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Eugen Faist, MD; Angelika Mewes, MD; Theodor Strasser, MD; Alfred Walz, MD; Sefik Alkan, MD; Christopher Baker, MD; Wolfgang Ertel, MD; George Heberer, MD

Arch Surg. 1988;123(3):287-292.

Abstract
• The macrophage exerts its stimulatory and regulatory functions within the specific immune response via the interleukin 1 (IL-1) and prostaglandin E₂ (PGE₂), respectively. In a screening study of macrophage-related variables following injury, a total of 58 patients (mean age, 32 years; mean Injury Severity Score, 38), macrophagic phenotyping with the monoclonal antibody Leu M3 and serial measuring of the antagonistic monokines IL-1 and PGE₂ and of the macrophage-activating lymphokine interferon gamma were carried out on posttrauma days 0,1,3,5,7,10,14, and 21. The posttraumatic course was characterized by significant monocytosis, showing a peak value of 32% of Leu M3—positive cells compared with 15% of these cells in normal control subjects. During the posttrauma course, the macrophagic PGE₂ output was significantly elevated up to eightfold on days 5 and 7 compared with that of control subjects (0.441 ±0.14 ng/mL vs 0.052 ± 0.01 ng/mL). Conversely, macrophagic IL-1 synthesis was significantly suppressed until day 10. Levels of interferon gamma were suppressed to a significant degree during the two-day observation period, with a trend to slow recovery at the end of week 3. These data suggest that a negative regulatory macrophagic function may be the event initiating posttraumatic immunosuppression. To restore impaired macrophagic T-helper cell interaction, cyclo-oxygenase inhibition and substitution of interferon gamma may be useful to potentiate facilitatory macrophagic function and to block inhibitory macrophagic activity.

(Arch Surg 1988;123:287-292)

Author Affiliations
From the Departments of Surgery (Drs Faist, Mewes, Ertel, and Heberer) and Medicine (Dr Strasser), Klinikum Grosshadern, Ludwig-Maximilians University, Munich; Theodor Kocher Institute, University of Bern, Bern, Switzerland (Dr Walz); Department of Immunology, Ciba-Geigy Ltd Research Center, Basel, Switzerland (Dr Alkan); and Department of Surgery, Yale University School of Medicine, New Haven, Conn (Dr Baker).

Footnotes
Accepted for publication Dec 1, 1987.

Read before the Seventh Annual Meeting of the Surgical Infection Society, Philadelphia, May 11, 1987.

Reprint requests to Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Marchianimstrasse 15, 8 Munich 70, West Germany (Dr Faist).

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