title: Detrimental effect of apoptosis of lymphocytes at an early time point of experimental abdominal sepsis.
abstract: BACKGROUND
  Apoptosis of lymphocytes is considered a late sequelum in the sepsis cascade. The role of apoptosis of lymphocytes as a driver of final outcome was investigated.
  
  
  METHODS
  Abdominal sepsis was induced after cecal ligation and puncture (CLP) in 31 rabbits. Blood was sampled at serial time intervals and peripheral blood mononuclear cells (PBMCs) were isolated. Apoptosis of lymphocytes and monocytes was measured through flow cytometric analysis. PBMCs were stimulated with LPS and Pam3Cys for the release of tumor necrosis factor-alpha (TNFα). Tissue bacterial growth was quantitatively measured. In a second set of experiments, CLP was performed in another 40 rabbits; 20 received single intravenous infusions of ciprofloxacin and of metronidazole 4 hours after surgery.
  
  
  RESULTS
  Animals were divided into two groups based on the percentage of lymphocyte apoptosis at 4 hours after surgery; less than or equal to 32% and more than 32%. Survival of the former was shorter than the latter (p: 0.017). Tissue growth was similar between groups. Apoptosis of lymphocytes and of monocytes was lower in the former group over follow-up. Release of ΤNFα did not differ. The above findings on survival were repeated in the second set of experiments. Administration of antimicrobials prolonged survival of the former group (p: 0.039) but not of the latter group (pNS).
  
  
  CONCLUSIONS
  Lymphocyte apoptosis at an early time point of experimental peritonitis is a major driver for death. A lower percentage of apoptosis leads earlier to death. Antimicrobials were beneficial even at that disease state.
authors.affiliation: 2nd Department of Surgery, University of Thessaloniki, Medical School, Thessaloniki, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Atmatzidis
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Koutelidakis
authors.forename: Grigorios
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Antigone
authors.initials: A
authors.lastname: Kotsaki
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Louis
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Pistiki
authors.forename: Athina
authors.initials: A
authors.lastname: Savva
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antonopoulou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Atmatzidis
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
mesh_terms: D000818:Animals; D017209:Apoptosis; D001419:Bacteria / Q000302:isolation & purification; D058491:Bacterial Load; D004195:Disease Models, Animal; D005434:Flow Cytometry; D008214:Lymphocytes / Q000276:immunology* / Q000473:pathology*; D008297:Male; D010538:Peritonitis / Q000276:immunology* / Q000473:pathology*; D011817:Rabbits; D018805:Sepsis / Q000276:immunology* / Q000473:pathology*; D013997:Time Factors
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