IMMUNOLOGICAL MARKERS OF UNCONTROLLED ATOPIC BRONCHIAL ASTHMA IN CHILDREN

Bronchial asthma is a prevalent chronic allergic disease of lungs at early ages. A priority  task in allergology  is to search  biological  markers  related  to uncontrolled atopic  bronchial asthma. Cytokines fulfill their distinct function in pathogenesis of atopic  bronchial asthma, participating at the initiation, development and persistence of allergic inflammation in airways, causing different  variations of clinical course of the disease (with  respect  to its acuteness, severity, frequency of exacerbations). The  present  work has studied  indices  of cellular  and  humoral links of immunity, as well as levels of some  pro and  anti-inflammatory cytokines in peripheral blood serum (IL-4, IL-10, IL-2 and TNFα), aiming to determine potential markers of uncontrolled atopic bronchial asthma in children. A group of Caucasian (European) children was involved into the research: Cohort 1, moderate atopic  bronchial asthma with controlled course during the last 3 months (n = 59); Cohort 2, severe/moderate-severe atopic bronchial asthma with uncontrolled course of the disease within last 3 months (n = 51),  Cohort 3 – control, practically healthy  children without signs of atopy  (n = 33). All the  children included in the group with atopic  bronchial asthma underwent regular mono/combined basic therapy  at high/ intermediate therapeutic doses.  We performed a comparative analysis  of cell  population indices  reflecting certain cellular  immunity links,  and  determined significantly  lower  levels of CD3⁺   lymphocytes, as well as decrease in relative  and  absolute  contents of CD4⁺  and  CD8+  cells in the  cohort with  uncontrolled course of atopic  bronchial asthma, as compared with controlled-course cohort. When  evaluating concentrations  of cytokines in peripheral blood serum of the patients with controlled and uncontrolled atopic  bronchial asthma, we revealed  significantly  higher  levels of IL-2, IL-4, and  IL-10, as compared to control group.  It was found that TNFα concentration is considerably higher in both cohorts of the patients, being 2to 3-fold higher than the levels of this cytokine in control group.  When comparing the cohorts with different  control of the disease course, we have found that TNFα concentration in the cohort with uncontrolled bronchial asthma is statistically higher  than  among  children with  controllable course  of the  disease.  Hence, the  following  parameters may serve as potential markers  of pediatric atopic  bronchial asthma with uncontrolled course:  low levels of total Т lymphocyte numbers in peripheral blood,  and decreased counts  of CD4⁺, CD8⁺ cells; IgE hyperproduction; low contents of common IgA, and high concentration of TNFα in peripheral blood serum.

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