interleukin-8 and Lymphohistiocytosis--Hemophagocytic

Infection with the novel coronavirus SARS-CoV-2 triggers severe illness with high mortality in a subgroup of patients. Such a critical course of COVID-19 is thought to be associated with the development of cytokine storm, a condition seen in macrophage activation syndrome (MAS) and secondary hemophagocytic lymphohistiocytosis (HLH). However, specific data demonstrating a clear association of cytokine storm with severe COVID-19 are still lacking. The aim of this study was to directly address whether immune activation in COVID-19 does indeed mimic the conditions found in these classic cytokine storm syndromes.. Levels of 22 biomarkers were quantified in serum samples from patients with COVID-19 (n = 30 patients, n = 83 longitudinal samples in total), patients with secondary HLH/MAS (n = 50), and healthy controls (n = 9). Measurements were performed using bead array assays and single-marker enzyme-linked immunosorbent assay. Serum biomarker levels were assessed for correlations with disease outcome.. In patients with secondary HLH/MAS, we observed pronounced activation of the interleukin-18 (IL-18)-interferon-γ axis, increased serum levels of IL-1 receptor antagonist, intercellular adhesion molecule 1, and IL-8, and strongly reduced levels of soluble Fas ligand in the course of SARS-CoV-2 infection. These observations appeared to discriminate immune dysregulation in critical COVID-19 from the well-recognized characteristics of other cytokine storm syndromes.. Serum biomarker profiles clearly separate COVID-19 from MAS or secondary HLH in terms of distinguishing the severe systemic hyperinflammation that occurs following SARS-CoV-2 infection. These findings could be useful in determining the efficacy of drugs targeting key molecules and pathways specifically associated with systemic cytokine storm conditions in the treatment of COVID-19.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; COVID-19; Cytokine Release Syndrome; Diagnosis, Differential; Female; Humans; Interleukin-18; Interleukin-8; Lymphohistiocytosis, Hemophagocytic; Macrophage Activation Syndrome; Male; Middle Aged; Young Adult

We encountered a neonatal patient with hemophagocytic lymphohistiocytosis (HLH) whose mother was positive for anti-Ro/SSA and anti-La/SSB antibodies. Complete atrioventricular block was found in a male patient at 29 weeks of gestation. The patient was born at 40 weeks of gestation. He showed severe circulatory disturbance at 22 h after the birth, and he also had elevated serum levels of aspartate aminotransferase (1027 IU l(-1)), alanine aminotransferase (121 IU l(-1)), lactic dehydrogenase (3490 IU l(-1)), ferritin (9769.7 ng ml(-1)) and soluble interleukin-2 (IL-2) receptor (3230 U ml(-1)). We could not find any known HLH genetic abnormality in the patient, but he fulfilled seven of the eight criteria for HLH. Serum levels of IL-6 and IL-8 had been already elevated in his cord blood, and serum levels of granulocyte-macrophage colony-stimulating factor and IL-8 were significantly increased on the second day of life. His symptoms regressed with the administration of hydrocortisone. We presumed that transplacental transfer of maternal antibodies could be related to the occurrence of HLH.

Topics: Antibodies, Antinuclear; Atrioventricular Block; Autoimmunity; Chemokines; Cytokines; Humans; Infant, Newborn; Interleukin-6; Interleukin-8; Lymphohistiocytosis, Hemophagocytic; Male; Sjogren's Syndrome

