title: The anti-inflammatory response dominates after septic shock: association of low monocyte HLA-DR expression and high interleukin-10 concentration.
abstract: The diminished expression of HLA-DR on monocytes has been proposed as a reliable marker of immunosuppression occuring during septic shock. The objective of the present observational study was to establish the time-dependent relation between plasma cytokines interleukin (IL)-10, transforming growth factor (TGF)-beta1, tumor necrosis factor (TNF)-alpha and monocyte HLA-DR expression in 38 adult patients with septic shock. All patients (mortality at 28 days: 42%, mean admission SAPS II score: 54) had decreased HLA-DR expression. This expression was significantly lower in non-survivors at all time points. All patients had elevated IL-10 concentrations, the highest values were found in non-survivors. IL-10 was the sole cytokine to significantly correlate with HLA-DR expression (r: -0.6, p<0.001). TNF and TGF values did not provide any prognostic information. TGF levels from septic patients were even found to be decreased in comparison with normal values which suggested that IL-10 is likely more important than TGF regarding the immunosuppressive properties of septic patients' plasma. This preliminary work showed that, at the systemic level, the anti-inflammatory response dominated after septic shock. Monocyte HLA-DR expression and IL-10 measurement deserve to be determined in parallel in a larger longitudinal study. They might constitute helpful indicators for staging patients and making a decision about whether to institute a therapy with molecules able of reversing sepsis-induced immunosuppression.
authors.affiliation: Immunology Laboratory (GM, MEF, FV, ALD, JBi) and Intensive Care Units (Jbo, AL), Lyon-Sud University Hospital, 69495 Pierre-Bénite, France. guillaume.monneret@chu-lyon.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Monneret
authors.forename: Marie-Emmanuelle
authors.initials: ME
authors.lastname: Finck
authors.forename: Fabienne
authors.initials: F
authors.lastname: Venet
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Debard
authors.forename: Julien
authors.initials: J
authors.lastname: Bohé
authors.forename: Jacques
authors.initials: J
authors.lastname: Bienvenu
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
mesh_terms: D000368:Aged; D005260:Female; D005786:Gene Expression Regulation; D006684:HLA-DR Antigens / Q000276:immunology / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000378:metabolism; D016753:Interleukin-10 / Q000276:immunology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology / Q000378:metabolism*; D018805:Sepsis / Q000276:immunology* / Q000378:metabolism*; D013997:Time Factors; D016212:Transforming Growth Factor beta / Q000378:metabolism; D048069:Tumor Necrosis Factors / Q000378:metabolism
chemical_list: D006684:HLA-DR Antigens; D016212:Transforming Growth Factor beta; D048069:Tumor Necrosis Factors; D016753:Interleukin-10