title: IMMUNE CELL PHENOTYPE AND FUNCTION IN SEPSIS.
abstract: Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis.The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of nonextracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed.A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes, but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8, and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes, and the cell function.
authors.affiliation: *Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France †Department of Anesthesiology and Critical Care and UMR INSERM 1160; Lariboisière Hospital, AP-HP and University Paris 7, Sorbonne Paris Cité, Paris, France ‡Nephrology, Dialysis and Kidney Transplantation Unit, University of Eastern Piedmont "A. Avogadro", "Maggiore della Carità" University Hospital, Novara, Italy §Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada ||Center for Critical Care Nephrology; The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania ¶Academia Colombiana de Medicina Critica (ACOMEC) **Division of Critical Care Medicine, Clínica Palermo, Bogotá, Colombia ††School of Medicine, University College Dublin, Dublin, Ireland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.forename: Hernando
authors.initials: H
authors.lastname: Gomez
authors.forename: Alonso
authors.initials: A
authors.lastname: Gomez
authors.forename: Patrick
authors.initials: P
authors.lastname: Murray
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular; D007113:Immunity, Innate; D007165:Immunosuppression Therapy; D018805:Sepsis / Q000276:immunology* / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology* / Q000473:pathology