Alterations of cell-mediated immune response following cardiac surgery

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Abstract
Nosocomial infections in patients following cardiac surgery arefrequently associated with opportunistic microorganisms indicating adysregulation of cell-mediated immune response. The objective of thisprospective randomized trial, therefore, was to investigate the mechanismsof dysregulation and the counterregulatory effects of immunomodulation.Twenty patients underwent conventional postoperative therapy, another 20patients received indomethacin, which inhibits synthesis of thedown-regulating mediator prostaglandin E2, and a further 20 patients weregiven thymopentin in addition to indomethacin, thereby augmentingactivation and differentiation of the T-lymphocytes. The immunologicparameters studied included T-lymphocytes and monocytes as well asinterleucin (IL)-1 and IL-6 synthesis by monocytes, and IL-2 and IL-6synthesis by T-lymphocytes. Following cardiac surgery a significant,persistent reduction of T-lymphocytes and IL-2 synthesis as well assignificant monocytosis could be observed. Indomethacin treatment resultedin a normalization of the cellular imbalance at the end of the firstpostoperative week, but IL-2 synthesis remained significantly reducedduring the entire observation period. Conversely, with combinedindomethacin and thymopentin treatment restoration of cellular distributionas well as protection of IL-2 synthesis could be achieved. These resultsindicate a quantitative and functional impairment of the forward regulationof cell-mediated immunity. It was shown for the first time that combinedindomethacin and thymopentin treatment could successfully counteract theseimmunomechanistic alterations.

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