Journal Article

Immunomodulatory effects of intraoperative dexmedetomidine on T helper 1, T helper 2, T helper 17 and regulatory T cells cytokine levels and their balance: a prospective, randomised, double-blind, dose-response clinical study

Baek, Soojin, Lee, Jaemin, Lee, Jae-Myeong, Yoo, Subin, Choi, Won-Kyu, Han, Hyo-Jo

2018

Overview

Background The ratio of T helper 1 (Th1) to T helper 2 (Th2) as well as T helper 17 (Th17) to regulatory T cells (Treg) represents the state and direction of immune response. Recent studies demonstrated that dexmedetomidine reduced the secretion of inflammatory cytokines. We performed this study to investigate the effect of different doses of intraoperative dexmedetomidine on the expression of Th1, Th2, T17 and Treg cytokines and their ratios. Methods Seventy-five patients undergoing laparoscopic cholecystectomy were randomly separated into one of three groups: the full dose group ( n  = 25), in which dexmedetomidine was infused with a 1.0 μg/kg loading followed by an infusion of 0.5 μg/kg/min after anaesthetic induction, or the half dose group ( n  = 26), in which the dose was half of that of full dose group, or the saline group ( n  = 24) which was control. T cell cytokines were quantified by sandwich enzyme-linked immunoassay for blood samples taken after anaesthetic induction (T0), at the end of surgery (T1), and 60 min after surgery (T2). IFN-gamma/IL-4 and IL-17/IL-10, which represent the ratio of Th1/Th2 and Th17/Treg cytokines, respectively, were calculated as indices of immune cell levels based upon serum cytokines levels in place of direct measurements. C-reactive protein (CRP) concentrations were measured on the next day following surgery. Results The full dose group was associated with higher ratios of IFN-gamma/IL-4 than those of half dose group and control [10.1 vs. 1.9 at T1 ( P  = 0.041) compared with half dose group, and 10.1 vs. 0.2 at T1 ( P  = 0.031), 7.4 vs. 0.1 at T2 ( P  = 0.025) compared with control]. IL-17/IL-10 ratios were higher in the full dose group than those in control [4.2 vs. 0.6 at T1 ( P  = 0.013), 3.0 vs. 0.3 at T2 ( P  = 0.011)]. The CRP levels were lower in the dexmedetomidine-treated groups in a dose-dependent manner. Conclusions Dexmedetomidine exhibits immunomodulatory effects, shifting the Th1/Th2 and T17/Treg cytokine balance toward Th1 and T17, respectively, in a dose-dependent pattern in patients with surgical and anaesthetic stress. Trial registration Clinical Research Information Service, Republic of Korea (CRIS); KCT0000503 ; Registration date: Aug 13, 2012.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Anesthesia / Anesthesiology / C-reactive protein / Cholecystectomy / Cholecystectomy - trends / Clinical trials / Critical Care Medicine / Cytokines / Cytokines - blood / Cytokines - immunology / Dexmedetomidine / Dexmedetomidine - administration & dosage / Dose-Response Relationship, Drug / Double-Blind Method / Double-blind studies / Emergency Medicine / Female / Gallbladder diseases / General pharmacology and pharmacokinetics / Helper cells / Humans / Hypnotics and Sedatives - administration & dosage / Immunologic Factors - administration & dosage / Immunomodulation / Immunomodulators / Immunoregulation / Inflammation / Information services / Intensive / Interferon / Interleukin 10 / Interleukin 17 / Interleukin 4 / Internal Medicine / Intraoperative Care - methods / Kinases / Laparoscopy / Lymphocytes / Lymphocytes T / Male / Medicine / Medicine & Public Health / Middle Aged / Postpositivism / Prospective Studies / Proteins / Ratios / Registration / Research Article / Surgery / T cell / T-Lymphocytes, Regulatory - drug effects / T-Lymphocytes, Regulatory - immunology / T-Lymphocytes, Regulatory - metabolism / T17/Treg balance / Th1 Cells - drug effects / Th1 Cells - immunology / Th1 Cells - metabolism / Th1/Th2 balance / Th17 Cells - drug effects / Th17 Cells - immunology / Th17 Cells - metabolism / Th2 Cells - drug effects / Th2 Cells - immunology / Th2 Cells - metabolism