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. 1978 Aug;188(2):142–152. doi: 10.1097/00000658-197808000-00003

Prevention of Liver Reticuloendothelial Systemic Host Defense Failure after Surgery by Intravenous Opsonic Glycoprotein Therapy

Thomas M Saba
PMCID: PMC1396734  PMID: 686878

Abstract

Depression of the reticuloendothelial system (RES) was observed in rats following operative trauma consisting of laparotomy and jejunal enterotomy. This RES depression was manifested as a significant impairment in the phagocytic clearance of intravenously injected blood-borne test colloid mediated by a decline in hepatic Kupffer cell phagocytosis. Reticuloendothelial systemic host defense depression was correlated with a significant decline in bioassayable and immunoreactive opsonic α2SB glycoprotein concentration over a 1-3 hr postoperative period with rebound elevation in opsonic activity by 24 hr postsurgery. Intravenous administration of purified opsonic α2SB glycoprotein at the end of the operation prevented postoperative opsonic deficiency and restored normal hepatic RES phagocytic function. These studies coupled with previous observations in patients following surgery or after severe multiple trauma suggest that reticuloendothelial depression during and after operation mediated by opsonic deficiency may lead to a precarious imbalance between systemic host defense and the dissemination of blood-borne foreign and effete particulate matter such as injured platelets, fibrin microaggregates and immune complexes. Immunoreactive serum opsonic α2SB glycoprotein determinations may serve as a valuable index of hepatic RE clearance capacity and opsonin therapy may potentially be a selective means to augment systemic host defense.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. W., Korelitz J., Alexander N. S. Prevention of wound infections. A case for closed suction drainage to remove wound fluids deficient in opsonic proteins. Am J Surg. 1976 Jul;132(1):59–63. doi: 10.1016/0002-9610(76)90291-9. [DOI] [PubMed] [Google Scholar]
  2. Alexander J. W., McClellan M. A., Ogle C. K., Ogle J. D. Consumptive opsoninopathy: possible pathogenesis in lethal and opportunistic infections. Ann Surg. 1976 Dec;184(6):672–678. doi: 10.1097/00000658-197612000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Allen C., Saba T. M., Molnar J. Isolation, purification and characterization of opsonic protein. J Reticuloendothel Soc. 1973 May;13(5):410–423. [PubMed] [Google Scholar]
  4. Altura B. M., Hershey S. G. Reticuloendothelial function in experimental injury and tolerance to shock. Adv Exp Med Biol. 1972;33(0):545–569. doi: 10.1007/978-1-4684-3228-2_57. [DOI] [PubMed] [Google Scholar]
  5. BUINAUSKAS P., McDONALD G. O., COLE W. H. Role of operative stress on the resistance of the experimental animal to inoculated cancer cells. Ann Surg. 1958 Oct;148(4):642–648. doi: 10.1097/00000658-195810000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Blumenstock F., Saba T. M., Weber P., Cho E. Purification and biochemical characterization of a macrophage stimulating alpha-2-globulin opsonic protein. J Reticuloendothel Soc. 1976 Mar;19(3):157–172. [PubMed] [Google Scholar]
  7. Blumenstock F., Weber P., Saba T. M. Isolation and biochemical characterization of alpha-2-opsonic glycoprotein from rat serum. J Biol Chem. 1977 Oct 25;252(20):7156–7162. [PubMed] [Google Scholar]
  8. Di Luzio N. R., Lindsey E. S. Surgery-induced alterations in plasma recognition factor activity in normal renal donors and renal recipients. Proc Soc Exp Biol Med. 1973 Jul;143(3):715–718. doi: 10.3181/00379727-143-37398. [DOI] [PubMed] [Google Scholar]
  9. Donovan A. J. The effect of surgery on reticuloendothelial function. Arch Surg. 1967 Feb;94(2):247–250. doi: 10.1001/archsurg.1967.01330080085022. [DOI] [PubMed] [Google Scholar]
  10. FISHER B., FISHER E. R. Host factors influencing the development of metastases. Surg Clin North Am. 1962 Apr;42:335–351. [PubMed] [Google Scholar]
  11. Fulton R. L., Jones C. E., Jr The etiology of post-traumatic pulmonary insufficiency in man. Rev Surg. 1975 Mar-Apr;32(2):84–85. [PubMed] [Google Scholar]
  12. Gans H., Lowman J. T. The uptake of fibrin and fibrin-degradation products by the isolated perfused rat liver. Blood. 1967 Apr;29(4):526–539. [PubMed] [Google Scholar]
  13. Gans H. Preservation of vascular patency as a function of reticuloendothelial clearance. Surgery. 1966 Dec;60(6):1216–1223. [PubMed] [Google Scholar]
  14. Goldman A. S., Rudloff H. B., McNamee R., Loose L. D., DiLuzio N. R. Deficiency of plasma humoral recognition factor activity following burn injury. J Reticuloendothel Soc. 1974 Mar;15(3):193–198. [PubMed] [Google Scholar]
  15. Kaplan J. E., Molnar J., Saba T. M., Allen C. Comparative disappearance and localization of isotopically labeled opsonic protein and soluble albumin following surgical trauma. J Reticuloendothel Soc. 1976 Nov;20(5):375–384. [PubMed] [Google Scholar]
