T-lymphocytes Expression of Toll-like Receptors 2 and 4 in Acute Myeloid Leukemia Patients with Invasive Fungal Infections

Muhamad R Abdel Hammed; Sherein G Elgendy; Mohamed A El-Mokhtar; Douaa Sayed; Samar M Mansour; Abeer M Darwish

doi:10.4084/MJHID.2022.022

T-lymphocytes Expression of Toll-like Receptors 2 and 4 in Acute Myeloid Leukemia Patients with Invasive Fungal Infections

Mediterr J Hematol Infect Dis. 2022 Mar 1;14(1):e2022022. doi: 10.4084/MJHID.2022.022. eCollection 2022.

Authors

Muhamad R Abdel Hammed¹, Sherein G Elgendy², Mohamed A El-Mokhtar², Douaa Sayed³, Samar M Mansour³, Abeer M Darwish³

Affiliations

¹ Internal Medicine Department and Hematology Unit, Assiut University Hospitals and South Egypt Cancer Institute Bone Marrow Transplantation Unit, Assiut University, Assiut, Egypt.
² Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
³ Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

Abstract

Background: Invasive fungal infections (IFIs) are important cause of mortality in acute myeloid leukemia (AML) patients on treatment with intensive induction chemotherapy. Toll-like receptors, mainly Toll-like receptors 2 and 4 (TLR2 and TLR4), play a considerable role in the host defense against microorganisms. The involvement of TLR signaling in modulation of innate immune response is extensively discussed, but the TLR expressions profiling on adaptive immune cells are not specified. Also, the expressions of TLRs and their association with the occurrence of IFIs in patients with AML are not studied. So, the novel aim of this study was to investigate the associations between the T-lymphocyte expression of TLR2 and TLR4 and the occurrence of IFIs in AML patients treated with intensive induction chemotherapy.

Materials and methods: One hundred twenty two newly diagnosed AML patients were evaluated. The laboratory diagnostic techniques for IFIs include culture, microscopic examination, histopathology, galactomannan assay and PCR. The expressions of TLR2 and TLR4 were analyzed by flow cytometry. The Control group included 20 age and sex-matched individuals.

Results: There was a significant increase in the expression of TLR4 in AML patients with IFI compared to healthy controls (p = 0.001). TLR2 and TLR4 expressions increased significantly in AML patients with mixed fungal and bacterial infection compared to healthy controls (p= 0.002 and p=0.001, respectively).

Conclusion: TLRs expressions could be important biological markers for the occurrence of IFI in non-M3 AML patients after intensive induction chemotherapy.

Keywords: Acute Myeloid Leukemia; Invasive Fungal Infection; TLR2; TLR4.