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Uthaya Kumar A, Ahmad Zan M, Ng CL, Chieng S, Nathan S. Diabetes and Infectious Diseases with a Focus on Melioidosis. Curr Microbiol 2024; 81:208. [PMID: 38833191 DOI: 10.1007/s00284-024-03748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
Diabetes mellitus (DM) leads to impaired innate and adaptive immune responses. This renders individuals with DM highly susceptible to microbial infections such as COVID-19, tuberculosis and melioidosis. Melioidosis is a tropical disease caused by the bacterial pathogen Burkholderia pseudomallei, where diabetes is consistently reported as the most significant risk factor associated with the disease. Type-2 diabetes is observed in 39% of melioidosis patients where the risk of infection is 13-fold higher than non-diabetic individuals. B. pseudomallei is found in the environment and is an opportunistic pathogen in humans, often exhibiting severe clinical manifestations in immunocompromised patients. The pathophysiology of diabetes significantly affects the host immune responses that play a critical role in fighting the infection, such as leukocyte and neutrophil impairment, macrophage and monocyte inhibition and natural killer cell dysfunction. These defects result in delayed recruitment as well as activation of immune cells to target the invading B. pseudomallei. This provides an advantage for the pathogen to survive and adapt within the immunocompromised diabetic patients. Nevertheless, knowledge gaps on diabetes-infectious disease comorbidity, in particular, melioidosis-diabetes comorbidity, need to be filled to fully understand the dysfunctional host immune responses and adaptation of the pathogen under diabetic conditions to guide therapeutic options.
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Affiliation(s)
- Asqwin Uthaya Kumar
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Muhammad Ahmad Zan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Chyan-Leong Ng
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sylvia Chieng
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
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2
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Llibre A, Dedicoat M, Burel JG, Demangel C, O’Shea MK, Mauro C. Host Immune-Metabolic Adaptations Upon Mycobacterial Infections and Associated Co-Morbidities. Front Immunol 2021; 12:747387. [PMID: 34630426 PMCID: PMC8495197 DOI: 10.3389/fimmu.2021.747387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022] Open
Abstract
Mycobacterial diseases are a major public health challenge. Their causative agents include, in order of impact, members of the Mycobacterium tuberculosis complex (causing tuberculosis), Mycobacterium leprae (causing leprosy), and non-tuberculous mycobacterial pathogens including Mycobacterium ulcerans. Macrophages are mycobacterial targets and they play an essential role in the host immune response to mycobacteria. This review aims to provide a comprehensive understanding of the immune-metabolic adaptations of the macrophage to mycobacterial infections. This metabolic rewiring involves changes in glycolysis and oxidative metabolism, as well as in the use of fatty acids and that of metals such as iron, zinc and copper. The macrophage metabolic adaptations result in changes in intracellular metabolites, which can post-translationally modify proteins including histones, with potential for shaping the epigenetic landscape. This review will also cover how critical tuberculosis co-morbidities such as smoking, diabetes and HIV infection shape host metabolic responses and impact disease outcome. Finally, we will explore how the immune-metabolic knowledge gained in the last decades can be harnessed towards the design of novel diagnostic and therapeutic tools, as well as vaccines.
