Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock
Background: Interleukin-6 (IL-6) is a pleiotropic cytokine with a multitude of pro-inflammatory effects. Serum C-reactive protein (CRP) is an acute phase protein induced mainly by IL-6 in response to inflammatory conditions, particularly infection. The biological functions of CRP include opsonisatio...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2019-11-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fimmu.2019.02629/full |
| _version_ | 1818131836375662592 |
|---|---|
| author | Marketa Bloomfield Marketa Bloomfield Zuzana Parackova Tamara Cabelova Iva Pospisilova Iva Pospisilova Pavel Kabicek Hana Houstkova Anna Sediva |
| author_facet | Marketa Bloomfield Marketa Bloomfield Zuzana Parackova Tamara Cabelova Iva Pospisilova Iva Pospisilova Pavel Kabicek Hana Houstkova Anna Sediva |
| author_sort | Marketa Bloomfield |
| collection | DOAJ |
| description | Background: Interleukin-6 (IL-6) is a pleiotropic cytokine with a multitude of pro-inflammatory effects. Serum C-reactive protein (CRP) is an acute phase protein induced mainly by IL-6 in response to inflammatory conditions, particularly infection. The biological functions of CRP include opsonisation, induction of phagocytosis, complement activation, or chemotaxis enhancement. Factors interfering with IL-6-mediated recruitment of innate immune responses, such as the presence of anti-IL6 antibodies, may therefore compromise the host resistance to microbial pathogens. This has major implications for the use of IL-6-targeting biologics, such as tocilizumab or sarilumab in rheumatologic, immune dysregulation diseases, and cancer.Case presentation: 20-month-old Czech female developed severe septic shock with clinical and laboratory signs of systemic inflammation but no increase of CRP or IL-6. The offending pathogen was most likely Staphylococcus aureus, detected in a throat swab; the response to antibiotic treatment was prompt. A defect in the integrity of IL-6/CRP axis was suspected and verified by the detection of neutralizing IL-6 antibodies in the serum of the child.Conclusion: We report a first case of systemic bacterial infection in a patient with anti-IL6 autoantibodies. Disturbed IL-6 signaling, whether iatrogenic by targeted IL-6 blockade or endogenous due to the presence of autoantibodies against IL-6, represents a risk factor for increased infectious susceptibility. Patients with severe bacterial infection without elevation of CRP should be examined for the presence of anti-IL6 autoantibodies. |
| first_indexed | 2024-12-11T08:27:16Z |
| format | Article |
| id | doaj.art-a234fccc451f4aafadfc855943facb72 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-11T08:27:16Z |
| publishDate | 2019-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-a234fccc451f4aafadfc855943facb722022-12-22T01:14:32ZengFrontiers Media S.A.Frontiers in Immunology1664-32242019-11-011010.3389/fimmu.2019.02629491955Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic ShockMarketa Bloomfield0Marketa Bloomfield1Zuzana Parackova2Tamara Cabelova3Iva Pospisilova4Iva Pospisilova5Pavel Kabicek6Hana Houstkova7Anna Sediva8Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, CzechiaDepartment of Pediatrics, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, CzechiaDepartment of Pediatrics, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Pediatrics, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Clinical Chemistry, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Pediatrics, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Pediatrics, 1st Faculty of Medicine, Thomayer's Hospital and Charles University, Prague, CzechiaDepartment of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, CzechiaBackground: Interleukin-6 (IL-6) is a pleiotropic cytokine with a multitude of pro-inflammatory effects. Serum C-reactive protein (CRP) is an acute phase protein induced mainly by IL-6 in response to inflammatory conditions, particularly infection. The biological functions of CRP include opsonisation, induction of phagocytosis, complement activation, or chemotaxis enhancement. Factors interfering with IL-6-mediated recruitment of innate immune responses, such as the presence of anti-IL6 antibodies, may therefore compromise the host resistance to microbial pathogens. This has major implications for the use of IL-6-targeting biologics, such as tocilizumab or sarilumab in rheumatologic, immune dysregulation diseases, and cancer.Case presentation: 20-month-old Czech female developed severe septic shock with clinical and laboratory signs of systemic inflammation but no increase of CRP or IL-6. The offending pathogen was most likely Staphylococcus aureus, detected in a throat swab; the response to antibiotic treatment was prompt. A defect in the integrity of IL-6/CRP axis was suspected and verified by the detection of neutralizing IL-6 antibodies in the serum of the child.Conclusion: We report a first case of systemic bacterial infection in a patient with anti-IL6 autoantibodies. Disturbed IL-6 signaling, whether iatrogenic by targeted IL-6 blockade or endogenous due to the presence of autoantibodies against IL-6, represents a risk factor for increased infectious susceptibility. Patients with severe bacterial infection without elevation of CRP should be examined for the presence of anti-IL6 autoantibodies.https://www.frontiersin.org/article/10.3389/fimmu.2019.02629/fullinterleukin 6C-reactive proteinanti-IL6 autoantibodiestocilizumabsiltuximabsarilumab |
| spellingShingle | Marketa Bloomfield Marketa Bloomfield Zuzana Parackova Tamara Cabelova Iva Pospisilova Iva Pospisilova Pavel Kabicek Hana Houstkova Anna Sediva Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock Frontiers in Immunology interleukin 6 C-reactive protein anti-IL6 autoantibodies tocilizumab siltuximab sarilumab |
| title | Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock |
| title_full | Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock |
| title_fullStr | Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock |
| title_full_unstemmed | Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock |
| title_short | Anti-IL6 Autoantibodies in an Infant With CRP-Less Septic Shock |
| title_sort | anti il6 autoantibodies in an infant with crp less septic shock |
| topic | interleukin 6 C-reactive protein anti-IL6 autoantibodies tocilizumab siltuximab sarilumab |
| url | https://www.frontiersin.org/article/10.3389/fimmu.2019.02629/full |
| work_keys_str_mv | AT marketabloomfield antiil6autoantibodiesinaninfantwithcrplesssepticshock AT marketabloomfield antiil6autoantibodiesinaninfantwithcrplesssepticshock AT zuzanaparackova antiil6autoantibodiesinaninfantwithcrplesssepticshock AT tamaracabelova antiil6autoantibodiesinaninfantwithcrplesssepticshock AT ivapospisilova antiil6autoantibodiesinaninfantwithcrplesssepticshock AT ivapospisilova antiil6autoantibodiesinaninfantwithcrplesssepticshock AT pavelkabicek antiil6autoantibodiesinaninfantwithcrplesssepticshock AT hanahoustkova antiil6autoantibodiesinaninfantwithcrplesssepticshock AT annasediva antiil6autoantibodiesinaninfantwithcrplesssepticshock |