The Use of Mesenchymal Stem Cells in the Complex Treatment of Kidney Tuberculosis (Experimental Study)

Serum Ceruloplasmin-to-Albumin Ratio as a Biochemical Marker in Pulmonary Tuberculosis Before and After Treatment

BACKGROUND

The study compares the serum ceruloplasmin-to-albumin ratio of tuberculosis (TB) patients before and after anti-tuberculosis treatment (ATT) to assess its diagnostic and prognostic value. Despite the pandemic's impact on TB notifications, global TB cases rose by 16% in 2022.

METHODS

The study was conducted at Meenakshi Medical College Hospital and Research Institute, Kanchipuram, from November 2022 to November 2023, with participants aged 15 and above diagnosed with pulmonary TB. The analysis of clinical, radiographic, microbiological, and biochemical data revealed a gender distribution of 58% male and 42% female individuals, with an average age of 49. Significant reductions in ceruloplasmin levels and increases in albumin levels were found following therapy, as well as a decrease in the ceruloplasmin-to-albumin ratio, showing that ceruloplasmin may serve as a severity measure and treatment indicator.

RESULTS

Male patients accounted for 58% of the study population, while females accounted for 42%. Patients aged 36-45 made up the largest group (26%). Following treatment, serum ceruloplasmin levels decreased significantly (from 66.28 mg/dL to 35.56 mg/dL), but albumin levels increased (from 2.96 g/dL to 4.19 g/dL). The ceruloplasmin-to-albumin ratio dropped from 0.022 to 0.008, showing treatment efficacy.

CONCLUSIONS

The study highlights the potential of serum biomarkers for diagnosing and monitoring TB. The serum ceruloplasmin-to-albumin ratio is a promising biochemical diagnostic. Further research is needed to validate these findings and investigate their clinical significance in TB management.

Mesenchymal stem cells-derived extracellular vesicles for therapeutics of renal tuberculosis

Extrapulmonary tuberculosis with a renal involvement can be a manifestation of a disseminated infection that requires therapeutic intervention, particularly with a decrease in efficacy of conventional regimens. In the present study, we investigated the therapeutic potency of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) in the complex anti-tuberculosis treatment (ATT). A rabbit model of renal tuberculosis (rTB) was constructed by injecting of the standard strain Mycobacterium tuberculosis H37Rv into the cortical layer of the kidney parenchyma. Isolated rabbit MSC-EVs were intravenously administered once as an addition to standard ATT (isoniazid, pyrazinamide, and ethambutol). The therapeutic efficacy was assessed by analyzing changes of blood biochemical biomarkers and levels of anti- and pro-inflammatory cytokines as well as by renal computed tomography with subsequent histological and morphometric examination. The therapeutic effect of therapy with MSC-EVs was shown by ELISA method that confirmed a statistically significant increase of the anti-inflammatory and decrease of pro-inflammatory cytokines as compared to conventional treatment. In addition, there is a positive trend in increase of ALP level, animal weigh, and normalization of ADA activity that can indicate an improvement of kidney state. A significant reduction of the area of specific and interstitial inflammation indicated positive affect of MSC-EVs that suggests a shorter duration of ATT. The number of MSC-EVs proteins (as identified by mass-spectometry analysis) with anti-microbial, anti-inflammatory and immunoregulatory functions reduced the level of the inflammatory response and the severity of kidney damage (further proved by morphometric analysis). In conclusion, MSC-EVs can be a promising tool for the complex treatment of various infectious diseases, in particularly rTB.

Comparative interleukins and chemokines analysis of mice mesenchymal stromal cells infected with Mycobacterium tuberculosis H37Rv and H37Ra

Inflammatory pathways involving Mesenchymal stromal cells (MSCs) play an important role in Mycobacterium tuberculosis (Mtb) infection. H37Rv (Rv) is a standard virulent strain, however, H37Ra (Ra) is a strain with reduced virulence. Interleukins and chemokines production are known to promote inflammation resistance in mammalian cells and is recently reported to regulate mycobacterial immunopathogenesis via inflammatory responses. MSCs are very important cells during Mtb infection. However, the different expressions of interleukins and chemokines in the process of Mtb-infected MSCs between Ra and Rv remain unclear. We used the techniques of RNA-Seq, Q-RT-PCR, ELISA, and Western Blotting. We have shown that Rv infection significantly increased mRNA expressions of Mndal, Gdap10, Bmp2, and Lif, thereby increasing more differentiation of MSCs compared with Ra infection in MSCs. Further investigation into the possible mechanisms, we found that Rv infection enhanced more inflammatory response (Mmp10, Mmp3, and Ptgs2) through more activation of the TLR2-MAP3K1-JNK pathway than did Ra infection in MSCs. Further action showed that Rv infection enhanced more Il1α, Il6, Il33, Cxcl2, Ccl3, and Ackr3 production than did Ra infection. Rv infection showed more expressions of Mmp10, Mmp3, Ptgs2, Il1α, Il6, Il33, Cxcl2, Ccl3, and Ackr3 possibly through more active TLR2-MAP3K1-JNK pathway than did Ra infection in MSCs. MSCs may therefore be a new candidate for the prevention and treatment of tuberculosis.