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Affiliation(s)
- Alba Llibre
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Dedicoat
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie G. Burel
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Caroline Demangel
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1224, Paris, France
| | - Matthew K. O’Shea
- Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Claudio Mauro
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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3
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Valtierra-Alvarado MA, Lugo-Villarino G, Dueñas-Arteaga F, González-Contreras BE, Lugo-Sánchez A, Castañeda-Delgado JE, González-Amaro R, Venegas Gurrola OA, Del Rocío González Valadez A, Enciso-Moreno JA, Serrano CJ. Impact of Type 2 Diabetes on the capacity of human macrophages infected with Mycobacterium tuberculosis to modulate monocyte differentiation through a bystander effect. Immunol Cell Biol 2021; 99:1026-1039. [PMID: 34379824 DOI: 10.1111/imcb.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a risk factor for the development of tuberculosis (TB) through mechanisms poorly understood. Monocytes and macrophages are key effector cells to control TB, but they are also subverted by Mycobacterium tuberculosis (Mtb). Specifically, Mtb can induce a bystander effect that skews monocyte differentiation towards macrophages with a permissive phenotype to infection. Here, we evaluated whether T2DM impacts this TB aspect. Our approach was to differentiate monocytes from healthy control (HC) subjects and T2DM patients into macrophages (MDM), and then assess their response to Mtb infection, including their secretome content and bystander effect capacity. Through flow cytometry analyses, we found a lower level of activation markers in MDM from T2DM patients in comparison to those from HC in response to mock (HLA-DR, CD86, and CD163) or Mtb challenge (CD14 and CD80). In spite of high TGF-β1 levels in mock-infected MDM from T2DM patients, cytometric bead arrays indicated there were no major differences in the secretome cytokine content in these cells relative to HC-MDM, even in response to Mtb. Mimicking a bystander effect, the secretome of Mtb-infected HC-MDM drove HC monocytes towards MDM with a permissive phenotype for Mtb intracellular growth. However, the secretome from Mtb-infected T2DM-MDM did not exacerbate the Mtb load compared to cmMTB-HC, possibly due to the high IL-1β production relative to Mtb-infected HC-MDM. Collectively, despite T2DM affecting the basal MDM activation, our approach revealed it has no major consequence on their response to Mtb or capacity to generate a bystander effect influencing monocyte differentiation.
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Affiliation(s)
- Monica Alejandra Valtierra-Alvarado
- Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, México.,Departamento de Inmunología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí (UASLP), México
| | - Geanncarlo Lugo-Villarino
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Fátima Dueñas-Arteaga
- Hospital General No. 26, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Zacatecas, México
| | - Beatriz Elena González-Contreras
- Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, México.,Departamento de Inmunología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí (UASLP), México
| | - Anahí Lugo-Sánchez
- Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, México.,Departamento de Inmunología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí (UASLP), México
| | - Julio Enrique Castañeda-Delgado
- Cátedras CONACyT, Consejo Nacional de Ciencia y Tecnología (CONACyT- México), Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, México
| | - Roberto González-Amaro
- Departamento de Inmunología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí (UASLP), México
| | - Omar Alberto Venegas Gurrola
- Hospital General No. 26, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Zacatecas, México
| | | | | | - Carmen Judith Serrano
- Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, México
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4
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Restrepo BI, Twahirwa M, Jagannath C. Hyperglycemia and dyslipidemia: Reduced HLA-DR expression in monocyte subpopulations from diabetes patients. Hum Immunol 2021; 82:124-129. [PMID: 33303215 PMCID: PMC9381160 DOI: 10.1016/j.humimm.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/24/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022]
Abstract
Immune dysfunction contributes to the higher risk of communicable and non-communicable diseases among diabetics. HLA-DR expression is a robust marker of immune competence in mononuclear cells, including antigen presentation to CD4 lymphocytes. Given the high prevalence of obesity among diabetics, we evaluated the independent association between hyperglycemia and dyslipidemias with respect to HLA-DR expression in blood monocytes from type 2 diabetes patients. The monocytes from individuals with (n = 16) or without diabetes (n = 25) were phenotyped by flow cytometry to assess the differential expression of HLA-DR on their three subpopulations (classical, intermediate and non-classical monocytes). Diabetes was independently associated with lower HLA-DR expression across all monocyte subpopulations (p < 0.05). Blood triglycerides were associated with further HLA-DR depression (interaction p < 0.002). Cholesterols counterbalanced the reductive effect, with CD36, a receptor for oxidized cholesterol, correlating with HLA-DR (rho = 0.373; p = 0.016). Future studies are warranted to elucidate the complex interactions between hyperglycemia and dyslipidemias on antigen presentation in diabetic monocytes.
