MONOCYTES OVERCOME LYMPHOCYTE DYSFUNCTION IN INJURED ADULTS WITH ELEVATED CANDIDA ANTIGEN TITERS

Objective: Severely injured adults with elevated Candida antigen titer s have increased mortality from sepsis, in part because of known neutr ophil (PMN) dysfunction. Since PMN function is modulated by monocytes and lymphocytes, this study was undertaken to determine the ability of monocytes and lymphocytes isolated from injured adults with elevated Candida antigen titers to activate the anticandidal function of normal PMNs. Methods: Lymphocytes with or without monocytes, isolated from 1 8 injured adults with elevated titers, were cultured in the presence o r absence of heat-killed Candida albicans for 48 hours. Culture supern atants were harvested, diluted 1:40, 1:160, and 1:640, and tested for the ability to stimulate the anticandidal function of normal PMNs usin g an H-3-glucose incorporation assay. Monocytes and lymphocytes isolat ed from nine volunteers were studied for comparison. Results: Supernat ants of lymphocytes from healthy volunteers that were cultured with he at-killed C. albicans significantly augmented normal PMN anticandidal function. Supernatants of lymphocytes from injured adults with elevate d titers that were cultured with heat-killed C. albicans did not signi ficantly augment normal PMN anticandidal function. Supernatants of mon ocytes or lymphocytes from both groups of patients were able to upregu late PMN anticandidal function. Conclusions: Lymphocytes from injured adults with elevated Candida antigen titers are defective in their abi lity to stimulate PMN anticandidal function. Monocytes from these pati ents can respond to Candida exposure and overcome the lymphocyte funct ional defect seen in injured patients with elevated titers.