Study of serum interleukin 5 level and factors that impact on this level in Iraqi asthmatic children

Raghdah Maytham Hameed; Haidar Abdul Amir Najim Abood; Mohanad Mohsin Ahmed; Aqeel Mahdi Hussein

doi:10.4103/bbrj.bbrj_126_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 3 | Issue : 4 | Page : 249-252

Study of serum interleukin 5 level and factors that impact on this level in Iraqi asthmatic children

Raghdah Maytham Hameed¹, Haidar Abdul Amir Najim Abood², Mohanad Mohsin Ahmed¹, Aqeel Mahdi Hussein³
¹ Department of Medical Microbiology, University of Kerbala, Karbala, Iraq
² Department of Pharmacology, University of Kerbala, Karbala, Iraq
³ Department of Consultant Pediatrician, Karbala Teaching Hospital for Children, Karbala, Iraq

Date of Submission	26-Aug-2019
Date of Acceptance	28-Sep-2019
Date of Web Publication	03-Dec-2019

Correspondence Address:
Ms. Raghdah Maytham Hameed
Department of Medical Microbiology, University of Kerbala, Kerbala
Iraq

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bbrj.bbrj_126_19

Abstract

Background: Interleukin-5 (IL-5) is a cytokine associated with the cause of several allergic diseases such as asthma due to their function in growth, activation, and maturation of eosinophils and stimulates B-cell growth and increases immunoglobulin E (IgE) secretion. The study aims to measure the IL-5 level in asthmatic children and detect the relationship between IL-5 level with eosinophils, total serum IgE level, and asthma severity. Methods: Eighty asthmatic children, including 55 males and 25 females with asthma who aged between 1 and 16 years collected at Kerbala Teaching Hospital for Children, were measured IL-5 level using Elabscience ELISA kit and measured total IgE level using EUROIMMUN IgE ELISA kit. However, absolute eosinophils count was examined by peripheral blood smear. In addition, the clinical characteristics of the patients were recorded by a questionnaire. Results: There was a significant difference in IL-5 level in asthma patients depending on sex, absolute eosinophil count, and use of treatment (P = 0.046, 0.046, and 0.001, respectively). However, there was no effect on the IL-5 level at asthmatic children depending on the age, body mass index, resident, exposure to cigarette smoking, family history of asthma/allergic diseases, asthma severity, and total serum IgE (P = 0.936, 0.769, 0.154, 0.898, 0.614, 0.550, and 0.874, respectively). Conclusions: IL-5 level had a positive correlation with absolute eosinophils count but not with total serum IgE. In addition, IL-5 level was a poor indicator of asthma severity.

Keywords: Asthma, eosinophil, interleukin 5, total serum immunoglobulin E

How to cite this article:
Hameed RM, Abood HA, Ahmed MM, Hussein AM. Study of serum interleukin 5 level and factors that impact on this level in Iraqi asthmatic children. Biomed Biotechnol Res J 2019;3:249-52

How to cite this URL:
Hameed RM, Abood HA, Ahmed MM, Hussein AM. Study of serum interleukin 5 level and factors that impact on this level in Iraqi asthmatic children. Biomed Biotechnol Res J [serial online] 2019 [cited 2020 Apr 8];3:249-52. Available from: http://www.bmbtrj.org/text.asp?2019/3/4/249/272187

Introduction

Asthma is the most common chronic lower respiratory tract and noncommunicable diseases in children and adults throughout the world, characterized by inflammation which affects both proximal and distal airways.^{[1],[2],[3],[4],[5]} It is a highly prevalent chronic inflammatory disease of the airways, with differences in etiology, immunologic mechanisms, clinical presentation, pathogenesis, comorbidities, prognosis, and response to treatment.^[6] Asthma is primarily an inflammatory disorder of the airways associated with T-helper type 2 (Th2), cell-dependent promotion of immunoglobulin E (IgE) production, and recruitment of mast cells and eosinophils.^[7] Allergic asthma may involve adaptive and innate, antigen-independent immune responses.^[8] Th2-type cytokines, such as interleukin 4 (IL-4), IL-5, and IL-13, are thought to drive the disease pathology in patients with asthma and play a role in driving many of the hallmarks of allergic inflammation.^[9],[10] IL-5 is the critical molecular switch for developing, migrating, and recruiting eosinophils to the lung during allergic inflammation.^[11],[12] IL-5 exerts its biological actions via stimulation of the IL-5 receptor expressed by eosinophils, and to a lesser extent, also by basophils.^[13]

IL-5 is an interdigitation homodimeric glycoprotein.^[14] IL-5 is produced by both hematopoietic and nonhematopoietic cells, including T-cells, granulocytes, and natural helper cells.^[15] IL-5 regulates the growth, differentiation, and activation of eosinophils.^[16] In addition, overexpression of IL-5 significantly increases antibody levelsin vivo and is reported to act as a B-cell differentiation factor by stimulating activated B-cells to secrete antibody.^[17],[18]

Ethical approval

The study protocol was approved by the Ethical Committee in the Kerbala Health Directorate. In addition, verbal approval was taken from the patients and/or their parents before taking the sample. Health measures and safety were taken when sampling.

Methods

Subjects

A cross-sectional study was carried out at Karbala Teaching Hospital for Children; the study was conducted from October 2018 to December 2018 and included 80 asthmatic children (55 males and 25 females, aged between 1 and 16 years). All children in this study were diagnosed as asthmatic patients by a clinician. A questionnaire was framed for collecting the information and clinical data from patients or their parents.

