Monocyte human leukocyte antigen-DR transcriptional downregulation by cortisol during septic shock.

Abstract:

:Monocyte deactivation has been identified as a major factor of immunosuppression in sepsis and is associated with a loss of surface human leukocyte antigen-DR (HLA-DR) expression on circulating monocytes. Using flow cytometry, quantitative reverse transcription-polymerase chain reaction, we investigated this phenomenon in septic patients. We confirmed the early loss of monocyte HLA-DR expression in all infected patients and demonstrated that this persistent lowered expression at Day 6 correlated with severity scores, secondary infection, and death. This phenomenon occurred at a transcriptional level via a decrease in the class II transactivator A (CIITA) transcription. Furthermore, these abnormalities correlated with the high cortisol levels observed in sepsis and not with those of other putative factors such as catecholamines or interleukin-10. Finally, in vitro studies evidenced that glucocorticoids decrease HLA-DR expression at a transcriptional level via a decrease in CIITA mRNA levels, mainly by down modulating its isoforms I and III. We conclude that in human sepsis, the loss of HLA-DR expression on circulating monocytes is associated with a poor outcome. We suggest that the high endogenous cortisol level observed in septic shock may be a possible new factor involved in the loss of HLA-DR expression on monocytes via its effect on HLA-DR and CIITA transcription.

authors

Le Tulzo Y,Pangault C,Amiot L,Guilloux V,Tribut O,Arvieux C,Camus C,Fauchet R,Thomas R,Drénou B

doi

10.1164/rccm.200309-1329OC

keywords:

subject

Has Abstract

pub_date

2004-05-15 00:00:00

pages

1144-51

issue

10

eissn

1073-449X

issn

1535-4970

pii

200309-1329OC

journal_volume

169

pub_type

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