Protective effect of IgM against colonization of the respiratory tract by nontypeable Haemophilus influenzae in patients with hypogammaglobulinemia.
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Micol Romain, Kayal Samer, Mahlaoui Nizar, Beauté Julien, Brosselin Pauline, Dudoit Yasmine, Obenga Gaëlle, Barlogis Vincent, Aladjidi Nathalie, Kebaili Kamila, Thomas Caroline, Dulieu Fabienne, Monpoux Fabrice, Nové-Josserand Raphaële, Pellier Isabelle, Lambotte Olivier, Salmon Alexandra, Masseau Agathe, Galanaud Pierre, Oksenhendler Eric, Tabone Marie-Dominique, Teira Pierre, Coignard-Biehler Hélène, Lanternier Fanny, Join-Lambert Olivier, Mouillot Gaël, Theodorou Ioannis, Lecron Jean-Claude, Alyanakian Marie-Alexandra, Picard Capucine, Blanche Stéphane, Hermine Olivier, Suarez Felipe, Debré Marianne, Lecuit Marc, Lortholary Olivier, Durandy Anne, Fischer Alain
Аннотация
OBJECTIVE: This study is aimed at identifying specific microbiological and clinical (infections) characteristics that distinguish immunoglobulin-substituted patients with PHG from patients with HIgM syndrome.
METHODS: A cohort of patients with HIgM syndrome (n = 25) and a cohort of patients with PHG (n = 86) were monitored prospectively for 2 years while receiving similar polyvalent immunoglobulin replacement therapies. Regular bacterial analyses of nasal swabs and sputum were performed, and clinical events were recorded. In parallel, serum and saliva IgM antibody concentrations were measured.
RESULTS: When compared with patients with PHG, patients with HIgM syndrome were found to have a significantly lower risk of nontypeable Haemophilus influenzae carriage in particular (relative risk, 0.39; 95% CI, 0.21-0.63). Moreover, patients with HIgM syndrome (including those unable to generate somatic hypermutations of immunoglobulin genes) displayed anti-nontypeable H influenzae IgM antibodies in their serum and saliva. Also, patients with HIgM syndrome had a lower incidence of acute respiratory tract infections.
CONCLUSIONS: IgM antibodies appear to be microbiologically and clinically protective and might thus attenuate the infectious consequences of a lack of production of other immunoglobulin isotypes in patients with HIgM syndrome. Polyvalent IgG replacement therapy might not fully compensate for IgM deficiency. It might thus be worth adapting long-term antimicrobial prophylactic regimens according to the underlying B-cell immunodeficiency phenotype.