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Affiliation(s)
- Blanca I Restrepo
- University of Texas Health Houston, School of Public Health, Brownsville, TX, USA; University of Texas Rio Grande Valley, School of Medicine, South Texas Diabetes and Obesity Institute, Edinburg, TX, USA.
| | - Marcel Twahirwa
- Diabetes and Endocrinology Institute, Doctors Hospital at Renaissance, Edinburg, TX, USA
| | - Chinnaswamy Jagannath
- Dept. of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
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5
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Enumeration of lymphocyte subsets during follow-up in the pulmonary tuberculosis patients with co morbid diabetes mellitus. Clin Chim Acta 2020; 510:566-572. [PMID: 32818492 DOI: 10.1016/j.cca.2020.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/11/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
The present study was designed to evaluate percentage of lymphocyte subsets in peripheral blood mononuclear cells of pulmonary tuberculosis patients with diabetes mellitus (TBDM) and household contacts (HHC) at the time of diagnosis and at different intervals of follow-up. T-lymphocyte subsets, monocytes and natural killer cells were evaluated using fluorescence associated cell sorting (FACS) in a total of 125 subjects including TBDM, pulmonary tuberculosis (PTB) patients, HHC, diabetes mellitus (DM) patients and healthy controls (HC), 25 in each category. CD4 proportion was significantly low in TBDM (p = 0.003), PTB (p = 0.0008) and HHC (p = 0.005) when compared to HCs and increased with treatment in PTB at 6 M and 12 M (p = 0.008). CD8 percentage was significantly low in DM (p = 0.01); Significantly high mean percentage was observed with respect to CD14 in TBDM (p = 0.008), PTB (p = 0.018), HHC (p = 0.008) and DM (p = 0.014); with CD16 in TBDM (p = 0.0001), PTB (p = 0.0001), HHC (p = 0.045); with CD56 in TBDM (p = 0.0003), PTB (p = 0.002) and HHC (p = 0.015) respectively when compared to HCs. These results indicate that TBDM patients have altered lymphocyte homeostasis and FACS analysis might have the potential of a non-invasive clinical indicator for the early detection and monitoring of TB in HHC.
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Fernández RDV, Díaz A, Bongiovanni B, Gallucci G, Bértola D, Gardeñez W, Lioi S, Bertolin Y, Galliano R, Bay ML, Bottasso O, D'Attilio L. Evidence for a More Disrupted Immune-Endocrine Relation and Cortisol Immunologic Influences in the Context of Tuberculosis and Type 2 Diabetes Comorbidity. Front Endocrinol (Lausanne) 2020; 11:126. [PMID: 32265833 PMCID: PMC7099637 DOI: 10.3389/fendo.2020.00126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary tuberculosis (PTB), caused by Mycobacterium tuberculosis (Mtb), is a major health problem worldwide, further aggravated by the convergence of type 2 diabetes mellitus (DM) which constitutes an important risk factor for TB development. The worse scenario of patients with PTB and DM may be partly related to a more unbalanced defensive response. As such, newly diagnosed PTB patients with DM (TB+DM, n = 11) or not (TB, n = 21), as well as DM (n = 18) patients and pair matched controls (Co, n = 22), were investigated for the circulating immuno-endocrine-metabolic profile (ELISA), along with studies in peripheral blood mononuclear cells (PBMC) analyzing transcript expression (RT-qPCR) of mediators involved in glucocorticoid functionality. Given the hyperglycemic/hypercortisolemic scenario of TB+DM patients, PBMC were also exposed to stress-related cortisol concentrations (0.1 and 1 μM) and supraphysiologic glucose doses (10, 20, and 40 mM) and assessed for the specific response against Mtb stimulation (lymphoproliferation, -thymidine incorporation-, and cytokine production -bead-cytometry). All TB patients displayed increased plasma amounts of cortisol, growth hormone -hGH-, and proinflammatory mediators. In turn, TB+DM showed even higher levels of interferon gamma -IFN-γ- and hGH (vs. TB), or IL-6, C reactive protein, cortisol and hGH (vs. DM). Both DM groups had equally augmented values of IL-10. All TB patients showed decreased dehydroepiandrosterone- sulfate concentrations, even more in TB+DM cases. Leptin was also decreased in both TB cases, particularly in the TB group, revealing a lower body mass index, as well. Unlike PBMC from TB cases showing a decreased relationship between the glucocorticoids receptor (GR) isoforms (GRα/GRβ; functional isoform/negative isoform), cells from TB+DM patients had no changes in this regard, along with an increased expression of 11-beta hydroxysteroid dehydrogenase type-1, the enzyme facilitating intracellular cortisone to cortisol conversion. TB+DM patients also showed an increased Mtb antigen-driven lymphoproliferation. Compared to TB, DM and HCo counterparts, PBMC from TB+DM patients had a biased Th1 response to Mtb stimulation (increased IL-2 and IFN-γ production), even when exposed to inhibitory cortisol doses. TB+DM patients show a more unbalanced immuno-endocrine relationship, respect the non-diabetic counterparts, with a relative deficiency of cortisol immunomodulatory influences, despite their more favorable microenvironment for cortisol-mediated immune effects.
