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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 09/04/2023] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John’s College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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Dong Z, Shi J, Dorhoi A, Zhang J, Soodeen-Lalloo AK, Tan W, Yin H, Sha W, Li W, Zheng R, Liu Z, Yang H, Qin L, Wang J, Huang X, Wu C, Kaufmann SHE, Feng Y. Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity. Chest 2017; 153:1187-1200. [PMID: 29224833 DOI: 10.1016/j.chest.2017.11.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/08/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exacerbated immunopathology is a frequent consequence of TB that is complicated by diabetes mellitus (DM); however, the underlying mechanisms are still poorly defined. METHODS In the two groups of age- and sex-matched patients with TB and DM (DM-TB) and with TB and without DM, we microscopically evaluated the areas of caseous necrosis and graded the extent of perinecrotic fibrosis in lung biopsies from the sputum smear-negative (SN) patients. We scored acid-fast bacilli in sputum smear-positive (SP) patients and compiled CT scan data from both the SN and SP patients. We compared inflammatory biomarkers and routine hematologic and biochemical parameters. Binary logistic regression analyses were applied to define the indices associated with the extent of lung injury. RESULTS Enlarged caseous necrotic areas with exacerbated fibrotic encapsulations were found in SN patients with DM-TB, consistent with the higher ratio of thick-walled cavities and more bacilli in the sputum from SP patients with DM-TB. Larger necrotic foci were detected in men compared with women within the SN TB groups. Significantly higher fibrinogen and lower high-density lipoprotein cholesterol (HDL-C) were observed in SN patients with DM-TB. Regression analyses revealed that diabetes, activation of the coagulation pathway (shown by increased platelet distribution width, decreased mean platelet volume, and shortened prothrombin time), and dyslipidemia (shown by decreased low-density lipoprotein cholesterol, HDL-C, and apolipoprotein A) are risk factors for severe lung lesions in both SN and SP patients with TB. CONCLUSIONS Hemostasis and dyslipidemia are associated with granuloma necrosis and fibroplasia leading to exacerbated lung damage in TB, especially in patients with DM-TB.
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Affiliation(s)
- Zhengwei Dong
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China; Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Jingyun Shi
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China; Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Anca Dorhoi
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Jie Zhang
- Department of Epidemiology and Biostatistics, Tongji University, School of Medicine, Shanghai, China
| | - Adiilah K Soodeen-Lalloo
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - WenLing Tan
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hongyun Yin
- Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wei Sha
- Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Weitong Li
- Department of Radiology, Shishi Hospital, Fujian, China
| | - Ruijuan Zheng
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Zhonghua Liu
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hua Yang
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Lianhua Qin
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Jie Wang
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xiaochen Huang
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Chunyan Wu
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China; Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Yonghong Feng
- Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China; Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
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53
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Patients with type 1 diabetes mellitus have impaired IL-1β production in response to Mycobacterium tuberculosis. Eur J Clin Microbiol Infect Dis 2017; 37:371-380. [PMID: 29189980 PMCID: PMC5780542 DOI: 10.1007/s10096-017-3145-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022]
Abstract
Patients with diabetes mellitus have an increased risk of developing tuberculosis. Although the underlying mechanism is unclear, evidence suggests a role for chronic hyperglycaemia. We examined the influence of hyperglycaemia on Mycobacterium tuberculosis-induced cytokine responses in patients with type 1 diabetes mellitus (T1D). Peripheral blood mononuclear cells (PBMCs) from 24 male T1D patients with sub-optimal glucose control [HbA1c > 7.0% (53 mmol/L)] and from 24 age-matched male healthy controls were stimulated with M. tuberculosis lysate. Cytokine analysis, assessment of aerobic glycolysis, receptor recognition and serum cross-over experiments were performed to explore the mechanistic differences. PBMCs from T1D patients produced less bioactive interleukin (IL)-1β in response to M. tuberculosis. IL-6 and interferon (IFN)-γ production trended towards a decrease, whilst other cytokines such as tumour necrosis factor (TNF)-α, IL-17 and IL-1Ra were normal. The decrease in cytokine production was not correlated to HbA1c or plasma glucose levels. Cross-over serum experiments did not alter the cytokine profile of T1D or control patients, arguing for an intrinsic cellular defect. Cellular metabolism and the expression of M. tuberculosis-related pattern recognition receptors (PRRs) such as TLR2, TLR4 and NOD2 did not differ between T1D patients and healthy controls. Compared to matched controls, T1D patients have a reduced capacity to produce pro-inflammatory cytokines in response to M. tuberculosis. The impaired IL-1β production in T1D patients may contribute to the increased susceptibility to tuberculosis. This effect appears not to be related to prevailing glucose levels but to an intrinsic cellular deficit.
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54
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Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0187967. [PMID: 29161276 PMCID: PMC5697825 DOI: 10.1371/journal.pone.0187967] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022] Open
Abstract
The burgeoning epidemic of diabetes mellitus (DM) is one of the major global health challenges. We systematically reviewed the published literature to provide a summary estimate of the association between DM and active tuberculosis (TB). We searched Medline and EMBASE databases for studies reporting adjusted estimates on the TB–DM association published before December 22, 2015, with no restrictions on region and language. In the meta-analysis, adjusted estimates were pooled using a DerSimonian-Laird random-effects model, according to study design. Risk of bias assessment and sensitivity analyses were conducted. 44 eligible studies were included, which consisted of 58,468,404 subjects from 16 countries. Compared with non-DM patients, DM patients had 3.59–fold (95% confidence interval (CI) 2.25–5.73), 1.55–fold (95% CI 1.39–1.72), and 2.09–fold (95% CI 1.71–2.55) increased risk of active TB in four prospective, 16 retrospective, and 17 case-control studies, respectively. Country income level (3.16–fold in low/middle–vs. 1.73–fold in high–income countries), background TB incidence (2.05–fold in countries with >50 vs. 1.89–fold in countries with ≤50 TB cases per 100,000 person-year), and geographical region (2.44–fold in Asia vs. 1.71–fold in Europe and 1.73–fold in USA/Canada) affected appreciably the estimated association, but potential risk of bias, type of population (general versus clinical), and potential for duplicate data, did not. Microbiological ascertainment for TB (3.03–fold) and/or blood testing for DM (3.10–fold), as well as uncontrolled DM (3.30–fold), resulted in stronger estimated association. DM is associated with a two- to four-fold increased risk of active TB. The association was stronger when ascertainment was based on biological testing rather than medical records or self-report. The burgeoning DM epidemic could impact upon the achievements of the WHO “End TB Strategy” for reducing TB incidence.
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Affiliation(s)
- Rami H. Al-Rifai
- Infectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- * E-mail: ,
| | - Fiona Pearson
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
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55
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Abstract
The increase in type 2 diabetes mellitus (DM) patients in countries where tuberculosis (TB) is also endemic has led to the reemerging importance of DM as a risk factor for TB. DM causes a 3-fold increase in TB risk and a 2-fold increase in adverse TB treatment outcomes. Given the sheer numbers of DM patients worldwide, there are now more TB patients with TB-DM comorbidity than TB-HIV coinfection. There is an urgent need to implement strategies for TB prevention and control among the millions of DM patients exposed to Mycobacterium tuberculosis. This chapter summarizes the current epidemiological, clinical, and immunological knowledge on TB and DM and their clinical and public health implications. These include the underlying mechanisms for TB risk in DM patients and their clinical and sociodemographic characteristics that distinguish them from TB patients without DM. TB-DM comorbidity is posing a new challenge for integrating the short-term care for TB with the long-term care for DM, particularly in low- and middle-income countries.
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Ronacher K, van Crevel R, Critchley JA, Bremer AA, Schlesinger LS, Kapur A, Basaraba R, Kornfeld H, Restrepo BI. Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes: Part 2: Underlying Biologic Mechanisms. Chest 2017; 152:174-180. [PMID: 28434937 PMCID: PMC5577357 DOI: 10.1016/j.chest.2017.02.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in the re-emerging interaction between type 2 diabetes (DM) and TB, but the underlying biologic mechanisms are poorly understood despite their possible implications in clinical management. Experts in epidemiologic, public health, basic science, and clinical studies recently convened and identified research priorities for elucidating the underlying mechanisms for the co-occurrence of TB and DM. We identified gaps in current knowledge of altered immunity in patients with DM during TB, where most studies suggest an underperforming innate immunity, but exaggerated adaptive immunity to Mycobacterium tuberculosis. Various molecular mechanisms and pathways may underlie these observations in the DM host. These include signaling induced by excess advanced glycation end products and their receptor, higher levels of reactive oxidative species and oxidative stress, epigenetic changes due to chronic hyperglycemia, altered nuclear receptors, and/or differences in cell metabolism (immunometabolism). Studies in humans at different stages of DM (no DM, pre-DM, and DM) or TB (latent or active TB) should be complemented with findings in animal models, which provide the unique opportunity to study early events in the host-pathogen interaction. Such studies could also help identify biomarkers that will complement clinical studies in order to tailor the prevention of TB-DM, or to avoid the adverse TB treatment outcomes that are more likely in these patients. Such studies will also inform new approaches to host-directed therapies.
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Affiliation(s)
- Katharina Ronacher
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia; Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research/Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radbourd University Medical Center, Nijmegen, the Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, UK
| | - Andrew A Bremer
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Larry S Schlesinger
- Department of Microbial Infection and Immunity, Ohio State University, Columbus, OH
| | - Anil Kapur
- World Diabetes Foundation, Copenhagen, Denmark
| | - Randall Basaraba
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Blanca I Restrepo
- School of Public Health, University of Texas Health Science Center Houston, Brownsville, TX
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57
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Kumar Nathella P, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology 2017; 152:13-24. [PMID: 28543817 DOI: 10.1111/imm.12762] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes mellitus(DM) is a major risk factor for the development of active pulmonary tuberculosis (TB), with development of DM pandemic in countries where TB is also endemic. Understanding the impact of DM on TB and the determinants of co-morbidity is essential in responding to this growing public health problem with improved therapeutic approaches. Despite the clinical and public health significance posed by the dual burden of TB and DM, little is known about the immunological and biochemical mechanisms of susceptibility. One possible mechanism is that an impaired immune response in patients with DM facilitates either primary infection with Mycobacterium tuberculosis or reactivation of latent TB. Diabetes is associated with immune dysfunction and alterations in the components of the immune system, including altered levels of specific cytokines and chemokines. Some effects of DM on adaptive immunity that are potentially relevant to TB defence have been identified in humans. In this review, we summarize current findings regarding the alterations in the innate and adaptive immune responses and immunological mechanisms of susceptibility of patients with DM to M. tuberculosis infection and disease.
