A Specific Pattern and Dynamics of Circulating Cytokines Are Associated with the Extension of Lung Injury and Mortality in Colombian Adults with Coronavirus Disease-19.

Increased systemic levels of inflammatory cytokines have been associated with the development of pathophysiologic events during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To further explore differences in the pattern and dynamics of plasma cytokines in individuals with coronavirus disease-19 (COVID-19), and the relationship with disease mortality, here we evaluated the plasma levels of proinflammatory and regulatory cytokines in Colombian patient survivors and nonsurvivors of SARS-CoV-2 infection. Individuals with confirmed COVID-19, with other respiratory diseases requiring hospitalization, and healthy controls, were included. Plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon-γ, IL-10, soluble tumor necrosis factor receptor I (sTNFRI), and transforming growth factor-ß1 were measured by a bead-based assay or enzyme-linked immunosorbent assay and clinical, laboratory, and tomographic parameters were registered during hospitalization. The levels of most of the evaluated cytokines were increased in COVID-19 individuals relative to healthy controls. The levels of IL-6, IL-10, and sTNFRI were directly associated with the development of respiratory failure, immune dysregulation, and coagulopathy, as well as with COVID-19 mortality. Particularly, the early, robust, and persistent increase of circulating IL-6 characterized COVID-19 nonsurvivors, while survivors were able to counteract the inflammatory cytokine response. In addition, IL-6 systemic levels positively correlated with the tomographic extension of lung damage in individuals with COVID-19. Thus, an exacerbated inflammatory cytokine response, particularly mediated by IL-6 added to the inefficiency of regulatory cytokines, distinguishes COVID-19-associated tissue disturbances, severity, and mortality in Colombian adults.

Papel de la interleuquina-17 en procesos inflamatorios y patologías pulmonares / Role of interleukin-17 in inflammatory processes and pulmonary pathologies

Resumen Introducción: Cuatro de las diez principales causas de muerte en el mundo corresponden a patologías pulmonares donde las infecciones respiratorias se ubican en tercer lugar y a su vez son uno de los principales motivos de consulta médica. Por otro lado, la interleuquina IL-17 parece tener un papel importante en la inmunopatogénesis de un gran número de enfermedades, pues se ha descrito que niveles elevados en sangre periférica u otros fluidos corporales se relacionan con metástasis e infecciones. Diferente a patologías cutáneas e intestinales, donde el papel de la IL-17 se conoce con mayor detalle, en procesos pulmonares su rol es aún controversial. Objetivo: Describir conocimientos actuales sobre la función de la IL-17 en procesos inflamatorios y patologías locales pulmonares. Metodología de búsqueda: Se realizó una búsqueda bibliográfica de artículos originales y revisiones de tema en los motores de búsqueda MEDLINE y Science Direct, de los cuales 50 cumplieron con los criterios de inclusión. Conclusiones: Se encontró que la respuesta de IL-17 parece estar relacionada con buen pronóstico en el caso de algunas neumonías bacterianas. Igualmente, el bloqueo de la vía de señalización de la IL-17 en neoplasias pulmonares podría ser beneficioso y se considera como un potencial blanco terapéutico en estas condiciones, por lo que los estudios en este tema continúan siendo fundamentales para conocer mejor el verdadero rol de esta proteína en diversas condiciones patológicas del pulmón. MÉD.UIS.2021;34(1): 55-62.

Abstract Introduction: Four out of ten major causes of death in the world are due to pulmonary pathologies where respiratory infections are in third place and in turn, are one of the main reasons for medical consultation. Interleukin (IL)-17 seems to have an important role in the immunopathogenesis of many diseases. Elevated levels of IL-17 in peripheral blood or other body fluids have been reported to be associated with metastases and infections. Likewise, the role that IL-17 has in the skin and intestinal pathology is clearly known, however; its role within pulmonary pathologies is controversial yet. Objective: To describe the current knowledge on the role of IL-17 in inflammatory processes and pulmonary pathologies. Search Methodology: A bibliographic search of original and review papers was carried out in the MEDLINE and Science Direct database, in which 50 articles matched the inclusion criteria. Conclusions: The response involving IL-17 in the lung seems to be related to a good prognosis in the case of some bacterial pneumonia. Blocking the IL-17 signaling pathway in lung cancer could be beneficial and is considered as a potential therapeutic target under these conditions, so studies on this subject must be continued to better understand the true role of this protein in every pathologic lung condition. MÉD.UIS.2021;34(1): 55-62.

Locally-secreted interleukin-6 is related with radiological severity in smear-negative pulmonary tuberculosis.

Pulmonary tuberculosis (PTB) has been identified as a substantial public health threat and diagnostic challenge. A large proportion of patients exhibit negative smear tests despite active infection. The role of cytokines in the pathophysiology and clinical severity of PTB remains a controversial question. We evaluated the pattern of cytokines presents locally in patients with smear-negative PTB. Levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17 in bronchoalveolar lavage fluid (BALf) from patients with smear-negative PTB, as well as in those with other pulmonary diseases and controls, were performed by flow cytometry. ROC curve and a radiological severity scale were used to establish the potential diagnosis use and the relationship of the cytokine levels with disease severity, respectively. The levels of IL-6 were higher in the PTB (P = 0.0249) and pneumonia (P = 0.0047) groups compared to controls. Low to undetectable levels of TNF-α, IFN-γ, IL-2, IL-4, IL-10, and IL-17 were found in BALf, even after sample concentration using filtration columns and centrifugation. IL-6 levels measured in BALf could distinguish PTB patients or pneumonia patients from controls (AUC: 0.91, P = 0.002 and AUC: 0.86, P = 0.001, respectively), but not patients with PTB from those with pneumonia (AUC: 0.51, P = 0.86). IL-6 levels were related with the severity of PTB, as levels were higher in patients with higher radiological severity. These results confirm the importance of IL-6 in the immunopathology of smear-negative PTB.

Ascaris pulmonar en paciente politraumatizado / Pulmonary ascariasis in a polytraumatized patient

La parasitosis pulmonar por Áscaris es una entidad poco frecuente asociada a factores predisponentes relacionados con la edad, condiciones ambientales y de higiene. Es generalmente asintomática, pero cuando la larva entra en el ciclo pulmonar se puede volver sintomática caracterizándose por fiebre, disnea, dolor torácico, tos con expectoración hemoptoica, eosinofilia e infiltrados alveolares en la radiografía de tórax. Su diagnóstico es la comprobación del parásito. Se describe el caso de un paciente politraumatizado que durante su hospitalización presentó infiltrados alveolares asociado a eosinofilia y se documentó una larva de áscaris en pulmón.