An open-label, pilot study to evaluate the benefits of using lyophilized human milk-derived nutritional product (NeoLact 70 – 1.55 g) as an immune-nutritional supplement in premature infants discharged from NICU

Background: Premature and low birth weight (LBW) infants are at increased risk of having inadequate growth in post-discharge periods. In this study, lyophilized human milk was used as an immune-nutrition supplement along with breastfeeding for a period of 1 month in preterm infants discharged from neonatal intensive care unit (NICU). Objectives: Primary objective was to assess the percentage change in serum immunoglobulins for the duration of supplementation, and secondary objectives were to correlate changes in immunoglobulins to number of episodes of infections including respiratory infections and diarrhea, requirement of antibiotics, weight gain, and episodes of feed intolerance during the study period. Methods: A total of 10 preterm and LBW infants were included in the study at the time of discharge from NICU after satisfying the inclusion and exclusion criteria. The serum immunoglobulins were estimated at baseline and at end of the study, other parameters such as episodes of infections, feed intolerance, and weight gain were recorded on the weekly follow-up visits. All the infants received supplementation with NeoLact 70 – 1.55 g on a TID frequency along with the regular breastfeeding for a period of 1-month post-discharge from NICU and were followed up on a weekly basis. Results: Ten infants completed the study, mean birth weight and gestational age were 1779.4±576 gm and 33.5±4.9 weeks, respectively. There was increase in immunoglobulins IgA, IgE, IgG, and IgM by 38.29%, 85.36%, 17.45%, and 48.25%, respectively, from baseline to end of study. None of the infants experienced feeding intolerance, diarrhea, abdominal distension, fever, respiratory infections, or rehospitalizations, none of the infants required antibiotics or probiotics during the study period. The average weight gain in the 1st, 2nd, 3rd, and 4th week of supplementation was 28.42 g/day, 31.57 g/day, 35.17 g/day, and 39.24 g/day, respectively, with a mean weight gain of 30.4 g/day achieved for the entire duration of the study. Conclusion: The immune-nutritional supplementation with lyophilized human milk (NeoLact 70 – 1.55 g) helps to ensure exclusive human milk diet post-discharge and reduce the risk of infections, diarrhea, and rehospitalization through the enhancement of immunoglobulins and ensuring optimal weight gain. However, these results should be confirmed through multicentric studies with larger sample size. Supplementation with NeoLact 70 – 1.55 g can clinically benefit premature and LBW infants post-discharge.

Alteration of Serum Immunoglobulin Levels in Woman with Ovarian Cancer

Ovarian cancer has a high mortality and delayed diagnosis. Several immunological alterations take place during ovarian carcinogenesis, and can be of value in the surveillance of the diseases. This research was conducted to evaluate serum immunoglobulin levels in women with ovarian cancer and to assess their role in disease process. The present study is composed of 85 women (mean age = 62.03±12.4 yrs) with clinically and pathologically confirmed ovarian cancer and 65 healthy females as a control group (mean age = 61±12.1 yrs). ELISA test was achieved for the determination of serum [IgG, IgA, IgM]. The findings of current study illustrated significant (P=0.001) increase in serum IgG, IgA, and IgM levels as compared to controls. Analyzing serum immunoglobulins levels might assist in identify patients with a weak prediction, the elevation of serum immunoglobulins can be considered as an indication for disease status.

Features of the immune status of middle and high school students in conditions of high blood content of a number of exogenous chemical impurities

Introduction. The quality of the habitat and increasing intensity of the educational load determine the negative changes of the health of schoolchildren, associated with a violation of immune mechanisms adaptation. Purpose. Study of features of the immune status of schoolchildren in the conditions of excessive hapten contamination by exogenous chemical factors. Materials and methods. Students who live in territories differing in the formation of excessive human-made chemical contamination (total 162 students) of senior and secondary education levels were examined. The analysis of contaminants in biological media utilizing gas chromatography method, high-performance liquid chromatography method, mass spectrometry method was performed. The state of cellular immunity was evaluated by the reaction of phagocytosis using formalinized ram erythrocytes and CD-immunogram parameters by flow cytometry. The state of humoral immunity identified with the production of serum immunoglobulins by radial immunodiffusion, as well as expression of specific antibodies to chemical factors by the method of allergosorbent testing. Results. We revealed an association of excess content of lead, nickel, formaldehyde, benzene, phenol in blood with deficiency phagocytic activity, imbalance of CD-subpopulations of immunocompetent cells characterized by the predominance of T lymphocytic activation (CD3+-lymphocytes), and a decrease in B-lymphocytes (CD19+-cells) both concerning the norm and to the group of schoolchildren with a permissible level of contaminating load. Secondary and senior students differed in imbalance of the immunoregulatory index CD4+/CD8+, and lower expression was revealed in high school students serum immunoglobulins IgM and IgA. In schoolchildren with excessive hapten contamination, there is a high level of sensitization to exogenous chemical factors according to the specific IgE antibodies to nickel, formaldehyde, and IgG to benzene, phenol, lead. Conclusion. The revealed imbalance of immune profile indices reflects the state of immunological health of schoolchildren, and the indices of cellular (immunoregulatory index CD4+/CD8+) and humoral (specific antihapten reagins) immunity, can be used as diagnostic for assessing the immune status in schoolchildren of secondary and senior levels of education in the conditions of excessive hapten contamination.

