Ann Lab Med 2019; 39(3): 284-290  https://doi.org/10.3343/alm.2019.39.3.284
Neopterin Levels and Indoleamine 2,3-Dioxygenase Activity as Biomarkers of Immune System Activation and Childhood Allergic Diseases
Songül Ünüvar, Ph.D.1, Duygu Erge, M.D.2, Bilge Kılıçarslan, M.S.3, Harika Gözde Gözükara Bağ, Ph.D.4, Ferhat Çatal, M.D.5, Gözde Girgin, Ph.D.3, and Terken Baydar, Ph.D.3
1İnönü University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Malatya, Turkey; 2Adnan Menderes Üniversitesi, Faculty of Medicine, Department of Pediatric Allergy & Immunollogy, Aydin, Turkey; 3Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey; 4İnönü University, Faculty of Medicine, Department of Biostatistics, Malatya, Turkey; 5İnönü University, TurgutOzal Medical Center, Department of Pediatric Allergy & Immunology, Malatya, Turkey
Corresponding author: Songül Ünüvar, Ph.D. https://orcid.org/0000-0001-8454-490X
Department of Pharmaceutical Toxicology, Faculty of Pharmacy, İnönü University, Malatya, Turkey
Tel: +90-422-341-0660
Fax: +90-422-341-1217
E-mail: songul.unuvar@inonu.edu.tr
Received: April 20, 2018; Revised: July 4, 2018; Accepted: December 11, 2018; Published online: May 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: Although Th2 immune activation is predominant in allergic diseases, neopterin levels and indoleamine 2,3-dioxygenase (IDO)-1 activity (kynurenine:tryptophan ratio), which reflect Th1 immune activity, increase with interferon-gamma (IFN-γ) stimulation. We investigated neopterin, tryptophan, and kynurenine levels as biomarkersof the Th1 immune system activation and changes in IDO-1 activityin children with asthma, allergic rhinitis, and atopic dermatitis, as well as the relationship between these biomarkers and the total IgE level, age, and disease severity.
Methods: We divided 205 children (80 girls and 125 boys, four months to 17 years old) into four groups: controls, patients with asthma, patients with allergic rhinitis, and patients with atopic dermatitis. Peripheral venous blood samples were collected. Neopterin levels were determined by an enzyme immunoassay. Tryptophan and kynurenine levels were analyzed using HPLC. IDO-1 enzyme activity was calculated using tryptophan and kynurenine levels. IgE levels were measured. The Mann–Whitney U test, Kruskal–Wallis test, and Conover post-hoc method were used for statistical analysis.
Results: Neopterin, tryptophan, and kynurenine levels were higher and IgE levels and IDO-1 enzyme activity were lower in patients with asthma and allergic rhinitis than in controls (P<0.05). Patients with atopic dermatitis showed higher neopterin, tryptophan, and kynurenine levels, higher IDO-1 activity, and lower IgE levels thancontrols (P<0.05).
Conclusions: The Th1/Th2 balance is disrupted in children with allergic diseases, concomitant with increased Th1-mediated immune response activation and reduced IgEproduction, which is promoted by Th2-type cytokines.
Keywords: Allergy, Kynurenine, Neopterin, Tryptophan, Atopic dermatitis, Allergic rhinitis, Asthma, Th1 immune response, indoleamine 2,3-dioxygenase activity



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