Local cytokine profile in adults with acute diarrhea and its correction with immunomodulatory therapy

Abstract

Background: Acute diarrhea (AD) is frequently caused by opportunistic microflora or intestinal viruses. Opportunistic microflora demonstrate growing resistance to antimicrobials. Antiviral treatment is absent. It is require new approaches to therapy of AD. Aminodihydrophthalasindione sodium (ADFNa) is immunomodulator approved by Russian MoH for pathogenetic therapy of infections of respiratory tract and intestine. ADFNa can influence cellular and humoral immunity, in particular, increase the functional activity of macrophages, the synthesis of interferons and lysozyme and regulate the balance of pro - and antiinflammatory cytokines. Aim of the study: assessment of the intestinal cytokine profile in patients with AD treated with standard treatment and the scheme supplemented by ADFNа in the dynamics of disease. Methods & Materials: 60 patients in the age of 42,3 ± 2,8 were divided into two groups (30 persons in each) depending on the treatment regimen. 1st group received standard treatment (regidratation, sorbents). ADFNа was added to the treatment of 2nd group. The spectrum of causative agents in both groups was represented by opportunistic enterobacteria, norovirises and rotaviruses were detected in a few cases. Coprofiltrates taken on 1-2 days from the symptoms onset and after 5 days were used to determine the level of cytokines (IFN-gamma, IL-4, IL-6, IL-10). Results: The significant increase of IL-6 and interferon-ϒ level and normal level of IL-4 and IL-10 was observed in the acute period of disease in both groups. In dynamics of AD the decrease of IL-6 (from 16,2 ± 0,9 in acute period to 12,2 ± 0,9 pg/mg at discharge, p = 0,03) and increase of IL-10 l from 24,3 ± 1,9 to 36,0 ± 1,4 pg/mg (p = 0,01) was detected in ADFNа group. The same but unreliable tendency was observed in 1st group. Changes in the cytokine profile reflected on the duration of symptoms of illnesses. In ADFNа group the duration of diarrhea was 4.0 ± 0.2 days and in the comparison group - 5,5 ± 0,2 days (p < 0,01). It led to shorter hospitalization period in ADFNа group. Conclusion: The obtained data allow to recommend correction of local cytokine profile with ADFNа and consider it inclusion in scheme of supportive treatment of AD in adults.