Understanding Brain Injury-Induced Immunosuppression and the Relationship to the Development of Infection
Date
2018-06-05
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Abstract
Infection is a leading cause of morbidity and mortality among hospitalized patients. It has become increasingly apparent that patients with neurological injury have an increased risk for infection due to secondary immunodeficiency. Previous work from our research group found a novel role for invariant natural killer (iNKT) cells in stroke-induced immune suppression, characterized by a shift from a Th1- to Th2-dominant systemic cytokine profile and an increased risk for infection. This work better defined the crosstalk that occurs between the brain and systemic immune system after ischemic stroke, however, many questions remained and whether similar mechanisms were involved in other types of brain injury was unclear. Thus, we evaluated the relationship between iNKT cells, Th1 and Th2 systemic cytokine profiles, and the development of infection among critically ill patients with traumatic brain injury and haemorrhagic stroke. We found that these patients had significantly subnormal levels of many immune mediators, including IFN-γ and TNF-α, indicative of systemic immune suppression. Moreover, iNKT cells were activated among these patients and positively associated with plasma Th2/Th1 cytokine ratios. Infection was common and occurred among forty-six percent of the patients. Additionally, we used animal models to investigate traumatic brain injury-induced immune modulation and its relationship to infection. We observed rapid activation of iNKT cells in the circulation and a >2-fold increase in plasma Th2/Th1 cytokine ratios, which peaked at 8 hours after injury. Remarkably, we also observed rapid changes in the lung microenvironment induced by traumatic brain injury, which influenced the outcome after infection. Moreover, in an attempt to better understand the epidemiology of infection among patients with traumatic brain injury, we conducted a systematic review of the world’s literature on this topic. We summarize and discuss the reported occurrence rates of infection, and the microbiology and risk factors associated with different types of infection, among patients hospitalized after traumatic brain injury. This thesis provides new insights into the relationship between brain injury and the development of infection. Understanding the unique risk for infection after acute brain injury will ultimately translate to better prevention and treatment regimens for these patients.
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Traumatic brain injury, Infection, Immunosuppression, Invariant Natural Killer T cells, Cytokines
Citation
Scott, B. N. V. (2018). Understanding Brain Injury-Induced Immunosuppression and the Relationship to the Development of Infection (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/31974