Phenotypic variants of occupational bronchial asthma (immune profile, cytokines, diagnosis and prognosis)

Abstract

Currently, occupational bronchial asthma is considered as a phenotypically and genotypically heterogeneous disease. The assessment of immunological characteristics opens up new opportunities in assessing the disease development, predicting the characteristics of the course, and establishing a personalized approach to pharmacotherapy of occupational asthma, as well as in developing an individual strategy for its prevention. The purpose of the study is to determine immunological markers of the risk of developing occupational bronchial asthma under conditions of exposure to sensitizing substances for various phenotypes of this disease. Materials and methods. The study included 170 patients with various phenotypes of occupational asthma and 50 participants in the control group. The levels of immunoglobulins A, M, and G in serum were determined by the Mancini technique (radial immunodiffusion). The determination of the levels of cytokines IL-1β, IL-4, IL-6, IL-8, IL-10, IL-17, TNF-α, MCP- 1, and IFN-γ, total IgE, C-reactive protein, and fibronectin in blood serum was carried out by enzyme-linked immunosorbent assay using kits and reagents (OOO Proteinovy Kontur, Vektor-Best, Diateks-E, DIA-plus, Pharmacia diagnostika). To study the content of vascular endothelial growth factor (VEGF) in blood serum, we used a sandwich-type enzyme-linked immunosorbent assay with a set of reagents from eBioscience. Genotyping was performed by real-time polymerase chain reaction using primers and probes developed with the PrimerQuest program (Integrated DNA Technologies, Inc.). Results. For the first time, the study has established the features of immunological manifestations in allergic and non-allergic phenotypes of occupational bronchial asthma, as well as the phenotypes of the combination of occupational asthma with occupational chronic obstructive pulmonary disease and metabolic syndrome. The features of the formation, pathogenesis, and prognosis of various phenotypes of occupational bronchial asthma have been identified. This allows recommending the determination of these immunological parameters during in-depth periodic medical examinations of workers exposed to sensitizing and irritating substances for differential diagnosis of various occupational asthma phenotypes in a specialized inpatient examination. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing working conditions in the studied comparison groups) limitations. Conclusion. The identified immunological features in various phenotypes of occupational bronchial asthma and the established profiles of occupational asthma genotypes can optimize the approach to early diagnosis, prognosis, prevention, and pharmacotherapy of this disease, as well as expand the list of immunological research indicators used during preliminary and periodic medical examinations, in-depth examination of patients with occupational asthma in occupational disease clinics and occupational pathology centers, and the use of new reliable criteria for predicting the course of the disease.