Use of the own platelet plasma in the treatment of chronic inflammatory conditions of the skin

Transcription

1 Dr. V.V.Bulat Use of the own platelet plasma in the treatment of chronic inflammatory conditions of the skin The chronic inflammatory diseases play an important role in the structure of the skin diseases and remain the main problem of dermatology. In recent years significantly increased the frequency of these diseases to persons aged years. The research purpose: studying the efficiency of use of the own platelet plasma (PAP - platelet autoplasma) in the treatment of chronic inflammatory diseases of the skin. Materials and methods:there have been observed 40 patients (average age 25 to 30 ± 1.5 years) suffering from chronic inflammatory diseases of the skin. The patients underwent clinical and general laboratory trials to determine the immunological status. The immunological statute was determined with the help ofsome unified method: the determination of the subpopulations of lymphocytes (the indirect immunofluorescence reaction with monoclonal antibodies); the phagocytic activity of neutrophils (as compared to cultures of Staph. aureus); the determination of immunoglobulin class A, M and G (the radial immunodiffusion reaction after Mancini); the determination of circulating immune complexes (the reaction of precipitation with polyethylene glycol 600). The statistical processing of the results was performed using a series of modern statistical analysis programs Stat Soft Statistics 6.0. The obtained results and their discussion The skin disorders occupy one of the main places in the overall human pathology not only because it is the first natural barrier between the body and the environment, but also by virtue of the elements of skin which play a particularly important role in maintaining the homeostasis. The properties of the skin are determined by its anatomic and physiological peculiarities. It is coated with a biologically active layer, which is the hydrolipidic film of the emulsion, so-called mantle, which contains lactic acid, unsaturated fatty acids of low molecular weight, which provide the necessary acid environment to inhibit pathogenic microbial flora, preventing viral entry into the cell. The skin without lesions is virtually impermeable to most bacteria. But the skin importance does not reduce the role of a purely mechanical barrier. The biochemical, ultrastructural and functional connections between the skin cells and cells of the immune system, as well as the intercellular interactions represent, in itself, the phenomena with immune character. The research has shown that the existence of some close connections between the immune system and the skin, that can be considered, rightly, an immunocompetent organ of first level [5].

2 The skin cell composition comprises lymphocytes, fibroblasts, histiocytes, melano phages, fibroblasts, keratinocytes, dendrites. For various pathological conditions of the skin, these cells provide necessary protection functions: phagocytosis and antigen removing material, production of cytokines and immunoglobulins of different classes. All these elements are in complex interaction, thus providing immunological protection of organism against penetration from the environment into the body of foreign antigens of diverse etymology. Despite the known role that the protective factors play, specific and non-specific, their degree of participation in infections depends on the pathogen agent and its antigenic structure. In the risk group in terms of immunological insufficiency with infectious syndrome are included the patients with bacterial, viral, fungal chronic recurrent infections and diseases, frequent and current, called single [4]. Among the most common skin diseases are listed the inflammatory purulent infections: furunculosis, carbuncle, streptoderma, staphyloderma etc. The antibacterial immunity includes all non-specific protection mechanisms. An important role has direct bactericidal action of complement system, as well as the endocytosis using phagocyte system cells. It is known the fact that the antibodies play a decisive role in eliminating bacteria that are unable to multiply within cells. In the case of bacterial disease, the secretion of antibodies, particularly secretory IgA antibody, can be reduced or even totally blocked. At the same time, the concentration of IgG and IgM specific antibodies in the blood serum in the case of bacterial infections is usually increased. The complement system provides the intensification of the specific protection with respect to enhancing the immune reactions of the body: its activation leads to direct lysis of cell and stimulation of phagocytic activity. The activation process is determined by the enzyme systems through limited proteolysis. The classical method of complement activation ensures its participation in the formation of immune complexes, in whose composition can enter IgM, IgG1, IgG2, IgG3 and a number of other factors. In general, this approach is oriented towards the strengthening the immune cytolysis. If in case of the deficiency of the component C2, the patients are proned to repeated microbial inflammatory processes, at the slowing down of the circulating immune complexes (streptoderma, staphyloderma). The phagocyte system can compensate the complement shortfall. The primary endocytosis of some bacteria depends on the surface structure of the pathogen agent and the entry gate of the infection and, therefore, the possibility of contact with different populations of macrophages. After embedding bacteria by the phagocytic system cells, their fate may be different: - Most often, the bacteria die under the action of the mechanisms described above (eg. in the case of staphylococcal infection);

