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Cellular immunophenotype of major spine surgery in adults

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Abstract

Purpose

ASD reconstructions are a major, sterile traumatic insult, likely causing perturbations to the immune systems. The immune response to surgery is associated with outcomes. The purpose of this study was to examine for a detectable immune signature associated with ASD surgery.

Methods

Consecutive patients undergoing ASD surgery were approached and enrolled. Peripheral blood was drawn before incision, 4 h after, and 24 h after incision. Blood was stabilized and comprehensive flow cytometric immunophenotyping performed. Leukocyte population frequency, absolute number and activation marker expression were defined. Immunologic features were defined and analyzed by hierarchical clustering and principal component analysis (PCA). Changes over time were evaluated by repeated measures ANOVA (RMANOVA) and were corrected for a 1% false discovery rate. Post hoc testing was by Dunn’s test. p values of <  = 0.05 were considered significant.

Results

Thirteen patients were enrolled; 11(85%) F, 65.4 years (± 7.5), surgical duration 418 ± 83 min, EBL 1928 ± 1253 mL. Hierarchical clustering and PCA found consistent time from incision-dependent changes. HLA-DR and activating co-stimulatory molecule CD86 were depressed at 4 h and furthermore at 24 h on monocyte surfaces. CD4 + HLA-DR + T cells, but not CD8 +, increased over time with increased expression of PD-1 at 4 and 24 h.

Conclusions

Despite surgery and patient heterogeneity, we identified an immune signature associated with the sterile trauma of ASD surgery. Circulating leukocyte populations change in composition and signaling protein expression after incision and persisting to 24 h after incision, suggesting an immunocompromised state. Further work may determine relationships between this state and poor outcomes after surgery.

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Funding

This study was supported by a Grant from the Scoliosis Research Society.

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Isaiah R. Turnbull, Annie Hess, Anja Fuchs, Sarbani Ghosh & Shin-Wen Hughes

  2. Department of Orthopedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Elfaridah P. Frazier & Michael P. Kelly

  3. Rady Children’s Hospital, University of California, San Diego, San Diego, CA, USA

    Michael P. Kelly

Authors
  1. Isaiah R. Turnbull
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  2. Annie Hess
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  3. Anja Fuchs
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  4. Elfaridah P. Frazier
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  5. Sarbani Ghosh
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  6. Shin-Wen Hughes
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  7. Michael P. Kelly
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Contributions

Conception/design: IRT, AF, EPF, MPK. Acquisition of data: IRP, AH, AF, EPF, SG, S-WH, MPK. Analysis: IRT, AH, AF. Interpretation: IRT, AH, AF, MPK. Drafting/revising: IRT, AH, AF, EPF, MPK. Final approval: IRP, AH, AF, EPF, SG, S-WH, MPK. Agree to accountability: IRP, AH, AF, EPF, SG, S-WH, MPK.

Corresponding author

Correspondence to Michael P. Kelly.

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Conflict of interest

Dr. Kelly reports institutional support from the Setting Scoliosis Straight Foundation. Drs. Turnbull, Hess, Fuchs, Frazier, Ghosh, and Hughes report no conflicts of interest.

Ethical standards

This project was approached by the local Institutional Review Board (IRB#201811009).

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Turnbull, I.R., Hess, A., Fuchs, A. et al. Cellular immunophenotype of major spine surgery in adults. Spine Deform 10, 1375–1384 (2022). https://doi.org/10.1007/s43390-022-00524-6

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  • DOI: https://doi.org/10.1007/s43390-022-00524-6

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