THE TOLL-LIKE RECEPTORS ROLE IN INFLAMMATORY DISEASES OF THE BRONCHOPULMONARY SYSTEM PATHOGENESIS

The role of Toll-like receptor 4 gene polymorphism in the development of organ dysfunction in patients with severe pneumonia associated with A/H1N1 influenza

The aim of the study. To identify the frequency of occurrence of TLR4 Asp299Gly (rs4986790) gene polymorphism and to establish its contribution to the development of organ dysfunction in patients with severe pneumonia associated with A/H1N1 influenza.

Materials and methods. The study included 55 patients with severe pneumonia associated with A/H1N1 influenza. Inclusion criteria: severe pneumonia; consolidation/ground-glass syndrome according to chest X-ray/CT. Exclusion criteria: unstable hemodynamics; body mass index > 30; diabetes mellitus; HIV; tuberculosis, oncopathology. Verification of the pathogen in the respiratory swab was carried out using PCR method: A/H1N1  influenza virus RNA was identified. The age of  the  patients was 47 [38; 62] years. Among all the patients the proportion of men was 47.8 %, of women – 52.2 %. Patients were divided into 2 groups: group 1 included patients with SOFA scale (Sequential Organ Failure Assessment) score ≥ 2 points; group 2 – patients with SOFA scale score ˂ 2 points. Gene SNPs were determined by PCR method using standard kits developed by Research and Production Company “Litekh” (Moscow). Amplification of the TLR4 gene fragments was carried out in a thermocycler Bis-M111 (Bis-N LLC, Novosibirsk). Genomic DNA isolated from whole blood leukocytes using the “DNA Express Blood” reagent was analyzed followed by an amplification reaction. The amplification product was detected in a 3% agarose gel.

Results. Multiple organ dysfunction (SOFA scale score ≥ 2 points) in patients with severe pneumonia associated with A/H1N1 influenza was registered in 24 (43.6 %) cases. When analyzing the frequency of occurrence of the minor Gly allele, according to genetic models, the differences were established between patients of the groups 1 and 2 in codominant (p = 0.023; odds ratio (OR) – 8.82 (0.95–81.89)) and dominant (p = 0.005; OR = 12.35 (1.40–109.07)) models.

Conclusion. Severe pneumonia associated with A/H1N1 influenza is accompanied by a high incidence of  organ dysfunction. The risk of organ failure development is  2.1  times increased in patients with severe pneumonia with identified TLR4 Asp299Gly gene polymorphism, which probably requires further study. 

The Effect of TLR4 Blockade on Some Indicators of Systemic Inflammatory Response to Proteus mirabilis LPS in Rats

The effects of TLR4 blocker on blood cell morphology, concentrations proinflammatory cytokines, and functional state of the liver and kidneys were studied in outbred male rats (n=60) after intravenous injection of 20 mg/kg LPS isolated from opportunistic Proteus mirabilis strain ATCC 51393. TLR4 blocker TLR4-IN-C34 was injected intravenously in a dose of 1 mg/kg/day over 3 days. Systemic inflammatory reaction induced by LPS was characterized by elevation of serum TNFα, IL-1β, IL-6, erythrocyte sedimentation rate, leukocytosis, and thrombocytosis. Increased activity of hepatocyte enzymes (ALT, alkaline phosphatase, and lactate dehydrogenase), retention of nitrogen metabolites (urea and creatinine), elevated content of protein oxidation products, and enhanced protein catabolism were also observed. Administration of TLR4 blocker reduced parameters of inflammatory reaction and prevented the development of hypercatabolic syndrome; endotoxicosis and kidney function indicators approached the normal levels.

[The role of modification of innate immunity in development of premature labore]

To clarify the role of the infectious factor in the development of premature birth (PB) in women in serum, the content of TLR-4, the p65 subunit of the nuclear factor NF-kB, the cytokine TNF-a and the activity of PLA2 (phospholipase A2) were determinated by the enzyme immunoassay was studied. The profile of bioregulators in women with premature births was characterized by a high content of TLR-4, TNF-a and an increase in PLA2 activity and a decrease in the activity of the p65 subunit of NF-kB. 89 women aged 20-39 years were examined at 34-40 weeks gestation. They were divided into two groups: 42 women with preterm birth at 34-36.6 weeks, the control group is represented by 47 patients. The risk factors for PB are the presence of PB in history, endocervicitis, colpitis, dysbiosis, diseases of the urinary system (chronic pyelonephritis, chronic cystitis), aggravated obstetric and gynecological history (the threat of abortion during gestation, moderate preeclampsia, anemia of the pregnant woman). The obtained data of the studied bioregulators testify to the role of the infectious inflammatory process in the development of PB, which is evidenced by the high level of TLR-4, a component of innate immunity leading to the activation of the TLR-4 signaling pathway, which increases the activity of PLA2-factor of premature contractile activity of the uterus.