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Affiliation(s)
- Pavan Kumar Nathella
- National Institutes of Health-International Centre for Excellence in Research, Chennai, India.,National Institute for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- National Institutes of Health-International Centre for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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58
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Huang LK, Wang HH, Lai YC, Chang SC. The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients. PLoS One 2017. [PMID: 28628646 PMCID: PMC5476287 DOI: 10.1371/journal.pone.0179750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Setting Diabetes mellitus (DM) may increase risk of pulmonary tuberculosis (PTB) and influence its radiological manifestations. Objective To evaluate the impact of glycemic status on radiological findings of PTB in diabetic patients. Methods Between January 2010 and December 2015, chest radiographs (CXRs) in consecutive 214 DM patients with culture-proved PTB and 123 available thoracic computed tomography (CT) scans were enrolled. An equal number of non-DM patients with similar demographics was included as the control group. Glycemic status was assessed by glycosylated hemoglobin (HbA1c), and a cutoff of 8% was used to further investigate radiological features of diabetic PTB. Two radiologists and one pulmonologist reviewed the chest images independently. Results Compared with non-DM patients, primary PTB pattern and extensive disease on CXRs as well as primary PTB pattern, large non-cavitary nodule, more than one cavity in a single lesion, unusual location, and all lobe involvement of lesions on thoracic CT scans were more common in DM patients. Furthermore, diabetics with HbA1c > 8% were more likely to exhibit unusual findings (P < 0.001), far advanced extensive lesions (P < 0.001) on CXRs, lymphadenopathy (P = 0.028), more than one cavity in a single lesion (P < 0.001) and all lobe involvement (P = 0.041) on thoracic CT scans. Conclusions Glycemic status influenced radiological manifestations of diabetic PTB. Given an increased risk of atypical radiological presentations of PTB in DM patients, physicians should be alert and pay more attention to those with poor glycemic control.
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Affiliation(s)
- Li-Kuo Huang
- Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsueh-Han Wang
- Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan
| | - Yi-Chun Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Division of Chest Medicine, National Yang-Ming University Hospital, Yi-Lan, Taiwan
| | - Shi-Chuan Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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59
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Prada-Medina CA, Fukutani KF, Pavan Kumar N, Gil-Santana L, Babu S, Lichtenstein F, West K, Sivakumar S, Menon PA, Viswanathan V, Andrade BB, Nakaya HI, Kornfeld H. Systems Immunology of Diabetes-Tuberculosis Comorbidity Reveals Signatures of Disease Complications. Sci Rep 2017; 7:1999. [PMID: 28515464 PMCID: PMC5435727 DOI: 10.1038/s41598-017-01767-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/10/2017] [Indexed: 12/13/2022] Open
Abstract
Comorbid diabetes mellitus (DM) increases tuberculosis (TB) risk and adverse outcomes but the pathological interactions between DM and TB remain incompletely understood. We performed an integrative analysis of whole blood gene expression and plasma analytes, comparing South Indian TB patients with and without DM to diabetic and non-diabetic controls without TB. Luminex assay of plasma cytokines and growth factors delineated a distinct biosignature in comorbid TBDM in this cohort. Transcriptional profiling revealed elements in common with published TB signatures from cohorts that excluded DM. Neutrophil count correlated with the molecular degree of perturbation, especially in TBDM patients. Body mass index and HDL cholesterol were negatively correlated with molecular degree of perturbation. Diabetic complication pathways including several pathways linked to epigenetic reprogramming were activated in TBDM above levels observed with DM alone. Our data provide a rationale for trials of host-directed therapies in TBDM, targeting neutrophilic inflammation and diabetic complication pathways to address the greater morbidity and mortality associated with this increasingly prevalent dual burden of communicable and non-communicable diseases.
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Affiliation(s)
- Cesar A Prada-Medina
- Department of Pathophysiology and Toxicology, School of Pharmaceutical Sciences, University of São Paulo, 05508, São Paulo, Brazil
| | - Kiyoshi F Fukutani
- Laboratório de Imunoparasitologia, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Nathella Pavan Kumar
- National Institutes of Health- NIRT - International Center for Excellence in Research, Chennai, India
| | - Leonardo Gil-Santana
- Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research, Instituto Brasileiro para a Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
| | - Subash Babu
- National Institutes of Health- NIRT - International Center for Excellence in Research, Chennai, India
| | - Flávio Lichtenstein
- Department of Pathophysiology and Toxicology, School of Pharmaceutical Sciences, University of São Paulo, 05508, São Paulo, Brazil
| | - Kim West
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | | | - Pradeep A Menon
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Bruno B Andrade
- Unidade de Medicina Investigativa, Laboratório Integrado de Microbiologia e Imunorregulação, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research, Instituto Brasileiro para a Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências, Salvador, Brazil
- Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - Helder I Nakaya
- Department of Pathophysiology and Toxicology, School of Pharmaceutical Sciences, University of São Paulo, 05508, São Paulo, Brazil.
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.
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60
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Alim MA, Sikder S, Bridson TL, Rush CM, Govan BL, Ketheesan N. Anti-mycobacterial function of macrophages is impaired in a diet induced model of type 2 diabetes. Tuberculosis (Edinb) 2016; 102:47-54. [PMID: 28061952 DOI: 10.1016/j.tube.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/13/2016] [Accepted: 12/05/2016] [Indexed: 12/22/2022]
Abstract
Type 2 diabetes (T2D) is one of the major risk factors for tuberculosis (TB). In this study, a diet induced murine model of T2D (DIMT2D) was developed and characterized in the context of metabolic, biochemical and histopathological features following diet intervention. Mycobacterial susceptibility was investigated using Mycobacterium fortuitum as a surrogate. Phagocytic capability of alveolar macrophages and resident peritoneal macrophages were determined by in vitro assays using mycolic acid coated beads and M. fortuitum. Results demonstrated that bacillary loads were significantly higher in liver, spleen, and lungs of diabetic mice compared to controls. Higher inflammatory lesions and impaired cytokine kinetics (TNF-α, MCP-1, IL-12, IFN-γ) were also observed in diabetic mice. Macrophages isolated from diabetic mice had lower uptake of mycolic acid coated beads, reduced bacterial internalization and killing and altered cytokine responses (TNF-α, IL-6, MCP-1). This model will be useful to further investigate different facets of host-pathogen interactions in TB-T2D.
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Affiliation(s)
- Md Abdul Alim
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Suchandan Sikder
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Tahnee L Bridson
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Catherine M Rush
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Brenda L Govan
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
| | - Natkunam Ketheesan
- Infectious Diseases and Immunopathogenesis Research Group, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, 4811, Australia.
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61
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Cheekatla SS, Tripathi D, Venkatasubramanian S, Nathella PK, Paidipally P, Ishibashi M, Welch E, Tvinnereim AR, Ikebe M, Valluri VL, Babu S, Kornfeld H, Vankayalapati R. NK-CD11c+ Cell Crosstalk in Diabetes Enhances IL-6-Mediated Inflammation during Mycobacterium tuberculosis Infection. PLoS Pathog 2016; 12:e1005972. [PMID: 27783671 PMCID: PMC5082658 DOI: 10.1371/journal.ppat.1005972] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/03/2016] [Indexed: 01/27/2023] Open
Abstract
In this study, we developed a mouse model of type 2 diabetes mellitus (T2DM) using streptozotocin and nicotinamide and identified factors that increase susceptibility of T2DM mice to infection by Mycobacterium tuberculosis (Mtb). All Mtb-infected T2DM mice and 40% of uninfected T2DM mice died within 10 months, whereas all control mice survived. In Mtb-infected mice, T2DM increased the bacterial burden and pro- and anti-inflammatory cytokine and chemokine production in the lungs relative to those in uninfected T2DM mice and infected control mice. Levels of IL-6 also increased. Anti-IL-6 monoclonal antibody treatment of Mtb-infected acute- and chronic-T2DM mice increased survival (to 100%) and reduced pro- and anti-inflammatory cytokine expression. CD11c+ cells were the major source of IL-6 in Mtb-infected T2DM mice. Pulmonary natural killer (NK) cells in Mtb-infected T2DM mice further increased IL-6 production by autologous CD11c+ cells through their activating receptors. Anti-NK1.1 antibody treatment of Mtb-infected acute-T2DM mice increased survival and reduced pro- and anti-inflammatory cytokine expression. Furthermore, IL-6 increased inflammatory cytokine production by T lymphocytes in pulmonary tuberculosis patients with T2DM. Overall, the results suggest that NK-CD11c+ cell interactions increase IL-6 production, which in turn drives the pathological immune response and mortality associated with Mtb infection in diabetic mice.
