Early, complete burn wound excision partially restores cytotoxic T lymphocyte function

Background. Cytotoxic lymphocytes (CTLs) are an important component of immune function, involved in antigen recognition and resistance to viral infection. Burn injury suppresses cell-mediated immunity, induces allograft tolerance, and increases the risk of viral infection, but the mechanisms are not well understood. This study analyzes the effect of burn size and burn wound excision on CTL activity. Methods. Anesthetized CBA mice (n=12) received a 0%, 20%, or 40% body surface area contact burn. Additional mice (n=16) received a 40% burn that was totally, partially, or not excised 72 hours after burn. Excised areas were covered with normal, syngeneic skin. Two weeks later harvested splenocytes were cocultured with allogeneic stimulators. CTL activity was determined by a ⁵¹Cr release assay, in which CTL effectors were tested on allogeneic, radiolabeled targets. Dilution curves of CTL activity were compared by ANOVA. Results. Both 20% and 40% burns significantly inhibited CTL activity (p<0.05). Total but not partial excision of a 40% burn restored CTL activity (p<0.01). Both total and partial wound excision also improved survival (p<0.05). Conclusions. Burn injury inhibits CTL activity in a size-dependent manner, and total wound excision significantly improves both CTL function and survival after injury. This study suggests a mechanism for the immunosuppressive effects of burn injury and provides an immunologic rationale for early, complete burn wound excision.