Major upper gastrointestinal surgery is associated with an antigen-dependent proinflammatory T cell response.
BACKGROUND
T cells play a central role in the immune response to injury. Oesophageal and pancreatic resections are associated with significant risk of systemic inflammatory response syndrome and sepsis. This study involved a detailed analysis of T cell function in a consecutive cohort of patients undergoing such surgery.


METHODS
Twenty-five patients undergoing major oncological upper gastrointestinal surgery were investigated for T cell expression of Fas and the activation markers CD69 and CD25, as well as interleukin (IL) 2, IL-10 and interferon (IFN) gamma responses to stimulation with staphylococcal enterotoxin B (SEB). T cell activation in healthy volunteer peripheral blood mononuclear cells was studied in co-culture with patients' serum, either alone or with cytotoxic T lymphocyte-associated antigen (CTLA) 4, an inhibitor of antigen presentation.


RESULTS
T cells expressed significantly raised levels of CD69 and CD25 after surgery, but no change in Fas expression was evident. There was a significant increase in the production of IL-2 after surgery without a concomitant increase in IFN-gamma or IL-10 in response to SEB. Postoperative serum activated healthy volunteer T cells, a response that was inhibited (P = 0.053) by co-incubation with CTLA-4.


CONCLUSIONS
Major surgery results in pan-T cell activation via a serum-mediated antigenic mechanism that is independent of Fas expression. Postoperative T cells are primed for an augmented proinflammatory response to superantigen, sustained for at least 1 week, implicating the adaptive immune system in the development of the postoperative systemic immunoinflammatory state.
Department of Clinical Surgery, St James's Hospital and Trinity College Dublin, Dublin 8, Ireland.
K J
KJ
Sweeney
M R
MR
Kell
N
N
Ravi
J V
JV
Reynolds
D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D000945:Antigens, Differentiation, T-Lymphocyte / Q000378:metabolism; D004768:Enterotoxins / Q000494:pharmacology; D004938:Esophageal Neoplasms / Q000276:immunology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D007378:Interleukins / Q000378:metabolism; D037181:Lectins, C-Type; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000276:immunology / Q000601:surgery*; D011183:Postoperative Complications / Q000276:immunology; D015375:Receptors, Interleukin-2 / Q000378:metabolism; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism; D013601:T-Lymphocytes / Q000276:immunology*; D019014:fas Receptor; D000099192:CD69 Antigens
D015703:Antigens, CD; D000945:Antigens, Differentiation, T-Lymphocyte; D004768:Enterotoxins; D007371:Interferon-gamma; D007378:Interleukins; D037181:Lectins, C-Type; D015375:Receptors, Interleukin-2; D018124:Receptors, Tumor Necrosis Factor; D019014:fas Receptor; D000099192:CD69 Antigens; C491901:FAS protein, human; C031818:enterotoxin B, staphylococcal