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Affiliation(s)
- Satyanarayana Swamy Cheekatla
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Deepak Tripathi
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Sambasivan Venkatasubramanian
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Pavan Kumar Nathella
- National Institutes of Health, International Center for Excellence in Research, Chennai, India
| | - Padmaja Paidipally
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Munenori Ishibashi
- Department of Cellular and Molecular Biology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Elwyn Welch
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Amy R. Tvinnereim
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Mitsuo Ikebe
- Department of Cellular and Molecular Biology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | | | - Subash Babu
- National Institutes of Health, International Center for Excellence in Research, Chennai, India
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Ramakrishna Vankayalapati
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
- * E-mail:
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Metabolic reprogramming & inflammation: Fuelling the host response to pathogens. Semin Immunol 2016; 28:450-468. [PMID: 27780657 DOI: 10.1016/j.smim.2016.10.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 12/24/2022]
Abstract
Successful immune responses to pathogens rely on efficient host innate processes to contain and limit bacterial growth, induce inflammatory response and promote antigen presentation for the development of adaptive immunity. This energy intensive process is regulated through multiple mechanisms including receptor-mediated signaling, control of phago-lysomal fusion events and promotion of bactericidal activities. Inherent macrophage activities therefore are dynamic and are modulated by signals and changes in the environment during infection. So too does the way these cells obtain their energy to adapt to altered homeostasis. It has emerged recently that the pathways employed by immune cells to derive energy from available or preferred nutrients underline the dynamic changes associated with immune activation. In particular, key breakpoints have been identified in the metabolism of glucose and lipids which direct not just how cells derive energy in the form of ATP, but also cellular phenotype and activation status. Much of this comes about through altered flux and accumulation of intermediate metabolites. How these changes in metabolism directly impact on the key processes required for anti-microbial immunity however, is less obvious. Here, we examine the 2 key nutrient utilization pathways employed by innate cells to fuel central energy metabolism and examine how these are altered in response to activation during infection, emphasising how certain metabolic switches or 'reprogramming' impacts anti-microbial processes. By examining carbohydrate and lipid pathways and how the flux of key intermediates intersects with innate immune signaling and the induction of bactericidal activities, we hope to illustrate the importance of these metabolic switches for protective immunity and provide a potential mechanism for how altered metabolic conditions in humans such as diabetes and hyperlipidemia alter the host response to infection.
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63
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Hauptmann M, Schaible UE. Linking microbiota and respiratory disease. FEBS Lett 2016; 590:3721-3738. [PMID: 27637588 DOI: 10.1002/1873-3468.12421] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
An increasing body of evidence indicates the relevance of microbiota for pulmonary health and disease. Independent investigations recently demonstrated that the lung harbors a resident microbiota. Therefore, it is intriguing that a lung microbiota can shape pulmonary immunity and epithelial barrier functions. Here, we discuss the ways how the composition of the microbial community in the lung may influence pulmonary health and vice versa, factors that determine community composition. Prominent microbiota at other body sites such as the intestinal one may also contribute to pulmonary health and disease. However, it is difficult to discriminate between influences of lung vs. gut microbiota due to systemic mutuality between both communities. With focuses on asthma and respiratory infections, we discuss how microbiota of lung and gut can determine pulmonary immunity and barrier functions.
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Affiliation(s)
- Matthias Hauptmann
- Priority Program Infections, Cellular Microbiology, Research Center Borstel, Germany
| | - Ulrich E Schaible
- Priority Program Infections, Cellular Microbiology, Research Center Borstel, Germany.,German Centre for Infection Research, TTU-TB, Borstel, Germany
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Martinez N, Ketheesan N, Martens GW, West K, Lien E, Kornfeld H. Defects in early cell recruitment contribute to the increased susceptibility to respiratory Klebsiella pneumoniae infection in diabetic mice. Microbes Infect 2016; 18:649-655. [PMID: 27256462 PMCID: PMC10687709 DOI: 10.1016/j.micinf.2016.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 01/04/2023]
Abstract
Diabetes is associated with increased susceptibility to Klebsiella pneumoniae and poor prognosis with infection. We demonstrate accelerated mortality in mice with streptozotocin-induced diabetes following tracheal instillation of K. pneumoniae. Diabetic mice recruited fewer granulocytes to the alveolar airspace and had reduced early production of CXCL1, CXCL2, IL-1β and TNF-α following tracheal instillation of K. pneumoniae-lipopolysaccharide. Additionally, TLR2 and TIRAP expression following K. pneumoniae-lipopolysaccharide exposure was decreased in hyperglycemic mice. These findings indicate that impaired innate sensing and failure to rapidly recruit granulocytes to the site of infection is a mechanism for diabetic susceptibility to respiratory K. pneumoniae infection.
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Affiliation(s)
- Nuria Martinez
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Natkunam Ketheesan
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; Australian Institute of Tropical Health and Medicine, James Cook University, Queensland 4811, Australia
| | - Gregory W Martens
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Kim West
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Egil Lien
- Program in Innate Immunity, Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA; CEMIR, Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - Hardy Kornfeld
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Tuberculosis Susceptibility and Vaccine Protection Are Independently Controlled by Host Genotype. mBio 2016; 7:mBio.01516-16. [PMID: 27651361 PMCID: PMC5030360 DOI: 10.1128/mbio.01516-16] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED The outcome of Mycobacterium tuberculosis infection and the immunological response to the bacillus Calmette-Guerin (BCG) vaccine are highly variable in humans. Deciphering the relative importance of host genetics, environment, and vaccine preparation for the efficacy of BCG has proven difficult in natural populations. We developed a model system that captures the breadth of immunological responses observed in outbred individual mice, which can be used to understand the contribution of host genetics to vaccine efficacy. This system employs a panel of highly diverse inbred mouse strains, consisting of the founders and recombinant progeny of the "Collaborative Cross" project. Unlike natural populations, the structure of this panel allows the serial evaluation of genetically identical individuals and the quantification of genotype-specific effects of interventions such as vaccination. When analyzed in the aggregate, our panel resembled natural populations in several important respects: the animals displayed a broad range of susceptibility to M. tuberculosis, differed in their immunological responses to infection, and were not durably protected by BCG vaccination. However, when analyzed at the genotype level, we found that these phenotypic differences were heritable. M. tuberculosis susceptibility varied between lines, from extreme sensitivity to progressive M. tuberculosis clearance. Similarly, only a minority of the genotypes was protected by vaccination. The efficacy of BCG was genetically separable from susceptibility to M. tuberculosis, and the lack of efficacy in the aggregate analysis was driven by nonresponsive lines that mounted a qualitatively distinct response to infection. These observations support an important role for host genetic diversity in determining BCG efficacy and provide a new resource to rationally develop more broadly efficacious vaccines. IMPORTANCE Tuberculosis (TB) remains an urgent global health crisis, and the efficacy of the currently used TB vaccine, M. bovis BCG, is highly variable. The design of more broadly efficacious vaccines depends on understanding the factors that limit the protection imparted by BCG. While these complex factors are difficult to disentangle in natural populations, we used a model population of mice to understand the role of host genetic composition in BCG efficacy. We found that the ability of BCG to protect mice with different genotypes was remarkably variable. The efficacy of BCG did not depend on the intrinsic susceptibility of the animal but, instead, correlated with qualitative differences in the immune responses to the pathogen. These studies suggest that host genetic polymorphism is a critical determinant of vaccine efficacy and provide a model system to develop interventions that will be useful in genetically diverse populations.
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Martinez N, Ketheesan N, West K, Vallerskog T, Kornfeld H. Impaired Recognition of Mycobacterium tuberculosis by Alveolar Macrophages From Diabetic Mice. J Infect Dis 2016; 214:1629-1637. [PMID: 27630197 DOI: 10.1093/infdis/jiw436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/01/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diabetes mellitus is associated with increased tuberculosis risk and severity. We previously reported that tuberculosis susceptibility in diabetic mice results from a delay in innate immune response to inhaled Mycobacterium tuberculosis, leading to delayed adaptive immune priming and, consequently, a higher plateau lung bacterial burden and greater immune pathology. METHODS We tested the capacity of alveolar macrophages from diabetic mice to phagocytose M. tuberculosis ex vivo and promote T-cell activation in vivo. RESULTS Alveolar macrophages from diabetic mice had reduced expression of CD14 and macrophage receptor with collagenous structure (MARCO), which recognize the bacterial cell wall component trehalose 6,6'-dimycolate (TDM). Diabetic alveolar macrophages exhibited reduced phagocytosis of M. tuberculosis or TDM-coated latex beads. This alveolar macrophage phenotype was absent in peritoneal and bone marrow-derived macrophages. Transfer of infected alveolar macrophages from diabetic mice into nondiabetic recipients confirmed an intrinsic alveolar macrophage defect that hindered T-cell priming. The diabetic alveolar macrophage phenotype depended in part on expression of the receptor for advanced glycation end products. CONCLUSIONS Reduced MARCO and CD14 expression contributes to defective sentinel function of alveolar macrophages, promoting tuberculosis susceptibility in diabetic hosts at a critical early step in the immune response to aerosol infection.
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Affiliation(s)
- Nuria Martinez
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Natkunam Ketheesan
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - Kim West
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Therese Vallerskog
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester
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Yoon YS, Jung JW, Jeon EJ, Seo H, Ryu YJ, Yim JJ, Kim YH, Lee BH, Park YB, Lee BJ, Kang H, Choi JC. The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study. Thorax 2016; 72:263-270. [PMID: 27553224 DOI: 10.1136/thoraxjnl-2015-207686] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB. METHODS A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment. RESULTS Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p<0.001) and presence of cavities (p<0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022). CONCLUSIONS Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.
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Affiliation(s)
- Young Soon Yoon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Jae-Woo Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea
| | - Eun Ju Jeon
- Department of Internal Medicine, Hallym Hospital, Incheon, South Korea
| | - Haesook Seo
- Department of Tuberculosis, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yee Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Byoung-Hoon Lee
- Department of Pulmonology and Allergy, Eulji Hospital, College of Medicine, Eulji University, Seoul, South Korea
| | - Yong Bum Park
- Department of Internal Medicine, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Byoung Jun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea
| | - Jae Chol Choi
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea
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MAGEE MJ, FOOTE M, RAY SM, GANDHI NR, KEMPKER RR. Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality. Epidemiol Infect 2016; 144:2209-16. [PMID: 26926092 PMCID: PMC5388926 DOI: 10.1017/s0950268816000364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 01/13/2023] Open
Abstract
Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ⩾16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27·8%) had any EPTB including 258 (19·5%) with only EPTB and 111 (8·4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11·9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1·04, 95% confidence interval (CI) 0·70-1·56]. The risk of death was 23·8% in patients with EPTB and diabetes vs. 9·8% in those with no diabetes (P < 0·01); after adjusting for covariates the difference was not significant (aRR 1·19, 95% CI 0·54-2·63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.
