Acute chemokine response in the blood and cerebrospinal fluid of children with enterovirus 71-associated brainstem encephalitis.
BACKGROUND
Brainstem encephalitis (BE) is a serious neurological complication of enterovirus 71 (EV71) infection. The present study was designed to determine the characteristics of the chemokine response in the blood and cerebrospinal fluid (CSF) of patients with EV71-associated BE.


METHODS
Thirty-one patients with BE were studied. They consisted of 12 with uncomplicated BE, 9 with autonomic nervous system (ANS) dysregulation, and 10 with pulmonary edema (PE); 13 healthy control subjects were also studied. Plasma and CSF concentrations of various chemokines were determined by a particle-based flow cytometry immunoassay.


RESULTS
Plasma levels of interferon (IFN)-gamma-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, monokine induced by IFN-gamma (MIG), and interleukin (IL)-8 were significantly higher in patients with PE than in those with uncomplicated BE. CSF levels of MIG were significantly higher in patients with PE than in those with uncomplicated BE and ANS dysregulation. The ratios of mean CSF to plasma levels for MCP-1 and IL-8 were highest in patients with uncomplicated BE and tended to fall with increasing severity of the disease.


CONCLUSIONS
Overexpression of the chemokine cascade in the central nervous system compartment appears to play an important role in the elicitation of the immune response to EV71. The chemokine CSF to plasma ratios suggest that IL-8, IP-10, MCP-1, and possibly MIG-but not RANTES-are synthesized in the brain in response to encephalitis.
Wang
Shih-Min
SM
Department of Emergency Medicine, National Cheng Kung University Medical College and Hospital, Taipei, Taiwan.
Lei
Huan-Yao
HY
Yu
Chun-Keung
CK
Wang
Jen-Ren
JR
Su
Ih-Jen
IJ
Liu
Ching-Chuan
CC
D001933:Brain Stem / Q000821:virology*; D018932:Chemokine CCL2 / Q000097:blood / Q000134:cerebrospinal fluid; D018946:Chemokine CCL5 / Q000097:blood / Q000134:cerebrospinal fluid; D054357:Chemokine CXCL10 / Q000097:blood / Q000134:cerebrospinal fluid; D054370:Chemokine CXCL9 / Q000097:blood / Q000134:cerebrospinal fluid; D018925:Chemokines / Q000097:blood* / Q000134:cerebrospinal fluid*; D002648:Child; D018792:Encephalitis, Viral / Q000276:immunology*; D029821:Enterovirus A, Human; D004769:Enterovirus Infections / Q000276:immunology*; D006801:Humans; D016209:Interleukin-8 / Q000097:blood / Q000134:cerebrospinal fluid; D010614:Pharynx / Q000821:virology
C111835:CCL2 protein, human; C483024:CCL5 protein, human; C114753:CXCL10 protein, human; C080810:CXCL9 protein, human; D018932:Chemokine CCL2; D018946:Chemokine CCL5; D054357:Chemokine CXCL10; D054370:Chemokine CXCL9; D018925:Chemokines; D016209:Interleukin-8