Antimicrobial peptides are highly abundant and active in postoperative pleural drainage fluids

Konrad Hoetzenecker, Moritz Hochdaninger, Denise Traxler, Maria Gschwandtner, Mohammad Mahdi Kasiri, Andreas Mitterbauer, Thomas Schweiger, Balazs Hegedus, Walter Klepetko, Erwin Tschachler, Hendrik J. Ankersmit, Michael Mildner

Research output: Contribution to journalArticle


Background. The human lung is considered a nonsterile organ, and surgical interventions therefore take place in a more or less contaminated operating field. Nevertheless, infectious complications of the pleural cavity are low after major lung resections. Antimicrobial peptides (AMPs) are part of the innate immunity and display a broad capacity to kill pathogens. We hypothesized that the pleural space must have a high natural antimicrobial barrier and that AMPs might effectively protect the pleural cavity. Methods. Pleural effusions were collected after lung operations. Antimicrobial activity of the fluids against gram-positive and gram-negative pathogens was analyzed by microdilution assays. AMPs were determined by enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and immunohistochemical analysis. The impact of proinflammatory triggers on AMP release from pleural mesothelial cells was evaluated. Results. Antimicrobial activity assays revealed high bactericidal properties of postoperative pleural drainage fluids. They effectively killed gram-negative pathogens (Escherichia coli, Pseudomonas aeruginosa) as well as gram-positive pathogens (Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes). A variety of AMPs was detected at constantly high concentrations in the pleural fluids. They mainly derived from leukocytes and pleural epithelium. Although proinflammatory cytokine levels were elevated in the postoperative pleural fluids, AMP expression could not be augmented by Toll-like receptor (TLR) triggering or by the proinflammatory cytokines interleukin (IL)-1β and tumor necrosis factor (TNF)α. Conclusions. We provide the first evidence of a high abundance of AMPs in postoperative pleural fluids. Our findings might explain the broad protection against infectious complications of the pleural space after major lung operations.

Original languageEnglish
Pages (from-to)1042-1050
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number3
Publication statusPublished - Sep 2014

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Hoetzenecker, K., Hochdaninger, M., Traxler, D., Gschwandtner, M., Kasiri, M. M., Mitterbauer, A., Schweiger, T., Hegedus, B., Klepetko, W., Tschachler, E., Ankersmit, H. J., & Mildner, M. (2014). Antimicrobial peptides are highly abundant and active in postoperative pleural drainage fluids. Annals of Thoracic Surgery, 98(3), 1042-1050.