Mechanisms of Altered Monocyte Prostaglandin E2 Production in Severely Injured Patients

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Abstract
• Monocytes from immunosuppressed trauma (11 patients) and burn (12 patients) patients stimulated with muramyl dipeptide, a potent prostaglandin E2(PGE2) secretagogue, showed twofold greater PGE2production compared with normal controls or immunocompetent patients. Monocyte plasminogen activator production was markedly depressed and inversely correlated to patients' monocyte hyper PGE2production. Levels of the PGE2-producing monocyte subset (selected as high-affinity Fc+ receptors) were progressively elevated after injury in immunosuppressed patients, reaching 65% to 80% of the total monocyte population (39% for normal controls). Although early T-suppressor (Ts) lymphocytes did not augment monocyte PGE2secretion, Tslymphocytes that appeared late (>12 days after injury), during chronic infection, acted as monocyte PGE2secretagogues. Posttraumatic increases in monocyte sensitivity to PGE2secretagogues augmented the numbers of PGE2-secreting monocytes, and the appearance of Tslymphocytes with PGE2secretagogue activity may be responsible for elevated monocyte PGE2production in immunosuppressed trauma patients. (Arch Surg1988;123:293-299)