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Affiliation(s)
- Rocío D. V. Fernández
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Ariana Díaz
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
| | - Georgina Gallucci
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
| | - Diego Bértola
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
- Hospital Provincial del Centenario, Rosario, Argentina
| | - Walter Gardeñez
- Servicio de Neumonología, Hospital Provincial del Centenario, Rosario, Argentina
| | - Susana Lioi
- Laboratorio Central, Hospital Provincial del Centenario, Rosario, Argentina
| | - Yésica Bertolin
- Servicio de Medicina Transfusional, Hospital Provincial del Centenario, Rosario, Argentina
| | - Romina Galliano
- Servicio de Medicina Transfusional, Hospital Provincial del Centenario, Rosario, Argentina
| | - María L. Bay
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
| | - Luciano D'Attilio
- Instituto de Inmunología Clínica y Experimental de Rosario CONICET-UNR, Rosario, Argentina
- Facultad de Ciencias Médicas, UNR, Rosario, Argentina
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Tripathi D, Radhakrishnan RK, Sivangala Thandi R, Paidipally P, Devalraju KP, Neela VSK, McAllister MK, Samten B, Valluri VL, Vankayalapati R. IL-22 produced by type 3 innate lymphoid cells (ILC3s) reduces the mortality of type 2 diabetes mellitus (T2DM) mice infected with Mycobacterium tuberculosis. PLoS Pathog 2019; 15:e1008140. [PMID: 31809521 PMCID: PMC6919622 DOI: 10.1371/journal.ppat.1008140] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 12/18/2019] [Accepted: 10/09/2019] [Indexed: 12/14/2022] Open
Abstract
Previously, we found that pathological immune responses enhance the mortality rate of Mycobacterium tuberculosis (Mtb)-infected mice with type 2 diabetes mellitus (T2DM). In the current study, we evaluated the role of the cytokine IL-22 (known to play a protective role in bacterial infections) and type 3 innate lymphoid cells (ILC3s) in regulating inflammation and mortality in Mtb-infected T2DM mice. IL-22 levels were significantly lower in Mtb-infected T2DM mice than in nondiabetic Mtb-infected mice. Similarly, serum IL-22 levels were significantly lower in tuberculosis (TB) patients with T2DM than in TB patients without T2DM. ILC3s were an important source of IL-22 in mice infected with Mtb, and recombinant IL-22 treatment or adoptive transfer of ILC3s prolonged the survival of Mtb-infected T2DM mice. Recombinant IL-22 treatment reduced serum insulin levels and improved lipid metabolism. Recombinant IL-22 treatment or ILC3 transfer prevented neutrophil accumulation near alveoli, inhibited neutrophil elastase 2 (ELA2) production and prevented epithelial cell damage, identifying a novel mechanism for IL-22 and ILC3-mediated inhibition of inflammation in T2DM mice infected with an intracellular pathogen. Our findings suggest that the IL-22 pathway may be a novel target for therapeutic intervention in T2DM patients with active TB disease.
