Genetic polymorphisms of innate and adaptive immunity as predictors of outcome in critically ill patients

Background:This review article is important for allergists/immunologists and otolaryngologists. It discussed chronic rhinosinusitis, epidemiology, pathogenesis, innate adaptive immunology, nuclear factor–kappa B related to inflammation, sepsis, complement, reactive oxygen species, asthma, sinusitis, elderly pathogenesis, oxidative stress, depression, seasonal variation, vitamin D, genetic susceptibility and sepsis, hereditary angioedema related to trauma and stress.Objective:The objective of this review is to link chronic rhinosinusitis, epidemiology, innate and adaptive immunology, NF-kappa B related to inflammation, sepsis, complement, reactive oxygen species, asthma and sinusitis.Methods:A literature search was conducted from several articles, prospective studies, recent reviews and earlier reports. A synergistic relationship develops between activation of the innate immune system and the loss of organ barrier functions. Many complex factors, such as genetics, physical agents, mediators in the development of organ failure both in asthma, sinusitis, stress, depression and trauma, leading to posttraumatic organ failure. Asthma and sepsis, a common condition encountered in hospital environments remains an important cause of death at intensive care units where allergists/immunologists and otolaryngologists are frequently consulted. The patient's immune surveillance could fail to eliminate the pathogen, allowing it to spread and there is a proinflammatory mediator release with inappropriate activation.Conclusion:This review discussed chronic rhinosinusitis, sinusitis related to trauma, the innate and adaptive immunology, NF-kappa B related to inflammation, sepsis, complement, inflammation, reactive oxygen species, asthma pathogenesis, and asthma in the elderly, oxidative stress, depression, seasonal variation and vitamin D, cytokines, genetic susceptibility related to sepsis, hereditary angioedema related to trauma and stress.

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“…Thus, a role that host immune genetic variations may play in the susceptibility to ICU-acquired sepsis and ICU mortality. 54 …”

Section: Genetic Susceptibility Related To Sepsismentioning

confidence: 99%

Review: Immunology of Sinusitis, Trauma, Asthma, and Sepsis

Frieri¹,

Kumar

Boutin

2015

Allergy�Rhinol (Providence)

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“…Therefore, as showed in Fig. 1, this meta-analysis finally included 28 eligible articles, containing 51 independent case-control studies (31 for the polymorphism rs4986790 and 20 for rs4986791)13141617181920212223242526272829303132333435363738394041. The characteristics of included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The relationship between toll like receptor 4 gene rs4986790 and rs4986791 polymorphisms and sepsis susceptibility: A meta-analysis

Wang

et al. 2016

Sci Rep

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Accumulating evidences have demonstrated that lipopolysaccharide (LPS) represents the important etiologic factor for sepsis. Some previous studies have reported the relationship between common polymorphisms rs4986790 and rs4986791 in the coding gene for this receptor and the susceptibility to sepsis, but there were distinct divergences between those findings. We therefore designed this meta-analysis incorporated 28 published articles containing 6,537 sepsis patients and 8,832 controls for a more comprehensive conclusion on this matter. Odds ratios (ORs) and 95% confidence interval (95% CIs) were calculated to evaluate the association of toll like receptor 4 gene polymorphisms rs4986790 and rs4986791 with sepsis risk. Heterogeneity between included studies was inspected using Q test, and sensitivity analysis was implemented via sequential deletion of each included study to investigate the stability of overall estimates. Funnel plot and Egger’s test were adopted to examine publication bias across selected studies. We found no significant association for either the polymorphism rs4986790 or rs4986791 with sepsis susceptibility in total analysis under any genetic models. Neither did we after combining these two polymorphisms. The results of this meta-analysis suggest that the rs4986790 and rs4986791 polymorphisms in toll like receptor 4 gene may have no statistically significant influence on sepsis susceptibility.

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“…The first line of defense against invaders consists of physical barriers such as the skin [ 13 , 14 ], the mucous membranes of our gastrointestinal [ 15 ], and respiratory [ 16 ] and genitourinary [ 17 ] tracts. The second line is the rapid defense by the innate immune system (including complement proteins, sentinel phagocyte cells, and natural killer cells), which plays an activator and a controller role of the adaptive immune system [ 18 ]. The innate system acts by broad recognition of antigens, mainly by sensing pathogen-associated molecular patterns (PAMP) of carbohydrates and fatty acids located on the surfaces of common pathogens.…”

Section: Pathophysiologymentioning

confidence: 99%

Sepsis: From Pathophysiology to Individualized Patient Care

László

Trásy

Molnár

et al. 2015

Journal of Immunology Research

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Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review.

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Genetic polymorphisms of innate and adaptive immunity as predictors of outcome in critically ill patients

Cited by 21 publications

References 53 publications

Review: Immunology of Sinusitis, Trauma, Asthma, and Sepsis

Review: Immunology of Sinusitis, Trauma, Asthma, and Sepsis

The relationship between toll like receptor 4 gene rs4986790 and rs4986791 polymorphisms and sepsis susceptibility: A meta-analysis

Sepsis: From Pathophysiology to Individualized Patient Care

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