Comprehensive assessment of clinical and immune disorders in patients with acute concussion

Abstract

Introduction. Craniocerebral trauma remains one of the most common forms of brain pathology. Its relevance is determined by both, high prevalence and significant financial costs associated with the treatment, and rehabilitation of injured. Mild forms predominate in the general structure of injury. Immune response is one of the manifestations characteristic for a complex of biochemical and pathophysiological reactions triggered in the brain in response to injury. At the same time, the subtle mechanisms of its functioning and their role in pathogenesis of diseases remain the subject of discussion. Our research was aimed to study the role of immune reactions in the pathogenesis of mild brain injury. Materials and methods. 22 patients with concussion (aged from 20 to 45) were examined. The control group included 37 healthy individuals aged 20 to 46. The examination included the collection of complaints, medical history, assessment of somatic and neurological status, neuropsychological testing. The object of laboratory research was venous blood. Attention was mainly paid to the T-helpers of central (CM, CD45RA–CD62L+) and effector (EM, CD45RA–CD62L–) memory, which were evaluated using multicolored cytometric analysis. Results. Patients presented complaints of general and cognitive nature upon admission to the hospital. Cerebellar lesion symptoms dominated while neurological status evaluation. Neuropsychological examination allowed us to detect neuro-dynamic and regulatory disorders predominance. While conducting the analysis of the main stages of cell maturation in the blood of patients with concussion, it was noted that there was a significant increase in both, relative and absolute content of central memory T-helpers compared to the control group. At the same time, the percentage of EM Th in those with injury was slightly reduced. Also, in patients with injured Th cells of central memory, the relative content of Th1 cells decreased and the relative content of Th17 cells increased. In addition, within the CM Th pool, there was an increase in the proportion of three types of Th17 — CCR6+DN Th17, Th17.1 and «classic» CCR4+CXCR3– Th17. Conclusion. Changes in T-helpers of central memory and T-helpers of peripheral memory subpopulation among CD3+CD4+ cells can be considered as a predictor of the course of concussion in the acute period. However, T cells involved in autoimmunity, do not necessarily reflect the immune system disorders. It is possible that the basis for the decrease in the Th1 level in the circulatory bed in patients with brain injury is the recruitment of immune cells. An increase in the proportion of Th17 was also detected among T-helpers of central memory patrolling the lymphoid tissue the other day after the brain injury. This circumstance may indicate the fact that in the early stages after the nervous tissue damage, processes leading to the formation of «pro-inflammatory» cells are triggered. It allows us to consider these lymphocytes as one of the main populations of immunocompetent cells possessing a neuro-destructive effect.