Association of Profoundly Impaired Immune Competence in H1N1v-Infected Patients with a Severe or Fatal Clinical Course

作者:Agrati Chiara*; Gioia Cristiana; Lalle Eleonora; Cimini Eleonora; Castilletti Concetta; Armignacco Orlando; Lauria Francesco Nicola; Ferraro Federica; Antonini Mario; Ippolito Giuseppe; Capobianchi Maria Rosaria; Martini Federico
来源:Journal of Infectious Diseases, 2010, 202(5): 681-689.
DOI:10.1086/655469

摘要

Background. Pandemic A/H1N1v influenza is characterized by a mild clinical course. However, a small subset of patients develops a rapidly progressive course caused by primary viral pneumonia or secondary bacterial infections that, in many cases, lead to death due to respiratory failure. The aim of the present study was to analyze the involvement of the immune response in the clinical presentation of H1N1v influenza.
Methods. The differentiation and functional capability of T cells from H1N1v-infected patients presenting with either mild disease (n = 22) or severe or fatal disease (n=6) were compared. Moreover, plasma cytokines and chemokines were quantified
Results. T cells from H1N1v-infected patients presenting with a severe clinical course resulted in impaired effector cell differentiation and failed to respond to mitogenic stimulation. T cell anergy was strictly associated with a severe acute phase of infection, but T cells could be restored in patients able to recover. Of interest, massive expression of CD95 marker was found on anergic T cells, suggesting an apoptosis-related mechanism. Finally, lower plasma levels of interferon-alpha and monocyte chemoattractant protein-1 were found in patients with a worse clinical course of influenza, suggesting impaired production of these cytokines.
Conclusions. Our results show a strict association between host immune competence and the severity of the clinical course of H1N1v infection. By monitoring host functional response, patients with an enhanced risk of developing influenza-associated severe complications could be identified in a timely manner.

  • 出版日期2010-9-1