Prognostic value of TH1/TH2 cytokines in infants with wheezing in a three year follow-up study.

Introduction: The immune system is known to play a key role in the development of viral-induced wheeze, but the pattern of cytokine response is not clear. The aim of the study was to determine whether plasma cytokine levels during the acute wheezing illness in infants are associated with the subsequent development of persistent recurrent wheezing (PRW).

Material And Methods: 43 infants admitted to Iashvili Central Children Hospital, Tbilisi, Georgia, were selected. The concentrations of IFN-g, TNF-a and IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). Total serum IgE level was also determined. IgM and IgG antibodies to RSV, Chlamydophila pneumonia and Mycoplasma pneumonia were tested by ELISA. All children were followed-up during 3 years period.

Results: There was no significant association with PRW and atopy in the infant or parental atopy, low maternal age, low birth weight, serum level of IL-6, serum level of IFN-g, serum level of total IgE and the particular pathogen. There was a tendency for the association with male sex, bottle feeding and household cigarette smoking, although the relation was not significant. There was just TNF-a which was strongly associated with the risk of PRW after three years of follow up.

Conclusion: We have identified TNF-a, as a biomarker, which can be detected in children under 3 years of age and may be useful in the prediction of development of persistence of wheezing later. To further evaluate the usefulness of this and other markers and establish cutoff levels for prediction and use in clinical practice, a larger prospective follow-up study is needed.