Lymphocyte stimulation test in the diagnostics of adverse reactions to antituberculouse line 1 and 2 drugs

Adverse drug reactions to anti-TB drugs (ADR) are found in 6-20% of patients and have various clinical manifestations and are detected in the lymphocyte stimulation test (LST), recorded by the incorporation on H3 thymidine, but nowadays it has significant limitations. We used LST with WST-1 reagent to detect ADR to the main 1-st and 2-nd line antituberculosis drugs in 11 tuberculosis patients who had ADR (6 - hepatotoxic reaction, 3 - blood eosinophilia and 2 - with joint pain syndrome). 6 people with tuberculosis contacts made up the control group. LST evaluation with WST-1 showed that in patients with a hepatotoxic reaction, the SI index was>2 and exceeded the values in the control group (3.28±0.59, 95% CI-1.16 and 0, 74±0.16, 95% CI - 0.31, respectively) upon stimulation of cell cultures with rifampicin alone but not with other drugs. Cell cultures stimulated with the PHA mitogen have SI >2 in ADR patients (mainly with hepatotoxic reactions). Control group SI was <2 (4,93±0.53, 95% CI - 1, 04 and 1.97±0.3, 95% CI - 0.59, respectively). We have not detected PPD-L cell cultures stimulation with WST-1 reagent both in the group of patients with ADR and the control group. In patients with eosinophilia and joint pain syndrome SI was low for all studied drugs and did not differ from the control group. The sensitivity of the LST test with WST-1 reagent is not sufficient to determine ADR to anti-TB drugs.

Th1, Th17, and Th1Th17 Lymphocytes during Tuberculosis: Th1 Lymphocytes Predominate and Appear as Low-Differentiated CXCR3+CCR6+ Cells in the Blood and Highly Differentiated CXCR3+/-CCR6- Cells in the Lungs

Th1 lymphocytes are considered the main mediators of protection against tuberculosis (TB); however, their phenotypic characteristics and relationship with Th17 and Th1Th17 populations during TB are poorly understood. We have analyzed Th1, Th17, and Th1Th17 lymphocytes in the blood and pulmonary lesions of TB patients. The populations were identified based on the production of IFN-γ and/or IL-17 and the coexpression of CXCR3 (X3) and CCR6 (R6). In the blood, IL-17⁺ and IFN-γ⁺IL-17⁺ lymphocytes were barely detectable (median, <0.01% of CD4⁺ lymphocytes), whereas IFN-γ⁺ lymphocytes predominated (median, 0.45%). Most IFN-γ⁺ lymphocytes (52%) were X3⁺R6⁺, suggesting their "nonclassical" (ex-Th17) nature. In the lungs, IL-17⁺ and IFN-γ⁺IL-17⁺ lymphocytes were more frequent (0.3%, p < 0.005), yet IFN-γ⁺ cells predominated (11%). Phenotypically, lung CD4⁺ cells were X3^+/loR6^- The degree of differentiation of blood effector CD4⁺ lymphocytes (evaluated based on CD62L/CD27/CD28 coexpression) increased as follows: X3⁺R6⁺ < X3⁺R6^- < X3^-R6^-, with X3^-R6^- cells being largely terminally differentiated CD62L^-CD27^-CD28^- cells. Lung CD4⁺ lymphocytes were highly differentiated, recalling blood X3^+/-R6^- populations. Following in vitro stimulation with anti-CD3/anti-CD28 Abs, X3⁺R6⁺CD4⁺ lymphocytes converted into X3⁺R6^- and X3^-R6^- cells. The results demonstrate that, during active TB, Th1 lymphocytes predominate in blood and lungs, document differences in X3/R6 expression by blood and lung CD4⁺ cells, and link the pattern of X3/R6 expression with the degree of cell differentiation. These findings add to the understanding of immune mechanisms operating during TB and are relevant for the development of better strategies to control it.

