DIAGNOSTIC MARKERS OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS IN PATIENTS WITH BRONCHIAL ASTHMA

Abstract

Studies of probable significance of different immunological mediators for the development of chronic allergic inflammation in patients with allergic bronchopulmonary aspergillosis (ABPA) are necessary in order to specify potential targets for therapeutic intervention and timely diagnosis of the disease. The purpose of present study was to determine the features of immune response regulation, and to identify diagnostic markers associated with development of ABPA in patients with bronchial asthma, and to evaluate clinical and immunological efficacy of specific antimycotic therapy. The study involved 13 patients with ABPA, 14 patients with bronchial asthma with fungal sensitization (BAFS), 17 patients with bronchial asthma (BA) and 12 apparently healthy individuals. Levels of thymic stromal lymphopoietin (TSLP), thymus and activation-regulated chemokine (TARC), IL-8, as well as levels of total IgE and specific IgE to Aspergillus fumigatus (A. fumigatus) were measured in blood serum by enzyme immunoassay; blood eosinophil counts were also made. Monitoring of these immunological markers in the course of antimycotic therapy was carried out. Significantly higher numbers of eosinophils, increased levels of total IgE and sIgE for A. fumigatus, as well as TARC and IL-8 in serum were revealed in patients with ABPA when compared to the patients with BA. No significant differences in TSLP content were found between the examined groups of patients. A positive correlation between the levels of sIgE to A. fumigatus and contents of TARC and IL-8, numbers of eosinophils, and total IgE levels confirms the important diagnostic value of proinflammatory cytokines in ABPA patients. In the course of itraconazole medication, a positive clinical and immunological dynamics in ABPA patients was revealed. After 12 weeks of therapy, a significant increase in AST, FEV1 and Tiffno respiratory indexes, along with decreased number of eosinophils, total IgE levels, and a trend towards a decrease in TARC and IL-8 levels were documented. This dynamics confirms clinical efficiency of antifungal drugs when treating chronic allergic inflammation in ABPA patients. Implementation of modern immunological biomarkers, alongside with traditional indicators, will allow to differentially evaluate a probability for ABLA development in patients with bronchial asthma, to present additional evidence for discerning early stages of the disease, and to conclude about the efficiency of the therapy applied.