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Affiliation(s)
- M. J. MAGEE
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - M. FOOTE
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - S. M. RAY
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - N. R. GANDHI
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R. R. KEMPKER
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Effect of IFN-γ, IL-12 and IL-10 cytokine production and mRNA expression in tuberculosis patients with diabetes mellitus and their household contacts. Cytokine 2016; 81:127-36. [DOI: 10.1016/j.cyto.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 11/18/2022]
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Hawn TR, Shah JA, Kalman D. New tricks for old dogs: countering antibiotic resistance in tuberculosis with host-directed therapeutics. Immunol Rev 2015; 264:344-62. [PMID: 25703571 DOI: 10.1111/imr.12255] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite the availability of Mycobacterium tuberculosis (Mtb) drugs for over 50 years, tuberculosis (TB) remains at pandemic levels. New drugs are urgently needed for resistant strains, shortening duration of treatment, and targeting different stages of the disease, especially for treatment during human immunodeficiency virus co-infection. One solution to the conundrum that antibiotics kill the bacillus yet select for resistance is to target the host rather than the pathogen. Here, we discuss recent progress in so-called 'host-directed therapeutics' (HDTs), focusing on two general mechanistic strategies: (i) HDTs that disrupt Mtb pathogenesis in macrophages and (ii) immunomodulatory HDTs that facilitate protective immune responses that kill Mtb or reduce deleterious responses that exacerbate disease. HDTs hold significant promise as adjunctive therapies in that they are less likely to engender resistance, will likely have efficacy against antibiotic-resistant strains, and may have activity against non-replicating Mtb. However, TB is a complex and variegated disease, and human populations exhibit significant diversity in their immune responses to it, which presents a complicated landscape for HDTs to navigate. Nevertheless, we suggest that a detailed mechanistic understanding of drug action, together with careful selection of disease stage targets and dosing strategies may overcome such limitations and allow the development of HDTs as effective adjunctive treatment options for TB.
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Affiliation(s)
- Thomas R Hawn
- Department of Medicine, University of Washington, Seattle, WA, USA
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Ronacher K, Joosten SA, van Crevel R, Dockrell HM, Walzl G, Ottenhoff THM. Acquired immunodeficiencies and tuberculosis: focus on HIV/AIDS and diabetes mellitus. Immunol Rev 2015; 264:121-37. [PMID: 25703556 DOI: 10.1111/imr.12257] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The spread of human immunodeficiency virus (HIV) infection within Africa led to marked increases in numbers of cases of tuberculosis (TB), and although the epidemic peaked in 2006, there were still 1.8 million new cases in 2013, with 29.2 million prevalent cases. Half of all TB cases in Africa are in those with HIV co-infection. A brief review of the well-documented main immunological mechanisms of HIV-associated increased susceptibility to TB is presented. However, a new threat is facing TB control, which presents itself in the form of a rapid increase in the number of people living with type II diabetes mellitus (T2DM), particularly in areas that are already hardest hit by the TB epidemic. T2DM increases susceptibility to TB threefold, and the TB burden attributable to T2DM is 15%. This review addresses the much smaller body of research information available on T2DM-TB, compared to HIV-TB comorbidity. We discuss the altered clinical presentation of TB in the context of T2DM comorbidity, changes in innate and adaptive immune responses, including lymphocyte subsets and T-cell phenotypes, the effect of treatment of the different comorbidities, changes in biomarker expression and genetic predisposition to the respective morbidities, and other factors affecting the comorbidity. Although significant gains have been made in improving our understanding of the underlying mechanisms of T2DM-associated increased susceptibility, knowledge gaps still exist that require urgent attention.
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Affiliation(s)
- Katharina Ronacher
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and MRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Jenjaroen K, Chumseng S, Sumonwiriya M, Ariyaprasert P, Chantratita N, Sunyakumthorn P, Hongsuwan M, Wuthiekanun V, Fletcher HA, Teparrukkul P, Limmathurotsakul D, Day NPJ, Dunachie SJ. T-Cell Responses Are Associated with Survival in Acute Melioidosis Patients. PLoS Negl Trop Dis 2015; 9:e0004152. [PMID: 26495852 PMCID: PMC4619742 DOI: 10.1371/journal.pntd.0004152] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022] Open
Abstract
Background Melioidosis is an increasingly recognised cause of sepsis and death across South East Asia and Northern Australia, caused by the bacterium Burkholderia pseudomallei. Risk factors include diabetes, alcoholism and renal disease, and a vaccine targeting at-risk populations is urgently required. A better understanding of the protective immune response in naturally infected patients is essential for vaccine design. Methods We conducted a longitudinal clinical and immunological study of 200 patients with melioidosis on admission, 12 weeks (n = 113) and 52 weeks (n = 65) later. Responses to whole killed B. pseudomallei were measured in peripheral blood mononuclear cells (PBMC) by interferon-gamma (IFN-γ) ELIspot assay and flow cytometry and compared to those of control subjects in the region with diabetes (n = 45) and without diabetes (n = 43). Results We demonstrated strong CD4+ and CD8+ responses to B. pseudomallei during acute disease, 12 weeks and 52 weeks later. 28-day mortality was 26% for melioidosis patients, and B. pseudomallei-specific cellular responses in fatal cases (mean 98 IFN-γ cells per million PBMC) were significantly lower than those in the survivors (mean 142 IFN-γ cells per million PBMC) in a multivariable logistic regression model (P = 0.01). A J-shaped curve association between circulating neutrophil count and mortality was seen with an optimal count of 4000 to 8000 neutrophils/μl. Melioidosis patients with known diabetes had poor diabetic control (median glycated haemoglobin HbA1c 10.2%, interquartile range 9.2–13.1) and showed a stunted B. pseudomallei-specific cellular response during acute illness compared to those without diabetes. Conclusions The results demonstrate the role of both CD4+ and CD8+ T-cells in protection against melioidosis, and an interaction between diabetes and cellular responses. This supports development of vaccine strategies that induce strong T-cell responses for the control of intracellular pathogens such as B. pseudomallei. Melioidosis is a key cause of death in South East Asia and Northern Australia. It is caused by the soil-dwelling bacteria Burkholderia pseudomallei, and presents as a range of clinical illnesses including pneumonia and bloodstream infections. About two-thirds of patients with melioidosis in Thailand have diabetes, but the immune responses associated with death and diabetes are unknown. This study examined the relationship between immune responses to the bacteria and death by studying the bacteria-specific lymphocyte responses in 200 patients admitted to hospital with acute melioidosis and following the patients for up to one year where possible. 26% of patients died within 28 days despite receiving antibiotics and supportive care. We showed people with melioidosis make bacteria-specific lymphocyte responses, with lower levels seen in fatal cases compared to survivors. People with diabetes make lower responses than people without diabetes, and higher levels of circulating neutrophils on admission to hospital were associated with lower lymphocyte responses both during illness and three months later in survivors. This highlighting of lymphocyte responses to melioidosis is important for the design of vaccines to target at risk groups.
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Affiliation(s)
- Kemajittra Jenjaroen
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Suchintana Chumseng
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | | | - Narisara Chantratita
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Maliwan Hongsuwan
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Vanaporn Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Helen A. Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Susanna J. Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Clinical Pharmacokinetics of Rifampin in Patients with Tuberculosis and Type 2 Diabetes Mellitus: Association with Biochemical and Immunological Parameters. Antimicrob Agents Chemother 2015; 59:7707-14. [PMID: 26438503 DOI: 10.1128/aac.01067-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/25/2015] [Indexed: 12/25/2022] Open
Abstract
Tuberculosis (TB) remains a major public health issue due to the increasing incidence of type 2 diabetes mellitus (T2DM), which exacerbates the clinical course of TB and increases the risk of poor long-term outcomes. The aim of this study was to characterize the pharmacokinetics of rifampin (RIF) and its relationship with biochemical and immunological parameters in patients with TB and T2DM. The biochemical and immunological parameters were assessed on the same day that the pharmacokinetic evaluation of RIF was performed. Factors related to the metabolic syndrome that is characteristic of T2DM patients were not detected in the TB-T2DM group (where predominant malnutrition was present) or in the TB group. Percentages of CD8(+) T lymphocytes and NK cells were diminished in the TB and TB-T2DM patients, who had high tumor necrosis factor alpha (TNF-α) and low interleukin-17 (IL-17) levels compared to healthy volunteers. Delayed RIF absorption was observed in the TB and TB-T2DM patients; absorption was poor and slower in the latter group due to poor glycemic control. RIF clearance was also slower in the diabetic patients, thereby prolonging the mean residence time of RIF. There was a significant association between glycemic control, increased TNF-α serum concentrations, and RIF pharmacokinetics in the TB-T2DM patients. These altered metabolic and immune conditions may be factors to be considered in anti-TB therapy management when TB and T2DM are concurrently present.
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Hasanain AFA, Zayed AAAH, Mahdy RE, Nafee AMA, Attia RAMH, Mohamed AO. Hookworm infection among patients with pulmonary tuberculosis: Impact of co-infection on the therapeutic failure of pulmonary tuberculosis. Int J Mycobacteriol 2015; 4:318-22. [PMID: 26964815 DOI: 10.1016/j.ijmyco.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE/BACKGROUND The aim of this study is to determine the rate of hookworm infection among patients with pulmonary tuberculosis (TB) and to find out if there is a relation between hookworm infection and the therapeutic failure of pulmonary TB. METHODS We carried out a prospective, hospital-based study. The study included 231 naïve patients with pulmonary TB, consecutively. Patients were evaluated at the 4th month of therapy for persistence of Mycobacterium tuberculosis infection. All patients had clinical evaluation, laboratory investigations (including sputum culture and stool microscopic examination), and imaging studies (abdominal ultrasonography and chest radiography). RESULTS The study population mean age was 42.7±13.9 years old with 26.8% of them 40 years old or more. Out of 231 patients, 133 (57.6%) were men. Therapeutic failure rate of pulmonary TB was 29.4%. Hookworm infection was diagnosed among 16.5% of patients and 27.7% had diabetes mellitus (DM). Using multivariate analysis, it was found that age of 40 years or more (odds ratio [OR] 8.4; 95% confidence interval [CI] 1.7-41.3; p=.009), hookworm infection (OR 7.6; 95% CI 1.2-49.9; p=.034), and DM (OR 5.9; 1.2-28; p=.027) were independently associated with therapeutic failure of pulmonary TB among the study population with pulmonary TB. CONCLUSION In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response.
