Augmentation des synthèses locales de la lactoferrine et du lysozyme chez des patients infectés par le virus de l'immunodéficience humaine avec candidose oropharyngée : rôle de l'immunité muqueuse innée ?

Abstract

In spite of the highly active antiretroviral therapy (HAART), oropharyngeal candidiasis (OPC) remains one of the most frequent infections in human immunodeficiency virus-infected patients. The infection is often recurrent and the emergence of antifungal drug resistance is sometimes observed. The aim of the study was to analyze lactoferrin and lysozyme in serum, saliva and stools, in 30 subjects (11 HIV positive patients without OPC, 8 HIV positive patients with OPC and 11 healthy subjects), in order to explore the non specific immunity response against Candida albicans. The two antibacterial proteins were measured by avidin-biotin-amplified time resolved-immunofluorometric assay. The results showed an increase in mucosal permeability (oral mucosa and intestine) due to an inflammatory response against Candida albicans and the HIV infection. In the same way, in HIV positive patients with OPC, there was a marked increase in mean lactoferrin concentrations (66.8 mg/L ( p = 0.001) and 3.3 mg/L vs 10.2 mg/L and 0.2 mg/L in healthy subjects, respectively) and mean relative coefficients of excretion (103801 vs 13835, p = 0,007), in the saliva and the stools, and an increase in salivary lysozyme for the HIV positive patients with OPC (171 mG/L vs 23 mg/L in healthy subjects, p = 0,007). High local production of lactoferrin and lysozyme against Candida albicans was also demonstrated indicating natural mucosal immunity due to the phagocytic cells (neutrophils, monocytes-macrophages), and mediated by lactoferrin and lysozyme. The association of these antibacterial proteins with the usual antifungal therapy could be useful against OPC.