캐나다 토론토 종합병원과 스페인 발라돌리드 대학병원 공동연구팀이 신종플루 중증환자의 경우 인터류킨17의 혈중수치가 높고 경증환자는 인터류킨17의 혈중 수치가 낮다는 연구결과를 [Journal of Critical Care] 최신호에 발표했다는 소식입니다.
연구팀은 신종플루 감염 후 중환자실로 옮겨진 환자 10명, 일반병실 환자 10명, 외래환자 15명, 감염되지 않은 사람 15명의 혈액을 분석했다고 합니다.
외신보도를 보니 캐나다 연구팀을 이끈 면역학 교수 데이비드 켈빈 박사의 인터뷰가 실려 있더군요. 그는 “인터류킨17을 억제하거나 차단하면 신종플루 환자의 폐 염증을 막고 빨리 회복시킬 수 있을 것”이라고 말하며, “인터류킨17 검사법은 곧 개발될 것”이라고 밝히며, “이 검사를 통해 고위험군 환자를 미리 알 수 있다”고 희망찬 얘기를 했습니다.
그런데 연구에 사용된 혈액샘플이 많지 않은 것 같고… 과연 백혈구 활동을 조절하는 IL-17의 혈중농도만으로 신종플루 고위험군을 가려낼 수 있을지.. 또한 IL-17을 억제하거나 차단하여 신종플루 고위험군의 폐렴 증상이 악화되는 것을 막아낼 수 있을지… 그리고 이러한 치료법이 실제 임상에 적용될 수 있을지에 대해서는 후속연구를 좀 더 지켜봐야 할 것 같습니다.
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Th1 and Th17 hypercytokinemia as early host response signature in severe pandemic influenza
Jesus F Bermejo-Martin , Raul Ortiz de Lejarazu , Tomas Pumarola , Jordi Rello , Raquel Almansa , Paula Ramirez , Ignacio Martin-Loeches , David Varillas , Maria C Gallegos , Carlos Seron , Dariela Micheloud , Jose Manuel Gomez , Alberto Tenorio-Abreu , Maria J Ramos , M Lourdes Molina , Samantha Huidobro , Elia Sanchez , Monica Gordon , Victoria Fernandez , Alberto del Castillo , Ma Angeles Marcos , Beatriz Villanueva , Carlos Javier Lopez , Mario Rodriguez-Dominguez , Juan-Carlos Galan , Rafael Canton , Aurora Lietor , Silvia Rojo , Jose M Eiros , Carmen Hinojosa , Isabel Gonzalez , Nuria Torner , David Banner , Alberto Leon , Pablo Cuesta , Thomas Rowe and David J Kelvin
출처 : Critical Care Volume 13 Issue 6
http://ccforum.com/content/13/6/R201
Critical Care 2009, 13:R201doi:10.1186/cc8208
Published: 11 December 2009
Abstract (provisional)
Introduction
Human host immune response following infection with the new variant of A/H1N1 pandemic influenza virus (nvH1N1) is poorly understood. We utilize here systemic cytokine and antibody levels in evaluating differences in early immune response in both mild and severe patients infected with nvH1N1.
Methods
We profiled 29 cytokines and chemokines and evaluated the haemagglutination inhibition activity as quantitative and qualitative measurements of host immune responses in serum obtained during the first 5 days after symptoms onset, in two cohorts of nvH1N1 infected patients. Severe patients required hospitalization (n = 20), due to respiratory insufficiency (10 of them were admitted to the intensive care unit), while mild patients had exclusively flu-like symptoms (n = 15). A group of healthy donors was included as control (n = 15). Differences in levels of mediators between groups were assessed by using the non parametric U-Mann Whitney test. Association between variables was determined by calculating the Spearman correlation coefficient. Viral load was performed in serum by using real-time PCR targeting the neuraminidase gene.
Results
Increased levels of innate-immunity mediators (IP-10, MCP-1, MIP-1beta), and the absence of anti-nvH1N1 antibodies, characterized the early response to nvH1N1 infection in both hospitalized and mild patients. High systemic levels of type-II interferon (IFN-gamma) and also of a group of mediators involved in the development of T-helper 17 (IL-8, IL-9, IL-17, IL-6) and T-helper 1 (TNF-alpha, IL-15, IL-12p70) responses were exclusively found in hospitalized patients. IL-15, IL-12p70, IL-6 constituted a hallmark of critical illness in our study. A significant inverse association was found between IL-6, IL-8 and PaO2 in critical patients.
Conclusions
While infection with the nvH1N1 induces a typical innate response in both mild and severe patients, severe disease with respiratory involvement is characterized by early secretion of Th17 and Th1 cytokines usually associated with cell mediated immunity but also commonly linked to the pathogenesis of autoimmune/ inflammatory diseases. The exact role of Th1 and Th17 mediators in the evolution of nvH1N1 mild and severe disease merits further investigation as to the detrimental or beneficial role these cytokines play in severe illness