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Affiliation(s)
| | | | - Reem Ezzat Mahdy
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Asmaa Omar Mohamed
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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75
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Inafuku M, Matsuzaki G, Oku H. Intravenous Mycobacterium Bovis Bacillus Calmette-Guérin Ameliorates Nonalcoholic Fatty Liver Disease in Obese, Diabetic ob/ob Mice. PLoS One 2015; 10:e0128676. [PMID: 26039731 PMCID: PMC4454685 DOI: 10.1371/journal.pone.0128676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/29/2015] [Indexed: 12/15/2022] Open
Abstract
Inflammation and immune response profoundly influence metabolic syndrome and fatty acid metabolism. To analyze influence of systemic inflammatory response to metabolic syndrome, we inoculated an attenuated vaccine strain of Mycobacterium bovis Bacillus Calmette–Guérin (BCG) into leptin-deficient ob/ob mice. BCG administration significantly decreased epididymal white adipose tissue weight, serum insulin levels, and a homeostasis model assessment of insulin resistance. Serum high molecular weight (HMW) adiponectin level and HMW/total adiponectin ratio of the BCG treated mice were significantly higher than those of control mice. Hepatic triglyceride accumulation and macrovesicular steatosis were markedly alleviated, and the enzymatic activities and mRNA levels of lipogenic-related genes in liver were significantly decreased in the BCG injected mice. We also exposed human hepatocellular carcinoma HepG2 cells to high levels of palmitate, which enhanced endoplasmic reticulum stress-related gene expression and impaired insulin-stimulated Akt phosphorylation (Ser473). BCG treatment ameliorated both of these detrimental events. The present study therefore suggested that BCG administration suppressed development of nonalcoholic fatty liver disease, at least partly, by alleviating fatty acid-induced insulin resistance in the liver.
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Affiliation(s)
- Masashi Inafuku
- Department of Tropical Bio-resources, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa, Japan
- * E-mail:
| | - Goro Matsuzaki
- Department of Infectious Diseases, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hirosuke Oku
- Department of Tropical Bio-resources, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa, Japan
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76
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Wang JY, Lee MC, Shu CC, Lee CH, Lee LN, Chao KM, Chang FY. Optimal duration of anti-TB treatment in patients with diabetes: nine or six months? Chest 2015; 147:520-528. [PMID: 25255302 DOI: 10.1378/chest.14-0918] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases the risk of TB recurrence. This study investigated whether 9-month anti-TB treatment is associated with a lower risk of TB recurrence within 2 years after complete treatment than 6-month treatment in patients with DM with an emphasis on the impact of directly observed therapy, short course (DOTs). METHODS Patients with pulmonary but not extrapulmonary TB receiving treatment of 173 to 277 days between 2002 and 2010 were identified from the National Health Insurance Research Database of Taiwan. Patients with DM were then selected and classified into two groups based on anti-TB treatment duration (9 months vs 6 months). Factors predicting 2-year TB recurrence were explored using Cox regression analysis. RESULTS Among 12,688 patients with DM and 43,195 patients without DM, the 2-year TB recurrence rate was 2.20% and 1.38%, respectively (P < .001). Of the patients with DM, recurrence rate decreased from 3.54% to 1.19% after implementation of DOTs (P < .001). A total of 4,506 (35.5%) were classified into 9-month anti-TB treatment group. Although a 9-month anti-TB treatment was associated with a lower recurrence rate (hazard ratio, 0.76 [95% CI, 0.59-0.97]), the benefit disappeared (hazard ratio, 0.69 [95% CI, 0.43-1.11]) under DOTs. Other predictors of recurrence included older age, male sex, malignancy, earlier TB diagnosis year, culture positivity after 2 months of anti-TB treatment, and anti-TB treatment being ≤ 80% consistent with standard regimen. CONCLUSIONS The 2-year TB recurrence rate is higher in a diabetic population in Taiwan and can be reduced by treatment supervision. Extending the anti-TB treatment by 3 months may also decrease the recurrence rate when treatment is not supervised.
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Affiliation(s)
- Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ming-Chia Lee
- Department of Pharmacy Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, New Taipei
| | - Chin-Chung Shu
- Department of Traumatology, National Taiwan University Hospital, Taipei
| | - Chih-Hsin Lee
- Department of Pulmonary Medicine Wanfang Hospital, Taipei Medical University, Taipei.
| | - Li-Na Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei
| | - Kun-Mao Chao
- Graduate Institute of Biomedical Electronics and Bioinformatics National Taiwan University, Taipei
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Hodgson K, Morris J, Bridson T, Govan B, Rush C, Ketheesan N. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology 2015; 144:171-85. [PMID: 25262977 DOI: 10.1111/imm.12394] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 12/11/2022] Open
Abstract
Diabetes has been recognized as an important risk factor for a variety of intracellular bacterial infections, but research into the dysregulated immune mechanisms contributing to the impaired host-pathogen interactions is in its infancy. Diabetes is characterized by a chronic state of low-grade inflammation due to activation of pro-inflammatory mediators and increased formation of advanced glycation end products. Increased oxidative stress also exacerbates the chronic inflammatory processes observed in diabetes. The reduced phagocytic and antibacterial activity of neutrophils and macrophages provides an intracellular niche for the pathogen to replicate. Phagocytic and antibacterial dysfunction may be mediated directly through altered glucose metabolism and oxidative stress. Furthermore, impaired activation of natural killer cells contributes to decreased levels of interferon-γ, required for promoting macrophage antibacterial mechanisms. Together with impaired dendritic cell function, this impedes timely activation of adaptive immune responses. Increased intracellular oxidation of antigen-presenting cells in individuals with diabetes alters the cytokine profile generated and the subsequent balance of T-cell immunity. The establishment of acute intracellular bacterial infections in the diabetic host is associated with impaired T-cell-mediated immune responses. Concomitant to the greater intracellular bacterial burden and potential cumulative effect of chronic inflammatory processes, late hyper-inflammatory cytokine responses are often observed in individuals with diabetes, contributing to systemic pathology. The convergence of intracellular bacterial infections and diabetes poses new challenges for immunologists, providing the impetus for multidisciplinary research.
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Affiliation(s)
- Kelly Hodgson
- Infectious Diseases and Immunopathogenesis Research Group, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld, Australia
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78
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Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, Lee TI, Yu MC. The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis. PLoS One 2015; 10:e0121698. [PMID: 25822974 PMCID: PMC4378948 DOI: 10.1371/journal.pone.0121698] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/03/2015] [Indexed: 01/14/2023] Open
Abstract
Background To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Methodology/Principal Findings Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005–2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7–9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%–9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40–5.25) and HbA1C 7–9% (adjOR 1.62, 95% CI 1.07–2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70–1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19–5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89–4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344). Conclusions/Significance Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.
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Affiliation(s)
- Chen Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan Jen Bai
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsien Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Jen Jyh Lee
- Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Donald A. Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Ting-I Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chih Yu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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79
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The effect of hyperglycaemia on in vitro cytokine production and macrophage infection with Mycobacterium tuberculosis. PLoS One 2015; 10:e0117941. [PMID: 25664765 PMCID: PMC4322041 DOI: 10.1371/journal.pone.0117941] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/02/2015] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus is an established risk factor for tuberculosis but the underlying mechanisms are largely unknown. We examined the effects of hyperglycaemia, a hallmark of diabetes, on the cytokine response to and macrophage infection with Mycobacterium tuberculosis. Increasing in vitro glucose concentrations from 5 to 25 mmol/L had marginal effects on cytokine production following stimulation of peripheral blood mononuclear cells (PBMCs) with M. tuberculosis lysate, LPS or Candida albicans, while 40 mmol/L glucose increased production of TNF-α, IL-1β, IL-6 and IL-10, but not of IFN-γ, IL-17A and IL-22. Macrophage differentiation under hyperglycaemic conditions of 25 mmol/L glucose was also associated with increased cytokine production upon stimulation with M. tuberculosis lysate and LPS but in infection experiments no differences in M. tuberculosis killing or outgrowth was observed. The phagocytic capacity of these hyperglycaemic macrophages also remained unaltered. The fact that only very high glucose concentrations were able to significantly influence cytokine production by macrophages suggests that hyperglycaemia alone cannot fully explain the increased susceptibility of diabetes mellitus patients to tuberculosis.
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80
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Restrepo BI, Schlesinger LS. Impact of diabetes on the natural history of tuberculosis. Diabetes Res Clin Pract 2014; 106:191-9. [PMID: 25082309 PMCID: PMC4260985 DOI: 10.1016/j.diabres.2014.06.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the number one bacterial killer worldwide and the current increase in type 2 diabetes mellitus patients (DM), particularly in countries where TB is also endemic, has led to the re-emerging importance of DM2 as a risk factor for TB. There is an urgent need to implement strategies for TB prevention among the millions of DM patients exposed to Mycobacterium tuberculosis (Mtb) worldwide, but knowledge is limited on how and when DM2 alters the natural history of this infection. In this review we summarize the current epidemiological, clinical and immunologic studies on TB and DM and discuss the clinical and public health implications of these findings. Specifically, we evaluate the mechanisms by which DM patients have a higher risk of Mtb infection and TB development, present with signs and symptoms indicative of a more infectious TB infection, and are more likely to have adverse TB treatment outcomes, including death. Emphasis is placed on type 2 DM given its higher prevalence in contemporary times, but the underlying role of hyperglycemia and of type 1 DM is also discussed.
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Affiliation(s)
- Blanca I Restrepo
- UTHealth Houston, School of Public Health at Brownsville, 80 Fort Brown, Brownsville, TX 78520, United States.
| | - Larry S Schlesinger
- Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, The Ohio State University, 460W 12th Avenue, Columbus, OH 43210, United States
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81
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Factors affecting susceptibility to Mycobacterium tuberculosis: a close view of immunological defence mechanism. Appl Biochem Biotechnol 2014; 174:2663-73. [PMID: 25296626 DOI: 10.1007/s12010-014-1217-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
Tuberculosis is the most deadly infectious disease. In particular, pulmonary tuberculosis, being the predominant one, is highly contagious. In past the 200 years, one billion tuberculosis (TB) deaths had occurred, and it is anticipated that in the next 25 years, more than 40 million people may be killed by TB unless control measures are implemented. There are various causes which increase the susceptibility to Mycobacterium tuberculosis infection; these include weakened immune system which occurs through various diseases and medications like human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), type II diabetes, end-stage kidney disease, alcoholism and intravenous drug use, certain cancers, cancer treatment such as chemotherapy, malnutrition and very young or advanced age. Some other factors include tobacco use, which increases the risk of getting TB and dying from it. In this manuscript, the authors tried to summarize all the alterations occurring in immune system at cellular and molecular level which occur due to infection, metabolic changes and chemical exposure, which increase susceptibility to mycobacterial infection.
