Association of plasma cytokines with radiological recovery in pulmonary tuberculosis patients

Objective/Background: the characterization of tuberculosis [TB] patients as slow or fast responders post anti-TB treatment has always been a matter of tremendous interest as slow responders are most likely to relapse and/or develop complications. Pulmonary tissue healing as assessed with radiology is the only available tool for tissue recovery but is not predictive at intake. The objective of the current study was to assess biomarkers associated with fast and slow recovery in TB patients at recruitment

Methods: pulmonary TB patients [N = 15] were assessed for radiological recovery serially in parallel with clinical signs and symptoms, hematological parameters, and plasma cytokines at O months, 6 months, 12 months, and 24 months. On the basis of differential radiological healing, patients were characterized into slow [>12 months], intermediate [<12 months], and fast [<6 months] responders

Results: baseline plasma cytokines [interleukin [IL]-2, -4, -6, -10, tumor necrosis factor-ex, and interferon-y] were determined using cytometric bead array. IL-2 and -4 were able to accurately differentiate slow and fast responders into two distinct clusters using hierarchal clustering analysis. Compared with fast responders, slow responders showed significantly high IL-2 and -4 at baseline [p = .001 Mann-Whitney U test]

Conclusion: in-depth analysis of cytokines and its association with radiological recovery in TB patients may be useful in monitoring TB patients postchemotherapy for both clinicians and TB control program

Interplay of Chemo Attractant Peptides (Cathelicidin and Chemerin) with Vitamin- D in Patients with Pulmonary Tuberculosis.

Aim: Both Cathelicidin and Chemerin are chemo-attractant proteins and possess antimicrobial activity. Sufficient level of Vitamin D is important for optimum response of Cathelicidin for its antimycobacterial activity. Studies on the role of these antimicrobial peptides and their relationship with Vitamin D level are limited in tuberculosis. The aim of this study was to investigate an association of Vitamin D with antimicrobial peptide (Cathelicidin) and an adipokine (Chemerin) in patients with pulmonary tuberculosis (TB). Methods: In a case control study we estimated level of Vitamin D, Chemerin, Cathelicidin and TNF α in pulmonary TB patients (n=22) and healthy endemic controls (n=17) using sandwich ELISA methodology. The study was conducted at Aga Khan University Karachi during 2011. Results: TB group had higher proportion of subjects above median level of Cathelicidin (median test; p=0.034) and fewer number of subjects with Chemerin (median test; p=0.001). Pairwise comparison also showed significant differences between average ranks of Vitamin D vs. Cathelicidin (p<0.0001), Chemerin vs. Cathelicidin (p=0.04) and Vitamin D vs. TNFα (p<0.0001). Cathelicidin was identified as most discriminatory marker between TB disease and healthy group (ROC, AUC 0.780; p=0.007). Conclusion: Our results highlight the role of Cathelicidin as a potential biomarker of active TB disease. The role of Cathelicidin and Chemerin as plausible biomarkers requires further studies in both inflammatory and non-inflammatory conditions.

Mortality in sepsis and its relationship with gender

Sepsis remains a leading cause of death across the world, carrying a mortality rate of 20-50%. Women have been reported to be less likely to suffer from sepsis and to have a lower risk of mortality from sepsis compared to men. The objective of this study was to determine the relationship between gender and mortality in sepsis, and compare cytokine profiles of male and female patients. This was a prospective case series on 97 patients admitted with sepsis. Clinical and microbiological data was gathered, blood samples were collected for cytokine [IL-10, IL-6 and TNFalpha] levels and patients were followed up for clinical outcome. There were 54% males and 46% females, with no significant difference of age or comorbids between genders. Respiratory tract infection was the commonest source of sepsis, and was more common in females [60%] compared to males [39%] [p=0.034]. Males had a higher mortality [p=0.048, RR 1.73] and plasma IL-6 level [p=0.040] compared to females. Mean IL-6 plasma level was significantly [p<0.01] higher in patients who died vs. who recovered. Our study shows that males with sepsis have a 70% greater mortality rate, and mortality is associated with a higher IL-6 plasma level