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Kumar NP, Venkataraman A, Nancy A, Selvaraj N, Moideen K, Ahamed SF, Renji RM, Sasidaran K, Kumar S, Periyakuppan M, Sangaralingam T, Varadarajan P, Chelladurai E, Babu S. Immune Profiles in Multisystem Inflammatory Syndrome in Children with Cardiovascular Abnormalities. Viruses 2023; 15:2162. [PMID: 38005840 PMCID: PMC10674423 DOI: 10.3390/v15112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), a sequela of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV2), has been progressively reported worldwide, with cardiac involvement being a frequent presentation. Although the clinical and immunological characteristics of MIS-C with and without cardiac involvement have been described, the immunological differences between cardiac and non-cardiac MIS-C are not well understood. METHODS The levels of type 1, type 2, type 17, other proinflammatory cytokines and CC chemokines and CXC chemokines were measured using the Magpix multiplex cytokine assay system in MIS-C children with MIS-C cardiac (MIS-C (C) (n = 88)) and MIS-C non-cardiac (MIS-C (NC) (n = 64)) abnormalities. RESULTS MIS-C children with cardiac manifestations presented with significantly increased levels of cytokines such as IFN-γ, IL-2, TNFα, IL-5, IL-1α, IL-1β, IL-6, IL-10 and IL-12p70 and chemokines such as CCL2, CCL3, CCL11 and CXCL10 in comparison to MIS-C children without cardiac manifestations. Clustering analysis revealed that cytokines and chemokines could clearly distinguish MIS-C children with and without cardiac manifestations. In addition, these responses significantly diminished and normalized 9 months after treatment. CONCLUSIONS This is one of the first studies characterizing and differentiating systemic inflammation in MIS-C with and without cardiac involvement from a low- and middle-income country (LMIC). Our study contributes to the existing body of evidence and advances our knowledge of the immunopathogenesis of MIS-C in children.
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Affiliation(s)
- Nathella Pavan Kumar
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Aishwarya Venkataraman
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
| | - Arul Nancy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Nandhini Selvaraj
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kadar Moideen
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Shaik Fayaz Ahamed
- ICMR—National Institute for Research in Tuberculosis, Chennai 600031, India; (A.V.); (S.F.A.)
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Rachel Marriam Renji
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
| | - Kandasamy Sasidaran
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | - Sandip Kumar
- Dr. Mehta’s Children’s Hospital, Chennai 600031, India; (K.S.); (M.P.); (T.S.)
| | | | | | - Poovazhagi Varadarajan
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Elilarasi Chelladurai
- Institute of Child Health and Hospital for Children, Chennai 600008, India; (P.V.); (E.C.)
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; (A.N.); (N.S.); (K.M.); (R.M.R.); (S.B.)
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Moideen K, Nathella PK, Madabushi S, Renji RM, Srinivasan P, Ahamed SF, Rajkumar H, Bethunaickan R, Babu S. Plasma Vitamin D levels in correlation with circulatory proteins could be a potential biomarker tool for pulmonary tuberculosis and treatment monitoring. Cytokine 2023; 168:156238. [PMID: 37276815 DOI: 10.1016/j.cyto.2023.156238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Tuberculosis (TB), a life-threatening immune challenging disease to the global human community has to be diagnosed earlier and eliminated in the upcoming era. Vitamin D, a fat-soluble micronutrient, mainly from epidermal cells of the skin and a few dietary sources, is associated with the immune system in various disease management. Therefore, a better understanding of vitamin D metabolism and immune function in tuberculosis should be studied for the consideration of biomarkers. METHODS The study consist of Pulmonary Tuberculosis (PTB) patients (n = 32) at two-time points: Baseline (PTB BL) and after 6 months of anti-TB treatment (ATT) (PTB PT), latently Mtb infected (IFNγ + ) group (n = 32) and a non-LTB healthy control (IFNγ-) group (n = 32). Vitamin D levels were measured using High-performance liquid chromatography (HPLC). The cytokine data from the same participants assayed by ELISA from our earlier investigations were used to correlate it with serum Vitamin D levels. RESULTS The assayed serum Vitamin D levels between the groups showed significantly lowered levels in PTB BL when compared with IFNγ + and IFNγ- groups. And, the Vitamin D levels in the PTB group after ATT were significantly lower than the baseline levels. The Vitamin D data were compared with pro- and anti-inflammatory cytokines and adipokines levels by performing a principal component regression analysis. Based on the PC scores, the study group showed distinct clusters for the TB group and control group. And, the correlation analysis between the study group and immunological indices showed significant correlations. Vitamin D significantly correlated with IFNγ, TNFα, IL17A, IL-4 and Resistin in the TB group, whereas IL-6 and G-CSF in the control group. CONCLUSION The baseline measurement of Vitamin D levels was significantly decreased in the PTB group when compared with IFNγ + and IFNγ- groups showing the importance of Vitamin D as a preventive factor against the TB disease progression. The six-month post-treatment of TB showed a further decrease in Vitamin D levels in PTB. The significantly correlated immunological indices with Vitamin D levels are the biomarker profile that could predict TB.
