Artikel
The influence of body mass index on cd69 expression of cd4+ regulatory t-cells in geriatric patients following femoral fracture
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Autoren
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Pascal Anand
- Experimentelle Unfallchirurgie Klinikum Rechts, Technische Universität München, München, Germany
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Sven Rieder
- Abteilung für experimentelle Unfallchirurgie, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Gregor Römmermann
- Technische Universität München, Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, München, Germany
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Lisa-Sophia Wenner
- Technische Universität München, Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, München, Germany
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Julia Hinterer
- Abteilung für experimentelle Unfallchirurgie, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Sandra Schneider
- Klinik und Poliklinik für Unfallchirugie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Olivia Mair
- Technische Universität München, Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, München, Germany
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Anna Friesen
- Klinikum rechts der Isar, Experimentelle Unfallchirurgie, München, Germany
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Peter Biberthaler
- Klinikum rechts der Isar, Klinik für Unfallchirurgie, München, Germany
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Laura Heimann
- Klinikum rechts der Isar, Experimentelle Unfallchirurgie, München, Germany
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Marc Hanschen
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
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Objectives: In our aging population, femoral fractures are of growing clinical relevance. An immunological imbalance is suspected as the primary cause for complications in the early post-traumatic period. In this context. CD4+ regulatory T cells (CD4+ Tregs) play a mainly counterinflammatory role. CD69 has been reported to be involved in the regulation of inflammation partly through CD4+ Treg activation and differentiation. We aimed to investigate the process of post-traumatic immune disturbance in geriatric patients after femoral fracture and the role of the body mass index (BMI).
Methods: We included 120 patients (55 years or older) with proximal femur fracture requiring surgery. Repeated blood draws were performed over the first seven days following hospitalization to conduct flow cytometry analysis of peripheral CD4+ Tregs. To analyze the impact of BMI, we divided the patients into three cohorts: Underweight (BMI < 18.5 kg/m ² (n= 14)), normal weight (BMI= 18.5 – 24.9 kg/m ² (n= 52)), overweight (BMI > 25 kg/m ² (n= 43)).
Results and conclusion: The CD4+ Treg/CD4+ ratio increased significantly in the normal- and overweight group from admission to the 7th post-op day. In contrast, there was no significant increase in the underweight population. The overall CD4+ cell count increased until the 3rd post-op day and then decreased on the 7th. The CD4+ Tregs count increased continuously within the time period.
CD69 expression on CD4+ Tregs increased constantly in all BMI groups between admission and the 7th post-op day. This increase was statistically significant in all groups. A comparison between the BMI groups regarding CD69 expression on Tregs showed significantly higher values in the overweight compared to the underweight cohort (p=0.0062) on the first post-op day.
As CD4+ Tregs are predominantly prescribed as key player in the compensatory antiinflammatory response syndrome, a lack of increase in the CD4+ Treg/CD4+ ratio underweight patients following trauma could point to immunodeficiency. This in turn could help to explain the generally higher prevalence of complications in underweight geriatric patients following fractures.
The rising CD69 expression levels of CD4+ Tregs in all subgroups suggest a linkage between injury and posttraumatic CD69 upregulation which is in line with previous findings, indicating a modulating effect of CD69 after trauma. The BMI seems to have an influence on the CD69 expression as we observed a significant difference between under-and overweight patients on the first post-op day.
