Abstract
BackgroundSerious infections are common in patients undergoing autologous stem cell transplantation (ASCT) mainly because of the effects of immunosuppression. The innate immune system plays an important role in the defense against different infections. Mannose binding lectin (MBL) is a central molecule of the innate immune system. There are several promoter polymorphisms and structural variants of the MBL2 gene that encodes for this protein. These variants produce low levels of MBL and have been associated with an increased risk for infections.MethodsProspective cohort study. The incidence, severity of infections and mortality in 72 consecutive patients with hematologic diseases who underwent ASCT between February 2006 and June 2008 in a tertiary referral center were analyzed according to their MBL2 genotype. INNO-LiPA MBL2 was used for MBL2 gene amplification and genotyping. Relative risks (RR) (IC95%) as measure of association were calculated. Multivariate analysis was performed using logistic regression.ResultsA statistically significant higher number of fungal infections was found in patients with MBL2 variants causing low MBL levels (21.1%versus1.9%, p=0.016). In this MBL2 variant group infection was more frequently the cause of mortality than in the MBL2 wild-type group (p=0.05). Although not statistically significant, there was a higher incidence of major infections in the MBL2 variant group as well as a higher number of infections caused by gram-positive bacteria.ConclusionsLow-producer MBL2 genotypes were associated with an increased number of fungal infections in ASCT patients, which would suggest that MBL has a protective role against such infections. ASCT patients with MBL2 variant genotypes are more likely to die as a result of an infection.
Highlights
Serious infections are common in patients undergoing autologous stem cell transplantation (ASCT) mainly because of the effects of immunosuppression
VCI: Venous catheter infection; UTI: Urinary tract infection. This prospective study focused on comparing the incidence of infection and mortality after ASCT between patients with the wild-type MBL2 genotype compared to patients carrying a variant MBL2 genotype
In summary, the results of our study suggest that ASCT patients with the MBL2 variant gene have increased fungal infections, which would suggest that Mannose binding lectin (MBL) offers protection against such infections
Summary
Serious infections are common in patients undergoing autologous stem cell transplantation (ASCT) mainly because of the effects of immunosuppression. There are several promoter polymorphisms and structural variants of the MBL2 gene that encodes for this protein These variants produce low levels of MBL and have been associated with an increased risk for infections. Isolated low MBL serum levels do not usually cause disease This deficiency appears to be associated with severe infections when other immune deficiencies occur [11]. The effect of MBL deficiency in the infectious complications of patients receiving chemotherapy is variable [11] It has been associated with serious infections and more prolonged episodes of febrile neutropenia [11,12,13], as well as with an earlier first severe infection in deficient patients [14]. The focus of this study is the association between MBL2 gene variants and the risk of infections in patients with different hematologic diseases undergoing ASCT
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