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82
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Martinez N, Vallerskog T, West K, Nunes-Alves C, Lee J, Martens GW, Behar SM, Kornfeld H. Chromatin decondensation and T cell hyperresponsiveness in diabetes-associated hyperglycemia. THE JOURNAL OF IMMUNOLOGY 2014; 193:4457-68. [PMID: 25246495 DOI: 10.4049/jimmunol.1401125] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetes is linked to increased inflammation and susceptibility to certain infectious diseases including tuberculosis (TB). We previously reported that aerosol TB in mice with chronic (≥ 12 wk) hyperglycemia features increased bacterial load, overproduction of several cytokines, and increased immune pathology compared with normoglycemic controls. A similar phenotype exists in human patients with diabetes with TB. The mechanisms of increased T cell activation in diabetes are unknown. In the current study, we tested the hypothesis that hyperglycemia modifies the intrinsic responsiveness of naive T cells to TCR stimulation. Purified T cells from chronically hyperglycemic (HG) mice produced higher levels of Th1, Th2, and Th17 cytokines and proliferated more than T cells from normoglycemic controls after anti-CD3e or Ag stimulation. In this way, naive T cells from HG mice resembled Ag-experienced cells, although CD44 expression was not increased. Chromatin decondensation, another characteristic of Ag-experienced T cells, was increased in naive T cells from HG mice. That phenotype depended on expression of the receptor for advanced glycation end products and could be reversed by inhibiting p38 MAPK. Chromatin decondensation and hyperresponsiveness to TCR stimulation persisted following transfer of T cells from HG mice into normoglycemic mice. We propose that chronic hyperglycemia causes receptor for advanced glycation end products-mediated epigenetic modification of naive T cells leading to p38 MAPK-dependent chromatin decondensation. This preactivation state facilitates transcription factor access to DNA, increasing cytokine production and proliferation following TCR stimulation. This mechanism may contribute to pathological inflammation associated with diabetes and might offer a novel therapeutic target.
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Affiliation(s)
- Nuria Martinez
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
| | - Therese Vallerskog
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
| | - Kim West
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
| | - Claudio Nunes-Alves
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Jinhee Lee
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
| | - Gregory W Martens
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
| | - Samuel M Behar
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655; and
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83
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Odone A, Houben RMGJ, White RG, Lönnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. Lancet Diabetes Endocrinol 2014; 2:754-64. [PMID: 25194888 DOI: 10.1016/s2213-8587(14)70164-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To achieve the post-2015 global tuberculosis target of 90% reduction in tuberculosis incidence by 2035, the present rate of decline must accelerate. Among factors that hinder tuberculosis control, malnutrition and diabetes are key challenges. We review available data to describe the complex relationship between tuberculosis, diabetes, and nutritional status. Additionally, we review past trends, present burden, and available future global projections for diabetes, overweight and obesity, as well as undernutrition and food insecurity. Using a mathematical model, we estimate the potential effect of these factors on tuberculosis burden up to 2035. Great potential exists for reduction of worldwide tuberculosis burden by combination of improved prevention and care of diabetes with reduction of undernutrition. To achieve this combination will require joint efforts and strong cross-programme links, enabling synergistic effects of public health policies that promote good nutrition and optimum clinical care for tuberculosis and diabetes.
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Affiliation(s)
- Anna Odone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Rein M G J Houben
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard G White
- Tuberculosis Modelling Group, Tuberculosis Centre and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Knut Lönnroth
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
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84
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Mehrotra P, Jamwal SV, Saquib N, Sinha N, Siddiqui Z, Manivel V, Chatterjee S, Rao KVS. Pathogenicity of Mycobacterium tuberculosis is expressed by regulating metabolic thresholds of the host macrophage. PLoS Pathog 2014; 10:e1004265. [PMID: 25058590 PMCID: PMC4110042 DOI: 10.1371/journal.ppat.1004265] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 06/06/2014] [Indexed: 11/18/2022] Open
Abstract
The success of Mycobacterium tuberculosis as a pathogen derives from its facile adaptation to the intracellular milieu of human macrophages. To explore this process, we asked whether adaptation also required interference with the metabolic machinery of the host cell. Temporal profiling of the metabolic flux, in cells infected with differently virulent mycobacterial strains, confirmed that this was indeed the case. Subsequent analysis identified the core subset of host reactions that were targeted. It also elucidated that the goal of regulation was to integrate pathways facilitating macrophage survival, with those promoting mycobacterial sustenance. Intriguingly, this synthesis then provided an axis where both host- and pathogen-derived factors converged to define determinants of pathogenicity. Consequently, whereas the requirement for macrophage survival sensitized TB susceptibility to the glycemic status of the individual, mediation by pathogen ensured that the virulence properties of the infecting strain also contributed towards the resulting pathology. Mycobacterium tuberculosis (Mtb) is a highly successful human pathogen, representing the leading bacterial cause of death worldwide. Mtb infects macrophages and it adapts to the hostile intracellular milieu of this cell by exploiting the plasticity of its central carbon metabolism machinery. While several studies have detailed the bacterial adaptations that accompany infection, it is still unclear whether this process also involves engagement with host metabolic pathways. We therefore profiled the kinetic flux of host cell metabolites in macrophages that were infected with differently virulent Mtb strains. Interestingly, we found that Mtb pathogenicity was indeed intimately linked to its capacity to regulate host cell metabolism. A unique subset of host pathways was targeted so as to integrate the glycolytic threshold governing macrophage viability with mechanisms ensuring intracellular bacterial survival. Perturbation of macrophage glycolytic flux was enforced through pathogen-induced enhancement in glucose uptake, which in turn was also influenced by the extracellular glucose concentration. This observation rationalizes the increased susceptibility of diabetic individuals to TB infection Interestingly, Mtb strains also differed in their capacities to stimulate macrophage glucose uptake. Consequently, the resulting pathology is likely dictated both by the individual's glycemic status, and the nature of the infecting strain.
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Affiliation(s)
- Parul Mehrotra
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Shilpa V. Jamwal
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Najmuddin Saquib
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Neeraj Sinha
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Zaved Siddiqui
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Venkatasamy Manivel
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Samrat Chatterjee
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kanury V. S. Rao
- Immunology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- * E-mail:
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85
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Vieira A, Michels M, Florentino D, Lauriano AA, Danielski LG, Fortunato JJ, Barichello T, Felipe DP, Quevedo J, Petronilho F. Increased on oxidative brain injury in the diabetic rats following sepsis. Synapse 2014; 68:410-8. [DOI: 10.1002/syn.21753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/27/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Andriele Vieira
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - Monique Michels
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - Drielly Florentino
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - André Antunes Lauriano
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - Lucineia Gainski Danielski
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - Jucelia Jeremias Fortunato
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
| | - Tatiana Barichello
- Laboratory of Experimental Microbiology, Graduate Program in Health Sciences, Universidade do Extremo Sul Catarinense (UNESC); Criciúma Santa Catarina Brazil
- Department of Psychiatry and Behavioral Sciences; Center for Experimental Models in Psychiatry, The University of Texas Medical School at Houston; Texas
| | - Dal-Pizzol Felipe
- Experimental Pathophysiology Laboratory - FISIOPAT, Graduate Program in Health Sciences, Universidade do Extremo Sul de Santa Catarina (UNESC); Criciuma Santa Catarina Brazil
| | - Joao Quevedo
- Department of Psychiatry and Behavioral Sciences; Center for Experimental Models in Psychiatry, The University of Texas Medical School at Houston; Texas
- Laboratory of Neurociences, Graduate Program in Health Sciences, Universidade do Extremo Sul de Santa Catarina (UNESC); Criciuma Santa Catarina Brazil
| | - Fabricia Petronilho
- Clinical and Experimental Pathophysiology Laboratory - FICEXP, Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina (UNISUL); Tubarão Santa Catarina Brazil
- Department of Psychiatry and Behavioral Sciences; Center for Experimental Models in Psychiatry, The University of Texas Medical School at Houston; Texas
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86
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Restrepo BI, Twahirwa M, Rahbar MH, Schlesinger LS. Phagocytosis via complement or Fc-gamma receptors is compromised in monocytes from type 2 diabetes patients with chronic hyperglycemia. PLoS One 2014; 9:e92977. [PMID: 24671137 PMCID: PMC3966862 DOI: 10.1371/journal.pone.0092977] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/27/2014] [Indexed: 02/07/2023] Open
Abstract
Type 2 diabetes patients (DM2) have a higher risk of tuberculosis (TB) that may be attributed to functional defects in their mononuclear phagocytes given the critical role of these cells in Mycobacterium tuberculosis containment. Our previous findings suggest that monocytes from DM2 have reduced association with serum-opsonized M. tuberculosis. To determine if this alteration is due to defects in phagocytosis via complement or Fc-gamma receptors (FcγRs), in this study we evaluated the uptake of sheep red blood cells coated with IgG or complement, respectively, by monocytes from individuals with and without DM2. We found that chronic hyperglycemia was significantly associated with reduced phagocytosis via either receptor by univariable and multivariable analyses. This defect was independent of host serum opsonins and flow cytometry data indicated this was not attributed to reduced expression of these phagocytic receptors on DM2 monocytes. The positive correlation between both pathways (R = 0.64; p = 0.003) indicate that monocytes from individuals with chronic hyperglycemia have a defect in the two predominant phagocytic pathways of these cells. Given that phagocytosis is linked to activation of effector mechanisms for bacterial killing, it is likely that this defect is one factor contributing to the higher susceptibility of DM2 patients to pathogens like M. tuberculosis.
