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Th1-like and Th2-like cytokines in patients undergoing open versus laparascopic cholecystectomy
Insights
Laparoscopic cholecystectomy (LC) maintains a balanced immune response with moderate inflammation, unlike open cholecystectomy (OC). LC preserves immunocompetence and promotes Th1-like cytokine production, indicating better anti-microbial activity.
Area of Science:
- Immunology
- Surgical Oncology
Background:
- Laparoscopic cholecystectomy (LC) offers advantages over open cholecystectomy (OC) due to its minimally invasive nature and potentially reduced inflammatory response.
- Understanding the impact of these surgical approaches on immune function, specifically T-helper cell (Th1/Th2) cytokine profiles, is crucial for patient outcomes.
Purpose of the Study:
- To investigate the in vivo and in vitro production of Th1 (IFN-gamma) and Th2 (IL-4, IL-6, IL-10, IL-13) cytokines in patients undergoing OC versus LC.
- To compare the inflammatory response and immunocompetence following both surgical procedures.
Main Methods:
- Evaluated Th1/Th2 cytokine profiles (IL-4, IL-6, IL-10, IL-13, IFN-gamma, TNF-alpha) in sera and stimulated mononuclear cells from 42 patients (22 LC, 20 OC) pre- and post-operatively.
- Assessed white blood cell counts and in vitro cellular responses to mitogens (phytohemagglutinin, lipopolysaccharide).
Main Results:
- Open cholecystectomy (OC) led to a significantly higher increase in the acute phase cytokine IL-6 compared to laparoscopic cholecystectomy (LC).
- In vitro, OC patients showed reduced IFN-gamma and increased Th2 cytokines, while LC patients exhibited higher IFN-gamma and increased Th2 cytokines (IL-10, IL-13), maintaining a balanced Th1/Th2 response.
- LC did not significantly impair immunocompetence, showing a moderate inflammatory response and robust Th1-like cytokine production indicative of anti-microbial activity, unlike OC.
Conclusions:
- Laparoscopic cholecystectomy (LC) results in a more favorable immune response compared to open cholecystectomy (OC).
- LC preserves immunocompetence and promotes a balanced Th1/Th2 cytokine profile, suggesting enhanced anti-microbial defense and a moderate inflammatory response.
- The findings support LC as a surgical approach that better maintains immune homeostasis post-cholecystectomy.
Abstract:
The advantages of laparoscopic (LC versus, open cholecystectomy (OC) seems to be related to minimal invasive procedure and to the moderate inflammatory response. The aim of this study is to define the involvement of Th1 (IFN-gamma) and Th2 (IL-4, IL-6, IL-10, IL-13) cytokines production in vivo and in vitro in patients undergoing OC or LC. In 42 patients undergoing LC (n = 22) and OC (n = 20) Th1-like and Th2-like was evaluated before operation and at 6, 24 and 48 hours after operation for white blood cell counting and cytokines (IL-4, IL-6, IL-10, IL-13, IFN-gamma, TNF-alpha) in the sera and in the supernatants from circulating mononuclear cells stimulated with phytohemagglutinin or lipopolysaccharide. The acute phase response cytokine, IL-6, appeared significantly increased following OC than after LC. All other cytokines did not very significantly. In vitro data shows a reduction of IFN-gamma and increase in Th2-like cytokines in OC patients compared with the basal value. In LC subjects we observed an high production of IFN-gamma associated to an increase of Th2-like cytokines, like IL-10 and IL-13, even though IL-4 and IL-6 were unmodified. In contrast to OC, LC did not significantly affect immunocompetence, maintaining a moderate inflammatory response and an adequate balance between Th1 and Th2 cytokine. Furthermore, the strong activation of cells producing Th1-like cytokines in LC patients following mitogen activation indicated a consistent anti-microbial activity, that was not detectable in OC patients, that showed after activation only a Th2 response.