Research Article
An Alteration of Lymphocytes Subpopulations and
Immunoglobulins Levels in Patients with Diabetic Foot
Ulcers Infected Particularly by Resistant Pathogens
Vladimíra Fejfarová,
1
Alexandra Jirkovská,
1
Michal Dubský,
1
Frances Game,
2
Jana Vydláková,
3
Alena Sekerková,
3
Jana Franeková,
4
Monika KuIerová,
1
Ilja StlíD,
3
Vladimír Petkov,
5
Robert Bém,
1
Veronika Wosková,
1
Andrea Njmcová,
1
and Jelena Skibová
1
1
Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
2
Diabetes Unit, Derby Hospitals NHS Foundation Trust, Derby, UK
3
Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
4
Department of Clinical Biochemistry, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
5
Department of Clinical Microbiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Correspondence should be addressed to Vladim´ ıra Fejfarov´ a; vlfe@medicon.cz
Received 15 May 2016; Revised 30 September 2016; Accepted 17 October 2016
Academic Editor: Eusebio Chiefari
Copyright © 2016 Vladim´ ıra Fejfarov´ a et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Te aim of our study was to analyse immune abnormalities in patients with chronic infected diabetic foot ulcers (DFUs) especially
those infected by resistant microorganisms. Methods. 68 patients treated in our foot clinic for infected chronic DFUs with 34
matched diabetic controls were studied. Patients with infected DFUs were subdivided into two subgroups according to the antibiotic
sensitivity of causal pathogen: subgroup S infected by sensitive ( = 50) and subgroup R by resistant pathogens ( = 18). Selected
immunological markers were compared between the study groups and subgroups. Results. Patients with infected chronic DFUs had,
in comparison with diabetic controls, signifcantly reduced percentages ( < 0.01) and total numbers of lymphocytes ( < 0.001)
involving B lymphocytes ( < 0.01), CD4+ ( < 0.01), and CD8+ T cells ( < 0.01) and their naive and memory efector cells.
Higher levels of IgG ( < 0.05) including IgG1 ( < 0.001) and IgG3 ( < 0.05) were found in patients with DFUs compared
to diabetic controls. Serum levels of immunoglobulin subclasses IgG2 and IgG3 correlated negatively with metabolic control
( < 0.05). A trend towards an increased frequency of IgG2 defciency was found in patients with DFUs compared to diabetic
controls (22% versus 15%; NS). Subgroup R revealed lower levels of immunoglobulins, especially of IgG4 ( < 0.01) in contrast to
patients infected by sensitive bacteria. Te innate immunity did not difer signifcantly between the study groups. Conclusion. Our
study showed changes mainly in the adaptive immune system represented by low levels of lymphocyte subpopulations and their
memory efector cells, and also changes in humoral immunity in patients with DFUs, even those infected by resistant pathogens,
in comparison with diabetic controls.
1. Introduction
During the process of infection, afer the engagement of
innate immunity into the defence system, adaptive immu-
nity is activated. Tis type of immunity consists of dual
branches of cellular and humoral immunity. Te principal
efectors of cellular immunity are T lymphocytes, while the
principle efectors of humoral immunity are B lymphocytes
[1]. Te activation of adaptive immunity is mediated by the
production of antibodies by B lymphocytes that are able, for
example, to block the adhesion of pathogens on mucosal
surfaces, agglutinate bacteria, or to neutralise pathogens
in blood circulation and subsequently activate complement
[2]. Te antigens are then eliminated by T cells or in
Hindawi Publishing Corporation
Journal of Diabetes Research
Volume 2016, Article ID 2356870, 9 pages
http://dx.doi.org/10.1155/2016/2356870