Healthy organisms constantly maintain a balance between inflammatory and anti-inflammatory processes, thus preventing the harmful effects of excessive systemic inflammation. Important factors in the regulation of inflammation include the endocrinic hypothalamic-pituitary-suprarenal pathway and the sympathetic-medullary-adrenal pathway, as well as the neurogenic vagal. 25 years of research has led to a more detailed understanding of the action and function of the newly discovered cholinergic anti-inflammatory response. Its activation in the nucleus tractus solitarius is triggered by initial mediators of inflammation, followed by activation of the efferent vagus and the splenic nerve, from which noradrenaline is released into the white pulp of the spleen. Noradrenaline activates specific T lymphocytes in the spleen, which synthesize and release acetylcholine. It binds to α7 subunits of the nicotinic receptor on nearby monocytes and affects signal pathways in monocytes to reduce inflammation. Determining the expression of the nicotinic (CHRNA7) and adrenergic (ADRB2) receptors, as well as the choline acetyltransferase (CHAT) and acetylcholinesterase (ACHE) opens new possibilities for understanding the course of the cholinergic anti-inflammatory response. The experimental process, that has been critically tested and analysed, includes the isolation of immune cells from peripheral human blood, the isolation of RNA with DNase and the measurement of the expression of various genes of the cholinergic system by qPCR in real time. The expression of CHRNA7 was confirmed in all types of leukocytes; it is the highest in monocytes and negligible in neutrophils. We successfully determined the expression of ACHE in T lymphocytes, but we did not get reliable results of the expression of CHAT and ADRB2 in T lymphocytes. In a small group of patients with a moderately severe acute COVID-19, we confirmed decreased expression of CHRNA7 in monocytes and characteristically increased expression of ACHE in T lymphocytes. This is in accordance with the results of other studies and suggests weakened anti-inflammatory system in these patients. Even though the measurement of expression of CHAT and ADRB2 is not reliable enough for further quantitative analysis, we laid the foundation for further research and monitoring the expression of biological markers in peripheral blood leukocytes, which provide insight into the state and function of the anti-inflammatory cholinergic system.
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