Personalized algorithm of immunocorrection with intravenous immunoglobulins for preventing and treating complications of burn disease by comprehensively analyzing immune status

Cover Page

Cite item

Abstract

Intravenous immunoglobulin preparations with proven effectiveness are widely used for treatment of various immunodeficient, autoimmune, inflammatory and infectious diseases. Nevertheless, algorithms for use of immunoglobulin preparations to correct immune status in burn disease, prevention, etc. have not been developed yet. Here we present the results of a prospective controlled study with 70 patients assessing effectiveness of using immunoglobulin preparations for intravenous administration in complex treatment of subjects suffering from extensive burns. Expanded immunological examination (more than 300 studies) in this patient cohort at different stages of burn disease consisted of phenotyping lymphocytes, granulocytes, monocytes (constitutive and activation markers, cell functional activity), immunoglobulin level and phagocyte oxygen metabolism. Data analysis included significant parameters only. Patient selection for using intravenous immunoglobulins to prevent or treat septic complications was performed by using the previously proposed 95%-specificity sepsis prognosis formula: LF < 9.3%, NK cells < 5%, HLA-DR+ Mn < 50%, IgG < 4.0-6.0 g/l, LII > 4.0 u, CD64+ Gy > 90-100%, N/I NF > 21%. Immunosuppressive therapy with drug “GabriglobinIgG” at a dose of 50 ml per day for preventing infection spread in patients with burns for 5 days as well as for treatment of sepsis for 10 days, exerted pronounced immunomodulatory effect compared to control groups not only restoring baseline IgG deficiency, but also normalizing quantitative deficit of key immune parameters such as total lymphocytes, B and T cells, natural killer cells, cytotoxic T lymphocytes. Use of gabriglobin for sepsis prevention was effective in 72% of cases (control group without gabriglobin – 37%), so that clinical and immunological effectiveness was as high as 79% (control group – 32%). At the same time, along with conventional immune indicators in heavily burned patients, immune markers previously underestimated were: CD56+ and CD25+ monocytes, CD14+ and CD40+ granulocytes, CD40+ lymphocytes (B cell subset), various effector and regulatory natural killer subsets. It allowed to obtain radically new information about immune system state, inflammation, and bacterial complications in heavily burned patients and apply a personalized approach for immunocorrection by using several intravenous immunoglobulin preparations for effective comprehensive treatment of burn injury-related consequences.

About the authors

M. N. Kozlova

A. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: mnkozlova@rambler.ru

Kozlova Maria N. - PhD (Medicine), Senior Research Associate

117997, Moscow, Bolshaya Serpukhovskaya str., 27

Phone: 7 (903) 731-91-57

Russian Federation

V. M. Zemskov

A. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

PhD, MD (Medicine), Professor, Head, Clinical Immunology group

Moscow

Russian Federation

N. S. Shishkina

A. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

Junior Research Associate, Clinical and Diagnostic Laboratory

Moscow

Russian Federation

A. A. Barsukov

A. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

PhD (Medicine), Senior Research Associate, Clinical and Diagnostic Laboratory

Moscow

Russian Federation

V. S. Demidova

A. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

PhD, MD (Biology), Head, Clinical and Diagnostic Laboratory

Moscow

Russian Federation

A. A. Alekseev

A. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

PhD, MD (Medicine), Professor, Deputy Director

Moscow

Russian Federation

References

  1. Алексеев А.А., Крутиков М.Г., Яковлев В.П. Ожоговая инфекция. Этиология, патогенез, диагностика, профилактика и лечение: монография. М.: Вузовская книга, 2010. 416 с. [Alekseev A.A., Krutikov M.G., Yakovlev V.P. Burn infection. Etiology, pathogenesis, diagnosis, prevention and treatment: monograph]. Moscow: University Book, 2010. 416 p.
  2. Durandy A., Kaveri S.V., Kuijpers T.W., Basta M., Miescher S., Ravetch J.V., Rieben R. Intravenous immunoglobulins-understanding properties and mechanisms. Clin. Exp. Immunol., 2009, Vol. 158, Suppl. 1, pp. 2-13.
  3. Norbury W., Herndon D.N., Tanksley J., Jeschke M.G., Finnerty C.C. Infection in burns. Surg. Infect. (Larchmt), 2016, Vol. 17, no. 2, pp. 250-255.
  4. Perez E.E., Orange J.S., Bonilla F., Chinen J., Chinn I.K., Dorsey M., El-Gamal Y., Harville T.O., Hossny E., Mazer B., Nelson R., Secord E., Jordan S.C., Stiehm E.R., Vo A.A., Ballow M. Update on the use of immunoglobulin in human disease: а review of evidence. J. Allergy Clin. Immunol., 2017, Vol. 139 (3S), pp. 1-46.
  5. Stanojcic M., Vinaik R., Jeschke M.G. Status and challenges of predicting and diagnosing sepsis in burn patients. Surg. Infect. (Larchmt). 2018, Vol. 19, no. 2, pp. 168-175.
  6. Zemskov V.M., Alekseev A.A., Kozlova M.N., Shiskina N.S., Bleykhman D.A., Zemskov A.M., Suchkov S.V. Changes in the immune system depending on the stage of burn disease and the area of thermal destruction. Immunoglobin replacement therapy with gabriglobin. Int. J. Recent Sci. Res., 2017, Vol. 8, Iss. 2, pp. 15653-15662.
  7. Zemskov V.M., Alekseev A.A., Gnatenko D.A., Kozlova M.N., Shishkina N.S., Zemskov A.M., Zhegalova I.V., Bleykhman D.A., Bahov N.I., Suchkov S.V. Composite biomarker panel as a highly informative and reliable tool for predicting septic complications. Jacobs J. Biomarkers, 2016, Vol. 2, no. 1, 016, pp. 1-10.

Copyright (c) 2020 Kozlova M.N., Zemskov V.M., Shishkina N.S., Barsukov A.A., Demidova V.S., Alekseev A.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Свидетельство о регистрации СМИ ПИ № 77 - 11525 от 04.01.2002 выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies