Severe H1N1 Infection Linked to Elevated Cytokine Levels

The role of Th1 and Th17 mediators in mild and severe H1N1 disease warrant further study
By Jeff Muise
HealthDay Reporter

TUESDAY, Dec. 22 (HealthDay News) -- Hospitalized patients with severe novel H1N1 virus (nvH1N1) infection at 10 Spanish hospitals had high levels of the Th17 and Th1 cytokines, indicating either a robust immune response to the infection or an over-response similar to that found in autoimmune diseases, according to research published online Dec. 11 in Critical Care.

Jesus F. Bermejo-Martin, M.D., of Hospital Clínico Universitario de Valladolid in Spain, and colleagues studied the early immune response of patients infected with the nvH1N1 during the pandemic wave of the virus in July and August 2009. The researchers measured systemic cytokine and chemokine levels in 20 severely infected patients hospitalized for respiratory insufficiency, 15 outpatients with milder symptoms, and 15 control subjects.

In the patients' early response, the researchers noted the absence of nvH1N1 antibodies and increased innate-immunity mediators in the patients with both mild and severe disease. However, among the patients with severe disease and respiratory involvement, they found high levels of T-helper 17 (Th17) and T-helper 1 (Th1) cytokines.

"While infection with the nvH1N1 induces a typical innate response in both mild and severe patients, severe disease with respiratory involvement is characterized by early secretion of Th17 and Th1 cytokines usually associated with cell mediated immunity but also commonly linked to the pathogenesis of autoimmune/inflammatory diseases," the authors write. "The exact role of Th1 and Th17 mediators in the evolution of nvH1N1 mild and severe disease merits further investigation as to the detrimental or beneficial role these cytokines play in severe illness."

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