Joint Research Unit, Hospice Civils de Lyon, bioMerieux, Centre Hospitalier Lyon Sud, Pierre-Benite, France.
Medical Diagnostic Discovery Department, bioMérieux S.A., Grenoble, France.
Front Immunol. 2018 Oct 16;9:2367. doi: 10.3389/fimmu.2018.02367. eCollection 2018.
The immune response is a dynamic system that maintains the integrity of the body, and more specifically fight against infections. However, an unbalanced host immune response is highlighted in many diseases. Exacerbated responses lead to autoimmune and allergic diseases, whereas, low or inefficient responses favor opportunistic infections and viral reactivations. Conflicting situations may also occur, such as in sepsis where inflammation and compensatory immunosuppression make it difficult to deploy the appropriate drug treatment. Until the current day, assessing the immune profile of patients remains a challenge. This is especially due to the inter-individual variability-a key feature of the immune system-which hinders precise diagnosis, prognosis, and therapeutic stratification. Our incapacity to practically interpret the host response may contribute to a high morbidity and mortality, such as the annual 6 million worldwide deaths in sepsis alone. Therefore, there is a high and increasing demand to assess patient immune function in routine clinical practice, currently met by Immune Functional Assays. Immune Functional Assays (IFA) hold a plethora of potentials that include the precise diagnosis of infections, as well as prediction of secondary and latent infections. Current available products are devoted to indirect pathogen detection such as Mycobacteria tuberculosis interferon gamma release assays (IGRA). In addition, identifying the status and the underlying factors of immune dysfunction (e.g., in septic patients) may guide immune targeted therapies. Tools to monitor and stratify the immune status are currently being studied but they still have many limitations such as technical standardization, biomarkers relevance, systematic interpretation and need to be simplified, in order to set the boundaries of "healthy," "ill," and "critically ill" responses. Thus, the design of new tools that give a comprehensive insight into the immune functionality, at the bedside, and in a timely manner represents a leap toward immunoprofiling of patients.
免疫反应是一个维持身体完整性的动态系统，更具体地说，是抵抗感染的系统。然而，在许多疾病中，宿主的免疫反应失衡更为明显。过度的反应会导致自身免疫和过敏疾病，而低水平或低效的反应则有利于机会性感染和病毒再激活。也可能出现冲突情况，例如在败血症中，炎症和代偿性免疫抑制使得难以部署适当的药物治疗。直到今天，评估患者的免疫状况仍然是一个挑战。这主要是由于个体间的可变性——免疫系统的一个关键特征——这阻碍了精确的诊断、预后和治疗分层。我们无法实际解释宿主的反应可能导致高发病率和死亡率，例如仅败血症每年就导致全球 600 万人死亡。因此，在常规临床实践中评估患者免疫功能的需求很高且在不断增加，目前通过免疫功能检测来满足这一需求。免疫功能检测具有多种潜力，包括感染的精确诊断，以及二次和潜伏感染的预测。目前可用的产品致力于间接病原体检测，如结核分枝杆菌干扰素 γ 释放检测（IGRA）。此外，确定免疫功能障碍的状态和潜在因素（例如，败血症患者）可能指导免疫靶向治疗。目前正在研究用于监测和分层免疫状态的工具，但它们仍存在许多限制，例如技术标准化、生物标志物相关性、系统解释和简化的需要，以便为“健康”、“患病”和“危重”反应设定界限。因此，设计新的工具，以便在床边及时全面地了解免疫功能，代表着向患者免疫分析迈出的一步。