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Affiliation(s)
- Blanca I Restrepo
- Division of Epidemiology, UTHealth Houston, School of Public Health at Brownsville, Brownsville, Texas, United States of America
| | - Marcel Twahirwa
- Joslin Diabetes Center-Doctors Hospital at Renaissance, Edinburg, Texas, United States of America
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Larry S Schlesinger
- Center for Microbial Interface Biology and Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, United States of America
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87
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Lee PH, Lin HC, Huang ASE, Wei SH, Lai MS, Lin HH. Diabetes and risk of tuberculosis relapse: nationwide nested case-control study. PLoS One 2014; 9:e92623. [PMID: 24663327 PMCID: PMC3963913 DOI: 10.1371/journal.pone.0092623] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/25/2014] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to investigate the association between diabetes mellitus (DM) and tuberculosis (TB) relapse using the nationwide TB registry in Taiwan. We conducted a case-control study nested within a nationwide cohort of all incident cases of pulmonary TB that were notified during 2006–2007 and had completed anti-TB treatment. The relapse of TB was confirmed by bacteriological or pathological findings. For each relapse case, one control was selected from the study cohort matching by time since treatment completion. DM status was ascertained by medical chart review and cross-matching with the National Health Insurance claims database. A total of 305 cases of relapse were identified after a median follow-up of 3 years (relapse rate: 488 per 100,000 person-year; 95% confidence interval (CI): 434–546). Presence of DM during previous anti-TB treatment was 34.0% and 22.7% in cases and controls, respectively. After adjusting for other potential confounders, DM was associated with increased risk of TB relapse (adjusted odds ratio: 1.96, 95% CI: 1.22–3.15). Only one-third of the DM-TB patients in our study received glycaemic monitoring using HbA1c during anti-TB treatment. Presence of DM was independently associated with risk of TB relapse. TB programs should seriously consider rigorous glucose control in DM-TB patients.
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Affiliation(s)
- Pin-Hui Lee
- Centers for Disease Control, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | - Sung-Hsi Wei
- Centers for Disease Control, Taipei, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail:
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88
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Martinez N, Kornfeld H. Diabetes and immunity to tuberculosis. Eur J Immunol 2014; 44:617-26. [PMID: 24448841 DOI: 10.1002/eji.201344301] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 02/06/2023]
Abstract
The dual burden of tuberculosis (TB) and diabetes has attracted much attention in the past decade as diabetes prevalence has increased dramatically in countries already afflicted with a high burden of TB. The confluence of these two major diseases presents a serious threat to global public health; at the same time it also presents an opportunity to learn more about the key elements of human immunity to TB that may be relevant to the general population. Some effects of diabetes on innate and adaptive immunity that are potentially relevant to TB defense have been identified, but have yet to be verified in humans and are unlikely to fully explain the interaction of these two disease states. This review provides an update on the clinical and epidemiological features of TB in the diabetic population and relates them to recent advances in understanding the mechanistic basis of TB susceptibility and other complications of diabetes. Issues that merit further investigation - such as geographic host and pathogen differences in the diabetes/TB interaction, the role of hyperglycemia-induced epigenetic reprogramming in immune dysfunction, and the impact of diabetes on lung injury and fibrosis caused by TB - are highlighted in this review.
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Affiliation(s)
- Nuria Martinez
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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89
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Podell BK, Ackart DF, Obregon-Henao A, Eck SP, Henao-Tamayo M, Richardson M, Orme IM, Ordway DJ, Basaraba RJ. Increased severity of tuberculosis in Guinea pigs with type 2 diabetes: a model of diabetes-tuberculosis comorbidity. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:1104-1118. [PMID: 24492198 DOI: 10.1016/j.ajpath.2013.12.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/27/2013] [Accepted: 12/05/2013] [Indexed: 01/14/2023]
Abstract
Impaired glucose tolerance and type 2 diabetes were induced in guinea pigs to model the emerging comorbidity of Mycobacterium tuberculosis infection in diabetic patients. Type 2 diabetes mellitus was induced by low-dose streptozotocin in guinea pigs rendered glucose intolerant by first feeding a high-fat, high-carbohydrate diet before M. tuberculosis exposure. M. tuberculosis infection of diabetic guinea pigs resulted in severe and rapidly progressive tuberculosis (TB) with a shortened survival interval, more severe pulmonary and extrapulmonary pathology, and a higher bacterial burden compared with glucose-intolerant and nondiabetic controls. Compared with nondiabetics, diabetic guinea pigs with TB had an exacerbated proinflammatory response with more severe granulocytic inflammation and higher gene expression for the cytokines/chemokines interferon-γ, IL-17A, IL-8, and IL-10 in the lung and for interferon-γ, tumor necrosis factor-α, IL-8, and monocyte chemoattractant protein-1 in the spleen. TB disease progression in guinea pigs with impaired glucose tolerance was similar to that of nondiabetic controls in the early stages of infection but was more severe by day 90. The guinea pig model of type 2 diabetes-TB comorbidity mimics important features of the naturally occurring disease in humans. This model will be beneficial in understanding the complex pathogenesis of TB in diabetic patients and to test new strategies to improve TB and diabetes control when the two diseases occur together.
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Affiliation(s)
- Brendan K Podell
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - David F Ackart
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Andres Obregon-Henao
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Sarah P Eck
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Marcela Henao-Tamayo
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Michael Richardson
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Ian M Orme
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Diane J Ordway
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado
| | - Randall J Basaraba
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado.
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90
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Restrepo BI, Schlesinger LS. Host-pathogen interactions in tuberculosis patients with type 2 diabetes mellitus. Tuberculosis (Edinb) 2013; 93 Suppl:S10-4. [PMID: 24388642 PMCID: PMC4019931 DOI: 10.1016/s1472-9792(13)70004-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is known to be fueled by HIV as well as social and economic factors. With progression of the diabetes mellitus (DM) pandemic in countries where TB is also endemic, focus is increasing on the potential links between DM and TB. Despite the magnitude of the DM-TB association worldwide, it is striking how little we know about the underlying biology that promotes this association which is a major concern to public health. In this review we summarize current findings regarding the alterations in the innate and adaptive immune responses of DM patients to Mycobacterium tuberculosis (Mtb). Current findings suggest underperforming innate immunity followed by a hyper-reactive cellular response to Mtb, but the contribution of these altered responses to TB susceptibility or to the more adverse clinical outcomes of TB patients with DM remains unclear. Elucidating the basic mechanisms underlying the higher susceptibility of DM patients to TB should lead to a strategy for stratification of the millions of DM patients worldwide into those with the highest TB risk for targeted TB prevention.
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Affiliation(s)
- Blanca I Restrepo
- UTHealth Houston, School of Public Health at Brownsville, 80 Fort Brown, Brownsville, Texas 78520, USA.
| | - Larry S Schlesinger
- Center for Microbial Interface Biology and Department of Microbial Infection and Immunity, 460W 12th Ave, The Ohio State University, Columbus, Ohio 43210, USA
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91
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Kuo MC, Lin SH, Lin CH, Mao IC, Chang SJ, Hsieh MC. Type 2 diabetes: an independent risk factor for tuberculosis: a nationwide population-based study. PLoS One 2013; 8:e78924. [PMID: 24236069 PMCID: PMC3827305 DOI: 10.1371/journal.pone.0078924] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Tuberculosis continues to be a major global health problem. We wanted to investigate whether Type 2 diabetes was a risk factor for tuberculosis in an Asian population. Methods From Taiwan’s National Health Insurance Research Database, we collected data from 31,237 female patients with type 2 diabetes and 92,642 female controls and 32,493 male patients with type 2 diabetes and 96,977 male controls. Cox proportional hazard regression was performed to evaluate independent risk factors for tuberculosis in all patients and to identify risk factors in patients with type 2 diabetes. Results During the study period, both female (standardized incidence ratio (SIR): 1.40, p<0.01) and male (SIR: 1.48, p<0.01) patients with type 2 diabetes were found to have a significantly higher rate of incident tuberculosis than the control group. Type 2 diabetes (HR:1.31, 1.23–1.39, p<0.001) was significantly associated with tuberculosis after adjusting sex, age, bronchiectasis, asthma and chronic obstructive lung disease. Conclusions Patients with type 2 diabetes have a higher risk of tuberculosis compared to control subjects after adjusting for confounding factors. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions. Therefore, preventive measures, including addressing the possibility that type 2 diabetes increase the individual’s susceptibility for incident TB, should be taken to further reduce the incidence of tuberculosis.
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Affiliation(s)
- Ming-Chun Kuo
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Hao Lin
- Division of Chest medicine, Department of internal medicine, Changhua Christian Hospital, Changhua City, Taiwan
- Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest medicine, Department of internal medicine, Changhua Christian Hospital, Changhua City, Taiwan
- Taiwan School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - I-Chieh Mao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung City, Taiwan
- * E-mail: (S-JC); (M-CH)
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (S-JC); (M-CH)
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92
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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93
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Lee MC, Lee CH, Shu CC, Pong WB, Lan CC, Wang JY, Lee LN, Chao KM. The impact of diabetes mellitus and its control on the development of tuberculosis: a nationwide longitudinal study in Taiwan. Pharmacoepidemiol Drug Saf 2013. [DOI: 10.1002/pds.3491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ming-Chia Lee
- Department of Pharmacy; Buddhist Tzu Chi General Hospital; Taipei Branch Taiwan
| | - Chih-Hsin Lee
- Graduate Institute of Biomedical Electronics and Bioinformatics; National Taiwan University; Taipei Taiwan
- Department of Internal Medicine; Buddhist Tzu Chi General Hospital; Taipei Branch Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Chin-Chung Shu
- Department of Traumatology; National Taiwan University Hospital; Taipei Taiwan
| | - Wei-Bang Pong
- Department of Internal Medicine; Buddhist Tzu Chi General Hospital; Taipei Branch Taiwan
| | - Chou-Chin Lan
- Department of Internal Medicine; Buddhist Tzu Chi General Hospital; Taipei Branch Taiwan
- School of Medicine; Tzu Chi University; Hualien Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Li-Na Lee
- Department of Laboratory Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Kun-Mao Chao
- Graduate Institute of Biomedical Electronics and Bioinformatics; National Taiwan University; Taipei Taiwan
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94
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Carlos D, Spiller F, Souto FO, Trevelin SC, Borges VF, de Freitas A, Alves-Filho JC, Silva JS, Ryffel B, Cunha FQ. Histamine h2 receptor signaling in the pathogenesis of sepsis: studies in a murine diabetes model. THE JOURNAL OF IMMUNOLOGY 2013; 191:1373-82. [PMID: 23817413 DOI: 10.4049/jimmunol.1202907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Type 1 diabetes enhances susceptibility to infection and favors the sepsis development. In addition, diabetic mice produced higher levels of histamine in several tissues and in the blood after LPS stimulation than nondiabetic mice. In this study, we aimed to explore the role of mast cells (MCs) and histamine in neutrophil migration and, consequently, infection control in diabetic mice with mild sepsis (MS) induced by cecum ligation and puncture. We used female BALB/c, MC-sufficient (WB/B6), MC-deficient (W/W(v)), and NOD mice. Diabetic mice given MS displayed 100% mortality within 24 h, whereas all nondiabetic mice survived for at least 5 d. The mortality rate of diabetic mice was reduced to 57% after the depletion of MC granules with compound 48/80. Moreover, this pretreatment increased neutrophil migration to the focus of infection, which reduced systemic inflammatory response and bacteremia. The downregulation of CXCR2 and upregulation of G protein-coupled receptor kinase 2 in neutrophils was prevented by pretreatment of diabetic mice given MS with compound 48/80. In addition, blocking the histamine H2 receptor restored neutrophil migration, enhanced CXCR2 expression, decreased bacteremia, and improved sepsis survival in alloxan-induced diabetic and spontaneous NOD mice. Finally, diabetic W/W(v) mice had neutrophil migration to the peritoneal cavity, increased CXCR2 expression, and reduced bacteremia compared with diabetic WB/B6 mice. These results demonstrate that histamine released by MCs reduces diabetic host resistance to septic peritonitis in mice.
