Anaesthetic impairment of immune function is mediated via GABA(A) receptors.

BACKGROUND: GABA(A) receptors are members of the Cys-loop family of neurotransmitter receptors, proteins which are responsible for fast synaptic transmission, and are the site of action of wide range of drugs. Recent work has shown that Cys-loop receptors are present on immune cells, but their physiological roles and the effects of drugs that modify their function in the innate immune system are currently unclear. We are interested in how and why anaesthetics increase infections in intensive care patients; a serious problem as more than 50% of patients with severe sepsis will die. As many anaesthetics act via GABA(A) receptors, the aim of this study was to determine if these receptors are present on immune cells, and could play a role in immunocompromising patients. PRINCIPAL FINDINGS: We demonstrate, using RT-PCR, that monocytes express GABA(A) receptors constructed of α1, α4, β2, γ1 and/or δ subunits. Whole cell patch clamp electrophysiological studies show that GABA can activate these receptors, resulting in the opening of a chloride-selective channel; activation is inhibited by the GABA(A) receptor antagonists bicuculline and picrotoxin, but not enhanced by the positive modulator diazepam. The anaesthetic drugs propofol and thiopental, which can act via GABA(A) receptors, impaired monocyte function in classic immunological chemotaxis and phagocytosis assays, an effect reversed by bicuculline and picrotoxin. SIGNIFICANCE: Our results show that functional GABA(A) receptors are present on monocytes with properties similar to CNS GABA(A) receptors. The functional data provide a possible explanation as to why chronic propofol and thiopental administration can increase the risk of infection in critically ill patients: their action on GABA(A) receptors inhibits normal monocyte behaviour. The data also suggest a potential solution: monocyte GABA(A) receptors are insensitive to diazepam, thus the use of benzodiazepines as an alternative anesthetising agent may be advantageous where infection is a life threatening problem.

Retinal adaptation of visual processing time delays.

A significant proportion of the processing delays within the visual system are luminance dependent. Thus placing an attenuating filter over one eye causes a temporal delay between the eyes and thus an illusion of motion in depth for objects moving in the fronto-parallel plane, known as the Pulfrich effect. We have used this effect to study adaptation to such an interocular delay in two normal subjects wearing 75% attenuating neutral density filters over one eye. In two separate experimental periods both subjects showed about 60% adaptation over 9 days. Reciprocal effects were seen on removal of the filters. To isolate the site of adaptation we also measured the subjects' flicker fusion frequencies (FFFs) and contrast sensitivity functions (CSFs). Both subjects showed significant adaptation in their FFFs. An attempt to model the Pulfrich and FFF adaptation curves with a change in a single parameter in Kelly's [(1971) Journal of the Optical Society of America, 71, 537-546] retinal model was only partially successful. Although we have demonstrated adaptation in normal subjects to induced time delays in the visual system we postulate that this may at least partly represent retinal adaptation to the change in mean luminance.