Severe Tuberculosis in Humans Correlates Best with Neutrophil Abundance and Lymphocyte Deficiency and Does Not Correlate with Antigen-Specific CD4 T-Cell Response

It is generally thought that Mycobacterium tuberculosis (Mtb)-specific CD4⁺ Th1 cells producing IFN-γ are essential for protection against tuberculosis (TB). In some studies, protection has recently been associated with polyfunctional subpopulation of Mtb-specific Th1 cells, i.e., with cells able to simultaneously secrete several type 1 cytokines. However, the role for Mtb-specific Th1 cells and their polyfunctional subpopulations during established TB disease is not fully defined. Pulmonary TB is characterized by a great variability of disease manifestations. To address the role for Mtb-specific Th1 responses during TB, we investigated how Th1 and other immune cells correlated with particular TB manifestations, such as the degree of pulmonary destruction, TB extent, the level of bacteria excretion, clinical disease severity, clinical TB forms, and “Timika X-ray score,” an integrative parameter of pulmonary TB pathology. In comparison with healthy Mtb-exposed controls, TB patients (TBP) did not exhibit deficiency in Mtb-specific cytokine-producing CD4⁺ cells circulating in the blood and differed by a polyfunctional profile of these cells, which was biased toward the accumulation of bifunctional TNF-α⁺IFN-γ⁺IL-2⁻ lymphocytes. Importantly, however, severity of different TB manifestations was not associated with Mtb-specific cytokine-producing cells or their polyfunctional profile. In contrast, several TB manifestations were strongly correlated with leukocyte numbers, the percent or the absolute number of lymphocytes, segmented or band neutrophils. In multiple alternative statistical analyses, band neutrophils appeared as the strongest positive correlate of pulmonary destruction, bacteria excretion, and “Timika X-ray score.” In contrast, clinical TB severity was primarily and inversely correlated with the number of lymphocytes in the blood. The results suggest that: (i) different TB manifestations may be driven by distinct mechanisms; (ii) quantitative parameters and polyfunctional profile of circulating Mtb-specific CD4⁺ cells play a minor role in determining TB severity; and (iii) general shifts in production/removal of granulocytic and lymphocytic lineages represent an important factor of TB pathogenesis. Mechanisms leading to these shifts and their specific role during TB are yet to be determined but are likely to involve changes in human hematopoietic system.

Gr-1dimCD11b+ immature myeloid-derived suppressor cells but not neutrophils are markers of lethal tuberculosis infection in mice

Tuberculosis (TB) disease may progress at different rates and have different outcomes. Neutrophils have been implicated in TB progression; however, data on their role during TB are controversial. In this study, we show that in mice, TB progression is associated with the accumulation of cells that express neutrophilic markers Gr-1 and Ly-6G but do not belong to conventional neutrophils. The cells exhibit unsegmented nuclei, have Gr-1(dim)Ly-6G(dim)CD11b(+) phenotype, and express F4/80, CD49d, Ly-6C, CD117, and CD135 markers characteristic not of neutrophils but of immature myeloid cells. The cells accumulate in the lungs, bone marrow, spleen, and blood at the advanced (prelethal) stage of Mycobacterium tuberculosis infection and represent a heterogeneous population of myeloid cells at different stages of their differentiation. The accumulation of Gr-1(dim)CD11b(+) cells is accompanied by the disappearance of conventional neutrophils (Gr-1(hi)Ly-6G(hi)-expressing cells). The Gr-1(dim)CD11b(+) cells suppress T cell proliferation and IFN-γ production in vitro via NO-dependent mechanisms, that is, they exhibit characteristics of myeloid-derived suppressor cells. These results document the generation of myeloid-derived suppressor cells during TB, suggesting their role in TB pathogenesis, and arguing that neutrophils do not contribute to TB pathology at the advanced disease stage.

Secondary lymphoid organs are dispensable for the development of T-cell-mediated immunity during tuberculosis

Tuberculosis causes 2 million deaths per year, yet in most cases the immune response successfully contains the infection and prevents disease outbreak. Induced lymphoid structures associated with pulmonary granuloma are observed during tuberculosis in both humans and mice and could orchestrate host defense. To investigate whether granuloma perform lymphoid functions, mice lacking secondary lymphoid organs (SLO) were infected with Mycobacterium tuberculosis (MTB). As in WT mice, granuloma developed, exponential growth of MTB was controlled, and antigen-specific T-cell responses including memory T cells were generated in the absence of SLO. Moreover, adoptively transferred T cells were primed locally in lungs in a granuloma-dependent manner. T-cell activation was delayed in the absence of SLO, but resulted in a normal development program including protective subsets and functional recall responses that protected mice against secondary MTB infection. Our data demonstrate that protective immune responses can be generated independently of SLO during MTB infection and implicate local pulmonary T-cell priming as a mechanism contributing to host defense.

