Abstract
BackgroundThe innate and adaptive immune system is involved in the airway inflammation associated with acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). We evaluated the association of mannose-binding lectin (MBL), immunoglobulin (Ig) and ficolin-2 concentrations with COPD exacerbations and according to the glucocorticoid treatment duration for an index exacerbation.MethodsPost-hoc analysis of the randomized, double-blind, placebo-controlled REDUCE trial of 5 vs. 14 days of glucocorticoid treatment for an index exacerbation. MBL, ficolin-2 and total IgG/IgA and subclass concentrations were determined in stored samples drawn (n = 178) 30 days after the index exacerbation and associated with the risk of re-exacerbation during a 180-day follow-up period.ResultsIgG and subclass concentrations were significantly lower after 14 days vs. 5 days of glucocorticoid treatment. Patients with higher MBL concentrations were more likely to suffer from a future exacerbation (multivariable hazard ratio 1.03 per 200 ng/ml increase (95% confidence interval (CI) 1.00–1.06), p = 0.048), whereas ficolin-2 and IgG deficiency were not associated. The risk was most pronounced in patients with high MBL concentrations, IgG deficiency and 14 days of glucocorticoid treatment pointing towards an interactive effect of MBL and IgG deficiency in the presence of prolonged glucocorticoid treatment duration [Relative excess risk due to interaction 2.13 (95% CI − 0.41–4.66, p = 0.10)]. IgG concentrations were significantly lower in patients with frequent re-exacerbations (IgG, 7.81 g/L vs. 9.53 g/L, p = 0.03).ConclusionsMBL modified the short-term exacerbation risk after a recent acute exacerbation of COPD, particularly in the setting of concurrent IgG deficiency and recent prolonged systemic glucocorticoid treatment. Ficolin-2 did not emerge as a predictor of a future exacerbation risk.
Highlights
The innate and adaptive immune system is involved in the airway inflammation associated with acute exacerbations in patients with chronic obstructive pulmonary disease (COPD)
Ficolin-2 did not emerge as a predictor of a future exacerbation risk
For the present analysis, serum samples of 178 patients comprising 57% of the original trial population were available, including 96 (54%) patients who were treated for 14 days and 82 (46%) patients who were treated for 5 days with 40 mg prednisone daily for the index exacerbation
Summary
The innate and adaptive immune system is involved in the airway inflammation associated with acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). We evaluated the association of mannose-binding lectin (MBL), immunoglobulin (Ig) and ficolin-2 concentrations with COPD exacerbations and according to the glucocorticoid treatment duration for an index exacerbation. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death according to the World Health Organization (WHO) [1]. Exacerbations are characterized by significant airway inflammation that is likely orchestrated by members of the innate and adaptive immunity. Mannose-binding lectin (MBL) is a soluble pattern recognition receptor (PRR) of the innate immune system. Upon binding to carbohydrate-enriched regions of microorganisms, the lectin pathway of the complement system is activated and phagocytosis enabled. In COPD, data regarding the association of MBL deficiency with the risk of exacerbation are conflicting [5,6,7,8]
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