Disorders of local pulmonary immune response in patients with chronic obstructive pulmonary diseases during exacerbation

Abstract

Introduction. Morbidity due to reduced local immune reaction in patients affected by chronic obstructive pulmonary disease (COPD) is extremely high and continues to grow. The results of a research on changes in the local immune response in patients with COPD at the exacerbation stage are discussed in this paper. The pathogenesis of COPD during exacerbation is characterized by deterioration of the local innate and acquired immunity. The process is accompanied by pathological changes of the systemic immunity. Various cells of the immune response are involved in the inflammation process, attracting increased amounts of macrophages, neutrophils, T- and B-lymphocytes, and dendritic cells. The number of neutrophils and B-lymphocytes are observed in patients suffering from a severe disorder. Most common symptoms of COPD are irreversible narrowing of the airways, destruction of the parenchyma of the lung accompanied by emphysema, and progression of the obstructive pulmonary disease.

The aim of the study – to learn the changes in functionality of bronchoalveolar lavage (BAL) cells and peripheral blood cells (PBC) in COPD patients and provide an explanation for these changes in light of pathogenetic characteristics to predict the course of the disease and justify the necessity of a local immunotherapy in comprehensive treatment of COPD patients.

Research Methods. The focus of the research was on BAL cells and PBC of patients with COPD at different stages and on blood serum. CD3, CD4, CD8, CD16 and CD19 of BAL and PBC cells were identified using different specific monoclonal antibodies. Receptor expression to IL-2 (CD25) was examined, adhesive molecules were identified using CD54, proliferation levels were measured using IPO-38, as well as was measured the expression of class II antigens MHC (HLA-DR) in the blast transformation reaction that was induced by PHA and Con A mitogens. Phagocytic activity of phagocytizing neutrophils cells, alveolar macrophages (AM), and phagocytizing PBC cells was evaluated. Levels of free radical processes and antioxidant defence were studied using a chemiluminescence method.

Results and Discussion. The amount of AM cells in COPD patients declined significantly, whereas the amount of neutrophils notably increased, as well as concentrations of the myeloperoxidase and the eosinophil cationic protein. Examination of phlegm and BAL cells obtained from COPD patients at the exacerbation stage of the disease indicate that 23 % of samples displayed gram-negative bacterial flora (primary pathogens being Pseudomones aeruginosa, Haemophillus influensae, Enterobacter spp.), 15 % – candidas, 61 % – pathogen type was not identified. Researching local and systemic immune response in COPD patients and functional activity changes of BAL and PBC indicated that patients showed significant changes in their local immune system, which manifested in significant reduction in the amount of neutrophils in the lavage, reduction in CD3, CD19, and increased expression  of receptors to HLA-DR antigen expression.

Summary. Parallel study of the local and systemic immunological responses contributes to expand our knowledge and understanding of pathogenesis of COPD. It is useful in determining methods to help decrease the number of complications and aid in COPD prophylaxis in persons of working age. It also provides information on which local immunotherapy will prove to be most effective. Exploring the subject further should provide fundamental understanding of similar and different symptoms of various disorders in patients with inflammation processes at the local immune level in different body locations, such as respiratory organs during COPD, in the peritoneal cavity during peritonitis, dermal lesions or any other changes in the local immune system of a different body location.