Critical role of methylglyoxal and AGE in mycobacteria-induced macrophage apoptosis and activation

Apoptosis and activation of macrophages play an important role in the host response to mycobacterial infection involving TNF-α as a critical autocrine mediator. The underlying mechanisms are still ill-defined. Here, we demonstrate elevated levels of methylglyoxal (MG), a small and reactive molecule that is usually a physiological product of various metabolic pathways, and advanced glycation end products (AGE) during mycobacterial infection of macrophages, leading to apoptosis and activation of macrophages. Moreover, we demonstrate abundant AGE in pulmonary lesions of tuberculosis (TB) patients. Global gene expression profiling of MG-treated macrophages revealed a diverse spectrum of functions induced by MG, including apoptosis and immune response. Our results not only provide first evidence for the involvement of MG and AGE in TB, but also form a basis for novel intervention strategies against infectious diseases in which MG and AGE play critical roles.

Unique transcriptome signature of Mycobacterium tuberculosis in pulmonary tuberculosis

Although tuberculosis remains a substantial global threat, the mechanisms that enable mycobacterial persistence and replication within the human host are ill defined. This study represents the first genome-wide expression analysis of Mycobacterium tuberculosis from clinical lung samples, which has enabled the identification of M. tuberculosis genes actively expressed during pulmonary tuberculosis. To obtain optimal information from our DNA array analyses, we analyzed the differentially expressed genes within the context of computationally inferred protein networks. Protein networks were constructed using functional linkages established by the Rosetta stone, phylogenetic profile, conserved gene neighbor, and operon computational methods. This combined approach revealed that during pulmonary tuberculosis, M. tuberculosis actively transcribes a number of genes involved in active fortification and evasion from host defense systems. These genes may provide targets for novel intervention strategies.

Differential organization of the local immune response in patients with active cavitary tuberculosis or with nonprogressive tuberculoma

BACKGROUND

In 90% of all cases, Mycobacterium tuberculosis infection results in latency rather than active disease, with the pathogen being contained within granulomatous lesions at the site of primary infection. Failure of this containment leads to reactivation of postprimary tuberculosis (TB). The regional immune processes that sustain the delicate balance with persistent M. tuberculosis, however, remain unclear.

METHODS

We compared activation statuses, biological functions, and interactions of host immune cells in human nonprogressive tuberculoma and active cavitary tuberculous lung tissue.

RESULTS

Dissection of early granuloma formations revealed differential cellular distribution and activation statuses of distinct cell types in different regions relative to the central caseotic caverna or the tuberculoma in tuberculous lung tissue. In patients with tuberculoma with latent infection, distant parts of lung tissue exhibited strong vascularization and profound proliferative activity, indicating that continuous immune defense is required for mycobacterial containment, which is absent in cavitary tuberculous lung lesions.

CONCLUSIONS

We conclude that differential regulation of the local immune response is crucial for the containment of M. tuberculosis and that a continuous antigen-specific cross talk between the host immune system and M. tuberculosis is ensured during latency. This activation requires sufficient supply of nutrients and well-coordinated structural organization, both of which are lost during reactivation of TB.

Modified immunohistological staining allows detection of Ziehl-Neelsen-negative Mycobacterium tuberculosis organisms and their precise localization in human tissue

The diagnosis of mycobacterial infection depends on the Ziehl-Neelsen (ZN) stain, which detects mycobacteria because of their characteristic acid-fast cell wall composition and structure. The histological diagnosis of tuberculosis (TB) comprises various aspects: (1) sensitive detection of mycobacteria; (2) precise localization of mycobacteria in the context of granulomatous lesions; (3) 'staging' of disease according to mycobacterial spread and granulomatous tissue integrity. Thus, detection of minute numbers of acid-fast bacteria in tissue specimens is critical. The conventional ZN stain fails to identify mycobacteria in numbers less than 10(4) per ml. Hence many infections evade diagnosis. PCR is highly sensitive, but allows neither localization within tissues nor staging of mycobacterial disease, and positive findings frequently do not correlate with disease. In this study, an anti-Mycobacterium bovis bacille Calmette-Guérin polyclonal antiserum (pAbBCG) was used to improve immunostaining, which was compared to the ZN stain in histological samples. Screening of tissue samples including lungs, pleural lesions, lymph nodes, bone marrow, and skin for mycobacterial infection revealed that pAbBCG staining detects infected macrophages harbouring intracellular mycobacteria or mycobacterial material as well as free mycobacteria that are present at low abundance and not detected by the ZN stain. The positive pAbBCG staining results were confirmed either by PCR analysis of microdissected stained tissue or by culture from tissue. This immunostaining approach allows precise localization of the pathogen in infected tissue.