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Affiliation(s)
- Kadar Moideen
- NIH-NIRT-International Centre for Excellence in Research, India; Department of Immunology, National Institute for Research in Tuberculosis (NIRT), India
| | - Pavan Kumar Nathella
- Department of Immunology, National Institute for Research in Tuberculosis (NIRT), India
| | | | | | - Padmanaban Srinivasan
- Department of Biostatistics, National Institute for Research in Tuberculosis (NIRT), India
| | - Shaik Fayaz Ahamed
- Department of Biostatistics, National Institute for Research in Tuberculosis (NIRT), India
| | | | | | - Subash Babu
- NIH-NIRT-International Centre for Excellence in Research, India; LPD, NIAID, NIH, Bethesda, MD, USA
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Rajamanickam A, Nathella PK, Venkataraman A, Dasan B, Putlibai S, Ahamed SF, Selvaraj N, Sadasivam K, Sundaram B, Nutman TB, Babu S. Levels of Complement Components in Children With Acute COVID-19 or Multisystem Inflammatory Syndrome. JAMA Netw Open 2023; 6:e231713. [PMID: 36961465 DOI: 10.1001/jamanetworkopen.2023.1713] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Importance Multisystem inflammatory syndrome in children (MIS-C) is a severe and unrestrained inflammatory response with multiorgan involvement, which occurs within a few weeks following the resolution of acute SARS-CoV-2 infection. The complement system is a vital part of the innate immune system and plays a role in COVID-19 pathogenesis. Objective To examine and compare the levels of complement components and regulators along with complement activation products in the different clinical spectrum of children with SARS-CoV-2 and a control group. Design, Setting, and Participants This cross-sectional study analyzed children with MIS-C admitted to a single hospital in India from June through September 2020. Eligible participants were children who were hospitalized of either sex, aged 1 to 18 years. Data were analyzed August 2022. Measures Levels of complement components and regulators along with complement activation products in all the groups of children. Mann-Whitney U test and Kruskal-Wallis analysis were used to compare the complement component levels, and Spearman rank correlation analysis was used to describe the association between complement components and laboratory and biochemical parameters. Results A total 145 children were included (median age, 5 years [range, 1 month-17 years); 84 [58%] male): 44 children with MIS-C, 33 with acute COVID-19 (reverse transcriptase-polymerase chain reaction [RT-PCR] positive), 47 with convalescent COVID-19 (immunoglobulin G-positive non-MIS-C) and 21 children for a control group (both serology and RT-PCR negative). Children with MIS-C and COVID-19 had higher levels of C1q (geometric mean [SD]: MIS-C, 61.5 [18.5] ng/mL; acute COVID-19, 56.9 [18.6] ng/mL; controls, 24.1 [3.3] ng/mL), C2 (MIS-C, 605.8 [219.7] ng/mL; acute COVID-19, 606.4 [167.7] ng/mL; controls, 255.9 [73.3] ng/mL), C3 (MIS-C, 318.2 [70.7] ng/mL; acute COVID-19, 237.7 [61.8] ng/mL; controls, 123.4 [15.7] ng/mL), C4b (MIS-C, 712.4 ng/mL; acute COVID-19, 640.7 ng/mL; controls, 351.5 ng/mL), C5 (MIS-C, 1487 ng/mL; acute COVID-19, 1364 ng/mL; controls, 561.9 ng/mL), C5a, (MIS-C, 2614.0 [336.2] ng/mL; acute COVID-19, 1826.0 [541.0] ng/mL; controls, 462.5 [132.4] ng/mL), C3b/iC3b (MIS-C, 3971.0 [635.1] ng/mL; acute COVID-19, 3702.0 [653.9] ng/mL; controls, 2039.0 [344.5] ng/mL), and factor B (MIS-C, 47.6 [7.8] ng/mL; acute COVID-19, 44.6 [6.3] ng/mL; controls, 27.5 [5.0] ng/mL), factor D (MIS-C, 44.0 [17.2] ng/mL; acute COVID-19, 33.8 [18.4] ng/mL; controls, 21.3 [6.1] ng/mL), and factor H (MIS-C, 53.1 [4.0] ng/mL; acute COVID-19, 50.8 [5.7] ng/mL; controls, 43.6 [3.8] ng/mL) in comparison with convalescent and control children. In addition, children with MIS-C had significantly elevated levels of C3 (318.2 [70.7] ng/mL vs 237.7 [61.8] ng/mL), C5a (2614 [336.2] ng/mL vs 1826 [541.0] ng/mL), and mannose-binding lectin (79.4 [12.4] ng/mL vs 69.6 [14.7] ng/mL) in comparison to children with acute COVID-19. Levels of some of these analytes at admission (ie, pretreatment) were more elevated in children with MIS-C who needed pediatric intensive care unit (PICU) support as compared with those who did not require PICU support, and in children with COVID-19 who developed moderate to severe disease compared with those who developed mild disease. Overall, MIS-C and acute COVID-19 were associated with the hyperactivation of complement components and complement regulators. Conclusions and Relevance In this cross-sectional study, the complement system was associated with the pathogenesis of MIS-C and COVID-19 in children; complement inhibition could be further explored as a potential treatment option.
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Affiliation(s)
- Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | - Pavan Kumar Nathella
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Aishwarya Venkataraman
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - Bindu Dasan
- National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | | | - Shaik Fayaz Ahamed
- National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | - Nandhini Selvaraj
- National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
| | | | | | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis, International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Kumar NP, Nancy A, Viswanathan V, Sivakumar S, Thiruvengadam K, Ahamed SF, Hissar S, Kornfeld H, Babu S. Chitinase and indoleamine 2, 3-dioxygenase are prognostic biomarkers for unfavorable treatment outcomes in pulmonary tuberculosis. Front Immunol 2023; 14:1093640. [PMID: 36814914 PMCID: PMC9939892 DOI: 10.3389/fimmu.2023.1093640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction Chitinase, Indoleamine 2,3-dioxygenesae-1 (IDO-1) and heme oxygenase-1 (HO-1) are candidate diagnostic biomarkers for tuberculosis (TB). Whether these immune markers could also serve as predictive biomarkers of unfavorable treatment outcomes in pulmonary TB (PTB) is not known. Methods A cohort of newly diagnosed, sputum culture-positive adults with drug-sensitive PTB were recruited. Plasma chitinase protein, IDO protein and HO-1 levels measured before treatment initiation were compared between 68 cases with unfavorable outcomes (treatment failure, death, or recurrence) and 108 control individuals who had recurrence-free cure. Results Plasma chitinase and IDO protein levels but not HO-1 levels were lower in cases compared to controls. The low chitinase and IDO protein levels were associated with increased risk of unfavourable outcomes in unadjusted and adjusted analyses. Receiver operating characteristic analysis revealed that chitinase and IDO proteins exhibited high sensitivity and specificity in differentiating cases vs controls as well as in differentiating treatment failure vs controls and recurrence vs controls, respectively. Classification and regression trees (CART) were used to determine threshold values for these two immune markers. Discussion Our study revealed a plasma chitinase and IDO protein signature that may be used as a tool for predicting adverse treatment outcomes in PTB.
