Comparative effect of immunomodulators on the contents of hydrolase inhibitors and lactoferrin in community-acquired pneumonia in adults

Abstract

The purpose of our study was to examine the effect of immunomodulators (broncho-vaxom, immunovac-VP4 vaccine and polyoxidonium) upon the kinetics of serum hydrolase inhibitors and lactoferrin in the treatment of community-acquired pneumonia (CAP). The study included 71 CAP patients at the age of 18 to 70 years. The patients were divided into 4 groups: Group I (15 people) was a control group treated with basic antibacterial and symptomatic therapy, according to the standard treatment regimen, without use of immunomodulators; the patients from group II (19 patients) were additionally administered bronchovaxom (the drug was prescribed upon admission: 1 course over 30 days, then 2 rounds for 10 days each, with an interval in 20 days); group III (20 cases) contained the patients who additionally received polyoxidonium (the drug was prescribed from the 1st day of hospitalization, 6 mg daily i/m for 3 days, then 10 injections over 10 days); group IV (17 cases): Immunovac-VP4 vaccine was administered orally 4 ml and intranasally 2 drops on days 1, 4, 7, 10, 13, 19, 25, 31, along with antibacterial and symptomatic therapy. This vaccine consists of antigens from opportunistic microorganisms (a multicomponent mixture of water-soluble antigens of S. aureus, K. pneumoniae, P. vulgaris, E. coli). Serum concentrations of α2-macroglobulin and α1-antitrypsin hydrolase inhibitors were determined by the method of quantitative immunoelectrophoresis using the research test systems; lactoferrin (LF) levels were evaluated by enzyme-linked immunosorbent assay using commercial test systems. These indicators were studied in blood serum before treatment, on the 2nd, 13th, and 60th days of observation. It was shown that administration of immune modulators combined with antibiotic therapy in patients with CAP can affect the kinetics of acute phase inflammatory proteins. The effect of broncho-vaxom corresponds to the classical pathway of the response to inflammatory process, i.e., activation of complex of positive acute phase reactants (α1-antitrypsin and lactoferrin) and inhibition (blocking) of negative acute phase reactants (α2macroglobulin). Polyoxidonium has a noticeable effect only upon neutrophils secreting lactoferrin. ImmunovacVP4 promotes only short-term secretion of this protein. One may assume that activation of hydrolase inhibitors and lactoferrin after use of immunotropic drugs enhances clinical effect of therapy, with decreased severity and duration of symptoms, as well as lower exacerbation risk of chronic diseases and lesser volume of drug intake. Antibacterial therapy does not significantly affect the kinetics of acute phase inflammation reactants in patients with CAP. Administration of immunomodulators in combination with standard basic therapy may affects the inflammatory process to different degree, thus, in turn, leading to improved prognosis in this disease.

Keywords

• immunomodulators
• hydrolase inhibitors
• lactoferrin
• community-acquired pneumonia