Human tuberculous granulomas induce peripheral lymphoid follicle-like structures to orchestrate local host defence in the lung

The human tuberculous granuloma provides the morphological basis for local immune processes central to the outcome of tuberculosis. Because of the scarcity of information in human patients, the aim of the present study was to gain insights into the functional and structural properties of infiltrated tissue. To this end, the mycobacterial load in lesions and dissemination to different tissue locations were investigated, as well as distribution, biological functions, and interactions of host immune cells. Analysis of early granuloma formation in formerly healthy lung tissue revealed a spatio-temporal sequence of cellular infiltration to sites of mycobacterial infection. A general structure of the developing granuloma was identified, comprising an inner cell layer with few CD8(+) cells surrounding the necrotic centre and an outer area of lymphocyte infiltration harbouring mycobacteria-containing antigen-presenting cells as well as CD4(+), CD8(+), and B cells in active follicle-like centres resembling secondary lymphoid organs. It is concluded that the follicular structures in the peripheral rim of granulomas serve as a morphological substrate for the orchestration of the enduring host response in pulmonary tuberculosis.

[Experience with kipferon use in the treatment of patients with pulmonary tuberculosis]

Kipferon that is a combination of recombinant human (2-interferon and a complex of immunoglobulins G, M and A, was used in suppositories as an auxiliary agent in the routine chemotherapy in 36 new cases of pulmonary tuberculosis. A control group included 19 patients identical in sex, age, and the pattern of pulmonary tuberculosis. The clinical, X-ray, and laboratory indices (primarily cellular immunity) were studies before and 1 and 3 months after treatment. The beneficial effect of kipferon was manifested by a more rapid arrest of symptoms of total intoxication eliminated after 2 weeks in 39% of patients in the experimental group and only in 21% in the controls. Normalization of blood parameters occurred following a month in 58.3 and 47% of patients, respectively. Mycobacteria tuberculosis disappeared in the sputum smears following a month of treatment in 62% of those isolating bacteria in the experimental group and only in 37.5% in the controls (P > 0.1; t = 1.6). Positive lung X-ray changes as resolved infiltration, the reduction and closure of caverns were more pronounced in the patients of the experimental group. The most characteristic change in the parameters of cellular immunity during kipferon was a short (as long as 1-1.5 months) decrease in RBT to FGA, which was noted in 47% and 6.7% of patients in the experimental and control groups, respectively (P < 0.01) and which was followed by an increase in the count of CD8+ cytotoxic lymphocytes. This is indicative of the enhancement of these mechanisms of immunity and a reduced need of enhancing or maintaining the activity of proliferative reactions of immunocompetent cells under the conditions of a favourable influence on the course of tuberculous infection.

[Tuberculous IgE antibodies. Part II. Study of its concentrations in different forms of tuberculosis]

Tuberculosis-afflicted lung are infiltrated by two functionally types of lymphocytes, which presumably counteract with each other by producing proinflammatory (type 1) and anti-inflammatory (type 2) cytokines. It is held that irregular sequestration of antigen into different compartments of the lung may lead to preferential activation of T-helper 1 or T-helper 2 lymphocytes. Unlike IgE antibodies, specific tuberculosis IgE antibodies are seen only in tuberculosis infection. The mean values of IgE antibodies in tuberculosis (7.661 +/- 0.849 IU/ml) are significantly greater than those in other pulmonary diseases (1.768 +/- 0.116 IU/ml). Low concentrations of tuberculosis IgE antibodies in persons with a marked hyperergic response to tuberculin (1.808 +/- 0.097 IU/ml) are of importance. Significant concentrations of mycobacterial IgE antibodies are mainly detected in fibrocavernous (14.56 +/- 1.11 IU/ml), infiltrative (10.10 +/- 1.08 IU/ml), peripheral lymph nodal (10.53 +/- 1.09 IU/ml) tuberculosis rather than intrathoracic lymph nodal tuberculosis (4.555 +/- 0.340 IU/ml). There is a particularly considerable increase in specific IgE antibodies in a phase of decay (15.98 +/- 1.64 IU/ml) and infiltration (12.66 +/- 1.08 IU/ml). These groups also show a concurrent rise in tuberculosis IgG antibodies, which nevertheless disagree with the increase of IgE (the correlation coefficient is 0.599).