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Affiliation(s)
- Daniela Carlos
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, 14049-900 Ribeirão Preto, São Paulo, Brazil
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95
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Kapur A, Harries AD. The double burden of diabetes and tuberculosis - public health implications. Diabetes Res Clin Pract 2013; 101:10-9. [PMID: 23305899 DOI: 10.1016/j.diabres.2012.12.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 01/04/2023]
Abstract
Diabetes mellitus (DM) and tuberculosis (TB) have existed for thousands of years and even now the global disease burden from DM and TB is huge. The incidence of TB is declining slowly but it still remains a big problem in many populous large low and middle income countries. On the other, hand the burden of diabetes is increasing very rapidly, particularly in the very same countries where TB is endemic. The intersecting double burden is therefore ominous particularly as several studies and systematic reviews have indicated that DM increases the risk of TB disease and results in poor treatment outcomes. To address the double burden, WHO and the International Union Against Tuberculosis and Lung Disease (The Union) in 2011 launched a collaborative framework for the care and control of diabetes and tuberculosis, to encourage collaborative research and implement bidirectional screening of the two diseases in routine settings. This review article (i) explores some of the new evidence for the association between TB and DM, (ii) discusses issues with regard to clinical presentation and outcomes, (iii) presents the evidence, challenges and strategies for bidirectional screening based on field studies to implement the framework and (iv) finally presents suggestions on how diabetes care delivery may benefit from the lessons of the TB DOTS approach and public health principles for structured care delivery.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Diseases, Paris, France; London School of Hygiene and Tropical Medicine, London, UK
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96
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Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, Lee J, Zhan X, Kang H, Hwang S, Carroll M, Cai Y, Cho SN, Barry CE, Via LE, Kornfeld H. Impact of diabetes and smoking on mortality in tuberculosis. PLoS One 2013; 8:e58044. [PMID: 23469139 PMCID: PMC3585219 DOI: 10.1371/journal.pone.0058044] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 01/30/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. METHODS A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. RESULTS The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. CONCLUSIONS In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.
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Affiliation(s)
- George W. Reed
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Hongjo Choi
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - So Young Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Myungsun Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Youngran Kim
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Hyemi Park
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Jongseok Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Xin Zhan
- Information Services Department, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Hyeungseok Kang
- National Masan Tuberculosis Hospital, Changwon, Republic of Korea
| | - SooHee Hwang
- National Masan Tuberculosis Hospital, Changwon, Republic of Korea
| | - Matthew Carroll
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Sang-Nae Cho
- International Tuberculosis Research Center, Changwon, Republic of Korea
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Clifton E. Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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97
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Repasy T, Lee J, Marino S, Martinez N, Kirschner DE, Hendricks G, Baker S, Wilson AA, Kotton DN, Kornfeld H. Intracellular bacillary burden reflects a burst size for Mycobacterium tuberculosis in vivo. PLoS Pathog 2013; 9:e1003190. [PMID: 23436998 PMCID: PMC3578792 DOI: 10.1371/journal.ppat.1003190] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 12/28/2012] [Indexed: 01/12/2023] Open
Abstract
We previously reported that Mycobacterium tuberculosis triggers macrophage necrosis in vitro at a threshold intracellular load of ∼25 bacilli. This suggests a model for tuberculosis where bacilli invading lung macrophages at low multiplicity of infection proliferate to burst size and spread to naïve phagocytes for repeated cycles of replication and cytolysis. The current study evaluated that model in vivo, an environment significantly more complex than in vitro culture. In the lungs of mice infected with M. tuberculosis by aerosol we observed three distinct mononuclear leukocyte populations (CD11b− CD11c+/hi, CD11b+/lo CD11clo/−, CD11b+/hi CD11c+/hi) and neutrophils hosting bacilli. Four weeks after aerosol challenge, CD11b+/hi CD11c+/hi mononuclear cells and neutrophils were the predominant hosts for M. tuberculosis while CD11b+/lo CD11clo/− cells assumed that role by ten weeks. Alveolar macrophages (CD11b− CD11c+/hi) were a minority infected cell type at both time points. The burst size model predicts that individual lung phagocytes would harbor a range of bacillary loads with most containing few bacilli, a smaller proportion containing many bacilli, and few or none exceeding a burst size load. Bacterial load per cell was enumerated in lung monocytic cells and neutrophils at time points after aerosol challenge of wild type and interferon-γ null mice. The resulting data fulfilled those predictions, suggesting a median in vivo burst size in the range of 20 to 40 bacilli for monocytic cells. Most heavily burdened monocytic cells were nonviable, with morphological features similar to those observed after high multiplicity challenge in vitro: nuclear condensation without fragmentation and disintegration of cell membranes without apoptotic vesicle formation. Neutrophils had a narrow range and lower peak bacillary burden than monocytic cells and some exhibited cell death with release of extracellular neutrophil traps. Our studies suggest that burst size cytolysis is a major cause of infection-induced mononuclear cell death in tuberculosis. Macrophages patrol the lung to ingest and destroy inhaled microbes. Mycobacterium tuberculosis, the bacteria causing tuberculosis, can survive within macrophages and use them as a protected environment for growth. Macrophages by themselves are poorly equipped to kill M. tuberculosis but may undergo programmed cell death (apoptosis) to limit bacterial replication. Virulent M. tuberculosis has evolved the capacity to inhibit macrophage apoptosis, thereby protecting the replication niche. In previous studies we showed that upon reaching a threshold intracellular number (burst size), virulent M. tuberculosis kills macrophages by necrosis and escapes for spreading infection. The present study was designed to test whether this mechanism seen in vitro operates during pulmonary tuberculosis in vivo. The distribution of M. tuberculosis numbers inside lung phagocytes of mice with tuberculosis conformed to predictions based on the burst size hypothesis, as did the appearance of dying cells. We identified four different types of phagocytes hosting intracellular M. tuberculosis. The distribution of M. tuberculosis load within individual phagocytes and between different types of phagocyte changed over the course of tuberculosis disease. These studies reveal the complexity of host defense in tuberculosis that must be considered as new therapies are sought.
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MESH Headings
- Animals
- Bacterial Load
- Cell Death
- Cells, Cultured
- Interferon-gamma/genetics
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/microbiology
- Lung/immunology
- Lung/microbiology
- Macrophages, Alveolar/cytology
- Macrophages, Alveolar/microbiology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Models, Immunological
- Mycobacterium tuberculosis/cytology
- Mycobacterium tuberculosis/growth & development
- Mycobacterium tuberculosis/immunology
- Neutrophils/microbiology
- Tuberculosis, Pulmonary/immunology
- Tuberculosis, Pulmonary/microbiology
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Affiliation(s)
- Teresa Repasy
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Jinhee Lee
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Simeone Marino
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Nuria Martinez
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Denise E. Kirschner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Gregory Hendricks
- Department of Cell Biology, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Stephen Baker
- Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Andrew A. Wilson
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Darrell N. Kotton
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
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98
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Jeon CY, Murray MB, Baker MA. Managing tuberculosis in patients with diabetes mellitus: why we care and what we know. Expert Rev Anti Infect Ther 2013; 10:863-8. [PMID: 23030325 DOI: 10.1586/eri.12.75] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As the global prevalence of diabetes mellitus (DM) increases, especially in low-to-middle income countries where tuberculosis (TB) remains endemic, we will encounter a growing number of TB patients with DM. This is a major concern for TB control programs, clinicians and patients alike because DM patients are at an increased risk of TB and are more likely to face poor TB treatment outcomes, including treatment failure, relapse and even death. Priority should be placed on early detection of both diseases through active screening, monitoring of adherence to medications for both diseases, and integration of TB and DM management strategies that would facilitate the provision of more comprehensive services that TB patients with DM require.
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Affiliation(s)
- Christie Y Jeon
- Columbia University School of Nursing, 617 W 168th St 355, New York, NY 10032, USA.
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Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulm Med 2013; 2013:828939. [PMID: 23476764 PMCID: PMC3583136 DOI: 10.1155/2013/828939] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/27/2012] [Accepted: 01/05/2013] [Indexed: 01/07/2023] Open
Abstract
The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli.
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Affiliation(s)
- Padmanesan Narasimhan
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - James Wood
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
| | - Dilip Mathai
- Infectious Diseases Research and Training Centre, Department of Medicine-I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Tuberculosis, Epidemiology of. Infect Dis (Lond) 2013. [DOI: 10.1007/978-1-4614-5719-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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