Indicators of cellular and humoral immunity, proteolytic activity of blood serum in patients with various forms of coronary heart disease and types of atherosclerotic plaques

Abstract

Objectives. To identify the parameters of the immune system and proteolytic activity of blood serum, indicating active systemic inflammation in patients with various forms of coronary artery disease (CAD) and types of atherosclerotic plaques (ASP) according to the data of ultrasound examination of the arteries. Material and methods. The study involved 85 patients aged from 38 to 60 years: 52 patients with effort angina pectoris (EAP) of functional class II (36 men, 16 women), 23 patients with myocardial infarction (MI) (16 men, 7 women). The serum concentration of interleukins IL-4, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor (TNF-α); the content of T- and B-lymphocytes, IgA, IgG, IgM, circulating immune complexes (CIC) in peripheral blood; elastase and trypsin-like blood serum activity were determined. Ultrasound examination of peripheral arteries was performed and the types of ASP and their ultrasound characteristics were evaluated according to the Gray–Weal and Geroulakos classification. Results. In patients with EAP for type 3 ASP, the maximum values (among other identified types of ASP) of the IL-6 cytokine level, the IL-6/IL-10 ratio, the monocyte/HDL-C ratio, the sVCAM-1 adhesion molecules count, as well as 1.16 times increase in trypsin-like serum activity were determined in comparison with the 2nd type of ASP (p= 0.04) and leukocytes count in the blood serum was increased by 16% compared with the 2nd type of ASP (p= 0.025). In the 3rd type of ASP, the minimum concentration of the anti-inflammatory cytokine IL-10 and 1.73 times decrease in IgM concentration in comparison with the 2nd type of ASP were revealed (p=0.047). In patients with MI, the highest activity of systemic inflammation is characteristic of type 2 and type 3 of ASP. The maximum values of elastase and trypsin-like enzyme activity, the monocytes and T-lymphocytes count, the sVCAM-1 and CIC cell adhesion molecules count, IL-6, IL-8, IL-18 cytokines, IL-6/IL-10 ratio were revealed in type 2 ASP, the minimum IgM, IL-4, IL-10 concentration was observed. Trypsin-like serum activity and IL-6 concentration were significantly lower (1.41 times (p=0.03) and 1.28 times (p=0.034), respectively) in type 2 ASP. Conclusions. The highest activity of systemic inflammation according to the studied parameters of cellular and humoral immunity, as well as according to the investigation of proteolytic activity of blood serum was revealed for type 3 ASP in patients with EAP of FC II and for types 2 and 3 ASP in patients with MI. Thus, these types of ASP may pose the greatest danger in terms of destabilization of the atherosclerotic process with the potential development of acute cardiovascular events.

Keywords

• immune system
• atherosclerosis
• coronary heart disease
• cytokines
• proteolytic activity
• atherosclerotic plaque