Association of Serum Immunoglobulins Levels With Specific Disease Phenotypes of Crohn's Disease: A Multicenter Analysis in China

Background and Aim: Serum immunoglobulins were reported to be associated with clinical characteristics of inflammatory bowel disease. However, whether a difference exists in the serum immunoglobulins levels in patients with Crohn's disease (CD) with different disease location and behavior phenotypes remains unclear. Therefore, this study aimed to explore the associations of serum immunoglobulins levels with specific CD phenotypes.Methods: Patients with CD having recorded serum immunoglobulins levels were recruited through multicenter collaborative efforts. The associations between serum immunoglobulins levels and distinct phenotypes of CD were evaluated using multiple logistic regression models.Results: A total of 608 patients with CD were included in the study. Elevated (above the upper limit of normal) serum immunoglobulin G (IgG), IgA, IgM, and IgG4 were identified in 24.5, 17.4, 2.1, and 8.2% of patients, respectively. Elevated serum IgG4 levels negatively correlated with complicated disease behavior [odds ratio (OR) 0.49, 95% confidence interval (CI) 0.26–0.92]. Elevated serum IgG was linked to isolated ileal disease with an OR of 0.37 (95% CI 0.23–0.61). The ORs of isolated ileal disease progressively reduced across increasing quartiles of IgG (P for trend < 0.001). The adjusted ORs of isolated ileal disease for increasing quartiles of IgM were 1.82 (1.07–3.1), 1.92 (1.14–3.24), 1.17 (0.69–1.98), and 1 (P for trend = 0.008). Besides, serum IgA and IgG levels significantly correlated with several disease activity indices.Conclusions: These results suggested that certain serum immunoglobulins were associated with specific disease phenotypes of CD. Further investigations to account for the associations are warranted.

Determinants of Serum Immunoglobulin Levels: A Systematic Review and Meta-Analysis

BackgroundAn up-to-date overview of determinants of serum immunoglobulins in adults is pivotal for clinical practice and research, but currently lacking. We therefore performed a systematic review and meta-analysis to identify determinants of serum immunoglobulin levels.MethodsEmbase, Web of Science, Medline, Cochrane, and Google Scholar were searched from inception to July 11th, 2019 for articles reporting on determinants of serum immunoglobulin A, G or M (IgA, IgG or IgM) in adult humans. Random and fixed effect models were applied to obtain pooled mean differences (MDs) and 95% confidence intervals (CIs) for the association of age and sex with serum immunoglobulins.ResultsWe retrieved 117 articles reporting on determinants of serum immunoglobulins, of which 28 could be meta-analyzed. Older compared to younger individuals had higher IgA (MD: 0.38; CI: 0.18 – 0.58), but lower IgM levels (MD: -0.40; 95%: -0.66 – -0.14). Men had higher IgA (MD: 0.22; CI: 0.03 – 0.42), but lower IgM levels (MD: -0.21; CI: -0.32 – -0.10) than women. Age and sex did not influence IgG. Caucasian ethnicity was associated with lower IgA, IgG, and IgM. Smoking and corticosteroid use were associated with lower IgG. Positive associations were reported of probiotics with IgG, alcohol with IgA, hypertension with IgA and IgG, and acute psychological stress with IgA, IgG, and IgM.ConclusionsOlder age and male sex are associated with higher IgA, but lower IgM, and urge investigation of age- and sex-specific reference ranges of immunoglobulins. Other identified determinants were ethnicity, diet, lifestyle and cardio-metabolic factors.

Clinical and immunological features in children with secondary hypogammaglobulinemiae

Antibody deficiency may be a manifestation of primary immunodeficiency or can be generated by extrinsic factors. The frequency of secondary hypogammaglobulinemias has increased significantly in recent years in children with oncohematological pathology. Purpose — to study of clinical, biochemical and immunological indicators in children with secondary hypogammaglobulinemiae in order to determine management and treatment tactics. Materials and methods. 52 children with secondary hypogammaglobulinemiae were examined. Children were divided into 4 groups according to the primary diagnosis (acute myeloblastic, lymphoblastic leukemia and mixed phenotype leukemia, glomerulonephritis, nephrotic syndrome). Anamnesis and data of immunological (levels of serum immunoglobulins IgA, IgM, IgG, subpopulations of lymphocytes) evaluation prior to immunoglobulin replacement therapy. Results. Infectious diseases were observed in 22 children (42.3%). Allergic diseases occurred in 11 children (21%). Toxic complications of chemotherapy by internal organs and systems were found in 38 children (73%). Chronic kidney disease was diagnosed in 5 children (10%). The level of IgG was the lowest in children with nephrotic syndrome (2.6±1.54 g/l). The level of T lymphocytes — CD3+ (0.89±0.93x109/l) and T cytotoxic lymphocytes — CD3+CD8+ (0.33±0.38x109/l) were the lowest in the group of children with acute lymphoblastic leukemia. The level of T helper cells (CD3+CD4+) was low in the group of children with acute lymphoblastic (0.39±0.4x109/l) and myeloblastic leukemia (0.69±0.39x109/l). Level of B lymphocytes was low in the group of children with acute lymphoblastic (0.23±0.23x109/l) and myeloblastic leukemia (0), as well as in the group of children with nephrotic syndrome (0.18±0.13x109/l). Conclusions. Infectious diseases are common in children with secondary hypogammaglobulinemiae. In the group of children with acute leukemia bacterial and fungal diseases occurred more frequently and were more severe compared to the group of children with nephrotic syndrome. Therefore children with secondary hypogammaglobulinemia require control of serum immunoglobulin levels before starting immunosuppressive therapy, bone marrow transplantation and after its completion for the timely initiation of immunoglobulin replacement therapy in order to prevent infectious diseases and their complications. There is a need to determine serum antibody levels in children with nephrotic syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of a participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: secondary hypohammaglobulinemia, children, serum immunoglobulins, subpopulations of lymphocytes, nephrotic syndrome, proteinuria, acute leukemia.