[Anti-tuberculous IgE antibodies. I. Immunodominant antigens]

It is widely accepted that protection against tuberculosis is provided by the formation of type 1 immune response, which is characterized by the production of IFN-gamma and IL-2. However, type 2 antimycobacterial immune response is also present: specific IgE antibodies that are IL-4 dependent, are usually found in tuberculosis patients. There is elevated production of type 2 cytokines in some cases. Thus, both types of an immune response can simultaneously develop, probably counteracting with each other. It is unknown which of mycobacterial antigens are capable of inducing a preferential type 2 response. To detect these antigens, the authors studied tuberculosis IgE antibodies in the sera of 500 tuberculosis patients by using the ELISA assay with ultrasonic disintegrated M. Tuberculosis H37Rv (sonicate). Antigens recognized by IgE antibodies were found to be localized in the cell wall of mycobacteria. The IgE-response was specific since the sera did not react with the antigens of atypical mycobacteria and other bacterial species.

[Immunology of tuberculosis: current status]

The paper outlines the high-priority trends in basic and applied investigations of antituberculous immunity. It presents the results obtained from studies of the genetic mechanisms responsible for the control of susceptibility in experimental tuberculosis, from analyses of novel chemical and recombinant tuberculosis vaccines, from examinations of the role of immunological memory in the disease. While describing the results of tuberculosis immunodiagnosis, particular emphasis is laid on its major aspects: on the differential diagnosis of tuberculosis and other lung diseases and on the screening of high-risk group populations for disease progression in order to made further in-depth studies. Current aspects of evaluating the immune status and nonspecific responsiveness in patients with tuberculosis are considered.

[The immunomodulating action of cyclosporin A in vitro and in vivo on the lymphocytes of patients with alveolitis]

The paper presents the first results of using cyclosporin A (CsA) to treat lymphocytes during their extracorporeal immunomodulation (EIL) in patient with fibrotic alveolitis of various etiology. Two-hour lymphocytic incubation in the medium containing 0.1-10 micrograms per ml of CsA was sufficient for CsA to show its in vitro immunosuppressive effect, which resulted in a substantial inhibition of a proliferative lymphocytic response to mitogens and antigens. Administration of CsA-treated lymphocytes induced no profound structural changes in lymphocytic subpopulations (CD3, CD4, CD8), but it was followed by a reduction in the baseline high proliferative lymphocytic response to PHA. The clinical effect, alveolitis alleviation was noted in all patients. It is suggested that clinical effects may be produced by a local concentration of the treated lymphocytes and their transferred CsA as well.

[Phenotypic and functional analysis of blood lymphocytes and pathological focus in patients with pulmonary tuberculosis]

A subpopulation study of lymphocytes concentrating in cavernous, lymph node tissues and blood from patients with fibrous-cavernous tuberculosis of the lungs showed that in spite of high CD3+ and CD4+ cell levels in the cavern, the response of these cells to mitogens may be weaker than blood lymphocyte response. IL-2 production by cavern lymphocytes varied and was unrelated to proliferative response of these cells to M. tuberculosis antigens.

[Use of bronchovaxom in the treatment of patients with chronic obstructive bronchitis and bronchial asthma]

Polyvalent vaccine bronchovaxom (BV) was studied for efficacy against chronic obstructive bronchitis and bronchial asthma exacerbation. Good results were reported: reduction of disability duration, number of recurrences, cough intensity, discharged sputum. Laboratory tests discovered that BV brought about IgE decrease, IgA, T3, T4/T8 increase in bronchoalveolar lavage.

[Lymphocyte subpopulations in malignant bone tumors and their relation to the immune response to the tumor]

Comparative studies of the subpopulations of lymphocytes, isolated from the tumor tissue and blood of 15 osteosarcoma patients, showed that the total lymphocyte count in the neoplasms ranged from 0 to 19% of the total cell population. In various patients tumor lymphocytes were represented either mainly by T cells (up to 80% of lymphocytes) or by "null" cells lacking any surface markers. The population of lymphocytes with surface membrane immunoglobulins with complement and Fc receptors was usually low although the tumors contained up to 90% of nonlymphoid cells with the same markers. Lower (less than 60%) counts of blood T lymphocytes were found only in one third of osteosarcoma patients. The immune response of blood lymphocytes against living autologous tumor cells was found in 85% of the patients, and its intensity depended on the content of T lymphocytes in tumor but not in blood.

[Rheumatoid factor in oncological patients]

In sera of 20% of patients with tumors of different localization and histological type the rheumatoid factor (RF) was found, which more frequently occurs in patients with soft tissue tumors as compared with bone tumors. The blocking properties of the sera revealed by RBT to PHA and by RIML would show no correlation with the occurrence of RF in them. Water-salt extracts of some tumors contain RF, which occurrence correlates well with the concentration of tumor cells having receptors for Fc-site of IgG on their surface.