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Vivian E. Mack; Martin D. McCarter, MD; Hassan A. Naama, MD; Steve E. Calvano, PhD; John M. Daly, MD

Arch Surg. 1996;131(12):1303-1309.

Abstract
Objective
To determine whether severe injury leads to a dominance of splenocyte-produced T-helper (Th) 2–type cytokines, partly explaining the observed defects in cellular immune responses in the posttraumatic state.

Design
Female BALB/c mice (n=6 per group) were randomized to receive anesthesia alone (control) or a combined femur fracture and a hemorrhage of 40% of total blood volume (trauma). On days 1 and 7 after injury, mice were killed and spleens were harvested. Splenocytes were stimulated in vitro with 2.5 µg of concanavalin A per milliliter. After 72 hours of incubation, splenocyte proliferation was determined by means of tritiated thymidine uptake. Production of interferon- and interleukins (IL) -2, -4, -5, -6, and -10 from supernatants harvested after 24 or 72 hours of incubation was quantified by enzyme-linked immunosorbent assay.

Setting
Surgical immunology research laboratory of a medical college.

Main Outcome Measures
Mouse spleen weight, splenocyte number, and proliferation in addition to cytokine production (interferon-, IL-2, IL-4, IL-5, IL-6, and IL-10).

Results
Splenocyte proliferative capacity was unaffected at day 1 after injury but was significantly suppressed (P<.05) by day 7 after injury. Similarly, there were no changes in splenocyte cytokine production in a comparison of control and injured mice at day 1. At day 7, however, there was nearly a 90% decrease in the Th₁-type cytokines (interferon- and IL-2; P.002) and at least a 30% increase in the Th2-type cytokines IL-4, IL-5, IL-6, and IL-10 (P=.06 for IL-6 and P.03 for IL-4, IL-5, and IL-10).

Conclusions
These data indicate that a shift to a Th₂-type splenocyte cytokine response occurs late, at 7 days after injury. Modulation of Th cell cytokine responses may partially explain defects observed in cellular immune responses in postinjury states. Therapies that augment Th₁-type cytokine production and/or neutralize Th₂-type cytokines may prove beneficial.

Arch Surg. 1996;131:1303-1309

Author Affiliations
From the Department of Surgery, The New York Hospital—Cornell University Medical Center, New York, NY.

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