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Clinical Investigations: PNEUMONIA |

Role of Interleukin-18 and T-helper Type 1 Cytokines in the Development of Mycoplasma pneumoniae Pneumonia in Adults*

Hiroshi Tanaka, MD; Mitsuo Narita, MD; Shin Teramoto, MD; Toyohiro Saikai, MD; Kensuke Oashi, MD; Tomofumi Igarashi, MD; Shosaku Abe, MD
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*From the Third Department of Internal Medicine (Drs. Tanaka, Teramoto, Saikai, Oashi, and Abe), Sapporo Medical University School of Medicine, Sapporo; Department of Pediatrics (Dr. Narita), Sapporo Tetsudo (JR) Hospital; and Respiratory Medicine (Dr. Igarashi), Kushiro City General Hospital, Kushiro, Japan.

Correspondence to: Hiroshi Tanaka, MD, Third Department of Internal Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-8543, Japan; e-mail: tanakah@sapmed.ac.jp



Chest. 2002;121(5):1493-1497. doi:10.1378/chest.121.5.1493
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Study objective: Interleukin (IL)-18 is a proinflammatory cytokine, originally termed interferon (IFN)-γ-inducing factor, which promotes T-helper type 1 (Th1) cytokine responses. We recently reported that serum IL-18 levels were elevated in children with Mycoplasma pneumoniae pneumonia (MP). In this study, we investigated the contribution of IL-18 to the infection and assessed the Th1 cytokine response to pulmonary involvement in adults.

Methods: We investigated the clinical course, pulmonary involvement, and serum levels of IL-18, IFN-γ, IL-12p40, and soluble IL-2 receptor (sIL-2R) in 21 patients with acute-stage MP and in 21 age- and sex-matched control subjects.

Results: Significantly (p < 0.001) increased serum IL-18 (median, 248 pg/mL [range, 89 to 441 pg/mL] vs median, 126 pg/mL [range, 47 to 217 pg/mL]) and sIL-2R (median, 617 U/mL [range, 410 to 1,032 U/mL] vs median, 425 U/mL [range, 268 to 601 U/mL]) were found in patients with MP as compared with healthy control subjects, and there was a tendency toward increased serum IFN-γ and IL-12p40. Circulating IL-18 values had a positive correlation with serum sIL-2R levels (r = 0.62, p = 0.028) and the number of affected pulmonary lobes (ς = 0.61, p = 0.024), but not with the serum levels of antibodies to M pneumoniae, IFN-γ, or IL-12p40. Serum IL-18 and sIL-2R values in severe cases were significantly higher (p < 0.03) than those in mild cases. IFN-γ and sIL-2R levels in four patients with pleural effusion were significantly (p < 0.05) higher than those in the other 17 subjects.

Conclusions: Serum levels of IL-18 were raised during the acute phase of MP. We suggest IL-18 and Th1 cytokines may play a significant role in the immunopathologic responses in MP.

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