MARKERS OF APOPTOSIS IN CHILDREN WITH VARICELLA, PATHOGENETIC APPROACH TO TREATMENT

Abstract

The aim of the study was to determine the indicators of apoptosis by intrinsic and extrinsic pathways and possible methods of correction in patients with varicella.

Patients and methods. The study included 150 patients with chickenpox aged 1 month to 17 years hospitalized at the Vinnytsia Regional Clinical Pediatric Infectious Diseases Hospital in 2015-2019. Among the patients formed: comparison group – patients with chickenpox who received traditional treatment (n=35), the main group – patients with chickenpox who received traditional treatment and L-arginine (n=35), control group – healthy children (n=30).

The research was performed in the research clinical and diagnostic laboratory of VNMU certified by the Ministry of Health of Ukraine (certificate of accreditation of the measuring laboratory series KDL No. 002087, certificate of re-certification No. 049/15 of March 2, 2015). Caspase 8 and AIF were determined in serum by enzyme-linked immunosorbent assay using commercial kits «Human CASP8 (Caspase 8) ELISA Kit» («Elabscience Biotechnology Inc.», USA) and «Human AIF (Apoptosis Inducing Factor) ELISA Kit» («Elabscience Biotechnology Inc.”, USA). The results were analyzed in accordance with the manufacturer’s recommendations.

Results. When assessing the rates of apoptosis in healthy and children with varicella, it was found that in patients with chickenpox serum caspase-8 content increased significantly by 43 % (p<0.05), and AIF content by 37.6 % (p<0.05), compared with a group of healthy children. Having clarified these patterns and considering the information that these indicators can adversely affect the course of the disease and cause complications (due to remodeling and vascular damage), we included in the treatment L-arginine, which affects NO synthesis and can simulate apoptosis process. It was found that in the main group before treatment the median content of caspase-8 is 0.522 (95 % CI 0.488–0.557) ng/ml and AIF – 8.17 (95 % CI 7.82–8.70) pg/ml and after treatment, there was a significant decrease in the mean serum level of caspase-8 by 21.5 % (p<0.05), which was 0.410 (95 % CI 0.292–0.531) ng/ml, and AIF – by 22.7 % (p<0.05) and was 6.41 (95 % CI 5.68– 6.93) pg/ml.

Conclusions. The use of caspase 8 and AIF determination revealed the initiation of a program of apoptosis of cells both extrinsic and intrinsic pathways in patients with varicella. Because of high risk developing vascular remodeling with subsequent complications in patients with varicella, we recommend to include L-arginine in the treatment regimen, which has an antiapoptic effect, which may further prevent complications associated with VZV-vasculopathy.