Geriatric Surgery Produces a Hypoactive Molecular Phenotype in the Monocyte Immune Gene Transcriptome

Author:

Oren Rachel L.1ORCID,Grasfield Rachel H.1,Friese Matthew B.2ORCID,Chibnik Lori B.3,Chi John H.4,Groff Michael W.4,Kang James D.5,Xie Zhongcong6ORCID,Culley Deborah J.7ORCID,Crosby Gregory8

Affiliation:

1. Cognitive Outcomes of Geriatric Surgery Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA

2. Translational Medicine and Clinical Pharmacology, Sanofi, Cambridge, MA 02139, USA

3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA

4. Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA

5. Department of Orthopedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA

6. Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA

7. Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA

8. Cognitive Outcomes of Geriatric Surgery Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA

Abstract

Surgery is a major challenge for the immune system, but little is known about the immune response of geriatric patients to surgery. We therefore investigated the impact of surgery on the molecular signature of circulating CD14+ monocytes, cells implicated in clinical recovery from surgery, in older patients. We enrolled older patients having elective joint replacement (N = 19) or spine (N = 16) surgery and investigated pre- to postoperative expression changes in 784 immune-related genes in monocytes. Joint replacement altered the expression of 489 genes (adjusted p < 0.05), of which 38 had a |logFC| > 1. Spine surgery changed the expression of 209 genes (adjusted p < 0.05), of which 27 had a |logFC| > 1. In both, the majority of genes with a |logFC| > 1 change were downregulated. In the combined group (N = 35), 471 transcripts were differentially expressed (adjusted p < 0.05) after surgery; 29 had a |logFC| > 1 and 72% of these were downregulated. Notably, 21 transcripts were common across procedures. Thus, elective surgery in older patients produces myriad changes in the immune gene transcriptome of monocytes, with many suggesting development of an immunocompromised/hypoactive phenotype. Because monocytes are strongly implicated in the quality of surgical recovery, this signature provides insight into the cellular and molecular mechanisms of the immune response to surgery and warrants further study as a potential biomarker for predicting poor outcomes in older surgical patients.

Funder

National Institutes of Health

Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital

Brigham and Women’s Hospital

Publisher

MDPI AG

Subject

General Medicine

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