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Ramasubramani P, Kar SS, Sarkar S, Negi VS, Satheeh S, Mohanty Mohapatra M, Chengappa K. Association of Selected Cardiovascular Markers With Tuberculosis: Community-Based Exploratory Cross-Sectional Analytical Study in Puducherry. Cureus 2023; 15:e42343. [PMID: 37621832 PMCID: PMC10444981 DOI: 10.7759/cureus.42343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction India accounts for one-fourth of the global tuberculosis (TB) burden and also faces a rising burden of non-communicable diseases. Only a few have studied the association between the infective pathogenesis of TB and cardiovascular diseases (CVD). Methods A cross-sectional exploratory analytical design was used to compare CVD risk factors and immunological and radiological parameters. This was a pilot study conducted in two primary health centers in urban Puducherry between February 2020 and March 2021. Household contacts (HHC) were either spouses or siblings of the newly diagnosed pulmonary tuberculosis (PTB) patients selected for comparison as their exposure to infection would be similar to those who were diseased yet did not develop illness. Assuming a difference of 5% in CVD risk between the general population and TB patients, with a 95% confidence interval, the sample size calculated was 153 in each group by nMaster v2.0. Considering the feasibility and resource constrain, we recruited 50 newly diagnosed PTB patients, their age- and gender-matched 50 HHC and 50 PTB patients who completed treatment a year before. CVD risk factors were compared using chi-square or Fisher exact test. Interleukins-6 (IL-6), interferon-gamma (INF-γ), highly specific - C reactive protein (hs-CRP), and carotid intima-media thickness (CIMT) were compared using ANOVA or Kruskal-Wallis test. Results Most participants from each group belonged to lower socio-economic strata and were males (40/50). Alcohol intake was higher among newly diagnosed and treatment-completed PTB patients (82.5% vs 72.5%). Excess salt intake (58%) was present more in newly diagnosed PTB patients. General and abdominal obesity were seen more among HHC (64% and 84%) and treatment-completed PTB patients (50% and 74%). IL-6 was higher in newly diagnosed PTB patients, whereas INF-γ and hs-CRP were higher in treatment-completed PTB patients. The largest proportion of those having high CIMT values was also in the treatment-completed PTB patients. Conclusion Levels of immune markers hint at the role of inflammation due to TB disease being related to the high CIMT values among the newly diagnosed and treatment-completed PTB patients. CVD risk was higher among TB patients even if they had completed treatment and were declared cured.
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Affiliation(s)
- Premkumar Ramasubramani
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Santhosh Satheeh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, IND
| | - Madhusmita Mohanty Mohapatra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Kavadichanda Chengappa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, IND
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Ahmad R, Xie L, Pyle M, Suarez MF, Broger T, Steinberg D, Ame SM, Lucero MG, Szucs MJ, MacMullan M, Berven FS, Dutta A, Sanvictores DM, Tallo VL, Bencher R, Eisinger DP, Dhingra U, Deb S, Ali SM, Mehta S, Fawzi WW, Riley ID, Sazawal S, Premji Z, Black R, Murray CJL, Rodriguez B, Carr SA, Walt DR, Gillette MA. A rapid triage test for active pulmonary tuberculosis in adult patients with persistent cough. Sci Transl Med 2020; 11:11/515/eaaw8287. [PMID: 31645455 DOI: 10.1126/scitranslmed.aaw8287] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/23/2019] [Indexed: 01/08/2023]
Abstract
Improved tuberculosis (TB) prevention and control depend critically on the development of a simple, readily accessible rapid triage test to stratify TB risk. We hypothesized that a blood protein-based host response signature for active TB (ATB) could distinguish it from other TB-like disease (OTD) in adult patients with persistent cough, thereby providing a foundation for a point-of-care (POC) triage test for ATB. Three adult cohorts consisting of ATB suspects were recruited. A bead-based immunoassay and machine learning algorithms identified a panel of four host blood proteins, interleukin-6 (IL-6), IL-8, IL-18, and vascular endothelial growth factor (VEGF), that distinguished ATB from OTD. An ultrasensitive POC-amenable single-molecule array (Simoa) panel was configured, and the ATB diagnostic algorithm underwent blind validation in an independent, multinational cohort in which ATB was distinguished from OTD with receiver operator characteristic-area under the curve (ROC-AUC) of 0.80 [95% confidence interval (CI), 0.75 to 0.85], 80% sensitivity (95% CI, 73 to 85%), and 65% specificity (95% CI, 57 to 71%). When host antibodies against TB antigen Ag85B were added to the panel, performance improved to 86% sensitivity and 69% specificity. A blood-based host response panel consisting of four proteins and antibodies to one TB antigen can help to differentiate ATB from other causes of persistent cough in patients with and without HIV infection from Africa, Asia, and South America. Performance characteristics approach World Health Organization (WHO) target product profile accuracy requirements and may provide the foundation for an urgently needed blood-based POC TB triage test.