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Affiliation(s)
- Deepak Tripathi
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Rajesh Kumar Radhakrishnan
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Ramya Sivangala Thandi
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Padmaja Paidipally
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Kamakshi Prudhula Devalraju
- Immunology and Molecular Biology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Telangana, India
| | - Venkata Sanjeev Kumar Neela
- Immunology and Molecular Biology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Telangana, India
| | - Madeline Kay McAllister
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Buka Samten
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
| | - Vijaya Lakshmi Valluri
- Immunology and Molecular Biology Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, Telangana, India
| | - Ramakrishna Vankayalapati
- Department of Pulmonary Immunology, Center for Biomedical Research, The University of Texas Health Science Center, Tyler, Texas, TX, United States of America
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8
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Kumar NP, Moideen K, Bhootra Y, Nancy A, Viswanathan V, Shruthi BS, Sivakumar S, Natarajan M, Kornfeld H, Babu S. Elevated circulating levels of monocyte activation markers among tuberculosis patients with diabetes co-morbidity. Immunology 2018; 156:249-258. [PMID: 30427060 DOI: 10.1111/imm.13023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023] Open
Abstract
Alteration in the frequency of monocyte subsets is a hallmark of tuberculosis-diabetes co-morbidity (TB-DM). To study this association, we examined the plasma levels of sCD14, sCD163, C-reactive protein (CRP) and soluble tissue factor (sTF) in individuals with TB-DM, TB or diabetes mellitus (DM), and in healthy controls (HC). Circulating levels of sCD14, sCD163 and sTF were significantly increased in TB-DM and DM compared with TB and HC; however, CRP was significantly increased in TB-DM and TB compared with DM and HC. During longitudinal follow up, sCD14, CRP and sTF levels remained significantly increased in TB-DM compared with TB from baseline (pre-treatment), during treatment (2nd month) and at the completion (6th month) of anti-TB treatment (ATT), whereas sCD163 was significantly higher in TB-DM compared with TB only at baseline. Moreover, the levels of sCD14 and sCD163 were significantly higher in TB-DM individuals with bilateral and cavitary disease and exhibited a significant positive relationship with bacterial burden. Levels of sCD14, sCD163 and CRP exhibited a positive relationship with HbA1c levels. Within the TB-DM group, those with known diabetes before incident TB (KDM) exhibited significantly higher levels of sCD14 and sCD163 compared with individuals with newly diagnosed DM with TB (NDM). Finally, KDM individuals on metformin treatment exhibited significantly lower levels of sCD14, sCD163 and CRP compared with those on non-metformin-containing regimens. Our data demonstrate that systemic monocyte activation marker levels reflect baseline disease severity and extent in TB-DM, differentiate KDM from NDM and are modulated by ATT and metformin therapy.
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Affiliation(s)
- Nathella P Kumar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Yukthi Bhootra
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Arul Nancy
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | | | | | | | - Mohan Natarajan
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,LPD, NIAID, NIH, Bethesda, MD, USA
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Abstract
Protective immunity in tuberculosis (TB) is subject of debate in the TB research community, as this is key to fully understand TB pathogenesis and to develop new promising tools for TB diagnosis and prognosis as well as a more efficient TB vaccine. IFN-γ producing CD4+ T cells are key in TB control, but may not be sufficient to provide protection. Additional subsets have been identified that contribute to protection such as multifunctional and cytolytic T-cell subsets, including classical and nonclassical T cells as well as novel innate immune cell subsets resulting from trained immunity. However, to define protective immune responses against TB, the complexity of balancing TB immunity also has to be considered. In this review, insights into effector cell immunity and how this is modulated by regulatory cells, associated comorbidities and the host microbiome, is discussed. We systematically map how different suppressive immune cell subsets may affect effector cell responses at the local site of infection. We also dissect how common comorbidities such as HIV, helminths and diabetes may bias protective TB immunity towards pathogenic and regulatory responses. Finally, also the composition and diversity of the microbiome in the lung and gut could affect host TB immunity. Understanding these various aspects of the immunological balance in the human host is fundamental to prevent TB infection and disease.
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Affiliation(s)
- Susanna Brighenti
- Karolinska Institutet, Department of Medicine, Center for Infectious Medicine (CIM), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Simone A. Joosten
- Leiden University Medical Center, Department of Infectious Diseases, Leiden, The Netherlands
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Mendoza-Almanza G, Rivas-Santiago CE, Salgado Bustamante M, López-Hernández Y. Diabetes and tuberculosis in Mexico: results from epidemiological studies. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-017-0599-5] [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: 11/24/2022] Open
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11
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Lopez-Lopez N, Martinez AGR, Garcia-Hernandez MH, Hernandez-Pando R, Castañeda-Delgado JE, Lugo-Villarino G, Cougoule C, Neyrolles O, Rivas-Santiago B, Valtierra-Alvarado MA, Rubio-Caceres M, Enciso-Moreno JA, Serrano CJ. Type-2 diabetes alters the basal phenotype of human macrophages and diminishes their capacity to respond, internalise, and control Mycobacterium tuberculosis. Mem Inst Oswaldo Cruz 2018; 113:e170326. [PMID: 29513874 PMCID: PMC5851047 DOI: 10.1590/0074-02760170326] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/31/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a risk factor for the development of tuberculosis (TB), although the associated mechanisms are not known. OBJECTIVES To study the association between T2D and the basal phenotype of macrophages, and their immune response to Mycobacterium tuberculosis (Mtb) infection. METHODS We evaluated the influence of T2D on the response of monocyte-derived macrophages (MDM) to Mtb in patients with T2D (n = 10) compared to healthy subjects (n = 9), before and after infection with Mtb clinical isolates bearing different degrees of virulence. The levels of cell surface markers for activation secreted cytokines and chemokines, bacterial association, and intracellular bacterial growth were evaluated. FINDINGS The expression levels of HLA-DR, CD80, and CD86 were low while those of of PD-L1 were high in uninfected MDMs derived from patients with diabetes; as a result of Mtb infection, changes were only observed in the expression levels of PD-L1. The levels of cytokines (e.g., IL-6, IL-1β, IL-10, and IL-12) and chemokines (e.g., MCP-1, MIG, and RANTES) are perturbed in MDMs derived from patients with diabetes, both before infection and in response to Mtb infection. In response to the more virulent Mtb strains, the levels of association and bacterial clearance were diminished in MDMs derived from patients with diabetes. CONCLUSIONS T2D affects the basal activation state of the macrophages and its capacity to respond and control Mtb infection.
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Affiliation(s)
- Nallely Lopez-Lopez
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica Zacatecas, Zacatecas, Mexico
- Universidad Autónoma de San Luis Potosí, Escuela de Medicina, Departamento de Inmunología, San Luis Potosí, Mexico
| | - Ana Gabriela Ramos Martinez
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica Zacatecas, Zacatecas, Mexico
- Universidad Autónoma de San Luis Potosí, Escuela de Medicina, Departamento de Inmunología, San Luis Potosí, Mexico
| | | | - Rogelio Hernandez-Pando
- Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Departamento de Patología, Sección de Patología Experimental, Ciudad de México, México
| | - Julio Enrique Castañeda-Delgado
- Consejo Nacional de Ciencia Y Tecnología-CONACyT, Cátedras CONACyT, Unidad de Investigación Biomédica Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, México
| | - Geanncarlo Lugo-Villarino
- Université Paul Sabatier, Centre National de la Recherche Scientifique, Institut de Pharmacologie et Biologie Structurale, Toulouse, France
| | - Céline Cougoule
- Université Paul Sabatier, Centre National de la Recherche Scientifique, Institut de Pharmacologie et Biologie Structurale, Toulouse, France
| | - Olivier Neyrolles
- Université Paul Sabatier, Centre National de la Recherche Scientifique, Institut de Pharmacologie et Biologie Structurale, Toulouse, France
| | - Bruno Rivas-Santiago
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica Zacatecas, Zacatecas, Mexico
| | - Monica Alejandra Valtierra-Alvarado
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica Zacatecas, Zacatecas, Mexico
- Universidad Autónoma de San Luis Potosí, Escuela de Medicina, Departamento de Inmunología, San Luis Potosí, Mexico
| | - Marisela Rubio-Caceres
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 4, Guadalupe, Zacatecas, México
| | | | - Carmen Judith Serrano
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica Zacatecas, Zacatecas, Mexico
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12
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Dunachie SJ, Jenjaroen K, Reynolds CJ, Quigley KJ, Sergeant R, Sumonwiriya M, Chaichana P, Chumseng S, Ariyaprasert P, Lassaux P, Gourlay L, Promwong C, Teparrukkul P, Limmathurotsakul D, Day NPJ, Altmann DM, Boyton RJ. Infection with Burkholderia pseudomallei - immune correlates of survival in acute melioidosis. Sci Rep 2017; 7:12143. [PMID: 28939855 PMCID: PMC5610189 DOI: 10.1038/s41598-017-12331-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022] Open
Abstract
Melioidosis, caused by Burkholderia pseudomallei, is a potentially lethal infection with no licensed vaccine. There is little understanding of why some exposed individuals have no symptoms, while others rapidly progress to sepsis and death, or why diabetes confers increased susceptibility. We prospectively recruited a cohort of 183 acute melioidosis patients and 21 control subjects from Northeast Thailand and studied immune parameters in the context of survival status and the presence or absence of diabetes. HLA-B*46 (one of the commonest HLA class I alleles in SE Asia) and HLA-C*01 were associated with an increased risk of death (odds ratio 2.8 and 3.1 respectively). Transcriptomic analysis during acute infection in diabetics indicated the importance of interplay between immune pathways including those involved in antigen presentation, chemotaxis, innate and adaptive immunity and their regulation. Survival was associated with enhanced T cell immunity to nine of fifteen immunodominant antigens analysed including AhpC (BPSL2096), BopE (BPSS1525), PilO (BPSS1599), ATP binding protein (BPSS1385) and an uncharacterised protein (BPSL2520). T cell immunity to GroEL (BPSL2697) was specifically impaired in diabetic individuals. This characterization of immunity associated with survival during acute infection offers insights into correlates of protection and a foundation for design of an effective multivalent vaccine.
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Affiliation(s)
- Susanna J Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.
| | - Kemajittra Jenjaroen
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | - Kathryn J Quigley
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Ruhena Sergeant
- Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Panjaporn Chaichana
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Suchintana Chumseng
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | | | - Louise Gourlay
- Department of Biosciences, University of Milan, Milan, Italy
| | | | | | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- 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 and Global Health, University of Oxford, Oxford, United Kingdom
| | - Daniel M Altmann
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Rosemary J Boyton
- Department of Medicine, Imperial College London, London, United Kingdom.
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13
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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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14
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Schmidt AM. 22016 ATVB Plenary Lecture: Receptor for Advanced Glycation Endproducts and Implications for the Pathogenesis and Treatment of Cardiometabolic Disorders: Spotlight on the Macrophage. Arterioscler Thromb Vasc Biol 2017; 37:613-621. [PMID: 28183700 PMCID: PMC5364055 DOI: 10.1161/atvbaha.117.307263] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/30/2017] [Indexed: 12/23/2022]
Abstract
The receptor for advanced glycation endproducts (RAGE) interacts with a unique repertoire of ligands that form and collect in the tissues and circulation in diabetes mellitus, aging, inflammation, renal failure, and obesity. RAGE is expressed on multiple cell types linked to tissue perturbation in these settings. This brief review focuses on the role of RAGE in monocytes/macrophages and how RAGE ligand engagement on these cells mediates seminal changes in monocyte/macrophage migration, oxidative stress, cholesterol efflux, and pro- versus anti-inflammatory cues that signal to tissue damage. Studies using mice devoid of Ager (gene encoding RAGE) or pharmacological antagonists of RAGE are protective in animal models of diabetes mellitus, atherosclerosis, and high-fat diet-induced obesity, in least in part through key roles in monocytes/macrophages. RAGE signal transduction requires the interaction of RAGE cytoplasmic domain with the formin, DIAPH1 (diaphanous 1) and novel antagonists of this interaction show significant promise in attenuation of the maladaptive effects of RAGE ligands in cellular and in vivo models. Finally, this brief review discusses evidence for RAGE axis perturbation in human monocytes/macrophages and how tracing RAGE activity in these cells may identify target engagement biomarkers of RAGE antagonism for future clinical trials.
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Affiliation(s)
- Ann Marie Schmidt
- From the Diabetes Research Program, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York.
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15
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Girardi E, Sañé Schepisi M, Goletti D, Bates M, Mwaba P, Yeboah-Manu D, Ntoumi F, Palmieri F, Maeurer M, Zumla A, Ippolito G. The global dynamics of diabetes and tuberculosis: the impact of migration and policy implications. Int J Infect Dis 2017; 56:45-53. [PMID: 28153793 DOI: 10.1016/j.ijid.2017.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 12/25/2022] Open
Abstract
The convergence between tuberculosis (TB) and diabetes mellitus (DM) will represent a major public health challenge in the near future. DM increases the risk of developing TB by two to three times and also increases the risk of TB treatment failure, relapse, and death. The global prevalence of DM is predicted to rise significantly in the next two decades, particularly in some of the low- and middle-income countries with the highest TB burden. Migration may add further complexity to the effort to control the impact on TB of the growing DM pandemic. Migration may increase the risk of DM, although the magnitude of this association varies according to country of origin and ethnic group, due to genetic factors and lifestyle differences. Migrants with TB may have an increased prevalence of DM compared to the native population, and the risk of TB among persons with DM may be higher in migrants than in autochthonous populations. Screening for DM among migrants, screening migrants with DM for active and latent TB, and improving access to DM care, could contribute to mitigate the effects of DM on TB.
