This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Cyclical ischaemic preconditioning modulates the adaptive immune response in human limb ischaemia–reperfusion injury. BJS 2009; 96: 381-390.
Published: 12th March 2009
Authors: P. J. Sullivan, K. J. Sweeney, K. M. Hirpara, C. B. Malone, W. Curtin, M. J. Kerin et al.
Background
Reperfusion injury (RI) has significant local and systemic consequences. Ischaemic preconditioning (IPC) modulates RI and the innate immune response. This study examined whether IPC attenuates RI‐mediated changes in lymphocyte populations and function following elective surgery.
Method
Twenty‐five patients sustaining 1 h of tourniquet ischaemia during cruciate ligament reconstruction were randomized before surgery to three 5‐min ischaemia cycles separated by 5 min of reperfusion, or to a control group. Systemic levels of interleukin (IL) 4 and interferon (IFN) γ, and surface expression of CD45ro/ra, CD62L and CD95 were measured. T cells were examined systemically and in stimulated serum co‐culture to determine CD4/CD8 and Th1/Th2 shifts through intracellular cytokine production.
Results
CD4 CD45ro cell numbers increased after RI without IPC, whereas CD8 cells expressing CD45ro and CD95 increased with IPC. Preconditioned serum in co‐culture attenuated increases in CD4 and decreases in CD8 numbers, a process prevented by inhibition of antigen activation. Following RI, systemic IL‐2 levels were significantly lower after IPC, whereas co‐culture with post‐RI serum increased proinflammatory intracellular cytokine production.
Conclusion
IPC modulated T cell responses in limb RI through reduced activation and proinflammatory cytokine production by CD4 cells, while preventing CD4/CD8 derangement. IPC prevented lymphocyte‐directed immune dysfunction. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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