infectious complications were reduced.


CONCLUSIONS
These results suggest that Filgrastim treatment reinforces innate immunity, enabling better prevention of infection. Thus, this unique combination of hematopoietic, anti-inflammatory and anti-infectious effects on the innate immune system warrants further study of clinical efficacy and sepsis prophylaxis.
Schneider
Christian
C
Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
von Aulock
Sonja
S
Zedler
Siegfried
S
Schinkel
Christian
C
Hartung
Thomas
T
Faist
Eugen
E
D000368:Aged; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D018836:Inflammation Mediators / Q000032:analysis; D007279:Injections, Subcutaneous; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011994:Recombinant Proteins; D012016:Reference Values; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000187:drug effects
D018836:Inflammation Mediators; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim