title: An Alteration of Lymphocytes Subpopulations and Immunoglobulins Levels in Patients with Diabetic Foot Ulcers Infected Particularly by Resistant Pathogens.
abstract: Theaimof our study was to analyse immune abnormalities in patients with chronic infected diabetic foot ulcers (DFUs) especially those infected by resistant microorganisms.Methods. 68 patients treated in our foot clinic for infected chronic DFUs with 34 matched diabetic controls were studied. Patients with infected DFUs were subdivided into two subgroups according to the antibiotic sensitivity of causal pathogen: subgroup S infected by sensitive (n= 50) and subgroup R by resistant pathogens (n= 18). Selected immunological markers were compared between the study groups and subgroups.Results. Patients with infected chronic DFUs had, in comparison with diabetic controls, significantly reduced percentages (p< 0.01) and total numbers of lymphocytes (p< 0.001) involving B lymphocytes (p< 0.01), CD4+ (p< 0.01), and CD8+ T cells (p< 0.01) and their naive and memory effector cells. Higher levels of IgG (p< 0.05) including IgG1 (p< 0.001) and IgG3 (p< 0.05) were found in patients with DFUs compared to diabetic controls. Serum levels of immunoglobulin subclasses IgG2 and IgG3 correlated negatively with metabolic control (p< 0.05). A trend towards an increased frequency of IgG2 deficiency was found in patients with DFUs compared to diabetic controls (22% versus 15%; NS). Subgroup R revealed lower levels of immunoglobulins, especially of IgG4 (p< 0.01) in contrast to patients infected by sensitive bacteria. The innate immunity did not differ significantly between the study groups.Conclusion. Our study showed changes mainly in the adaptive immune system represented by low levels of lymphocyte subpopulations and their memory effector cells, and also changes in humoral immunity in patients with DFUs, even those infected by resistant pathogens, in comparison with diabetic controls.
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Vladimíra
authors.identifier: 0000-0003-4486-5383
authors.initials: V
authors.lastname: Fejfarová
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jirkovská
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Dubský
authors.affiliation: Diabetes Unit, Derby Hospitals NHS Foundation Trust, Derby, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Game
authors.affiliation: Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Vydláková
authors.affiliation: Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Sekerková
authors.affiliation: Department of Clinical Biochemistry, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Franeková
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Monika
authors.initials: M
authors.lastname: Kučerová
authors.affiliation: Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ilja
authors.initials: I
authors.lastname: Stříž
authors.affiliation: Department of Clinical Microbiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Petkov
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Robert
authors.identifier: 0000-0003-4127-1846
authors.initials: R
authors.lastname: Bém
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Veronika
authors.identifier: 0000-0001-5371-7011
authors.initials: V
authors.lastname: Wosková
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Andrea
authors.initials: A
authors.lastname: Němcová
authors.affiliation: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jelena
authors.initials: J
authors.lastname: Skibová
mesh_terms: D056704:Adaptive Immunity; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D006801:Humans; D007113:Immunity, Innate; D007136:Immunoglobulins / Q000097:blood*; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D007136:Immunoglobulins