Why do you want to test cytokines？
What are cytokines?
Cytokines are a kind of multifunctional, low molecular weight and secretory protein, which can reach other parts of the body more easily through blood and lymph circulation, such as kidney, liver, bone marrow, spleen and lymph nodes. When the body is infected by pathogenic microorganisms, immune cells, epithelial cells at the infected site and vascular/lymphatic endothelial cells will produce a variety of cytokines, which will call immune cells to the infected site and jointly form a defense response to clear the infection.
Cytokines can be divided into two categories: one is pro-inflammatory cytokines, which can help activate many kinds of immune cells and promote the occurrence and development of inflammatory reactions. The second type is anti-inflammatory cytokines, which, as the name implies, can subside or inhibit inflammatory reaction and make the body return to steady state.
When infected by pathogenic microorganisms, various cytokines released by immune cells, epithelial cells, endothelial cells, etc. act on receptors on the surfaces of other cells to establish a network of cytokines and even various immune cells, and accurately and timely regulate the process and degree of anti-infection immune response. When the body uses cytokines and other immune effector molecules to remove pathogenic microorganisms, the inflammatory reaction subsides and the body returns to steady state.
For example, IL-6 can not only promote the expression of IL-1β and TNFα-α, but also help other lymphocytes to activate, or recruit more neutrophils and macrophages to accumulate in infected tissues. Cells (such as regulatory T cells, Treg) and cytokines (IL-10 and TGF-β) that can antagonize or inhibit inflammation play an important role in the regression period of inflammatory reaction.
The main types of cytokines include interleukin ,IL), interferon ,IFN), chemokine ,CK), tumor necroptosis factor ,TNF), transforming growth factor β (TGF-β) family and colony-stimulating factor ,CSF).
Why detect cytokines?
Cytokines are involved in immune and inflammatory reactions of the body, which are very sensitive inflammatory indicators. Dynamic monitoring of cytokine levels in the process of disease development can timely find the tendency of disease to get worse, treat it in time, avoid or reduce the risk of deterioration of the disease, achieve "no serious treatment" and improve the effective rate of clinical treatment.
At present, the joint detection of cytokines includes six, seven, twelve and fourteen items, including IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17 and TNF-α.
Combined detection is helpful for clinical realization:
1.Auxiliary diagnosis of early infection, timely guidance of treatment, to avoid the deterioration of the disease; Evaluate the efficacy earlier and avoid overtreatment.
2. Identify the source of infection
Studies have shown that cytokines will increase and change in different degrees when infected by bacteria and viruses. When the relevant cytokines exceed the critical value, they can be used as the basis for identifying the source of infection.
3. Early warning of cytokine storm and timely treatment can improve the survival rate of critically ill patients.
Sepsis, severe infection, hemophagocytic syndrome, tumor immunotherapy, fever to be investigated, rare mutant virus infection or patients undergoing major surgery can all cause cytokine storms. Monitoring cytokines and timely treatment can improve the survival rate of critically ill patients.
4. Evaluate the inflammatory and immune status of the body (SIRS/CARS/MARS) and provide accurate treatment.
Severe patients may have three inflammatory/immune states: SIRS (Systemic Inflammatory Response Syndrome), CARS (Antagonistic Inflammatory Response Syndrome) and MARS (Mixed Antagonistic Response Syndrome). Monitoring the level of cytokines in critically ill patients is helpful to distinguish the immune/inflammatory state and provide accurate treatment.
5. Monitor the immune function of critically ill patients.
Severe patients generally have severe infection or inflammation. Under normal immune function, pro-inflammatory cytokines will increase significantly. If cytokines in severe patients do not increase or slightly increase, but CRP or white blood cells increase significantly, it indicates that patients’ immune function is inhibited.
6. Early warning of abortion and pre-eclampsia risk
Normal pregnancy requires the maternal immune system to recognize the fetal antigen from the father and produce immune tolerance. If the immune tolerance microenvironment is out of balance, it will lead to abortion. Therefore, the detection of cytokines can evaluate the risk of abortion of pregnant women and the clinical therapeutic effect of some infertile patients.
7. Guide the clinical application of hormones/anti-inflammatory drugs to avoid excessive dosage and lead to excessive immunosuppression.
Patients with strong inflammatory reaction need hormone therapy, but too high dose of hormone/anti-inflammatory drugs can easily lead to low immune function. Detection of cytokines can evaluate the immune function of the body, guide clinical dose adjustment, and reduce the risk of secondary infection caused by hormone/anti-inflammatory drugs.
8. Autoimmune disease condition/efficacy monitoring
The pathological injury mechanism of autoimmune diseases is inflammatory reaction, and cytokines play an important role in the pathological injury process of autoimmune diseases, such as IL-6, IL-8 and TNF-α in rheumatoid arthritis. By monitoring the changes of cytokines, the therapeutic effect and condition of autoimmune diseases can be evaluated.
9. Monitor the progress/prognosis and curative effect of inflammation caused by radiotherapy and chemotherapy/immunotherapy/postoperative.
After chemotherapy or immunotherapy, tumor patients will lead to an increase in the level of pro-inflammatory cytokines, leading to a strong inflammatory response. Detection of cytokine levels can evaluate the severity of inflammatory response caused by radiotherapy and chemotherapy or immunotherapy.
At present, the immunotherapy effect of PD-1 or CAR-T on tumors has been recognized by clinical experts and patients, but at the same time, there are serious clinical adverse reactions, among which the highest and most serious one is cytokine release syndrome (CRS). CRS is characterized by a large increase of multiple cytokines, with a single cytokine increasing by more than 250 times and two or more cytokines increasing by more than 75 times, which indicates the occurrence of CRS.
Excluding infection, if the level of Th1 cytokines (IL-2, IFN-γ, TNF-α) increases, it indicates that the tumor condition is getting better or the treatment scheme is effective. If the level of Th2 cytokines (IL-4, IL-6, IL-10) is increased, it indicates that the tumor is progressing or the treatment scheme is ineffective.
summarize
As a sensitive inflammatory index, the imbalance of cytokine expression and regulation is related to the occurrence and development of many diseases, which has a wide range of application values in clinical departments and is an ideal monitoring index for precision medical treatment and personalized treatment.
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WenzhanglaiSource: Zhengzhou Huawo Medical Inspection Institute, reservation.Please contact us if there is any infringement or reprinting restriction, and we will contact you as soon as possible to delete it.
Editor: Green is about to drip
Review: Chenchen