Monitoring of immune mechanisms of pathogenesis and efficiency of immune therapy in children with various phenotypes of bronchial asthma

Background. Peculiarities of the disease and effectiveness of therapy depend on changes in availability and functions of effector immunocompetent cells and cytokine profile. Purpose. To study the peculiarities of immune pathogenetic mechanisms of virus-induced and allergen-induced bronchial asthma phenotypes in children in order to justify the use of immune therapy and to analyze it’s effectiveness. Materials and methods. We have performed an integrated assessment of immunological parameters in 120 children at the age of 3-11 y.o. with virus-induced and allergen-induced phenotypes of bronchial asthma (BA) and in 30 healthy children. Withdrawal criteria: severe BA, immune therapy during preceding 6 months. We used flow flow cytometer COULTER EPICS XL (Beckman Coulter Inc.) for identification of venous blood cells, CYTOKINE-STIMUL-BEST sets (Vektor-Best JSC, Novosibirsk) for levels of spontaneous and mitogen-induced production of cytokines identification. The immunological effectiveness of treatment was analyzed in the open parallel prospective study using random sampling technique in subgroups on the basis of treatment regimen. Statistical data processing was performed by «Statistica 10» program with critical significance level p<0,05, correlations were analyzed using Spearman rank correlation coefficient, clustering with nonparametric analysis of variance «Kruskal-Wallis ANOVA». Results. Children with various phenotypes of BA demonstrated discrepancies between impairments of availability, proliferation, differentiation and functional activity of immunocompetent cells and cytokine production. The imbalance of cytokine production and impairments of availability and functioning of immunocompetent cells remained unchanged after treatment by inhaled glucocorticoids. When bacterial lysate was added to therapy the normalization of parameters of cellular immune response was observed in patients with virus-induced BA. When glucosaminylmuramyl dipeptide was administered, the recovery of the cells’ capacity for production of spontaneous and mitogen-induced IFN-y was noted in children with allergen-induced phenotype of the disease. Conclusion. Immune pathogenetic mechanisms of virus-induced and allergen-induced BA in children with different immune mechanisms of the disease phenotype justifies individual immunotropic therapy use.

immunopathogenesis, pharmacological control, immune therapy, allergen-induced and virus-induced bronchial asthma, children