3 - Bacterial membrane cannot completely disintegrate if it contains poorly soluble glycolipids (e.g. at streptococci); - Certain bacteria (Chlamydia, micro bacteria, etc.) can multiply intracellularly, because their destruction is prevented by the slowdown process of the fusion of phagosomes with lysosomes. Incase of streptoderma and staphiloderma is observed a deficit of nonspecific protective factors, especially the phagocytic activity of leukocytes. We can assume that this is related to some extent, to the reduction in the neutrophil myeloperoxidase - enzyme responsible for the bactericidal character of these cells. The disorder of the hemostasis of phagocytic cells is one of the main causes of recurrent staphylococcal skin infections. The antigen presentation function is taken over by keratinocytes, which selectively activate CD8 +. In the capsules of streptococci in the A and C serum groups is contained the nonimmunogenic hyaluronic acid, which determine the virulence. Streptococci secrete a number of extracellular substances that have immunogenic properties. Some of the products of the secretion are pathogenic. The Streptococci cause predominantly a humoral immune response. Thus, the development of purulent inflammatory diseases of the skin is observed on the background of immune system suppression. The authors determined the immunomodulatory effectiveness of the use of own platelet plasma (PAP) in the treatment of patients with purulent inflammatory diseases of the skin. The table below presents the immunogram indicators of the patients (aged 25 to 30 years) in the standard therapy and the therapy with use of PAP. The immunogram of patients with purulent inflammatory diseases of the skin in case of standard therapy and the therapy with the use of PAP Immunologic status indicators Normal values for an adult Standard treatment Treatment with use of PAP Up to More than Up to More than Leucocytes, v. abs. 3,0-9,0 4,0±0,5 6,0±0,3* 4,9±0,7 7,4±0,7* Lymphocytes, % 29,4±1,1 32,0±1,5 34,0±1,3 20,2±2,4 24,5±1,5 Lymphocytes, v. abs. 1,65±0,11 1,36±0,18 1,69±0,11 0,81±0,10 1,40±0,21* CD3+,% 67,3±1,2 46,0±4,0 50,4±3,2 56,0±2,5 46,0±4,2 CD3+ v. abs. 1,1±0,1 0,62±0,07 1,0±0,12* 0,43±0,06 0,85±0,07*

4 CD4+,% ,0±2,2 40,0±4,8 37,4±4,4 32,6±0,9 CD4+ v. abs. 0,6-1,6 0,50±0,04 0,77±0,11* 0,36±0,03 0,49±0,02* CD8+,% ,0±3,14 24,8±4,4 25,5±3,8 27,0±2,2 CD8+ v. abs.. 0,3-0,8 0,14±0,04 0,50±0,07* 0,24±0,03 0,51±0,07* CD22+,% 8,2±0,8 20,0±2,5 21,6±2,8 25,4±3,8 26,0±2,2 CD22+ v. abs. 0,14±0,1 0,27±0,03 0,21±0,07 0,22±0,04 0,47±0,07* Immunoreactive insulin (CD4: CD8) 1,2-2,5 1,94±0,24 1,61±0,40 1,47±0,30 1,21±0,20 Phagocytosis, % ,8±3,3 72,4±7,5 67,8±3,3 77,8±2,5* IgA, mg/% ,0±14,5 176,0±36,6 193,0±48,3 326,0±36,5* IgM, mg/% ,0±20,2 145,0±21,6 144,0±17,3 132,0±14,6 IgG, mg/% ,0±26,3 1150,0±23,3 1616,0±61,5 1787,0±57,5 CIC (circulating immune complexes), c.u ,0±27,1 100,0±7,1 44,3±11,9 84,3±13,4* Note. PAP platelet autoplasma; *- р<0,05 in relation to the appropriate therapy up to treatment. As it is concluded from the data obtained, both at the respondents in the group subjected to standard therapy, as well as at those subjected to complex therapy group, it was observed an increase in the overall content of leukocytes, including lymphocytes, in blood, although their values did not exceed the maximum norm. The analysis of T lymphocyte subpopulations in standard therapy and complexes demonstrates their level increase. Thus, at the complex treatment was observed absolute increase of the content of CD3 + (2.0 times), CD4 + (1.4 times) and CD8 + (2.1 times). It is known that the cytotoxic lymphocytes from the subpopulations of T lymphocytes with CD8 + marker regulates the various forms of humoral and cellular links of the immune response, inhibits the formation of immune complexes and the excess of the antibodies [6]. The immunoregulatory index (IRI) in the case of standard therapy and PRP therapy did not change significantly, although there was a trend to reduce it. The determining of the number of B cells (CD22 +) allowed to establish their absolute increase of their contents of better than 2 times at the inclusion of PRP in the treatment of patients. Also, in this group of patients was observed an increase of the phagocytic activity by 15%.

5 The level of the immunoglobulins of IgA class incase of complex therapy increased 1.7 times and that of other classes has changed slightly. As is known, IgA prevent the ingress of micro-organisms in tissues, limit the development of the inflammatory reactions, and contribute to the antibody-dependent cellular cytotoxicity [1, 3]. Simultaneously, the level of circulating immune complexes (CIC), which is the result of the compensatory reaction of antibody formation process, increased in case of complex therapy 1.9 times. As a result, the use of the own platelet plasma (PAP) in the therapy of the patients with purulent inflammatory skin diseases contributed to the activation and compensating reaction of the basic links of the immune system, oriented to mobilization of the protection forces of the body.