Sample collection and processing

Sera were used to determine the serum IL-5 and total serum IgE levels by BioTek ELX800 automated immunoassay analyzer (BioTek, USA) using Elabscience ELISA kit (LOT NO. 4CN1IPT94C) and EUROIMMUN total IgE ELISA kit (LOT NO. A180417AC), respectively. While, whole blood was used for total and differential white blood cells' count that was measured by Sysmex XN-350 five differential automated hematology analyzer (Sysmex, Japan). Differential leukocyte count was displayed in percentage. Therefore, the absolute eosinophil count was measured by the following equation: Absolute eosinophil count = (WBC × eosinophils%)/100.

Data analysis

Data were introduced into a specific software Statistical Package for the Social Sciences version 21 for Windows (GraphPad Software, San Diego, California, USA) to do the statistical analysis. The results were expressed as mean ± standard deviation. Comparisons between two means were performed using t-test, while ANOVA was using to compare among mean. A P< 0.05 was considered to indicate the statistical significance and highly significant if P < 0.001.

Results

[Table 1] shows the demographic and biochemical profile of asthmatic children. Comparison between demographic pictures, clinical characteristics, and immunological parameters of asthmatic children in IL-5 levels is presented in [Table 2].

Table 1: Characteristics of study population (n=85)

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Table 2: Comparison between demographic pictures, clinical characteristics, and immunological parameters of asthmatic children in interleukin-5 levels

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Further, in this study, there was a significant difference in the IL-5 level in asthma patients depending on sex, absolute eosinophil count, and use of treatment (P = 0.046, 0.046, and 0.001, respectively). However, there was no effect on IL-5 level at asthmatic children depending on the age, body mass index, resident, exposure to cigarette smoking, family history of asthma/allergic diseases, asthma severity, and total serum IgE (P = 0.936, 0.769, 0.154, 0.898, 0.614, 0.550, and 0.874 respectively), as shown in [Table 2].

Discussion

IL-5 is thought to have an important role in the pathogenesis of asthma^[19] and prominent feature of airway inflammation in asthma^[20] due to their ability to regulate the growth, activation, and survival of eosinophils.^{[13],[16],[21],[22]}

The current study shows a significant correlation between serum IL-5 levels and absolute eosinophil count in asthmatic children (P = 0.045). The result agrees with the previous study,^[23] who mentioned that a robust relationship between blood eosinophilia and IL-5. In addition, Kuo et al. and Kouro and Takatsu^[17],[24] concluded that there was increased expression of IL-5 of patients with asthma and this expression may autoregulate eosinophil and increase eosinophil numbers. Other researchers found that the biologic effects of IL-5 were best characterized by eosinophils.^[22] This result is because IL-5 is the key cytokine responsible for maturation, activation, proliferation, and survival of eosinophils.^[25] IL-5 is responsible for the maturation and release of eosinophils in the bone marrow.^[13] IL-5 is a critical regulator of eosinophilia and has effects on eosinophil progenitors.^[26] In addition, IL-5 acts on eosinophils at multiple functional levels and time points during their life span.^[27]

The study shows no significant correlation between IL-5 levels and total serum IgE in asthmatic children (P = 0.874). The result agrees with other previous results, who mentioned that IL-5 alone was not enough to induce IgE production.^{[28],[29],[30]} Deo et al.^[31] confirmed the importance of IL-5 in eosinophilic inflammation but no correlation between IL-5 levels and IgE in asthma (P = 0.13). In contrast, another study showed that IL-5 production was associated within vivo total IgE levels in an infant.^[32]

This study shows that the serum IL-5 levels were 32.4 pg/ml in moderate asthma while 31.2 pg/ml in mild asthma. This result agrees with previous study,^[19] who mentioned that IL-5 levels elevated in mild and moderate asthma, but there was a tendency for serum IL-5 levels to be higher in moderate asthmatic children compared to mild asthmatic children. The serum IL-5 levels had no highly significant difference between mild and moderate asthma (high levels in mild and moderate) because IL-5 could have contributed to airway smooth muscle hyperresponsiveness and airway inflammation and this result is as same as another previous study.^[33] Moreover, Huang et al. mentioned that serum IL-5 levels were a poor indicator of disease activity in acute asthma. The presence of IL-5 might be more relevant to the pathogenesis of asthma but not be closely reflected asthma severity.^[34] This finding is also consistent with the present study.

Higher serum IL-5 levels might relate to obesity in patients with asthma,^[35],[36] while the current study disagrees with previous study. There was no significant associated between high mean of IL-5 levels and obesity in asthmatic children. The present study shows no significant difference in IL-5 level between asthmatic patients who exposed to smoking and patients not exposed, but on the contrary, Krisiukeniene et al. reported higher IL-5 levels found in asthmatic patients who never smoked.^[37]

The results of the study reveal that the level of IL-5 in asthmatic children on controller therapy was lower than the level in patients without controller (25.2 ml and 36.8 pg/ml respectively, P < 0.001). This result agrees with other previous studies, who mentioned that after montelukast therapy for 7 days, the levels of IL-5 in patients were significantly decreased.^[38],[39] The cause of IL-5 level reduction is that montelukast can regulate the Th1/Th2 balance, block IL-5 mRNA expression, and improve the airway inflammation caused by acute bronchial asthma (BA) and the clinical symptoms and lung function of patients with acute BA.^[39]

Conclusions

IL-5 has an important role in asthma pathogenesis through activation, maturation, and attraction of eosinophils. IL-5 level has a positive correlation with absolute eosinophils count but not with total serum IgE levels. Further, IL-5 level was high in both mild and moderate asthma. The use of montelukast treatment may reduce IL-5 level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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