Is There Immune

Suppression in the
Critically Ill Patient
- Con?
Tanaphon Kusonthomarat, 600710062
6th year medical student, CMU

1
SIRS - CARS (Compensatory anti-inflammatory response syndrome)

CARS - immunodepression ?

- Immune cells are rarely hypoactive

- Reprogramming of blood leukocytes

- Nature of the agonists used to activate the immune cells

influences observation
 Reprogramming of circulation blood leukocytes

- CARS occurred almost concomitant with SIRS

- Immune alteration : major lymphopenia - significant apoptosis of

lymphocytes and dendritic cells, apoptosis of neutrophils reduced

- Reduced delayed type hypersensitivity

 Nature of activating signal

- Nature of activator used to stimulate the cells influences the results.

Increase proinflammatory cytokines

Endotoxin
Decrease anti-inflammatory cytokines

Normal production of inflammatory

Whole heat-killed bacteria
cytokines
- In sepsis patient, alteration of expression of inflammatory cytokines
was observed when stimulated with LPS. However, heat-killed
bacteria responses was unchanged.
- Monocytes from SIRS and sepsis display altered function to
produce inflammatory cytokines but not phagocytosis.

- Tissues are major source of inflammatory cytokines.

- Each organ has its own specific cytokine production as

reflection of its local environment.

- Enhanced antimicrobial activity, MMP-9/19, VEGF-alpha, in

patient with sepsis.
- However, Immune cells in organs did not have altered immune
function when compared to peripheral immune cells.

- Immune cells in different organs have different responses when

stimulated with activator.

- In alveolar, liver, peritoneal cells increase amount of cytokines

production was noted as compared to peripheral and spleen immune
cells.

- In bone marrow, hemophagocytosis was observed in sepsis patient.

Ferritin was used as marker of poor outcomes.