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Affiliation(s)
- Enrico Girardi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Monica Sañé Schepisi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Delia Goletti
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Matthew Bates
- Division of Infection and Immunity, University College London; and National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK; UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mwaba
- UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia
| | - Dorothy Yeboah-Manu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Faculté des Sciences de la Santé, Marien Ngouabi University; and Faculté des Sciences et Techniques, Marien Ngouabi University, Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Fabrizio Palmieri
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy
| | - Markus Maeurer
- Therapeutic Immunology (TIM) Division, Department of Laboratory Medicine, Karolinska University Hospital Huddinge; and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London; and National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK; UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia; International Public Health Crisis Group (IPHCG), London, United Kingdom - Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy; International Public Health Crisis Group (IPHCG), London, United Kingdom - Rome, Italy.
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16
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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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17
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Kumar NP, Moideen K, Dhakshinraj SD, Banurekha VV, Nair D, Dolla C, Kumaran P, Babu S. Profiling leucocyte subsets in tuberculosis-diabetes co-morbidity. Immunology 2015; 146:243-50. [PMID: 26095067 DOI: 10.1111/imm.12496] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 12/24/2022] Open
Abstract
The immune system plays an important role in the pathogenesis of pulmonary tuberculosis-type 2 diabetes mellitus (PTB-DM) co-morbidity. However, the phenotypic profile of leucocyte subsets at homeostasis in individuals with active or latent tuberculosis (LTB) with coincident diabetes is not known. To characterize the influence of diabetes on leucocyte phenotypes in PTB or LTB, we examined the frequency (Fo ) of leucocyte subsets in individuals with TB with (PTB-DM) or without (PTB) diabetes; individuals with latent TB with (LTB-DM) or without (LTB) diabetes and non-TB-infected individuals with (NTB-DM) or without (NTB) diabetes. Coincident DM is characterized by significantly lower Fo of effector memory CD4(+) T cells in LTB individuals. In contrast, DM is characterized by significantly lower Fo of effector memory CD8(+) T cells and significantly higher Fo of central memory CD8(+) T cells in PTB individuals. Coincident DM resulted in significantly higher Fo of classical memory B cells in PTB and significantly higher Fo of activated memory and atypical B cells in LTB individuals. Coincident DM resulted in significantly lower Fo of classical and intermediate monocytes in PTB, LTB and NTB individuals. Finally, DM resulted in significantly lower Fo of myeloid and plasmacytoid dendritic cells in PTB, LTB and NTB individuals. Our data reveal that coincident diabetes alters the cellular subset distribution of T cells, B cells, dendritic cells and monocytes in both individuals with active TB and those with latent TB, thus potentially impacting the pathogenesis of this co-morbid condition.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health-NIRT-International Centre for Excellence in Research, Chennai, India.,National Institute for Research in Tuberculosis, Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Centre for Excellence in Research, Chennai, India
| | - Sharmila D Dhakshinraj
- National Institutes of Health-NIRT-International Centre for Excellence in Research, Chennai, India
| | | | - Dina Nair
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Paul Kumaran
- National Institute for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Centre for Excellence in Research, Chennai, India
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18
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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: 243] [Impact Index Per Article: 27.0] [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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19
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Dhandayuthapani S, Jagannath C. 3rd Texas Tuberculosis Research Symposium: strengthening of TB research in the border state. Tuberculosis (Edinb) 2014; 93 Suppl:S1-2. [PMID: 24388641 DOI: 10.1016/s1472-9792(13)70002-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Subramanian Dhandayuthapani
- University of Texas Health Science Center San Antonio, Department of Microbiology and Immunology and Regional Academic Health Center, Edinburg, Texas, USA
| | - Chinnaswamy Jagannath
- University Texas Health Science Center Houston, Department of Pathology and Laboratory Medicine, pathology, Houston, Texas, USA
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20
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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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