Recently attention has been paid to the role of cytokines in clinical pathology, since they can mediate a wide variety of biological effects. For these reasons multiplex methods have been developed to simultaneously measure numerous cytokines in individual small volume specimens. The aim of the study was to assess the usefulness of flow cytometric analysis of cytokines in peripheral blood and bone marrow plasma with Cytometric Bead Array (CBA) kits.. The study involved 59 children. Tests were performed in peripheral blood and bone marrow plasma. Human Inflammatory Cytokine Kit (IL-8, -1β, -6, -10, TNF, -12p70) and Human Th₁/Th₂/Th₁₇ Cytokine Kit (IL-2, -4, -6, -10, TNF, INF-γ, -17A) (BD Bioscience) were used. Samples were analyzed on a Cytomics FC500 flow cytometer (Beckman Coulter).. In patients diagnosed for hemophagocytic lymphohistiocytosis (HLH) (n=10) and for acute lymphoblastic leukemia (ALL) (n=12) Human Inflammatory Cytokine Kit was used. In almost all samples individual cytokines were detected in a wide range of concentrations (0.47 - 653.74 pg/ml). In samples from patients suffering from allergy (n=12) and in healthy children (n=25) Human Th₁/Th₂/Th₁₇ Cytokine Kit was used. Detection of individual cytokines was much lower: concentration range 0.09-30.17 pg/ml.. Based on our analysis the CBA test is suitable for analysis of several cytokines in small volumes of samples. A simple flow cytometer can be used for this test. The CBA test is more suitable for samples with expected increased levels of cytokines. When the levels of cytokines are low, the sensitivity of the CBA test can be too low.

Topics: Biomarkers; Bone Marrow; Child; Child, Preschool; Cytokines; Female; Flow Cytometry; Humans; Hypersensitivity; Interleukin-2; Interleukin-8; Lymphohistiocytosis, Hemophagocytic; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Reference Values; Retrospective Studies

Familial hemophagocytic lymphohistiocytosis (FHL) is a rare, genetically heterogeneous autosomal recessive immune disorder that results when the critical regulatory pathways that mediate immune defense mechanisms and the natural termination of immune/inflammatory responses are disrupted or overwhelmed. To advance the understanding of FHL, we performed gene expression profiling of peripheral blood mononuclear cells from 11 children with untreated FHL. Total RNA was isolated and gene expression levels were determined using microarray analysis. Comparisons between patients with FHL and normal pediatric controls (n = 30) identified 915 down-regulated and 550 up-regulated genes with more than or equal to 2.5-fold difference in expression (P ≤ .05). The expression of genes associated with natural killer cell functions, innate and adaptive immune responses, proapoptotic proteins, and B- and T-cell differentiation were down-regulated in patients with FHL. Genes associated with the canonical pathways of interleukin-6 (IL-6), IL-10 IL-1, IL-8, TREM1, LXR/RXR activation, and PPAR signaling and genes encoding of antiapoptotic proteins were overexpressed in patients with FHL. This first study of genome-wide expression profiling in children with FHL demonstrates the complexity of gene expression patterns, which underlie the immunobiology of FHL.

Topics: B-Lymphocytes; Child, Preschool; Female; Gene Expression Profiling; Humans; Interleukin-1; Interleukin-10; Interleukin-6; Interleukin-8; Killer Cells, Natural; Leukocytes, Mononuclear; Liver X Receptors; Lymphohistiocytosis, Hemophagocytic; Male; Membrane Glycoproteins; Oligonucleotide Array Sequence Analysis; Orphan Nuclear Receptors; Perforin; Peroxisome Proliferator-Activated Receptors; Receptors, Immunologic; Retinoid X Receptor alpha; Signal Transduction; T-Lymphocytes; Triggering Receptor Expressed on Myeloid Cells-1

Hemophagocytic lymphohistiocytosis (HLH) is characterized by hypercytokinemia caused by macrophage and T cell activation. We analyzed the serum concentrations of monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1beta, and interleukin (IL)-8 to investigate the roles of these chemokines in the pathophysiology of HLH.. Seven patients clinically diagnosed with HLH were examined. Serum cytokines and chemokines were measured. The differences in the serum concentrations between the patients with HLH and the controls were investigated.. In patients with an active phase of HLH, the serum MCP-1, MIP-1beta, and IL-8 levels all were significantly higher than in healthy controls. The chemokine elevations decreased rapidly after initiation of chemotherapy. During increases in disease activity, elevation of MCP-1 and MIP-1beta preceded elevation of the serum ferritin level, which is a clinical indicator of HLH disease activity.. These results suggest that MCP-1, MIP-1beta, and IL-8 play important roles in the pathophysiology of HLH. In addition, the serum concentrations of these chemokines may be sensitive markers for assessing disease activity in patients with HLH.

Topics: Adolescent; Chemokine CCL2; Chemokine CCL4; Child; Child, Preschool; Disease Progression; Female; Humans; Interleukin-8; Lymphohistiocytosis, Hemophagocytic; Male