Article received: 14.04.2013, accepted for publication: It has been traditionally considered that primary immunodeficiency states (PID) are rare diseases. However, the incidence rate of PID in Europe is significantly higher than in Russia: our statistics on innate immunodeficiency morbidity is far from reality. Experience of establishing a register of PID patients in the Rostov Region proved that the combination of organizational and educational activities contributes to timely diagnostics, rational therapy and life quality improvement in patients with primary immunodeficiencies.

Lifetime use of IgG replacement therapy  is the standard of CVID treatment. However, full control over stabilization of chronic infection loci is not always achieved, even if this therapy  is continuously applied. The purpose  of this study was to carry out comparative analysis of changes  in cellular  component of adaptive and  innate immune response, depending on effectiveness of replacement therapy  of patients with infectious CVID  phenotype. The  observation group  consisted of 15 patients with  CVID  who  were  diagnosed since early childhood in 100% of cases. They had prolonged respiratory infections followed by the development of complications requiring continuous treatment with antibiotics.After  reaching mean  age of 15 years  old,  the  intensity of infection-associated antibody deficiency was 6-8  times  per year. After verification of the  diagnosis, the  patients received  replacement therapy, first at the saturation dose,  and,  after stabilization of IgG  at the level of 7-8 g/l,  at the monthly maintenance dose. The clinical  course  of the disease was traced  during  a full year of replacement therapy, and the cellular  immunity indices  were evaluated. In all patients, after a year of therapy  corresponding to clinical  guidelines, there  was an improvement in quality  of life indices, decreased rates of recurrent bacterial infections. At the same time, 40% of them continued to suffer, on average, 5.4±1.1 times a year and required long-term courses of antibiotic therapy. Evaluation of immune status did not reveal statistically significant  differences in IgG plasma saturation between the groups of patients with different treatment efficiency: 8.7 (8-9) g/l and 9.1 (8.5-10.5) g/l, at p = 0.5. The  differences related  to immune cell factors  in cases of smaller  effect of IVIG  therapy  are manifested in higher  relative  numbers of T effectors  containing lytic Granzyme B granules  and CD14+CD284+  monocytes, accompanied by lower spontaneous active  oxygen forms produced by neutrophils, lesser contents of CD16+ natural killers in peripheral blood.The obtained data illustrate the value of monitoring, not only serum  IgG  level, but also the parameters of the  cellular  immune response. Such  analysis  may be essential  as a prognostic criterion for efficacy  of IVIG therapy. Reduced levels of some parameters of innate immunity cells serves a basis to formulate the concept of combined treatment and usage of tools that alter functions of immunocompetent cells.

Chronic psycho-emotional stress can cause dysfunction of neuroimmunoendocrine dysregulation with consequences in the form of a violation of the functional potential of the immune system. Adaptation to new living conditions at the start of studies at a medical university is one of the inevitable circumstances that first-year students overcome. Education under the military training program at a medical university carries an additional stress load in this aspect. Research on the mechanisms of formation of adaptive reactions of the immune system during training under the military training program for officers of the medical service is of undoubted interest. The purpose of the study was to compare the clinical manifestations of immune-mediated pathology and the parameters of adaptive and innate immunity of medical students depending on the length of service and training program. Under observation were 104 medical students, all men, of which 37 were first-year students and 67 were third-year students of a medical university. The subjects of each course were divided into two subgroups depending on the training program. The group of first-year students consisted of 18 people from the military training center (VTC) and 19 people from the medical and preventive faculty (LPF). Among the third-year students of the VUC – 31, LPF – 36. For the clinical characterization of the incidence during the year of study, registration cards for the analysis of immune-mediated pathology were used, the parameters of the immune system at the end of the spring semester were studied using standard methodological approaches. The data obtained indicate that in the first year students with an additional load in the form of a military training program have a more difficult time adapting to learning in comparison with first-year students of the medical faculty. These differences consist in a more frequent and significant clinical manifestation of infectious pathology and are reflected in the functional potential of cellular parameters of innate immunity. The statement of signs of inhibition of the functional potencies of macrophage cells and natural killers in firstyear students of a military training center is an alarming factor in the possible disruption of the adaptive reserves of the immune response system, which probably suggests the need to develop programs to prevent the negative impact of stress-forming factors. By the third year of study, the students of the military training center have the best clinical and immunological indicators of the functioning of the immune system in comparison with the students of the standard educational program of general practitioners. It is likely that during this period the process of psychological adaptation of military medical students is completed.

Objective: B-2 lymphocytes characteristic of patients with CVID in the process of forming a post-vaccination response to the peptide vaccine against SARS-CoV-2.   Materials and methods: 10 people with CVID diagnosis were included in the study among a cohort of patients with primary immunodeficiency under the supervision of the Research Institute and the Department of Clinical Immunology and allergology of Rostov State Medical University. For the immunoprophylaxis of COVID-19, a recombinant peptide vaccine was used, which was administered intramuscularly at a dose of 0.5 ml twice with an interval of 21 days. The parameters of the immune system were evaluated before vaccination, then 21 days after the first and second doses and 72 days after the first injection. Phenotypic characteristic of peripheral blood B cells was performed by cytofluoriometry flow method.   Results: before vaccination,  the number of memory B cells with a phenotypic option of switched and unswitched to antibody synthesis at the patients with CVID was lower than the control parameters of practically healthy donors. 21 days after the administration of the first dose, an increase in un-switched and switched memory B cells, plasma blasts, and a decrease in the proportion of B-regulatory lymphocytes were noted in relation to the initial values. 21 days after the second injection, an increase in the total pool of B-2 lymphocytes, naive B cells, switched memory B cells, plasma blasts were revealed. A month later, this tendency continued.   Conclusion: in the process of forming a post-vaccination response to the peptide vaccine against SARS-CoV-2 in patients with CVID, a transformation of the subpopulation composition of B lymphocytes was revealed, as well as in the form of an increase in the number of memory B2 lymphocytes.

Common variable immunodeficiency (CVID) is a variant of primary immunodeficiency in which inhibition of antibody production is formed due to disorders of intercellular interaction affecting cellular elements of both innate and adaptive immune responses. A feature of CVID is the late start and variability of clinical minifestation. These arguments determine the purpose of the study: to identify the dynamics of changes in the cellular parameters of the adaptive and innate immune response depending on the duration and severity of the infectious manifestation of CVID. In this regard, a retrospective analysis of medical histories and dynamic observation of fifteen patients with CVID were carried out. Selection of specific parameters of cellular indices of factors of innate resistance and adaptive immunity was carried out on the basis of systemic-functional approach of immunodiagnostics. It is shown that in patients with CVID -mediated hypogammaglobulinemia and infectious phenotype of clinical manifestation, enhancement of quantitative and functional potentials of T-link effector cells of adaptive immunity is recorded against the background of reduction of number of regulatory T-helpers. With a more severe clinical course of the disease, the number of CD3+HLA DR + limphocytes is lower than with a more favorable version, there is a tendency to decrease the number of these cells, as well as the number of peripheral Treg with an increase in the length of the disease. Cellular components of innate immunity are characterized by a decrease in neutrophil activity, inhibition of antigen-presenting monocyte activity, the number and cytotoxicity of natural killers. At the same time, the tendency to decrease the cytolytic potential of NK with an increase in the length of illness and statistically significant differences depending on the severity of the manifestation of the infectious phenotype of CVID was recorded. The obtained results determine the importance of evaluating the cellular link of the immune system in patients with CVID, including as a prognostic criterion for the severity of the course.