Comparative effect of immunomodulators on the contents of hydrolase inhibitors and lactoferrin in community-acquired pneumonia in adults

The  purpose  of our  study  was to  examine the  effect  of immunomodulators (broncho-vaxom, immunovac-VP4 vaccine  and polyoxidonium) upon  the kinetics  of serum hydrolase inhibitors and lactoferrin in the treatment of community-acquired pneumonia (CAP). The  study included 71 CAP  patients at the age of 18 to 70 years. The  patients were divided  into  4 groups:  Group I (15 people)  was a control group  treated with basic antibacterial and  symptomatic therapy, according to the standard treatment regimen, without use of immunomodulators; the  patients from  group  II  (19  patients) were  additionally administered bronchovaxom (the  drug was prescribed upon  admission: 1 course  over 30 days, then  2 rounds  for 10 days each,  with an interval  in 20 days); group III  (20 cases) contained the patients who additionally received  polyoxidonium (the drug was prescribed from the 1st day of hospitalization, 6 mg daily i/m  for 3 days, then  10 injections over 10 days); group IV (17 cases): Immunovac-VP4 vaccine  was administered orally 4 ml and intranasally 2 drops on days 1, 4, 7, 10, 13, 19, 25, 31, along  with antibacterial and  symptomatic therapy. This  vaccine  consists of  antigens   from  opportunistic microorganisms (a  multicomponent  mixture of  water-soluble antigens   of S. aureus, K. pneumoniae, P. vulgaris, E. coli). Serum  concentrations of α2-macroglobulin and α1-antitrypsin hydrolase inhibitors were determined by the method of quantitative immunoelectrophoresis using the research test systems; lactoferrin (LF)  levels were evaluated by enzyme-linked immunosorbent assay using commercial test systems. These  indicators were studied  in blood serum  before treatment, on the 2nd, 13th, and 60th   days of observation.

It was shown that administration of immune modulators combined with antibiotic therapy  in patients with CAP can affect the kinetics of acute phase inflammatory proteins. The effect of broncho-vaxom corresponds to the classical pathway of the response to inflammatory process, i.e., activation of complex of positive acute phase reactants (α1-antitrypsin and  lactoferrin) and  inhibition (blocking) of negative  acute  phase  reactants (α2macroglobulin). Polyoxidonium has a noticeable effect only upon neutrophils secreting lactoferrin. ImmunovacVP4 promotes only short-term secretion of this protein. One may assume that activation of hydrolase inhibitors and lactoferrin after use of immunotropic drugs enhances clinical effect of therapy, with decreased severity and duration of symptoms, as well as lower exacerbation risk of chronic diseases and lesser volume  of drug intake. Antibacterial therapy  does not significantly  affect the kinetics of acute phase inflammation reactants in patients with CAP.  Administration of immunomodulators in combination with standard basic therapy  may affects the inflammatory process to different  degree,  thus, in turn,  leading to improved prognosis  in this disease.

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