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Affiliation(s)
- Nathella Pavan Kumar
- Department of Immunology, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Arul Nancy
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India
| | - Vijay Viswanathan
- Diabetology, Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | - Shanmugam Sivakumar
- Department of Bacteriology, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Kannan Thiruvengadam
- Epidemiology Statistics, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Shaik Fayaz Ahamed
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India
| | - Syed Hissar
- Clinical Research, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Subash Babu
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases (LPD), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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Munisankar S, Rajamanickam A, Balasubramanian S, Muthusamy S, Menon PA, Ahamed SF, Whalen C, Gumne P, Kaur I, Nadimpalli V, Deverakonda A, Chen Z, Otto JD, Habitegiyorgis T, Kandaswamy H, Babu S. Prevalence of proximate risk factors of active tuberculosis in latent tuberculosis infection: A cross-sectional study from South India. Front Public Health 2022; 10:1011388. [PMID: 36276400 PMCID: PMC9583021 DOI: 10.3389/fpubh.2022.1011388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023] Open
Abstract
The prevalence of proximate risk factors for active tuberculosis (TB) in areas of high prevalence of latent tuberculosis infection (LTBI) is not clearly understood. We aimed at assessing the prevalence of non-communicable multi-morbidity focusing on diabetes mellitus (DM), malnutrition, and hypertension (HTN) as common risk factors of LTBI progressing to active TB. In a cross-sectional study, 2,351 adults (45% male and 55% female) from villages in the Kancheepuram district of South India were enrolled between 2013 and 2020. DM was defined as HbA1c >6.4%, undernutrition was defined as low body mass index (LBMI) <18.5 kg/m2, obesity was classified as BMI ≥25 kg/m2, HTN was reported as systolic pressure >130 mmHg, and LTBI was defined as positive (≥ 0.35 international units/ml) by QuantiFERON Gold In-Tube assay. A total of 1,226 individuals (52%) were positive for LTBI out of 2351 tested individuals. The prevalence of DM and pre-diabetes mellitus (PDM) was 21 and 35%, respectively, HTN was 15% in latent tuberculosis (LTB)-infected individuals. The association of DM [odds ratio (OR)]; adjusted odds ratio (aOR) (OR = 1.26, 95% CI: 1.13-1.65; aOR = 1.19, 95% CI: 1.10-1.58), PDM (OR = 1.11, 95% CI: 1.0-1.35), and HTN (OR = 1.28, 95% CI: 1.11-1.62; aOR = 1.18, 95% CI: 1.0-1.56) poses as risk factors of LTBI progression to active TB. The prevalence of LBMI 9% (OR = 1.07, 95% CI: 0.78-1.48) and obesity 42% (OR = 0.85, 95% CI: 0.70-1.03) did not show any statistically significant association with LTB-infected individuals. The present evidence of a high burden of multi-morbidity suggests that proximate risk factors of active TB in LTBI can be managed by nutrition and lifestyle modification.
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Affiliation(s)
- Saravanan Munisankar
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India,*Correspondence: Saravanan Munisankar
| | - Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Suganthi Balasubramanian
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Satishwaran Muthusamy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | | | - Shaik Fayaz Ahamed
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Christopher Whalen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Paschaline Gumne
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Inderdeep Kaur
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Varma Nadimpalli
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Akshay Deverakonda
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Zhenhao Chen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - John David Otto
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Tesfalidet Habitegiyorgis
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Harish Kandaswamy
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India,Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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Nathella PK, Moideen K, Viswanathan V, Sivakumar S, Ahamed SF, Ponnuraja C, Hissar S, Kornfeld H, Babu S. Heightened microbial translocation is a prognostic biomarker of recurrent tuberculosis. Clin Infect Dis 2022; 75:1820-1826. [PMID: 35352112 PMCID: PMC9662171 DOI: 10.1093/cid/ciac236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Microbial translocation is a known characteristic of pulmonary tuberculosis (PTB). Whether microbial translocation is also a biomarker of recurrence in PTB is not known. METHODS We examined the presence of microbial translocation in a cohort of newly diagnosed, sputum smear and culture positive individuals with drug-sensitive PTB. Participants were followed up for a year following the end of anti-tuberculosis treatment. They were classified as cases (in the event of recurrence, n=30) and compared to age and gender matched controls (in the event of successful, recurrence free cure; n=51). Plasma samples were used to measure the circulating microbial translocation markers. All the enrolled study participants were treatment naïve, HIV negative and with or without diabetes mellitus. RESULTS Baseline levels of lipopolysaccharide (LPS) (p=0.0002), sCD14 (p=0.0191) and LPS-binding protein (LBP) (p<0.0001) were significantly higher in recurrence than controls and were associated with increased risk for recurrence, while Intestinal fatty acid binding protein (I-FABP) and Endocab showed no association. ROC curve analysis demonstrated the utility of these individual microbial markers in discriminating recurrence from cure with high sensitivity, specificity and AUC. CONCLUSION Recurrence following microbiological cure in PTB is characterized by heightened baseline microbial translocation. These markers can be used as a rapid prognostic tool for predicting recurrence in PTB.
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Affiliation(s)
| | - Kadar Moideen
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India
| | | | | | | | - C Ponnuraja
- National Institute for Research in Tuberculosis, Chennai, India
| | - Syed Hissar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institute for Research in Tuberculosis, Chennai, India.,LPD, NIAID, NIH, MD, USA
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