Clinical and immunological efficacy of arginine in the complex treatment of patients with non-proliferative diabetic retinopathy
Summary. The aim of this work was to study the performance of the immune and cytokine status in patients with nonproliferative diabetic retinopathy (DR) during complex treatment with the inclusion of the amino acid arginine. Material and methods. There were examined 127 patients with nonproliferative DR (average age — 68.3±2.1 years). The patients were divided into two groups: those who have received traditional therapy (comparison group, n=42) and the amino acid arginine (Tivortin) in addition to the traditional therapy during 1 month intravenously with transition to oral suspension during 1 month (main group, n=85). The control group consisted of 36 healthy individuals. Results. The appointment of traditional therapy in combination with arginine contributed to the increase in the number of CD3+-lymphocytes on 35.02% (p<0.05), reduction of the B-lymphocytosis in the background of significant changes in number of activated lymphocyte subpopulations expressing various adhesion molecules, to restore balance to the circulating immune complexes (there was a significant decrease in the level of pathogenic CIC of medium size (11–19S) — 18.30% (p<0.05), small size (<11S) — by 25.81% (p<0.05) while increase in the concentration of physiological CIC of large size (>19S) by 41.14% (p<0.05)) and significant decrease of proinflammatory cytokines (tumor necrosis factor-α — by 52.57% (p<0.05), IL-1β — by 44.66% (p<0.05), IL-6 — by 38.02% (p<0.05), transforming growth factor-β — by 2.15 times (p<0.05), as well as an increase of serum concentrations of anti-inflammatory IL-4 by 30.11% (p<0.05) — to values that did not differ from the norm. Conclusions. It was shown high clinical and immunological efficacy of adding the amino acid arginine in the complex therapy of patients with non-proliferative DR: reduce of the level of activated subpopulations of lymphocytes expressing different adhesion molecules, their effector functions, and migration to the inflammatory focus in the vascular wall. It was also found normalization of proinflammatory cytokines and transforming growth factor-β, as their constant uncontrolled hyper-production is the crucial point for the subsequent damage of organ of vision in diabetes mellitus with the development of severe forms of DR.