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Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?

Esther van de Vosse¹, Monique M van Ostaijen-Ten Dam², René Vermaire¹

¹Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.

Clinical Immunology (Orlando, Fla.)

|May 11, 2017

Abstract:

Elderly with late-onset recurrent respiratory tract infections (RRTI) often have specific anti-polysaccharide antibody deficiency (SPAD). We hypothesized that late-onset RRTI is caused by mild immunodeficiencies, such as SPAD, that remain hidden through adult life. We analyzed seventeen elderly RRTI patients and matched controls. We determined lymphocyte subsets, expression of BAFF receptors, serum immunoglobulins, complement pathways, Pneumovax-23 vaccination response and genetic variations in BAFFR and MBL2. Twelve patients (71%) and ten controls (59%) had SPAD. IgA was lower in patients than in controls, but other parameters did not differ. However, a high percentage of both patients (53%) and controls (65%) were MBL deficient, much more than in the general population. Often, MBL2 secretor genotypes did not match functional deficiency, suggesting that functional MBL deficiency can be an acquired condition. In conclusion, we found SPAD and MBL deficiency in many elderly, and conjecture that at least the latter arises with age.

Insights

Elderly individuals with recurrent respiratory infections often have specific anti-polysaccharide antibody deficiency (SPAD) or mannose-binding lectin (MBL) deficiency. These mild immunodeficiencies may develop with age, contributing to infections in later life.

Area of Science:

Immunology
Geriatrics
Infectious Diseases

Background:

Late-onset recurrent respiratory tract infections (RRTI) in the elderly are frequently linked to underlying immunodeficiencies.
Specific anti-polysaccharide antibody deficiency (SPAD) is a known, yet often hidden, mild immune issue.
The study investigates the prevalence of SPAD and MBL deficiency in elderly patients with RRTI.

Purpose of the Study:

To test the hypothesis that mild immunodeficiencies, such as SPAD, contribute to late-onset RRTI in the elderly.
To compare immunological parameters between elderly RRTI patients and age-matched controls.
To explore the role of MBL deficiency and its potential age-related acquisition.

Main Methods:

Analysis of lymphocyte subsets, BAFF receptor expression, serum immunoglobulins, and complement pathways.
Assessment of Pneumovax-23 vaccination response in elderly patients and controls.
Evaluation of genetic variations in BAFFR and MBL2 genes, alongside functional MBL levels.

Main Results:

Specific anti-polysaccharide antibody deficiency (SPAD) was prevalent in both elderly RRTI patients (71%) and controls (59%).
Lower IgA levels were observed in patients compared to controls; other parameters showed no significant differences.
High rates of mannose-binding lectin (MBL) deficiency (53% in patients, 65% in controls) were found, exceeding general population levels.

Conclusions:

Both SPAD and MBL deficiency are common in the elderly population, including those without recurrent infections.
Functional MBL deficiency may be an acquired condition, potentially developing with age.
These findings suggest that age-related changes in the immune system may predispose elderly individuals to infections.

Read full analysis

Keywords:

B-cell activating factor Elderly Immunodeficiency Late onset Mannose binding lectin Respiratory tract infection Specific anti-polysaccharide deficiency

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