Th1 cells probably exert a tumor suppressive effect in bladder cancer [13]. In fact, in bladder

tumor patients, a marked polarization exists towards the expression of Th2-type cytokines, whereas Th1 remains suppressed. Th1 cytokines play an important role in bacillus Calmette-Guérin (BCG)-induced macrophage cytotoxicity, and the combination of BCG with select Th1-stimulating cytokines may enhance the effect of BCG in the treatment of bladder cancer patients [41]. In patients undergoing BAL anesthesia, a significant APO866 purchase reduction in Treg levels of 30% was observed in the early peri-operative period (T1) (p = 0.03; Table 3) and remained constant up to T2, showing values similar to those measured in healthy controls. This is the first study to evaluate the effect on circulating levels of Tregs due to various types of anesthesia. Earlier evidence suggested that Tregs accumulate in tumors and in the peripheral blood of patients with cancer and through suppression of the anti-tumor immune response these cells DAPT promote tumor growth and disease progression in a variety of human malignancies, including

bladder cancer [18, 19, 42]. The role of Tregs in metastasis is just beginning to emerge, and circulating Tregs are buy PRIMA-1MET associated with poor prognosis in some human cancers [43]. In vivo expansion of Tregs is mediated by glucocorticoid-induced tumor necrosis factor receptor family-related (GITR) proteins [44]. Interestingly, Tregs detected in tumor tissues express high levels of GITR molecules. Depletion of Tregs by anti-GITR mAb represents a novel mechanism for cancer immunotherapy [45]. Therefore, the reduction in Tregs we observed in the BAL group appears particularly remarkable in patients with bladder cancer, a type of neoplasm that is responsive to immunotherapy. Conclusions The increase in the Th1 response observed in the TIVA-TCI group and the reduction in Tregs observed in BAL patients seem to balance

the putative immunosuppressive effect induced by IL-6 and supports the hypothesis that TIVA-TCI and BAL techniques can be both used during major surgery in patients with bladder cancer without worsening the outcome. Funding This work Thalidomide was supported by a grant from “Istituto Nazionale Tumori Regina Elena” and “Ministero della Salute” for the Research project “Anesthesia and Immunity.” References 1. Grivennikov SI, Greten FR, Karin M: Immunity, inflammation, and cancer. Cell 2010, 140:883–899.PubMedCrossRef 2. Rakoff-Nahoum S, Medzhitov R: Toll-like receptors and cancer. Nat Rev Cancer 2009, 9:57–63.PubMedCrossRef 3. Margel D, Pevsner-Fischer M, Baniel J, Yossepowitch O, Cohen IR: Stress proteins and cytokines are urinary biomarkers for diagnosis and staging of bladder cancer. Eur Urol 2011, 59:113–119.PubMedCrossRef 4. Kurosawa S, Kato M: Anesthetics, immune cells, and immune responses. J Anesth 2008, 22:263–277.PubMedCrossRef 5. Homburger JA, Meiler SE: Anesthesia drugs, immunity, and long-term outcome.