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Affiliation(s)
- Rushdy Ahmad
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA.
| | - Liangxia Xie
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.,Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Department of Chemistry, Tufts University, Medford, MA 02155, USA
| | - Margaret Pyle
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Marta F Suarez
- Daktari Diagnostics, 85 Bolton Street, Cambridge, MA 02140, USA
| | - Tobias Broger
- Foundation for Innovative New Diagnostics, 9 Chemin des Mines, 1202 Geneva, Switzerland
| | - Dan Steinberg
- Salford Systems, 9685 Via Excelencia, Suite 208, San Diego, CA 92126, USA
| | - Shaali M Ame
- Public Health Laboratory-Ivo de Carneri, Wawi, Chake Chake, Pemba 5501021, Tanzania
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City, Alabang, Muntinlupa City, 1781, Metro Manila, Philippines
| | - Matthew J Szucs
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Melanie MacMullan
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Frode S Berven
- Proteomics Unit, Department of Biomedicine, University of Bergen, 5009 Bergen, Norway
| | - Arup Dutta
- Center for Public Health Kinetics, 214A Vinobapuri, Lajpat Nagar-II, New Delhi 110024, India
| | - Diozele M Sanvictores
- Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City, Alabang, Muntinlupa City, 1781, Metro Manila, Philippines
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, 9002 Research Drive, Filinvest Corporate City, Alabang, Muntinlupa City, 1781, Metro Manila, Philippines
| | | | | | - Usha Dhingra
- Center for Public Health Kinetics, 214A Vinobapuri, Lajpat Nagar-II, New Delhi 110024, India
| | - Saikat Deb
- Center for Public Health Kinetics, 214A Vinobapuri, Lajpat Nagar-II, New Delhi 110024, India
| | - Said M Ali
- Public Health Laboratory-Ivo de Carneri, Wawi, Chake Chake, Pemba 5501021, Tanzania
| | - Saurabh Mehta
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, 314 Savage Hall, Ithaca, NY 14850, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Building 1, Room 1102, Boston, MA 02115, USA
| | - Ian D Riley
- The University of Queensland, Brisbane, QLD 4072, Australia
| | - Sunil Sazawal
- Center for Public Health Kinetics, 214A Vinobapuri, Lajpat Nagar-II, New Delhi 110024, India
| | - Zul Premji
- Department of Parasitology and Entomology, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam 0702172, Tanzania
| | - Robert Black
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Bill Rodriguez
- Draper Richards Kaplan Foundation, 535 Boylston Street, Boston, MA 02116, USA
| | - Steven A Carr
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - David R Walt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA. .,Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, USA.,Department of Chemistry, Tufts University, Medford, MA 02155, USA
| | - Michael A Gillette
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA. .,Massachusetts General Hospital Division of Pulmonary and Critical Care Medicine, 55 Fruit Street, Boston, MA 02114, USA
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Al-Mozaini MA, Tsolaki AG, Abdul-Aziz M, Abozaid SM, Al-Ahdal MN, Pathan AA, Murugaiah V, Makarov EM, Kaur A, Sim RB, Kishore U, Kouser L. Human Properdin Modulates Macrophage: Mycobacterium bovis BCG Interaction via Thrombospondin Repeats 4 and 5. Front Immunol 2018; 9:533. [PMID: 29867915 PMCID: PMC5951972 DOI: 10.3389/fimmu.2018.00533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/01/2018] [Indexed: 02/01/2023] Open
Abstract
Mycobacterium tuberculosis can proficiently enter macrophages and diminish complement activation on its cell surface. Within macrophages, the mycobacterium can suppress macrophage apoptosis and survive within the intracellular environment. Previously, we have shown that complement regulatory proteins such as factor H may interfere with pathogen–macrophage interactions during tuberculosis infection. In this study, we show that Mycobacterium bovis BCG binds properdin, an upregulator of the complement alternative pathway. TSR4+5, a recombinant form of thrombospondin repeats 4 and 5 of human properdin expressed in tandem, which is an inhibitor of the alternative pathway, was also able to bind to M. bovis BCG. Properdin and TSR4+5 were found to inhibit uptake of M. bovis BCG by THP-1 macrophage cells in a dose-dependent manner. Quantitative real-time PCR revealed elevated pro-inflammatory responses (TNF-α, IL-1β, and IL-6) in the presence of properdin or TSR4+5, which gradually decreased over 6 h. Correspondingly, anti-inflammatory responses (IL-10 and TGF-β) showed suppressed levels of expression in the presence of properdin, which gradually increased over 6 h. Multiplex cytokine array analysis also revealed that properdin and TSR4+5 significantly enhanced the pro-inflammatory response (TNF-α, IL-1β, and IL-1α) at 24 h, which declined at 48 h, whereas the anti-inflammatory response (IL-10) was suppressed. Our results suggest that properdin may interfere with mycobacterial entry into macrophages via TSR4 and TSR5, particularly during the initial stages of infection, thus affecting the extracellular survival of the pathogen. This study offers novel insights into the non-complement related functions of properdin during host–pathogen interactions in tuberculosis.
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Affiliation(s)
- Maha Ahmed Al-Mozaini
- College of Health and Life Sciences, Brunel University London, London, United Kingdom.,Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Anthony G Tsolaki
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Munirah Abdul-Aziz
- College of Health and Life Sciences, Brunel University London, London, United Kingdom.,Department of Biochemistry, Oxford University, Oxford, United Kingdom
| | - Suhair M Abozaid
- College of Health and Life Sciences, Brunel University London, London, United Kingdom.,Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed N Al-Ahdal
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ansar A Pathan
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Valarmathy Murugaiah
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Evgeny M Makarov
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Anuvinder Kaur
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Robert B Sim
- Department of Biochemistry, Oxford University, Oxford, United Kingdom
| | - Uday Kishore
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Lubna Kouser
- College of Health and Life Sciences, Brunel University London, London, United Kingdom
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