  16. Kaplan J. E., Saba T. M. Humoral deficiency and reticuloendothelial depression after traumatic shock. Am J Physiol. 1976 Jan;230(1):7–14. doi: 10.1152/ajplegacy.1976.230.1.7. [DOI] [PubMed] [Google Scholar]
  17. Kaplan J. E., Scovill W. A., Bernard H., Saba T. M., Gray V. Reticuloendothelial phagocytic response to bacterial challenge after traumatic shock. Circ Shock. 1977;4(1):1–12. [PubMed] [Google Scholar]
  18. LEE L., McCLUSKEY R. T. Immunohistochemical demonstration of the reticuloendothelial clearance of circulating fibrin aggregates. J Exp Med. 1962 Nov 1;116:611–618. doi: 10.1084/jem.116.5.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. LEWIS M. R., COLE W. H. Experimental increase of lung metastases after operative trauma (amputation of limb with tumor). AMA Arch Surg. 1958 Oct;77(4):621–626. doi: 10.1001/archsurg.1958.04370010153015. [DOI] [PubMed] [Google Scholar]
  20. Olcay I., Holper K., Kitahama A., Miller R. H., Drapanas T., Trejo R. A., Di Luzio N. R. Reticuloendothelial function: determinant for survival following hepatic ischemia in the baboon. Surgery. 1974 Oct;76(4):643–653. [PubMed] [Google Scholar]
  21. PROSE P. H., LEE L., BALK S. D. ELECTRON MICROSCOPIC STUDY OF THE PHAGOCYTIC FIBRIN-CLEARING MECHANISM. Am J Pathol. 1965 Sep;47:403–417. [PMC free article] [PubMed] [Google Scholar]
  22. Pardy B. J., Dudley H. A. Post-traumatic pulmonary insufficiency. Surg Gynecol Obstet. 1977 Feb;144(2):259–269. [PubMed] [Google Scholar]
  23. Rapaport F. T., Bachvaroff R., Nemirovsky M., Ball S. K. Pulmonary microembolization in severe thermal injury. Proc Soc Exp Biol Med. 1972 Mar;139(3):1013–1016. doi: 10.3181/00379727-139-36287. [DOI] [PubMed] [Google Scholar]
  24. Saba T. M., Antikatzides T. G. Decreased resistance to intravenous tumour-cell challenge during reticuloendothelial depression following surgery. Br J Cancer. 1976 Oct;34(4):381–389. doi: 10.1038/bjc.1976.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Saba T. M., Di Luzio N. R. Reticuloendothelial blockade and recovery as a function of opsonic activity. Am J Physiol. 1969 Jan;216(1):197–205. doi: 10.1152/ajplegacy.1969.216.1.197. [DOI] [PubMed] [Google Scholar]
  26. Saba T. M. Effect of surgical trauma on the clearance and localization of blood-borne particulate matter. Surgery. 1972 May;71(5):675–685. [PubMed] [Google Scholar]
  27. Saba T. M. Physiology and physiopathology of the reticuloendothelial system. Arch Intern Med. 1970 Dec;126(6):1031–1052. [PubMed] [Google Scholar]
  28. Saba T. M., Scovill W. A. Effect of surgical trauma on host defense. Surg Annu. 1975;7:71–102. [PubMed] [Google Scholar]
  29. Schildt B. E., Bouveng R. Effect of burning on hepatic phagocytosis as studied in vitro. Life Sci I. 1971 Apr 1;10(7):397–404. doi: 10.1016/0024-3205(71)90145-7. [DOI] [PubMed] [Google Scholar]
  30. Schildt B., Gertz I., Wide L. Differentiated reticuloendothelial system (res) function in some critical surgical conditions. Acta Chir Scand. 1974;140(8):611–617. [PubMed] [Google Scholar]
  31. Scovill W. A., Saba T. M., Kaplan J. E., Bernard H. R., Powers S. R., Jr Disturbances in circulating opsonic activity in man after operative and blunt trauma. J Surg Res. 1977 Jun;22(6):709–716. doi: 10.1016/0022-4804(77)90113-5. [DOI] [PubMed] [Google Scholar]
  32. Scovill W. A., Saba T. M., Kaplan J. E., Bernard H., Powers S., Jr Deficits in reticuloendothelial humoral control mechanisms in patients after trauma. J Trauma. 1976 Nov;16(11):898–904. doi: 10.1097/00005373-197611000-00008. [DOI] [PubMed] [Google Scholar]
  33. Sherman L. A., Harwig S., Lee J. In vitro formation and i vivo clearance of fibrinogen: fibrin complexes. J Lab Clin Med. 1975 Jul;86(1):100–111. [PubMed] [Google Scholar]
  34. Tonaki H., Saba T. M., Mayron L. W., Kaplan E. Phagocytosis of gelatinized "R. E. test lipid emulsion" by Kupffer cells: electronmicroscopic observations. Exp Mol Pathol. 1976 Oct;25(2):189–201. doi: 10.1016/0014-4800(76)90029-0. [DOI] [PubMed] [Google Scholar]
  35. ZWEIFACH B. W., BENACERRAF B. Effect of hemorrhagic shock on the phagocytic function of Kupffer cells. Circ Res. 1958 Jan;6(1):83–87. doi: 10.1161/01.res.6.1.83. [DOI] [PubMed] [Google Scholar]
  36. ZWEIFACH B. W., BENACERRAF B., THOMAS L. The relationship between the vascular manifestations of shock produced by endotoxin, trauma, and hemorrhage. II. The possible role of the reticulo-endothelial system in resistance to each type of shock. J Exp Med. 1957 Sep 1;106(3):403–414. doi: 10.1084/jem.106.3.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. el Rifi K., Bacon B., Mehigan J., Hoppe E., Cole W. H. Increased incidence of pulmonary metastases after celiotomy: counteraction by heparin. Arch Surg. 1965 Oct;91(4):625–629. doi: 10.1001/archsurg.1965.01320160079018. [DOI] [PubMed] [Google Scholar]
  38. van Oss C. J., Bronson P. M., Border J. R. Changes in the serum alpha glycoprotein distribution in trauma patients. J Trauma. 1975 May;15(5):451–455. doi: 10.1097/00005373-197505000-00013. [DOI] [PubMed] [Google Scholar]

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